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Background Objective Methods Results Conclusion Chronic inflammation is a key factor in type 2 diabetes mellitus (T2DM) development. The cholinergic anti‐inflammatory pathway (CAP) reduces inflammation by activating α7 nicotinic acetylcholine receptors (α7nAChRs) on macrophages, suppressing proinflammatory cytokines. Acetylcholinesterase inhibitors (AChEis), primarily used for Alzheimer's disease (AD), may exert anti‐inflammatory effects through the CAP. One AChEi, galantamine, also directly agonizes α7nAChRs, potentially enhancing its anti‐inflammatory properties.This study aimed to investigate the association between AChEi use, particularly galantamine, and T2DM risk in AD patients.We conducted a retrospective analysis of Veterans Health Administration (VA) data, examining early‐ and late‐onset AD patients receiving galantamine or other AD medications. Propensity score matching was used to balance groups and minimize confounding. Cox proportional hazard models assessed T2DM risk for galantamine, other AChEis and memantine.A total of 40 065 AD patients were included in the study. Among early‐onset AD patients, galantamine use significantly reduced T2DM risk (hazard ratio [HR] = 0.80, 95% confidence interval [CI]: 0.66–0.98). Memantine also showed a protective effect (HR = 0.82, 95% CI: 0.69–1) in this group. Neither galantamine nor memantine influenced T2DM risk in late‐onset AD. Other AD medications showed no association with T2DM risk.Galantamine use was associated with a lower risk of T2DM in early‐onset AD patients, potentially due to enhanced anti‐inflammatory effects through both AChE inhibition and direct α7nAChR agonism. Memantine also demonstrated a protective effect. These findings suggest potential new applications for existing AD medications in T2DM prevention, particularly in early‐onset AD patients. Further research, including randomized controlled trials with diverse populations, is needed to confirm these results and the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion We aimed to characterise and compare individuals diagnosed with type 1 diabetes (T1D), latent autoimmune diabetes in adults (LADA) and type 2 diabetes (T2D), in a real‐world setting.Anthropometric and clinical data from 36 959 people with diabetes diagnosed at age 30–70 years enrolled in the prospective diabetes patients follow‐up (DPV) registry from 1995 to 2022 were analysed cross‐sectionally at diagnosis and follow‐up (≥6 months after diagnosis). LADA was defined as clinical diagnosis of T2D, positivity of ≥1 islet autoantibody and an insulin‐free interval of ≥6 months upon diabetes diagnosis.At diagnosis, age, body mass index, waist circumference, C‐peptide and HbA1c in people with LADA (n = 747) fell in between individuals with T1D (n = 940) and T2D (n = 35 272) (all p‐values < 0.01). At follow‐up, after adjusting for age, sex and diabetes duration, the prevalence of dyslipidemia and hypertension was the highest in people with LADA (90.6%, 77.7%) compared to people with T2D (81.8%, 60.4%) and T1D (75.7%, 39.7%) (p < 0.01). The prevalence of diabetic kidney disease (DKD) was higher in LADA (44.2%), than in T1D (19.9%) (p < 0.01). The prevalence of peripheral neuropathy was higher in individuals with LADA (55.1%) than in T2D (43.9%) and T1D (42.1%) (p < 0.05). Coverage of treatment for hypertension and dyslipidemia were 22.4% and 15.0% in T1D, 63.0% and 36.6% in LADA and 29.4% and 18.2% in T2D.People with LADA had a higher prevalence of cardiovascular risk factors (dyslipidemia, hypertension) and cardiovascular complications (DKD and peripheral neuropathy), suggesting that people with LADA are at need for improved recognition and care. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Previous studies indicated that metabolic heterogeneity of obesity would affect the risk of cardiovascular disease (CVD). However, the alterations in CVD risk associated with transitions between various metabolic health statuses influenced by obesity status remain unclear.We utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal cohort study involving Chinese residents aged 45 years and older. Baseline data were collected in 2011–2012, with follow‐up surveys conducted up to 2020. Participants in the study were categorized into four body mass index–metabolic phenotypes: metabolically healthy normal weight (MHNW), metabolically healthy overweight/obesity (MHOO), metabolically unhealthy normal weight (MUNW) and metabolically unhealthy overweight/obesity (MUOO). Transitions in these phenotypes over 4 years were analysed. Cox regression models were used to assess the associations of these phenotypes and their transitions with CVD incidence.Among 7721 participants, 1353 (17.5%) developed CVD during the follow‐up period. Both overweight/obese and metabolically unhealthy statuses were associated with increased CVD risk. The highest risk was observed in the MUOO group (hazard ratio [HR]: 1.74, 95% confidence interval [CI]: 1.50–2.09, p < 0.0001), followed by the MUNW (HR 1.35, 95% CI: 1.13–1.66, p < 0.001) and MHOO (HR: 1.29, 95% CI: 1.08–1.56, p = 0.002) groups compared to the MHNW group. The deteriorations of obesity and metabolic health status elevated the incidence of CVD, whereas improvements in these statuses reduced the risk of CVD. Additionally, alterations in metabolic health status conferred greater benefits in overweight/obese individuals compared to those with normal weight.The study highlights the importance of maintaining and promoting metabolic health, particularly in overweight/obese individuals, to reduce CVD risk. Metabolic health status plays a more crucial role than obesity status in predicting CVD incidence. [ABSTRACT FROM AUTHOR]

Aim: To analyse patterns of glucose‐lowering therapies among people with type 2 diabetes (T2D) in Denmark from 2016 to 2023. Materials and Methods: We examined time trends in the clinical profiles of people with T2D who initiated different glucose‐lowering therapy classes for the first time. We furthermore investigated individual‐level treatment trajectories following first‐ever glucose‐lowering therapy in people with or without cardiorenal disease. The study utilized data from the nationwide Danish health registries and included all individuals who filled a first‐ever prescription for metformin, dipeptidyl peptidase‐4 inhibitors, glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs), sodium‐glucose co‐transporter‐2 inhibitors (SGLT‐2is) or insulin, excluding those without HbA1c‐confirmed T2D or probable type 1 diabetes. Results: We included 260 393 individuals initiating a new glucose‐lowering therapy class from 2016 to 2023, during which there were 6‐ and 3‐fold increases in initiators of GLP‐1RAs and SGLT‐2is, respectively. The median HbA1c level at treatment initiation with GLP‐1RAs or SGLT‐2is decreased, from 67‐68 mmol/mol in 2016‐2017 to 57‐58 mmol/mol in 2022‐2023. Among individuals who initiated metformin as first‐line therapy, the proportion who started additional glucose‐lowering therapy within 2 years increased from 25% in 2016 to 40% in 2021. Among the 38% of individuals who had established cardiorenal disease when they initiated first‐ever glucose‐lowering therapy in 2020, 22% used SGLT‐2is and 18% GLP‐1RAs after 2.5 years, compared with 17% and 21% among initiators without cardiorenal disease, respectively. Conclusions: Our study documents a trend towards earlier T2D treatment intensification and an increase in the use of GLP‐1RAs and SGLT‐2is in Denmark. However, optimal T2D treatment is still not received by most individuals with early T2D and established cardiorenal disease. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the utilization and costs of non‐insulin glucose‐lowering drugs (GLDs) in Australia from 2013 to 2023. Materials and Methods: We conducted a retrospective analysis of the Australian Pharmaceutical Benefits Scheme (PBS) administrative dataset of 118 727 494 GLD prescriptions. The main outcome measures were the annual number of GLD prescriptions dispensed, accounting for type 2 diabetes mellitus (T2DM) prevalence and healthcare system costs, adjusted for inflation. Results: Utilization of GLDs doubled from 6.4 million prescriptions in 2013 to 15.6 million in 2023. The average annual percent increase in utilization was 8.1%, compared to the average annual increase in prevalence of T2DM of 1.8%. The biggest change was in sodium‐glucose cotransporter‐2 (SGLT2) inhibitors, for which there was an average annual increase in utilization of 59.4% (95% confidence interval [CI] 51.7%, 68.2%; p < 0.05) from 2014 (first full year of PBS listing), followed by glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs), which showed an increase of 31.4% (95% CI 28.5%, 33.8%; p < 0.05) annually (2013 to 2023). Dipeptidyl peptidase‐4 inhibitor utilization tripled, with an average annual increase of 10.9% (95% CI 8.1%, 13.8%; p < 0.05), but this plateaued from 2020. Metformin utilization increased by 4.7% (95% CI 2.0%, 6.9%; p < 0.05) annually. In contrast, sulphonylurea, glitazone and acarbose utilization declined. Total GLD costs increased threefold over the same period. Despite only accounting for 11.7% of utilization, GLP‐1RAs contributed to 35% of the costs. Conclusion: Utilization of GLDs doubled, and associated costs tripled over the past 11 years, with no sign of either utilization or costs plateauing, predominantly due to increased GLP‐1RA and SGLT2 inhibitor prescribing. [ABSTRACT FROM AUTHOR]

This article examines the early adoption of semaglutide, a drug used to treat type 2 diabetes, in Scandinavia, with a focus on Denmark. The study analyzes nationwide prescription data from Denmark, Norway, and Sweden to compare the use of semaglutide with other glucose-lowering drugs and to compare the characteristics of semaglutide initiators with initiators of other drugs. The findings reveal that semaglutide is widely used in Scandinavia and that the characteristics of semaglutide initiators differ slightly from initiators of other drugs. The study also identifies differences between early and late initiators of semaglutide, suggesting potential off-label use for weight loss. However, the study acknowledges limitations, such as the lack of data on specific indications for use. [Extracted from the article]

