Daily Endocrinology Research Analysis

AIMS: To evaluate the global dementia burden attributable to type 2 diabetes (T2D) from 1990 to 2050 and assess the potential for dementia prevention in T2D through targeted risk factor modification. MATERIALS AND METHODS: This multinational study used data from the prospective UK Biobank cohort and the Global Burden of Disease Study 2021. Lifetime risk of dementia in T2D was quantified with cumulative incidence functions. The T2D-attributable dementia burden was assessed across 204 countries/territories from 1990 to 2050. Further, modifiable risk factors for dementia in T2D were evaluated using multivariable Cox models, and potential preventive effects were quantified. RESULTS: T2D was associated with a higher risk and earlier onset of dementia, especially in cases with T2D diagnosed at ages 30-54 years. Globally, an estimated 9.57 million (95% CI, 5.59-10.39) dementia cases in 2021 were attributable to T2D, accounting for 16.85% (9.64%-18.33%) of the global dementia burden, and this proportion is expected to exceed 25% by 2050. This increasing risk of dementia in T2D was significantly associated with multidomain modifiable risk factors, and optimizing all these factors to favourable levels could potentially prevent 47.1% of dementia cases in T2D. To facilitate the clinical practice of risk prevention, a concise set of T2D Cognitive Health Essential 10 with evidence-based intervention targets was further developed, which was associated with no significant excess dementia risk in T2D. CONCLUSIONS: T2D-attributable dementia is a time-evolving, escalating, and highly modifiable global health challenge. Integrating multidomain interventions into standard diabetes care, particularly for individuals with younger-onset T2D, and adapting strategies to local contexts may substantially reduce the dementia burden.

AIMS: Studies evaluating automated insulin delivery (AID) in type 2 diabetes are limited in number and often conducted in small cohorts. We aimed to summarize efficacy and safety data through a systematic review and meta-analysis. MATERIALS AND METHODS: We searched MEDLINE, PubMed, Web of Science, and CENTRAL databases and performed hand searching until July 1, 2025. We included randomized controlled trials enrolling individuals with type 2 diabetes, evaluating AID against other glucose-lowering treatments, and reporting 24-h time spent in the 70-180 mg/dL glucose range (TIR 70-180 mg/dL) as an outcome. Risk of bias was assessed through the RoB2 tool. RESULTS: A total of nine studies, accounting for 714 adults with type 2 diabetes, were included. AID was associated with improved TIR 70-180 mg/dL (mean difference [MD] 18.43%, 95% confidence interval [CI]: 12.40 to 24.46; low certainty), time above range (TAR; low certainty), TAR > 250 mg/dL, mean glucose, standard deviation (moderate certainty), and HbA1c (moderate certainty) compared to controls, without differences in time below range (TBR; moderate certainty), TBR < 54 mg/dL, and coefficient of variation. Despite similar total daily insulin doses, AID led to a modest gain in body weight (MD 1.58 kg; 95% CI: 0.75 to 2.40) compared to controls. Severe adverse events, including severe hypoglycemia, were rare. No episodes of diabetic ketoacidosis were reported. CONCLUSIONS: In individuals with type 2 diabetes, AID is associated with short-term improvements in glycemic control, although the certainty of evidence is low to moderate. TRAIL REGISTRATION: PROSPERO 2025 CRD420251083874.

OBJECTIVE: People receiving dialysis are at high risk of cardiovascular and all-cause mortality. Semaglutide reduces major adverse cardiovascular events (MACE) in people with type 2 diabetes (T2D) and those without T2D with obesity and high cardiovascular risk. Data to establish safety and efficacy in dialysis-dependent kidney failure are scarce. We aimed to assess the safety of semaglutide in people who initiate dialysis. RESEARCH DESIGN AND METHODS: In this post hoc analysis of four randomized, placebo-controlled trials (Trial to Evaluate Cardiovascular and Other Long-term Outcomes With Semaglutide in Subjects With Type 2 Diabetes [SUSTAIN-6], Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity [SELECT], Evaluate Renal Function With Semaglutide Once Weekly [FLOW], and Semaglutide Cardiovascular Outcomes [SOUL]), we evaluated systematically collected adverse events (AEs) from participants who initiated dialysis during study follow-up. We compared the proportion and event rates of systematically collected serious AEs (SAEs), including adjudicated MACE, and AEs leading to permanent treatment discontinuation in participants originally randomized to semaglutide or placebo who remained on treatment after dialysis initiation. RESULTS: Among 34,064 participants randomized across the trials, 307 initiated dialysis, of whom 165 participants randomized to semaglutide (n = 71) or placebo (n = 94) remained on treatment. After dialysis initiation, SAEs were reported in 32 of 71 (45%) and 54 of 94 (57%) participants, and the proportion of participants who permanently discontinued trial medication was 8.5% and 10.6% in the semaglutide and placebo groups, respectively. The MACE event rates were 9.7 and 16.1 events per 100 person-years, and all-cause mortality event rates were 13.8 and 18.1 events per 100 person-years, in the semaglutide and placebo groups, respectively. CONCLUSIONS: Although more evidence is needed, continuation of semaglutide after dialysis initiation appears safe and warrants efficacy testing regarding reduction in MACE and death.