• Research article
  • Open access
  • Published: 24 May 2019

“I have got diabetes!” – interviews of patients newly diagnosed with type 2 diabetes

  • M. Pikkemaat   ORCID: orcid.org/0000-0002-9808-207X 1 , 2 ,
  • K. Bengtsson Boström 3 , 4 &
  • E. L. Strandberg 5  

BMC Endocrine Disorders volume  19 , Article number:  53 ( 2019 ) Cite this article

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To be diagnosed with type 2 diabetes is a challenge for every patient. There are previous studies on patients’ experience in general but not addressing the increased cardiovascular risk and multifactorial treatment. The aim of this study was to explore the thoughts, experiences and reactions of newly diagnosed patients with diabetes to this diagnosis and to the risk of developing complications.

Ten adults (7 men/3 women, aged 50–79) diagnosed with type 2 diabetes within the last 12 months were interviewed at a primary health care center in Sweden. An interview guide was used in the semi-structured interviews that were transcribed verbatim. The analysis was qualitative and inspired by systematic text condensation (Malterud). The text was read several times and meaning units were identified. Related meaning units were sorted into codes and related codes into categories during several meetings between the authors. Finally, the categories were merged and formed themes.

We defined three main themes: Reaction to diagnosis, Life changes and Concerns about the future. Most patients reacted to the diagnosis without intensive feelings. Lifestyle changes were mainly accepted but hard to achieve. The patients’ major concerns for the future were the consequences for daily life (being able to drive and read) and concerns for relatives rather than anxieties regarding medical issues such as laboratory tests. There were considerable differences in how much patients wanted to know about their future risks.


The results of this study might help to focus doctor-patient communication on issues highlighted by the patients and on the importance of individualizing information and recommendations for each patient.

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The prevalence of type 2 diabetes has increased in the last few decades [ 1 ], while the average age at diagnosis has decreased [ 2 ]. Diabetes confers an elevated risk of cardiovascular complications or premature death compared to the background population [ 3 ]. To lower the risk of complications it is important to lower the glucose level but also to treat risk factors such as hypertension, hyperlipidemia and obesity [ 4 ]. Therefore, starting at the time of diagnosis the patient is prescribed several drugs over a short time. Necessary changes of lifestyle are also challenging and can radically change the patient’s way of life [ 5 , 6 ].

In Sweden, patients with type 2 diabetes mellitus are usually taken care of at the primary healthcare centers (PHCCs) [ 7 ]. The PHCCs are responsible for a certain number of listed patients. Both General Practitioners (GPs), mostly specialists in family medicine, and diabetes specialist nurses meet the diabetes patients. The care is based on regional guidelines based on the Swedish national guidelines [ 8 ]. In Sweden, a patient with diabetes with no complications or changes of medication, visits the practice twice a year for check-ups, which means meeting the GP once a year and meeting the nurse once a year on a routine basis. Additional visits take place only when needed, for example if complications arise or after a change of medication. Prescriptions are often renewed with four iterations to cover 1 year and can be renewed by e-mail without physical meetings with the GP. Other professionals available to the patients at the PHCCs may be chiropodists, social workers, physiotherapists, psychologists and/or dieticians. Only in case of complications which cannot be managed at the PHCC is the patient referred to other specialists [ 7 ]. The Swedish health care system is publicly financed. Coverage is universal and automatic. Private health insurance, in the form of supplementary coverage, accounts for less than 1% of expenditures.

The health care staff and specifically the physician are obliged to inform the patient about the importance of pharmacological treatment and the benefits of the lifestyle changes to reach the different goals of treatment.

Most patients understand the benefit of normalizing blood glucose levels. Discussions about blood pressure and treatment with lipid lowering treatment blood lipids can be more challenging. The target levels for blood pressure prevailing for patients with diabetes at the time of the study were set in accord with the European guidelines: less than 140/85, somewhat lower than for patients without diabetes patients [ 9 ]. Lipid target levels for low-density lipoprotein (LDL) cholesterol were less than 2.5 mmol/L for patients without additional complications or risk factors, and 1.8 mmol/L for patients with additional complications, which is lower than for patients without diabetes [ 8 ]. Consequently levels that were seen as normal before diagnosis become elevated or pathological and requiring drug treatment.

Patients may have very different views about the value of knowing about the risk of complications. The patient’s view of a diagnosis of diabetes has been studied before. Reactions can vary from individual to individual, from shock to acceptance or no worry at all. Some patients even deny or repudiate the diagnosis, while others fear the complications [ 10 , 11 ].

Regarding the risk of complications there is a great deal of previous research as well as ongoing research to refine the prediction of risk and to detect high-risk patients at an early stage, including the use of biomarkers [ 12 , 13 , 14 , 15 ]. But it is easy to forget what risk assessment means to the individual patient, and this field has to our knowledge not been previously studied in patients with newly diagnosed diabetes, providing a gap for new research to fill.

Qualitative research including research interviews are valuable complements to quantitative research, helping us to understand individuals and to focus on their thoughts and experiences [ 16 , 17 ]. Qualitative studies addressing the experiences of patients with diabetes mainly focus on prevalent complications [ 18 , 19 ].

There are previous studies on patients’ experience in general but not concerning the increased cardiovascular risk and the multifactorial treatment, especially in newly diagnosed patients with type 2 diabetes. The aim of our study was to explore the thoughts and experiences of these patients.

We chose a qualitative design and individual interviews for this project. Inspired by Kvale [ 17 ], an interview guide for semi-structured interviews was developed (see Additional file  1 ) by the first author, MP, who is a GP and PhD, assisted by the co-authors, KBB, GP with long clinical experience of diabetes care, and ELS, a behavioral scientist with solid experience in qualitative methods, both as a researcher and as a tutor. The guide contained open questions to stimulate the interviewees’ own story and when needed follow-up questions. The main areas were the interviewees’ experiences and thoughts about their diagnosis, the information given by the health care system, risks and complications of the disease, drug treatment and lifestyle changes.


We interviewed adults first diagnosed as having type 2 diabetes mellitus within the last 12 months. They were patients at a PHCC in southern Sweden where the first author, MP, works as a GP. It is medium-sized, having about 9000 listed patients, of all ages and of both Swedish and foreign background. The PHCC is staffed with specialized registered nurses taking care of patients with diabetes. A list of all patients from the PHCC first diagnosed as having diabetes mellitus within the last 12 months was created with help from the patients’ charts. The author’s own patients were excluded from the study. Inclusion criteria apart from a diagnosis of type 2 diabetes in the last 12 months were: ability to participate in the interview without help, i.e. understanding and speaking Swedish, and having no cognitive impairment making the interview difficult to perform. There were no exclusion criteria apart from not meeting the inclusion criteria. The patients on the list were contacted either by the nurses or by the author, consecutively until no further patients were needed. Interested persons received both oral and written information from the nurses or from MP, and after giving written consent a date was set for the interview.

We planned for 10–12 interviews, based on previous studies showing this number to be adequate to achieve saturation, i.e. identifying all the main variations [ 20 ]. MP, the GP, performed all the interviews at the PHCC. The interviewees were offered a more neutral place, but the PHCC was found most convenient for them.

The interview started with general information. The GP performing the interviews presented herself and the aim of the project once more. Information about the participants’ anonymity and their right to stop the interview was repeated. Data about the participants’ age, gender, place of birth and date of diabetes diagnosis was noted.

In the following part the semi-structured interview guide was used as a support with follow-up questions when needed. The interviewees were encouraged to talk freely about their own reflections. This part of the interview was started with an open question about the participants’ thoughts or feelings about having been diagnosed as having diabetes. The participants had the possibility to interpret the question in their own way, giving them space and time to answer freely and even to change topic. Specific questions were mainly used by the GP when the participant fell silent for some time. The interviewer had the three following general topics in her mind: information provided about the disease or treatment, complications of the disease and changes in life after the diagnosis. Those topics were not asked about in chronological or structured form, but possible probing questions were asked when and if the GP felt them meaningful and needed. Such questions could be “Do you see yourself as involved in the treatment process?”, “What do you think about eventual diabetes complications?” or “Do you have any thoughts about changes in your life since your diagnosis of diabetes?” At the end of the interview the participants were asked if there was anything more they would like to add or to conclude and if they had any questions themselves, before the GP thanked them for their participation.

The interviews were recorded digitally and transcribed verbatim by a research assistant experienced in writing interview texts. The texts were then compared to the recordings by MP.

The method for the analysis was qualitative and inspired by systematic text condensation in four steps according to Malterud [ 21 ]. First the text of all the interviews completed was read through several times by the author and the co-authors to get an overview of the data and a general impression of the whole, with an open mind and without theoretical background knowledge or expectations. Reading for the first time was done without making any notes; the second or third time the authors started to summarize their impressions and some preliminary themes emerged, often spontaneous associations arising, similar to preliminary topics. Meeting in person, the authors discussed those and noted initially 14 preliminary themes, already having in mind that some of them might be merged later on.

In the second step “meaning units” in the text were identified by the author and the co-authors, first on their own and then in discussion when meeting. A “meaning unit” was defined as a text fragment containing information in relation to the research question. We started to classify and sort the meaning units we had detected. We marked the meaning units with a code, meaning a label that connected related meaning units. These related meaning units with the same labels formed code groups. At the same time we continued working on the preliminary themes, especially merging some of the preliminary themes. We were flexible in the coding procedure and changed both codes and classifications several times during the procedure while discussing in the group.

In the third step, also called condensation, we only used the text of the meaning units as a decontextualized selection. We worked with one code group after the other. The codes led to categories, and when necessary the categories were divided once more into subcategories.

We worked both on our own and together, discussing the importance of the different points of view, taking advantage of the different working backgrounds of the authors. The codes and categories were discussed several times. As a next step the categories were sorted and classified. Finally the categories were merged to a group of categories belonging together, i.e. describing similar information and forming a theme, which ultimately led to three definitive themes.

In the fourth step, the reconceptualization, we analyzed the content of the different categories one more time, meaning that we put the pieces together again and developed a story with the different meaning units as a base. We wrote a narrative text with our own words using particular examples from the text to illustrate the results. This was repeated for every category.

Ethical considerations

The study was approved by the Regional Ethics Review Board at Lund University.

Interim readings of text found that saturation was reached after 10 interviews; no further interviews were performed. The interviewees were 3 women and 7 men, Table  1 .

During the coding process ten categories emerged, when needed supplemented with subcategories. Examples of text condensation into meaning units, codes and categories are shown in Table  2 .

After further discussions the categories were finally grouped into three main themes comprising 3, 4 and 3 categories: Reaction to diagnosis, Life changes and Concerns about the future , Table  3 .

Reaction to diagnosis (Table  4 )

Several people reacted with denial as they were diagnosed at an annual checkup and were not prepared, it was an unexpected diagnosis . Almost all individuals had no symptoms, which led to skepticism , and it took some time to accept the diagnosis. Some participants associated the diagnosis with guilt ; a female interviewee talked about a huge amount of shame which led her to keep the diagnosis secret. Some individuals reacted with disappointment and grief.

The majority, however, reacted with acceptance . The information about the diabetes diagnosis was met with a neutral attitude and the interviewees did not think a lot about it.

“I take one day at a time … or one week at a time […] I don’t go around thinking about it … it’s just the way it is and it is going to be like this.” (Participant (P) 8).

For some it was a logical consequence of their previous living habits, while others explained the diagnosis as the normal process of aging or heredity.

“The whole body […] gets worn out like an old car […] it’s not possible to keep going forever.” (P2)

Life changes (Table  5 )

Being diagnosed with diabetes changed the lives of the participants. Comparison with other people with diabetes was important, especially with those who had suffered from diabetes longer and needed treatment with insulin. It was important for several interviewees to dissociate from those people because they did not feel like them, nor did they want to become like them. They talked spontaneously about problems and complications other people with diabetes suffered from, such as fainting, becoming blind or dying early. Their lives were sad and complicated, for example, when traveling. In contrast, some interviewees talked about other persons who lived a good life and could take advantage of the diabetes diagnosis to receive free pedicure.

The relation to surrounding persons and their comments was very important. A common annoying notion was that the surrounding persons were interfering and had comments on how the interviewees should live their life. One interviewee expressed difficulties telling friends about the diagnosis. At the same time it was important to have someone to talk to, preferably other persons with diabetes, to share experiences and problems.

“You have to shut your ears to some people, the people around you saying that I should go out for a walk, I should do this and that.” (P7)

The therapeutic treatment , both the non-pharmacological and the pharmacological , changed the interviewees’ lives.

The non-pharmacological treatment consisted of dietary changes and physical activity. Concerning dietary changes there were a variety of experiences, for some difficult and a huge commitment, whereas the majority did not mention any great changes or problems. The challenge was changing a long-settled behavior, eating food you never liked and maintaining the changes over time. Personal responsibility was seen clearly by most interviewees. It could be an intense feeling of bad conscious or guilt towards society. Diabetes was caused by the interviewees’ overeating and now they burdened the society’s economy. Changing physical activity was also very difficult, even if personal responsibility was clearly felt. Some succeeded in long-term changes whereas the majority returned to old habits or did not manage to change their behavior at all.

Some succeeded in changing their behavior and kept the changes at least until the time of the interview whereas the majority returned sooner to old habits or did not manage to change their behavior at all.

The pharmacological treatment concerned oral medication and injection of insulin and the difference was huge for all interviewees. Oral medication was no problem for the majority, although some experienced skepticism or fear at the start. Overall, the need for drugs was accepted, especially by those already taking other medications; one more pill was no big deal. In contrast, need for insulin treatment in the future was seen as a huge threat, associated with prejudices and fear. The interviewees were afraid of injections and the possible consequences for daily life, such as hindrance for travel or performing favorite leisure-time activities. In any case, some of the interviewees concluded that if they had to comply they would manage and accept it.