Aim: To assess the prevalence of individual obesity‐related complications (ORCs) and multimorbidity (≥ 1, ≥ 2 and ≥ 3 ORCs), and multimorbidity‐associated healthcare costs, over 10 years. Methods: This retrospective open cohort study used Discover, a UK database of linked primary and secondary electronic health records. Adults were stratified by body mass index (BMI; overweight: 25‐< 30 kg/m2; obesity class I: 30‐< 35 kg/m2; obesity class II: 35‐< 40 kg/m2; obesity class III: ≥ 40 kg/m2). Outcomes by year since baseline were assessed for serial cross sections across the study period (1 January 2004 to 31 December 2019; the index date was the date of first eligible BMI measurement). Results: Across 1 410 146 individuals (overweight: 1 008 101; obesity class I: 278 782; obesity class II: 80 621; obesity class III: 42 642), ORC prevalence was higher in successive BMI groups, and increases over time were generally greater for obesity relative to overweight. In those with ORC multimorbidity, both higher BMI and the presence of more ORCs were associated with higher annual per‐person healthcare costs. Costs increased over time in those individuals with obesity and one or more ORC, as well as in those with obesity and two or more ORCs. Conclusions: Higher BMI was associated with higher baseline ORC prevalence and a greater increase in ORC prevalence over time, and with higher healthcare costs in those with multimorbidity. To reduce the burden of overweight and obesity on patients and healthcare systems, the presence, number and type of ORCs should be considered in developing effective, targeted prevention and management care pathways. [ABSTRACT FROM AUTHOR]

Aims: To estimate healthcare resource utilization (HCRU) and healthcare costs by body mass index (BMI) in a UK cohort and to explore how this varied by defined BMI strata. Materials and Methods: This retrospective open cohort study used Discover, a linked primary and secondary electronic health records database covering 2.7 million individuals. Adults were stratified by BMI as: overweight (25–<30 kg/m2); obesity class I (30–<35 kg/m2); obesity class II (35–<40 kg/m2); or obesity class III (≥40 kg/m2). Cost data, comprising primary care, secondary care (inpatient admissions, outpatient appointments and emergency room visits) and prescriptions, were reported for 2015–2019. Results: Overall, 1 008 101 individuals were overweight, 278 782 had obesity class I; 80 621 had obesity class II, and 42 642 had obesity class III. Healthcare costs and HCRU events per person per year increased over time (2015: £851–£1321 and 10.6–13.4 events; 2019: £1143–£1871 and 11.4–14.9 events), and were higher for each successive BMI group. Groups with chronic kidney disease or cardiovascular disease incurred particularly high costs. In 270 493 individuals with obesity in 2019, more than 72% of total healthcare costs were incurred by the highest cost quintile, which had a higher mean age and more obesity‐related complications (ORCs) than lower cost quintiles. Conclusions: The economic impact of obesity could be alleviated by weight management support based on unmet need, to limit the effects of BMI progression and ORC development. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusion A data‐driven cluster analysis in a cohort of European individuals with type 2 diabetes (T2D) has previously identified four subgroups based on clinical characteristics. In the current study, we performed a comprehensive statistical assessment to (1) replicate the above‐mentioned original clusters; (2) derive de novo T2D subphenotypes in the Kooperative Gesundheitsforschung in der Region Augsburg (KORA) cohort and (3) describe underlying genetic risk and diabetes complications.We used data from n = 301 individuals with T2D from KORA FF4 study (Southern Germany). Original cluster replication was assessed forcing k = 4 clusters using three different hyperparameter combinations. De novo clusters were derived by open k‐means analysis. Stability of de novo clusters was assessed by assignment congruence over different variable sets and Jaccard indices. Distribution of polygenic risk scores and diabetes complications in the respective clusters were described as an indication of underlying heterogeneity.Original clusters did not replicate well, indicated by substantially different assignment frequencies and cluster characteristics between the original and current sample. De novo clustering using k = 3 clusters and including high sensitivity C‐reactive protein in the variable set showed high stability (all Jaccard indices >0.75). The three de novo clusters (n = 96, n = 172, n = 33, respectively) adequately captured heterogeneity within the sample and showed different distributions of polygenic risk scores and diabetes complications, that is, cluster 1 was characterized by insulin resistance with high neuropathy prevalence, cluster 2 was defined as age‐related diabetes and cluster 3 showed highest risk of genetic and obesity‐related diabetes.T2D subphenotyping based on its sample's own clinical characteristics leads to stable categorization and adequately reflects T2D heterogeneity. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions To compare cardiorenal outcomes of dipeptidyl peptidase‐4 inhibitors (DPP‐4is) and sodium‐glucose co‐transporter‐2 inhibitors (SGLT‐2is) in a national diabetic kidney disease (DKD) population.A cohort study was conducted using Taiwan's National Health Insurance Research Database and Laboratory Databases. Propensity score‐matched prevalent new users of SGLT‐2is (n = 1524) and DPP‐4is (n = 6005) during 2017‐2018 were selected from adults with DKD and an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2. Composite renal outcomes included sustained eGFR decrease, renal failure and renal mortality. Composite cardiovascular (CV) outcomes included acute myocardial infarction, stroke, hospitalization for heart failure and CV death. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs).Compared with DPP‐4i users, SGLT‐2i users had a reduced risk of composite renal endpoint (HR: 0.16; CI: 0.12‐0.24), consistently for a prolonged time to 50% or higher eGFR decrease (HR 0.17; CI: 0.11‐0.27), renal failure (HR: 0.14; CI: 0.08‐0.23) and decreased renal death (HR: 0.10; CI: 0.01‐0.70). SGLT‐2i users had a better composite CV outcome than DPP‐4i users (HR: 0.74; CI: 0.64‐0.85), and lower risks of stroke (HR: 0.76; CI: 0.62‐0.92) and hospitalization for heart failure (HR: 0.68; CI: 0.55‐0.84). Findings were consistent in analyses stratified by concomitant antidiabetic agents or intervals between DKD diagnosis and study drug initiation.This study shows the superior cardiorenal benefits of SGLT‐2is compared with DPP‐4is in the DKD population, regardless of concomitant antidiabetic agents or time from DKD onset to study drug initiation. SGLT‐2is should be prioritized in adult patients with DKD. [ABSTRACT FROM AUTHOR]

Diabetic Charcot neuroarthropathy (DCN), first described in 1936, occurs in less than 1% of diabetic patients, but in those diabetic subjects with distal symmetrical polyneuropathy, the overall incidence increases to 30% and the risk is even greater in those with type 1 diabetes. Factors that precipitate DCN are trauma, ischaemia due to arterio‐venous shunting, increased osteoclastic activity and inflammation. DCN usually presents with a painless swollen foot and/or ankle which is ‘hot to the touch’. These clinical findings are soon followed by characteristic magnetic resonance imaging (MRI) abnormalities and later X‐ray changes. The joints that are most typically involved in chronological order are the tarsometatarsals followed by the naviculocuniform, sub‐tarsal, talonavicular and metatarsal and tarsophalangeal. The cornerstone of therapy is prolonged (3–12 months) offloading with immobilization. Bisphosphonates may possibly accelerate recovery, whereas other unproven possible therapies include rhPTH, 1–34, calcitonin and methylprednisolone, which are not only ineffective but in some cases may also prolong the time to healing. Denosumab is potentially an efficacious, if unproven, therapy to accelerate healing. The risk of amputation is high and increases in the presence of a foot ulcer. DCN is associated with manifestations of autonomic neuropathy, including cardiac denervation, so that the risks of a cardiac event and heart failure are increased with DCN. Mortality is also increased with DCN, especially in the presence of a foot ulcer. To avoid the recurrence of DCN and especially to lower the risk of the recurrence of a foot ulcer recurrence reconstructive, surgery may be needed. [ABSTRACT FROM AUTHOR]

Aim: The relative contributions of insulin secretory defects and possible additional contribution of insulin resistance for the development of cystic fibrosis (CF)‐related diabetes (CFRD) are poorly understood. We aimed to (a) determine which indices of insulin resistance predict progression to CFRD, and (b) to model the relative contributions of insulin secretory function and insulin resistance to predict the risk of CFRD. Materials and Methods: Three hundred and three individuals living with CF underwent a 2‐h oral glucose tolerance test with blood sampling every 30 min at 12–24‐month intervals until they developed CFRD or until the end of follow‐up (up to 15 years). Indices of insulin resistance (e.g. Stumvoll) and insulin secretion were calculated from oral glucose tolerance test glucose and insulin measurements. CFRD‐free survival was assessed by survival analysis. Results: Estimated insulin resistance showed associations with glucose homeostasis and risk of progression to CFRD. The CFRD‐free survival was significantly different between quartiles of insulin resistance (p < 0.0001). When patients were subdivided according to both insulin resistance and insulin secretion (insulinogenic index), CFRD‐free survival was significantly lower in those with combined lowest insulin secretion and highest insulin resistance (Stumvoll) indices (hazard ratio: 11.2; p < 0.0001). There was no significant difference when the same analysis was performed for the nine other indices. Conclusions: Insulin resistance is correlated with glucose homeostasis and the risk of progression to CFRD. Patients combining low insulin secretion and high insulin resistance had the greatest odds of developing CFRD over a 15‐year period. [ABSTRACT FROM AUTHOR]

