Background:Type 2 diabetes accounts for over 90% of all diabetes cases and continues to rise globally, with projections reaching 853 million adults by 2050. Prediabetes, a key risk state, offers a critical window for prevention, as lifestyle changes can reduce progression to type 2 diabetes by nearly 50%. Despite clear guidelines emphasizing diet and physical activity, adherence remains challenging due to socioeconomic, cultural, and behavioral barriers. Aim:The aim of this study was to explore men's attitudes toward managing their diet and lifestyle after being diagnosed with prediabetes. Methods:A qualitative study used individual and group interviews with 21 Swedish men aged 60-72 with prediabetes, recruited from the Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort via convenience sampling. Data collected from May to August 2025 through Microsoft Teams included open-ended questions. Interviews were audio-recorded and transcribed. Analysis followed Graneheim and Lundman's qualitative content analysis. Results:The men recognized the importance of healthy habits but doubted they could maintain lasting change. This ambivalence was caused by personal limitations and a focus on short-term goals. Some men sought support from family or friends, moving from contemplation to preparation. Learning from successes and setbacks, they gained a more realistic view of their ability to change. The analysis identified one main theme, "Grasping the message about healthy habits but still doubting one's ability to change", and two additional themes, each with three subthemes. Conclusion:Men with prediabetes know how to eat healthy but struggle to turn knowledge into habits. Emotional distress, ambivalence, and triggers often undermine motivation. Short-term goals like weight loss dominate over long-term strategies. Yet, men seek social support and engaging activities, showing readiness for change. Implications:Interventions should target psychological barriers, use social networks, and offer practical strategies for lasting lifestyle changes.

BackgroundMany persons with type 2 diabetes (T2D) lack risk awareness or underestimate their cardiovascular risk. Although health care professionals in primary health care strive to implement risk-awareness strategies for cardiovascular risk, persons with T2D report a lack of meaningful dialogue with health care professionals. Co-creation is grounded in participatory action research and involves participants as equal partners across all stages of a project. This study describes the development of an intervention to increase cardiovascular risk awareness in people with T2D. ObjectiveThis study aims to describe the co-creation process of developing an intervention to increase awareness of cardiovascular risk in persons with T2D. MethodsA co-creative design was used to develop an intervention following a participatory action research framework. Four workshops with persons with T2D, diabetes specialist nurses, and physicians in primary health care explored communication about cardiovascular risk, co-identified needs, co-designed solutions, tested prototypes, and redefined and retested the content of the intervention. The data were analyzed using reflexive thematic analysis. ResultsThe analysis identified 4 themes: co-define: taking the person’s voice into account; co-design: problem-solving and generating ideas; prototype and test: drafting intervention proposals; and redefine and retest: reviewing suggested interventions. The workshop discussions highlighted the need for new interventions, including a risk assessment tool, a patient handbook, material to prompt reflection, and a web education for specialist diabetes nurses. ConclusionsThis study demonstrates the value of co-creation, which was used to develop an intervention to enhance cardiovascular risk awareness in persons with T2D. Diabetes specialist nurses need to explore patients’ perceptions of risk and provide space for emotional responses. The web education is intended to strengthen the person-centered approach of diabetes specialist nurses, the patient handbook encourages reflection and dialogue on personal risk, and the risk assessment tool visualizes individual risk. These components may contribute to increased awareness of cardiovascular risk.

