Achieving at Least 15% Weight Loss within 2 Years of T2D Diagnosis is Associated with a Lower Long-Term Risk of Micro- and Macrovascular Disease: A UK Cohort Study

Presenter: Naveed Sattar, et al.

This retrospective cohort study assessed the impact of substantial weight loss on vascular outcomes in adults with newly diagnosed type 2 diabetes (T2D) and obesity using UK Clinical Practice Research Datalink (CPRD) data. Individuals who achieved at least 15% weight loss within 2 years of T2D diagnosis were propensity score matched 1:4 with controls who maintained stable weight (<2% weight change). The matched cohort included 13,658 individuals in the weight-loss group and 54,632 controls. Matching accounted for factors such as age, sex, ethnicity, body mass index (BMI), glycated hemoglobin (HbA1c), smoking status, diabetes medications, and comorbidities. Compared with controls, individuals achieving ≥15% weight loss had a 13% lower risk of microvascular events (hazard ratio [HR] 0.87; 95% confidence interval [CI] 0.82–0.91) and a 10% lower risk of macrovascular events (HR 0.90; 95% CI 0.84–0.95). Glycemic outcomes were also better in the weight-loss group, with a substantially higher proportion of individuals achieving HbA1c targets of ≤6.5% and <5.7% compared with controls.

Overall, achieving at least 15% weight loss within 2 years of type 2 diabetes diagnosis was associated with lower risks of both microvascular and macrovascular complications, as well as improved glycemic control, supporting the value of early weight-loss interventions in T2D management.

Association Between Time in Range and Advanced Cardiovascular-Kidney-Metabolic Syndrome in Older Adults with Type 2 Diabetes: A Cross-Sectional Study

Presenter: Jiaying Ni

This cross-sectional study examined the relationship between time in range (TIR) and advanced cardiovascular-kidney-metabolic (CKM) syndrome in 2,497 adults aged 60 years or older with type 2 diabetes. TIR was measured using continuous glucose monitoring and defined as the percentage of time glucose levels remained between 3.9 and 10.0 mmol/L. Participants with advanced CKM syndrome (stages 3–4) had significantly lower TIR values than those without advanced disease (P<0.001). After adjusting for potential confounders, each 1-standard deviation decrease in TIR was associated with a 28% higher likelihood of advanced CKM syndrome (odds ratio [OR] 1.28; 95% confidence interval [CI] 1.16–1.42). The predictive ability of TIR was comparable to that of glycated haemoglobin (HbA1c). A linear inverse relationship was observed between TIR and advanced CKM syndrome, with risk beginning to increase below a TIR of approximately 70%. Compared with the commonly recommended TIR target of 50%, a threshold of 70% significantly improved risk classification (net reclassification improvement 0.133; 95% CI 0.060–0.205). Although the highest odds of advanced CKM syndrome were seen in individuals with TIR ≤50%, those with TIR between 50% and 70% also remained at increased risk (OR 1.40; 95% CI 1.12–1.75). These findings indicate that lower TIR is independently associated with a higher likelihood of advanced CKM syndrome and suggest that maintaining TIR above 70% may be a more appropriate glycemic target for older adults with type 2 diabetes.

Overall, lower TIR was independently associated with advanced CKM syndrome, supporting a TIR target above 70% for improved cardiometabolic risk management in older adults with type 2 diabetes.

Association of Glucose Metrics Including Time in Tight Range with Risk of Major Adverse Cardiovascular Events and Severe Hypoglycaemia in Type 2 Diabetes: A Post Hoc Multivariate Analysis of Devote

Presenter: Louise Lawson-Smith, et al.

