Background: Diabetic kidney disease (DKD) is a serious complication arising from long-term diabetes, disproportionately affecting historically marginalized populations, such as racial and ethnic minority groups, populations with low socioeconomic status, or a lower level of education. This review explores the causes of these disparities and barriers to accessing DKD therapies and proposes solutions. Summary: Socioeconomic factors like lack of health insurance, low income, and limited health literacy significantly hinder access to DKD therapies for marginalized communities. Additionally, inadequate access to healthcare services further exacerbates the issue. Clinical factors also contribute to the inequity. Under-recognition of DKD, under-prescription of effective medications, and a lack of a patient-centered healthcare environment are prominent concerns. Implicit bias among healthcare professionals may also play a role. Patient factors include limited awareness of DKD, challenges with treatment adherence, and frequent healthcare interruptions. Policy interventions like the Inflation Reduction Act, expanding health insurance coverage, and increasing reimbursement for DKD therapies can improve affordability and access. Additionally, a shift toward preventive care models is crucial. Clinical interventions focus on improving early detection, accurate diagnosis, and proper management of DKD. Educating healthcare providers about the benefits of DKD therapies and implementing value-based kidney care programs are essential steps. Patient interventions involve raising awareness about DKD, implementing culturally appropriate educational programs, and fostering community-based support systems. Key Messages: Addressing these disparities requires a multipronged approach involving policy changes, improved healthcare delivery, and patient education. This collaborative effort can ensure equitable access to DKD therapies and improve health outcomes for all populations. .

This cross-sectional study examines the association between language preference and receipt of continuous glucose monitor prescription among adults with type 2 diabetes.

BACKGROUND:Given rising diabetes prevalence in the USA, especially among minoritized communities, it is critical to understand perception of diabetes risk and risk factors in the general population and in subpopulations known to be at increased risk for diabetes. OBJECTIVE:We aimed to describe overall and cause-specific perceived diabetes risk, especially racial and ethnic differences in perceived risk. DESIGN:Cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018, during which years the survey asked participants whether they believed they were at risk for diabetes, and if so, for what reason(s). PARTICIPANTS:Adult participants in the NHANES without diagnosed diabetes. MAIN MEASURES:Self-reported race or ethnicity, as well as educational attainment and glycemic status, was examined as primary exposures. The primary outcomes examined were rates of overall and cause-specific perceived diabetes risk, in strata of race or ethnicity and either educational attainment or glycemic status. KEY RESULTS:Compared to non-Hispanic White (NHW) participants, perceived diabetes risk was higher among Mexican-American and Other/Multi-Racial participants and lower among non-Hispanic Asian (NHA) participants. Perceived race-related diabetes risk was higher in all minoritized groups. Perceived overall, family history-related, and race-related risk increased with increasing educational attainment among minoritized but not NHW participants, and with knowledge of pre-diabetes status among all groups (24% perceived risk if normoglycemia, 69% if known pre-diabetes). Family history was the most frequently reported cause for perceived diabetes risk in all groups. In adjusted analyses, race and ethnicity were strongly associated with perceived race-related diabetes risk. CONCLUSIONS:Compared to NHW individuals, US adults of any other race or ethnicity perceived higher race-related diabetes risk, increasing with educational attainment. Further research is needed to explore the impact of this perceived risk on physical and mental health outcomes and health behaviors.

Continuous glucose monitors (CGMs) are becoming increasingly available, yet the relationship between CGM metrics and hemoglobin A1c (HbA1c) among individuals with prediabetes and normoglycemia remains unclear. We examined associations between HbA1c and eight CGM metrics across glycemic status. Our cohort included 972 individuals: 421 (43.3%) with type 2 diabetes, 319 (32.8%) with prediabetes, and 232 (23.9%) with normoglycemia. Associations were strongest in type 2 diabetes, with mean glucose showing the strongest relationships (standardized β = 0.79, P < 0.001). In prediabetes, associations were substantially attenuated, with mean glucose showing moderate association (standardized β = 0.22, P < 0.001). Among individuals with normoglycemia, CGM metrics showed minimal associations with HbA1c, with mean glucose demonstrating a weak association (standardized β = 0.10, P = 0.022) and time in range showing no significant relationship. All interaction terms were statistically significant (P < 0.001). These findings suggest that standard CGM metrics should not be interpreted to reflect HbA1c for individuals with prediabetes and normoglycemia.