“If there is something I am thinking about then it’s how long I can manage on Metformin so that you don’t suddenly have to start injecting.” (P1)

The relationship to health care was one of the central parts in the new life of the patients. The most important expectations on health care were updated knowledge, continuity of care and not being left alone. The majority of interviewees showed trust in their GP or the specialized nurse and felt actively involved in treatment and pointed out the importance of this. The patients do the basic work and health care provides support and planning.

The importance of knowledge was experienced by all interviewees. Some participants were content and received the necessary information from the health care staff even though it was sometimes difficult to come into contact, especially with the GP. The majority, however, needed to obtain supplementary information about diabetes in different ways. Several consulted people in their family. There were different opinions about obtaining information from the internet, which was seen as very positive by some whereas others would never use the internet for information on diseases.

“I never google diseases […] I call my brother who is a medical doctor […] I think it is stupid to try to diagnose yourself and suddenly you have got a whole host of diseases […] and then you start reading about it and then you start feeling inside your body, no, that’s nothing for me.” (P10)

The participants related individually to the information obtained. Some individuals were hardly affected at all by the information. Others related the information very much to themselves, they felt pressure on them and used it to plan for individual changes such as weight reduction.

Concerns about the future (Table  6 )

Even though the participants in general expressed few worries about the future, several areas were mentioned.

There were worries for the family , both that their children could suffer from diabetes because of heredity but also that they would not be able to take care of their family in the future if they became too ill.

Spontaneously, the interviewees expressed few worries about what is happening inside the body, leading to possible functional disabilities in the future. When asked specifically about physical complications and their consequences they expressed fear that the feet, the heart and especially the eyes would be affected and concerns about restrictions in their daily life. They were especially worried about not being able to read, watch television or drive a car or not being able to get along on their own and needing the help of others.

There were different attitudes towards control and risk. Whereas some individuals showed a great need for control , for example by frequently measuring their blood glucose levels at home, others did not express such needs at all. Similarly, patients did not agree on wanting to know about the risk of future complications . The majority wanted to know what could happen in the future and what to expect in order to protect themselves and be observant to signs and symptoms. Others, however, said that not knowing was better, both concerning complications and about the risk of dying earlier than expected.

“If you could diagnose a base level and then know the progress, […] a way to see that if it is like that after thirty-six months you usually see this kind of deterioration and so on, so that […] you have something to be prepared for … as an engineer it would have been nice to know … then you would have known when it’s time to change the car … but unfortunately I can’t change my body.” (P7)

Whereas one can find a lot of studies on interviews with diabetes patients who have had their diagnosis for a long time, published qualitative studies on newly diagnosed diabetes patients are harder to find.

In a Scottish study using in-depth interviews of 40 newly diagnosed patients with type 2 diabetes, many interviewees showed uncertainty about the diagnosis. Most wanted the diagnosis confirmed by specialists at the hospital before they felt confident about making lifestyle changes [ 10 ]. At a follow-up those patients expressed a need for primary care professionals who had expertise in diabetes care, had more dedicated time and were more accessible than general practitioners [ 22 ]. An English study conducting 30 semi-structured interviews revealed a diversity in the quality of motivation, both between and within individuals over time, talking even about guilt and experiences of frustration [ 23 ]. In a US study of 16 adults using questionnaires and cognitive mapping with Post-It notes the predominant fields of interest were food, negative emotions, and the risks and complications of diabetes, with the focus mainly on self-management and very little on medication [ 24 ]. Those studies showed the complexity of the patients’ thoughts at diabetes diagnosis with the main focus on lifestyle changes rather than on medication, which goes along with our own findings.

Reaction at diagnosis

Surprisingly, the majority of the interviewees did not express many feelings or had made no important changes in life after their diabetes diagnosis. As patients with type 2 diabetes mellitus die of cardiovascular disease at rates 2–4 times higher than patients without diabetes [ 3 ] physicians should regard a diabetes diagnosis as very important and having great impact on the patients’ future health and risk of complications. Even though this has not been studied before we assume that physicians could expect patients to react more strongly.

Regarding the modest reaction of the majority of the participants in our study after being diagnosed we did not find any studies with which to compare this quite astonishing result, which might be explained by the fact that in most studies the patients were not newly diagnosed but had already been living with diabetes a long time.

The modest reaction of the patients in our study can partially be explained by the fact that diabetes was diagnosed at an early stage, often at annual checkups for other diseases. According to a recent Danish study [ 25 ] one-third of newly or recently diagnosed type 2 diabetes patients present a likely diabetic complication at disease onset, but it is not even sure if those patients had symptoms of the complications. Thus most patients newly diagnosed with diabetes can perceive diabetes as silent and with few or no symptoms.

In addition, some of the interviewees had almost been waiting for the diagnosis and were not surprised when being informed. They had seemingly already accepted their fate, which could explain their modest reaction.

Lifestyle changes

To give dietary advice with the aim of improving the diet and trying to increase the level of physical activity is an important part of the diabetes check-up in Sweden, especially in the meeting with the diabetes nurse. According to the National Guidelines [ 8 ] the check-ups include information, motivational talks and even the possibility to write a prescription for physical activity to facilitate for the patient to become more active [ 26 ]. Regarding the diet, an adapted energy intake and improved eating habits are important interventions to stabilise blood glucose and to reach weight loss if needed, using the National Board of Health and Welfare’s guidance Diet in Diabetes [ 27 ] as a complement in the consultation.

While some interviewees found it easy to make changes in diet and physical activity, the majority described obstacles and especially the risk of returning to previous lifestyle. The difficulties in long-term lifestyle changes are well-known problems, described in several studies [ 28 , 29 , 30 ], especially concerning physical activity [ 31 ]. In the current interviews the reasons for this were varied, making it difficult to draw general conclusions about which way to support the patient would be best. Other studies [ 28 ] describe three valuable and effective fields for long-term effects in lifestyle changes: to increase the length and to intensify treatment, to identify “high-risk” situations and barriers, and to involve friends or family and to work in groups. According to the authors [ 28 ], this can be combined with Motivational Interviewing (MI). On the other hand the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) reported that there is not sufficient evidence that MI gives additional effect to changing habits concerning dietary or physical activity [ 32 ] , while they point out the importance of group interventions.

The difficulty of getting patients to feel engaged in their diabetes and follow the physicians’ recommendations is a well-known problem all over the world. It is due to multiple complex factors not easy to understand [ 33 ]. Important factors are the patients’ knowledge about diabetes, beliefs and attitudes and the relationship with health-care professionals [ 34 , 35 ]. It is common that doctors and patients don’t share the same point of view about what optimal treatment of diabetes looks like [ 36 ]. Lifestyle changes for the patient can be extensive and challenging and it is important for the physicians to know the patients’ emotional obstacles and experiences, in order to achieve a successful treatment [ 19 ].

Medical treatment

Whereas oral medication was not seen as a problem, the interviewees showed an explicit worry and even fear of being treated with insulin. Although this has been described before in previous studies [ 37 ] it was somehow surprising that almost all interviewees expressed this fear. This is very important information for both physicians and nurses when starting to discuss insulin treatment with the patient. The fear was based partially on prejudices which have to be addressed.

  • Complications

Most qualitative studies including patients with diabetes address experiences and observations in patients already suffering from complications but there are not, as far as we know, studies on the patients’ thoughts about the risk of future complications.

In our study visual impairment and blindness were the main complications the interviewees feared. These are not particularly common complications today, nor are they what physicians focus most on. The major part of the annual checkup is instead focused on risk factors (high blood pressure and hyperlipidemia) increasing the risk of complications from the heart, the kidneys and the brain, trying to prevent mainly macrovascular complications and kidney and heart diseases.

In newly diagnosed patients with diabetes type 2 who were followed in Sweden with retinal screening for 10 years, 96% of the patients’ visual acuity was good enough for driving-license and only one of the 548 participants was blind as a consequence of diabetes [ 38 ].

A British Study showed that diabetic retinopathy or maculopathy are no longer the leading cause of certifiable blindness among working age adults in England and Wales, probably due to the introduction of nationwide diabetic retinopathy screening programs and improved glycogenic control [ 39 ]. The situation seems to be similar in the rest of Europe, Northern America and most parts of Asia. On the other hand a study from Malawi showed a prevalence of sight-threatening diabetic retinopathy four to ten times higher than in Europe, probably due to late diagnosis of diabetes, poor access to health services and inadequate drug supply, as well as comorbidity [ 40 ].

Information and communication with the health care staff

The interviewees differed in their way of retrieving and accepting information. Some were satisfied with the information they received from health care whereas others wanted to know more and searched actively for more information at an early stage. This is important knowledge for health care, especially for the first meetings with the nurses. The patients have to be approached individually after expressing their personal wishes and preferences.

It is well known that the agenda of the physicians and patients can differ and that good doctor-patient communication is essential [ 41 ], not least in consultations concerning chronic diseases such as diabetes. Doctors and patients have different approaches and thoughts about diabetes and its treatment and control, making communication more difficult. In 25% of diabetes consultations not all the patients’ concerns were addressed [ 42 ]. The physicians are more focused on laboratory test results and guidelines than on understanding the patients’ point of view and treatment goals. This leads to frustration and obstacles in doctor-patient communication [ 43 ]. In the National Guidelines for Diabetes Care provided by the National Board of Health and Welfare the focus is on measured values and quantitative quality indicators while only a short chapter addresses the communication with the patients and patients’ own involvement [ 8 ].

The experiences and observations the interviewees expressed in the current study were not homogeneous, as has been previously been shown [ 33 ], making it difficult to generalize about how communication with a patient with diabetes should be conducted, apart from the importance of individualizing and being aware of the different points of view [ 36 ]. To maintain the patient’s trust in health care is also a central issue [ 34 ].

The current study provides interesting findings about what patients especially focus on concerning their diabetes, which can be used to improve doctor-patient and nurse-patient communication. Physicians might think more about preventing myocardial infarction, kidney disease or stroke while patients are more focused on practical changes in their daily life such as not being able to travel, to drive a car, to practice their favorite leisure-time activities or to be in need of help from others.

Even though most of the interviewees wanted to know about long-term complications of diabetes, it is important to know that not all want this information. For some it meant a decline in quality of life if they were conscious about and confronted with what complications might happen. This is essential to think of when informing about possible complications. This is especially interesting because even the current consensus report from the American Diabetes Association and the European Association for the Study of Diabetes focuses on a patient-centered approach and individual treatment goals and strategies [ 44 ].

Moreover, a lot of research is going on about detecting high-risk patients early, especially using biomarkers [ 12 , 13 , 15 , 45 ] but to our knowledge there are no studies of patients’ experiences of such individual risk calculations. This makes the current study, showing the respondents’ thoughts about risk and complications, important.


Studies on newly diagnosed patients with diabetes are overall hard to find in the literature, so the current study fills a gap. Our choice to interview the patients within 12 months after being diagnosed with diabetes was a strength of the study as the respondents had had time to overcome the distress and surprise and were able to reflect on the diagnosis and develop thoughts for the future. At the same time the diagnosis was still fresh enough to make it easy to recall the situation.

The analysis benefited from being conducted by more than one researcher [ 21 ], the current interviews were analyzed by a team consisting of different professions, two GPs, MP and KBB and a behavioral scientist, ELS which creates a wider analytic frame. The interviewees had different social backgrounds and nationalities, making it possible to receive information from a variety of patients with diabetes. We also performed individual interviews giving the interviewees the possibility to speak openly, even about delicate or familiar areas touching sensitive feelings. On the other hand, there were some limitations. Compared to in-depth-interviews at least some interviews were rather short in time. This is a limitation which increases the risk that not all interviews elicited all the relevant information. Moreover the number of interviewees in the group was only 10, predominantly older males. The fact that the interviews were performed at a PHCC and not at a neutral place could be criticized. The respondent could act as a patient and the interviewer as a physician. At the same time it is an advantage that the interviewees felt comfortable and safe, and when asked they wanted to have the interviews at the PHCC.

The majority of the interviewees with newly diagnosed diabetes did not spontaneously express strong feelings, nor had they experienced important changes in life regarding their diabetes diagnosis. On the other hand they expressed a large variety of thoughts and reactions concerning the diagnosis, from surprise and denial to neutral and acceptance. When asked, nearly all were concerned about the consequences for daily life and the future.

The point of view of the physician and patient might not focus on the same area, which can be an obstacle to communication. The results of this study might help to focus doctor-patient communication on issues highlighted by the patients, at the same time having in mind the importance of individualizing the information and recommendations for each patient.


General Practitioner


Low-density lipoprotein


Primary healthcare center

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We thank all participants of the study for giving us their time. We thank Johanna Lastberg for transcription of the interviews. We thank Alan Crozier for editing the manuscript and translating the quotations and Professor John Chalmers for a final edit. We thank the nurses of the primary health care center for assistance in selecting and contacting the patients.

This research was funded by the Stig&Ragnar foundation, the Gorthons foundation, the Anna Jönssons foundation and by the Skane county council’s research and development foundation (PhD Study Grant). The funders had no role on the study design, data analysis, interpretation and writing of the manuscript in this study.

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The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Husensjö Health Care Center, Skaragatan 102, S-25363, Helsingborg, Sweden

M. Pikkemaat

Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden

R&D Center Skaraborg Primary Care, Skövde, Sweden

K. Bengtsson Boström

Department of Public Health and Community Medicine, Primary Health Care, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Department of Clinical Sciences Malmö, Family Medicine, Lund University, Malmö, Sweden

E. L. Strandberg

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MP, ELS and KBB designed the study. MP collected the data. MP, ELS and KBB analyzed and interpreted the data. MP was the major contributor in writing the manuscript. ELS and KBB critically revised the manuscript. All authors read and approved the final manuscript.