Aim: To examine the associations of tea consumption (both frequency and type) with (1) prediabetes and diabetes and (2) urinary glucose and sodium excretion in Chinese community‐dwelling adults. Materials and Methods: In 1923 participants (457 with diabetes, 720 with prediabetes, and 746 with normoglycaemia), the frequency (occasional, frequent, daily, or nil) and type (green, black, dark, or other) of tea consumption were assessed using a standardized questionnaire. Morning spot urinary glucose and urine glucose‐to‐creatinine ratios (UGCRs) were assessed as markers of urinary glucose excretion. Tanaka's equation was used to estimate 24‐h urinary sodium excretion. Logistic and multivariate linear regression analyses were performed. Results: Compared with non‐tea drinkers, the corresponding multivariable‐adjusted odds ratios (ORs) for prediabetes and diabetes were 0.63 (95% confidence interval [CI] 0.48, 0.83) and 0.58 (95% CI 0.41, 0.82) in participants drinking tea daily. However, only drinking dark tea was associated with reduced ORs for prediabetes (0.49, 95% CI 0.36, 0.66) and diabetes (0.41, 95% CI 0.28, 0.62). Dark tea consumption was associated with increased morning spot urinary glucose (0.22 mmol/L, 95% CI 0.11, 0.34 mmol/L), UGCR (0.15 mmol/mmol, 95% CI 0.05, 0.25 mmol/L) and estimated 24‐h urinary sodium (7.78 mEq/day, 95% CI 2.27, 13.28 mEq/day). Conclusions: Regular tea consumption, especially dark tea, is associated with a reduced risk of dysglycaemia and increased urinary glucose and sodium excretion in Chinese community‐dwelling adults. [ABSTRACT FROM AUTHOR]

Aim: The management of type 2 diabetes mellitus has advanced in the last two decades since the introduction of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs). However, multiple factors may interfere with achieving better glycaemic control. This study evaluated the differences between various GLP‐1RAs in efficacy, adherence and persistence. Materials and Methods: We conducted a retrospective cohort study using the electronic medical database from Clalit Health Services. Adults with type 2 diabetes mellitus who purchased any GLP‐1RA between 2009 and 2021 were included. The Index Date was defined as the date of the first purchase of any GLP‐1RA. We evaluated the adherence, persistence and glycaemic control after GLP‐1RAs initiation. Baseline glycaemic and post‐treatment glycaemic controls were analysed. Results: In total, 70 654 patients were included. The mean age was 11.7 ± 60.4, and 51% were females. A significant reduction in glycated haemoglobin (HbA1c) was observed in all patients who received GLP‐1RAs. However, the percentage of changes in the HbA1c was higher among weekly GLP‐1RA than daily initiators (14.6% vs. 10.2%, p < 0.001). The proportion of subjects with any decrease in HbA1c was higher among the once‐weekly compared with the daily dose (82.4% vs. 74.7%) and mainly patients initiated semaglutide or dulaglutide, with 16.0% and 14.7% reduction. The frequency of good adherence (the proportion of days covered ≥80%) was significantly higher among the weekly group odds ratio = 1.25 (95% confidence interval 1.21–1.28). Good adherence was reported in older age, female gender, Jewish ethnicity and high socio‐economic status (p < 0.001). Conclusions: Weekly GLP‐1RAs initiators were more adherent, persistent to therapy and achieved better glycaemic control. Epidemiological variables might play a role in achieving this goal. [ABSTRACT FROM AUTHOR]

Aim: To investigate the clinical significance of body weight changes on kidney outcomes among individuals with diabetes using sodium–glucose cotransporter‐2 (SGLT2) inhibitors. Materials and Methods: This is a retrospective cohort study using a nationwide epidemiological database, and we conducted an analysis involving 11 569 individuals with diabetes who were newly prescribed SGLT2 inhibitors. The main outcome was the rate of decline in estimated glomerular filtration rate (eGFR), determined through a linear mixed‐effects model with an unstructured covariance structure. Results: The median age of the patients was 52 (Q1–Q3: 47–58) years, and the median fasting plasma glucose and glycated haemoglobin (HbA1c) levels were 144 (Q1–Q3: 124–175) mg/dL and 7.4 (Q1–Q3: 6.8–8.3)%, respectively. The median estimated eGFR was 77.7 (Q1–Q3: 67.2–89.1) mL/min/1.73 m2. The median follow‐up period was 1.7 (Q1–Q3: 1.0–2.6) years. Participants were stratified into three groups based on the body mass index change rate tertiles between baseline and 1 year after (tertile 1: <−4.55%, tertile 2: −4.55% to −1.43%, tertile 3: >−1.43%). The annual change in eGFR was −0.78 (−0.94 to −0.63) mL/min/1.73 m2 in tertile 1, −0.95 (−1.09 to −0.81) mL/min/1.73 m2 in tertile 2, and −1.65 mL/min/1.73 m2 (−1.84 to −1.47) in tertile 3 (pinteraction < 0.001). A variety of sensitivity analyses confirmed the relationship between the 1‐year body mass index decrease and favourable kidney outcomes after SGLT2 inhibitor administration. Conclusions: Our analysis of a nationwide epidemiological cohort revealed that kidney outcomes following the initiation of SGLT2 inhibitors would be more favourable, with greater body weight loss observed after the initiation of SGLT2 inhibitors. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the renal prognosis of dipeptidyl peptidase‐4 inhibitor (DPP‐4i) users and non‐users using real‐world Asian data. Methods: Using databases from DeSC Healthcare, Inc., patients aged 30 years or older who used antidiabetic drugs from 2014 to 2021 were identified. Propensity score matching analyses were used to compare renal prognosis between DPP‐4i users and non‐users. The primary outcomes were estimated glomerular filtration rate (eGFR) decline and end‐stage kidney disease (ESKD) development in the eGFR of 45 mL/min/1.73m2 or higher and eGFR of less than 45 mL/min/1.73m2 groups, respectively. Results: In total, 65 375 and 9866 patients were identified in the eGFR of 45 mL/min/1.73m2 or higher and eGFR of less than 45 mL/min/1.73m2 groups, respectively. In the eGFR of 45 mL/min/1.73m2 or higher group, propensity score matching created 16 002 pairs. A significant difference was observed in the primary outcome of eGFR decline between DPP‐4i users and non‐users at 2 years (−2.31 vs. −2.56 mL/min/1.73m2: difference, 0.25 mL/min/1.73m2; 95% confidence interval [CI], 0.06‐0.44) and 3 years (−2.75 vs. −3.41 mL/min/1.73m2: difference, 0.66 mL/min/1.73m2; 95% CI, 0.39‐0.93). In the eGFR less than 45 mL/min/1.73m2 group, propensity score matching created 2086 pairs. After a mean of 2.2 years of observation, ESKD development was 1.15% and 2.30% in users and non‐users, respectively, and Kaplan–Meier analysis revealed a significant difference (log rank P =.005). Conclusions: This retrospective real‐world study revealed that patients using DPP‐4is had a better renal prognosis than those not using DPP‐4is. [ABSTRACT FROM AUTHOR]

Aim: To evaluate associations between social disadvantage and insulin pump use among adults with type 1 diabetes (T1D) in the context of a universal publicly funded insulin pump programme in Ontario, Canada, and to ascertain whether social disparities in insulin pump programme enrolment have decreased over time. Methods: Population‐based cross‐sectional studies were conducted using administrative healthcare data in Ontario, Canada. First, among adults aged older than 18 years diagnosed with T1D before 31 March 2021, logistic regression was used to assess the association between neighbourhood social disadvantage (Ontario marginalization index quintiles) and insulin pump use. Second, among all paediatric and adult applicants to the insulin pump programme from 1 September 2006 to 31 March 2022, ordinal logistic regression was used to evaluate associations between year of insulin pump initiation and social disadvantage. Results: Among 27 453 adults with T1D, 60% used insulin pumps. Greater social disadvantage was associated with lower odds of insulin pump use (adjusted odds ratio [OR] 0.44 [95% confidence interval {CI} 0.39‐0.48] for greatest vs. lowest social disadvantage quintile). Among 21 002 paediatric and adult applicants to the insulin pump programme, social disparities in pump use decreased in the first 3 years of the programme, plateaued until 2020, then increased from 2020 to 2022, with no change in the odds of being in a higher social deprivation quintile for 2022 relative to 2007 (OR 1.09 [95% CI 0.83‐1.44]). Conclusions: Despite a universal pump programme for individuals with T1D, disparities by social disadvantage persist. Residual financial and non‐financial barriers must be addressed to promote equitable insulin pump uptake. [ABSTRACT FROM AUTHOR]

