This study examines the link between early-onset diabetes and health factors in South Korean young adults (20-39) using data from the Korea National Health and Nutrition Examination Survey (2010-2020).

A matched case-control study was conducted in 2022 with 103 patients with diabetes and 103 controls, matched by age, gender, and BMI. All data, including socioeconomic status (income, education, occupation), health behaviors (smoking, alcohol consumption, physical activity), and medical histories, were extracted from the KNHANES database. We analyzed socioeconomic status, health behaviors, and medical histories using descriptive statistics, chi-square tests, and binary logistic regression.

The study revealed that educational attainment and economic status are substantial predictors of diabetes, with those holding only a high school diploma showing a nearly threefold increased risk compared to college graduates (OR = 2.986; 95% CI = 1.334-6.687). Additionally, participants with a higher number of chronic diseases (OR = 3.534; 95% CI: 1.547-8.073) and those who felt unwell in the past two weeks (OR = 4.010; 95% CI: 1.388-11.585) also demonstrated significantly increased odds of diabetes. And having a parent with diabetes was an exceptionally strong predictor, with these participants having a significantly increased risk of diabetes (OR = 47.022; 95% CI = 4.206-525.704).

The study emphasizes that improving educational and economic conditions, coupled with targeted screening programs for individuals with a family history of diabetes, may be effective in curbing the tide of early-onset diabetes in South Korea. These strategies may have profound implications for public health policies aimed at mitigating the risk in this increasingly vulnerable group.

The prevalence and incidence of diabetes in pediatrics have dramatically increased over the last three decades. Comparatively, pediatric diabetes has faster pancreatic β-cells decline and early progression to complications compared with adult diabetes. Therefore, diabetic complications are a major concern in children and adolescents with diabetes. Diabetes has detrimental effects on the macro- and microvascular systems, resulting in cardiovascular diseases, leading causes of morbidity and mortality in youth with diabetes. Oxidative stress plays a critical role in developing cardiovascular complications in the context of pediatric diabetes. In pediatric patients with diabetes, several factors can contribute to the development of excess reactive oxygen species and oxidative stress, including nutritional deficiencies, puberty, environmental exposures, and metabolic disorders such as obesity and high blood pressure. The present study aims to raise awareness of diabetic cardiovascular complications in children and adolescents with diabetes and the role of oxidative stress and their molecular mechanisms in the pathogenesis of cardiovascular complications. In addition, some novel therapeutic strategies for the treatment and prevention of diabetic cardiovascular complications in the pediatric populations are highlighted. In summary, children and adolescents with diabetes no matter type 1 diabetes (T1D) or type 1 diabetes (T2D), have many features similar to those in adults with same kinds of diabetes, but also have many their own features distinct from adults. By developing targeted therapies and preventive measures, healthcare providers can better address the rising incidence of diabetes-related complications in children and adolescents.

Diabetes mellitus type 1 (DM1) and type 2 (DM2) are well-established risk factors for cardiovascular disease but differ pathophysiologically in that DM1 results from insulin deficiency, whereas DM2 results from insulin insensitivity. The association between DM1 and DM2 and cardiovascular events remains undetermined.

For DM1 or DM2 patients aged 46 to 75 years receiving care at outpatient facilities with primary care and/or endocrinology enrolled in the National Cardiovascular Data Registry Veradigm Metabolic Registry 2017-2022, we compared the prevalence of incident cardiovascular events including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, stroke, carotid revascularization, limb ischemia, and peripheral revascularization.

The study population included 5823 DM1 patients (3.59%) and 156,204 DM2 patients (95.41%) with a total of 758,643 visits. DM1 patients were younger and had fewer comorbidities. A total of 11,096 incident cardiovascular events occurred with a prevalence ratio (PR) of 0.63 (95% CI, 0.55-0.71) for fewer events associated with DM1 than DM2. After adjustment for age, the PR was 0.66 (95% CI, 0.58-0.74). When analyzed by separate cardiovascular events, DM1 was associated with less myocardial infarction, percutaneous coronary intervention, stroke, and limb ischemia than DM2. Overall cardiovascular event probability was lower in DM1 than in DM2 across all 10-year age categories, in both female and male patients, before and during/after the coronavirus disease 2019 pandemic, and after adjustment for comorbidities, hemoglobin A1c, and serum creatinine.

DM1 was associated with a lower probability of incident cardiovascular events than DM2. Although DM1 may carry a lower risk of incident cardiovascular events than DM2, the pathophysiology, prevention, and treatment of cardiovascular disease in DM1 remain poorly understood.

Early-onset type 2 diabetes (T2DM) (18-45 years) is rising globally, yet complication incidence in this group remains unclear. We investigated the incidence of early-onset T2DM, the incidence of micro- and macrovascular complications, and how comorbidities (e.g., severe mental illness) and sociodemographic factors (e.g., education level) influence complication risk and timing in Denmark.

Using nationwide registers, we followed 8,129,005 individuals from 1996 to 2020 to estimate the incidence rate (IR) of early-onset T2DM. 49,850 individuals with early-onset T2DM were followed to calculate IRs for microvascular (nephropathy, retinopathy) and macrovascular (cardiovascular disease, amputation) complications. Incidence rate ratios (IRRs) assessed associations between comorbidities, sociodemographic factors, and complications. Poisson regression models calculated IRs and IRRs.

From 1996 to 2020, the IR of early-onset T2DM more than doubled in men and tripled in women, with women dominating younger age groups. During follow-up (7.9-9.8 years), 37.6 % developed complications. Higher complication IRs were observed in men, those with sociodemographic disadvantages, and individuals with comorbidities. Early complications (≤5 years) were more common among the unemployed, single individuals, and those with comorbidities.

The rising IR of early-onset T2DM in younger women, and complications disproportionately affecting men and those with comorbidities or sociodemographic disadvantages, highlight the need for targeted interventions.

To compare the incidence of end-stage renal disease (ESRD) between slowly progressive type 1 diabetes and acute-onset type 1 diabetes.

This cohort study enrolled all 521 patients with childhood-onset type 1 diabetes with the year of onset from 1959 to 1996 in Hokkaido Prefecture, Japan. We calculated the ESRD incidence rate per 100,000 person-years by sex, onset year, onset age, and type 1 diabetes subtype (slowly progressive or acute-onset). We also constructed a Kaplan-Meier curve for ESRD by these risk factors.

The data of 391 patients were gathered, among whom 66 developed ESRD. The ESRD incidence rate per 100,000 person-years was 525 among all patients; 538 and 503 among women (n = 235) and men (n = 156); 893, 413, and 225 for onset year of 1959-1979 (n = 107), 1980-1989 (n = 201), and 1990-1996 (n = 83); 420 and 715 for onset before (n = 243) and after (n = 148) puberty; and 1388 and 432 for the slowly progressive (n = 41) and acute-onset (n = 350) subtypes, respectively. The Kaplan-Meier curve also indicated a significantly higher incidence of ESRD in slowly progressive than in acute-onset type 1 diabetes.

