Endocrinology

Comprehensive review clarifies modern type 1 diabetes diagnosis and management

This review characterizes type 1 diabetes as autoimmune β-cell destruction causing insulin deficiency in about 5%–10% of diabetes cases. It emphasizes that 90%–95% of patients have at least one islet autoantibody at diagnosis, often detectable before symptoms emerge. Autoantibody testing helps distinguish type 1 from type 2 or monogenic diabetes and enables early-stage identification. The article outlines basal–bolus insulin regimens and highlights that continuous glucose monitor–pump systems reduce hypoglycemia and improve HbA1c, particularly at higher baseline levels. 1

Tight glycemic targets in GDM reduce LGA and cesareans but increase insulin use

In this single-center RCT, 650 women with GDM were randomized to tight versus less tight glucose targets from 12–31 weeks’ gestation. Tight targets (fasting <5.1 mmol/L; 1-hour postprandial <7.0 mmol/L) reduced large-for-gestational-age births versus less tight targets. Tight control also lowered cesarean delivery rates and gestational weight gain without increasing serious maternal or neonatal complications. Insulin use was substantially higher with tight targets, indicating greater treatment burden and follow-up needs. 2

GLP-1 receptor agonists double 1-year NAION risk versus DPP-4 inhibitors

This active-comparator new-user cohort compared incident NAION after starting GLP-1 receptor agonists versus DPP-4 inhibitors in adults with type 2 diabetes. At 1 year, NAION incidence was 18.5 per 100,000 GLP-1 initiators versus 7.2 per 100,000 DPP-4 initiators. GLP-1 therapy was associated with higher NAION risk (RR 2.56; 95% CI 1.44–4.86; risk difference 11.3 per 100,000). Risk was greatest in the first 6 months and higher in younger patients, men, ever-smokers, and those with ≥1% HbA1c reduction. 3

Metabolic bariatric surgery in T1D produces large weight loss and insulin reductions

This multicenter retrospective cohort included 162 adults with type 1 diabetes and obesity undergoing metabolic bariatric surgery. At 1 year, mean total weight loss was about 30%, with marked reductions in daily insulin requirements. Insulin doses fell from 0.75 to 0.32 units/kg/day, accompanied by a modest but statistically significant HbA1c reduction. Lipid parameters, including LDL, HDL, total cholesterol, and triglycerides, improved significantly after surgery. 4