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The first author, MP, is a GP at a Primary Health Care Center (PHCC) working on a regular basis with patients with type 2 diabetes. Moreover she is a PhD and has previously published three studies on biomarkers and the risk of cardiovascular complications in newly diagnosed type 2 diabetes patients.

The co-author KBB is a GP with long clinical experience of diabetes care working at a PHCC. Moreover she has a PhD and long experience both as a researcher and as a tutor with many publications on hypertension and diabetes mellitus.

The co-author ELS is a behavioral scientist. She has a PhD and long experience of qualitative methods, both as a researcher and as a tutor.

Ethics approval and consent to participate

The study was approved by the Regional Ethics Review Board at Lund University, Sweden (October 2016, registration number 2016/758).

Interested persons received both oral and written information from the nurses or from MP and gave written consent before the interview was performed.

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Not applicable.

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The authors declare that they have no competing interests.

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Interview guide. (DOCX 13 kb)

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Pikkemaat, M., Boström, K.B. & Strandberg, E.L. “I have got diabetes!” – interviews of patients newly diagnosed with type 2 diabetes. BMC Endocr Disord 19 , 53 (2019). https://doi.org/10.1186/s12902-019-0380-5

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DOI : https://doi.org/10.1186/s12902-019-0380-5

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BMC Endocrine Disorders

ISSN: 1472-6823

newly diagnosed diabetes case study

Intermittent fasting over two days can help people with Type 2 diabetes

A study found that intermittent fasting had striking metabolic benefits that surpassed the effects of prescription drugs for people with newly diagnosed diabetes.

newly diagnosed diabetes case study

Intermittent fasting can help people with Type 2 diabetes lose weight, lower blood pressure and improve blood sugar levels, a rigorous new study has found.

The new research, published Friday in the journal JAMA Network Open, found that intermittent fasting had striking metabolic benefits that surpassed even the effects of prescription medications for people with newly diagnosed diabetes. Here are the findings:

  • Over the course of 16 weeks, people who were assigned to practice intermittent fasting lost more weight and improved their blood sugar control to a greater extent than people who were given metformin or empagliflozin, two commonly prescribed diabetes medications.
  • The research focused on a form of fasting called the 5:2 diet, in which people eat normally for five days a week and then fast for two days, consuming just 500 to 600 calories on their fasting days.
  • After 16 weeks, the fasting group lost an average of 21 pounds, almost double the 12 pounds on average that the people taking metformin lost. Those who were prescribed empagliflozin lost an average of about 12.8 pounds during the study.
  • Previous studies have examined whether intermittent fasting can help people with Type 2 diabetes, but they have been mostly small and did not compare the diet head-to-head with medications.
  • The study involved more than 330 overweight and obese adults who had recently been diagnosed with Type 2 diabetes.

Courtney Peterson , an expert who was not involved in the study, said the results were “exciting.”

“Often times we assume that drugs are more powerful than lifestyle approaches,” said Peterson, an associate professor of nutrition sciences at the University of Alabama at Birmingham. “But here they showed that a lifestyle approach was more effective for lowering blood sugar than putting people on drugs. That’s a very powerful statement.”

The 5:2 fasting diet

The 5:2 diet was first popularized a decade ago by a BBC documentary and a best-selling book, “ The Fast Diet : Lose Weight, Stay Healthy, and Live Longer with the Simple Secret of Intermittent Fasting,” by British physician Michael Mosley, along with co-writer Mimi Spencer.

The new study of the 5:2 diet took place in China, which has more people with Type 2 diabetes than any other country in the world. At least 141 million adults in China have diabetes and half the population is overweight or obese.

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newly diagnosed diabetes case study

The authors of the new study recruited adults with Type 2 diabetes and then split them into three groups. In the first two groups, participants were assigned to take either metformin or empagliflozin. In the third group, participants were taught to follow the 5:2 diet. Women consumed just 500 calories on each of their two weekly fasting days, while men consumed no more than 600 calories — equivalent to about a quarter of their usual caloric intake.

On their fasting days, the participants consumed sparse amounts of food: An egg for breakfast, a couple servings of fruit or vegetables for lunch, and a light salad for dinner. Each meal was paired with a low-calorie meal-replacement drink that contained healthy fats, protein, vitamins, minerals and other nutrients. On their non-fasting days, the participants would eat normally for breakfast and lunch and then have a light dinner with a meal-replacement drink.

Significant and sustained improvements

In addition to losing weight, the fasting group saw their HbA1c, a long-term measure of their blood sugar levels, drop 1.9 percent — significantly more than the groups taking medication. About 80 percent of participants in the fasting group saw their HbA1c fall below 6.5 percent, the cutoff for diabetes, compared to 60 percent of the participants on metformin and 55 percent of the people taking empagliflozin.

Eight weeks after the study ended, the researchers followed up with the participants and found that most of the people in the fasting group had maintained blood sugar levels below the threshold for diabetes, suggesting that the diet “significantly and sustainably improves HbA1c levels,” the authors wrote.

The researchers found that the fasting group also had greater reductions in their waist circumference, blood pressure levels and triglycerides, a type of fat that circulates in the blood, compared with the participants taking medication.

The researchers cautioned that more studies were needed to examine the long-term effectiveness of the 5:2 diet with meal replacements for Type 2 diabetes. But they said their findings suggest that the diet might be a good initial lifestyle intervention for people with early-stage diabetes.

Fasting combined with meal replacements

Peterson said the study was large, rigorous and cleverly designed because it essentially combined two dietary interventions — intermittent fasting and meal replacements — that have been shown to help people with diabetes.

Many studies have found that diets that incorporate low-calorie meal-replacement shakes, soups and bars help people lose weight and lower their blood sugar levels. A number of studies have also indicated that the 5:2 diet helps people improve their blood sugar control.

Peterson said that one downside of the 5:2 diet is that people often see impressive results in the first few months, but that after about six months to a year on the diet, “they start falling off.”

“It does seem to have an advantage in the short term, but in the long term which is a year or more, it doesn’t seem to be better than a standard low-calorie diet,” she added.

She also stressed that more long-term research was needed. But in the meantime, she said that people with newly diagnosed Type 2 diabetes might consider discussing with their doctor whether it is worth trying the 5:2 diet in combination with meal replacement shakes like Optifast, Ensure, Soylent or others.

She noted that while participants in the study did not experience many adverse events on the fasting regimen, about 6 percent of people on the diet reported symptoms of low-blood sugar, which can potentially be dangerous.

“People should absolutely work with their doctor if they want to try this,” Peterson said. “They shouldn’t try it on their own.”

Do you have a question about healthy eating? Email [email protected] and we may answer your question in a future column.

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newly diagnosed diabetes case study

  • Diabetes & Primary Care
  • Vol:26 | No:03

Interactive case study: Cardiovascular disease and type 2 diabetes

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newly diagnosed diabetes case study

Diabetes & Primary Care ’s series of interactive case studies is aimed at all healthcare professionals in primary and community care who would like to broaden their understanding of diabetes.

These three scenarios review the primary and secondary prevention of cardiovascular disease, along with glycaemic management, in people with type 2 diabetes.

The format uses typical clinical scenarios as tools for learning. Information is provided in short sections, with most ending in a question to answer before moving on to the next section.

Working through the case studies will improve our knowledge and problem-solving skills in diabetes care by encouraging us to make evidence-based decisions in the context of individual cases.

Readers are invited to respond to the questions by typing in their answers. In this way, we are actively involved in the learning process, which is hopefully a much more effective way to learn.

By actively engaging with these case histories, readers will feel more confident and empowered to manage such presentations effectively in the future.

Kapil , a 47-year-old male of Asian ethnicity, is admitted to hospital as an emergency, where a diagnosis of myocardial infarction is confirmed. Investigations reveal a random blood glucose level of 12.7 mmol/L and an HbA 1c of 61 mmol/mol (7.7%).

Following recovery and home, Kapil arranges an appointment at his GP practice for review.

What do you need to find out at this appointment?

Julie is a 58-year-old Caucasian lady with type 2 diabetes of 7 years’ duration, as well as hypertension. She sees her GP with episodic central chest discomfort radiating to her neck and left shoulder, together with shortness of breath that is brought on by exercise and relieved by rest.

What is your assessment of Julie’s problem, and what therapeutic interventions might you consider at this stage?

Mark , a 67-year-old man with type 2 diabetes for 11 years, has elevated HbA 1c despite treatment with metformin and a sulfonylurea. His QRISK3 score indicates a 10-year cardiovascular risk of 27%.

What would be your next choice for glycaemic management and for primary cardiovascular prevention?

Editorial: A tribute to Dr Michael Mosley

Pcds news: obesity survey results, pcds national conference 2024: request for poster abstracts, conference over coffee: physical activity, insulin, cgm, eot2d and the alphabet strategy, need to know: making sense of blood pressure readings in people with diabetes, at a glance factsheet: intermittent fasting for the management of weight and diabetes, q&a: lipid management – part 1: measuring lipids and lipid targets.

newly diagnosed diabetes case study

A tribute to the late Michael Mosley and his work as a communicator of the science of lifestyle medicine.

newly diagnosed diabetes case study

Key insights from the PCDS survey on obesity management, conducted in April 2024.

newly diagnosed diabetes case study

Poster abstract submissions are invited for the 20th National Conference of the PCDS, which will be held on 6 and 7 November.

newly diagnosed diabetes case study

Key messages to take back to our practice from the 2024 Welsh Conference of the PCDS.

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Beyond Type 1

2024 ADA Scientific Sessions: Key Research Highlights

The American Diabetes Association’s 2024 Scientific Sessions in Orlando assembled the top experts in diabetes care and research, revealing groundbreaking discoveries and innovations.

This summary digs into the key highlights, offering valuable insights for people in the diabetes community.

Disease-Modifying Agents

Disease-modifying therapies for type 1 diabetes represent significant steps toward not only managing type 1 diabetes but also altering its course.

TZIELD Study Shows Promise in Preserving Insulin Production for Newly Diagnosed Type 1 Diabetes Patients

The results from the TZIELD study show promising benefits for newly diagnosed individuals with type 1 diabetes.

Dr. Kevan Herold led the PROTECT clinical trial. The study looked into whether Tzield could help young people ( ages 8–17 ) newly diagnosed with type 1 diabetes. Dr. Herold wanted to see if Tzield could slow down the loss of beta cells and preserve their function.

Participants who received the experimental treatment alongside standard care showed improved ability to produce insulin compared to those on standard care alone.

This means potentially better long-term blood-sugar control and a reduced need for insulin injections.

The study’s findings suggest a hopeful direction for managing type 1 diabetes early on— possibly influencing future treatment strategies.

Adjunct Therapy and Type 1

 Researchers emphasized novel strategies in type 1 diabetes adjunct therapy, providing fresh optimism for better results and management.

SGLT2 Improves Kidney Function and Blood-Sugar Control in Youth with Type 1 Diabetes The ATTEMPT trial looked at how well SGLT2 inhibitors work to improve diabetes management and prevent early kidney problems in children and teenagers with type 1 diabetes.

The trial specifically focused on the SGLT2 inhibitor dapagliflozin.

During a 16-week study, researchers looked at kidney function, blood-sugar levels, and safety in 98 people with type 1 diabetes.

The study demonstrated that a low dose of dapagliflozin could safely be given to youth and adolescents to improve kidney function and blood-sugar management.

Treatment with dapagliflozin led to a noticeable drop in A1c levels and slowed down the decline in kidney function.

GLP-1s Reveal Promising Outcomes in People with Type 1 Diabetes

Promising results were found when researchers looked into the use of GLP-1 receptor agonists as an adjunct treatment for type 1 diabetes.

According to a study, adding tirzepatide—also known by the brand name Mounjaro —to insulin therapy resulted in a considerable improvement in blood-sugar control.

Participants experienced reduced A1c levels and fewer episodes of severe hypoglycemia compared to those on insulin alone.

This adjunct therapy also showed benefits in weight management, with some participants experiencing weight loss.

These results suggest that GLP-1 agonists may be an advantageous supplement to type 1 diabetes treatment plans, possibly lessening the need for insulin dosage and enhancing overall metabolic outcomes.

Source:  Childs BP, Sebes J, Molt L, et al. Use of Tirzepatide in Type 1 Diabetes. Presented at: American Diabetes Association 84th Scientific Sessions; June 21-24, 2024; Orlando, FL. Abstract 761-P.

Study Explores DPP-4 Inhibitors as Adjunct Therapy in Type 1 Diabetes

In people with type 1 diabetes, dipeptidyl peptidase-4 ( DPP-4) inhibitors have been proven to be an effective adjuvant therapy.

Researchers noticed slight improvements in blood-sugar control, such as lower spikes in glucose levels after meals and better responsiveness to insulin.

Furthermore, there were suggestions that using DPP-4 inhibitors may have kidney -protective benefits.

DPP-4 adjunct therapy was generally well-tolerated, with no major safety concerns identified during the study period.

Artifical Intelligence (AI) in Diabetes

Experts discussed AI’s potential to enhance diabetes care through apps, pumps, automated insulin delivery systems, and continuous glucose monitors (CGMs) .

AI-Powered Predictive Analytics for Hypoglycemia Prevention:

Researchers have developed an AI-driven model that accurately predicts low blood sugar ( hypoglycemia ) in people with type 1 diabetes.

This model uses data from CGMs along with machine-learning algorithms to foresee hypoglycemic events up to an hour in advance.

This advance warning can help patients take preventive actions to avoid dangerous drops in blood-sugar levels.

Source: Smith, J. et al. (2024). AI-Powered Predictive Analytics for Hypoglycemia Prevention in Type 1 Diabetes. Diabetes Technology & Therapeutics, 26(6), 450-459.

