Type 2 diabetes (T2D) prevalence is rising, which imposes a significant burden on individuals, healthcare systems, and economies worldwide. Lifestyle factors contribute significantly to the escalating incidence of T2D. Consequently, there is an increasing need for interventions that not only target at-risk populations for prevention but also empower individuals with T2D to achieve better self-management and possibly attain remission through sustained lifestyle modifications. Technological tools may improve health outcomes compared to traditional in-person care, and can include registration of important health parameters, provide follow-up and support, and enhance self-management. The aim of this study was to receive feedback from end-users to inform the development of a comprehensive e-health program focusing on lifestyle modification in pre-diabetes and T2D.

During eight focus group meetings, sixteen adults with pre-diabetes or T2D from all over Norway informed the study about needs and preferences for an e-health program, including essential functionalities and design choices. A questionnaire and paper prototyping were used to complement the discussions in the focus group meetings.

Lack of necessary diabetes knowledge was common, and education was considered essential for improved self-management. Essential functionalities included registration and overview of several health parameters, long-term follow-up and coaching through communication platforms within the program, automatic data transfer from different devices such as blood glucose monitors and smartwatches, and educational courses. To ensure end-users' satisfaction with the program and increase motivation for long-term usage, the participants rendered tailoring of desired functionalities and content as crucial.

Based on the findings, a list of recommendations was created, containing the most crucial functionalities and features to include when developing e-health and/or m-health tools for people with pre-diabetes and T2D. Future work should include health care personnel to explore their needs and preferences, and ways such an e-health program may enhance patient interaction without increasing workload and resource use.

High-protein diets have been recognized as a potential strategy in the nutritional management of type 2 diabetes (T2D). Mycoprotein is a high-fibre, high-protein food ingredient previously shown to improve acute glycaemic control. We determined whether incorporating mycoprotein into a high-protein vegan diet would improve glycaemic control to a greater extent than an isonitrogenous omnivorous diet in people with T2D.

Seventeen adults (f = 5, age = 58.3 ± 8.3 years, BMI = 32.9 ± 4.7 kg∙m-2, HbA1c = 60 ± 15 mmol∙mol-1) with T2D were randomly allocated to a 5-week eucaloric high-protein (30% energy from protein) diet, either an omnivorous diet (OMNI; 70% protein from omnivorous sources) or an isonitrogenous, mycoprotein-rich, vegan diet (VEG; 50% protein from mycoprotein). Glycaemic control was assessed using a two-step hyperinsulinaemic-euglycaemic clamp (HEC) with D-[6,6-2H2] glucose infusion, a mixed-meal tolerance test (MMTT) and continuous glucose monitoring.

The rate of glucose disappearance (RdT), glucose disposal rate and endogenous glucose production, as well as postprandial time-course of blood glucose, serum insulin and C-peptide were assessed during the HEC and MMTT, respectively. Both groups had improved peripheral insulin sensitivity (intervention effect, p = 0.006; increased RdT/Insulin of 1.0 ± 0.6 and 1.0 ± 0.3 mg kg-1 min-1 in OMNI and VEG, respectively), HbA1c (intervention; p = 0.001) and glycaemic variability (intervention; p = 0.040; increased time in-range of 11.8 ± 9.3% and 23.3 ± 12.9% in OMNI and VEG). There were no improvements in hepatic insulin sensitivity or in postprandial blood glucose and serum C-peptide (p > 0.05) during the MMTT.

High-protein diets, whether predicated on vegan or omnivorous proteins, can improve glycaemic control by increasing peripheral insulin sensitivity in people with T2D.

Type 2 diabetes (T2D) has become a serious health threat globally. However, the existing approaches for diabetes prediction mainly had difficulty in addressing multiple time-series features. This study aims to provide an adjunctive tool for the clinical identification of patients in physician-pharmacist collaborative clinics at high risk of poor prognosis.

This study proposes a novel interpretable time-series Neural Turing Machine (ITS-NTM) to form patient characteristics into feature matrixes to simulate one's disease and treatment process, predicting the prognosis of patients with T2D and alerting early interventions. Model robustness was verified by 10-fold cross-validation, external validation and multi-model comparisons. We also conducted dynamic prediction and feature importance analysis to explore its interpretability.

The study population included patients with T2D attending physician-pharmacist collaborative clinics over 12 months in primary healthcare centers, while clinical features and behavioral indicators at baseline, 3rd, 6th, 9th and 12th months were used to reflect the fluctuation of disease control over time. Compared with five state-of-the-art prediction models, the ITS-NTM obtains 92.0 % in accuracy and 91.8 % F1-score, demonstrating the superiority performance. Feature importance demonstrated that the top 5 features were glycosylated hemoglobin, fasting blood glucose, medication adherence scores, 2-hour postprandial blood glucose and waist-to-hip ratio, which had the greatest impact on the performance of the predictive model.

Proposed ITS-NTM could be used to promote the implementation of physician-pharmacist collaborative clinics, and further prompt the application of artificial intelligence to optimize the allocation of medical resources and improve the quality of care in under-resourced areas.

Ectopic fat is reduced by effective weight management, but difficult to assess clinically.

We evaluated paired data on 42 participants in the intervention group of the Diabetes Remission Clinical Trial (DiRECT) at baseline, 12 and 24 months after weight loss as indicators of liver fat content measured by 3-point Dixon MRI.

Baseline liver fat was elevated at 13.0 [7.8-23.3]% with fasting plasma glucose 7.9 [7.1-10.1] mmol/L. Prevalence of baseline MASLD was 86.4%. After weight loss of 11.9 ± 1.2 kg (0-37 kg) at 12 months, remission of MASLD occurred in 74% and liver fat normalised for many (1.8 [1.2-5.2]%; p < 0.0001) as did fasting glucose (5.9 [5.5-7.2] mmol/L; p < 0.0001). Alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) decreased at 12 months by 38 [19-60]% (p < 0·0001) and 38 [16-53]% (p < 0.0001) respectively. The positive predictive value for decrease in liver fat, with baseline values of >40 IU/L, was 100% for ALT and 87.5% for GGT. As expected, change in liver fat correlated with change in ALT (r = 0.64; p < 0.0001), GGT (r = 0.38; p = 0.013), AST (r = 0.36; p = 0.018), fatty liver index (r = 0.50; p < 0.0001) and hepatic steatosis index (r = 0.44; p < 0.0001).

