IntroductionDiabetic ketoacidosis (DKA) is a potentially fatal diabetes complication marked by hyperglycemia, ketonemia, and acidosis that remains a major global healthcare burden despite advances in diabetes management. The aim of this study was to quantify the healthcare costs of DKA admissions at a tertiary hospital in the United Arab Emirates (UAE), and evaluate cost-effective preventative strategies.MethodsA retrospective electronic record analysis of all DKA admissions from 2019 to 2023 at Tawam Hospital, Al Ain, was conducted after ethical approval from Tawam Human Research Ethics Committee, approval number MF2058-2023-916. Clinical characteristics, precipitating factors, length of stay, insurance status, and total inpatient costs were analyzed for all consecutive adult (≥ 16 years) DKA admissions over this period. The cost of DKA-related admission was compared to the price of insulin therapy in underinsured patients who are unable to afford insulin.ResultsThere were 134 patients admitted with DKA (157 admissions) over 5 years (one DKA admission every 11.6 days). The mean hospitalization cost per DKA admission was 12,274 ± 10,213 USD (45,461 ± 37,826 AED), with an average length of stay of 10.2 ± 11.7 days (1203 USD [4,457 AED] per day). Insulin unaffordability, a preventable factor, led to 13.4% (21 cases) of admissions, incurring a total cost of 257,765 USD (954,686 AED). Underinsured patients demonstrated significantly higher ICU utilization (76.8% vs 52.5%, p < 0.01) and mean costs (14,269 USD [52,847 AED] vs 11,133 USD [41,235 AED], p = 0.07) compared to adequately insured patients. In comparison, the average cost of insulin is 38 USD (139.5 AED) per patient/month, indicating that the cost of one preventable DKA admission equals 27 years of insulin therapy. The overall mortality rate of DKA admissions was 4.5%.ConclusionDKA imposes a substantial economic and clinical burden in the UAE, with mean hospitalization costs of 12,274 USD per admission. While insulin unaffordability accounts for 13.4% of admissions (costing 257,765 over 5 years), infections represent the largest precipitating factor at 49.0%. Comprehensive DKA prevention requires a multifaceted approach: infection management education, ensuring insulin access for underinsured patients, and structured diabetes education. Our analysis suggests that addressing insulin affordability could be economically favorable, as preventing one DKA admission would offset 27 years of insulin costs. However, optimal resource allocation requires addressing all major precipitating factors to achieve meaningful reductions in DKA burden.Graphical abstract available for this article.Graphical Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-025-01812-w.

IntroductionIcoSema is under development as a once-weekly injectable combination therapy of icodec (basal insulin) and semaglutide (glucagon-like peptide 1 receptor agonist). This study assessed the pharmacokinetic characteristics of icodec and semaglutide following IcoSema administration vs. administration of icodec and semaglutide alone in Chinese individuals with type 2 diabetes (T2D).MethodsIn a randomized, double-blind, three-period crossover study, 20 Chinese individuals with T2D (18–64 years, body mass index 18.5–34.9 kg/m2, glycated hemoglobin ≤ 9.0%) were given single subcutaneous administrations of IcoSema, icodec, or semaglutide separated by 6–9 weeks. Blood was drawn for pharmacokinetic measurement until 840 h post dose.ResultsCombining icodec with semaglutide had no impact on icodec pharmacokinetics. The ratio and 90% confidence interval of IcoSema/icodec was 1.04 [0.99;1.08] for area under the curve from zero to last quantifiable observation (AUC0–t) and 1.02 [0.96;1.09] for maximum concentration (Cmax), i.e., within the bioequivalence acceptance interval of 0.80–1.25. Likewise, combining semaglutide with icodec had no impact on semaglutide AUC0–t (IcoSema/semaglutide 0.99 [0.94;1.05]). However, semaglutide Cmax was higher for IcoSema vs. semaglutide alone (1.42 [1.31;1.53]) and occurred earlier for IcoSema (12 vs. 66 h). All three treatments were safe with no differences in frequency, severity or outcome of adverse events, or relationship to study product.ConclusionIn Chinese individuals with T2D, icodec pharmacokinetics and semaglutide total exposure are unaffected when combining icodec and semaglutide in IcoSema. However, maximum semaglutide concentration is higher and occurs earlier with IcoSema. This information may help to ensure suitable dose recommendations for IcoSema.Trial RegistrationClinicalTrials.gov identifier, NCT05435677.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-025-01803-x.