The incidence of ESRD was higher in slowly progressive than acute-onset type 1 diabetes.

Diabetic foot ulcer (DFU) is one of the most severe complications of type 2 diabetes, which is manifested in chronic skin ulcers of lower extremities. DFU treatment remains complex and expensive despite the availability of well-established protocols. Early prediction of potential DFU development at the onset of type 2 diabetes can greatly improve the aftermath of this complication.

To assess potential genetic markers for DFU, a group of diabetic patients from Moscow region with and without DFU was genotyped for a number of SNPs previously reported to be associated with the DFU.

Obtained results did not confirm previously claimed association of rs1024611, rs3918242, rs2073618, rs1800629, rs4986790, rs179998, rs1963645 and rs11549465 (respectively, in MCP1, MMP9, TNFRSF11B, TNFα, TLR4, eNOS, NOS1AP and HIF1α genes) with the DFU. Surprisingly, the t allele of rs7903146 in the TCF7l2 gene known as one of the most prominent risk factors for type 2 diabetes has shown a protective effect on DFU with OR(95%) = 0.68(0.48-0.96).

Non-replication of previously published SNP associations with DFU suggests that the role of genetic factors in the DFU onset is either highly variable in different populations or is not as significant as the role of non-genetic factors.

Younger-onset type 2 diabetes is associated with accelerated complications. We assessed whether complications and mortality rates differed for younger age compared with older age at diagnosis over 30 years of follow-up.

In this study, we used data from the UKPDS, collected between 1977 and 2007, of participants aged 25-65 years with newly diagnosed type 2 diabetes with younger-onset (younger than 40 years) or later-onset (40 years or older), and without diabetes autoantibodies. We analysed standardised mortality ratios (SMR) using UK general population data, and incidence rates of prespecified outcomes by 10-year age intervals at diagnosis.

Of 4550 participants testing negative to all measured autoantibodies, 429 (9·4%) had younger-onset type 2 diabetes. 2704 (59·4%) were male, and mean HbA1c was 76 mmol/mol (SD 24·6). The median follow-up was 17·5 years (IQR 12·7-20·8). SMR for younger-onset type 2 diabetes was higher (3·72 [95% CI 2·98-4·64]) compared with later-onset type 2 diabetes (1·54 [1·47-1·61]). The incidence rate was higher for all outcomes in later-onset type 2 diabetes, except for microvascular disease (younger-onset 14·5 (11·9-17·7) vs later-onset 12·1 (11·3-13·0) per 1000 person-years). However, at any given age, the 5-year incidence of any diabetes-related endpoint, all-cause mortality, microvascular disease, and myocardial infarction was higher with younger age at diagnosis. Annual mean HbA1c was higher in the first 20 years in younger-onset compared with later-onset type 2 diabetes. Among participants randomised to intensive versus conventional glycaemic control, we observed no interactions by subgroup of younger-onset versus later-onset type 2 diabetes for any outcome.

The risk of dying relative to the general population is even greater for people diagnosed with type 2 diabetes at younger ages. The increased risk of complications and poorer glycaemic control in younger-onset type 2 diabetes calls for the development of services to identify and manage these individuals.

National Institute of Health and Care Research's Biomedical Research Centre.

The global prevalence of type 2 diabetes mellitus (T2DM) has increased significantly in recent decades. Despite numerous studies and systematic reviews, there is a gap in comprehensive and up-to-date evaluations in this rapidly evolving field.

This review provides a comprehensive and current overview of the efficacy of Traditional Chinese Medicine (TCM) in treating T2DM.

A systematic review was conducted using PubMed, Web of Science, Wanfang Data, CNKI, and Medline databases, with a search timeframe extending up to November 2023. The search strategy involved a combination of subject terms and free words in English, including 'Diabetes,' 'Traditional Chinese Medicine,' 'TCM,' 'Hypoglycemic Effect,' 'Clinical Trial,' and 'Randomized Controlled Trial.' The studies were rigorously screened by two investigators, with a third investigator reviewing and approving the final selection based on inclusion and exclusion criteria.

A total of 108 relevant papers were systematically reviewed. The findings suggest that TCMs not only demonstrate clinical efficacy comparable to existing Western medications in managing hypoglycemia but also offer fewer adverse effects and a multitarget therapeutic approach. Five main biological mechanisms through which TCM treats diabetes were identified: improving glucose transport and utilization, improving glycogen metabolism, promoting GLP-1 release, protecting pancreatic islets from damage, and improving intestinal flora.

TCM has demonstrated significant protective effects against diabetes and presents a viable option for the prevention and treatment of T2DM. These findings support the further exploration and integration of TCM into broader diabetes management strategies.

Background: Childhood obesity is an epidemic and a significant health concern all over the world. Several factors can influence excess weight gain, including eating behaviors, physical inactivity, and genetics. Children and adolescents with obesity have a four-times greater risk of developing type 2 diabetes (T2D) compared with their normal-weight peers. The management of obesity before the development of its comorbidities may prevent its escalation into significant medical and psychosocial problems. However, treatment options for obesity and T2D in youth remained limited for many years, and moreover, available drugs were characterized by low efficacy. The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study showed that metformin in monotherapy failed in almost 52% of children with T2D, while adjuncts to rosiglitazone and lifestyle intervention failed in 38.6% and 46.6%, respectively. Recently approved antiobesity medications and/or bariatric surgery are revolutionizing the management of adolescents with obesity and T2D. This work aims to provide a comprehensive overview of the current treatment possibilities for childhood obesity and T2D. Methods: An in-depth review of articles with evidence-based research from different countries discussing novel management options for adolescents with obesity and/or T2D was conducted in this review paper. Results: The new medications, such as SGLT2 receptor agonists and GLP-1 agonists, are highly effective in treating T2D in adolescents with obesity. Conclusions: Based on the performed literature review, the recent approval of a novel generation of drugs seems to be the dawn of a new era in childhood obesity and T2D treatment.

Fermentation significantly influences the chemical composition of black tea, yet the effects of different fermentation temperatures on non-volatile components and their in vitro hypoglycemic activity are insufficiently studied. This research investigates how varying temperatures (20, 25, and 30°C) affect the bioactive profile and the inhibitory activity of Jinxuan black tea against α-glucosidase and α-amylase. Our results show that lower fermentation temperatures (20°C) lead to elevated levels of key bioactive compounds, including tea polyphenols (9.24%), soluble sugars (8.24%), thearubigins (7.17%), and theasinesin A (0.15%). These compounds correlate strongly with enhanced α-glucosidase inhibition (R = 0.76-0.97). Non-targeted metabolomic analysis revealed that 36 differential metabolites, including catechins, exhibited altered levels with increasing fermentation temperature. Notably, tea fermented at 20°C exhibited superior hypoglycemic activity, with α-glucosidase inhibition (IC50 = 14.00 ± 1.00 μg/ml) significantly outperforming α-amylase inhibition (IC50 = 2.48 ± 0.28 mg/ml). The findings of this research underscore the importance of fermentation temperature in optimizing the bioactive profile of black tea. It is proposed that recommendations for future processing or formulation should emphasize the use of lower fermentation temperatures, aimed at augmenting the health benefits linked to higher polyphenol content and stronger hypoglycemic activity.