Aim: Diabetes mellitus is a major cause of death. Outpatients with diabetes have more complications than patients in general practice; mortality patterns have only been studied in the total diabetes population. This study aims to assess mortality, causes, and predictors in outpatients with diabetes. Materials and Methods: A cohort study, included people with diabetes mellitus from the nationwide Dutch Paediatric and Adult Registry of Diabetes (DPARD) visiting diabetes outpatient clinics in 2016‐2020. DPARD data were linked to Statistics Netherlands (CBS), comprising data on mortality, ethnicity and education. All‐cause and cardiovascular mortality rates were estimated using Cox proportional hazard regression. Results: During a median follow‐up of 3.1 years among 12 992 people with diabetes, mortality rates per 10 000 person‐years were 67.7 in adult type 1 diabetes and 324.2 in type 2 diabetes. The major cause of non‐cardiovascular death was malignancy. During the pandemic years of influenza (2018) and COVID (2020), mortality rates peaked. Age, smoking and an estimated glomerular filtration rate of <60 ml/min were associated with all‐cause mortality. In type 2 diabetes, additional factors were male sex, body mass index <20 kg/m2, diabetes duration <1 year and hypertension. Conclusions: Mortality among Dutch outpatients with diabetes is high. Smoking and renal failure were associated with mortality in both types. Further focus on early detection and treatment of mortality‐associated factors may improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Aims Materials and Methods Results Conclusions In 2022, the Centers for Medicare & Medicaid Services released proposed changes to Medicare's continuous glucose monitoring (CGM) coverage policy, making individuals with a history of problematic hypoglycaemia eligible for CGM coverage, irrespective of insulin use. This study estimated the burden of hypoglycaemia in Medicare Advantage beneficiaries with noninsulin‐treated type 2 diabetes (T2D).We retrospectively analysed US healthcare claims data using Optum's deidentified Clinformatics® database. Noninsulin‐treated beneficiaries were identified in the 16 years from January 2007 to March 2023. Hypoglycaemia‐related encounters (HREs) were those accompanied by a hypoglycaemia‐specific ICD‐9/10 diagnosis code in any position on the claim or the first or second position. HREs following the first claim related to T2D were reported by setting (ambulatory or inpatient/emergency department [ED]).HREs were identified in 689,853 (21.4%) of 3,229,695 noninsulin‐treated Medicare Advantage beneficiaries, of whom 82.9% (n = 571,581) had ≥1 HRE in an ambulatory location and 26.8% (n = 184,833) in an ED/inpatient location. Use of sulfonylurea (odds ratio [OR]: 4.33 confidence interval [CI: 4.27–4.38]), evidence of end‐stage kidney disease (OR: 2.87 [CI: 2.79–2.94]), hypertension (OR: 3.09 [CI: 3.04–3.15]) and retinopathy (OR: 2.94 [CI: 2.82–3.07]) were the strongest predictors of an HRE (p < 0.001).These findings show that HREs are prevalent in noninsulin‐treated diabetes and identify a large number of patients who may benefit from CGM. Because >80% of HREs occur in the ambulatory setting and >70% occur in patients not taking sulfonylureas, primary care providers should be aware of the latest eligibility criteria for Medicare's coverage of CGM and not restrict this technology to their sulfonylurea‐treated patients. [ABSTRACT FROM AUTHOR]

Aim Materials and Methods Results Conclusion To develop an automated computable phenotype (CP) algorithm for identifying diabetes cases in children and adolescents using electronic health records (EHRs) from the UF Health System.The CP algorithm was iteratively derived based on structured data from EHRs (UF Health System 2012–2020). We randomly selected 536 presumed cases among individuals aged <18 years who had (1) glycated haemoglobin levels ≥ 6.5%; or (2) fasting glucose levels ≥126 mg/dL; or (3) random plasma glucose levels ≥200 mg/dL; or (4) a diabetes‐related diagnosis code from an inpatient or outpatient encounter; or (5) prescribed, administered, or dispensed diabetes‐related medication. Four reviewers independently reviewed the patient charts to determine diabetes status and type.Presumed cases without type 1 (T1D) or type 2 diabetes (T2D) diagnosis codes were categorized as non‐diabetes/other types of diabetes. The rest were categorized as T1D if the most recent diagnosis was T1D, or otherwise categorized as T2D if the most recent diagnosis was T2D. Next, we applied a list of diagnoses and procedures that can determine diabetes type (e.g., steroid use suggests induced diabetes) to correct misclassifications from Step 1. Among the 536 reviewed cases, 159 and 64 had T1D and T2D, respectively. The sensitivity, specificity, and positive predictive values of the CP algorithm were 94%, 98% and 96%, respectively, for T1D and 95%, 95% and 73% for T2D.We developed a highly accurate EHR‐based CP for diabetes in youth based on EHR data from UF Health. Consistent with prior studies, T2D was more difficult to identify using these methods. [ABSTRACT FROM AUTHOR]

Aim: To examine the associations between visceral adipose tissue (VAT) and brain structural measures at midlife and explore how these associations may be affected by age, sex and cardiometabolic factors. Methods: We used abdominal and brain magnetic resonance imaging data from a population‐based cohort of people at midlife in the UK Biobank. Regression modelling was applied to study associations of VAT volume with total brain volume (TBV), grey matter volume (GMV), white matter volume, white matter hyperintensity volume (WMHV) and total hippocampal volume (THV), and whether these associations were altered by age, sex or cardiometabolic factors. Results: Complete data were available for 17 377 participants (mean age 63 years, standard deviation = 12, 53% female). Greater VAT was associated with lower TBV, GMV and THV (P <.001). We found an interaction between VAT and sex on TBV (P <.001), such that the negative association of VAT with TBV was greater in men (β = −2.89, 95% confidence interval [CI] −2.32 to −10.15) than in women (β = −1.32, 95% CI −0.49 to −3.14), with similar findings for GMV. We also found an interaction between VAT and age (but not sex) on WMHV (P <.001). The addition of other cardiometabolic factors or measures of physical activity resulted in little change to the models. Conclusions: VAT volume is associated with poorer brain health in midlife and this relationship is greatest in men and those at younger ages. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of denosumab on (i) the incidence of type 2 diabetes (T2D), and (ii) long‐term health outcomes (microvascular [neuropathy, retinopathy, nephropathy] and macrovascular [cardiovascular disease, cerebrovascular accident] complications, and all‐cause mortality) in patients with T2D, before (iii) combining results with prior studies using meta‐analysis. Methods: A retrospective analysis of data in a large global federated database (TriNetX; Cambridge, MA) was conducted from 331 375 patients, without baseline T2D or cancer, prescribed either denosumab (treatment, n = 45 854) or bisphosphonates (control, n = 285 521), across 83 healthcare organizations. Propensity score matching (1:1) of confounders was undertaken that resulted in 45 851 in each cohort. Secondary analysis further evaluated the impact of denosumab on long‐term health outcomes in patients with T2D. Additionally, we systematically searched prior literature that assessed the association between denosumab and T2D. Estimates were pooled using random‐effects meta‐analysis. Risk of bias and evidence quality were assessed using Cochrane‐endorsed tools. Results: Denosumab (vs. bisphosphonates) was associated with a lower risk of incident T2D over 5 years (hazard ratio 0.83 [95% confidence interval {CI} 0.78‐0.88]). Secondary analysis showed significant risk reduction in all‐cause mortality (0.79 [0.72‐0.87]) and foot ulceration (0.67 [0.53‐0.86]). Also, pooled results from four studies (three observational, one randomized controlled trial) following meta‐analysis showed a reduced relative risk (RR [95% CI]) for incident T2D in patients prescribed denosumab (0.83 [0.79‐0.87]) (I2 = 10.76%). Conclusions: This is the largest cohort study to show that denosumab treatment is associated with a reduced RR of incident T2D, as well as an associated reduced RR of all‐cause mortality and microvascular complications, findings that may influence guideline development in the treatment of osteoporosis, particularly in patients who are at a high risk of T2D. [ABSTRACT FROM AUTHOR]

Aim: To investigate if patients with diabetes taking metformin have better outcomes versus those not taking metformin following an emergency room visit for influenza. Methods: Using electronic medical records, we performed a retrospective chart review of all adult patients with a diagnosis of diabetes seen in any Duke University Medical Center‐affiliated emergency department for influenza over a 6‐year period. We documented patient characteristics and comorbidities, and compared outcomes for patients taking metformin versus patients not taking metformin using both univariable and multivariable analyses. Our primary outcome was hospital admission rate. Secondary outcomes were in‐hospital length of stay and in‐hospital death. Results: Our cohort included 1023 adult patients with diabetes, of whom 59.9% were female. The mean age was 62.9 years, 58.4% were African American, 36.1% were White, and 81.9% were obese or overweight. Of these patients, 347 (34%) were taking metformin. Patients with diabetes taking metformin were less likely to be hospitalized following an emergency department visit for influenza than patients with diabetes not taking metformin (56.8% vs. 70.1%; p < 0.001). Of those patients admitted, there was no statistically significant difference in length of stay or death. Conclusions: In patients with diabetes, metformin use is associated with lower rate of hospitalization following an emergency department visit for influenza. [ABSTRACT FROM AUTHOR]

This research letter discusses a study that explores the suicide rates among individuals with diabetes in the United States. The study reveals that individuals with diabetes have a higher risk of suicide compared to the general population. The risk is particularly elevated among White patients with diabetes, but diabetes is a larger risk factor for suicide among Black patients. Additionally, females with diabetes are more susceptible to suicide than males, and all levels of urbanization are associated with a higher suicide risk. The study suggests that targeted interventions for at-risk populations could help reduce suicide rates among individuals with diabetes. However, the study has limitations, such as the lack of differentiation between type 1 and type 2 diabetes in the data and the inability to establish a causal relationship between diabetes and suicide. The authors emphasize the urgent need for action from policymakers, investigators, and healthcare professionals to address the growing burden of both diabetes and suicide in the United States. [Extracted from the article]

This article, published in the journal Diabetes, Obesity & Metabolism, discusses a study that examines the connection between carpal tunnel syndrome (CTS) and the development of diabetes. The study used data from Danish nationwide registries to compare patients who had surgery for CTS with a control group from the general population. The findings indicate that individuals with CTS have a higher risk of developing diabetes compared to the control group. The study emphasizes the importance of early detection and intervention for better outcomes. However, other factors like obesity and glycated hemoglobin levels may also influence this relationship. Further research is needed to fully understand the connection between CTS and diabetes. [Extracted from the article]