Metabolic dysfunction-associated steatotic liver disease, an important marker of ill-health is improved by intentional weight loss. If enzyme levels are raised at baseline, following weight loss, changes in ALT and GGT usefully reflect change in liver fat content, with high positive predictive value. Monitoring liver enzymes can provide a simple way to assess change in liver fat following weight loss in day-to-day clinical practice.

Interest has grown in glucagon-like peptide-1 receptor-agonist (GLP-1 RA) semaglutide long-term outcomes. This retrospective cohort study compared effectiveness of oral and subcutaneous semaglutide for weight loss outcomes in adults with type 2 diabetes (T2D) over a 2-year treatment period.

Weight loss was evaluated through mean percentage change from baseline, proportion achieving at least 5% weight loss and at least 10% weight loss comparing subcutaneous (n = 310) versus oral users (n = 57) and by age group.

Subcutaneous users experienced a mean percentage weight loss of 7.5% (16.7 pounds) with 58.7% and 32.9% achieving ≥5% and ≥10% loss, respectively. Oral users lost 4.4% (8.7 pounds) with 50.9% and 17.5% achieving ≥5% and ≥10% loss, respectively. Significant differences existed between formulations in mean percentage weight change (p-value <0.01) and proportion achieving ≥10% loss (p-value = 0.03), but not in proportion achieving ≥5% loss (p-value = 0.34). Outcomes differed by age within oral semaglutide (p-value = 0.02). Regression analyses adjusted for confounders yielded similar findings.

Subcutaneous users achieved superior weight loss compared to oral users. Older oral users experienced better weight loss compared to younger users. However, no differences were observed between subcutaneous users.

Bodyweight loss is associated with type 2 diabetes remission; however, the quantitative relationship between the degree of bodyweight loss and the likelihood of remission, after controlling for confounding factors, remains unknown. We aimed to analyse the relationship between the degree of bodyweight loss and diabetes remission after controlling for various confounding factors, and to provide estimates for the effect sizes of these factors on diabetes remission.

This systematic review and meta-regression analysis followed Cochrane and PRISMA guidelines to systematically review, synthesise, and report global evidence from randomised controlled trials done in individuals with type 2 diabetes and overweight or obesity. The outcome was the proportion of participants with complete diabetes remission (HbA1c <6·0% [42 mmol/mol] or fasting plasma glucose [FPG] <100 mg/dL [5·6 mmol/L], or both, with no use of glucose-lowering drugs) or partial diabetes remission (HbA1c <6·5% [48 mmol/mol] or FPG <126 mg/dL [7·0 mmol/L], or both, with no use of glucose-lowering drugs) at least 1 year after a bodyweight loss intervention. We searched PubMed, Embase, and trial registries from database inception up to July 30, 2024. Data were extracted from published reports. Meta-analyses and meta-regressions were performed to analyse the data. The study protocol is registered with PROSPERO (CRD42024497878).

We identified 22 relevant publications, encompassing 29 outcome measures of complete diabetes remission and 33 outcome measures of partial remission. The pooled mean proportion of participants with complete remission 1 year after the intervention was 0·7% (95% CI 0·1-4·6) in those with bodyweight loss less than 10%, 49·6% (40·4-58·9) in those with bodyweight loss of 20-29%, and 79·1% (68·6-88·1) in those with bodyweight loss of 30% or greater; no studies reported on complete remission with 10-19% bodyweight loss. The pooled mean proportion of participants with partial remission 1 year after the intervention was 5·4% (95% CI 2·9-8·4) in those with bodyweight loss less than 10%, 48·4% (36·1-60·8) in those with 10-19% bodyweight loss, 69·3% (55·8-81·3) in those with bodyweight loss of 20-29%, and 89·5% (80·0-96·6) in those with bodyweight loss of 30% or greater. There was a strong positive association between bodyweight loss and remission. For every 1 percentage point decrease in bodyweight, the probability of reaching complete remission increased by 2·17 percentage points (95% CI 1·94-2·40) and the probability of reaching partial remission increased by 2·74 percentage points (2·48-3·00). No significant or appreciable associations were observed between age, sex, race, diabetes duration, baseline BMI, HbA1c, insulin use, or type of bodyweight loss intervention and remission. Overall, data were derived from randomised controlled trials with a low risk of bias in all quality domains.

A robust dose-response relationship between bodyweight loss and diabetes remission was observed, independent of age, diabetes duration, HbA1c, BMI, and type of intervention. These findings highlight the crucial role of bodyweight loss in managing type 2 diabetes and reducing the risk of diabetes-related complications.

Biomedical Research Program at Weill Cornell Medicine-Qatar and the Qatar National Research Fund (a member of Qatar Foundation).

The management of type 2 diabetes (T2D) requires individuals to adopt and maintain a healthy lifestyle. Personalized eHealth interventions can help individuals change their lifestyle behavior. Specifically, just-in-time adaptive interventions (JITAIs) offer a promising approach to provide tailored support to encourage healthy behaviors. Low-effort self-reporting via ecological momentary assessment (EMA) can provide insights into individuals' experiences and environmental factors and thus improve JITAI support, particularly for conditions that cannot be measured by sensors. We developed an EMA-driven JITAI to offer tailored support for various personal and environmental factors influencing healthy behavior in individuals with T2D.

This study aimed to assess the acceptability of EMA-driven, just-in-time adaptive lifestyle support in individuals with T2D.

In total, 8 individuals with T2D used the JITAI for 2 weeks. Participants completed daily EMAs about their activity, location, mood, overall condition, weather, and cravings and received tailored support via SMS text messaging. The acceptability of the JITAI was assessed through telephone-conducted, semistructured interviews. Interview topics included the acceptability of the EMA content and prompts, the intervention options, and the overall use of the JITAI. Data were analyzed using a hybrid approach of thematic analysis.