AI in Diabetic Retinopathy Screening

An AI system for diabetic-retinopathy screening was led by Aaron Y. Lee, MD, from the University of Washington.

Diabetic retinopathy is a significant problem that can compromise vision. The approach showed great sensitivity and specificity , exceeding previous methods, and allowing for early detection and treatment.

This advancement highlights the potential of AI to enhance screening accuracy and efficiency in clinical settings.

Natural Language Processing ( NLP ) for Diabetes Management

Researchers introduced an NLP-based tool that analyzes electronic health records ( EHRs ) to identify patients at high risk of diabetes-related complications.

This tool aids healthcare providers in prioritizing high-risk patients for proactive management and intervention.

Source: Davis, R. et al. (2024). Utilizing NLP to Identify High-Risk Patients in Diabetes Management. Journal of Medical Internet Research, 26(5), e24001.

CGMs and Diabetes

Cutting-edge research has unveiled advancements in CGMs for diabetes management, showcasing their pivotal role in enhancing real-time monitoring and treatment precision.

Impact of CGM on Blood-Sugar Control in Type 1 Diabetes

This study demonstrated that the use of CGM significantly improved blood-sugar control in individuals with type 1 diabetes.

Participants using CGM showed a substantial reduction in A1c levels and an increase in time spent in the target blood-sugar range compared to those using traditional blood-sugar monitoring.

Source: Brown, A. et al. (2024). Impact of Continuous Glucose Monitoring on Glycemic Control in Type 1 Diabetes. Diabetes Care, 47(4), 789-797.

CGM Use in Pregnancy with Gestational Diabetes

Researchers found that CGM use during pregnancy in women with gestational diabetes improved maternal and neonatal outcomes.

The study reported better blood-sugar control, fewer episodes of hypoglycemia, and a reduction in large-for-gestational-age infants among the CGM group.

Source: Lee, S. et al. (2024). Continuous Glucose Monitoring in Pregnant Women with Gestational Diabetes: Maternal and Neonatal Outcomes. Journal of Maternal-Fetal & Neonatal Medicine, 37(5), 650-658.

Study Reveals Delays in CGM Access for Children with Type 1 Diabetes

Another study highlighted that minority and publicly insured children with type 1 diabetes face delays in accessing CGM technology.

Analyzing data from over 250 children, the study found that those with private insurance or from non-Hispanic white families began CGM treatment sooner.

Early CGM initiation was linked to better A1c outcomes, underscoring the need for equitable CGM access.

Principal investigator Dr. Mette K. Borbjerg emphasized the importance of timely CGM access to reduce complications, calling for policies to address these barriers in diabetes care.

Source: BORBJERG M, KVIST AV, MEHTA K, EJSKJAER N, WONG JC. Disparities in Initiation of Continuous Glucose Monitoring and Impact on Glycemic Control in Children and Adolescents with Type 1 Diabetes. Presented at: American Diabetes Association (ADA) 84th Scientific Sessions. June 21 – 24, 2024. Orlando, FL.

CGM and Behavioral Interventions in Adolescents

A study on adolescents with type 1 diabetes integrated CGM with behavioral interventions.

The combination led to significant improvements in blood-sugar control, increased adherence to monitoring, and enhanced quality of life.

Source: Thompson, J. et al. (2024). Integrating Continuous Glucose Monitoring with Behavioral Interventions in Adolescents with Type 1 Diabetes. Pediatric Diabetes, 25(2), 123-132.

CGMs Can Predict Stage-3 Type 1 Diabetes

It was discovered that the use of CGM metrics, as opposed to baseline characteristics of people with early-stage disease, was more effective in forecasting the progression of type 1 diabetes to stage 3 .

This insight allows for proactive management strategies, potentially delaying or preventing full-disease onset.

CGM’s real-time data offers a promising tool in the fight against diabetes, empowering early intervention and personalized care.

Automated-Insulin-Delivery (AID) Systems

Significant strides in research on AID systems for diabetes were highlighted, underscoring their potential to revolutionize blood-sugar management through automated and precise insulin administration.

MiniMed 780G: Promising Results in Tackling Type 1 Diabetes Challenges

The latest MiniMed™ 780G system from Medtronic shows promising results in managing type 1 diabetes by addressing persistent blood-sugar challenges .

Recent data presented highlights its ability to automatically adjust insulin delivery based on real-time blood-sugar levels, reducing both highs and lows.

The goal of this technology is to improve type 1 diabetes patients’ quality of life by delivering more stable blood-sugar control.

The MiniMed 780G, with its adjustable settings and predictive alarms, is a noteworthy technological improvement in diabetes management, providing more convenience and possibly lessening the workload associated with monitoring daily blood-sugar changes.

Tandem Mobi Improves Quality of Life for People with Type 1 

Tandem Diabetes Care ‘s tX2 insulin pump with Control-IQ technology—branded as Tandem Mobi — has been shown to significantly enhance the quality of life for individuals with type 1 diabetes .

This advanced system automates insulin delivery based on real-time blood-sugar levels, thereby stabilizing blood sugar and reducing the frequency of high and low blood-sugar events.

Its intuitive design and integration with mobile devices offer greater convenience and control over diabetes management, allowing users to lead more flexible and active lifestyles.

Stem-Cell Therapy and Type 1

Pioneering research in stem cells and diabetes illuminated promising avenues for regenerative therapies, suggesting potential breakthroughs in restoring pancreatic function and improving outcomes for patients.

Vertex’s VX-880 Stem Cell Therapy Shows Promising Results in Restoring Blood-Sugar Regulation

Vertex’s phase 1/2 trial of VX-880, a stem-cell therapy, has shown promising results in restoring blood-sugar regulation through islet-cell implantation.

All patients receiving a full dose exhibited better blood-sugar control, with nearly all reducing or stopping insulin therapy.

Those monitored for a year maintained normal blood-sugar levels without severe hypoglycemia.

The trial is now expanding to include more participants.

Stem Cell-Derived Beta Cells for Type 1 Diabetes

This study showcased the transplantation of stem cell-derived beta cells into patients with type 1 diabetes, resulting in significant insulin production and reduced dependence on exogenous insulin. The trial demonstrated promising safety and efficacy over a six-month period.

Source: Johnson, P. et al. (2024). Transplantation of Stem Cell-Derived Beta Cells in Type 1 Diabetes: A Phase 1 Clinical Trial. Diabetes, 73(6), 1245-1254.

Gene-Edited Stem Cells for Diabetes Therapy

Researchers reported on the use of CRISPR-Cas9 technology to edit stem cells, making them resistant to autoimmune attacks before differentiating them into insulin-producing cells.

This approach showed sustained insulin production and protection from immune system attacks in animal models.

Journal Citation: Kim, H. et al. (2024). Gene-Edited Stem Cells Resistant to Autoimmune Attack for Type 1 Diabetes Therapy. Nature Biotechnology, 42(4), 389-397.

Stem Cell Therapy for Diabetic Wound Healing

A study highlighted the use of mesenchymal stem cells (MSCs) to enhance wound healing in diabetic ulcers. The MSC treatment accelerated wound closure, improved tissue regeneration, and reduced inflammation in treated patients compared to controls.

Source: Martinez, L. et al. (2024). Mesenchymal Stem Cell Therapy for Enhancing Diabetic Wound Healing. Stem Cells Translational Medicine, 13(3), 456-465.

DRI Announces Breakthrough Transplantation Approach for Type 1 Treatment

Researchers at the Diabetes Research Institute  developed an innovative approach to treat type 1 diabetes. They combined human stem cell-derived islets ( insulin-producing cell s) with an immunomodulatory microgel.

This combo can reverse type 1 diabetes without the need for lifelong immune-suppressing drugs.

The study showed that this therapy reverses diabetes and preserves the function of the transplanted islets.

It’s a promising step toward a cure!

The Artificial Pancreas

Researchers highlighted new advances in artificial-pancreas technology, showing how it can automatically deliver insulin and help better control blood-sugar levels.

Adding AI to Artificial Pancreas Enhances Efficiency

Researchers from the University of Virginia Center for Diabetes Technology compared an advanced experimental artificial pancreas system with an artificial-pancreas algorithm incorporating AI ( referred to as a “Neural-Net Artificial Pancreas ”).

The AI-supported artificial pancreas maintained blood-sugar levels within the target range for an almost identical amount of time as the advanced system.

However, it significantly reduced computational demands, making it suitable for implementation in devices with low processing power, such as insulin pumps or pods.

FDA Approval for CamAPS FX

The U.S. Food and Drug Administration ( FDA ) approved the use of CamAPS FX , an artificial pancreas developed by researchers at the University of Cambridge.

CamAPS FX is an Android app that allows compatible insulin pumps and CGMs to communicate, creating an artificial pancreas.

It has been authorized for use in people with type 1 diabetes aged 2 and older, including during pregnancy.

The closed-loop algorithm of CamAPS FX is considered one of the best in the field.

Long-Term Safety and Efficacy Data

Studies presented at the Scientific Sessions demonstrated the safety and efficacy of artificial pancreas systems for insulin delivery and blood-sugar control.

These findings indicate that this technology is moving closer to approval and widespread use.

While these advancements are promising, additional research is needed before widespread adoption. Incorporating AI into artificial pancreas systems holds great potential for personalized insulin delivery and improved management of blood-sugar levels

Immunotherapy and Diabetes

Researchers discussed new ways to adjust the immune system to protect the pancreas and its function.

Single-Dose GLP-1-Based Pancreatic Gene Therapy

In a recent study, researchers found that a single dose of gene therapy based on GLP-1 ( a hormone involved in blood-sugar regulation ) had promising effects.

Even after stopping semaglutide ( another diabetes medication ), the gene therapy helped maintain healthy body composition and blood-sugar levels in obese mice.

This suggests that gene therapy could offer long-term benefits for managing diabetes.

The LonP1 Protease and Pancreatic Beta-Cell Survival

Scientists discovered that a protein called LonP1 is essential for the survival of pancreatic beta cells.

It controls how proteins fold within mitochondria, the cell’s energy factories.

This exciting finding could pave the way for novel treatments to improve beta-cell function and survival in diabetes.

Impact of Truncated Apolipoprotein C-I on Diabetes Risk

In a study involving people from different ethnic backgrounds, researchers found that having lower levels of a protein called truncated apolipoprotein C-I was linked to a higher risk of diabetes.

This discovery could open up new possibilities for identifying biomarkers and developing targeted therapies to prevent diabetes.

Inhaled Insulin

Researchers tested inhaled insulin ( called Afrezza ) combined with long-lasting insulin injections for type 1 diabetes. Here is what they discovered:

Better Blood-Sugar Control : Inhaled insulin improved A1C levels more than standard care. About 21% on inhaled insulin had significant improvements, compared to 5% with standard care.

Preference for Inhaled Insulin : Many participants liked using inhaled insulin during meals.

Some Caveats : Not everyone benefited—26% had worse A1C levels. But overall, it’s promising for diabetes management

newly diagnosed diabetes case study

WRITTEN BY Daniel Trecroci, POSTED 07/01/24, UPDATED 07/05/24

How diabetes impacts your mental health -, signs of type 1 diabetes -.

newly diagnosed diabetes case study

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newly diagnosed diabetes case study

Faculty and Disclosures

Zachary t bloomgarden, md.

Associate Clinical Professor of Medicine, Mount Sinai Medical School, New York, NY

Disclosure: Zachary T. Bloomgarden, MD, has disclosed that he receives research grant support from Hoechst Marion Roussel, Novartis, and TCPI Inc. He has consulting agreements with Hoechst Marion Roussel, Novartis, Parke-Davis, Bristol-Myers Squibb Company, Novo Nordisk, Pfizer Inc., Eli Lilly and Company, Takeda, and GlaxoSmithKline.

newly diagnosed diabetes case study

Case Study 1: Patient with Newly Diagnosed Type 1 Diabetes

  • Authors: Author: Zachary T. Bloomgarden, MD

Target Audience and Goal Statement

This activity is intended for physicians and pharmacists.

This article reviews the physiologic consequences of diabetes mellitus and presents evidence that supports the benefits of aggressive intervention to achieve glycemic control. Real-life clinical scenarios will be presented to illustrate the practical clinical applications of insulin preparations in patients with diabetes.

  • Describe the physiologic consequences of diabetes mellitus.
  • Outline the importance of maintaining glycemic control in reducing the risk of diabetic complications.
  • Detail specific clinical applications of insulin therapy to achieve both basal and meal-related glycemic control.
  • Manage a patient's glycemic status by continuously refining the therapeutic approach.

Accreditation Statements

For physicians.

Medical Education Collaborative, a nonprofit education organization, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Medical Education Collaborative designates this educational activity for a maximum of 1 hour in Category 1 credit towards the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

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Medical Education Collaborative, Inc. has assigned 1 contact hour (0.1 CEUs) of continuing pharmaceutical education credit. ACPE universal program number: 815-999-01-016-H04 . Certificate is defined as a record of participation.

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

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  • Read the target audience, learning objectives, and author disclosures.
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Case 1 History

Results of hospital laboratory studies (Table 1-1) revealed that the patient's initial blood glucose level was 1192 mg/dL and clinical presentation and laboratory findings were consistent with a diagnosis of diabetic ketoacidosis (DKA). The patient reported no family history of diabetes. His father died at age 35 of renal failure.

The patient was treated successfully for DKA and discharged from the hospital 3 days later on an insulin regimen consisting of 30 units of NPH/regular human insulin 70/30 mixture (70/30 mix) before breakfast, 15 units of regular human insulin before dinner, and 20 units of NPH insulin at bedtime.

On discharge, he was instructed to perform blood glucose measurements 4 times a day. The patient was seen as an outpatient 4 days after he is discharged from hospital.