Aim: The transition to the ICD‐10‐CM coding system has reduced the utility of hypoglycaemia algorithms based on ICD‐9‐CM diagnosis codes in real‐world studies of antidiabetic drugs. We mapped a validated ICD‐9‐CM hypoglycaemia algorithm to ICD‐10‐CM codes to create an ICD‐10‐CM hypoglycaemia algorithm and assessed its performance in identifying severe hypoglycaemia. Materials and Methods: We assembled a cohort of Medicare patients with DM and linked electronic health record (EHR) data to the University of North Carolina Health System and identified candidate severe hypoglycaemia events from their Medicare claims using the ICD‐10‐CM hypoglycaemia algorithm. We confirmed severe hypoglycaemia by EHR review and computed a positive predictive value (PPV) of the algorithm to assess its performance. We refined the algorithm by removing poor performing codes (PPV ≤0.5) and computed a Cohen's κ statistic to evaluate the agreement of the EHR reviews. Results: The algorithm identified 642 candidate severe hypoglycaemia events, and we confirmed 455 as true severe hypoglycaemia events, PPV of 0.709 (95% confidence interval: 0.672, 0.744). When we refined the algorithm, the PPV increased to 0.893 (0.862, 0.918) and missed <2.42% (<11) true severe hypoglycaemia events. Agreement between reviewers was high, κ = 0.93 (0.89, 0.97). Conclusions: We translated an ICD‐9‐CM hypoglycaemia algorithm to an ICD‐10‐CM version and found its performance was modest. The performance of the algorithm improved by removing poor performing codes at the trade‐off of missing very few severe hypoglycaemia events. The algorithm has the potential to be used to identify severe hypoglycaemia in real‐world studies of antidiabetic drugs. [ABSTRACT FROM AUTHOR]

Aim: To characterize the impact of the COVID‐19 pandemic on diabetes diagnosis using data from Alberta's Tomorrow Project (ATP), a population‐based cohort study of chronic diseases in Alberta, Canada. Materials and Methods: The ATP participants who were free of diabetes on 1 April 2018 were included in the study. A time‐segmented regression model was used to compare incidence rates of diabetes before the COVID‐19 pandemic, during the first two COVID‐19 states of emergency, and in the period when the state of emergency was relaxed, after adjusting for seasonality, sociodemographic factors, socioeconomic status, and lifestyle behaviours. Results: Among 43 705 ATP participants free of diabetes (65.5% females, age 60.4 ± 9.5 years in 2018), the rate of diabetes was 4.75 per 1000 person‐year (PY) during the COVID‐19 pandemic (up to 31 March 2021), which was 32% lower (95% confidence interval [CI] 21%, 42%; p < 0.001) than pre‐pandemic (6.98 per 1000 PY for the period 1 April 2018 to 16 March 2020). In multivariable regression analysis, the first COVID‐19 state of emergency (first wave) was associated with an 87.3% (95% CI −98.6%, 13.9%; p = 0.07) reduction in diabetes diagnosis; this decreasing trend was sustained to the second COVID‐19 state of emergency and no substantial rebound (increase) was observed when the COVID‐19 state of emergency was relaxed. Conclusions: The COVID‐19 public health emergencies had a negative impact on diabetes diagnosis in Alberta. The reduction in diabetes diagnosis was likely due to province‐wide health service disruptions during the COVID‐19 pandemic. Systematic plans to close the post‐COVID‐19 diagnostic gap are required in diabetes to avoid substantial downstream sequelae of undiagnosed disease. [ABSTRACT FROM AUTHOR]

Aim: To assess temporal trends of chronic kidney disease (CKD) attributable to type 2 diabetes (T2D) globally and in five sociodemographic index (SDI) regions. Materials and Methods: We extracted the population data and CKD burden attributable to T2D from the Global Burden of Disease Study 2019. We evaluated the trends of disability‐adjusted life years (DALYs), mortality, prevalence and incidence through age‐period‐cohort modelling, and calculated net drifts (overall annual percentage changes), local drifts (annual percentage changes in each age group), longitudinal age curves (fitted longitudinal age‐specific rates), period relative risks (RRs) and cohort RRs. Results: From 1990 to 2019, the global burden of CKD attributable to T2D showed increasing trends in general. The burden of CKD attributable to T2D was highest in the middle SDI region and lowest in the low SDI region. Age effects increased with age, and peaked at the ages of 75‐79 and 80‐84 years for incidence and prevalence, respectively. Period RRs in the burden of CKD attributable to T2D increased, with the high SDI being the most remarkable in DALYs and mortality, and the middle SDI being the most notable in incidence. Cohort RRs showed unfavourable trends in incidence and prevalence among recent cohorts. Conclusions: After a lengthy period of multi‐initiative diabetes management, the high‐middle SDI region exhibited improvement. However, unresolved issues and improvement gaps were still remarkable. Future efforts to reduce the burden of CKD attributable to T2D in the population should prioritize addressing the unfavourable patterns identified. [ABSTRACT FROM AUTHOR]

Aims: To quantify the incremental health and economic burden associated with cognitive impairment (CI) among non‐institutionalized people with diabetes ≥65 years in the United States. Materials and Methods: Using 2016‐2019 Medical Expenditure Panel Surveys data, we identified participants ≥65 years with diabetes. We used propensity score weighting to quantify the CI‐associated incremental burden on health‐related quality of life measured by the 12‐item Short Form Survey (SF‐12), including the mental component summary score, physical component summary score and health utility. We also compared the annual health service utilization and expenditures on ambulatory visits, prescriptions, home care, emergency room (ER), hospitalizations and total annual direct medical expenditures. Results: We included 5094 adults aged ≥65 with diabetes, of whom 804 had CI. After propensity score weighting, CI was associated with a lower mental component summary score (−8.4, p <.001), physical component summary score (−5.2, p <.001) and health utility (–0.12, p <.001). The CI group had more ambulatory visits (+4.4, p =.004) and prescriptions (+9.9, p <.001), with higher probabilities of having home care (+11.3%, p <.001) and ER visits (+8.2%, p =.001). People with CI spent $5441 (p <.001) more annually, $2039 (p =.002) more on prescriptions, $2695 (p <.001) more on home care and $118 (p <.001) more on ER visits. There is no statistically significant difference in the utilization and expenditure of hospitalizations. Conclusion: CI was associated with worse health‐related quality of life, higher health service utilization and expenditures. Our findings can be used to monitor the health and economic burden of CI in non‐institutionalized older persons with diabetes. [ABSTRACT FROM AUTHOR]

Aim: Frequent hypoglycaemia results in disruption to usual hypoglycaemic autonomic responses leading to impaired awareness of hypoglycaemia, which is associated with an increased risk of severe hypoglycaemia requiring third‐party assistance (SH). The UK Driving and Vehicle Licensing Agency (DVLA) does not permit car driving if they have either a complete loss of hypoglycaemia awareness or more than one SH event a year. Methods: The FreeStyle Libre (FSL) Association of British Clinical Diabetologists (ABCD) Nationwide Audit consists of data collected by clinicians during routine clinical work, submitted into a secure web‐based tool held within the National Health Service (NHS) N3 network. Analysis of paired baseline and follow‐up data for people with type 1 diabetes who also held a driving licence was undertaken. Results: The study consisted of 6304 people who had data recorded about driving status from 102 UK specialist diabetes centres, of which 4218 held a driving licence: 4178 a group 1, standard licence, 33 a group 2, large lorries and buses, seven a taxi licence; 1819 did not drive. Paired baseline and follow‐up data were available for a sub‐cohort of 1606/4218. At a mean follow‐up of 6.9 months [95% CI (6.8, 7.1)], the Gold score had improved (2.3 ± 1.5 vs. 2.0 ± 1.3 p <.001), and the number of people who experienced an SH episode was also significantly lower (12.1% vs. 2.7%, p <.001). Conclusion: This study suggests that intermittently scanned continuous glucose monitoring may improve impaired awareness of hypoglycaemia and reduce the number of people with type 1 diabetes with a driving licence experiencing a severe hypoglycaemic episode. [ABSTRACT FROM AUTHOR]

This document summarizes a study on the use of BIAsp 30, a type of insulin, as an alternative to basal-bolus insulin regimens for people with type 2 diabetes. The study found that adding or switching to BIAsp 30 resulted in a small reduction in HbA1c levels after 6 months, along with minor changes in BMI and high treatment persistence. However, some patients still had poor glycemic control and may have needed additional treatments. The study has limitations, including potential errors and a small sample size, and was sponsored by Novo Nordisk A/S. [Extracted from the article]

Aim: To assess the implementation of the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline recommendations for lipid‐lowering therapies among more than 30 000 patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) in a German and Austrian registry from 2020 to 2022. Materials and Methods: Registry data from 2020 and 2021 of 32 170 adult patients (8314 patients with T1D and 23 856 with T2D) were stratified according to the 2019 ESC/EAS risk categories, and guideline‐based low‐density lipoprotein cholesterol (LDL‐C) and non‐high‐density lipoprotein cholesterol (non‐HDL‐C) goal attainment was analysed. Results: In patients with T1D (median age 38.35 [20.51‐57.13] years), overall statin use was 19.3%, ezetimibe use was 2.2% and the use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors or fibrates was less than 1%. In patients with T2D (median age 68.76 [58.86‐78.39] years), 45.7% received statins, 3.4% received ezetimibe, and fibrates and PCSK9 inhibitors were used by 1% and 0.1%, respectively. Among patients with T1D, 6.16% reached their risk‐based recommended LDL‐C goal of less than 55 mg/dL (very high risk), 10.97% of less than 70 mg/dL (high risk), and 69.50% of less than 100 mg/dL (moderate risk), respectively. In patients with T2D, 11.81% reached their risk‐based goal of LDL‐C less than 55 mg/dL, 16.25% of less than 70 mg/dL, and 51.33% of less than 100 mg/dL. Non‐HDL‐C goals were reached more often, with 15.3%, 25.52% and 91.61% in patients with T1D and 18.56%, 17.96% and 82.30% in patients with T2D for very high, high and moderate risk, respectively. Conclusion: Approximately 2 years after publication of the guidelines, LDL‐C and non‐HDL‐C goal attainment was rarely achieved in patients with T1D and T2D with a high or very high cardiovascular risk. [ABSTRACT FROM AUTHOR]