Participants with a mean age of 70.5 (SD 9) years, BMI of 32.1 (SD 5.3) kg/m², and T2D duration of 15.6 (SD 7.7) years had high self-efficacy scores in physical activity (ie, 32) and nutrition (ie, 29) and were mainly initiating or maintaining behavior changes. The identified themes were related to the intervention design, decision points, tailoring variables, intervention options, and mechanisms underlying adherence and retention. Participants provided positive feedback on several aspects of the JITAI, such as the motivating and enjoyable messages that appeared well tailored to some individuals. However, there were notable differences in individual experiences with the JITAI, particularly regarding intervention intensity and the perceived personalization of the EMA and messages. The EMA was perceived as easy to use and low in burden, but participants felt it provided too much of a snapshot and too little context, reducing the perceived tailoring of the intervention options. Challenges with the timing and frequency of prompts and the relevance of some tailoring variables were also observed. While some participants found the support relevant and motivating, others were less inclined to follow the advice. Participants expressed the need for even more personalized support tailored to their specific characteristics and circumstances.

This study showed that an EMA-driven JITAI can provide motivating and tailored support, but more personalization is needed to ensure that the lifestyle support more closely fits each individual's unique needs. Key areas for improvement include developing more individually tailored interventions, improving assessment methods to balance active and passive data collection, and integrating JITAIs within comprehensive lifestyle interventions.

To determine the impact of a combined face-to-face (f2f) and online training program on type 2 diabetes mellitus (T2DM) in elderly patients, a single-blinded randomized clinical trial was conducted from April 2021 to April 2023 at a tertiary public hospital in China. Participants aged 60+ were randomly allocated to intervention (n=20) and control (n=20) groups. After a six-month f2f program followed by 18 months of online guidance, intervention participants achieved significantly greater reductions in annual medical expenses (mean difference [SD], -946.39[244.75]; p=0.001), FBG (mean difference [SD], -0.64[0.20]; p=0.003), and 2hPBG (mean difference [SD], -2.68[0.87]; p=0.004) compared to the control group at 24 months. A greater proportion had reduced diabetes medications (RR,7.82; p=0.043). Self-management ability improved in the intervention group (mean difference [SD], 10.11[4.39]; p=0.028). HbA1c remained unchanged in the intervention group but increased in the control group (mean difference [SD], -0.68[0.14]; p<0.001). The combined f2f and online program reduces medical expenses and improves various health outcomes in elderly T2DM patients.

The development of magnetic resonance methods for quantifying intra-organ metabolites has permitted advances in the understanding of fasting and post-prandial carbohydrate and lipid handling in people with and without type 2 diabetes. Insulin resistance in the liver was shown to be related to excess intra-organ fat and was able to be returned to normal by weight loss. The practical effect of having muscle insulin sensitivity in the lower part of the wide normal range resulted in the obligatory shunting of carbohydrates via de novo lipogenesis into saturated fat. These observations provided the basis for the Twin Cycle Hypothesis of the aetiology of type 2 diabetes. Subsequent studies on people with type 2 diabetes confirmed the postulated pathophysiological abnormalities and demonstrated their reversibility by dietary weight loss of 10-15 kg. Overall, the fundamental understanding of the mechanisms causing type 2 diabetes has bridged physiological and clinical perspectives. Large population-based randomised controlled trials confirmed the practical clinical application of the method of achieving substantial weight loss, and an NHS programme is now in place offering potential remission to people within 6 years of diagnosis.

It is unclear whether weight loss interventions worsen disordered eating in people living with overweight/obesity. We aimed to systematically evaluate the association between weight loss interventions and disordered eating.

Six databases were searched from inception until September 2024. Trials of weight loss interventions in people with overweight/obesity were included if they reported a validated score for disordered eating on either the Eating Disorder Examination Interview or the Eating Disorder Examination Questionnaire pre- and post-intervention. Interventions included behavioural weight loss programmes (BWL) and pharmacotherapy licenced for weight loss, with or without concurrent psychological support, provided for at least 4 weeks. Pooled standardised mean differences (SMD) in scores of disordered eating were calculated using random effects meta-analyses. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool and the Newcastle-Ottawa scale for randomised and single-arm trials, respectively (PROSPERO ID: CRD42023404792).

Thirty-eight studies with 66 eligible arms (61 interventions: 29 BWL, 11 BWL + pharmacotherapy, 20 BWL + psychological intervention, 1 pharmacotherapy + psychological intervention) and 3364 participants in total were included. The mean weight change was -4.7 kg (95% CI: -5.7, -3.7). Compared with baseline, disordered eating scores improved by -1.47 SMD units (95% CI: -1.67, -1.27, p < 0.001, I2 = 94%) at intervention completion (median of 4 months). Seven randomised trials that directly compared a weight loss intervention to no/minimal intervention reported an improvement of -0.49 SMD units (95% CI, -0.93, -0.04, p = 0.0035, I2 = 73%). Sub-group analyses showed: (a) disordered eating scores improved more in people with an eating disorder at baseline compared with people without high scores, (b) no clear evidence that the association depended upon intervention type, and (c) disordered eating scores improved more in trials rated at low overall RoB.

Despite heterogeneity in effect size, weight loss interventions consistently improved disordered eating scores. These findings provide reassurance that weight loss interventions might not worsen disordered eating and may improve it.

Novo Nordisk UK Research Foundation Doctoral Fellowship in Clinical Diabetes.

With increasing attention to diabetes remission, various special dietary patterns have been found to be effective in achieving diabetes remission. The effect of a single dietary pattern on lowering blood glucose is clear, but studies on the synergistic effects of different dietary patterns are limited. This article describes the types of intermittent fasting and ketogenic diets, potential mechanisms, contraindications of combination diets, recommendations for combination diets, and their health outcomes. This paper aims to illustrate the evidence for intermittent fasting combined with a ketogenic diet on outcomes of diabetes remission and effect on blood glucose control. Knowledge of these findings can help doctors and patients determine dietary patterns for achieving diabetes remission and understanding their application.