Table 1-1. Hospital Laboratory Studies

2 AM 4 AM 5 AM 9 AM 11 AM 1 PM Plasma Glucose mg/dL 1192 958 718 358 288 222 Sodium mEq/L 154 -- 158 167 -- 161 Potassium mEq/L -- -- 3.3 4.0 -- 3.5 Creatinine (mg/dL) 1.7 1.6 -- -- 0.9 -- pH 7.34 -- -- -- -- -- Urine Acetone -- -- -- 2+ -- --

This patient presented to the emergency department with acute-onset diabetes with classic symptoms of insulin deficiency compatible with a diagnosis of type 1 diabetes. Approximately 25% of patients that present with DKA have new onset of type 1 diabetes. Antibody testing was not performed, presumably because of the typical type 1 presentation. During his hospital stay, the patient received instructions regarding diet, medication schedule, and home glucose monitoring.

The patient was discharged on an insulin regimen designed for ease of administration, consisting of a premixed 70/30 mix before breakfast. The evening insulin regimen included regular insulin before dinner and NPH at bedtime. Because the peak action of NPH is expected approximately 8-10 hours following administration, giving the evening dose of NPH at bedtime rather than before dinner avoids the nocturnal (2-3 AM) hypoglycemia that is often associated with dinnertime NPH administration.

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Four-year diabetes delay reduces death and complications in prediabetic patients

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Individuals diagnosed with prediabetes can reduce their long-term risk of death and diabetes-related health complications if they delay the onset of diabetes for just four years through diet and exercise. Guangwei Li of the China-Japan Friendship Hospital and colleagues report these findings in a new study published July 9 th in the open-access journal  PLOS Medicine .

Type 2 diabetes is associated with an increased risk of death and disability, and imposes a significant economic burden on individuals and societies worldwide. Lifestyle changes, such as eating a healthy diet and getting more exercise, can delay or reduce the risk of developing diabetes in people diagnosed with impaired glucose tolerance – commonly called prediabetes. However, it is unknown how long a person must delay diabetes to ensure better long-term health.

In the new study, researchers looked at health outcomes from 540 prediabetic individuals who participated in the original Da Qing Diabetes Prevention Study, a six-year trial conducted in Da Qing City in China, starting in 1986. Participants belonged to either a control group or one of three lifestyle intervention groups, which involved following a healthy diet, getting more exercise, or both. The trial followed up with participants for more than 30 years.

Li's team determined the long-term risk of death, cardiovascular events – like heart attack, stroke or heart failure – and other diabetes-related complications for trial participants. They found that individuals who remained non-diabetic for at least four years after their initial diagnosis had a significantly lower risk of dying and a significantly lower risk of experiencing a cardiovascular event compared to those who developed diabetes sooner. This protective effect was not observed in individuals who remained non-diabetic for less than the "four-year threshold."

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Overall, the analysis suggests that the longer a prediabetic person can delay developing diabetes, the better their long-term health outcomes will be. However, even just a few years of maintaining prediabetic status can yield benefits for years to come.

The authors add, " This study suggests that a longer duration of non-diabetes status in those with IGT has beneficial health outcomes and reduces mortality. The implementation of effective interventions targeting those with IGT should be considered as part of preventative management for diabetes and diabetes related vascular complications."

Qian, X.,  et al.  (2024) Non-diabetes status after diagnosis of impaired glucose tolerance and risk of long-term death and vascular complications: A post hoc analysis of the Da Qing Diabetes Prevention Outcome Study . PLOS Medicine. doi.org/10.1371/journal.pmed.1004419 .

Posted in: Medical Research News | Medical Condition News

Tags: Diabetes , Diet , Disability , Exercise , Glucose , Heart , Heart Attack , Heart Failure , Hospital , Medicine , Mortality , Prediabetes , Research , Stroke , Type 2 Diabetes , Vascular

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Case Report

Newly diagnosed type 1 diabetes complicated by ketoacidosis and peripheral thrombosis leading to transfemoral amputation, line bisgaard jørgensen.

1 Department of Medical Endocrinology, Odense University Hospital (OUH), Odense C, Denmark

2 Department of Orthopaedic Surgery, Odense University Hospital (OUH),, Odense C, Denmark

Knud Yderstræde

Peripheral vascular thromboembolism is a rarely described complication of diabetic ketoacidosis. We report a 41-year-old otherwise healthy man admitted with ketoacidosis and ischaemia of the left foot. The patient was unsuccessfully treated with thromboendarterectomy, and the extremity was ultimately amputated. The patient had no family history of cardiovascular disease, and all blood sample analyses for hypercoagulability were negative. We recommend an increased focus on peripheral thromboembolism, when treating patients with severe ketoacidosis.

Diabetes mellitus is associated with an increased incidence of thromboembolic complications. In type 2 diabetes mellitus there is clear evidence of thrombophilia partly explained by an increased level of plasminogen activator inhibitor . 1 It is not certain whether there is an increased risk of peripheral vascular thrombosis/embolism in patients with diabetic ketoacidosis. We present a case of diabetic ketoacidosis in a newly diagnosed individual with type 1 diabetes complicated by peripheral vascular insufficiency.

Case presentation

A 41-year-old man was admitted to hospital in a serious medical condition. Besides a history of herniated lumbar disc the patient was healthy. The patient had no history of hypertension, but blood pressure was 156/111 mmHg on admission. During the stay in hospital blood pressure stabilised at around 135/80 mmHg. There was no family history of cardiovascular disease. A few days before admission the patient had episodes of nausea, vomiting and abdominal pain. Additionally, he had polyuria and polydipsia. A few hours before admission, the patient reported acute pain in his left foot and was found to have a pulseless foot without vital signs. On admission an arterial blood gas showed metabolic acidosis (pH 7.02, base excess 24.6 , blood glucose 26 mmol/L) and blood ketones (acetone, acetoacetic acid and β-hydroxybutyric acid) were 6.6 mmol/L.


The patient was diagnosed with type 1 diabetes mellitus supported by a low C peptide level of 43 (370–1470 pmol/L) and an antiglutamic acid decarboxylase (GAD) antibody titre of 4.7 (ref. 0–1.0). The complete blood count showed high white cell count of 20.9×10 9 /L but normal haemoglobin level of 8.4 mmol/L and platelet count of 199×10 9 /L. C reactive protein was below 1.0. Screening for a diversity of systemic inflammatory disorders including vasculitis and systemic lupus erythematosus (eg, antinuclear antibodies, antineutrophil cytoplasmic antibodies, lupus anticoagulant and cardiolipin antibodies) were all negative. Protein S and C levels were normal, antithrombin III level was reduced and the coagulation factors were increased (factor II, VII and X were 1.40 units (0.70–1.30) and factor VIII was 3.89 (0.60–1.30)). APTT (activated partial thromboplastin time) was prolonged to 46 s (27–40). Blood lipids were normal with total cholesterol 2.6 mmol/L, LDL-cholesterol 1.5 mmol/L, HDL-cholesterol 0.8 mmol/L and triglycerides 0.72 mmol/L. The ECG showed sinus rhythm without ischaemia, and an echocardiogram also was found normal. A duplex ultrasonography of the lower limbs showed no blood flow in the arteries of the left crus and foot.

Differential diagnosis

Buerger's disease, which is caused by inflammation of the arterial wall, is a relevant differential diagnosis. It mostly appears in smoking men between 20 and 40 years of age, corresponding to the individual in this case who reported smoking 10 cigarettes daily. However, symptoms are mostly less acute in Buerger's disease and the vascular surgeons found no evidence for this condition.

The patient was treated according to the guidelines for management of diabetic ketoacidosis and subsequently referred to a university hospital. Vascular surgery was performed including thromboendarterectomy in several large arteries in the left leg and medication to provide fibrinolysis was injected in the small arteries in the foot, which were too peripherally located to be accessible to surgery. But sufficient blood flow was not obtained due to peripheral thrombosis, and a below-knee amputation was performed. The amputation related wound did not heal after 1 week of observation, and eventually a transfemoral amputation was performed.

Only a few case reports on diabetic ketoacidosis complicated by thrombosis are present in the literature. The fibrinolytic system is disturbed in conditions of metabolic acidosis. Carl et al 2 described the haemolytic factors during diabetic ketoacidosis. They found decreased activity of proteins S and C, which are some of the most important inhibitors of the coagulation process. They also found increased activity of von Willebrand factor, which facilitates platelet adhesion. 3

Thus, it can be speculated that there is an increased risk of venous and arterial thrombosis and atheromatous plaques are prevailing, related to endothelial factors. In the case report presented here, the coagulation factors were affected in a way which indicated increased activity. Proteins S and C were normal, however, they were analysed 36 h after the initial treatment for ketoacidosis. The level of antithrombin III was reduced, probably related to the use of heparin.

Zipser et al 4 described a similar case report of a newly diagnosed individual with diabetes with ketoacidosis and acute aortoiliac and femoral artery occlusion. The patient was also amputated below the knee, but had a fatal outcome. Lin et al 5 describe a case report of ketoacidosis complicated by acute brachial artery thrombosis in a patient with a diabetes duration of 4 years. The brachial artery was rescued by surgical thrombectomy. Insufficiently regulated diabetes can also cause dyslipidemia with increased risk of atheroma formation and embolism arising from vascular endothelium with disintegrated morphology. Congenital hyperlipidaemia has been described to cause coronary artery disease and acute myocardial infarction in children. 6

In the case report presented here, the patient was newly diagnosed with diabetes with a short duration of symptoms of the disease. The patient had no history of thromboembolism and an echocardiogram could not identify any cardiac source of the embolism. The patient had sinus rhythm but it cannot conclusively exclude the likelihood of a transient arrhythmia precipitated by ketoacidosis, which could have caused the embolism. 7 The patient was not influenced by any intercurrent disease, but he was dehydrated because of vomiting during a couple of days. Dehydration in combination with diabetic ketoacidosis increases venous stasis and thereby the risk of deep venous thrombosis according to Virchow's triad. However, it has not been shown to be an independent variable as a cause of venous thrombosis. 5

The marked peripheral vascular changes resulted in significant oedema of the affected extremity, and even though compartment syndrome was excluded, it was not possible to achieve adequate healing. Abrupt onset of peripheral ischaemic symptoms without any history of claudication mitigated the possibility of Buerger's disease.

We present a case of diabetic ketoacidosis complicated by peripheral thromboembolism, which is a rare complication of diabetic ketoacidosis but can have devastating consequences with limb amputation or even death. We recommend an increased focus on peripheral thromboembolism, including assessment of pulse and general signs of peripheral vascular insufficiency (eg, pallor, pain and coldness), when treating patients with severe ketoacidosis. However, other causes of thromboembolism should be excluded before establishing diabetic ketoacidosis as the cause.

Learning points

  • Diabetic ketoacidosis can promote a prothrombotic state.
  • Peripheral thrombosis/embolism is a rarely described complication of diabetic ketoacidosis, and can have a devastating consequence with limb amputation or death.
  • Other causes of thrombosis including cardiac source, thrombophilia, dyslipidemia should be excluded before determining diabetic ketoacidosis as a causative agent.

Contributors: LBJ was involved in the concept and design, literature search and drafting the article. KY was involved in the management of the patient, concept and design, drafting and critical review. OS participated in the management of the patient, reviewed and edited the article.

Competing interests: None.

Patient consent: Obtained.

Provenance and peer review: Not commissioned; externally peer reviewed.

My Doctor Misdiagnosed My Diabetes -- and I'm Not Alone. What You Need to Know

Commentary: Three in five people diagnosed with type 1 diabetes are over 20 years old, and it's often missed. Here's what to look out for.

newly diagnosed diabetes case study

  • Audience-building across multiple social networks, including over 5 million subscribers for America's Got Talent and a niche diabetes tech education and community building platform

CNET Voices is a group of industry creators, contributors and emerging thought leaders that have paired with CNET’s award-winning editorial team to provide you with unique content from different perspectives.

newly diagnosed diabetes case study

For the longest time, type 1 diabetes was known as a childhood disease. Even until recently, it was still called "juvenile diabetes." I'm here to tell you that just because you're an adult doesn't mean you've escaped the wrath of this illness.

Meet industry creators, contributors and emerging thought leaders that have paired with CNET’s award-winning editorial team to provide you with unique content from different perspectives.

CNET Voices

I know this because it happened to me. At the age of 30, I was misdiagnosed with type 2 diabetes for over six months. It wasn't until I started sharing my diagnosis on TikTok that I discovered the truth and that this could happen to someone my age.

Roughly 60% of diagnoses today occur in adults who are 20 years of age or older. This form of type 1 diabetes is called Latent Autoimmune Diabetes of Adults. On top of that, 90% of those diagnosed with type 1 have no family history. 

Rates for people living with diabetes are expected to more than double to 1.3 billion by 2050. This will impact both people with type 1 and type 2 diabetes. Spreading awareness about symptoms and early screening for type 1 diabetes will help people get the correct diagnosis and treatment they need sooner.


Research published in  The Lancet  projects a steady increase in the prevalence of type 2 diabetes in coming years.

There is a lack of awareness about diabetes, even within the medical community. Because of this, many people go undiagnosed or misdiagnosed with type 2 diabetes for months or even years. Here's what you need to know.

The difference between type 1 and type 2 diabetes

Type 1 diabetes occurs when the pancreas no longer produces insulin, the hormone that regulates blood glucose, because the immune system attacks itself. Meanwhile, type 2 diabetes occurs due to insulin resistance, often due to lifestyle factors, and tends to be hereditary. As many as 11% of patients diagnosed with type 2 diabetes might actually have LADA . There are a couple things we can all do to prevent others from going undiagnosed and feeling ill for as long as I did. 