Pregnancies are increasingly affected by young-onset type 2 diabetes mellitus (YT2DM), an aggressive phenotype associated with a higher vascular risk profile compared to type 1 diabetes mellitus (T1DM). We compared pregnancy outcomes to illuminate areas where differing management guidance might be needed.

This retrospective single-centre study (2010 2019) included 259 singleton pregnancies affected by pregestational T1DM (N = 124) or YT2DM (N = 135) diagnosed at < 40 years. Primary outcomes included preterm delivery, large for gestational age (LGA) infants, and pre-eclampsia.

The YT2DM cohort were older, with more obesity, greater apparent sociodemographic disadvantage, and lower measures of pregnancy preparedness. Overweight/obesity were also prevalent in the T1DM cohort (46 % affected). The second/third trimester mean HbA1c measurements were significantly higher in the T1DM cohort. Pre-eclampsia and preterm delivery rates were similar between the cohorts. Significantly lower rates of LGA infants, NICU admission, neonatal hypoglycaemia, and neonatal respiratory distress were seen in the YT2DM cohort (p < 0.05 for all).

In pregnancy, YT2DM appears to be the lower-risk cohort compared to T1DM despite higher obesity rates. Gaps in achieving glycaemic targets exist for both subtypes but particularly for T1DM. The relative impact of increasing BMI in pregnancies affected by T1DM requires further elucidation.

Historically perceived as a disease mainly affecting adults, the prevalence of type 2 diabetes mellitus (T2DM) among children and adolescents has been rising, mirroring the increasing rates of childhood obesity. Currently, youth-onset T2DM poses a significant public health challenge globally. Treating youth-onset T2DM poses numerous critical challenges, namely limited and inadequate therapeutic options, and difficulties with conducting therapeutic studies. As a result, current treatment guidelines are based on adult studies and expert consensus. Few prominent guidelines on the treatment of youth-onset T2DM have been published recently, i.e., by the American Diabetes Association (ADA) 2024, National Institute for Healthcare and Excellence United Kingdom (NICE UK) 2023, International Society Paediatric and Adolescents Diabetes (ISPAD) 2022, Australasian Paediatric Endocrine Group (APEG) 2020 and Diabetes Canada 2018. This review first explores the unique aspects of youth-onset T2DM. It then summarises the different treatment guidelines, discusses the different treatment modalities based on available evidence and identifies any gaps. The review also explores challenges in the treatment of youth-onset T2DM with potential solutions and discusses recent trials on the treatment of youth-onset T2DM. Continued research aims to optimise treatment, improve outcomes, and alleviate the burden of T2DM on youths.

To explore the 5-year incidence and relative rates of sleep disorders in younger (16-≤40 years) and middle-older (=>40 years) age adults with and without newly diagnosed type 2 diabetes.

This retrospective, observational cohort study utilised data from the US Collaborative Network within the TriNetX database. We compared 5-year cumulative incidence of sleep disorders in younger (n = 110,088) and middle-older populations (n = 1,185,961).

The absolute risk of developing any type of sleep disorder was greater in individuals with type 2 diabetes vs. those without. Over the 5-year follow-up period, 14.2 % of younger adults and 18.5 % of middle-older age adults with newly diagnosed type 2 diabetes developed any form of sleep disorder, compared to 4.5 % and 7.9 % propensity matched individuals without diabetes. We observed a more pronounced relative rate across the observed sleep disorders in younger adults.

The 5-year risk of sleep disorders is higher in those with newly diagnosed type 2 diabetes vs. those without. A higher absolute risk was seen in middle-older adults, but relative rates were consistently higher in younger adults with type 2 diabetes. Sleep should be regularly discussed as part of a holistic approach to diabetes care, particularly in those aged ≤40.

To investigate the excess mortality and life-years lost associated with diabetes and prediabetes in China.

This national cohort study enrolled 135,405 participants aged 18 years or older from the general population in China. Cox proportional hazards regression models were used to estimate adjusted mortality rate ratio (RR). The life table method was used to estimate life expectancy.

Among the 135,405 participants, 10.5% had diabetes and 36.2% had prediabetes in 2013. During a median follow-up of 6 years, 5517 deaths were recorded, including 1428 and 2300 deaths among people with diabetes and prediabetes, respectively. Diabetes and prediabetes were significantly associated with increased risk of all-cause (diabetes: RR, 1.61 [95% CI 1.49, 1.73]; prediabetes: RR, 1.08 [95% CI 1.01, 1.15]), and cardiovascular disease (diabetes: RR, 1.59 [95% CI 1.41, 1.78]; prediabetes: RR, 1.10 [95% CI 1.00, 1.21]) mortality. Additionally, diabetes was significantly associated with increased risks of death resulting from cancer, respiratory disease, liver disease, and diabetic ketoacidosis or coma. Compared with participants with normoglycemia, life expectancy of those with diabetes and prediabetes was shorter, on average, by 4.2 and 0.7 years at age 40 years, respectively. The magnitude of the associations of diabetes and prediabetes with all-cause and cardiovascular disease mortality varied by age and residence.

In this national study, diabetes and prediabetes were significantly associated with reduced life expectancy and increased all-cause and cause-specific mortality risks. The disparities in excess mortality associated with diabetes and prediabetes between different ages and residences have implications for diabetes and prediabetes prevention and treatment programs.

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.

It is unclear whether type 2 diabetes diagnosed in young adulthood is associated with increased severity than that occurring later in life beyond longer lifetime exposure to hyperglycemia. This study aimed at assessing the independent association of age at type 2 diabetes diagnosis with all-cause mortality.

This prospective cohort study enrolled 15,773 Caucasian patients with type 2 diabetes in 19 Italian centers in 2006-2008. Cardiometabolic risk profile and presence of complications and comorbidities were assessed at baseline and participants were stratified by quartiles of age at diabetes diagnosis. All-cause mortality was verified on 31 October 2015.

Valid information on vital status was retrieved for 15,656 participants (99.3%). Patients in the lowest quartile had the longest diabetes duration, the worst glycemic control and the highest prevalence of insulin treatment, obesity, atherogenic dyslipidemia, and smoking habits. All complications were inversely associated with age at diabetes diagnosis after adjustment for age and sex, but not after further adjustment for diabetes duration. Percentages of death, Kaplan-Meier estimates, and unadjusted hazard ratios and mortality rates increased from the lowest to the highest quartile. In contrast, when adjusting for age and sex, participants falling in the lowest quartile, showed the highest mortality risk [hazard ratio 1.321 (95% confidence interval 1.196-1.460), P < 0.0001]. However, differences among quartiles disappeared after adjustment for diabetes duration, complications/comorbidities, or other cardiovascular risk factors.

