Diabetes Canada

BackgroundFamily-focused interventions promoting lifestyle behaviors such as physical activity and healthy eating can be effective strategies for obesity management in children. To maximize public health impact, there is an urgent need to develop innovative solutions to improve the scalability of childhood obesity management interventions. Stand-alone web-based interventions are easily administered but may be hindered by low participant engagement and limited support. A blended intervention that includes both facilitated web-based group sessions and self-guided resources may enhance engagement, thereby optimizing improvements in children’s health outcomes. However, the long-term effectiveness of stand-alone versus blended web-based interventions to manage childhood obesity has not yet been evaluated.ObjectiveThe primary objective of this randomized controlled trial is to evaluate the long-term effectiveness of a blended, web-based, family-focused healthy living program (Family Healthy Living Program [FHLP]) compared to an active control (self-guided web-based educational resources) in lowering BMI z scores in children with overweight or obesity over 12 months. The secondary objective is to examine intervention effects on children’s physical activity, dietary behaviors, and health-related quality of life as well as parental self-efficacy and motivation to support children’s lifestyle behaviors.MethodsThis single-blind 2×4 trial aims to recruit 278 parent-child dyads across Canada to be randomly assigned to the FHLP intervention group or an active control group (1:1 ratio). The 10 weeks of FHLP activities have been designed based on the multiprocess action control framework to support children and parents in learning behavioral change skills that will enable them to improve their healthy lifestyle behaviors, and the FHLP delivery has been piloted previously. Families in the intervention group will receive weekly web-based synchronous group sessions and access to additional resources and suggested activities. Families in the control group will receive access to 10 weeks of self-guided web-based educational resources only. Outcomes, including child’s height and weight, daily physical activity, dietary behaviors, health-related quality of life, and parental support, will be measured via questionnaire at 4 assessment time points over 1 year (ie, baseline, 10 wk, 6 mo, and 12 mo). Intervention engagement and attrition will also be recorded. Multiple linear regression models will be used to examine the effectiveness of the FHLP intervention compared to stand-alone web resources only.ResultsThis study was funded in 2020, with 270 participants enrolled between January 2021 and May 2024. The 12-month data collection period ended in June 2025 and data analysis is currently underway. Study results are expected to be published in winter 2025. Results will be disseminated via conference presentations, peer-reviewed publications, and other media channels.ConclusionsThe blended web-based FHLP intervention has the potential to become a scalable solution for the prevention of obesity and related health conditions.Trial RegistrationClinicalTrials.gov NCT06777888; https://www.clinicaltrials.gov/study/NCT06777888International Registered Report Identifier (IRRID)DERR1-10.2196/76837

<h3>Objectives</h3> The terms ‘prediabetes’ (6.0% ≤ A1c ≤ 6.4%) and ‘mild diabetes’ (6.5% ≤ A1c ≤ 7.0%) describe conditions where blood sugar levels are elevated but still fall within the treatment targets set by national guidelines and specialty societies for type 2 diabetes. While some view these diagnostic labels as offering opportunities for early intervention and delaying disease progression, there are concerns regarding overdiagnosis, with potential consequences including over-testing and overtreatment. Currently, there is limited understanding of patient experiences and priorities regarding the diagnosis and management of pre- or mild diabetes. <h3>Method</h3> We conducted a qualitative study engaging individuals recently diagnosed with pre- or mild diabetes, in collaboration with health services researchers, healthcare professionals, and patient research partners. Following the Patient Engagement Framework from the Strategy for Patient Oriented Research (SPOR), we worked with three patient research partners from British Columbia, Alberta, and Ontario, Canada. Together, we obtained funding, designed and conducted pre-interview surveys and interviews, and analyzed data to better understand patient experiences and priorities. We used reflexive thematic analysis, following Braun and Clarke’s approach, to develop meaning-based themes. <h3>Results</h3> Twelve adults have participated in this study so far, with four to eight more anticipated. Of all participants 66.7% had prediabetes and 33.3% had mild diabetes. The majority (58.3%) of participants were in the 40–60 years age range. We developed three main themes: i) While experiencing a range of negative emotions following initial diagnosis, participants often expressed gratitude for early detection and symptom awareness, ii) valued receiving information and education early on, and iii) desired individualized treatment approaches that aligned with their priorities, taking health equity factors into account. As an important subtheme under the third theme, while lifestyle modification was often preferred as the initial approach, many participants also acknowledged pharmacotherapy as a viable option when lifestyle changes had been maximized or could no longer be further optimized. <h3>Conclusions</h3> This study focuses on the balance between the perceived benefits of early intervention and the risks of overdiagnosis and its consequences. Understanding patient experiences and perspectives in early-stage diabetes highlights the need for shared decision-making and individualized care. Insights will guide the development of tools and resources to help both patients and clinicians shape and navigate informed, patient-centered care. Future work is needed to clarify the evidence for early diagnosis or treatment of people with pre- or mild diabetes to avoid overdiagnosis and overtreatment.

