ABSTRACT Type 1 diabetes (T1D) in adults is characterised by a less aggressive disease course than in children. Most patients retain preserved C‐peptide (> 02 nmol/L) and some of them benefit from a protracted phase without the need for insulin. Here, we propose a hypothesis‐generating therapeutic paradigm with once‐weekly basal insulin combined with an SGLT2 inhibitor (SGLT2is) as initial therapy in T1D patients with preserved C‐peptide. Once‐weekly basal insulin, approved in Europe and now also in the US, confirm comparable HbA1c reductions to insulin degludec or glargine, albeit always alongside prandial insulin. SGLT2is, approved as adjuncts in T1D in select regions, can control prandial peaks without boluses. No trials have tested the combination of weekly insulin with SGLT2is in adult T1D patients. Nonetheless, the rationale is robust especially in adults with C‐peptide > 0·2 nmol/L. In this respect, we urge proof‐of‐concept trials of 12‐months randomised studies in adults ≥ 18 years, to evaluate this combination.
ABSTRACT Aims Diabetes mellitus (DM) is a common comorbidity of psoriatic arthritis (PsA); however, its global prevalence and the impact of treatment exposure remain unclear. This study aimed to assess the global prevalence of DM in patients with PsA using different subgroup analyses. Materials and Methods A systematic search of PubMed, Embase, the Cochrane Library and the Web of Science was performed from inception until February 2025 for observational studies reporting the prevalence or incidence of DM in PsA patients. Random‐effects models were applied to pool estimates, and subgroup, meta‐regression, and sensitivity analyses were conducted to explore heterogeneity. Publication bias was evaluated using the Egger's test and the trim‐and‐fill method. Results Sixty‐three studies, including 293,582 patients with PsA, were analysed. Patients with PsA included in this study were divided into treatment‐disclosed and non‐treatment‐disclosed groups. DM overall prevalence in patients with PsA was 13.84% in the non‐treatment‐disclosed population and 13.50% in the treatment‐disclosed cohort. Geographically, the comorbidity prevalence rates were higher in South America (37.98%) and Asia (16.76%) than in Europe (12.81%) and North America (12.38%) in the non‐treatment‐disclosed population. In the treatment‐disclosed population, prevalence was also highest in South America (28.13%), followed by Asia (18.30%). Meta‐regression analysis identified age, type of DM, region, and study design as contributors to heterogeneity. Evidence of small‐study effects was detected in the T2DM subgroup and cohorts receiving systemic therapy plus biologics. Conclusions Subgroup analysis shows that the prevalence of DM is associated with the type of study and the region in which the patients were located. These findings support routine metabolic screening for PsA and highlight the need for longitudinal studies to track disease activity, treatment patterns, and metabolic outcomes.
ABSTRACT Patients with type 2 diabetes mellitus (T2DM) often present with normal or even elevated bone mineral density (BMD), yet exhibit a significantly increased fracture risk—a phenomenon referred to as the ‘diabetic bone paradox’. This discrepancy underscores the inadequacy of conventional BMD‐centred assessment systems in fully elucidating the mechanisms underlying bone fragility in T2DM. Current evidence suggests that T2DM‐related skeletal fragility is multifactorial, involving alterations in bone quality, advanced glycation end‐product (AGE) accumulation, low bone turnover, microarchitectural deterioration, diabetic complications, increased fall risk and chronic inflammation. Recent advances in osteoimmunology have revealed that immune cell polarization driven by chronic low‐grade inflammation, along with an imbalanced receptor activator of nuclear factor‐κB ligand/osteoprotegerin (RANKL/OPG) axis, may contribute to the dysregulation of bone remodelling in T2DM. As a cornerstone intervention in T2DM management, exercise not only acts directly on bone tissue via mechanical loading but also may exert systemic immunomodulatory effects through myokines secreted by skeletal muscle. Exercise‐induced myokines, such as interleukin‐6 (IL‐6), irisin, β‐aminoisobutyric acid (BAIBA) and interleukin‐15 (IL‐15), may modulate the osteoimmune microenvironment and restore the dynamic equilibrium between bone resorption and formation by modulating macrophage polarization, restoring the Th17/Treg balance, bone marrow adipose tissue metabolism, and chronic inflammatory signalling pathways. Moreover, exercise may further promote bone metabolic homoeostasis by suppressing negative regulatory signals, such as myostatin. Therefore, this narrative review summarises the aberrant features of the osteoimmune axis in T2DM, with a focus on the potential mechanisms by which exercise and its induced myokines may modulate the osteoimmune microenvironment to ameliorate diabetic bone disease, thereby providing a framework for understanding exercise as a potential non‐pharmacological intervention and identifying areas requiring further translational investigation.
ABSTRACT Early screening for type 1 diabetes (T1D) is receiving increasing attention as presymptomatic screening initiatives and disease‐modifying therapies continue to expand. However, the perspectives of professional stakeholders, who play a pivotal role in implementation, patient engagement, and health system preparedness, have not been systematically synthesised. We conducted a systematic review to examine professional views on paediatric early T1D screening. Following PRISMA guidelines, six databases (Medline, Embase, Scopus, CINAHL, PsycINFO, ASSIA) and grey literature were searched through January 2026. Twelve studies met the inclusion criteria, predominantly involving paediatricians and diabetes specialists; nurses, genetic counsellors, policymakers, and other healthcare professionals were represented in few studies. Methodological appraisal using the Mixed Methods Appraisal Tool (MMAT) identified recurring limitations in sample representativeness and potential nonresponse bias. Given the heterogeneity and primarily descriptive nature of the study design and outcomes, findings were synthesised narratively. Professional perspectives varied according to the population targeted, professional group studied, screening scenario, and the implementation context. Where directly compared, support was greater for at‐risk than for general‐population screening. Reported benefits included diabetic ketoacidosis (DKA) prevention, earlier clinical engagement, and improved preparedness for families. However, concerns persisted regarding psychosocial burden, workforce capacity, and unclear referral and follow‐up pathways. More favourable evaluations were reported in some structured programmes, although these findings may reflect reliance on existing infrastructures and targeted participant selection. By consolidating previously fragmented evidence, this review identifies recurring clinical, psychosocial, and organisational considerations relevant to paediatric T1D screening. These findings primarily reflect clinical perspectives and indicate conditional rather than uniform support. Further studies should evaluate how standardised pathways, professional training, and integrated psychosocial support affect the feasibility and acceptability of screening across different healthcare contexts.