Type 2 diabetes (T2D) is a chronic, debilitating disease that disproportionally affects the Hispanic/Latino community residing in the United States. Optimal nutrition therapy is fundamental to the proper management of T2D and must be culturally adapted to facilitate permanent behavior change in this population. This review selected and assessed the nutrition components of interventions aimed to improve T2D outcomes in US-based Latinos/Hispanics, published from 2002 to 2023. An overview of the participant characteristics, nutrition intervention, and dietary assessment and outcomes is included. Nutrition interventions in this community benefit from the inclusion of bicultural registered dietitian nutritionist (RDNs) to assure the counseling team promotes culturally tailored nutrition recommendations based on current dietary guidelines. Nutrition assessment and outcomes should be captured with the use of validated dietary assessment tools and dietary quality indices appropriate to their target population. Standardizing these practices will facilitate intervention comparability and replicability and ultimately better target the needs of this community.

Editor’s note This article is adapted from the address Dr. Caballero delivered as the recipient of the American Diabetes Association’s Outstanding Educator in Diabetes Award for 2023. He delivered the address in June 2023 during the Association’s 83rd Scientific Sessions in San Diego, CA. A webcast of this speech is available for viewing on the DiabetesPro website (https://events.diabetes.org/live/25/page/186).

Background Differences in the prevalence of four diabetes subgroups have been reported in Mexico compared to other populations, but factors that may contribute to these differences are poorly understood. Here, we estimate the prevalence of diabetes subgroups in Mexico and evaluate their correlates with indicators of social disadvantage using data from national representative surveys. Methods We analyzed serial, cross-sectional Mexican National Health and Nutrition Surveys spanning 2016, 2018, 2020, 2021, and 2022, including 23,354 adults (>20 years). Diabetes subgroups (obesity-related [MOD], severe insulin-deficient [SIDD], severe insulin-resistant [SIRD], and age-related [MARD]) were classified using self-normalizing neural networks based on a previously validated algorithm. We used the density-independent social lag index (DISLI) as a proxy of state-level social disadvantage. Findings We identified 4204 adults (median age: 57, IQR: 47-66, women: 64%) living with diabetes, yielding a pooled prevalence of 16.04% [95% CI: 14.92-17.17]. When stratified by diabetes subgroup, prevalence was 6.62% (5.69-7.55) for SIDD, 5.25% (4.52-5.97) for MOD, 2.39% (1.95-2.83) for MARD, and 1.27% (1.00-1.54) for SIRD. SIDD and MOD clustered in Southern Mexico, whereas MARD and SIRD clustered in Northern Mexico and Mexico City. Each standard deviation increase in DISLI was associated with higher odds of SIDD (OR: 1.12, 95% CI: 1.06-1.12) and lower odds of MOD (OR: 0.93, 0.88-0.99). Speaking an indigenous language was associated with higher odds of SIDD (OR: 1.35, 1.16-1.57) and lower odds of MARD (OR 0.58, 0.45-0.74). Interpretation Diabetes prevalence in Mexico is rising in the context of regional and sociodemographic inequalities across distinct diabetes subgroups. SIDD is a subgroup of concern that may be associated with inadequate diabetes management, mainly in marginalized states.

Despite advances in type 2 diabetes management, disparities persist among Latinos living in the United States. Latinos, the fastest-growing ethnic minority population in the United States, are twice as likely to have diabetes-related complications and 1.3 times more likely to die from diabetes than non-Latino Whites (1). These inequities are driven by a complex interplay of biological, social, structural, and health system factors, including difficulty navigating the health care system (2,3). For example, Latinos have higher no-show rates to clinic visits and have lower rates of medication adherence than non-Latino Whites (4,5). These persistent disparities demand innovation.