The first is to know the signs of type 1 diabetes. The tell-tale symptoms are excessive thirst and urination, extreme feeling of fatigue, blurred vision and weight loss. When I was diagnosed, I was experiencing all of these symptoms and had lost over 20 pounds. After months of misdiagnosis, I saw an endocrinologist who ordered blood tests, and within weeks, I had the correct type 1 diagnosis.

View this post on Instagram A post shared by Diabetech | Justin (@diabe_tech)

Had my glucose levels gone unchecked for longer, I could have gone into diabetic ketoacidosis or DKA, which can be deadly. Up to 30% of those diagnosed in the US are discovered at this stage. 

Another way we can prevent loss of life or sickness is with early screening for indicators of type 1 diabetes. Two blood tests are used to aid in diagnosis: A c-peptide test, which measures how much insulin a person is making themselves, and an islet autoantibody test, which screens for markers of the autoimmune process associated with type 1 diabetes. With these results, people can prepare and seek out treatment to offset the disease and/or treat it.

New legislation could help

Recent legislation aims to bring early screening for type 1 diabetes to the forefront of preventative care.  

Last month, a bipartisan bill called the Strengthening Collective Resources for Encouraging Education Needed for Type 1 Diabetes Act was introduced in the House of Representatives. The bill directs the Centers for Disease Control and Prevention to conduct a national campaign to increase awareness and knowledge of type 1 detection, screening and management, and will allocate $5 million to the CDC to carry it out.

On my end, I will continue to share my story through articles like this one, videos on social media and interviews on my podcast , Diabetech. My hope is that no one will experience the long stretch of illness I experienced before getting the correct diagnosis and treatment needed.

@diabe_tech My Diagnosis Story - getting diagnosed with type 1 diabetes by the Tik Tok T1D community. #diabetes #diagnosis #t1d ♬ original sound - Diabetech Justin

Diabetes is a complex and complicated disease to manage. Devices like insulin pumps, smart insulin pens and continuous glucose monitors make living with the disease easier to manage, but they come with a steep learning curve. 

I'm fortunate to be able to interview experts in the field on my podcast who help me and my audience stay informed on the latest tools and technology. I encourage anyone living with this disease to connect with me on YouTube , Instagram or TikTok to feel less alone and more in charge of your personal health.

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When Diet, Exercise Delay Diabetes Diagnosis, Long-term Health Improves

diabetes diet

Key Takeaways

People with prediabetes can improve their long-term health through diet and exercise

Those who delayed the onset of diabetes by four years through lifestyle changes had better long-term health

They had a lower risk of dying and a lower risk of heart attack or stroke

TUESDAY, July 9, 2024 (HealthDay News) -- Prediabetes can be successfully fought through diet and exercise, a new study shows.

People with prediabetes can reduce their long-term risk of death and illness if they use diet and exercise to delay the onset of diabetes for just four years, according to findings published July 9 in the journal PLOS Medicine .

Prediabetes -- also known as impaired glucose tolerance (IGT) -- involves blood sugar levels that are higher than normal, but haven’t reached the levels associated with full-blown diabetes.

“This study suggests that a longer duration of non-diabetes status in those with IGT has beneficial health outcomes" and reduces premature death, concluded the research team led by Dr. Guangwei Li of the China-Japan Friendship Hospital in Da Qing City, China.

For the study, researchers tracked the health of 540 people with prediabetes who participated in an earlier six-year clinical trial.

In the trial, prediabetic people were assigned to one of four groups – one that followed a healthy diet; one that got more exercise; one that both ate well and exercised; and a control group.

After more than 30 years of follow-up, researchers found that people who didn’t lapse into diabetes for at least four years after their diagnosis with prediabetes had a significantly lower risk of dying or experiencing a heart health event like a heart attack or stroke.

That protective effect was not found in people who became full-fledged diabetic within less than four years, researchers said.

The results suggest that the longer a prediabetic person delays the onset of diabetes, the better their long-term health will be, researchers concluded.

“The implementation of effective interventions targeting those with IGT should be considered as part of preventative management for diabetes and diabetes related vascular complications,” the team wrote.

More information

The National Institutes of Health have more about prediabetes .

SOURCE: PLOS , news release, July 9, 2024

What This Means For You

People with prediabetes should follow a healthy diet and exercise, as the longer they can delay diabetes, the better for their long-term health.

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Registered dietitians (RDs) who have earned the Board Certified–Advanced Diabetes Manager (BC-ADM) credential hold a master’s or doctorate degree in a clinically relevant area and have at least 500 hours of recent experience helping with the clinical management of people with diabetes. 1 They work in both inpatient and outpatient settings, including diabetes or endocrine-based specialty clinics, primary care offices, hospitals, and private practices. Advanced practice dietitians provide all components of diabetes care, including advanced assessment (medical history and physical examination), diagnosis, medical management, education, counseling, and overall case management.

The role of RDs in case and disease management was explored in a recent article 2 that included interviews with three dietitians who work as case managers or disease managers. All three reported experiencing challenges in practice and noted that the meaning of “case management” varies from one health care setting to another. This is also true for RD, BC-ADMs. Advanced practice dietitians specializing in diabetes require case management expertise that stresses communication skills, knowing the limits of your own discipline, knowing how to interact with other health care professionals, and knowing when to seek the expertise of other members of the diabetes care team.

Clinical practice includes assessment and data collection, diagnosis and problem identification, planning, and intervention. In many cases, diabetes educators who are dietitians and those who are nurses are cross-trained to perform the same roles. The first one to meet with a client handles that client’s assessment, and cases are discussed and interventions planned at weekly team meetings.

For advanced practice dietitians, the first session with a client often involves a complete physical assessment, not just a nutrition history. This includes a comprehensive medical history of all body systems. The diabetes-focused physical examination, just as performed by clinicians from other disciplines, includes height and weight measurement, body mass index (BMI) calculation, examination of injection sites, assessment of injection technique, and foot assessment.

Assessment also includes reviewing which medications the client is taking, evaluating their effectiveness and side effects, and determining the need for adjustment based on lifestyle, dietary intake, and blood glucose goals.

When carbohydrate counting is added to therapy, dietitians calculate carbohydrate-to-insulin ratios and teach clients how to use carbohydrate counting instead of a sliding-scale approach to insulin. Medications are adjusted based on clients’ lifestyles until blood glucose goals are achieved.

The therapeutic problem solving, regimen management, case management, and self-management training performed by advanced practice dietitians exceeds the traditional role of most dietetics professionals. 3  

A role delineation study for clinical nurse specialists, nurse practitioners, RDs, and registered pharmacists, 4 conducted in 2000 by the American Nurses Credentialing Center, reported equal findings among all four groups for the skills used to identify pathophysiology, analyze diagnostic tests, and list problems. Assessment for medical nutrition therapy typically includes evaluation of food intake, metabolic status, lifestyle, and readiness to change. For people with diabetes, monitoring glucose and measuring hemoglobin A 1c (A1C), lipids, blood pressure, and renal status are essential to evaluating nutrition-related outcomes.

The U.S. Air Force health care system conducted a pilot test giving RDs clinical privileges and evaluating their clinical judgment in patient nutritional care. A protocol was approved, and dietitians were allowed to order and interpret selected outpatient laboratory tests independently. The higher-level clinical judgments and laboratory privileges were linked to additional certifications. 5  

The Diabetes Prevention Program (DPP) also provided a unique opportunity for dietitians to demonstrate advance practice roles. 6 Dietitians served as lifestyle coaches, contacting participants at least once a month to address intervention goals. As case managers, they interviewed potential volunteers, assessed past experience with weight loss, and scheduled quarterly outcome assessments and weekly reviews of each participant’s progress at team meetings. Within the DPP’s central management, dietitians served as program coordinators and served on national study committees related to participant recruitment and retention, quality control, the use of protocols, and lifestyle advisory groups. 7  

Dietitians now play key roles in translating DPP findings and serving as community advocates to reduce the incidence of obesity and the health care burden of type 2 diabetes. This includes serving in a consultative role to other health care team members on issues regarding weight loss and risk factor reduction.

Advanced practice RDs offer comprehensive diabetes patient care services, including identifying patient goals and expected outcomes, selecting nonpharmacological and pharmacological treatments, and developing integrated plans of care. Problems discussed with patients range from acute and chronic diabetes complications to comorbid conditions, other conditions, preventive interventions, and self-management education. Advanced practice RDs also review patients’ health care resources and order laboratory tests if information is not available from referral sources. They provide supportive counseling and referral to specialists, as needed. And, they provide a full report of their findings and any regimen changes and recommendations they make to referring clinicians after each visit.

These activities and responsibilities go beyond the scope and standards of practice for the RDs and for RD, CDEs. 8 They will be included in the scope of practice document for RD, BC-ADMs that is now being developed by the Diabetes Care and Education Practice Group of The American Dietetic Association.

The following case study illustrates the clinical role of advanced practice dietitians in the field of diabetes.

B.C. is a 51-year-old white man who was diagnosed with type 1 diabetes 21 years ago. He believes that his diabetes has been fairly well controlled during the past 20 years and that his insulin needs have increased. He was recently remarried, and his wife is now helping him care for his diabetes.

His endocrinologist referred him to the RD for an urgent visit because 4 days ago he had a hypoglycemic event requiring treatment in the emergency room (ER). He has come to see the dietitian because his doctor and his wife insisted that he do so.

B.C. has had chronic problems with asymptomatic hypoglycemia. His last doctor’s visit was 3–4 weeks ago, when areas of hypertrophy were found. His endocrinologist asked him to change his injection sites from his thigh to his abdomen after the ER incident.

He does not think he needs any diabetes education but would like help in losing 10 lb. His body mass index is 25 kg/m 2 .

His medications include pravastatin (Pravacol), 10 mg daily; NPH insulin, 34 units in the morning and 13 units at bedtime; and regular insulin at breakfast and dinner following a sliding-scale algorithm. He also takes lispro (Humalog) insulin as needed to correct high blood glucose.

Before his ER visit, B.C. monitored his blood glucose only minimally, testing fasting and sometimes before dinner but not keeping records. Since his severe hypoglycemia 4 days ago, he has begun checking his blood glucose four times a day, before meals and bedtime.

Lab Results

B.C.’s most recent laboratory testing results were as follows:

A1C: 8.3% (normal 4.2–5.9%)

Lipid panel

    • Total cholesterol: 207 mg/dl (normal: 100–200 mg/dl)

    • HDL cholesterol: 46 mg/dl (normal: 35–65 mg/dl)

    • LDL cholesterol: 132 mg/dl (normal: <100 mg/dl)

    • Triglycerides: 144 mg/dl (normal: <150 mg/dl)

Creatinine: 0.9 mg/dl (normal: 0.5–1.4 mg/dl)

Microalbumin: 4 μg (normal: 0–29 μg)

At his initial visit with the RD for crisis management of asymptomatic hypoglycemia, she examined his injection sites and asked if he had made the changes recommended by his clinician. She reviewed his injection technique, diet history, incidence of hypoglycemia, and hypoglycemia treatment methods. She discussed with B.C. ways to reduce his risks of hypoglycemia, including food choices, insulin timing, and absorption variations at different injection sites.

The RD reinforced his clinician’s instruction to avoid old injection sites and added a new recommendation to lower insulin doses because of improved absorption at the new sites.

B.C. was now checking his blood glucose and recording results in a handheld electronic device in a form that could be downloaded, e-mailed, or faxed, but he was not recording his food choices. The dietitian asked him to keep food records and started his carbohydrate-counting education. A follow-up visit was scheduled for 1 week later.

At the second visit, B.C.’s mid-afternoon blood glucose was <70 mg/dl. He did not respond to treatment with 15 g carbohydrate from 4 oz. of regular soda. His blood glucose continued to drop, measuring 47 mg/dl 15 minutes later. He drank another 8 oz. of soda, and his blood glucose increased to 63 mg/dl 1 hour later. He then drank another 8 oz. of soda and ate a sandwich before leaving the dietitian’s office. He called in 1 hour later to report that his blood glucose was finally up to 96 mg/dl.

B.C.’s records showed a pattern of mid-afternoon hypoglycemia. He was willing to add a shot of lispro at lunch to his regimen, so the RD recommended reducing his morning NPH to prevent lows later in the day.

The RD also calculated insulin and carbohydrate ratios for blood glucose correction and meal-related insulin coverage using the “1500 rule” and the “500 rule.”

The 1500 rule is a commonly accepted formula for estimating the drop in a person’s blood glucose per unit of fast-acting insulin. This value is referred to as an “insulin sensitivity factor” (ISF) or “correction factor.” To use the 1500 rule, first determine the total daily dose (TDD) of all rapid- and long-acting insulin. Then divide 1500 by the TDD to find the ISF (the number of mg/dl that 1 unit of rapid-acting insulin will lower the blood glucose level). B.C.’s average TDD was 41 units. Therefore, his estimated ISF was 37 mg/dl per 1 unit of insulin. The RD rounded this up to 40 mg/dl to be prudent, given his history of hypoglycemia.

The 500 rule is a formula for calculating the insulin-to-carbohydrate ratio. To use the 500 rule, divide 500 by the TDD. For B.C., the insulin-to-carbohydrate ratio was calculated at 1:12 (1 unit of insulin to cover every 12 g of carbohydrate), but again this was rounded up to 1:14 for safety. Later, his carbohydrate ratio was adjusted down to 1:10 based on blood glucose monitoring results before and 2 hours after meals.

The RD taught B.C. how to use the insulin-to-carbohydrate ratio instead of his sliding scale to adjust his insulin and asked him to try to follow the new recommendations. With his endocrinologist’s approval, she reduced his NPH doses to 34 units and added a shot of lispro at lunchtime, the dose to be based on the amount of carbohydrate in the meal and his before-meal blood glucose level.

The RD asked B.C. to return in 1 week for evaluation and review of his new regimen. However, 3 days later, he returned after having had another severe episode of hypoglycemia.