Aims: We investigated the impact of intentional weight loss on health care resource utilization (HCRU) and costs among people with obesity. Materials and Methods: This retrospective, observational cohort study used data from the Clinical Practice Research Datalink (CPRD) GOLD database. Adults >18 years at index date [first recorded body mass index (BMI) of 30‐50 kg/m2 between 2006 and 2015 with a further BMI record 4 years later] were assigned to an intentional weight loss cohort (−25% to −10% BMI change) or a stable weight cohort (−3% to +3%), based on their BMI change during a 4‐year baseline period from index date. Evidence of intention to lose weight during the baseline period was required. Linked Hospital Episode Statistics datasets captured HCRU and costs over an 8‐year follow‐up period. Mixed effects models adjusted for demographics, total costs during baseline and baseline comorbidities were used. Results: Baseline characteristics were similar between cohorts with weight loss (n = 8676) and stable weight (n = 44 519). Over follow‐up, the weight loss cohort experienced a significantly lower mean annual increase in total costs [2.1% (95% confidence interval: 1.3‐2.8)] than the stable weight cohort [4.3% (95% confidence interval: 4.0‐4.6); p <.0001]. Weight loss was associated with a lower mean annual increase in multiple HCRU and cost components compared with maintaining a stable high weight. Conclusions: Our findings suggest that intentional weight loss of 10‐25% is associated with lower HCRU and costs in the long term among individuals living with obesity, relative to stable weight. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the prevalence of overweight/obesity and associated complications from a large, cross‐sectional, nationwide database in China. Materials and Methods: Data were obtained from 519 Meinian health check‐up centres across 243 cities. Eligible participants were aged ≥18 years, with a routine check‐up in 2019 (N = 21 771 683) and complete height, weight, sex and region data. The unadjusted prevalence rates of overweight/obesity were calculated by age, sex and region. In addition, the nationwide prevalence rates of overweight and obesity were standardized according to the 2010 China census by age group and sex. The prevalence of obesity‐related complications by body mass index (BMI) groups was calculated using logistic regression. Results: There were 15 770 094 eligible participants (median age 40 years; mean BMI 24.1 kg/m2; 52.8% male). By Chinese BMI classification, 34.8% were overweight and 14.1% were obese. Overweight and obesity were more prevalent in male than female participants (standardized: overweight 40.2% vs. 27.4%; obesity 17.6% vs. 9.6%, respectively). The prevalence of assessed complications was higher in participants with overweight/obesity versus those with normal BMI (P < 0.001 for trends). The most prevalent complications in participants with overweight/obesity were fatty liver disease, prediabetes, dyslipidaemia and hypertension. The number of complications increased with higher BMI. Conclusions: Overweight/obesity and related complications are highly prevalent in this population. These data may better inform management and prevention public health strategies in China. [ABSTRACT FROM AUTHOR]

Aims: This study investigated the ethnic differences in glycaemic levels and clinical characteristics among insulin‐naïve people with type 2 diabetes (T2D) initiating biphasic insulin aspart 30/70 (BIAsp 30) in primary practice in England. Materials and Methods: Retrospective, observational cohort study utilizing data from the Clinical Practice Research Datalink Aurum database, including White, South Asian, Black and Chinese insulin‐naïve adults with T2D, initiating BIAsp 30. The index date was that of the first BIAsp 30 prescription. Endpoints included change in glycated haemoglobin (HbA1c) and body mass index (BMI) 6 months post index. Results: In total, 11 186 eligible people were selected (9443 White, 1116 South Asian, 594 Black, 33 Chinese). HbA1c decreased across all subgroups 6 months post index: estimated %‐point changes [95% CI of −2.32 (−2.36; −2.28) (White); −1.91 (−2.02; −1.80) (South Asian); −2.55 (−2.69; −2.40) (Black); and −2.64 (−3.24; −2.04) (Chinese)]. The BMI increased modestly 6 months post index in all subgroups [estimated changes (95% CI) kg/m2: White, 0.92 (0.86; 0.99); South Asian, 0.60 (0.41; 0.78); Black, 1.41 (1.16; 1.65); and Chinese, 0.32 (−0.67; 1.30)]. In the overall population, hypoglycaemic event rates increased from 0.92 events per 100 patient‐years before the index to 3.37 events per 100 patient‐years post index; event numbers were too low to be analysed by subgroup. Conclusions: Among insulin‐naïve people with T2D initiating BIAsp 30, clinically meaningful HbA1c reductions in all ethnicities were observed. Some ethnic groups had larger reductions than others, but differences were small. In all groups, small BMI increases were seen, with small differences observed between groups. Hypoglycaemia rates were low. [ABSTRACT FROM AUTHOR]

Aim: To identify predictive factors for diabetic ketoacidosis (DKA) by retrospective analysis of registry data and the use of a subgroup discovery algorithm. Materials and Methods: Data from adults and children with type 1 diabetes and more than two diabetes‐related visits were analysed from the Diabetes Prospective Follow‐up Registry. Q‐Finder, a supervised non‐parametric proprietary subgroup discovery algorithm, was used to identify subgroups with clinical characteristics associated with increased DKA risk. DKA was defined as pH less than 7.3 during a hospitalization event. Results: Data for 108 223 adults and children, of whom 5609 (5.2%) had DKA, were studied. Q‐Finder analysis identified 11 profiles associated with an increased risk of DKA: low body mass index standard deviation score; DKA at diagnosis; age 6‐10 years; age 11‐15 years; an HbA1c of 8.87% or higher (≥ 73 mmol/mol); no fast‐acting insulin intake; age younger than 15 years and not using a continuous glucose monitoring system; physician diagnosis of nephrotic kidney disease; severe hypoglycaemia; hypoglycaemic coma; and autoimmune thyroiditis. Risk of DKA increased with the number of risk profiles matching patients' characteristics. Conclusions: Q‐Finder confirmed common risk profiles identified by conventional statistical methods and allowed the generation of new profiles that may help predict patients with type 1 diabetes who are at a greater risk of experiencing DKA. [ABSTRACT FROM AUTHOR]

Aims: To describe clinical characteristics, treatment patterns and glucagon‐like peptide‐1 receptor agonist (GLP‐1 RA) persistence in individuals with type 2 diabetes (T2D) initiating their first GLP‐1 RA. Materials and Methods: A real‐world analysis of adults with T2D initiating GLP‐1 RA therapy between 2007 and June 2020 from the multicentre Diabetes Prospective Follow‐Up (DPV) Registry, stratified by antidiabetes therapy at the time of GLP‐1 RA initiation: oral antidiabetic drugs (OAD), insulin ± OAD or lifestyle modification (LM). GLP‐1 RA treatment persistence in individuals with ≥12 months follow‐up was determined by Kaplan‐Meier analysis. Results: Overall, 15 111 individuals with T2D initiating GLP‐1 RA therapy (55% men) were identified; median [interquartile range (IQR)] age [58.7 (50.6‐66.7) years], diabetes duration [8.5 (3.6‐14.7) years], glycated haemoglobin [HbA1c; 8.2 (7.1‐9.8)%]. Median (95% confidence interval) GLP‐1 RA persistence in eligible individuals (n = 5189) was 11 (10‐12) months; OAD 12 (11‐14) months (n = 2453); insulin ± OAD 11 (9‐12) months (n = 2204); and LM 7 (5‐9) months (n = 532). Median treatment persistence tended to increase from 2007‐2012 to 2017‐2020. Median (IQR) HbA1c decreased from baseline [8.2 (7.1‐9.8)%] to discontinuation [7.5 (6.6‐8.7)%], with a greater decrease observed in individuals with persistence >12 months versus ≤12 months. Individuals who discontinued GLP‐1 RA therapy predominantly switched to insulin (if not already using) or dipeptidyl peptidase‐4 inhibitors. Conclusion: Real‐world registry data revealed improved outcomes with longer median GLP‐1 RA persistence; ~50% of patients overall achieved HbA1c <7% at 12 months. Persistence was highest with baseline OAD and/or insulin, and tended to increase over the period 2007‐2020. [ABSTRACT FROM AUTHOR]

Aim: To investigate the impact of treatment with once‐weekly subcutaneous semaglutide, a glucagon‐like peptide‐1 receptor agonist (GLP‐1RA), for up to 2 years in people with type 2 diabetes (T2D) managed in routine clinical practice. Materials and methods: The study was based on data from national registries. People who redeemed at least one prescription of semaglutide and had 2 years of follow‐up were included. Data were collected at baseline and after 180, 360, 540 and 720 days of treatment (all timepoints ± 90 days). Results: In total, 9284 people redeemed at least one semaglutide prescription (intention‐to‐treat) and 4132 people redeemed semaglutide continuously (on‐treatment). For the on‐treatment cohort, the median (interquartile range) age was 62.0 (16.0) years, diabetes duration was 10.8 (8.7) years, and glycated haemoglobin (HbA1c) level was 62.0 (18.0) mmol/mol at baseline. A subset of the on‐treatment cohort, comprising 2676 people, had HbA1c measurements at baseline and at least once during 720 days. The mean (95% confidence interval) changes in HbA1c after 720 days were –12.6 (–13.6; –11.6) mmol/mol (P < 0.001) for GLP‐1RA‐naïve people, and –5.6 (–6.2; –5.0) mmol/mol (P < 0.001) for GLP‐1RA‐experienced people. Similarly, 55% of GLP‐1RA‐naïve people and 43% of GLP‐1RA‐experienced people reached a HbA1c target of ≤53 mmol/mol after 2 years. Conclusions: People treated with semaglutide in routine clinical practice experienced clinically relevant and sustained improvements in glycaemic control after 180, 360, 540 and 720 days, irrespective of former GLP‐1RA exposure, effects which were comparable with those observed in clinical studies. These results support the use of semaglutide in routine clinical practice for the long‐term management of T2D. [ABSTRACT FROM AUTHOR]