Aims: To describe the effect of three classes of GLP1 analogues on HbA1c and weight over one year in a homogenous group of patients at the Dubai Diabetes Center in Dubai, United Arab Emirates. The specific objectives are to study the extent of change in HbA1c and weight loss on these medications as well as the sustainability of change over one year. Methods: A retrospective audit of patients diagnosed Type 2 diabetes receiving one of the three following GLP-1 agonists (Exenatide LA 2 mg weekly, liraglutide 1.8 mg once daily, Dulaglutide 1.5 mg) over one year and documenting changes in HbA1c and weight at 3-, 6-, 9-, and 12-months intervals. Results: The study shows that while there was significant reduction in HbA1c and weight in the first 3 months, this change was not clinically significant. Also, the change was not maintained at the end of the year. By the final quarter, the effect of the medication diminishes, accompanied by a partial regain of weight. Conclusion: GLP1 agonists favorable initial effect on HbA1c and weight may not be sustainable beyond a certain period. The exact reason and factors contributing to this need further exploration.

Diabetes and cardiovascular disease do not equally affect all populations. Clear differences in the prevalence and incidence rates of these conditions along with multiple related comorbidities and diabetes-related complications among racial/ethnic groups have been described. Some of these differences are based on distinct pathophysiologic abnormalities. In some cases, specific genetic defects have been identified. Disparities in the genesis of diabetes and cardiovascular disease have also been appreciated when looking at populations by gender and sexual orientation. A wide range of complex social and cultural factors in all these groups also contribute to these disparities. Most importantly, it is now better recognized that health care systems and health care providers are often falling short in providing optimal care to these populations. Inequities in access to health care and opportunities to improve their health status often exist. There is also a general difficulty in addressing psychological, social, financial, educational, and cultural factors in diabetes and cardiovascular care in routine clinical practice. There is an urgent need and a great opportunity for health care providers in the U.S. and around the world to develop and implement comprehensive diabetes and cardiovascular disease prevention and treatment programs that incorporate the latest scientific information in these fields with practical and feasible culturally and socially oriented strategies that improve the lives of all people affected by these conditions.

"Implicit bias," also called "unconscious bias," refers to associations outside of conscious awareness that adversely affect one's perception of a person or group. Awareness of implicit bias has been increasing in the realm of diabetes care. Here, the authors highlight several types of unconscious bias on the part of clinicians and patients, including biases based on race, ethnicity, and obesity. They discuss how these biases can negatively affect patient-centered clinical interactions and diabetes care delivery, and they recommend implementation of evidence-based interventions and other health system policy approaches to reduce the potential impact of such biases in health care settings.

Background: Diabetes subgroups are a promising framework for characterizing diabetes heterogeneity but data on the epidemiology and sociodemographic profile of these subgroups in the Mexican population are sparse. Methods: We conducted a serial cross-sectional analysis of the National Health and Nutrition Survey in Mexico (2016-2021). Diabetes subgroups (obesity related [MOD], severe-insulin deficient [SIID], severe-insulin resistant [SIRD], and age-related [MARD]) were classified using self-normalizing neural networks using HbA1c, time since diabetes diagnosis, HOMA2-IR, HOMA2-B, and BMI. Sociodemographic inequalities were proxied with the social lag index, which captures state-level social disadvantage. Results: Diabetes prevalence in Mexico increased from 13.3% (95%CI 11.5-15.1) in 2016 to 15.8% (95%CI 13.6-17.9) in 2021, with the highest increases in the Northern-Pacific, Central-Pacific, and Center regions. SIDD was the most prevalent diabetes subgroup in Mexico, followed by MOD, MARD, and SIRD. Increases in diabetes prevalence were primarily attributed to MOD and SIRD. SIID had higher aggregation in states with higher social lag (Fig. 1). Conclusion: Diabetes subgroups in the Mexican population display geographic and sociodemographic differences, which may help identify populations at higher risk of health disparities and adverse outcomes. Disclosure N.Antonio villa: None. A.Caballero: None. J.A.Seiglie: Consultant; BDMT Global, Techspert Expert Network. O.Bello-chavolla: None. D.Ramírez-garcía: None. C.Fermin: None. A.Vargas-vázquez: None. M.R.Basile-alvarez: None. A.Nuñez: None. C.D.Paz cabrera: None. L.Fernández chirino: None.