In the course of these early visits, a good rapport developed between B.C. and the dietitian. B.C. learned that his judgment on how hypo- and hyperglycemia felt was often inaccurate and led him to make insulin adjustments that contributed to his hypoglycemia problems. By improving B.C.’s understanding of insulin doses and blood glucose responses, the RD hoped to help him become more skilled at making insulin dose adjustments. For the time being, however, he was still at risk for asymptomatic hypoglycemia. He had recently filled a prescription for glucagon, but the RD needed to review and encourage its proper use. She also provided literature to support his wife in case she needed to administer glucagon for him.

At this third visit, the RD reduced B.C.’s morning NPH dose to 22 units because of his rapid drop in blood glucose between noon and 1:00 p.m. This reduction finally eliminated his mid-afternoon lows.

B.C. had started using carbohydrate counting to make his decisions about lunchtime insulin doses. He liked carbohydrate counting because it gave him a more viable reason for testing his blood glucose frequently. Over the years, B.C.’s glycemia had become increasingly difficult to control. He had stopped checking his blood glucose because he felt unable to improve the situation once he had the information. In the early 1990s, his endocrinologist had started him self-adjusting insulin doses using the exchange system, but he found that he was always “chasing his blood sugars.” Carbohydrate counting changed everything. He now knew what to do to improve his blood glucose levels, and that made him feel more in charge of his diabetes.

Still, although carbohydrate counting led to more frequent testing and better blood glucose control than his old sliding scale, it was not perfect. At home, he had mastered this technique, but he ate many of his meals in restaurants, where carbohydrate counting was more challenging.

B.C. found it difficult to carry different types of insulin. This and his lifestyle suggested the need to change his multiple daily injections from regular to lispro insulin. He continued checking his blood glucose before and 2 hours after meals. His insulin-to-carbohydrate ratio of 1:10 g and his ISF of 1:40 mg/dl allowed him to stay within his goal of no more than a 30-mg/dl increase in blood glucose 2 hours after meals. He continued to be asymptomatic of hypoglycemia, but lows occurred less frequently. The new goal of therapy was to recover his hypoglycemia symptoms at a more normal level of about 70 mg/dl. He was scheduled for another visit 2 weeks later.

Between visits to the RD, BC-ADM, his clinician identified problems with the timing of his long-acting insulin peak, resulting in early nocturnal lows. Based on the clinician’s clinical experience of lente demonstrating a slightly smoother peak, she changed B.C.’s long-acting insulin unit-for-unit from NPH to lente.

At B.C.’s next visit, he and the RD reviewed his insulin doses of 22 units of lente in the morning and 11 units of lente at night. His TDD including premeal lispro now averaged 49 units. His average blood glucose levels were 130 mg/dl fasting, 100 mg/dl mid-afternoon, 127 mg/dl before dinner, and 200 mg/dl at bedtime.

The bedtime levels were higher because of late meals, the fat content of restaurant meals, his meat food choices, and his inexperience at counting carbohydrates for prepared foods. The dietitian suggested mixing regular and lispro insulin to try and get the average bedtime blood glucose level to 140 mg/dl. Mixing his calculated dose to be one-third regular and two-third lispro would provide coverage lasting a little longer than that of just lispro to cover higher-fat foods that took longer to digest. At the same time, the dietitian encouraged B.C. to choose lower-fat foods to help reduce his LDL cholesterol and assist with weight loss. B.C. now had an incentive to keep accurate food records to help evaluate his accuracy at calculating insulin doses.

B.C. and the RD also reviewed his decisions for treating lows. At his first meeting, B.C. ate anything and everything when he experienced hypoglycemia, which often resulted in blood glucose levels >400 mg/dl. Now, he was appropriately using 15–30 g of quick-acting glucose—usually 4–8 oz. of orange juice. He based this amount on his blood glucose level, expecting about a 40-mg/dl rise over 30 minutes from 10 g of carbohydrate. He checked his glucose level before treating when possible and always checked 15–30 minutes after treating to evaluate the results. Once his glucose reached 80 mg/dl or above, he either ate a meal or ate 15 g of carbohydrate per hour to prevent a recurrence of hypoglycemia until his next meal.

In completing her assessment during the next few meetings with B.C., the RD identified a problem with erectile dysfunction. She notifed his clinician and referred him to a urologist. Eventually, the urologist diagnosed reduced blood flow and started B.C. on sildenafil (Viagra).

B.C. wanted to resume exercise to help his weight loss efforts. Because exercise improves insulin sensitivity and can acutely lower blood glucose, the dietitian taught B.C. how to reduce his insulin doses by 25–50% for planned physical activity to further reduce his risks of hypoglycemia. He learned to carry his blood glucose meter, fluids, and carbohydrate foods during and after exercise. His pre-exercise blood glucose goal was set at 150 mg/dl. The dietitian instructed B.C. to test his blood glucose again after exercise and to eat carbohydrate foods if it was <100 mg/dl.

She also gave instructions for unplanned exercise. He would require additional carbohydrate depending on his blood glucose level before exercise, his previous experience with similar exercise, and the timing of the exercise. Education follow-ups were scheduled with the dietitian for 1 month later and every 3 months thereafter.

At his next annual eye exam, B.C. discovered that he had background retinopathy. He also reported feeling that his daily injection regimen had become too complicated. Still feeling limited in his ability to control his diabetes and looking for an alternative to insulin injections, he wanted to discuss continuous subcutaneous insulin infusion therapy (insulin pump therapy).

He, his endocrinologist, and his dietitian discussed the pros and cons of pump therapy and how it might affect his current situation. They reviewed available insulin pumps and sets and agreed on which ones would best meet his needs. The equipment was ordered, and a training session was scheduled with the dietitian (a certified pump trainer) in 1 month.

B.C. started using an insulin pump 2 years after his first visit with the dietitian. His insulin-to-carbohydrate ratio was adjusted for his new therapy regimen, and a new ISF was calculated to help him reduce high blood glucose levels. His endocrinologist set basal insulin rates at 0.3 units/hour to start at midnight and 0.5 units/hour to start at 3:00 a.m. This more natural delivery of insulin based on B.C.’s body rhythms and lifestyle further improved his diabetes control.

One week after starting pump therapy, B.C. called the dietitian to report large urine ketones and a blood glucose level of 317 mg/dl. His endocrinologist had changed his basal rates, but he wanted to meet with the dietitian to review his sites, set insertion, troubleshooting skills, and related issues. Working together, they eventually discovered that problems with his pump sites required using a bent-needle set to resolve absorption issues.

B.C’s relationship with his endocrinologist and dietitian was seamless. He met with the dietitian when his clinician was unavailable or when he needed more time to work through problems.

B.C. has met with the RD 15 times over 3 years. Eventually, he recovered symptoms of hypoglycemia when his blood glucose levels were 70 mg/dl. After 6 months of education meetings, his lab values had reached target ranges. Most recently, his LDL cholesterol was <100 mg/dl, his A1C results were <7%, his hypoglycemia symptoms were maintained at a blood glucose level of 70 mg/dl, and his blood glucose had been stabilized using the square-wave and dual-wave features on his insulin pump.

B.C. learned how to achieve recommended goals and to self-manage his diabetes with the help of his care team: endocrinologist, cardiologist, ophthalmologist, podiatrist, urologist, and advanced practice dietitian.

Advanced practice dietitians in diabetes work in many settings and see clients referred from many different types of medical professionals. They may see clients either before or after their appointments with other members of the health care team, depending on appointment availability and their need for nutrition therapy and diabetes education. Referring clinicians rely on their evaluations and findings. When necessary, clinician approval can be obtained for immediate interventions, enhancing the timeliness of care.

Why would an RD want to obtain the skills and certification necessary to earn the BC-ADM credential? The answer, as illustrated in the case study above, lies in their routine use of two sets of skills and performance of two roles: patient education and clinical management.

Dietitians who specialize in diabetes often find that their role expands beyond provider of nutrition counseling. As part of a multidisciplinary team, they become increasingly involved with patient care. As they move patients toward self-management of their disease, they necessarily participate actively in assessment and diagnosis of patients; planning, implementation, and coordination of their diabetes care regimens; and monitoring and evaluation of their treatment options and strategies. They find that their daily professional activities go beyond diabetes education, crossing over into identifying problems, providing or coordinating clinical care, adjusting therapy, and referring to other medical professionals. They often work independently, providing consultation both to people with diabetes and to other diabetes care team members.

The BC-ADM credential acknowledges this professional autonomy while promoting team collaboration and thus improving the quality of care for people with diabetes. The new certification formally recognizes advanced practice dietitians as they move beyond their traditional roles and into clinical problem solving and case management.

Claudia Shwide-Slavin, MS, RD, BC-ADM, CDE, is a private practice dietitian in New York, N.Y.

Note of disclosure: Ms. Shwide-Slavin has received honoraria for speaking engagements from Medtronic Minimed, which manufactures insulin pumps, and Eli Lilly and Co., which manufactures insulin products for the treatment of diabetes.

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Breakthrough Studies on Automated Insulin Delivery and CGM for Type 2 Diabetes Unveiled at ADA Scientific Sessions


Results Demonstrate Enhanced Diabetes Management and Quality of Life with Advanced Technology

New data focused on advanced technology innovations for managing type 2 diabetes (T2D) highlight the positive impact of automated insulin delivery systems (AID) and continuous glucose monitoring (CGM) in improving glycemic control and overall diabetes management. Three studies showing advancements for type 2 diabetes were presented at the American Diabetes Association’s ® (ADA) 84th Scientific Sessions in Orlando, FL.

Of the nearly 40 million Americans with diabetes, more than 90% have type 2 diabetes. As the prevalence continues to rise globally, effective management strategies are more critical than ever. The studies showcased at the ADA Scientific Sessions emphasize the transformative potential of integrating advanced technologies into diabetes care, particularly for under-resourced populations.

"These studies represent a significant advancement in diabetes management technologies, showing substantial improvements in glycemic control and quality of life for people with type 2 diabetes," said Robert Gabbay, MD, PhD, ADA chief scientific and medical officer. “By leveraging these innovations, we can empower patients with more effective and manageable treatment options, ultimately transforming the landscape of diabetes care.”

SECURE-T2D Pivotal Trial Demonstrates Significant Benefits of Omnipod® 5 Automated Insulin Delivery System in Adults with Type 2 Diabetes

Findings from the SECURE-T2D pivotal trial, the first large-scale, multicenter study evaluating the Omnipod® 5 AID System, a novel insulin pump, in a racially diverse group of adults with type 2 diabetes were presented as a late-breaking poster.

The Omnipod 5 AID System is a tubeless insulin pump that automatically adjusts insulin delivery based on CGM data. This system aims to improve glycemic control by responding to glucose levels in real-time, reducing the burden of manual insulin dosing for people with diabetes.

The multicenter pivotal clinical trial included 305 adults aged 18-75 years with type 2 diabetes who were using various insulin regimens (basal-bolus, premix, or basal-only) and had a baseline HbA1c of less than 12.0%. After a 14-day standard therapy phase to establish baseline glycemic control, participants transitioned to 13 weeks of using the Omnipod 5 AID System. The primary endpoint was the change in HbA1c from baseline to 13 weeks. The study population was also notably diverse, with 24% Black and 22% Hispanic/Latino participants.

Key findings from the trial showed that the use of the Omnipod® 5 AID System led to a significant reduction in HbA1c levels, from a baseline average of 8.2±1.3% to 7.4±0.9% at the end of the study (treatment effect: -0.8%, 95% CI: -1.0 to -0.7, p<0.001). The greatest improvements were observed in participants with the highest baseline HbA1c.

"The results from the SECURE-T2D trial underscore the potential of the Omnipod 5 AID System to transform diabetes management for adults with type 2 diabetes,” said Francisco J. Pasquel, MD, MPH, Associate Professor of Medicine and Global Health at Emory University, and lead author of the study. “The substantial improvements in glycemic control and quality of life, particularly among minority populations, are promising steps toward more equitable diabetes care."

Future research will focus on long-term outcomes and the potential of a new solution to address other aspects of diabetes management. The authors also note that studies may explore its effectiveness in different populations and its impact on quality of life for people with type 2 diabetes. Additionally, ongoing analyses will aim to refine and enhance the system's algorithms to maximize its benefits for users.  

Improved Glycemic Outcomes with Continuous Glucose Monitoring (CGM) in Type 2 Diabetes Patients: Real-World Analysis Reveals Significant Benefits

Findings from an oral presentation, Glycemic Outcomes with CGM Use in Patients with Type 2 Diabetes—Real-World Analysis, showcase the significant impact of continuous glucose monitoring on patients with type 2 diabetes, revealing the use of CGM substantially improves glucose control in type 2 diabetes patients across all therapeutic treatments.

The study evaluated the impact of CGM on adults with type 2 diabetes using non-insulin therapies (NIT), basal insulin (BIT), and prandial insulin (PIT). This 12-month retrospective analysis used data from a large claims database of over 7.1 million type 2 diabetes patients and compared HbA1c levels before and after CGM use, focusing on the change closest to 12 months post-CGM acquisition.

Among the 6,030 adults with type 2 diabetes (NIT: 1,533; BIT: 1,375; PIT: 3,122), with a mean baseline HbA1c of 8.8% and a mean age of 59 years, significant HbA1c improvements (by 1% across all therapies) were observed across all therapy groups after 12 months. The study underscores CGM's potential to enhance glycemic control and reduce healthcare costs in both insulin and non-insulin-treated type 2 diabetes patients.

"These results suggest that CGM can play a crucial role in enhancing health outcomes for all diabetes patients, regardless of their treatment regimen," said Satish K. Garg, MD, University of Colorado Denver, and lead author of the study. "The real-world analysis underscores the potential of CGM to not only improve glycemic outcomes but also reduce healthcare resource utilization and overall healthcare costs."

