Daily Endocrinology Research Analysis
A cluster randomized clinical trial in rural Bangladesh showed that a faith-integrated, mosque-based lifestyle program significantly reduced 12‑month type 2 diabetes incidence among adults with prediabetes. A network meta-analysis of 87 RCTs compared cancer risks across antidiabetic drug classes and suggested potential cancer risk reductions for several classes without an overall increase in cancer risk. Multi-omics data identified IL‑18/IL‑18R1 signaling as a candidate biomarker predicting resp
Summary
A cluster randomized clinical trial in rural Bangladesh showed that a faith-integrated, mosque-based lifestyle program significantly reduced 12‑month type 2 diabetes incidence among adults with prediabetes. A network meta-analysis of 87 RCTs compared cancer risks across antidiabetic drug classes and suggested potential cancer risk reductions for several classes without an overall increase in cancer risk. Multi-omics data identified IL‑18/IL‑18R1 signaling as a candidate biomarker predicting response to SGLT2 inhibitors, advancing precision therapeutics in type 2 diabetes.
Research Themes
- Culturally tailored, community-based diabetes prevention
- Cancer safety profiles across antidiabetic drug classes
- Precision medicine biomarkers for SGLT2 inhibitor response
Selected Articles
1. Faith-Based Lifestyle Intervention for Diabetes Prevention Among Adults in Bangladesh: A Cluster Randomized Clinical Trial.
In a cluster RCT of 8 mosque clusters and 799 high‑risk adults with prediabetes, a 12‑month faith-integrated lifestyle program reduced type 2 diabetes incidence from 17.1% to 9.8% (absolute risk reduction 7.3 percentage points; HR 0.75; P=.02), with an NNT of 14. Secondary outcomes, including weight, BMI, glycemic markers, lipids, activity, and quality of life, improved more in the intervention group.
Impact: This rigorous community-based trial demonstrates a scalable, culturally tailored prevention model that significantly reduces diabetes incidence in a low-resource setting.
Clinical Implications: Integrating faith-based, community-delivered lifestyle education into primary prevention could reduce diabetes conversion among high-risk adults, informing public health strategies in similar settings.
Key Findings
- 12-month cumulative T2D incidence was 9.8% vs 17.1% (absolute risk reduction 7.3 percentage points; NNT=14).
- Adjusted Cox model showed HR 0.75 (95% CI, 0.60–0.95; P=.02), indicating a 25% risk reduction.
- Secondary outcomes (weight, BMI, fasting and 2-hour glucose, HbA1c, lipid profiles, knowledge, physical activity, and QoL) improved more in the intervention arm.
Methodological Strengths
- Cluster randomized design with intention-to-treat analysis and clustering adjustment
- Validated risk screening and OGTT confirmation; trial registration (ISRCTN91564707)
Limitations
- Only 8 clusters, which may limit statistical power and generalizability
- Follow-up limited to 12 months; sustainability and long-term outcomes are unknown
Future Directions: Evaluate multi-year sustainability, cost-effectiveness, and scale-up across diverse geographies and faith settings; test integration with primary care and digital support.
2. Association between antidiabetic drugs and cancer risk in patients with type 2 diabetes mellitus: A systematic review and network meta-analysis.
Across 87 RCTs (216,106 participants), antidiabetic drugs did not increase overall cancer risk versus placebo. Network meta-analysis suggested potential reductions in specific cancers by several drug classes (e.g., GLP‑1 RAs for prostate/uterine/hepatocellular/renal/hematologic; SGLT2i for lung/bronchial; DPP‑4i for thyroid/rectal), though heterogeneity and indirectness warrant cautious interpretation.
Impact: Provides a cross-class, RCT-based synthesis of cancer risks that could influence drug selection for patients with varying oncologic risk profiles.
Clinical Implications: While overall cancer risk does not appear elevated with antidiabetic drugs, clinicians may consider class-specific associations when treating patients with heightened risks for certain cancers, pending further validation.
Key Findings
- No increase in overall cancer risk versus placebo across antidiabetic classes in RCTs.
- Class-specific associations suggested: GLP-1 RAs (prostate, uterine, hepatocellular, renal, hematologic), SGLT2i (lung/bronchial), DPP-4i (thyroid/rectal), sulfonylureas (gastric/colon), biguanides (pancreatic), insulin (bladder), TZDs (breast).
- Applied a network meta-analytic framework with confidence in network meta-analysis to rate evidence credibility.
Methodological Strengths
- Network meta-analysis across 26 drugs and 7 classes with large cumulative sample size
- Restricted to RCTs with ≥1 year follow-up; PRISMA-style approach and evidence grading (confidence in NMA)
Limitations
- Indirect comparisons and heterogeneity across trials; many RCTs not powered or designed for cancer endpoints
- Potential multiple-testing issues and variable follow-up durations may influence site-specific findings
Future Directions: Prospective, adequately powered, long-term trials or high-quality real-world studies with standardized cancer adjudication are needed to confirm class-specific associations and mechanisms.
3. Identification of IL18/IL18R1 signaling as a predictive biomarker of SGLT2 inhibitor efficacy in type 2 diabetes.
In 70 patients initiating SGLT2 inhibitors, multi-omics profiling linked reductions in IL‑18R1 to improvements in glycemia, albuminuria, adiposity, and liver function. High baseline IL‑18/IL‑18R1 predicted overall therapeutic response (AUC ~0.75), suggesting a candidate biomarker for precision selection of SGLT2i therapy.
Impact: Introduces an inflammation-related biomarker that may predict multidomain benefits from SGLT2 inhibitors, enabling individualized therapy.
Clinical Implications: Baseline IL‑18/IL‑18R1 measurement could help identify likely responders to SGLT2 inhibitors across glycemic, renal, and metabolic outcomes; clinical adoption requires external validation and standardized assays.
Key Findings
- Proteomics identified IL‑18R1 reduction associated with improved HbA1c, albuminuria, fat mass, and liver function after SGLT2i initiation.
- High baseline IL‑18/IL‑18R1 predicted overall treatment response with ROC AUC ~0.75.
- Transcriptomic data supported anti-inflammatory shifts in mononuclear cells during therapy.
Methodological Strengths
- Prospective clinical phenotyping integrated with plasma proteomics and transcriptomics
- Multidomain outcome assessment (glycemia, renal, adiposity, BP, uric acid, body composition)
Limitations
- Single-cohort sample (n=70) without external validation; cutoffs and assay standardization not established
- Non-randomized design cannot exclude confounding; follow-up duration not detailed
Future Directions: Validate IL‑18/IL‑18R1 as a predictive biomarker in larger, diverse cohorts and RCTs; define clinical cutoffs and assay standards; test biomarker-guided SGLT2i allocation.