Background:Specialist nurses in primary health care play a key role in supporting individuals at risk of type 2 diabetes to adopt healthier eating habits. Although dietary counselling is central to prevention, limited knowledge exists on how nurses experience providing individualized advice that considers gender, cultural background, and patients' everyday contexts. Objective:To explore specialist nurses' perceptions of delivering individualized dietary advice to patients at risk of type 2 diabetes, with attention to gender, culture, and contextual factors. Design:Qualitative study based on semi-structured interviews. Setting and participants:Specialist nurses in Swedish primary health care were recruited through snowball sampling. Data were collected between August and November 2025. Methods:Data were analysed using qualitative content analysis according to Graneheim and Lundman. Results:Four themes and 12 subthemes described how specialist nurses applied patient-centered strategies, considered gendered and multicultural influences, encountered clinical and motivational challenges, and expressed a need for enhanced organizational and educational support. Nurses emphasized empathy, small-step goal setting, and person-centered communication. However, limited consultation time, low patient motivation, socioeconomic constraints, and cultural complexity hindered effective counselling. Participants highlighted the need for cultural competence training, accessible and updated resources, and stronger organizational support. Conclusion:Effective dietary prevention requires that specialist nurses have sufficient time, appropriate tools, and organizational support to tailor advice to patients' everyday lives. Despite strong commitment, structural, cultural, and motivational barriers limit the effectiveness of prevention efforts. Strengthening organizational structures, improving access to culturally adapted resources, and adopting collaborative care models may enhance diabetes prevention in clinical practice.

BACKGROUND:In individuals with type 2 diabetes and hypertension, weight loss may reduce antihypertensive treatment needs, but effects on blood pressure variability and nocturnal dipping are unclear. We investigated changes in antihypertensive treatment and ambulatory blood pressure following a weight-loss intervention in adults with overweight and type 2 diabetes. METHODS:This single-arm intervention trial included 32 participants with type 2 diabetes undergoing a dietary weight-loss intervention. Antihypertensive medications were discontinued at intervention start and reintroduced if blood pressure increased. Changes in antihypertensive treatment, ambulatory blood pressure, and office blood pressure were assessed from baseline to 12 months. RESULTS:Mean (SD) age was 61 ± 6 years and baseline weight 102 ± 16 kg. Mean weight loss at 12 months was 11.6 ± 6.0 kg. The median number of antihypertensive medications decreased from 2 to 1 (p = 0.004), and antihypertensive treatment use from 88% to 59%. Office and ambulatory blood pressure, including nocturnal dipping, remained largely unchanged. Daytime and night-time heart rate, and night-time systolic blood pressure variability decreased (all p < 0.05). CONCLUSIONS:In adults with overweight and type 2 diabetes, office and ambulatory blood pressure remained stable after weight loss, despite a reduction in antihypertensive treatment.

This study aimed to investigate whether concurrent training, when added to a palaeolithic-type diet-induced weight loss intervention, is associated with altered physiological responses and circulating lipid dynamics during exercise and recovery in individuals with type 2 diabetes. In a previously reported clinical trial, individuals with overweight or obesity who had type 2 diabetes (n=27) were randomised to either 12 weeks of palaeolithic-type diet (PD) or PD and supervised concurrent exercise training three times weekly (PD+E). Physiological and glycaemic responses to exercise and recovery were monitored during an exercise test at baseline and following the intervention. This secondary analysis focuses on a subgroup (n=21), in which plasma samples were collected before and after exercise, and after 30 min of recovery, and lipid profiles were analysed using mass spectrometry-based lipidomics. Glycaemic management during and after the exercise test improved similarly in both groups, whereas only the PD+E group showed improvements in cardiometabolic fitness. In plasma samples obtained at rest before exercise, the intervention reduced levels of triacylglycerols in both groups, with additional reductions of very-long-chain ceramides (>C22 acyl chains) in the PD+E group. During the exercise test, sphingomyelins and ceramides increased in both groups, but only PD+E resulted in improved clearance of these bioactive lipids from circulation during recovery. The specific lipid response during recovery from exercise was associated with improvements in fat oxidation during exercise. Concurrent training during PD-induced weight loss improves cardiometabolic fitness and is associated with an enhanced ability to clear bioactive sphingomyelins and ceramides from the circulation in the recovery phase after an exercise test. The improved lipid response during recovery and its association with the capacity for fat oxidation suggest that concurrent training during PD-induced weight loss may augment lipid handling beyond diet-induced changes, although causal mechanisms cannot be established.

