News

Weight-loss surgery produces lasting diabetes remission, long-term study finds

A long-term clinical trial found that metabolic-bariatric surgery led to far higher rates of lasting type 2 diabetes remission than intensive medical and lifestyle management alone.

  • Published in Diabetes Care, journal of the American Diabetes Association
  • Trial: Alliance of Randomized Trials of Medicine vs. Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) — described as the largest, longest-running trial of metabolic surgery for diabetes
  • Participants: 262 people with type 2 diabetes — 166 assigned to surgery, 96 to medical/lifestyle management. Median follow-up 11 years, up to 14 years
  • Remission rate: 58% for surgery group vs. 3% for medical/lifestyle group. Remission defined as A1C below 6.5% without blood sugar-lowering medication
  • Factors linked to remission: Shorter duration of diabetes before treatment, no insulin use, fewer types of blood sugar-lowering medications, and greater weight loss in the first year after treatment
  • Factors linked to relapse after remission: Longer history of diabetes and taking more types of diabetes medications before treatment

The question has been whether benefits endure — this study shows they do, and suggests surgery could be offered earlier to the right patients, rather than as a last resort, based on characteristics that predict lasting remission.

Tackling diabetes with an electronic implant: how a tiny catalyst lowers blood sugar

Type 2 diabetes is rising worldwide, linked to obesity and long-term energy surplus. Insulin lowers blood sugar by pushing glucose into cells, but if that energy isn’t used, it gets stored as fat — so patients often keep gaining weight.

The new approach:
Instead of using drugs or engineered biological cells, researchers developed a fully inorganic, implantable electronic system. It was published in the journal Science.

How it works:

  • The catalyst: Graphite felt covered with gold nanoclusters that are “dusted” with even smaller platinum particles. The surface looks like tiny desert roses under an electron microscope. It needs no cells, enzymes, or biological components, which could make manufacturing and regulatory approval easier. It showed good biocompatibility.
  • What it does: Using a very low electrical voltage, it converts excess blood glucose into gluconate, which cannot be stored as fat and is excreted in urine.
  • Closed-loop control: A standard continuous glucose sensor (like those worn on the arm) monitors glucose. If levels rise too high after a meal, it sends a Bluetooth signal to a smartphone/smartwatch, which wirelessly powers the implant at 13.56 MHz and activates the catalyst. It switches off automatically when glucose returns to target, reducing risk of low blood sugar.
  • The implant: Contains the catalyst plus an electronic control unit in a 3D-printed casing, powered wirelessly.

What they tested:

  1. In a lab reservoir with 5 litres of glucose solution — about the volume of human blood — it successfully converted glucose.
  2. In diabetic mice for 6 weeks: blood sugar was precisely regulated, mice lost weight, and there was no evidence of tissue damage from electrical or heat effects.

What’s next:
No human testing yet. The team sees this as a paradigm shift from telling the body how to handle glucose (with drugs) to directly removing excess glucose with electronics. Because the components — sensors, wireless power, control electronics — already exist commercially, they plan to develop it into a medical device.

Researchers identify potential new target for type 2 diabetes

Researchers have identified elevated levels of a protein called Miro1 (Mitochondrial Rho GTPase1) in the skeletal muscle of people with Type 2 diabetes as a potential contributor to insulin resistance — and a possible future drug target.

What Miro1 does: Miro1 sits on the outer membrane of mitochondria (the cell’s energy producers). The team found that accumulation of Miro1 impairs muscle’s response to insulin.

Evidence across three levels:

  1. In people: Miro1 levels were elevated in skeletal muscle of people with Type 2 diabetes.
  2. In preclinical models: Removing Miro1 restored muscle insulin sensitivity, showing a causal effect.
  3. With exercise: In a randomized controlled trial of people with obesity and Type 2 diabetes, aerobic exercise vs. standard medical care led to reductions in muscle Miro1, along with improved insulin sensitivity and muscle energy production.