Type 2 diabetes onset in young adulthood is associated with increased mortality that is mainly driven by longer diabetes duration favoring the development of complications.

ClinicalTrials.gov, NCT00715481, retrospectively registered 15 July, 2008.

The incidence and prevalence of type 2 diabetes mellitus (T2DM) in young individuals (aged <40 years) have significantly increased in recent years, approximating two to threefold increase in the respective rates. Numerous risk factors including severe obesity, family history, ethnicity, maternal diabetes or gestational diabetes, and female sex contribute to a younger age of onset. In terms of pathogenesis, impaired insulin secretion is the key operating mechanism, alongside with ectopic adiposity-related insulin resistance. T2DM diagnosis in a young adult requires the exclusion of type 1 diabetes mellitus (T1DM), latent autoimmune diabetes of adults (LADA) and maturity-onset diabetes of the young (MODY). The establishment of such diagnosis is critical for prognosis, because early-onset T2DM is associated with rapid deterioration in pancreatic β-cell secretory function leading to earlier initiation of insulin therapy. Furthermore, mortality and lifetime risk of developing complications, especially microvascular, is increased in these patients compared to both later-onset T2DM and T1DM patients; also, the latter are often developed earlier in the course of disease. The management of early-onset T2DM follows the same guidelines as in later-onset T2DM; yet patients aged 18-39 years are underrepresented in the big clinical trials on which the development of guidelines is based. Finally, young people with T2DM face significant challenges associated with social determinants, which compromise their adherence to therapy and induce diabetes distress. Future research focusing on the pathogenesis of β-cell decline and complications, as well as on specific treatment shall lead to better understanding and management of early-onset T2DM.

Recent studies have demonstrated the remarkable potential of early life intervention strategies at influencing the course of postnatal development, thereby offering exciting possibilities for enhancing longevity and improving overall health. Metformin (MF), an FDA-approved medication for type II diabetes mellitus, has recently gained attention for its promising anti-aging properties, acting as a calorie restriction mimetic, and delaying precocious puberty. Additionally, trodusquemine (MSI-1436), an investigational drug, has been shown to combat obesity and metabolic disorders by inhibiting the enzyme protein tyrosine phosphatase 1b (Ptp1b), consequently reducing hepatic lipogenesis and counteracting insulin and leptin resistance. In this study, we aimed to further explore the effects of these compounds on young, developing mice to uncover biomolecular signatures that are central to liver metabolic processes. We found that MSI-1436 more potently alters mRNA and miRNA expression in the liver compared with MF, with bioinformatic analysis suggesting that cohorts of differentially expressed miRNAs inhibit the action of phosphoinositide 3-kinase (Pi3k), protein kinase B (Akt), and mammalian target of rapamycin (Mtor) to regulate the downstream processes of de novo lipogenesis, fatty acid oxidation, very-low-density lipoprotein transport, and cholesterol biosynthesis and efflux. In summary, our study demonstrates that administering these compounds during the postnatal window metabolically reprograms the liver through induction of potent epigenetic changes in the transcriptome, potentially forestalling the onset of age-related diseases and enhancing longevity. Future studies are necessary to determine the impacts on lifespan and overall quality of life.

Youth-onset type 2 diabetes (Y-T2D) is associated with increased risk for coronary atherosclerotic disease, but the timing of the earliest pathological features and evidence of cardiac endothelial dysfunction have not been evaluated in this population. Endothelial function magnetic resonance imaging may detect early and direct endothelial dysfunction in the absence of classical risk factors (severe hyperglycemia, hypertension, and hyperlipidemia). Using endothelial function magnetic resonance imaging, we evaluated peripheral and coronary artery structure and endothelial function in young adults with Y-T2D diagnosed ≤5 years compared with age-matched healthy peers. We isolated and characterized plasma-derived small extracellular vesicles and evaluated their effects on inflammatory and signaling biomarkers in healthy human coronary artery endothelial cells to validate the imaging findings.

Right coronary wall thickness, coronary artery flow-mediated dilation, and brachial artery flow-mediated dilation were measured at baseline and during isometric handgrip exercise using a 3.0T magnetic resonance imaging. Human coronary artery endothelial cells were treated with Y-T2D plasma-derived small extracellular vesicles. Protein expression was measured by Western blot analysis, oxidative stress was measured using the redox-sensitive probe dihydroethidium, and nitric oxide levels were measured by 4-amino-5-methylamino-2',7'-difluororescein diacetate.

Y-T2D (n=20) had higher hemoglobin A1c and high-sensitivity C-reactive protein, but similar total and LDL (low-density lipoprotein)-cholesterol compared with healthy peers (n=16). Y-T2D had greater coronary wall thickness (1.33±0.13 versus 1.22±0.13 mm; P=0.04) and impaired endothelial function: lower coronary artery flow-mediated dilation (-3.1±15.5 versus 15.9±17.3%; P<0.01) and brachial artery flow-mediated dilation (6.7±14.7 versus 26.4±15.2%; P=0.001). Y-T2D plasma-derived small extracellular vesicles reduced phosphorylated endothelial nitric oxide synthase expression and nitric oxide levels, increased reactive oxygen species production, and elevated ICAM (intercellular adhesion molecule)-mediated inflammatory pathways in human coronary artery endothelial cells.

Coronary and brachial endothelial dysfunction was evident in Y-T2D who were within 5 years of diagnosis and did not have severe hyperglycemia or dyslipidemia. Plasma-derived small extracellular vesicles induced markers of endothelial dysfunction, which corroborated accelerated subclinical coronary atherosclerosis as an early feature in Y-T2D.

URL: https://www.clinicaltrials.gov; Unique identifier: NCT02830308 and NCT01399385.

Type 2 diabetes is becoming more prevalent in many parts of the world. Malmö's population has increased in recent years mainly because of migration from other parts of Sweden and the world in addition to increased birth rates. We aimed to explore diabetes prevalence in Malmö in 2011-2018 as well as the achieved treatment targets for selected diabetes-related outcomes.

The current study is a part of the Cities Changing Diabetes Malmö project. Prevalence data were retrieved from the region's primary care and hospital diagnosis register, and data on treatment targets were collected from the National Diabetes Register. The inclusion criteria were either being a resident of Malmö or using a primary healthcare centre located in Malmö.