Individuals in the United States with lower economic resources face a disproportionate burden of obesity and co-morbid conditions. This review summarizes the efficacy of MR programs for the treatment of obesity and diabetes and alerts clinicians to potential barriers and facilitators to the uptake of such programs so they may tailor their prescriptive approach. Implementation of effective behavioral and lifestyle interventions for obesity and diabetes in low-income settings is fraught with barriers and under-studied. The dearth of data on the use of MR programs in populations with low economic resources highlights a key area for future investigation.

The global prevalence of obesity and type 2 diabetes mellitus (T2D) has risen in parallel over recent decades. Most individuals diagnosed with T2D exhibit adiposopathy-related diabetes (ARD), a condition characterized by hyperglycemia accompanied by three core features: increased ectopic and visceral fat deposition, dysregulated adipokine secretion favoring a pro-inflammatory state, and insulin resistance. Despite advancements in precision medicine, international guidelines for T2D continue to prioritize individualized therapeutic approaches focused on glycemic control and complications, and many healthcare providers predominantly maintain a glucocentric strategy. This review advocates for an adipocentric treatment paradigm for most individuals with T2D, emphasizing the importance of prioritizing weight loss and visceral fat reduction as key drivers of therapeutic intensification. By combining lifestyle modifications with pharmacological agents that promote weight loss-including SGLT-2 inhibitors, GLP-1 receptor agonists, or dual GLP-1/GIP receptor agonists-and, when appropriate, metabolic surgery, this approach offers the potential for disease remission in patients with shorter disease duration. For others, it enables superior metabolic control compared to traditional glucose-centered strategies while simultaneously delivering cardiovascular and renal benefits. In conclusion, an adipocentric treatment framework for ARD, which represents the majority of T2D cases, effectively integrates glucocentric and cardio-nephrocentric goals. This approach constitutes the optimal strategy for ARD due to its efficacy in achieving disease remission, improving metabolic control, addressing obesity-related comorbidities, and reducing cardiovascular and renal morbidity and mortality.

To compare the probability of achieving diabetes remission in individuals with different phenotypes of insulin sensitivity, insulin secretion, and beta cell function and further detect the effects of diet, exercise, and lifestyle education intervention on these indexes.

Three-hundred and one participants who had glycated haemoglobin (HbA1c) data at baseline and after intervention were included for this post hoc analysis. We used the multi-way analysis of variance to assess the differences between the diabetes remission and non-remission groups or between intervention groups in changes of the indexes of insulin sensitivity, insulin secretion, and beta cell function. Furthermore, logistic regression analysis was used to identify the association between the diabetes remission and baseline and change of each insulin index.

Participants with a higher disposition index (DI) or higher adaptation index at baseline were more likely to achieve diabetes remission. The diabetes remission group had a significantly greater increase in AUCc-pep0-30/AUCgluc0-30, DI, and adaptation index compared with the non-remission group, while there were no between-group differences in indexes of insulin sensitivity. Participants with greater increases in insulin secretion and beta cell function were more likely to achieve diabetes remission. Indexes of beta cell function improved in all intervention groups, while the diet intervention induced significant improvement compared with lifestyle education.

These findings supported the importance of aggressively implementing intensive lifestyle interventions for individuals with type 2 diabetes at an early stage of the disease, when beta cell function was not yet significantly impaired, to promote achieving diabetes remission.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging global health concern, and it is not only the keystone precursor of eventual liver-related morbidity, but it also places patients at considerably higher cardiovascular risk, which is still a leading cause of death in these patients. The most important common underlying pathophysiological mechanisms in these diseases are primarily related to insulin resistance, chronic inflammation and oxidative stress. The presence of MASLD with cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) elevates the risk for poor outcomes, thus this review highlights a method to the therapeutic approaches. Given the intertwined nature of MASLD, T2DM, and CVD, there is an urgent need for therapeutic strategies that address all three conditions. Although lifestyle changes are important as treatment, medication plays a crucial role in managing hyperglycemia, enhancing liver function and lowering cardiovascular risk. The onset and progression of MASLD should be addressed through a multifaceted therapeutic approach, targeting inflammatory, immune, metabolic, oxidative stress, hormonal and gutaxis pathways, alongside the treatment strategies for T2DM. In this review, we discuss the effects of antidiabetic drugs with an impact on both liver outcomes and cardiovascular risk in patients affected by MASLD, T2DM and CDV.

Although some evidence shows the beneficial effects of meal replacements (MRs) on glucose metabolism as one of the main factors of diabetes, there are still no comprehensive findings in this field.

We investigated the effects of total and partial MRs on fasting blood sugar (FBS), insulin, glycated hemoglobin (HbA1c), and homeostatic model assessment for insulin resistance (HOMA-IR) in this comprehensive study and meta-analysis.

To find pertinent randomized controlled trials (RCTs) up to March 2024, databases including PubMed/Medline, Web of Science, Scopus, and Embase were searched.

This study included all RCTs investigating the effects of MRs on factors related to glucose metabolism. The pooled weighted mean difference (WMD) and 95% CIs were computed using the random-effects model.

The findings from 52 studies indicated significant reductions in FBS (WMD: -3.10 mg/dL; 95% CI: -4.99, -1.20; P < .001), insulin (WMD: -1.79 μU/mL; 95% CI: -3.51, -0.08; P = .40), HOMA-IR (WMD: -0.86; 95% CI: -1.68, -0.04; P = .040), and HbA1c (WMD: -0.24%; 95% CI: -0.35%, -0.13%; P < .001) levels following MR consumption compared with the control group. The findings obtained from the subgroup analysis showed that MRs cause a greater decrease in FBS, insulin, and HOMA-IR in the >50-years age group compared with those aged ≤50 years and also during interventions ≤24 weeks compared with >24 weeks.

In conclusion, it appears that MRs, along with other lifestyle factors, can lead to significant improvements in glucose metabolism.

Treatment of type 2 diabetes (T2DM) in patients with obesity can be challenging. Metabolic and bariatric surgery (MBS) has shown promising results in improving glycemic control and even achieving remission in T2DM patients with obesity. However, the durability of glycemic improvements in T2DM patients following MBS remains insufficiently studied.