This post hoc analysis evaluated the association of derived time in range (dTIR), derived time in tight range (dTITR), and derived glucose variability (d%CV) with major adverse cardiovascular events (MACE) and severe hypoglycaemia in 5,774 adults with high-risk type 2 diabetes (T2D). During follow-up, 370 MACE events and 314 severe hypoglycaemic episodes were reported. Mean dTIR, dTITR, and d%CV were 74.6%, 52.1%, and 28.5%, respectively. In univariate analyses, both dTIR (p=0.002) and dTITR (p=0.02) were associated with MACE risk, but only dTIR remained significant after multivariable adjustment (p=0.01). Participants with dTIR ≥70% had a 27–29% lower risk of MACE. For severe hypoglycaemia, dTIR, dTITR, and d%CV were significant in univariate analyses (p=0.001), but not after multivariable adjustment. The relationship between dTITR and severe hypoglycaemia varied according to glucose variability (interaction p=0.011), with lower hypoglycaemia risk generally observed among individuals with low glucose variability and higher dTITR.

Overall, dTIR was independently associated with cardiovascular risk, while dTITR provided additional information on hypoglycaemia risk when interpreted together with glucose variability.

Cardio-Renal-Metabolic Multimorbidity in India: Findings from a Large Community-Based Study

Presenter: Sailesh Mohan, et al.

This large community-based study assessed the prevalence of Cardio-Renal-Metabolic Multimorbidity (CRMM) among 11,017 adults aged 30 years or older from North and South India. Data on sociodemographic characteristics, chronic diseases, and risk factors were collected through questionnaires, while blood pressure, anthropometric measurements, and fasting blood samples were obtained using standard methods. Cardio-Renal-Metabolic Multimorbidity was defined as the presence of at least two of the following conditions: diabetes, hypertension, cardiovascular disease, chronic kidney disease, and overweight/obesity. The mean age of participants was 49.1 years, and 53% were women. The overall prevalence of CRMM was 33.6% (95% confidence interval [CI]: 32.7–34.5), indicating that approximately one in three adults had multiple cardio-renal-metabolic conditions. Higher prevalence was observed among males (37.7%; 95% CI: 36.4–39.0), urban residents (42.9%; 95% CI: 41.6–44.3), individuals aged ≥60 years (49.7%; 95% CI: 47.8–51.7), and those in the highest wealth quintile (44.3%; 95% CI: 42.1–46.6).

These findings highlight the substantial burden of CRMM in India across different population groups. The authors suggest that integrated healthcare strategies targeting shared risk factors through primary care may help improve health outcomes associated with these interconnected conditions.

Impact of Baseline Glycemic Control on the Development of Diabetes-Related Complications in 111,519 Newly Diagnosed Type 2 Diabetes Patients: An 11-Year Longitudinal Analysis (2014-2025)

Presenter: Diego-Abelardo Alvarez-Hernandez, et al.

This retrospective longitudinal cohort study evaluated whether glycated hemoglobin (HbA1c) levels at diagnosis were associated with the risk of developing a first diabetes-related complication in newly diagnosed patients with type 2 diabetes (T2D) in primary healthcare units in Mexico. The analysis included 111,519 patients diagnosed with T2DM between 2014 and 2025 who had no diabetes-related complications at the time of diagnosis. Over 11 years of follow-up, 3,407 patients developed a first diabetes-related complication. The most frequently reported complications were neuropathy (37.1%), chronic kidney disease (CKD; 9.8%), and cardiovascular disease (CVD; 9.1%). Survival analysis showed that patients with a baseline HbA1c level greater than 12% had a significantly higher probability of developing diabetes-related complications than those with lower HbA1c levels (p<0.001). More than 25% of these patients experienced a complication by year 11 of follow-up. In the adjusted Cox proportional hazards model (n=43,320), a baseline HbA1c level above 12% was associated with a 34% higher risk of developing a first diabetes-related complication (p=0.001). Age was also an important predictor of risk. Compared with younger patients, those aged 45–59 years had a 50% higher risk (p=0.047), while patients older than 75 years had an 88% higher risk (p=0.006).

Overall, elevated HbA1c at diagnosis, particularly levels above 12%, was associated with faster development of diabetes-related complications, especially neuropathy, highlighting the importance of achieving glycemic control early in the disease course.

Lipid Management in Patients with High-Risk Diabetes Mellitus at Risk for a First Major Atherosclerotic Cardiovascular Event: Findings from the VESALIUS-REAL Global Study

Presenter: Mahendra Sibartie, et al.