IntroductionPainful diabetic peripheral neuropathy (pDPN) affects approximately 25% of individuals with diabetes in the UK and remains underdiagnosed and suboptimally managed in primary care. The condition causes chronic pain, limits daily functioning, impairs quality of life, and increases the risk of complications like foot ulcers and amputations due to underlying neuropathy. Current care pathways are fragmented, leading to delays in diagnosis and limited access to evidence-based therapies. This article aims to address the challenges of screening, diagnosis, and management of pDPN in UK primary care by proposing a consensus-driven, five-step pragmatic strategy.MethodsAn expert panel of general practitioners and a diabetes nurse practitioner from across the UK convened to review and discuss strategies for improving pDPN care. Consensus was reached through an evaluation of barriers in clinical practice, supported by real-world experience and examples of innovative care delivery models, resulting in the development of practical recommendations and workflow.ResultsKey barriers identified include insufficient training of healthcare professionals in pDPN, underutilisation of validated screening tools such as the DN4 questionnaire, and inconsistent and outdated treatment guidelines. To address these challenges, a five-step approach was proposed to include screening high-risk patients using validated questionnaires, following up on these patients to enable early diagnoses, initiating early treatments with first-line therapies while monitoring responses, referring complex cases to secondary care on the basis of structured criteria, and ensuring coordinated follow-up to streamline and optimise care delivery. Case studies demonstrate the practical application of these strategies in improving early detection, treatment adherence, and long-term care for individuals with pDPN.ConclusionCurrent practices have fallen short in providing adequate care for one in four individuals with diabetes. Implementing a straightforward five-step approach can significantly improve diagnostic accuracy and treatment outcomes, reducing the burden of pDPN on both patients and society.

IntroductionDiabetes represents an increasing public health challenge in France, yet national data distinguishing type 1 from type 2 diabetes and insulin use remain limited. This study aimed to describe trends in the epidemiology, care pathways and health outcomes of adult individuals living with type 1 or type 2 diabetes in France from 2010 to 2019. It focused on individuals treated or not with insulin and applied a predictive classification algorithm to accurately distinguish between diabetes types using real-world data.MethodsA 10-year retrospective population-based cohort study was conducted from a representative one-tenth sample of the French national healthcare database (i.e. SNDS, Système National des données de Santé), covering nearly the entire French population. Adults (≥ 18 years) affiliated with the general insurance scheme were included. A machine learning algorithm, trained on clinical data from general practitioners, was applied to classify diabetes type. Annual trends in prevalence, incidence, comorbidities, treatments, outpatient care, complications and mortality were assessed.ResultsAmong an extrapolated 5.5 million individuals with diabetes in 2019, 3.5% had type 1 diabetes and 96.5% had type 2 diabetes. The prevalence of type 2 diabetes increased from 6.2% in 2010 to 8.0% in 2019, while type 1 diabetes remained stable. Comorbidity rates were high and increasing in insulin-treated individuals with type 2 diabetes. In 2019, 15.3% of insulin-treated individuals with type 2 diabetes had at least one complication-related hospitalisation. Specialist consultations were underused, especially in type 2 diabetes. The mortality rate in individuals with type 1 diabetes declined from 2.6% to 1.5%, with an increase in mean age at death.ConclusionThis national study provides updated insights into diabetes in France and highlights the need to improve access to specialised care and reinforce long-term surveillance strategies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-025-01781-0.