AIMS:We evaluated overall and sex-specific performance of established diabetes risk models for predicting incident dysglycaemia in African and European populations. MATERIALS AND METHODS:We externally evaluated the African Diabetes Risk model, Finnish Diabetes Risk model, Epidemiological Study on the Insulin Resistance Syndrome model and the personal and clinical Framingham models. Evaluation was performed in three prospective cohorts: the Research on Obesity and Diabetes among African Migrants (RODAM-Pros; migrant and non-migrant Ghanaians; n = 1607), the Middle-aged Soweto cohort (MASC; urban Black South Africans; n = 515) and the Västerbotten Intervention Programme (VIP; Sweden; n = 3044). Dysglycaemia was defined according to American Diabetes Association criteria. Discrimination (c-statistic) and calibration were assessed before and after recalibration. RESULTS:Dysglycaemia developed in 17.7% of RODAM-Pros participants, 35.0% of MASC participants and 27.5% of VIP participants, with median follow-up of 6.7, 6.7 and 9.9 years, respectively. All models demonstrated poor-to-modest discrimination (c-statistic < 0.7). Most models substantially underestimated risk. Recalibration eliminated systematic miscalibration and reduced calibration error to ≤ 2.3% in RODAM-Pros and VIP and ≤ 3.4% in MASC. Performance varied by sex and cohort. CONCLUSIONS:Existing diabetes risk prediction models can be applied to predict incident dysglycaemia in both Sub-Saharan African and European populations, but only after recalibration to local risk levels.

Exercise elicits a spectrum of metabolic and inflammatory responses that are crucial for skeletal muscle adaptation and overall health, particularly in the context of metabolic diseases, yet the contribution of prostanoid signalling to these processes remains unclear. We hypothesised that exercise-induced thromboxane production enhances skeletal muscle glucose uptake and improves whole-body glucose control. Plasma prostanoids were quantified in men and women with normal glucose tolerance or type 2 diabetes before, immediately after and 3 h after a single bout of exercise. Cyclooxygenase (COX-2) transcript levels were evaluated in human skeletal muscle, whole blood, peripheral blood mononuclear cells and skeletal muscle-resident immune cells. Metabolic and transcriptomic effects of thromboxane receptor activation were analysed in mouse C2C12, rat L6 and human primary skeletal muscle cells. Glucose tolerance in vivo was assessed following i.p. administration of the thromboxane receptor agonist I-BOP in male and female mice. Tissue-specific glucose uptake was quantified by measuring radiolabelled 2-deoxyglucose incorporation during an IVGTT. Acute exercise increased plasma thromboxane B₂ concentrations and skeletal muscle mRNA levels of PTGS2 (encoding COX-2) selectively in monocyte/macrophage populations. In skeletal muscle cells, the thromboxane receptor agonist I-BOP increased glucose uptake in a dose-dependent manner up to 2.5-fold within 4 h and enhanced glycogen synthesis by 430

Background:Prediabetes is a condition in which blood glucose levels are elevated but not high enough to meet the diagnostic criteria for diabetes. It often presents without symptoms but indicates a higher risk of developing type 2 diabetes and other health issues. Without lifestyle changes, many individuals with prediabetes develop type 2 diabetes within a few years. Objective:This study aimed to explore women's experiences of managing diet in daily life following a diagnosis of prediabetes. Methods:This qualitative study involved interviews with 16 Swedish women aged 59-72 with prediabetes from the SCAPIS cohort, recruited via convenience sampling. Data were collected from May to August 2025 using open-ended questions. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. Results:Women viewed food as both sustenance and emotional comfort, creating tension between health goals and emotional needs, complicating diet adherence. The analysis highlighted one main theme, "Imposed demands to take responsibility for one's own and others' healthy eating habits," and two additional themes, each with three subthemes. Conclusions:The results highlight that food serves not only as sustenance but also as emotional comfort, creating tension between health goals and emotional needs, which hampers adherence to dietary advice. Women often have different eating patterns than men, emphasizing the need for person-centered, gender-sensitive approaches.