Aims: To identify patient clusters with poor glucose control among type 2 diabetes mellitus (T2DM) patients with obesity who are receiving basal‐bolus insulin and to identify the potential therapeutic inertia factors associated with poor control. Methods: Glycated haemoglobin (HbA1c) trajectories across a 3‐year period were structured at 6‐month intervals for a retrospective cohort of T2DM patients with obesity on basal‐bolus insulin from the Veterans' Health Administration database. Based on each patient's longitudinal HbA1c features, an unsupervised clustering procedure was used to determine the numbers of clusters and associated trajectory patterns. Multinomial logistic regression was used to examine the association between HbA1c trajectory clusters and patient characteristics/treatment patterns. Results: A total of 51 273 patients were included, of whom 11.2% were in a subgroup with persistent missingness of HbA1c values. For those with sufficient HbA1c observations, cluster analysis indicated six distinct HbA1c trajectories: stable low (35.8%); stable high (20.8%); descending low (10.5%); ascending low (10.2%); descending high (5.7%); and ascending high (5.7%). Being of Black ethnicity, not initiating noninsulin antihyperglycaemic agents (sodium‐glucose cotransporter‐2 inhibitors, glucagon‐like peptide‐1 receptor agonists or thiazolidinediones) or concentrated insulin, low adherence (measured by proportion of days covered), and reduced insulin prescription refills were factors associated with poorer HbA1c clusters; similar factors were associated with persistent HbA1c missingness. Conclusion: The present study found the potential for therapeutic inertia among a significant proportion of T2DM patients with obesity on basal‐bolus insulin. Subgrouping T2DM patients based on HbA1c missingness and HbA1c trajectories can inform disease management strategies. [ABSTRACT FROM AUTHOR]

AimsTo use electronic health record data from real-world clinical practice to assess demographics, clinical characteristics and disease burden of adults with type 1 diabetes (T1D) in the United States.Materials and methodsRetrospective observational study of adults with T1D for ≥24 months at their first visit with a T1D diagnosis code ("index date") between July 2014 and June 2016 in the Optum Humedica database. Demographic characteristics, acute complications (severe hypoglycaemia [SH], diabetic ketoacidosis [DKA]), microvascular complications, cardiovascular (CV) events and health care resource utilization during the 12 months before the index date ("baseline period") were compared between patients with optimal versus suboptimal glycaemic control (glycated haemoglobin [HbA1c] 30 000 adults with T1D showed that individuals with suboptimal versus optimal glycaemic control differed significantly in terms of health care coverage, comorbidities, diabetes-related complications, health care utilization and CV risk factors. However, suboptimal control was not associated with increased risk of CV outcomes.

Aim: To compare outcomes in adults with type 2 diabetes (T2D) suboptimally controlled with basal insulin who initiated treatment with iGlarLixi or premixed insulin. Methods: This retrospective real‐world analysis was conducted using data from adults (age ≥ 18 years) with T2D in the US Optum Clinformatics database who had previously received basal insulin and newly initiated iGlarLixi or premixed insulin. Cohorts were propensity‐score matched on baseline characteristics using a greedy nearest neighbour‐matching algorithm, and outcomes were assessed at 12 months. Subgroup analyses were performed for those aged 65 years or older and those with a baseline HbA1c of 9% or higher. The primary endpoint was treatment persistence in the overall population. Secondary endpoints were treatment adherence, healthcare resource utilization (HRU), costs, hypoglycaemia events and change in HbA1c from baseline. Results: Each cohort comprised 834 participants. In the overall population, treatment persistence at 12 months was statistically significantly higher for iGlarLixi versus premixed insulin: 42.5% versus 39.1%; hazard ratio 0.88; 95% confidence interval 0.778‐0.998; P =.0465. Adherence and HbA1c reduction were similar between groups, whereas hypoglycaemia events, HRU and costs were numerically lower for iGlarLixi. Outcomes in both the age 65 years or older subgroup and in those with an HbA1c of 9% or higher were consistent with those for the overall population. Conclusions: In this observational study in people with T2D suboptimally controlled on basal insulin, once‐daily iGlarLixi was an effective treatment alternative to premixed insulin with significantly higher treatment persistence, similar adherence and HbA1c reduction, and numerically lower hypoglycaemia events, HRU and costs, regardless of age or baseline HbA1c. [ABSTRACT FROM AUTHOR]

2 TABLE Raw incidence rates (IR) of type 1 diabetes in Piedmont (Italy) by 100 000 residents and rate ratios (RR), comparison between before and during the COVID pandemic years. Nevertheless, over the 3 years of the COVID-19 pandemic, the overall incidence of DM1 has remained ~17% higher than before the pandemic, suggesting further work to understand the link between coronaviruses and diabetes is a priority. Keywords: database research; observational; population study; study; type 1 diabetes EN database research observational population study study type 1 diabetes 3068 3070 3 09/06/23 20231001 NES 231001 BACKGROUND There have now been several reports that the incidence of type 1 diabetes (DM1) increased during the COVID-19 pandemic, particularly in young children,[[1], [3]] although some data are conflicting.[4] Overall, however, there is emerging evidence from diabetes registries that this observed increase is real. [Extracted from the article]

Aim: To conduct a pharmacoepidemiological study to explore the association between sodium‐glucose cotransporter‐2 (SGLT2) inhibitors and gout in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: A retrospective open cohort study using the IQVIA Medical Research Data UK database was performed between November 1, 2012 and December 31, 2018, estimating the risk of gout in patients with T2DM who were new users of SGLT2 inhibitors, compared to propensity‐score‐matched new users of dipeptidyl peptidase‐4 (DPP‐4) inhibitors. Results: A total of 85 incident cases of gout were recorded over 30 389 person‐years of observation in 13 617 new users of SGLT2 inhibitors and 29 426 new users of DPP‐4 inhibitors. Crude incidence rates (IRs) per 1000 person‐years were 2.90 and 2.47 for new users of SGLT2 inhibitors and DPP‐4 inhibitors, respectively. The unadjusted hazard ratio (HR) was 1.18 (95% confidence interval [CI] 0.76‐1.83). The adjusted HR was 1.20 (95% CI 0.77‐1.86). In the at‐treatment analysis, crude IRs per 1000 person‐years were found to be 2.68 and 2.53 for SGLT2 inhibitor and DPP‐4 inhibitor users, respectively. In the adjusted model, the adjusted HR was 1.3 (95% CI 0.90‐2.29). Sensitivity analyses did not change the findings. Conclusions: In this nationwide study, no difference in the incidence of gout was documented in patients treated with SGLT2 inhibitors compared to DPP‐4 inhibitor users. This neutral finding remained consistent in sensitivity analyses. [ABSTRACT FROM AUTHOR]

Aim: For people with suboptimally controlled type 2 diabetes (T2D) on basal insulin (BI), guidelines recommend several treatment advancement options. This study compared the clinical effectiveness of once‐daily iGlarLixi versus a multiple‐injection BI + rapid acting insulin (RAI) regimen in adults with T2D advancing from BI therapy in real‐world clinical practice. Materials and methods: Electronic medical records from the Observational Medical Outcomes Partnership (OMOP) database were analysed retrospectively using propensity score matching to compare therapy advancement with iGlarLixi or BI + RAI in US adults ≥18 years with T2D on BI who had ≥1 valid glycated haemoglobin (HbA1c) value at baseline and at the 6‐month follow‐up. The primary objective was non‐inferiority of iGlarLixi to BI + RAI in HbA1c change from baseline to 6 months (margin 0.3%). Results: Propensity score matching generated cohorts with balanced baseline characteristics (N = 814 in each group). HbA1c reduction from baseline to 6 months with iGlarLixi was non‐inferior to BI + RAI [mean difference (95% confidence interval): 0.1 (−0.1, 0.2)%; one‐sided p =.0032]. At 6 months, weight gain was significantly lower with iGlarLixi than with BI + RAI [−0.8 (−1.3, −0.2) kg; two‐sided p =.0069]. Achievement of HbA1c <7% without hypoglycaemia and weight gain were similar between groups [odds ratio (95% confidence interval): 1.15 (0.81, 1.63); p =.4280]. Hypoglycaemia was low in both groups, probably because of underreporting. Conclusions: In real‐world clinical practice, glycaemic outcomes 6 months after treatment advancement from BI are similar for people with T2D using iGlarLixi versus BI + RAI, with iGlarLixi leading to less weight gain. [ABSTRACT FROM AUTHOR]