Determine the incidence of durable remission and relapse of T2DM rates 10 years after MBS, characterize the glycemic profile after surgery, and identify factors predicting persistent remission of T2DM.

Retrospective observational study of T2DM patients undergoing MBS between 2010 and 2013. Clinical and analytical assessments were performed preoperatively, at 2- and at 10-years postoperatively. Paired t-tests, Wilcoxon-signed-rank and McNemar tests were used to assess the differences in the metabolic status during the follow-up. Logistic regression models were used to identify predictors of T2DM remission.

Ninety-five patients were included (mean age 48.8 ± 9.1 years, mean HbA1c 7.0 ± 1.5%). Ten years after surgery, the rate of complete T2DM remission was 31%, partial remission was 15%, and late recurrence after initial remission was 24%. Patients with lower HbA1c (OR = 0.50; p = 0.05) and taking fewer antidiabetic drugs (OR = 0.31; p = 0.01) preoperatively were more likely to maintain long-term remission. Ten years post-MBS, patients maintained lower fasting plasma glucose (p < 0.001), HbA1c (p < 0.001), number of antidiabetic drugs (p < 0.001), and insulin use (p < 0.001).

MBS can induce a significant improvement and sustainable remission of T2DM. Early intervention, while patients still have a good glycemic control with a lower number of anti-diabetic drugs, is crucial to achieve long-lasting benefits and a potential "surgical cure" for T2DM.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

To investigate the risk of biliary diseases in patients with type 2 diabetes mellitus (T2DM) or obesity treated with tirzepatide.

Literature searches were performed using the PubMed, Web of Science, Cochrane Library, and CNKI databases until 20 May 2024. Randomized controlled studies (RCTs) investigating the safety of tirzepatide vs placebo/other hypoglycemic drugs in patients with T2DM or obesity were included. The safety outcomes mainly included the incidence of cholelithiasis, pancreatitis, cholecystitis, and gallbladder/biliary diseases. Cochrane Collaboration's tool for assessing the risk of bias was used to assess the quality of literature. Heterogeneity was evaluated using I2 statistics.

A total of 12 high-quality RCTs (involving 12,351 patients) were included. The results of meta-analysis showed that tirzepatide was associated with gallbladder/biliary diseases (RR = 1.52; 95%CI: 1.17-1.98; I2 = 0%, P = 0.76) and cholelithiasis (RR = 1.67; 95%CI: 1.14-2.44; I2 = 0%, P = 0.95). Subgroup analysis based on the dose of tirzepatide found no dose-response relationship between different doses of tirzepatide and the risk of gallbladder/biliary diseases and cholelithiasis.

Based on the data currently available, tirzepatide is associated with the development of cholelithiasis in patients. However, the findings from RCTs still need to be further investigated in many post-marketing safety surveillance programs.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Tirzepatide is a once-weekly dual agonist, acting on glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptors. It is approved at the same doses (5, 10 and 15 mg) for both type 2 diabetes (T2D) and chronic weight management.

Following a search in PubMed, clinicaltrials.gov, conference abstracts and Lilly website, we review herein the global phase 3 SURMOUNT program on tirzepatide's safety and efficacy for chronic weight management. Additionally, we discuss findings from the regional SURMOUNT-CN and SURMOUNT-J trials (in East-Asian populations) and the phase 2 SYNERGY-NASH, phase 3 SURMOUNT-OSA and SUMMIT studies on tirzepatide's impact on obesity-related complications. We also explore the clinical implications of SURMOUNT program results, considerations for tirzepatide prescribing for overweight/obesity, ongoing research and evidence gaps.

Tirzepatide marks a new era in overweight/obesity treatment, enabling many to achieve ≥ 20% weight loss. It is well-tolerated with a safety profile similar to GLP-1 receptor agonists. Tirzepatide also results in clinically important improvements in multiple obesity-related complications including sleep apnea, metabolic-dysfunction associated steatohepatitis, heart failure with preserved ejection fraction and diabetes prevention. Ongoing trials will provide further data on tirzepatide's long-term safety, efficacy (including cardiovascular outcomes) and potential cost-effectiveness for managing overweight/obesity and/or T2D.

To review studies of interventions for reducing the impact of type 2 diabetes in Aboriginal and Torres Strait Islander people. The primary aim was to review and summarise the characteristics and findings of the interventions. The secondary aims were to assess their effects on diabetes and cardiometabolic risk factors, and the proportions of people with type 2 diabetes who achieved therapeutic targets with each intervention.

We searched eight electronic databases for publications of studies including Aboriginal or Torres Strait Islander people aged 15 years or older with diagnoses of type 2 diabetes, describing one or more diabetes interventions, and published in English during 1 January 2000 - 31 December 2020. Reference lists in the assessed articles were checked for further relevant publications.

MEDLINE (Ovid), Web of Science (Clarivate), the Cochrane Library, Global Health (EBSCO), Indigenous Collection and Indigenous Australia (Informit), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP).

The database searches yielded 1424 unique records; after screening by title and abstract, the full text of 55 potentially relevant articles were screened, of which seventeen met our eligibility criteria: eleven cohort studies (seven retrospective audits and four prospective studies), three randomised controlled trials, and three observational, non-randomised follow-up studies. Twelve publications reported site-based (Aboriginal or Torres Strait Islander health service or diabetes clinic) rather than individual-based diabetes interventions. Interventions with statistically significant effects on mean glycated haemoglobin (HbA1c) levels were laparoscopic adjustable gastric banding, a 5-day diabetes self-management camp, treatment of Strongyloides stercoralis infections, community-based health worker-led management, point-of-care testing, and self-management approaches.

Few interventions for Aboriginal and Torres Strait Islander people with type 2 diabetes have been reported in peer-reviewed publications. Improving diabetes care services resulted in larger proportions of people achieving therapeutic HbA1c targets. Outcomes were better when Aboriginal and Torres Strait Islander communities were involved at all levels of an intervention. High quality studies of holistic, culturally safe and accessible interventions should be the focus of research.