AIM:To describe experiences of being a parent of a child with type 1 diabetes during adolescence and emerging adulthood, including during the transfer from paediatric to adult care. DESIGN:A qualitative approach was used. METHODS:Individual interviews started in February 2022 and continued to February 2023. Fourteen parents of emerging adults participated. Data were analysed using qualitative content analysis. FINDINGS:Being a parent of a child with type 1 diabetes involved struggling to accept the loss of control and slowly loosening the ties in the close parent-child relationship during adolescence and emerging adulthood. Parents were gradually reconciling with the illness that was turning the world upside down, making efforts to become a close-knit family team, relinquishing the priorities of supervision and instead cherishing the relationship, processing that the emerging adult is flying the nest and feeling abruptly cut off by healthcare during the transfer to adult care. CONCLUSION:The findings were interpreted as outlining a transitional process among parents that started in the onset period, continuing throughout the life span to their children's emerging adulthood. Parents also transition into new roles along with their children. Parents' experiences of complex daily life, multiple transitions and the abrupt transfer from paediatric to adult care are important to acknowledge. CLINICAL IMPLICATIONS FOR THE PROFESSION:Transfer is suggested to be carried out with consideration for the individuals' prerequisites and desires. Parents are important stakeholders guiding the transfer. In adult care, a more family-centred approach could help parents cope with new challenges in joint clinical visits. Parents should be welcomed to joint clinical visits in adult care with consent and parents could benefit from being offered support from nurses independently. REPORTING METHOD:The study adhered to EQUATOR guidelines and the COREQ checklist for qualitative studies was used as the reporting method. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

Leisure-time physical activity decreases the risk of type 2 diabetes. Whether occupational physical activity affects the risk of type 2 diabetes is still not fully understood. The primary aim of this study was to investigate the association between occupational physical activity and 10-year diabetes incidence in a general adult population in Northern Sweden. The secondary aim was to explore the moderating role of BMI on this association. This population-based, longitudinal cohort study included 16,282 diabetes-free individuals aged 28–52 years who participated in a cardiovascular intervention programme in Northern Sweden, and who reported the same occupational physical activity level at baseline and at 10-year follow-up. Incident type 2 diabetes was diagnosed based on oral glucose tolerance testing or a register-based diagnosis. Occupational physical activity was self-reported and categorized as: a) Low: ‘Sedentary or standing’ or ‘Light but partly physically active’, b) Moderate: ‘Light and physically active’, or c) High: Sometimes physically strenuous or ‘Physically strenuous most of the time’. Odds ratios (OR) and 95

OBJECT:Type 2 diabetes (T2D) is an established risk factor for cardiovascular disease (CVD), with increased risk already observed in the prediabetic state. This study aimed to investigate the association of insulin sensitivity, secretion, and clearance with subclinical atherosclerosis in a randomly selected cohort of Swedish adults aged 50-64 years without known diabetes. MATERIAL AND METHODS:For this cross-sectional analysis, data from the Umeå site of the Swedish CArdioPulmonary BioImage Study (SCAPIS) were used, which included 2507 individuals aged 50-64 years. After applying exclusion criteria, 2054 participants remained. Insulin sensitivity, secretion, and clearance were calculated using an oral glucose tolerance test (OGTT). Atherosclerosis was assessed by coronary computed tomography angiography (CCTA) and carotid ultrasound, yielding coronary artery calcification scores (CACS), coronary segment involvement scores (SIS), and total carotid plaque counts. Ordinal regression models analyzed associations between insulin measures and atherosclerosis, adjusting for cardiovascular risk factors. RESULTS:Lower insulin sensitivity, as measured by the GUTT index, was associated with higher CACS and SIS, but not with carotid plaque count. No significant relationship was found between insulin secretion (Insulinogenic Index) and any atherosclerotic marker. Reduced insulin clearance was associated with CACS and SIS in unadjusted analyses; however, these associations did not persist after multivariable adjustment. CONCLUSION:In individuals without diabetes, insulin resistance is associated with markers of subclinical coronary atherosclerosis, reinforcing its role in early CVD. Insulin secretion or clearance are not directly associated with measures of subclinical atherosclerosis in this population but may contribute indirectly via effects on circulating insulin levels.