This study evaluated lipid management practices in patients with high-risk diabetes mellitus (DM) who were at risk of experiencing their first major atherosclerotic cardiovascular event. Data were analyzed from 11 databases across North America, Europe, and the Asia-Pacific region between 2017 and 2022. High-risk DM was defined as diabetes with microvascular complications or chronic insulin use, along with elevated lipid levels and additional cardiovascular risk factors, but without a prior history of myocardial infarction or stroke. The analysis included 354,643 patients with high-risk DM, of whom 51% were women. Additionally, 14% had coronary artery disease, atherosclerotic cerebrovascular disease, or peripheral artery disease. Less than half of the patients (46%) were receiving lipid-lowering therapy (LLT) at the time they met study eligibility criteria. Among those receiving treatment, statin monotherapy was the most common regimen, accounting for 87% of LLT use. Among patients who were not receiving LLT at baseline, only 26% initiated treatment within one year. For patients already receiving LLT, treatment intensification within one year occurred in just 7% of cases. Lipid monitoring was also suboptimal, with only 42% of patients undergoing low-density lipoprotein cholesterol (LDL-C) testing during the first year of follow-up (n=149,495). Achievement of recommended LDL-C goals was low, with only 22% of patients reaching targets defined by local guidelines.

Overall, the findings indicate substantial gaps in lipid management among patients with high-risk DM, including low treatment rates, limited therapy intensification, inadequate lipid monitoring, and poor attainment of LDL-C goals.

Metabolic Memory in Type 2 Diabetes: Patients Achieving Early Normoglycemia Show 60% Lower Complication Burden Despite Current Control

Authors: Shubhashree Patil, et al.

This retrospective study evaluated the long-term impact of achieving early glycemic control on diabetes-related complications in approximately 400 patients with type 2 diabetes mellitus (T2DM) who had a disease duration of at least 5 years. Patients were categorized as “Early Achievers” if they attained glycated hemoglobin (HbA1c) levels below 6.5% within the first 5 years after diagnosis (n=89), and as “Late/Non-Achievers” if they did not achieve this target during the same period (n=311). At the time of assessment, the two groups had similar glycemic control (HbA1c: 7.2% vs 7.8%; p=0.08) and comparable diabetes duration (12.5 vs 11.8 years; p=0.42). Despite these similarities, patients who achieved early normoglycemia had a substantially lower complication burden. The rate of multiple complications was significantly lower in Early Achievers compared with Late/Non-Achievers (28% vs 68%; p<0.001), corresponding to a 59% relative risk reduction. Early Achievers also had lower rates of reduced bone density (58% vs 81%; p<0.01), neuropathy (32% vs 58%; p<0.001), and dyslipidemia (48% vs 72%; p<0.001). Notably, among patients with current suboptimal glycemic control (HbA1c 7–8%), Early Achievers continued to demonstrate a lower burden of multiple complications compared with Late/Non-Achievers (35% vs 73%; p<0.001), representing a 52% reduction. After adjustment for current HbA1c, age, body mass index (BMI), and diabetes duration, early achievement of HbA1c <6.5% remained an independent protective factor against complications (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.12–0.38).

Overall, these findings suggest that achieving normoglycemia within the first 5 years after diagnosis is associated with a sustained reduction in complication burden, supporting the concept of metabolic memory in type 2 diabetes.

 

Predictors of Therapeutic Inertia in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial

Presenter: Rachel Marie Perez, et al.