The prevalence of type 2 diabetes in 2018 doubled from 2011 in the entire Malmö population. During the same period, the prevalence of type 1 diabetes remained stable at 0.49 %. In 2011, the type 2 diabetes prevalence was 2.46 % (2.76 % for males and 2.28 % for females), and in 2018, it was 4.26 % (4.84 % for males and 3.82 % for females). The increase was 139 % for residents aged 0-29 years, 119.6 % for residents aged 30-39 years, 96.2 % for residents aged 40-49 years, 102 % for residents aged 50-59 years, 98.2 % for residents aged 60-69 years, and 115.5 % for those aged 70-79 years. Finally, the increase was 60.9 % for those aged 80-84 years and 90.7 % for residents 90 years of age and older. The National Diabetes Register reported that during 2019, 58 % of all patients with diabetes using primary care in Malmö reached HbA1c <52 mmol/mol, 20 % had albuminuria, 36 % had retinopathy, and 21 % had not had their feet inspected by a healthcare professional during the last year. The median HbA1c was 52.6 mmol/mol, and 17 % were registered as active smokers.

Diabetes prevalence in Malmö has increased markedly in recent years, exacerbated by a rise in type 2 diabetes mainly in the younger population. Targets regarding p-glucose lowering treatments were not met by 42 %. One patient out of three had microvascular complications in the eye, one out of five had impaired kidney function, one out of five had not had their feet inspected, and one out of five was an active smoker. Active diabetes treatments need to be improved to reduce the number of younger patients developing microvascular complications. Preventive activities need to target younger populations to counteract even more residents developing type 2 diabetes.

The key aim of diabetes management is to prevent complications, which are a major cause of morbidity and mortality. At an individual level, people with diabetes are less likely than they were several decades ago to experience classical macrovascular and microvascular complications as a result of improvements in modifiable cardiovascular risk factors and preventive healthcare. However, a significant burden of diabetes complications persists at a population level because of the increasing incidence of diabetes, as well as longer lifetime exposure to diabetes because of younger diagnosis and increased life expectancy. Trials have shown that the most effective strategy for preventing complications of diabetes is a multifactorial approach focussing simultaneously on the management of diet, exercise, glucose levels, blood pressure and lipids. In addition to the cornerstone strategies of addressing diet, exercise and lifestyle measures, the introduction of newer glucose-lowering agents, including sodium-glucose transport protein 2 inhibitors and glucagon-like peptide-1 agonists, have brought about a paradigm shift in preventing the onset and progression of complications of type 2 diabetes, particularly cardiovascular and renal disease. The improvement in rates of classical complications of diabetes over time has been accompanied by a growing awareness of non-traditional complications, including non-alcoholic fatty liver disease. These emerging complications may not respond to a glycaemic-centred approach alone and highlight the importance of foundational strategies centred on lifestyle measures and supported by pharmaceutical therapy to achieve weight loss and reduce metabolic risk in patients living with diabetes.

This review explores the emerging evidence regarding pathogenesis, future trajectories, treatment options, and phenotypes of youth-onset type 2 diabetes (T2D).

Youth-onset T2D is increasing in incidence and prevalence worldwide, disproportionately affecting First Nations communities, socioeconomically disadvantaged youth, and people of colour. Youth-onset T2D differs in pathogenesis to later-onset T2D and progresses more rapidly. It is associated with more complications, and these occur earlier. While there are limited licensed treatment options available, the available medications also appear to have a poorer response in youth with T2D. Multiple interacting factors likely contribute to this rising prevalence, as well as the increased severity of the condition, including structural inequities, increasing obesity and sedentary lifestyles, and intergenerational transmission from in-utero exposure to maternal hyperglycemia and obesity. Youth-onset T2D is also associated with stigma and poorer mental health, and these impact clinical management. There is an urgent need to develop effective interventions to prevent youth-onset T2D and enhance engagement of affected youth. It is also critical to better understand the differing phenotypes of youth-onset T2D, to effectively target treatments, and to address intergenerational transmission in high-risk populations.

Type 2 diabetes (T2D) is known as a major public health problem with a noticeable adverse impact on quality of life and health expenditures worldwide. Despite using routine multiple pharmacological and nonpharmacological interventions, including diet therapy and increasing physical activity, controlling this chronic disease remains a challenging issue, and therapeutic goals are often not achieved. Therefore, recently, other therapeutic procedures, such as using herbal products and functional foods as complementary or alternative medicine (CAM), have received great attention as a new approach to managing T2D complications, according to the literature. We reviewed the existing evidence that supports using various fundamental medicinal herbs, including cinnamon, saffron, ginger, jujube, turmeric, and barberry, as CAM adjunctive therapeutic strategies for T2D patients. The current review addressed different aspects of the potential impact of the abovementioned herbal products in improving glycemic indices and lipid profiles, including the effect size reported in the studies, their effective dose, possible side effects, herbs-drug interactions, and their potential action mechanisms.

Over the past 20 years, the incidence and prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents have increased, particularly in racial and ethnic minorities. Despite the rise in T2DM in children and adolescents, the pathophysiology and progression of disease in this population are not clearly understood. Youth-onset T2DM has a more adverse clinical course than is seen in those who develop T2DM in adulthood or those with T1DM. Furthermore, the available therapeutic options are more limited for children and adolescents with T2DM compared to adult patients, mostly due to the challenges of implementing clinical trials. A better understanding of the mechanisms underlying the de-velopment and aggressive disease phenotype of T2DM in youth is important to finding effective prevention and management strategies. This review highlights the key evidence about T2DM in children and adolescents and its current burden and challenges both in clinical care and research activities.

We evaluated baseline characteristics of participants with early-onset type 2 diabetes (T2D) from the SURPASS program and tirzepatide's effects on glycemic control, body weight (BW), and cardiometabolic markers.

This post hoc analysis compared baseline characteristics and changes in mean HbA1c, BW, waist circumference (WC), lipids, and blood pressure (BP) in 3,792 participants with early-onset versus later-onset T2D at week 40 (A Study of Tirzepatide [LY3298176] in Participants With Type 2 Diabetes Not Controlled With Diet and Exercise Alone [SURPASS-1] and A Study of Tirzepatide [LY3298176] Versus Semaglutide Once Weekly as Add-on Therapy to Metformin in Participants With Type 2 Diabetes [SURPASS-2]) or week 52 (A Study of Tirzepatide [LY3298176] Versus Insulin Degludec in Participants With Type 2 Diabetes [SURPASS-3]). Analyses were performed by study on data from participants while on assigned treatment without rescue medication in case of persistent hyperglycemia.

At baseline in SURPASS-2, participants with early-onset versus later-onset T2D were younger with longer diabetes duration (9 vs. 7 years, P < 0.001) higher glycemic levels (8.5% vs. 8.2%, P < 0.001), higher BW (97 vs. 93 kg, P < 0.001) and BMI (35 vs. 34 kg/m2, P < 0.001), and a similarly abnormal lipid profile (e.g., triglycerides 167 vs. 156 mg/dL). At week 40, similar improvements in HbA1c (-2.6% vs. -2.4%), BW (-14 vs. -13 kg), WC (-10 vs. -10 cm), triglycerides (-26% vs. -24%), HDL (7% vs. 7%), and systolic BP (-6 vs. -7 mmHg) were observed in both subgroups with tirzepatide.