IntroductionThe appropriate use of glycated haemoglobin (HbA1c), the international standard for assessing overall glycaemic status in diabetes mellitus, is critical to ensuring optimal clinical outcome and minimise complications. We describe a clinical laboratory-led general practice service development to facilitate targeted follow-up in high-risk patients.MethodsThe service development comprised monthly reports identifying high-risk individuals (HbA1c ≥ 58 mmol/mol) overdue HbA1c testing, sent by the Clinical Biochemistry Laboratory to general practices in the ‘Intervention’ group (n = 60). A ‘Non-intervention’ group comprised 51 practices not sent the reports. Comparisons comprised: (i) intervention vs non-intervention groups during two time periods (pre-intervention: 2017–2020; 275,843 tests; 59,206 patients, and post-intervention: 2020–2023; 307,525 tests; 65,449 patients), (ii) pre- versus post-intervention in each group.ResultsThe intervention group (vs non-intervention group) showed larger net change in proportion overdue a test (− 20.6% vs − 10.3%, p < 0.001), particularly in the > 75 mmol/mol category (7.8-fold larger improvement, p < 0.001). Improvements were also observed in median time overdue in the 58–75 mmol/mol group (− 14.3 vs − 4.3%; p = 0.027). Improvements were identified in median HbA1c (p = 0.012) and overall proportion with HbA1c ≥ 58 mmol/mol (p = 0.037), compared with the non-intervention group, despite performing more tests/patient/year (p < 0.001). All remained significant after adjustment for practice characteristics (age, sex, social deprivation, list size, diabetes prevalence) and pre-intervention levels.ConclusionsOur findings indicate that clinical laboratories can support general practices facilitating targeting monitoring to high-risk patients. Providing succinct reports that identify patients overdue for testing can reduce the number of such patients, thereby improving diabetes control and increasing the achievement of target levels.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-025-01766-z.

IntroductionThe expanding range of therapeutic options for type 2 diabetes (T2D) calls for a reassessment of clinical scenarios in which existing glucose-lowering therapies might be substituted with the oral glucagon-like peptide 1 receptor agonist (GLP-1 RA) semaglutide (OS). In light of the numerous unresolved questions, a panel of experts was convened to develop practical guidance for clinicians using the Delphi consensus method.MethodsA panel of 13 experts formulated 31 statements addressing the following clinical scenarios: switch from injectable GLP-1 RA to OS; switch from sodium-glucose cotransporter 2 inhibitor to OS; switch from insulin to OS; switch from dipeptidyl peptidase 4 inhibitor (DPP4i) to OS; switch from “old” oral therapies (i.e., sulfonylureas, glinides, pioglitazone, acarbose) to OS. A panel of 28 diabetologists from the Emilia-Romagna region evaluated each statement by assigning a relevance score on a 9-point scale via a dedicated online platform. The RAND/UCLA Appropriateness Method was employed to determine the presence of disagreement among panelists.ResultsPanelists showed agreement for all 31 statements, all considered relevant. Panelists agreed that in many circumstances OS can represent a valuable alternative to injectable GLP-1 RAs, other oral glucose-lowering drugs, and insulin. The selection of OS is justified by its proven effectiveness in reducing glycated hemoglobin and body weight, as well as its positive impact on cardiovascular outcomes and all-cause mortality. Furthermore, OS can allow a simplification of therapy in patients treated with insulin.ConclusionIn an ever-evolving therapeutic landscape, OS therapy stands as a valuable option in the management of patients with T2D.

IntroductionThe study aimed to describe the population of patients living with type 1 diabetes who had access to bariatric surgery (BS) in France, analyzing the changes in healthcare resource use and associated costs in the 3 years following this surgery.MethodsAn observational longitudinal study based on the French national health insurance database was conducted on all adult patients that underwent a first BS from 2015 to 2020. Cost analyses were conducted on a sub-population who underwent BS from 2016 to 2017 for sufficient observation time using a pre-post methodology.ResultsA total of 437 patients were identified as living with type 1 diabetes among the 234,077 patients who had undergone surgery over 6 years (2015–2020). The most frequently performed interventions were sleeve gastrectomy (n = 272; 62.2%) and gastric bypass (n = 154; 35.2%), with the majority of patients being women (77.8%) and an average age of 42.3 (± 12.0) years, consistent with the general population undergoing BS in France. While no significant differences were found in the overall healthcare costs when comparing the 3 years before and after BS, there was an increase in the frequency of biological measurements. Expenditures related to antidiabetic medications and insulin decreased significantly (p < 0.0001). The number of hospitalizations for severe hypoglycemia, coma, and ketoacidosis more than doubled in the 3 years following surgery compared with the period before (p = 0.04).ConclusionsThe risks of severe hypoglycemia or ketoacidosis in patients with type 1 diabetes undergoing BS remains a real concern and emphasizes the importance of involving the diabetologist in the operative decision with joint follow-up with the nutritionist.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-025-01709-8.