This post hoc analysis investigated the presence of therapeutic inertia (TI) in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, a multicenter study that enrolled approximately 10,000 participants with type 2 diabetes (T2D) and cardiovascular disease (CVD) or its risk factors. Participants were assigned to either intensive glycemic control (glycated hemoglobin [HbA1c] <6%) or standard glycemic control (HbA1c 7.0–7.9%). Despite protocol-defined treatment adjustment criteria, the study evaluated whether therapy was appropriately intensified when glycemic targets were not met. The analysis included 5,341 participants receiving insulin and covered 13,657 study visits. Therapeutic inertia was defined as failure to adjust insulin therapy or number of oral glucose-lowering agents despite HbA1c levels remaining above the treatment target for the assigned study arm. Across all visits, HbA1c was above target at 67% of encounters. Among these visits, therapeutic inertia was observed in 26% of cases, indicating that treatment was not intensified despite inadequate glycemic control. Age and sex were not associated with therapeutic inertia. Participants with higher HbA1c levels were less likely to experience therapeutic inertia compared with those with HbA1c levels of 8.0–8.9%. The likelihood of therapeutic inertia was lower in participants with HbA1c levels of 9.0–9.9% (odds ratio [OR] 0.53; 95% confidence interval [CI] 0.39–0.70) and HbA1c ≥10% (OR 0.64; 95% CI 0.42–0.97). In contrast, more frequent hypoglycemic events were associated with a greater likelihood of therapeutic inertia (OR 1.06; 95% CI 1.03–1.10 per additional weekly hypoglycemic event). Black participants were more likely to experience therapeutic inertia than other racial groups, with Black race remaining an independent predictor after adjustment for socioeconomic, clinical, and trial-related factors (OR 1.45; 95% CI 1.25–1.67).

Overall, therapeutic inertia was present even within a controlled clinical trial setting with predefined treatment protocols. Higher hypoglycemia frequency, Black race, and lower HbA1c levels were associated with a greater likelihood of therapeutic inertia.

Triple Target Achievement in Type 2 Diabetes

Presenter: Subhash Dalpat Sonawala, et al.

This cross-sectional study assessed whether achieving multiple metabolic targets was associated with a lower complication burden in 400 patients with type 2 diabetes mellitus (T2DM). Metabolic targets were defined as triglycerides <150 mg/dL, BMI 23–25, and HbA1c <7%. Patients were categorized based on the number of targets achieved: Group A (0–1 target), Group B (2 targets), and Group C (all three targets). Only 18% of patients achieved all three targets, while 45% achieved 0–1 target and 37% achieved 2 targets. The prevalence of multiple complications (≥2 of bone disease, neuropathy, or dyslipidemia) decreased with increasing target achievement, occurring in 68% of patients with 0–1 target and 42% of those with 2 targets. Achieving all three targets was associated with a 73% lower risk of multiple complications compared with achieving 0–1 target (relative risk [RR] 0.26; 95% confidence interval [CI] 0.14–0.49).Patients who met TG and BMI targets despite suboptimal HbA1c levels (7.2–8.1%) had fewer complications than those who achieved HbA1c <7% without meeting TG and BMI targets (28% vs 54%; p<0.01). Rates of osteoporosis (8% vs 32% vs 61%) and moderate-to-severe neuropathy (12% vs 38% vs 58%) also differed significantly across the groups (p<0.001 for both).

Overall, these findings suggest that achieving multiple metabolic targets is associated with a lower burden of diabetes-related complications than achieving glycemic targets alone.

When HbA1c Lies: Hypertriglyceridemia and Obesity Drive Multisystem Complications in “Well-Controlled” Type 2 Diabetes

Presenter: Shubhashree Patil et al.

This study evaluated the prevalence of complications among patients with type 2 diabetes mellitus (T2DM) who had achieved glycated hemoglobin (HbA1c) levels below 7%. Among 400 patients assessed, 168 had HbA1c <7% (mean 6.4%). Despite achieving glycemic targets, 44% (74/168) had multisystem complications, defined as involvement of at least two of the following: bone disease, neuropathy, or dyslipidemia. The prevalence of bone loss, neuropathy, and dyslipidemia was 58%, 35%, and 62%, respectively. Patients with multisystem complications had significantly higher triglyceride (TG) levels (198 vs 118 mg/dL; p<0.001) and body mass index (BMI) (29.8 vs 24.2 kg/m²; p<0.001) than those without complications, while HbA1c levels were similar (6.4% vs 6.3%; p=0.68). Elevated TG levels (>200 mg/dL) were associated with a 6.2-fold higher odds of multisystem complications (odds ratio [OR] 6.24; 95% confidence interval [CI] 2.84–13.71; p<0.001), while BMI >28 kg/m² was associated with a 4.8-fold higher odds (OR 4.78; 95% CI 2.31–9.89; p<0.001). Patients with both TG >200 mg/dL and BMI >28 kg/m² had a substantially higher complication rate than those with TG <150 mg/dL and BMI <25 kg/m² (82% vs 12%; p<0.001). Even among patients with HbA1c ≤6% (n=42), 38% had multisystem complications, all of whom had elevated TG levels (>180 mg/dL) or BMI (>27 kg/m²).