Introduction If a person is in diabetes remission, even if only for a short time, this reduces the risk of later diabetes complications and lowers healthcare costs. A recent study shows that long-term remission of type 2 diabetes can be achieved through calorie restriction using total diet replacement. However, this intervention involves support through face-to-face meetings every 2 to 4 weeks over a 2-year period, which is not feasible in routine care with limited resources. Therefore, we have developed an eHealth programme to help patients achieve diabetes remission through calorie restriction in a cost-effective manner. Our primary hypothesis is that an eHealth programme will be non-inferior to face-to-face meetings in helping patients with type 2 diabetes achieve remission through caloric restriction. Our second hypothesis is that eHealth support will be more cost-effective than face-to-face support.Methods and analysis The eHealth DIabetes remission Trial is a multicentre, two-arm, non-inferiority, open-label, randomised controlled parallel group trial with blinded endpoint assessment conducted at two centres in Sweden. The study duration is 2 years. People with type 2 diabetes (≤6 years duration) use total diet replacement (approximately 900 kcal/day) with the aim of losing 15 kg and achieving diabetes remission. Participants are randomly assigned to either the eHealth support group or the face-to-face support group. The treatment programme to achieve and maintain weight loss is the same in both groups, but the method of support differs between the groups. The primary outcome is haemoglobin A1c (HbA1c) after 1 year. The secondary outcome is HbA1c at 6 months and 2 years. Other important secondary outcomes are diabetes remission rate, body weight and cost-effectiveness. The latter is assessed using the incremental cost per quality-adjusted life-years gained.Ethics and dissemination The study was approved by the Swedish Ethical Review Authority (Dnr 2022-02242-01, 2023-03707-02). The results will be published in peer-reviewed scientific journals and discussed at national and international conferences and with patient organisations.Trial registration number ClinicalTrials.gov (NCT05491005).

INTRODUCTION:The prevalence of type 2 diabetes (T2D) within sub-Saharan Africa (SSA) is increasing. Despite the pathophysiology of T2D differing by ethnicity and sex, risk stratification and guidelines for the prevention of T2D are generic, relying on evidence from studies including predominantly Europeans. Accordingly, this study aims to develop ethnic-specific and sex-specific risk prediction models for the early detection of dysglycaemia (impaired glucose tolerance and T2D) to inform clinically feasible, culturally acceptable and cost-effective risk management and prevention strategies using dietary modification in SSA and European populations. METHODS AND ANALYSIS:This multinational collaboration will include the prospective cohort data from two African cohorts, the Middle-Aged Soweto Cohort from South Africa and the Research on Obesity and Diabetes among African Migrants Prospective cohort from Ghana and migrants living in Europe, and a Swedish cohort, the Pre-Swedish CArdioPulmonary bioImage Study. Targeted proteomics, as well as targeted and untargeted metabolomics, will be performed at baseline to discover known and novel ethnic-specific and sex-specific biomarkers that predict incident dysglycaemia in the different longitudinal cohorts. Dietary patterns that explain maximum variation in the biomarker profiles and that associate with dysglycaemia will be identified in the SSA and European cohorts and used to build the prototypes for dietary interventions to prevent T2D. A comparative cost-effectiveness analysis of the dietary interventions will be estimated in the different populations. Finally, the perceptions of at-risk participants and healthcare providers regarding ethnic-specific and sex-specific dietary recommendations for the prevention of T2D will be assessed using focus group discussions and in-depth interviews in South Africa, Ghana, Germany (Ghanaian migrants) and Sweden. ETHICS AND DISSEMINATION:Ethical clearance has been obtained from all participating sites. The study results will be disseminated at scientific conferences and in journal publications, and through community engagement events and diabetes organisations in the respective countries.