Background: Diabetes mellitus is associated with significant health care resource utilization (HCRU), partly due to acute complications, including diabetic ketoacidosis (DKA) and hypoglycemia. Aim: To investigate glycated hemoglobin (HbA1c) levels and HCRU before and after adoption of FreeStyle Libre Systems (FSL) in people with diabetes on multiple daily injections of insulin (MDI). Methods: This retrospective longitudinal study used administrative health data in Ontario, Canada, housed at IC/ES. The cohort comprised people with diabetes on MDI with a first FSL claim between September 16, 2019, and August 31, 2020 (index date), who remained on FSL for 24 months. HCRU (emergency department [ED] visits and hospitalization) was measured for 12 months before the index date and the last 12 months of follow-up. HbA1c data were taken from the last tests in each period. Results: Mean HbA1c was statistically significantly reduced after FSL among people with type 1 diabetes mellitus (T1DM; n = 10,510; age <25 years, -0.8%; 25-65 years, -0.5%; >65 years, -0.1%; all P < 0.0001) or type 2 diabetes mellitus (T2DM; n = 12,668; age ≤65 years, -0.6%; >65 years, -0.3%; both P < 0.0001). Overall HCRU was statistically significantly reduced in the T1DM subgroups aged <25 and 25-65 years (ED visits only) and both T2DM age subgroups, with some subgroups having statistically significant reductions in DKA- or hypoglycemia-associated HCRU. Conclusions: Among people with T1DM or T2DM on MDI, HbA1c was statistically significantly reduced after FSL, with statistically significant reductions in HCRU in some subgroups.

Hypoglycemia is a serious and potentially life-threatening condition for people with insulin-dependent diabetes. To provide a safeguard against hypoglycemia, we introduce a “smart” microneedle (MN) patch that senses glucose levels and delivers a blood glucose-raising agent (Zinc-Glucagon (Z-GCN)) in response to hypoglycemia. Herein, we describe the use of catechol and boronic acid chemistry to design a self-crosslinkable hydrogel-based MN that stimulates the release of Z-GCN during hypoglycemia. In this design, the catechol groups bind to Z-GCN through metal-ligand complexation. At hyperglycemia, boronic acids react with glucose to generate cyclic boronate esters. As the glucose concentration decreases, the boronic acid groups dissociate and are favored over Z-GCN in binding with catechol, which promotes the release of Z-GCN. We fully characterize the fabricated MN in vitro. Moreover, we further evaluate the MN and demonstrate the in vivo glucose-responsive delivery of Z-GCN from the patch. We also show its effectiveness in preventing hypoglycemia for up to 6 h in type 1 diabetic male rats against two consecutive insulin overdose challenges. Since many proteins/peptides have a high binding affinity to metal ions, the introduced mechanism driven by the competitive binding of catechol-metal ions has great implications in drug delivery applications of various protein/peptide-based therapeutics.