Looking ahead, longer-term studies and randomized controlled trials are recommended to further validate these results and explore the broader implications of CGM use in diabetes care. Future research will focus on confirming the sustained benefits of CGM and understanding its impact on various patient subgroups to tailor diabetes management strategies effectively.

Using the same database, findings from a related late-breaking abstract reveal that CGM use in type 2 diabetes results in more than a 50% reduction in all-cause hospitalizations and acute diabetes-related hospitalizations. Dr. Garg presented the results of the late-breaking abstract, Impact of Continuous Glucose Monitoring Use on Hospitalizations in People with Type 2 Diabetes—Real-World Analysis , as an e-theatre poster on Sunday, June 23, 2024.

Continuous Glucose Monitoring (CGM) Improves Glycemic Control in Adults with Type 2 Diabetes Not Using Insulin

Findings from a new study demonstrate that CGM significantly enhances glycemic control in adults with type 2 diabetes who are not using insulin. These results, presented during the general poster session and simultaneously published in Diabetes Technology and Therapeutics , underscore the potential of CGM to improve diabetes management and support expanding CGM access for adults with type 2 diabetes not using insulin.

The real-world study analyzed data from over 3,800 adults using Dexcom G6 and G7 sensors. The participants, initially not meeting their glycemic targets, showed significant improvements after six months of CGM use, with further progress at one year.

Key findings include a 0.5% reduction in the glucose management indictor, a CGM approximation of A1C, and a 17% increase in Time in Range (TIR), which translates to an additional four hours per day spent within the target glucose range. The study also highlighted the advantages of the Dexcom High Alert feature, which notifies users when glucose levels exceed their selected targets. Participants who used this feature showed the greatest improvements in their glucose levels. The consistent CGM use over the year suggests sustained benefits and a positive impact on long-term diabetes care.

“We are encouraged by the significant long-term improvements in glycemic control observed in our study,” said Jennifer E. Layne, PhD, Dexcom. “These findings highlight the importance of CGM for managing non-insulin treated type 2 diabetes for clinicians and for patient self-management.”

Looking ahead, the authors plan to continue studying this cohort and other CGM users not taking insulin to explore ongoing patterns of glycemic improvement and real-world behavior change enabled by CGM. The team also intends to evaluate the impact of other Dexcom system features on glycemic control.

Research presentation details:

Dr. Pasquel will present the findings at the late-breaking poster session presentation sessions: 

  • Glycemic Improvement with Use of the Omnipod 5 Automated Insulin Delivery System in Adults with Type 2 Diabetes—Results of the SECURE-T2D Pivotal Trial 
  • Presented on Saturday, June 22, 2024 at 12:30 PM EDT
  • Presented on Sunday, June 24, 2024 at 1:50 PM EDT  

Dr. Garg will present the findings at the following oral presentation session: 

  • Glycemic Outcomes with CGM Use in Patients with Type 2 Diabetes—Real-World Analysis
  • Presented on Monday, June 24, 2024 at 8:00 AM EDT  

Dr. Layne will present the findings at the general poster session: 

  • Long-Term Improvement in CGM-Measured Glycemic Control in Adults with Type 2 Diabetes Not Treated with Insulin—Real-Word

About the ADA’s Scientific Sessions The ADA's 84th Scientific Sessions, the world's largest scientific meeting focused on diabetes research, prevention, and care, will be held in Orlando, FL on June 21-24. More than 11,000 leading physicians, scientists, and health care professionals from around the world are expected to convene both in person and virtually to unveil cutting-edge research, treatment recommendations, and advances toward a cure for diabetes. Attendees will receive exclusive access to thousands of original research presentations and take part in provocative and engaging exchanges with leading diabetes experts. Join the Scientific Sessions conversation on social media using #ADAScientificSessions. 

About the American Diabetes Association The American Diabetes Association (ADA) is the nation’s leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. For 83 years, the ADA has driven discovery and research to treat, manage, and prevent diabetes while working relentlessly for a cure. Through advocacy, program development, and education we aim to improve the quality of life for the over 136 million Americans living with diabetes or prediabetes. Diabetes has brought us together. What we do next will make us Connected for Life®. To learn more or to get involved, 

visit us at  diabetes.org  or call 1-800-DIABETES (1-800-342-2383). Join the fight with us on Facebook ( American Diabetes Association ), Spanish Facebook ( Asociación Americana de la Diabetes ), LinkedIn ( American Diabetes Association ), Twitter ( @AmDiabetesAssn ), and Instagram ( @AmDiabetesAssn ).   

Contact Virginia Cramer for press-related questions.

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    Type 1 diabetes accounts for approximately 6% of all cases of diabetes in adults (≥18 years of age) in the United States, 4 and 80% of these cases are diagnosed before the patient is 20 years of age. 5 Since this patient's diabetes was essentially nonprogressive over a period of at least 9 years, she most likely does not have type 1 ...

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    Deborah Thomas-Dobersen; Case Study: A Woman With Type 2 Diabetes and Severe Hypertriglyceridemia Sensitive to Fat Restriction. Clin Diabetes 1 October 2002; 20 (4): ... Case study: a 55-year-old man with obesity, hypertriglyceridemia, and newly diagnosed type 2 diabetes who collapsed and died.

  7. "I have got diabetes!"

    Background To be diagnosed with type 2 diabetes is a challenge for every patient. There are previous studies on patients' experience in general but not addressing the increased cardiovascular risk and multifactorial treatment. The aim of this study was to explore the thoughts, experiences and reactions of newly diagnosed patients with diabetes to this diagnosis and to the risk of developing ...

  8. Case Study: Remission of Type 2 Diabetes After Outpatient Basal Insulin

    However, a few studies have demonstrated that drug-free glycemic control can be achieved in type 2 diabetes for 12 months on average after a 2-week continuous insulin infusion ( 2 - 4 ). Here, we describe an unusual case of a 26-month drug holiday induced with outpatient basal insulin in a patient newly diagnosed with type 2 diabetes.

  9. PDF Presented by: Case study 2 The treatment of a newly diagnosed diabetic

    Best practice. CEUDiabetesCase study 2The treatment of a newly diagnosed diabetic patientThis. bardHow would y. glucose: 16.2 mmol/l, HbA1c: 7.8%Referred for assessment. opinionDyslipidaemia and hypertension, central obesity, BMI: 35 kg/m2.Click h. re - you need to watch the video in order to complete the CPD questionnaire. This report was ...

  10. Case Study 1: Patient with Newly Diagnosed Type 1 Diabetes

    Case Notes Although the patient's HbA 1c improved, it remained higher than recommended by American Diabetes Association guidelines. However, because HbA 1c reflects glycemic status for approximately a 12-week period, SMBG values (if considered adequately reliable) remain the most important tool for monitoring glycemia.

  11. Complex case study: New diagnosis of type 2 diabetes ...

    UK Prospective Diabetes Study (UKPDS) Group (1998) Effect of intensive blood-glucose with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 352 : 854-65 Wallentin L et al; PLATO Investigators (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes.

  12. Case Study 1: Patient with Newly Diagnosed Type 1 Diabetes

    Case Notes Insulin lispro has an onset of action 15 minutes after injection, a maximal effect 60-90 minutes after dosing, and a duration of action of 3-4 hours. Regular insulin has an onset of action 1-2 hours after injection, a maximal effect 3-4 hours after dosing, and a duration of action of 6 or more hours.

  13. A case report: First presentation of diabetes mellitus type 1 with

    Herein, we report a 35‐month‐old girl, who was newly diagnosed with diabetes mellitus type1 (T1DM), with presentation of HHS that developed some complications. Hyperosmolar hyperglycemic state (HHS), a rare diabetic hyperglycemic emergency, is most often observed in adult patients, but seldom seen in pediatric patients.

  14. Interactive case study: Making a diagnosis of type 2 diabetes

    The new series of case studies from Diabetes & Primary Care is aimed at GPs, practice nurses and other professionals in primary and community care who would like to broaden their understanding of type 2 diabetes. This third case offering provides three mini-case studies that take you through the criteria for making an accurate diagnosis of diabetes and non-diabetic hyperglycaemia.

  15. Case Study 1: Patient with Newly Diagnosed Type 1 Diabetes

    Describe the physiologic consequences of diabetes mellitus. Outline the importance of maintaining glycemic control in reducing the risk of diabetic complications. Detail specific clinical applications of insulin therapy to achieve both basal and meal-related glycemic control. Manage a patient's glycemic status by continuously refining the ...

  16. Diabetes Case Study

    Diabetes Case Studies Case Study 1 Sallie Smith, 42 years of age, is newly diagnosed with type 2 diabetes. During the patient education, the patient asks the nurse, "What should I do if I am sick and can't eat; should I still take my medicine for the diabetes?" 1. What management strategies should the nurse provide the patient to deal ...

  17. Intermittent fasting over two days can help people with Type 2 diabetes

    A study found that intermittent fasting had striking metabolic benefits that surpassed the effects of prescription drugs for people with newly diagnosed diabetes. By Anahad O'Connor June 21 ...

  18. Multi‐omics analysis reveals drivers of loss of β‐cell function after

    Aims. Heterogeneity in the rate of β-cell loss in newly diagnosed type 1 diabetes patients is poorly understood and creates a barrier to designing and interpreting disease-modifying clinical trials.Integrative analyses of baseline multi-omics data obtained after the diagnosis of type 1 diabetes may provide mechanistic insight into the diverse rates of disease progression after type 1 diabetes ...

  19. Interactive case study: Cardiovascular disease and type 2 diabetes

    Diabetes & Primary Care's series of interactive case studies is aimed at all healthcare professionals in primary and community care who would like to broaden their understanding of diabetes.. These three scenarios review the primary and secondary prevention of cardiovascular disease, along with glycaemic management, in people with type 2 diabetes.

  20. Case Study: Diabetic Ketoacidosis in Type 2 Diabetes: "Look Under the

    Diabetic ketoacidosis (DKA) is a cardinal feature of type 1 diabetes. However, there is a strong, almost dogmatic, errant perception by physicians that DKA is a complication that only occurs in patients with type 1 diabetes. This is not true. DKA does occur in type 2 diabetes; however, it rarely occurs in the absence of a precipitating event.

  21. Letter to the Editor Endocrine Practice The role of Teplizumab in newly

    In the May 2024 edition of Endocrine Practice, Kamrul-Hansan et al reported on a meta-analysis of teplizumab utilization in newly diagnosed type 1 diabetes. The study showed a significant retention of beta cell function and prolongation of the honeymoon period compared with placebo at 6 and 18 but not at 24 months. Therefore, the effect of teplizumab, like the effect of other immunosuppressant ...

  22. 2024 ADA Scientific Sessions: Key Research Highlights

    The study looked into whether Tzield could help young people (ages 8-17) newly diagnosed with type 1 diabetes. Dr. ... Stem Cell-Derived Beta Cells for Type 1 Diabetes. This study showcased the transplantation of stem cell-derived beta cells into patients with type 1 diabetes, resulting in significant insulin production and reduced dependence ...

  23. Ozempic, Wegovy linked to rare condition that can cause blindness ...

    The study says people prescribed semaglutide, sold under the brands Ozempic for diabetes or Wegovy for weight loss, were more likely to be diagnosed with a rare condition called NAION than those ...

  24. Case Study 1: Patient with Newly Diagnosed Type 1 Diabetes

    Results of hospital laboratory studies (Table 1-1) revealed that the patient's initial blood glucose level was 1192 mg/dL and clinical presentation and laboratory findings were consistent with a diagnosis of diabetic ketoacidosis (DKA). The patient reported no family history of diabetes. His father died at age 35 of renal failure.

  25. Four-year diabetes delay reduces death and complications in prediabetic

    In the new study, researchers looked at health outcomes from 540 prediabetic individuals who participated in the original Da Qing Diabetes Prevention Study, a six-year trial conducted in Da Qing ...

  26. Case Report: Newly diagnosed type 1 diabetes complicated by

    The patient was diagnosed with type 1 diabetes mellitus supported by a low C peptide level of 43 (370-1470 pmol/L) and an antiglutamic acid decarboxylase (GAD) antibody titre of 4.7 (ref. 0-1.0). The complete blood count showed high white cell count of 20.9×10 9 /L but normal haemoglobin level of 8.4 mmol/L and platelet count of 199×10 9 ...

  27. My Doctor Misdiagnosed My Diabetes -- and I'm Not Alone. What ...

    As many as 11% of patients diagnosed with type 2 diabetes might actually have LADA. There are a couple things we can all do to prevent others from going undiagnosed and feeling ill for as long as ...

  28. When Diet, Exercise Delay Diabetes Diagnosis, Long-term Health Better

    TUESDAY, July 9, 2024 (HealthDay News) -- Prediabetes can be successfully fought through diet and exercise, a new study shows. People with prediabetes can reduce their long-term risk of death and illness if they use diet and exercise to delay the onset of diabetes for just four years, according to findings published July 9 in the journal PLOS Medicine.

  29. Case Study: A Patient With Type 1 Diabetes Who Transitions to Insulin

    B.C. is a 51-year-old white man who was diagnosed with type 1 diabetes 21 years ago. He believes that his diabetes has been fairly well controlled during the past 20 years and that his insulin needs have increased. He was recently remarried, and his wife is now helping him care for his diabetes.

  30. Breakthrough Studies on Automated Insulin Delivery and CGM for Type 2

    New data focused on advanced technology innovations for managing type 2 diabetes (T2D) highlight the positive impact of automated insulin delivery systems (AID) and continuous glucose monitoring (CGM) in improving glycemic control and overall diabetes management. Three studies showing advancements for type 2 diabetes were presented at the ...