IntroductionIn this systematic review, we investigated the diagnostic accuracy of surrogate measures of insulin secretion based on fasting samples and the oral glucose tolerance test (OGTT). The first phase of insulin secretion was calculated using two gold standard methods; the hyperglycemic clamp (HGC) test and intravenous glucose tolerance test (IVGTT).Research design and methodsWe conducted searches in the PubMed, Cochrane Central, and Web of Science databases, the last of which was conducted at the end of June 2021. Studies were included that measured first-phase insulin secretion in adults using both a gold-standard reference method (either HGC or IVGTT) and one or more surrogate measures from either fasting samples, OGTT or a meal-tolerance test. QUADAS-2, a revised tool for the quality assessment of diagnostic accuracy studies, was used for quality assessment. Random-effects meta-analyses were performed to examine the correlation between first-phase measured with gold standard and surrogate methods.ResultsA total of 33 articles, encompassing 5362 individuals with normal glucose tolerance, pre-diabetes or type 2 diabetes, were included in our systematic review. Homeostatic model assessment (HOMA)-beta and Insulinogenic Index 30 (IGI(30)) were the surrogate measures validated in the largest number of studies (17 and 13, respectively). HOMA-beta’s pooled correlation to the reference methods was 0.48 (95% CI 0.40 to 0.56) The pooled correlation of IGI to the reference methods was 0.61 (95% CI 0.54 to 0.68). The surrogate measures with the highest correlation to the reference methods were Kadowaki (0.67 (95% CI 0.61 to 0.73)) and Stumvoll’s first-phase secretion (0.65 (95% CI 0.58 to 0.71)), both calculated from an OGTT.ConclusionsSurrogate measures from the first 30 min of an OGTT capture the first phase of insulin secretion and are a good choice for epidemiological studies. HOMA-beta has a moderate correlation to the reference methods but is not a measure of the first phase specifically.PROSPERO registration numberThe meta-analysis was registered at PROSPERO (Id: CRD42020169064) before inclusion started.

BACKGROUND:Dyslipidaemia in patients with diabetes contributes to the risk of atherosclerotic cardiovascular disease. We aimed to identify a dyslipidemic profile associated with both dysglycemia and subclinical coronary atherosclerosis. METHODS:Study participants (n = 5050) were classified in three groups: normoglycemia, pre-diabetes, and diabetes. A coronary artery calcium score (CACS) > 0 defined subclinical coronary atherosclerosis. Two independent methods were used to identify, among 225 lipid biomarkers, those that were associated with pre-diabetes and diabetes and were further tested for association by zero inflated Poisson regression with CACS and with CACS burden in study participants with CACS>0. Estimates were adjusted for cardiovascular risk factors with an interaction term for dispensed lipid lowering drugs. RESULTS:Thirty-two biomarkers associated with prediabetes and diabetes were further investigated for association with CACS. HDL diameter [multi-adjusted OR of 0.85 and 95 %CI (0.78-0.92)] as well as free cholesterol, phospholipids and total lipids in extra large HDL were inversely associated with CACS. There was a borderline significant interaction between small HDL and dispensed lipid lowering drugs on the presence of CACS, with and multi-adjusted OR of 0.53 and 95 %CI (0.36-0.77). None of the 32 glycemic profile-related lipid biomarkers associated with the relative increase of CACS in those with CACS>0. No consistent association was observed between non-HDL lipoproteins and CACS. CONCLUSIONS:Changes in composition and relative concentration of HDL associated with both dysglycemia and subclinical coronary atherosclerosis. Treatment with lipid lowering drugs may contribute to reduce the risk associated with high circulating levels of small HDL.

Purpose To describe the process of becoming aware of and acting on personal cardiovascular (CVD) risk in type 2 diabetes (T2D). Method A purposive sample of 14 persons living with T2D participated in semi-structured, open-ended, in-dept interviews. The interviews were analysed with grounded theory. Result The analysis identified the core category “Balancing emotions, integrating knowledge and understanding to achieve risk awareness and act on it.” Five categories describe the movement from not being aware of the risk of cardiovascular disease (CVD) to becoming aware of this risk and taking action to reduce it. Persons with T2D need to transform their knowledge and experience of CVD risk and incorporate it in their individual situations. Emotional and existential experiences of CVD risk can lead to awareness about the severity of the condition and contribute to increased motivation for self-management. However, an overly high emotional response can be overwhelming and may result in insufficient self-management. Conclusion Persons with T2D seemed not to fully grasp their increased risk of CVD or recognize that self-management activities were aimed at reducing this risk. However, their awareness of CVD risk gradually increased as they came to understand the severity of T2D and became more emotionally and existentially engaged.