INTRODUCTION:Clinical observership programs have existed for many years as both formal initiatives organized at the institutional or professional society level and informal arrangements between individual physicians and prospective mentors. However, few programs longitudinally assess their impact on patient care and require implementation of a postobservership project to demonstrate learning. In 2018, the Harvard Medical School Office for External Education launched the International Clinical Leaders Observership Program (ICLOP) as an opportunity for midcareer physicians to shadow Harvard Medical School faculty in one of three specialty areas: oncology, cardiology, or diabetology. The culminating activity for each participant was presentation of a capstone project and commitment to implement it on returning home.METHODS:We summarize here the initial cohort and results from a follow-up survey measuring the impact of the program on their subsequent patient care, academic activities, and achievements.RESULTS:At 1 year of follow-up, 90% of survey respondents had implemented their project. Improvements were reported in areas of clinical, surgical, therapeutic, system, patient education, and team innovation, as well as personal benefits to the participants.DISCUSSION:ICLOP is a robust and reproducible initiative that resulted in meaningful improvements in patient care and physician-related outcomes for the first cohort of participants.

Aim: To identify which individual-, physician-, and the healthcare system-related factors can predict individualized hemoglobin A1c (HbA1c) targets and the likelihood of reaching those targets after initial insulin therapy over a two-year follow-up period. Methods: Real-world data, including baseline characteristics of people with type 2 diabetes mellitus (T2DM), psychosocial data, and diabetes medication use, collected from the Multinational Observational Study Assessing Insulin Use (MOSA1c) study in 18 countries were analyzed. Results: Overall, 225 of 1194 people with T2DM (18.8%) who received initial insulin therapy for >= 3 months reached HbA1c targets at two-year follow-up; most were likely to be White (64.9%) and perceptions of their relationship with physicians were less positive than those who did not reach HbA1c targets. Higher baseline HbA1c (>8%) was the strongest predictor of being assigned an HbA1c target >7% (odds ratio [OR] 6.06, 95% confidence interval [CI] 3.97, 9.26). A smaller difference between baseline and target HbA1c levels was the strongest predictor of reaching an HbA1c target at two-year follow-up (large vs small difference, OR 0.28, 95% CI 0.17, 0.47). Conclusions: Several factors were significantly associated with establishing individualized HbA1c targets and reaching these targets. A small proportion of people with T2DM on insulin therapy reached their HbA1c target. Personalized management of glycemic targets necessitates the adoption of multi-factorial strategies, as several factors could influence an individual's glycemic outcome. ClinicalTrials.gov identifier: NCT01400971

The COVID-19 pandemic has added an enormous toll to the existing challenge of diabetes care world-wide. A large proportion of patients with COVID-19 requiring hospitalization and/or succumbing to the disease have had diabetes and other chronic conditions as underlying risk factors. In particular, individuals belonging to racial/ethnic minorities in the U.S. and other countries have been significantly and disproportionately impacted. Multiple and complex socioeconomic factors have long played a role in increasing the risk for diabetes and now for COVID-19. Since the pandemic began, the global healthcare community has accumulated invaluable clinical experience on providing diabetes care in the setting of COVID-19. In addition, understanding of the pathophysiological mechanisms that link these two diseases is being developed. The current clinical management of diabetes is a work in progress, requiring a shift in patient-provider interaction beyond the walls of clinics and hospitals: the use of tele-medicine when feasible, innovative patient education programs, strategies to ensure medication and glucose testing availability and affordability, as well as numerous ideas on how to improve meal plans and physical activity. Notably, this worldwide experience offers us the possibility to not only prepare better for future disasters but also transform diabetes care beyond the COVID-19 era.