Despite younger age, participants with early-onset T2D from the SURPASS program had higher glycemic levels and worse overall metabolic health at baseline versus those with later-onset T2D. In this post hoc analysis, similar improvements in HbA1c, BW, and cardiometabolic markers were observed with tirzepatide, irrespective of age at T2D diagnosis. Future studies are needed to determine long-term outcomes of tirzepatide in early-onset T2D.

The majority of Iranian fig production is exported, making it one of the world's most well-known healthy crops. Therefore, the main objective of the current experiment was to investigate the effects of various types of organic fertilizers, such as animal manure (cow and sheep), bird manure (partridge, turkey, quail, and chicken), and vermicompost, on the nutritional status of trees, vegetative and reproductive tree characteristics, fruit yield, and fruit quality traits in dried fig cultivar ("Sabz"). According to the findings, applying organic fertilizers, particularly turkey and quail, significantly improves vegetative and reproductive characteristics. However, other manures such as sheep, chicken, and vermicompost had a similar effect on the growth parameters of fig trees. Additionally, the findings indicated that except for potassium, use of all organic fertilizers had an impact on macro and microelements such as phosphorus, nitrogen, and sodium amount in fig tree leaves. Also, based on fruit color analysis in dried figs, the use of all organic fertilizers improved fruit color. Moreover, the analyses fruit biochemical showed that the use of some organic fertilizers improved that TSS and polyphenol compounds such as coumarin, vanillin, hesperidin gallic acid and trans frolic acid. In general, the results indicated that the addition of organic fertilizers, especially turkey manure, led to increased vegetative productivity and improvement in the fruit quality of the rain-fed fig orchard.

Youth-onset type 2 diabetes is associated with poor glycemic control and early onset of complications. Identification of psychosocial factors associated with poor glycemic control is needed to inform efficacious interventions.

To identify psychosocial factors associated with glycated hemoglobin (HbA1c) levels in young adults with youth-onset type 2 diabetes.

For the iCount cohort study, HbA1c levels were measured twice (at baseline [T1] and at 1 year [T2]) during the last years (2017-2019) of the observational phase of the multicenter Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY2) study. Participants were young adults who had been diagnosed with type 2 diabetes during childhood or adolescence. Data were analyzed from December 2021 to September 2023.

Glycemic control was examined categorically (high [≥8.0%] vs low [<8.0%] HbA1c), continuously (HbA1c level), and over time (change in HbA1c: decreased ≥0.5%, remained stable, or increased ≥0.5%). Psychosocial measures included beliefs about medicines, depression and anxiety symptoms, diabetes distress, diabetes self-efficacy, self-management support, and unmet material needs. Multivariable logistic and linear regression models evaluated the association of each psychosocial factor with the probability of T2 HbA1c of 8.0% or greater, T2 HbA1c level, and change in HbA1c.

Of the 411 TODAY2 participants approached, 381 enrolled in the iCount study, and 348 with T1 and T2 HbA1c data comprised the analysis group. The 348 participants had a mean (SD) age of 26.1 (2.5) years and a mean (SD) HbA1c of 9.4% (2.8%). Most participants (229 [65.8%]) were women. In adjusted multivariable regressions, greater beliefs that diabetes medicines are necessary (odds ratio [OR], 1.19 [95% CI, 1.03-1.37]; P = .02), concerns about medicines (OR, 1.20 [95% CI, 1.00-1.45]; P = .049), diabetes distress (OR, 1.08 [95% CI, 1.02-1.15]; P = .006), and high distress (OR, 2.18 [95% CI, 1.15-4.13]; P = .02) increased the odds of high HbA1c at T2. Greater support (OR, 0.67 [95% CI, 0.46-0.97]; P = .04) and diabetes self-efficacy (OR, 0.91 [95% CI, 0.84-0.99]; P = .02) decreased the odds of high HbA1c at T2. Diabetes distress was associated with higher HbA1c level at T2 (coefficient, 0.08 [95% CI, 0.02-0.13]; P = .01). Beliefs that diabetes medicines are necessary (OR, 1.20 [95% CI, 1.03-1.39]; P = .02) and concerns about medicines (OR, 1.22 [95% CI, 1.00-1.47]; P = .048) increased the odds of an HbA1c decrease of at least 0.5% over 1 year.

In this cohort study of young adults with youth-onset type 2 diabetes, beliefs about medicines, high diabetes distress, low diabetes self-efficacy, and self-management support were associated with high HbA1c over time. Future research should assess whether interventions that address these factors result in improved glycemic control in this at-risk group.

Premature onset of type 2 diabetes and excess mortality are critical issues internationally, particularly in Indigenous populations. There is an urgent need for developmentally appropriate and culturally safe models of care. We describe the methods for the codesign, implementation and evaluation of enhanced models of care with Aboriginal and Torres Strait Islander youth living with type 2 diabetes across Northern Australia.

Our mixed-methods approach is informed by the principles of codesign. Across eight sites in four regions, the project brings together the lived experience of Aboriginal and Torres Strait Islander young people (aged 10-25) with type 2 diabetes, their families and communities, and health professionals providing diabetes care through a structured yet flexible codesign process. Participants will help identify and collaborate in the development of a range of multifaceted improvements to current models of care. These may include addressing needs identified in our formative work such as the development of screening and management guidelines, referral pathways, peer support networks, diabetes information resources and training for health professionals in youth type 2 diabetes management. The codesign process will adopt a range of methods including qualitative interviews, focus group discussions, art-based methods and healthcare systems assessments. A developmental evaluation approach will be used to create and refine the components and principles of enhanced models of care. We anticipate that this codesign study will produce new theoretical insights and practice frameworks, resources and approaches for age-appropriate, culturally safe models of care.

The study design was developed in collaboration with Aboriginal and Torres Strait Islander and non-Indigenous researchers, health professionals and health service managers and has received ethical approval across all sites. A range of outputs will be produced to disseminate findings to participants, other stakeholders and the scholarly community using creative and traditional formats.

Family-based programs may be a strategy to prevent health conditions with hereditary risk such as diabetes. This review examined the state of the science regarding interventions that adapted the Diabetes Prevention Program (DPP) lifestyle change curriculum to include family members.

CINAHL, Cochrane Central, PsycINFO, PubMed, and Scopus were searched for reports that were peer reviewed, written in English, evaluated interventions that adapted the DPP lifestyle change curriculum to be family-based, reported diabetes risk related outcomes, and published between 2002 and August 2023. Records were reviewed, data extracted, and quality assessed by two researchers working independently. A narrative synthesis was completed. Meta-analysis was not completed due to the small number of studies and the heterogeneity of the study characteristics.