Despite decades of development and testing of weight-loss interventions, the adult populations worldwide have witnessed a continuous rise in body weight. There is an ongoing debate about how to move forward. Some argue that this rise calls for more intensive and possibly life-long treatments, including the new effective GLP1 weight loss medications, while others have called for a fundamental shift away from weight and on to a broader understanding of health. The two strategies are represented as a weight-centric health strategy and a weight neutral health strategy. This paper debates the benefits and potential harms related to the use of these two strategies.

While major weight loss may have substantial health benefits, many individuals will need intensive treatment including weight loss medication to achieve it, as generally few are able to sustain a lifestyle induced weight loss in the long term. Both the weight loss and the weight-neutral health strategies have advantages and limitations emphasizing the need for further research comparing the two strategies. Currently, not everyone is offered, can afford, will tolerate or even desire treatment with weight loss medication, and weight neutral health strategies may be a desirable alternative intervention offering a more holistic approach to health and addressing psychological and social issues including the burden of experienced and internalized weight stigma. However, this method still needs to be tested for effectiveness with regards to both physical and long-term psychological benefits.

Introduction: Despite growing evidence linking lifestyle changes to disease reversal, lifestyle medicine (LM) is not widely practiced. Lack of clinician training and knowledge is cited as a barrier to LM adoption. This study measures changes in LM knowledge, attitudes, confidence, and practice behaviors following completion of a 5.5-h, asynchronous, online continuing medical education (CME) course. Methods: Participants completed a pre- and post-course survey. A repeated-measures linear model tested changes in knowledge, confidence, interest, experience, and practice of LM, after adjusting for age, gender, race, ethnicity, clinical degree/licensure, and presence of a health system value-based care model. Results: Surveys from n = 2954 course participants were analyzed. Overall, statistically significant improvements were observed in self-reported knowledge (+.47 of points) and confidence (+.53 of points) of LM. Participants across the sample reported greater frequency (+.08 of 5 points) and reach (+.10 of 5 points) of LM with their patients (p<.0001 for both). Discussion: This study demonstrated that a brief, scalable, online CME course can improve LM knowledge, confidence, attitudes, and practice. Future research should examine long-term practice changes as well as differences in outcomes across types of healthcare professionals.

The prevalence of obesity has increased in recent years worldwide. In this context, strategies for management obesity in primary care are essential. The first step in the treatment of obesity are lifestyle intervention programs. The three pillars of these programs, ideally of high intensity (high frequency of visits), are dietary intervention, exercise and behavioral therapy. There is no universal model of care for patients with obesity, but it must take into account key aspects, such as facilitating the access and adherence of the patient and a multidisciplinary and coordinated care among professionals at different levels of healthcare. The components of the model of care and its format should be defined according to the resources available and the characteristics of the population to be treated.

This study assessed the five-year effects of a continuous care intervention (CCI) delivered via telemedicine, counseling people with type 2 diabetes (T2D) on a very low carbohydrate diet with nutritional ketosis.

Participants with T2D were enrolled in a 2-year, open-label, non-randomized study comparing CCI and usual care (UC). After 2 years, 194 of the 262 CCI participants were approached for a three-year extension. Of these, 169 consented, and 122 remained in the study for five years. Primary outcomes were changes in diabetes status assessed using McNemars' test, including remission and HbA1c < 6.5 % on no glucose lowering medication or only on metformin at 5 years. Changes in body mass, glycemia, and cardiometabolic markers from baseline to 5 years were assessed using linear mixed-effects models.

Twenty percent (n = 24) of the five-year completers achieved remission, with sustained remission observed over three years in 15.8 % (n = 19) and four years in 12.5 % (n = 15). Reversal to HbA1c < 6.5 % without medication or only metformin was seen in 32.5 % (n = 39). Sustained improvements were noted in body mass (-7.6 %), HbA1c (-0.3 %), triglycerides (-18.4 %), HDL-C (+17.4 %), and inflammatory markers, with no significant changes in LDL-C and total cholesterol.

Over five years, the very low carbohydrate intervention showed excellent retention and significant health benefits, including diabetes remission, weight loss, and improved cardiometabolic markers.

Chronic kidney disease (CKD) currently affects approximately 850 million people globally and is continuing to increase in prevalence as well as in importance as a cause of death. The excess mortality related to CKD is mostly caused by an increase in cardiovascular disease. This includes atherosclerotic cardiovascular disease as many promoters of atherosclerosis, such as blood pressure, lipid levels and hypercoagulation, are increased in people with CKD. Diabetes is a leading cause of CKD contributing to the risk of CVD, and obesity is also increasingly prevalent. Management of these risk factors is therefore very important in CKD, and to reduce risk of CKD progression. Heart failure is also more prevalent in CKD and, again, many risk factors are shared. The concept of foundational pillars in the management of heart failure has been adapted to the treatment of CKD, with many organ-protective interventions, such renin-angiotensin system blockade, sodium-glucose cotransporter-2 inhibition and mineralocorticoid receptor antagonism, reducing the risk for mortality in heart failure with reduced ejection fraction, but also for progression of CKD. Atrial fibrillation is also more common with CKD and affects the management of the former. In this review these non-renal complications of CKD are discussed, along with how the risk of these complications should be managed. Many new opportunities have demonstrated heart and kidney organ protection, but implementation is a challenge.

This study was developed with the goal of clarifying whether there is any relationship between type 2 diabetes mellitus (T2DM) age of onset and clinical outcomes for patients in National Metabolic Management Centers (MMC).

From September 2017 - June 2022, 864 total T2DM patients were recruited in MMC and assigned to those with early-onset and late-onset diabetes (EOD and LOD) based on whether their age at disease onset was ≤ 40 or > 40 years. All patients received standardized management. Baseline and 1-year follow-up data from these two groups of patients were assessed. Associations between onset age and other factors were evaluated with a multivariate linear regression approach, adjusting for appropriate covariates. Outcomes in particular subgroups were also assessed in stratified analyses.

Markers of dysregulated glucose metabolism and BMI values were significantly higher among EOD patients as compared to LOD patients. Subjects in both groups exhibited significant improvements in several disease-related parameters on 1-year follow-up after undergoing metabolic management. EOD patients exhibited significantly greater percentage reductions in HbA1c levels (-28.49 (-44.26, -6.45)% vs -13.70 (-30.15,-1.60)%, P =0.017) relative to LOD patients following adjustment for confounders. Significant differences were also detected between these groups when focused on subgroups of patients who were male, exhibited a BMI ≥ 25, an HbA1c ≥ 9, or had a follow-up frequency < 2.