We aimed to investigate glycated haemoglobin (HbA1c) levels and healthcare resource utilization (HCRU; emergency department [ED] visits or hospitalization) before and after adoption of FreeStyle Libre sensor-based glucose monitoring systems (FSL) by people with type 2 diabetes mellitus (T2DM) on basal insulin without glucagon-like peptide 1 receptor agonist (GLP-1 RA) therapy, basal insulin with GLP-1 RA therapy, GLP-1 RA therapy without insulin or oral therapy alone. Routinely collected administrative health data (housed at IC/ES, formerly the Institute for Clinical Evaluative Sciences) in Ontario, Canada were used to identify 20 253 people with T2DM who had a first FSL claim between 16 September 2019 and 31 August 2020 (index date) and remained active on FSL for 24 months' follow-up. HCRU was measured for 12 months before the index date and the last 12 months of the 24-month follow-up period. HbA1c data were taken from the latest tests in each period. Mean HbA1c was statistically significantly reduced after FSL acquisition among people aged ≤65 or >65 years in all four treatment groups (range, 0.3-0.8% reduction). After FSL acquisition, ED visits and hospitalization were statistically significantly reduced in the oral therapy only group and in some basal insulin subgroups (without GLP-1 RA, all except hospitalization aged ≤65 years; with GLP-1 RA, only ED visits aged ≤65 years). Among people with T2DM using basal insulin and/or non-insulin therapies, HbA1c levels were statistically significantly improved and HCRU was reduced after initiation of FSL.

Abstract Environmental risk factors possess the potential to modulate the pathogenesis of type I diabetes (T1D). Foremost among these factors are early life influences impacting the gastrointestinal (GI) tract. During infancy, both the microbiota and immune system are influenced by maternal factors contributing to key events in the neonatal GI tract. Despite the well-known importance of maternal factors on infant immune development, whether maternal immune dysregulation and dysbiosis can perpetuate the same in offspring remains largely unknown. To explore how these maternal factors impact offspring disease development, we used IgA-deficiency induced maternal dysbiosis in Non-Obese Diabetic (NOD) dams to study T1D development in their progeny. We found that maternal dysbiosis and absence of IgA led to changes in IgA-sufficient offspring immune development resulting in heightened GI immune activity. Maternal dysbiosis also contributed to altered microbiome establishment in progeny, such that pups exhibited reduced colonic abundance of Akkermansia muciniphila and Clostridoides difficile. In adulthood, these mice exhibited a lowered incidence of T1D. This protection was replicated by fostering high incidence offspring to dysbiotic dams, prompting us to propose that altered breast milk composition in dysbiotic dams can influence immune development and microbiome establishment in offspring, contributing to T1D resistance.

Dopamine (DA) D2-like receptors in both the central nervous system (CNS) and the periphery are key modulators of metabolism. Moreover, disruption of D2-like receptor signaling is implicated in dysglycemia. Yet, the respective metabolic contributions of CNS versus peripheral D2-like receptors including D2 (D2R) and D3 (D3R) receptors remain poorly understood. To address this, we developed new pharmacological tools, D2-like receptor agonists with diminished and delayed blood-brain barrier capability, to selectively manipulate D2R/D3R signaling in the periphery. We designated bromocriptine methiodide (BrMeI), a quaternary methiodide analogue of D2R/D3R agonist and diabetes drug bromocriptine, as our lead compound based on preservation of D2R/D3R binding and functional efficacy. We then used BrMeI and unmodified bromocriptine to dissect relative contributions of CNS versus peripheral D2R/D3R signaling in treating dysglycemia. Systemic administration of bromocriptine, with unrestricted access to CNS and peripheral targets, significantly improved both insulin sensitivity and glucose tolerance in obese, dysglycemic mice in vivo. In contrast, metabolic improvements were attenuated when access to bromocriptine was restricted either to the CNS through intracerebroventricular administration or delayed access to the CNS via BrMeI. Our findings demonstrate that the coordinated actions of both CNS and peripheral D2-like receptors are required for correcting dysglycemia. Ultimately, the development of a first-generation of drugs designed to selectively target the periphery provides a blueprint for dissecting mechanisms of central versus peripheral DA signaling and paves the way for novel strategies to treat dysglycemia.

Metabolic tests are vital to determine in vivo insulin sensitivity and glucose metabolism in preclinical models, usually rodents. Such tests include glucose tolerance tests, insulin tolerance tests, and glucose clamps. Although these tests are not standardized, there are general guidelines for their completion and analysis that are constantly being refined. In this review, we describe metabolic tests in rodents as well as factors to consider when designing and performing these tests.