2177 records were identified with four meeting inclusion criteria. Primary participants for three studies were adults and one study focused on youth. Family participants were adult family members, children of the primary participant, or caregivers of the enrolled youth. For primary participants, two studies found significant intervention effects on weight-related outcomes. Of the studies with no intervention effects, one was a pilot feasibility study that was not powered to detect changes in weight outcomes. Three studies assessed outcomes in family participants with one finding significant intervention effects on weight.

While DPP interventions adapted to include family showed promising or similar results as individual-based DPP interventions, additional studies are needed to better understand the mechanisms of action and the most effective methods to engage family members in the programs.

The purpose of this review is to highlight the evidence of microvascular dysfunction in bone and marrow and its relation to poor skeletal outcomes in diabetes mellitus.

Diabetes mellitus is characterized by chronic hyperglycemia, which may lead to microangiopathy and macroangiopathy. Micro- and macroangiopathy have been diagnosed in Type 1 and Type 2 diabetes, coinciding with osteopenia, osteoporosis, enhanced fracture risk and delayed fracture healing. Microangiopathy has been reported in the skeleton, correlating with reduced blood flow and perfusion, vasomotor dysfunction, microvascular rarefaction, reduced angiogenic capabilities, and augmented vascular permeability. Microangiopathy within the skeleton may be detrimental to bone and manifest as, among other clinical abnormalities, reduced mass, enhanced fracture risk, and delayed fracture healing. More investigations are required to elucidate the various mechanisms by which diabetic microvascular dysfunction impacts the skeleton.

New Zealand (NZ) research into type 1 diabetes mellitus (T1DM) mortality can inform policy and future research. In this study we aimed to quantify the magnitude to which ethnicity and socioeconomic disparities influenced mortality at the population level among people with Type 1 diabetes (T1DM) in Auckland, New Zealand (NZ).

The cohort data were derived from the primary care diabetes audit program the Diabetes Care Support Service (DCSS), and linked with national primary care, pharmaceutical claims, hospitalisation, and death registration databases. People with T1DM enrolled in DCSS between 1994-2018 were included. All-cause, premature, and cardiovascular mortalities were estimated by Poisson regression models with adjustment for population-level confounders. The mortality rates ratio (MRR) was standardized against the DCSS type 2 diabetes population. Mortality rates were compared by ethnic group (NZ European (NZE) and non-NZE) and socioeconomic deprivation quintile. The population attributable fraction (PAF) was estimated for ethnic and socioeconomic disparities by Cox regression adjusting for demographic, lifestyle, and clinical covariates. The adjusted slope index inequality (SII) and relative index of inequality (RII) were used to measure the socioeconomic disparity in mortalities.

Overall, 2395 people with T1DM (median age 34.6 years; 45% female; 69% NZE) were enrolled, among whom the all-cause, premature and CVD mortalities were 6.69 (95% confidence interval: 5.93-7.53), 3.30 (2.77-3.90) and 1.77 (1.39-2.23) per 1,000 person-years over 25 years. The overall MRR was 0.39 (0.34-0.45), 0.65 (0.52-0.80), and 0.31 (0.24-0.41) for all-cause, premature and CVD mortality, respectively. PAF attributable to ethnicity disparity was not significantly different for mortality. The adjusted PAF indicated that 25.74 (0.84-44.39)% of all-cause mortality, 25.88 (0.69-44.69)% of premature mortality, 55.89 (1.20-80.31)% of CVD mortality could be attributed to socioeconomic inequality. The SII was 8.04 (6.30-9.78), 4.81 (3.60-6.02), 2.70 (1.82-3.59) per 1,000 person-years and RII was 2.20 (1.94-2.46), 2.46 (2.09-2.82), and 2.53 (2.03-3.03) for all-cause, premature and CVD mortality, respectively.

Our results suggest that socioeconomic disparities were responsible for a substantial proportion of all-cause, premature and CVD mortality in people with T1DM in Auckland, NZ. Reducing socioeconomic barriers to management and self-management would likely improve clinical outcomes.

A popular non-alcoholic beverage worldwide, tea can regulate blood glucose levels, lipid levels, and blood pressure, and may even prevent type 2 diabetes mellitus (T2DM). Different tea fermentation levels impact these effects. Tea products with different fermentation degrees containing different functional ingredients can lower post-meal blood glucose levels and may prevent T2DM. There are seven critical factors that shed light on how teas with different fermentation levels affect blood glucose regulation in humans. These factors include the inhibition of digestive enzymes, enhancement of cellular glucose uptake, suppression of gluconeogenesis-related enzymes, reduction in the formation of advanced glycation end products (AGEs), inhibition of dipeptidyl peptidase-4 (DPP-4) activity, modulation of gut flora, and the alleviation of inflammation associated with oxidative stress. Fermented teas can be used to lower post-meal blood glucose levels and can help consumers make more informed tea selections.

With the increase in prediabetes among adolescents with overweight and obesity, identifying those at highest risk for type 2 diabetes (T2D) can support prevention strategies.

To assess T2D risk by hemoglobin A1c (HbA1c) levels among adolescents with overweight and obesity.

This retrospective cohort study was conducted using data for January 1, 2010, to December 31, 2019, from a large California health care system. The study population comprised adolescents aged 10 to 17 years who had a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) at or above the 85th percentile, had HbA1c measured during 2010 to 2018, and did not have preexisting diabetes. Data abstraction and analyses were conducted from January 1, 2020, to November 16, 2023.

Baseline HbA1c, with covariates including BMI category (overweight: 85th to <95th percentile; moderate obesity: 100% to <120% of 95th percentile; or severe obesity: ≥120% of 95th percentile), age, sex, race and ethnicity, and Neighborhood Deprivation Index score.

The main outcome was incident T2D during follow-up through 2019, including cumulative incidence and multivariable hazard ratios (HRs) with 95% CIs using Cox proportional hazard regression analyses.