In conclusion, these findings suggest that factors beyond glycemic control, particularly hypertriglyceridemia and obesity, are associated with complication burden in patients with T2DM.

Lipid Variability Is Associated with Incident Heart Failure and Elevation in NT-proBNP in the Multiethnic Study of Atherosclerosis

Presenter: Daniel S Nuyujukian, et al.

This study investigated whether visit-to-visit variability in lipid levels is associated with the risk of heart failure (HF) and elevated levels of N-terminal B-type natriuretic peptide (NT-proBNP), a marker of cardiac stress, in participants from the Multi-Ethnic Study of Atherosclerosis (MESA). Lipid variability was assessed using the coefficient of variation for low-density lipoprotein cholesterol (CV-LDL) and log-transformed triglycerides (CV-logTrig). Participants with at least three lipid measurements before a heart failure event were included. Heart failure events were tracked for approximately 10 years. After adjustment for heart failure risk factors, greater variability in both triglycerides and low-density lipoprotein cholesterol was associated with a higher risk of heart failure. The hazard ratios were 1.47 (95% confidence interval [CI] 1.29–1.66) for CV-logTrig and 1.51 (95% CI 1.35–1.74) for CV-LDL (both p<0.001). Higher lipid variability was also associated with elevated NT-proBNP levels (>125 pg/mL) at follow-up. For CV-logTrig, the odds ratio (OR) was 1.09 (95% CI 1.01–1.18; p=0.03), while for CV-LDL it was 1.16 (95% CI 1.03–1.22; p=0.01). Associations were stronger for severely elevated NT-proBNP levels (>450 pg/mL), with ORs of 1.28 (95% CI 1.11–1.47; p<0.001) for CV-logTrig and 1.26 (95% CI 1.08–1.47; p=0.004) for CV-LDL.

These findings suggest that greater visit-to-visit variability in lipid levels is associated with an increased risk of heart failure and higher NT-proBNP levels, indicating a potential role of lipid variability in the early development of heart failure.

Unmet Need in Post-Stroke Antidiabetic Treatment Patterns among Individuals Newly Diagnosed with Type 2 Diabetes (T2D) during Ischemic Stroke Hospitalization

Presenter: Caichen Zhong et al.

Using the Premier Healthcare Database (2017-2023), this retrospective, observational cohort study compared post-stroke diabetes management in patients with newly diagnosed type 2 diabetes (newT2D) and those with established type 2 diabetes (estT2D) following hospitalization for ischemic stroke. The analysis included 18,799 patients with T2D, of whom 21% had newly diagnosed T2D and 71% had established T2D. During the 180-day follow-up period after discharge, 56% of all patients received at least one antidiabetic medication (ADM). Patients with newT2D were substantially less likely to receive any ADM than those with estT2D (31% vs 66%). Among patients receiving ADM, insulin was the most commonly prescribed treatment (38%). However, insulin use was less frequent in the newT2D group than in the estT2D group (19% vs 45%). Other commonly used medications included biguanides, sulfonylureas, dipeptidyl peptidase-4 inhibitors (DPP-4i), sodium-glucose cotransporter-2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1RA). Patients with newT2D were also less likely to have follow-up with a healthcare professional after discharge (57% vs 65%). Most follow-up visits occurred with primary care providers (49% vs 59%). NewT2D had lower observed rates all-cause readmission rates within 180 days (17% vs 26%) and lower stroke-related readmission rates (4% vs 5%) compared with those with established T2D.

Overall, newly diagnosed T2D patients received less post-stroke diabetes care than patients with established T2D, highlighting potential gaps in diabetes management following ischemic stroke.

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