Patients with type 2 diabetes have an increased risk of death and cardiovascular events and people with diabetes or prediabetes have been found to have increased atherosclerotic burden in the coronary and carotid arteries. This study will estimate the cross-sectional prevalence of atherosclerosis in the coronary and carotid arteries in individuals with prediabetes and diabetes, compared with normoglycaemic individuals in a large population-based cohort. The 30,154 study participants, 50–64 years, were categorized according to their fasting glycaemic status or self-reported data as normoglycaemic, prediabetes, and previously undetected or known diabetes. Prevalence of affected coronary artery segments, severity of stenosis and coronary artery calcium score (CACS) were determined by coronary computed tomography angiography. Total atherosclerotic burden was assessed in the 11 clinically most relevant segments using the Segment Involvement Score and as the presence of any coronary atherosclerosis. The presence of atherosclerotic plaque in the carotid arteries was determined by ultrasound examination. Study participants with prediabetes (n = 4804, 16.0

AIM:To explore young adults' experiences of living with type 1 diabetes in the transition to adulthood, including experiences of the transfer from paediatric to adult care.DESIGN:A qualitative approach was used.METHOD:Ten young adults, six women and four men, aged 19-29 years, participated. Participants were recruited at their regular diabetes clinic from spring 2021 to spring 2022. Semi-structured interviews were transcribed and analysed using qualitative content analysis.FINDINGS:Dreaming of being nurtured towards self-reliance was the overarching theme. Personal experiences of the transition to adulthood, including the transfer from paediatric to adult care, were described in terms of struggling to find balance in daily life, dealing with feelings of being different, being gradually supported to achieve independence, and wishing to be approached as a unique person in healthcare.CONCLUSION:In healthcare, it is important to emphasize not only diabetes-related factors but also emotional and psychosocial aspects of life connected to the transition to adulthood, including the transfer to adult care. The young adults wished to be seen as unique persons in healthcare during their emerging adulthood and should therefore be supported to achieve self-reliance through personal preparations for new challenges and for the consequences of transitioning to adulthood. Specialist nurses can provide appropriate knowledge and leadership.IMPLICATIONS FOR THE PROFESSION:These findings can guide nurse specialists in support for emerging adults to achieve self-reliance and indicate the importance of person-centred care when experiencing transition and transfer.REPORTING METHOD:The study adhered to EQUATOR guidelines, and the COREQ checklist for qualitative studies was used as the reporting method.

Introduction With pre-diabetes and diabetes increasingly recognized as heterogeneous conditions, assessment of beta-cell function is gaining clinical importance to identify disease subphenotypes. Our study aims to comprehensively validate all types of surrogate indices based on oral glucose tolerance test (OGTT) and fasting measurements in comparison with gold standard methods. Research design and methods The hyperglycemic clamp extended with glucagon-like peptide 1 (GLP-1) infusion and intravenous glucose tolerance test (IVGTT), as well as OGTT, was performed in two well-phenotyped cohorts. The gold standard–derived indices were compared with surrogate insulin secretion markers, derived from fasting state and OGTT, using both Pearson’s and Spearman’s correlation coefficients. The insulin-based and C-peptide-based indices were analyzed separately in different groups of glucose tolerance and the entire cohorts. Results The highest correlation coefficients were found for area under curve (AUC) (I 0-30 )/AUC (G 0-30 ), I 30 /G 30 , first-phase Stumvoll and Kadowaki model. These indices have high correlation coefficients with measures obtained from both insulin and C-peptide levels from IVGTT and hyperglycemic clamp. AUC (I 0-120 )/AUC (G 0-120 ), BIGTT-AIR 0-60-120 , I 30 /G 30 , first-phase Stumvoll and AUC (I 0-30 )/AUC (G 0-30 ) demonstrated the strongest association with incretin-stimulated insulin response. Conclusions We have identified glucose-stimulated and GLP-1-stimulated insulin secretion indices, derived from OGTT and fasting state, that have the strongest correlation with gold standard measures and could be potentially used in future researches and clinical practice.