Aim: To assess the change in HbA1c after initiation of biosimilar follow‐on insulin (Basaglar) or reference insulin (Lantus) among patients with type 2 diabetes. We also compared treatment adherence, safety events and costs at 1 year after initiation of insulin. Materials and Methods: Using claims data from a large US health plan during 2016‐2020, we identified adults with type 2 diabetes who initiated either Basaglar or Lantus. Generalized linear regression modelling assessed the differences in outcomes between the two groups. A 0.4% margin was used to determine non‐inferiority for HbA1c. Results: The study included 1136 Basaglar users and 6304 Lantus users. Both Lantus and Basaglar groups showed more than 1% reduction in HbA1c over 6 months and over 12 months. Reduction in HbA1c with Basaglar was similar (non‐inferior) to that with Lantus, with an adjusted difference of Basaglar to Lantus of 0.14% (95% CI −0.02 to 0.30) over 6 months and 0.17% (95% CI 0.02 to 0.32) over 12 months. Rates of adverse events were similar for both hypoglycaemia and vascular events. The Basaglar group showed higher adherence in terms of proportion of days covered (adjusted difference 0.06, 95% CI 0.04 to 0.08). Medical costs were similar, but the cost of Basaglar was lower (adjusted mean cost difference −$462, 95% CI −$556 to −$363) after adjustment. Conclusions: In patients with type 2 diabetes, Basaglar provided similar glycaemic control compared with Lantus, had a similar safety profile and lower drug costs, and showed more favourable adherence. [ABSTRACT FROM AUTHOR]

Aims: To quantify changes over time in cardiovascular (CV) risk factor control and in the uptake of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) and sodium‐glucose cotransporter‐2 (SGLT2) inhibitors from 2007 to 2020 in a real‐world community‐based cohort of type 2 diabetes (T2D) patients. Materials and Methods: This study identified 95 461 T2D patients, who were followed for an average of 6.4 years through a single healthcare organization's electronic health record. The primary outcome was global risk factor control according to four factors ("ABCS"): glycated haemoglobin (HbA1c [<8%]); Blood pressure (systolic/diastolic <140/90 mmHg); Cholesterol (non‐HDL cholesterol <130 mg/dL); and Smoking (not). Concomitant presence of microvascular complications and commonly used medication classes were tracked. Results: According to the ABCS metric, global risk factor control did not appreciably change over time; in 2020, 40.9% (95% confidence interval 40.2, 41.5) of patients had all four factors controlled. Among individual components, HbA1c control (<8%) worsened over time from 84% in 2007 to 78% in 2020, while lipid control (non‐HDL cholesterol <130 mg/dL) improved from 59% to 72%. Coexisting microvascular complications were more prevalent over time; for example, neuropathy prevalence increased from 21% (2007) to 35% (2020). Use of thiazolidinediones and sulphonylureas decreased over time while metformin, insulin, dipeptidyl peptidase‐4 inhibitor, GLP‐1RA and SGLT2 inhibitor use increased. In 2020, GLP‐1RAs and SGLT2 inhibitors were each used by 13% of T2D patients. Conclusions: In this community‐based study, global CV risk factor control in T2D did not improve, although glycaemic control worsened and lipid control improved. Given increased uptake of GLP‐1RAs and SGLT2 inhibitors, the collective effect of these changes on CV outcomes warrants evaluation. [ABSTRACT FROM AUTHOR]

Representation of risk of T2D among people with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection compared with influenza. Cohort study, database research, health economics, primary care, type 2 diabetes, population study INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may increase the risk of new-onset type 2 diabetes (T2D) with a few observations substantiating concern. Keywords: cohort study; database research; health economics; population study; primary care; type 2 diabetes EN cohort study database research health economics population study primary care type 2 diabetes 1176 1179 4 04/21/22 20220601 NES 220601 PEER REVIEW The peer review history for this article is available at https://publons.com/publon/10.1111/dom.14659. [Extracted from the article]

Aim: To determine the risk of adverse outcomes across the spectrum of glycated haemoglobin (HbA1c) levels among hospitalized COVID‐19 patients with and without diabetes. Materials and methods: Danish nationwide registries were used to study the association between HbA1c levels and 30‐day risk of all‐cause mortality and the composite of severe COVID‐19 infection, intensive care unit (ICU) admission and all‐cause mortality. The study population comprised patients hospitalized with COVID‐19 (3 March 2020 to 31 December 2020) with a positive polymerase chain reaction (PCR) test and an available HbA1c ≤ 6 months before the first positive PCR test. All patients had at least 30 days of follow‐up. Among patients with diabetes, HbA1c was categorized as <48 mmol/mol, 48 to 53 mmol/mol, 54 to 58 mmol/mol, 59 to 64 mmol/mol (reference) and >64 mmol/mol. Among patients without diabetes, HbA1c was stratified into <31 mmol/mol, 31 to 36 mmol/mol (reference), 37 to 41 mmol/mol and 42 to 47 mmol/mol. Thirty‐day standardized absolute risks and standardized absolute risk differences are reported. Results: We identified 3295 hospitalized COVID‐19 patients with an available HbA1c (56.2% male, median age 73.9 years), of whom 35.8% had diabetes. The median HbA1c was 54 and 37 mmol/mol among patients with and without diabetes, respectively. Among patients with diabetes, the standardized absolute risk difference of the composite outcome was higher with HbA1c < 48 mmol/mol (12.0% [95% confidence interval {CI} 3.3% to 20.8%]) and HbA1c > 64 mmol/mol (15.1% [95% CI 6.2% to 24.0%]), compared with HbA1c 59 to 64 mmol/mol (reference). Among patients without diabetes, the standardized absolute risk difference of the composite outcome was greater with HbA1c < 31 mmol/mol (8.5% [95% CI 0.5% to 16.5%]) and HbA1c 42 to 47 mmol/mol (6.7% [95% CI 1.3% to 12.1%]), compared with HbA1c 31 to 36 mmol/mol (reference). Conclusions: Patients with COVID‐19 and HbA1c < 48 mmol/mol or HbA1c > 64 mmol/mol had a higher associated risk of the composite outcome. Similarly, among patients without diabetes, varying HbA1c levels were associated with higher risk of the composite outcome. [ABSTRACT FROM AUTHOR]

Aim: To determine whether body mass index (BMI) can be accurately identified in epidemiological studies using claims databases. Materials and methods: Using the Mass General Brigham Research Patient Data Repository‐Medicare‐linked database, we identified a cohort of patients with a BMI measurement for the periods January 1 to June 31, 2014 or January 1 to June 31, 2016, to capture both the International Classification of Disease (ICD)‐9 and ICD‐10 eras. Patients were divided into two groups, with or without an obesity‐related ICD code in the 6 months before or after the BMI measurement date. We created two binary measures, first for composite overweight, obesity, or severe obesity (BMI ≥25 kg/m2), and second for obesity or severe obesity (BMI ≥30 kg/m2). We calculated accuracy measures (sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV]) for each obesity category for the overall cohort, and stratified by type 2 diabetes and ICD‐code era. Results: The cohort included 73 644 patients with a BMI measurement in 2014 or 2016, of whom 16 280 had an obesity‐related ICD code. The specificity of obesity‐related ICD codes (ICD‐9 and ICD‐10) was 99.7% for underweight/normal weight, 97.4% for overweight, 99.7% for obese and 98.9% for severely obese. For binary categories capturing BMI ≥25 kg/m2 and BMI ≥30 kg/m2, specificity was 97.0% and 98.2%, and PPV was 86.9% and 97.3%. Sensitivity was low overall (<40%). Codes for patients with type 2 diabetes and codes in the ICD‐10 era had higher sensitivity, PPV and NPV. Conclusion: Obesity‐related ICD codes can accurately identify patients with obesity in epidemiological studies using claims databases. [ABSTRACT FROM AUTHOR]

Aims: Studies examining the prevalence of and factors associated with switching from sulphonylureas (SUs) to dipeptidyl peptidase 4 (DPP‐4) inhibitors in real‐world settings are lacking. We assessed the factors associated with switching from SUs to DPP‐4 inhibitors in the United States. Materials and Methods: This retrospective cohort study was conducted using the Optum Clinformatics® Data Mart (2009‐2018). Adults with type 2 diabetes and newly prescribed at least two SUs were included and were followed for 2 years after the initiation of SU (index date). We compared the characteristics of those who switched from SUs to DPP‐4 inhibitors (only; no additional antidiabetic drugs) with those who continued with SUs (without adding other antidiabetic drugs) using multivariate logistic regression. Multinomial regression analyses were also conducted to assess the factors associated with switching to different drug classes versus continuation with SUs. Results: In a sample of 119 107 new SU users, 2.2% (2633) switched to DPP‐4 inhibitors, 3.8% (4542) switched to antidiabetic drugs other than DPP‐4 inhibitors, 68.3% (81 394) discontinued SUs but did not switch to another antidiabetic drug, 12.9% (15 345) continued with SUs and added other antidiabetic drugs, and 12.8% (15 193) continued with SUs only. Multivariate logistic regression showed that those who had significantly higher likelihood of switching were younger, female [vs. males; adjusted odds ratio (AOR) = 0.70], and living in the south; had previous use of DPP‐4 inhibitors (AOR = 1.71); were not using antidiabetic drugs at baseline; had more baseline diabetes‐related emergency room visits (AOR = 1.13), depression (AOR = 1.34), post‐index hypoglycaemia (AOR = 2.20), and an earlier index year; and were glyburide users (vs. glimepiride users; AOR = 1.29). Conclusions: The discontinuation rate for SUs is high. Factors associated with switching from SUs to DPP‐4 inhibitors included age, sex, geographic region, baseline antidiabetic drug use, type of SU, baseline diabetes‐related emergency room visits, hypoglycaemia and depression. [ABSTRACT FROM AUTHOR]