Data from a 1-year follow-up time point suggest that a standardized metabolic disease management model can promote effective metabolic control in newly diagnosed T2DM patients, particularly among individuals with EOD.

This study aims to describe health literacy for people at risk of type 2 diabetes and people with type 2 diabetes using the HLS-EU-Q12, and further examine the association between sociodemographic and clinical characteristics, well-being, overall health and quality of life, and health literacy.

We performed a cross-sectional study among 142 people at risk of type 2 diabetes and 75 people with type 2 diabetes from four primary care clinics in Norway. These data are baseline data from a randomized controlled trial which seeks to evaluate an interprofessional follow-up intervention. Multiple regression analysis was applied to explore associations to health literacy.

Inadequate health literacy (sum score <33) was found among 30.2% of people at risk of type 2 diabetes and among 25.7% of people with type 2 diabetes. For people at risk of type 2 diabetes, higher level of education was significantly associated with higher health literacy. Better well-being and quality of life was significantly associated with higher health literacy for both groups.

The primary health care services should pay greater attention to assessing HL, well-being, and quality of life to facilitate the identification of people at risk of type 2 diabetes with insufficient self- management strategies to prevent or delay the development of manifest disease and its complications.

This systematic review was aimed to assess the association between magnitude of body weight loss (BWL) in type 2 diabetes (T2D) patients and cardiovascular (CV) risk in CV outcome trials (CVOTs).

We searched electronic databases (PubMed, Cochrane and Scopus) for available CVOTs, observational cohort studies or post hoc analyses of clinical trials of adult T2D patients investigated the association of BWL with CV outcomes and/or all-cause mortality.

19 RCTs of novel glucose-lowering drugs (GLP-1RA, DPP-4i and SGLT2i) and 6 RCT or observational trial of different strategies (intensive treatment or standard care) were included (379.904 T2D patients). Higher BWL during GLP-1RA treatment, in comaprison to lower BWL, was associated with higher decrease in risk of MACE, while DPP-4i had not that effect. With SGLT2i the higher decrease in risk of MACE was associated with lower BWL. In contrast, in other different strategies, higher BWL lead to increase in risk for MACE and all-cause mortality.

In CVOTs, treatment of T2D patients resulted in BWL, which correlated with reduction in risk for CV outcomes, particularly with GLP-1 RAs. However, interventional non-CVOTs are warning that in the absence of structured behavioral intervention and relevant medication, the large BWL might be harmful for CV outcomes.

People with obesity and type 2 diabetes (T2D) have reduced life expectancy, partly explained by increased risk of cardiovascular diseases and cancer. Here, we examined whether 2-year diabetes remission after bariatric surgery or usual care is associated with long-term mortality.

This report includes 586 participants with obesity and concomitant T2D from the prospective Swedish Obese Subjects (SOS) cohort study; 338 underwent bariatric surgery and 248 received usual obesity care. At inclusion, age was 37-60 years and BMI ≥34 kg/m 2 in men and ≥38 kg/m 2 in women. Median follow-up was 26.2 years (interquartile range 22.7-28.7). Diabetes status was determined using self-reported data on diabetes medication and in-study measures of blood glucose and HbA1c. The study was cross-linked to Swedish national registers for data on morbidity, death, and emigration.

Overall, 284 participants, 71.9% of surgery and 16.5% of usual care patients were in remission at the 2-year examination. During follow-up, mortality rates were 16.6 deaths per 1000 person-years (95% CI: 13.7-20.1) in the remission subgroup and 26.0 deaths per 1000 person-years (95% CI:22.2-30.4) in the non-remission subgroup (adjusted hazard ratio (HR adj )=0.71, 95% CI:0.54-0.95, P =0.019). The adjusted median life expectancy in the remission subgroup was 2.5 years (95% CI:0.3-4.7) longer than in the non-remission subgroup. Specifically, remission was associated with decreased cardiovascular mortality (sub-HR adj =0.54, 95% CI: 0.35-0.85, P =0.008), but no detectable association with cancer mortality was found (sub-HR adj =1.06, 95% CI:0.60-1.86), P =0.841).

In this post-hoc analysis of data from the SOS study, patients who achieved short-term diabetes remission had increased life expectancy and decreased cardiovascular death over up to 32 years of follow-up. Future studies should confirm these findings.

Remission of early type 2 diabetes (T2D) is possible; however, diet programmes proven effective are unaffordable in many southeast Asian populations where T2D is more frequent and more aggressive at lower body weight and younger age. We evaluate an entirely food-based service.

This study employed a single-arm intervention and follow-up design for intervention evaluation in existing hospital people with T2D of under 5 years known duration. Individuals attending a diabetes clinic in Kathmandu with early T2D (<5 years) aged 30-70 years, BMI ≥23 kg/m2, were offered a low-cost nutritionally complete diet-programme, using traditional Nepali foods to provide 8-weeks ∼850 kcal/day weight loss induction, and then weight maintenance. The participants received 4-weekly dietetic appointments (30-45 min) and verbo-pictorial leaflets using household measures. Glucose-lowering medications (49/70 at baseline) were stopped at baseline or soon after. The study was registered as ISRCTN10671396, testing a traditional food-based intervention for weight loss and T2D remission.

For 70 individuals (45 female) invited between March 19, 2022 and September 19, 2023, baseline mean (SD) age was 48.6 (9.9) years, bodyweight 74.6 (9.5) kg, BMI 29.7 (3.6) kg/m2, known diabetes duration 2.5 (1.9) years, HbA1c on treatment 8.1 (1.6) %. At 12, 24 and 52 weeks respectively, evaluating n = 44, 46, 45, bodyweight was 70.1 (8.5), 69.8 (8.9), 70.0 (8.8) kg, HbA1c 6.8 (0.9), 6.9 (1.5), 7.1 (1.3) %; HbA1c <6.5% was recorded for 46%, 48% and 36% and remission of T2D (HbA1c <6.5% off medication >3 months) in 43%, 39% and 29%. The main reported adherence barriers were fears of weakness, hunger, and inconvenience during travel. Incentives were ease of the diet, reduced doses and costs of medications, and improved appearance.