This study included 74 552 adolescents with a mean (SD) age of 13.4 (2.3) years. More than half (50.6%) were female; 26.9% of individuals had overweight, 42.3% had moderate obesity, and 30.8% had severe obesity. Individuals identified as Asian or Pacific Islander (17.6%), Black (11.1%), Hispanic (43.6%), White (21.6%), and other or unknown race or ethnicity (6.1%). During follow-up, 698 adolescents (0.9%) developed diabetes, and 626 (89.7%) had T2D; 72 individuals (10.3%) who had type 1, secondary, or other diabetes were censored. The overall T2D incidence was 2.1 (95% CI, 1.9-2.3) per 1000 person-years, with a 5-year cumulative incidence of 1.0% (95% CI, 0.9%-1.1%). Higher baseline HbA1c (from <5.5% to 5.5%-5.6%, 5.7%-5.8%, 5.9%-6.0%, 6.1%-6.2%, and 6.3-6.4%) was associated with higher 5-year cumulative T2D incidence (from 0.3% [95% CI, 0.2%-0.4%] to 0.5% [0.4%-0.7%], 1.1% [0.8%-1.3%], 3.8% [3.2%-4.7%], 11.0% [8.9%-13.7%], and 28.5% [21.9%-36.5%], respectively). In addition, higher baseline HbA1c was associated with greater T2D risk (reference [HbA1c <5.5%]: HR, 1.7 [95% CI, 1.3-2.2], 2.8 [2.1-3.6], 9.3 [7.2-12.1], 23.3 [17.4-31.3], and 71.9 [51.1-101.1], respectively). Higher BMI category, older age, female sex, and Asian or Pacific Islander race (HR, 1.7 [95% CI, 1.3-2.2]), but not Black race or Hispanic ethnicity (compared with White race), were also independent indicators of T2D. In stratified analyses, incremental risk associated with higher HbA1c was greater for Asian or Pacific Islander and White adolescents than for Black and Hispanic adolescents.

In this cohort study of adolescents with overweight and obesity, T2D risk increased substantially with baseline HbA1c above 6.0%. Risk varied by BMI, age, sex, and race and ethnicity. These findings suggest that diabetes surveillance in adolescents should be tailored to optimize identification among high-risk subgroups.

Despite growing numbers of initiatives designed to address increasing diabetes prevalence in the U.S., the need remains for effective programs. Because family history is a diabetes risk factor, family focused programs may be a potential strategy to improve the health of the entire family. We present the development process and pretest results of a lifestyle change program for rural-dwelling mothers at risk for diabetes and their children.

We completed semistructured interviews with mothers (N = 17) focusing on program content and activities. Findings informed program development by identifying specific barriers motivators and potential leverage points such as focusing on the intrinsic incentives of health activities. The resulting program was pretested with rural-dwelling mothers (N = 5) who completed program activities with their families and provided feedback via semistructured interviews. All interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

While pretest results showed that the program was generally acceptable and feasible, feedback was used to further refine the program. The revised program consists of 8 group sessions with family focused content around physical activity, healthy eating, and making connections while engaging in health activities. Between sessions, mothers tracked the family goals, activity levels, and mood, and documented barriers to discuss during the sessions.

Our development process engaged intended program users to codesign a program that focuses on wellness and intrinsic incentives of engaging in health-enhancing activities as a family. By providing strategies to change behaviors as a family, this program aims to improve the mother's health while developing healthy habits in their children.

Youth-onset type 2 diabetes is a growing epidemic with a rising incidence worldwide. Although the pathogenesis and diagnosis of youth-onset type 2 diabetes are similar to adult-onset type 2 diabetes, youth-onset type 2 diabetes is unique, with greater insulin resistance, insulin hypersecretion, and faster progression of pancreatic beta cell function decline. Individuals with youth-onset type 2 diabetes also develop complications at higher rates within short periods of time compared to adults with type 2 diabetes or youth with type 1 diabetes. The highest prevalence and incidence of youth-onset type 2 diabetes in the United States is among youth from minoritized racial and ethnic groups. Risk factors include obesity, family history of type 2 diabetes, comorbid conditions and use of medications associated with insulin resistance and rapid weight gain, socioeconomic and environmental stressors, and birth history of small-for-gestational-age or pregnancy associated with gestational or pregestational diabetes. Patients with youth-onset type 2 diabetes should be treated using a multidisciplinary model with frequent clinic visits and emphasis on addressing of social and psychological barriers to care and glycemic control, as well as close monitoring for comorbidities and complications. Intensive health behavior therapy is an important component of treatment, in addition to medical management, both of which should be initiated at the diagnosis of type 2 diabetes. There are limited but growing pharmacologic treatment options, including metformin, insulin, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors. Although long-term outcomes are not fully known, metabolic/bariatric surgery in youth with type 2 diabetes has led to improved cardiometabolic outcomes.

Diabetes mellitus is a chronic metabolic disease, the prevalence of which is constantly increasing worldwide. It is often burdened by disabling comorbidities that reduce the quality and expectancy of life of the affected individuals. The traditional complications of diabetes are generally described as macrovascular complications (e.g., coronary heart disease, peripheral arterial disease, and stroke), and microvascular complications (e.g., diabetic kidney disease, retinopathy, and neuropathy). Recently, due to advances in diabetes management and the increased life expectancy of diabetic patients, a strong correlation between diabetes and other pathological conditions (such as liver diseases, cancer, neurodegenerative diseases, cognitive impairments, and sleep disorders) has emerged. Therefore, these comorbidities have been proposed as emerging complications of diabetes. P66Shc is a redox protein that plays a role in oxidative stress, apoptosis, glucose metabolism, and cellular aging. It can be regulated by various stressful stimuli typical of the diabetic milieu and is involved in various types of organ and tissue damage under diabetic conditions. Although its role in the pathogenesis of diabetes remains controversial, there is strong evidence regarding the involvement of p66Shc in the traditional complications of diabetes. In this review, we will summarize the evidence supporting the role of p66Shc in the pathogenesis of diabetes and its complications, focusing for the first time on the emerging complications of diabetes.

High cardiovascular mortality has been reported in young patients with diabetes. However, the underlying pathology in different age groups of patients with diabetes has not been studied.

The aim of this study was to investigate the plaque characteristics and underlying pathology of acute coronary syndrome in different age groups of patients with or without diabetes in a large cohort. Patients who presented with acute coronary syndrome and underwent preintervention optical coherence tomography imaging were included. Culprit plaque was classified as plaque rupture, plaque erosion, or calcified plaque and stratified into 5 age groups. Plaque characteristics including features of vulnerability were examined by optical coherence tomography. Among 1394 patients, 482 (34.6%) had diabetes. Patients with diabetes, compared with patients without diabetes, had a higher prevalence of lipid-rich plaque (71.2% versus 64.8%, P=0.016), macrophage (72.0% versus 62.6%, P<0.001), and cholesterol crystal (27.6% versus 19.7%, P<0.001). Both diabetes and nondiabetes groups showed a decreasing trend in plaque erosion with age (patients with diabetes, P=0.020; patients without diabetes, P<0.001). Patients without diabetes showed an increasing trend with age in plaque rupture (P=0.004) and lipid-rich plaque (P=0.018), whereas patients with diabetes had a high prevalence of these vulnerable features at an early age that remained high across age groups.

Patients without diabetes showed an increasing trend with age in plaque rupture and lipid-rich plaque, whereas patients with diabetes had a high prevalence of these vulnerable features at an early age. These results suggest that atherosclerotic vascular changes with increased vulnerability start at a younger age in patients with diabetes.

URL: https://www.clinicaltrials.gov; Unique identifiers: NCT04523194, NCT03479723. URL: https://www.umin.ac.jp/ctr/. Unique identifier: UMIN000041692.