The purpose of this randomized controlled clinical trial was to determine whether an A1C value obtained at home by participants followed by a phone discussion of the result with a clinician would lead to 1) a more rapid and significant decrease in A1C, 2) more effective advancement of diabetes treatment, and 3) improvement in diabetes self-care behaviors. The study included 307 participants with type 2 diabetes, most of whom were of Latino origin. All study participants experienced a statistically significant reduction in mean A1C (control subjects −0.3%, P = 0.04; intervention subjects −0.5%, P = 0.0002), but there was a statistically significant difference in the number of people who achieved a reduction of ≥0.5% by 6 months, favoring the intervention (33.6 vs. 46.7%, P = 0.05).

AimsTo describe global patterns of insulin treatment and to assess the impact of patient, provider, health system and economic influences on treatment decisions for patients with insulin‐treated type 2 diabetes (T2D).MethodsThis prospective cohort study of insulin‐treated patients with T2D was conducted across 18 countries categorized as high, upper‐middle or lower‐middle income regions. Information collected from patients included knowledge of diabetes, experiences and interactions with their healthcare provider. Physician information included specialty, practice size, availability of diabetes support services, volume of diabetes patients treated and time spent per patient. Physicians determined an individualized haemoglobin A1c (HbA1c) target for each patient by the start of the study. Changes in T2D therapies and HbA1c were recorded for 2 years.ResultsComplete treatment data were available for 2528 patients. Median age was 61 years and median duration of diabetes was 11.4 years. Changes to treatment regimen occurred in 90.0% of patients, but changes were less common in countries with a higher economic status (P < 0.001). Most treatment changes involved insulin, with changes in dose the most common. Overall predictors of change in insulin therapy included younger age, use of any insulin regimen other than basal only, higher mean baseline HbA1c and longer duration of T2D. HbA1c levels remained constant regardless of regional economic status. At baseline, 20.6% of patients were at their HbA1c target; at 2 years this was 26.8%.ConclusionsAmong insulin‐treated patients with T2D, treatment changes were common; however, only approximately one‐fourth of individuals achieved their HbA1c target.

BACKGROUND People from Latin America (LA) and the Hispanic/Latino community living in the United States (LUS) exhibit a high prevalence of diabetes (DM) and obesity (OB). The Gut Microbiome (GM) is capable of altering energy regulation and glucose metabolism, but for the expression of these diseases a combination of multiple factors such as ethnicity, genetic and nutritional factors are required. A systematic research was conducted to understand if the prevalence of OB and/or DM has an interaction with the GM in LA and LUS. METHODS Research was conducted in PubMed, Web of Science, Scielo, Embase and Google Scholar for articles between 1990 and 2017. It was restricted to human studies published in English, Spanish, or Portuguese that applied genetic techniques to study the GM in LA or LUS and discussed the association with OB and/or DM. RESULTS Different gut Firmicutes/Bacteroidetes relationships in several populations from LA influenced by geography, diet and lifestyles interacted with OB. Healthy people from the Mexico and US border had the same imbalance between Firmicutes and Bacteroidetes found in OB or Type 2 DM. High levels of Bacteroides and a reduced proportion of Prevotella, Megamonas, and Acidaminococcus were found in newly diagnosed type 1 DM. Once the patient was treated with insulin, an increase of Prevotella levels was seen. Inverse Firmicutes/Bacteroidetes relationship was reported before the development of Type 1 DM. CONCLUSION An important relation between GM and OB and/or DM exists in LA and LUS. Further elucidation of pathophysiologic mechanisms is required.

We are currently enjoying the benefits of great scientific advances in diabetes care. Never have we had such a deep understanding of the pathophysiology of type 1 and type 2 diabetes and their potential complications, nor had access to as many new technologies and effective therapeutic options for our patients with these conditions as we do today. In addition, effective lifestyle modification and patient education strategies have been identified and validated for the prevention and adequate management of the disease.