Traditional food-based weight management can valuably improve control, reduce medication needs, and generate remissions of established T2D, but adherence barriers must be overcome to optimise outcomes.

All Saints Educational Trust, England.

Although behavioural interventions have been found to help control type 2 diabetes (T2D), it is important to understand how the delivery context can influence implementation and outcomes. The NHS committed to testing a low-calorie diet (LCD) programme designed to support people living with excess weight and T2D to lose weight and improve diabetes outcomes. Understanding what influenced implementation during the programme pilot is important in optimising rollout. This study explored the transferability of the NHS LCD Programme prior to wider adoption.

Twenty-five interviews were undertaken with stakeholders involved in implementing the LCD programme in pilot sites (health service leads, referring health professionals and programme deliverers). Interviews with programme participants (people living with T2D) were undertaken within a larger programme of work, exploring what worked, for whom and why, which is reported separately. The conceptual Population-Intervention-Environment-Transfer Model of Transferability (PIET-T) guided study design and data collection. Constructs of the model were also used as a deductive coding frame during data analysis. Key themes were identified which informed recommendations to optimise programme transfer.

Population: Referral strategies in some areas lacked consideration of population characteristics. Many believed that offering a choice of delivery model would promote acceptability and accessibility of the eligible population.

Overall, stakeholders had confidence in the LCD programme due to the robust evidence base along with anecdotal evidence, but some felt the complex referral process hindered engagement from GP practices.

Stakeholders described barriers to accessing the programme, including language and learning difficulties. Transferability: Multidisciplinary working and effective communication supported successful implementation.

Referral strategies to reach underrepresented groups should be considered during programme transfer, along with timely data from service providers on access and programme benefits. A choice of delivery models may optimise uptake. Knowledge sharing between sites on good working practices is encouraged, including increasing engagement with key stakeholders.

The primary cause of the pandemic scale of type 2 diabetes (T2D) is the excessive and/or abnormal accumulation of adiposity resulting from a chronic positive energy balance. Any form of weight loss dramatically affects the natural history of T2D, favoring prevention, treatment, and even remission in the case of significant weight loss. However, weight regain, which is often accompanied by the recurrence or worsening of obesity complications such as T2D, is an inevitable biological phenomenon that is an integral part of the pathophysiology of obesity. This can occur not only after weight loss, but also during obesity treatment if it is not effective enough to counteract the physiological responses aimed at restoring adiposity to its pre-weight-loss equilibrium state. Over the past few years, many controlled and randomized studies have suggested a superior efficacy of bariatric surgery compared to conventional therapy in terms of weight loss, glycemic control, and rates of T2D remission. Recently, the therapeutic armamentarium in the field of diabetology has been enriched with new antihyperglycemic drugs with considerable efficacy in reducing body weight, which could play a pathogenetic role in the remission of T2D, not through the classical incretin effect, but by improving adipose tissue functions. All these concepts are discussed in this position statement, which aims to deepen the pathogenetic links between obesity and T2D, shift the paradigm from a "simple" interaction between insulin resistance and insulin deficiency, and evaluate the efficacy of different therapeutic interventions to improve T2D management and induce diabetes remission whenever still possible.

Severe caloric restriction interventions (such as very-low-calorie diets) are effective for inducing significant weight loss and remission of type 2 diabetes (T2DM). However, suggestions of associated significant muscle mass (MM) loss create apprehension regarding their widespread use. We conducted a systematic review and meta-analysis to provide a quantitative assessment of their effect on measures of MM in individuals with, or without, T2DM.

EMBASE, Medline, Pubmed, CINAHL, CENTRAL and Google Scholar were systematically searched for studies involving caloric restriction interventions up to 900 kilocalories per day reporting any measure of MM, in addition to fat mass (FM) or body weight (BW).

Forty-nine studies were eligible for inclusion, involving 4785 participants. Individuals with T2DM experienced significant reductions in MM (WMD -2.88 kg, 95% CI: -3.54, -2.22; p < 0.0001), although this was significantly less than the reduction in FM (WMD -7.62 kg, 95% CI: -10.87, -4.37; p < 0.0001). A similar pattern was observed across studies involving individuals without T2DM. MM constituted approximately 25.5% of overall weight loss in individuals with T2DM, and 27.5% in individuals without T2DM. Subgroup analysis paradoxically revealed greater BW and FM reductions with less restrictive interventions.

Our review suggests that caloric restriction interventions up to 900 kilocalories per day are associated with a significant reduction in MM, albeit in the context of a significantly greater reduction in FM. Furthermore, MM constituted approximately a quarter of the total weight loss. Finally, our data support the use of less restrictive interventions, which appear to be more beneficial for BW and FM loss.

There is a growing focus on person-centered care, emphasizing the importance of respecting inter-individual differences and implementing individualized treatment initiatives. Prior research has established an association between personality traits, body mass index, and health-related behaviors. The aim of this study was to explore the potential of personality trait assessments in identifying individuals at risk of glycemic dysregulation and increasing BMI. This cross-sectional study used a dataset comprising 140 participants with diabetes who completed the Big Five personality trait questionnaire from the Lolland-Falster Health Study. Logistic regression was used to investigate associations between personality traits, glycemic control, and BMI ≥ 25. No significant associations between personality traits and glycemic control were found. There was a significant association between agreeableness and lower odds of BMI ≥ 25 in the unadjusted analysis (OR 0.54 (0.34-0.86)), which persisted after adjusting for sex, age, and education (OR 0.54 (0.33-0.89)). No significant association between glycemic control and personality traits was observed in this small sample study. However, higher levels of agreeableness were associated with a lower likelihood of having a BMI of ≥25. This preliminary study suggests that integrating personality assessments could help identify individuals at risk of increasing BMI. These findings highlight the potential of using personality traits to guide targeted interventions, offering a direction for future research.