IntroductionClinical trials have demonstrated that glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce the risk of major adverse cardiovascular events (MACE) in adults with type 2 diabetes (T2D) who have established cardiovascular disease (CVD) or a high risk of CVD. Nevertheless, GLP-1RAs remain underutilized. This real-world, retrospective study compared cardiovascular and economic outcomes between individuals treated with GLP-1RAs and other glucose-lowering agents in England.MethodsClinical Practice Research Datalink-registered people indexed on GLP-1RAs, dipeptidyl peptidase-4 (DPP4) inhibitors, or basal insulin between January 1, 2014 and December 31, 2018 for their fourth line of T2D treatment were stratified into six cohorts based on their: (1) cardiovascular risk (high or very high risk) and (2) indexed therapy. Cox proportional hazards regression was used to compare the risk of MACE and all-cause death between GLP-1RA and other treatment cohorts. Generalized linear regression was used to quantify differences in healthcare resource use (HCRU) and costs between groups.ResultsOf 63,237 subjects, 10,607 were at high cardiovascular risk (GLP-1RA: 2709; DPP4 inhibitor: 2673; basal insulin: 5225) and 52,630 at very high cardiovascular risk (GLP-1RA: 14,692; DPP4 inhibitor: 18,461; basal insulin: 19,477). The crude incidence of all outcomes was lower in the GLP-1RA versus other treatment cohorts, regardless of cardiovascular risk. Among very-high-risk individuals treated with GLP-1RA, the adjusted risk of MACE was 33% (24–40%) and 23% (13–23%) lower versus DPP4 inhibitor and basal insulin cohorts, respectively. The adjusted total cardiovascular-related cost among very-high-risk individuals was £208.14 (£155.81–£260.47) and £151.74 (£110.69–£192.79) lower in the GLP-1RA versus DPP4 inhibitor or basal insulin cohorts, respectively.ConclusionsIn a real-world setting, GLP-1RAs may be associated with a lower risk of MACE and reduced HCRU and costs than DPP4 inhibitors or basal insulin in individuals with T2D, particularly among those at very high cardiovascular risk.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-025-01715-w.

IntroductionNovel therapies are emerging for the prevention of chronic kidney disease (CKD) progression in patients with type 2 diabetes (T2D). Within the FOUNTAIN platform (NCT05526157; EUPAS48148), this real-world study aimed to characterize cohorts of adults with CKD and T2D starting therapy with a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in Europe, Japan, and the United States (US) during 2012–2021.MethodsThis multinational, multicohort study was conducted in five data sources: the Danish National Health Registers (DNHR) (Denmark), PHARMO Data Network (PHARMO) (The Netherlands), Valencia Health System Integrated Database (VID) (Spain), Japan Chronic Kidney Disease Database Extension (J-CKD-DB-Ex) (Japan), and Optum’s de-identified Clinformatics® Data Mart Database (CDM) (US). Eligible patients had T2D (defined by data source-specific algorithms) and CKD (based on diagnosis codes, estimated glomerular filtration rate values, and/or urine albumin-to-creatinine ratio) and initiated an GLP-1 RA during 2012–2021. Baseline demographic, lifestyle, and clinical characteristics were analyzed, and treatment patterns were described.ResultsStudy cohorts included 18,929 GLP-1 RA initiators in DNHR; 476 in PHARMO; 11,798 in VID; 329 in J-CKD-DB-Ex; and 70,158 in CDM. Across cohorts, mean age ranged from 66.1 years in J-CKD-DB-Ex to 67.9 years in CDM, and between 46.6% (PHARMO) and 59.6% (J-CKD-DB-Ex) of patients were men. There was a steady increase in GLP-1 RA initiators from 2012 (when 1.6–4.8% of GLP-1 RA initiators started therapy) to 2019 (when 19.8–31.5% started therapy). The median duration of initial treatment with a GLP-1 RA ranged from 2.3 months (PHARMO) to 12.4 months (VID). At 1-year follow-up, between 52% (CDM) and 78% (DNHR) of patients were receiving treatment. Findings suggested that GLP-1 RA use was independent of CKD severity.ConclusionsDuring 2012–2021, GLP-1 RA use steadily increased across multinational cohorts of patients with T2D and CKD, and persistence with treatment was high. GLP-1 use was independent of CKD severity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-025-01717-8.