Study details: Published in Nature Communications. Led by senior author Dr. John P. Kirwan — who did the work at LSU’s Pennington Biomedical Research Center and is now Executive Director of the OU Health Harold Hamm Diabetes Center at the University of Oklahoma. First author is Elizabeth Heintz, doctoral candidate at Pennington Biomedical; co-corresponding author is Christopher Axelrod, now also at Harold Hamm.

Significance and next steps: Insulin resistance in muscle is central to Type 2 diabetes but its molecular causes remain unclear. This work proposes Miro1 as a new therapeutic target and helps explain why exercise is effective. The authors note more research is needed to determine if targeting Miro1 can lead to new treatments.

Continuous glucose monitors help type 2 diabetes patients spend five more hours a day in healthy blood sugar range

This trial found that continuous glucose monitors (CGMs) meaning small sensors worn on the body that track glucose all day and night, significantly improved blood sugar control in type 2 diabetes patients who do not use insulin.

What the study did:

  • Largest trial of its kind for this population: 283 adults across 22 US primary care practices, followed for 26 weeks
  • Published in the New England Journal of Medicine
  • First large-scale, multicenter randomized controlled trial to focus only on patients treated in primary care, where most Americans with type 2 diabetes receive care

Key results:

  • Time in range: CGM users spent about 5 more hours per day in their target blood sugar range compared with routine care
  • A1c (a measure of average blood sugar over about 3 months): CGM group improved by 0.9 percentage points more than the control group. The authors note this greatly exceeds what is generally considered clinically meaningful
  • A1c goal: Nearly twice as many CGM users reached an A1c below 7%, a common treatment goal

Why it matters:
An estimated 20 million US adults have type 2 diabetes and do not take insulin, and many do not reach glycemic targets, which over time raises risk for heart disease, kidney disease, and vision loss.

Currently, American Diabetes Association guidelines cite Level A evidence, the highest rating, for CGM use in people who use insulin, but only Level C evidence, reflecting limited research, for people who do not use insulin. The authors hope this trial provides robust evidence to strengthen guidelines and expand insurance coverage.

For now, they suggest people with type 2 diabetes not using insulin discuss CGM use with their primary care provider.

Longer sleep may be linked to a higher risk of kidney disease in people with type 2 diabetes

A study published in the Journal of the Endocrine Society found that people with type 2 diabetes who habitually sleep longer may have an increased risk of developing or worsening diabetic kidney disease [diabetic nephropathy].

Key details:

  • Who was studied: 678 Japanese people with type 2 diabetes, followed for about 6 years.
  • What was found: Longer habitual sleep duration was associated with a higher risk of developing or worsening nephropathy. The link was strongest in older adults and in those who already had signs of kidney damage, like microalbuminuria or reduced kidney function.
  • Context: Diabetic kidney disease affects 30-40% of people with diabetes and can lead to kidney failure and higher cardiovascular risk.

What it does NOT mean:

Lead author Dr. Tomoya Mita of Juntendo University Graduate School of Medicine in Tokyo stressed this was an observational study. It does not show that long sleep causes kidney disease, and should not be taken as a recommendation to sleep less.

Instead, researchers suggest longer sleep may be a readily observable marker of underlying health vulnerability — a simple clue to help identify people with diabetes who may need closer monitoring of their kidney health.

Norway shows a relative 11% increase in incidence of type 1 diabetes in children aged 0.5 to 5 years after nationwide introduction of rotavirus vaccine, but secondary analyses suggest vaccine probably not the cause

New study summary:

Study: Nationwide cohort study in Norway, to be presented at the EASD Annual Meeting in Milan and published in Diabetologia. Lead author is PhD student Maria Östman, University of Oslo.

Background: Rotavirus causes gastroenteritis in young children. Norway introduced the oral live-attenuated monovalent Rotarix® vaccine into its national childhood immunization programme in September 2014, with rapid, high uptake — 92.8%. Previous studies on rotavirus vaccine and type 1 diabetes risk have had conflicting results.[T1D]

Methods: Researchers followed all children born in Norway 2007-2019 — 740,744 children — from 0.5 to 5 years of age for T1D diagnosis, with follow-up through Dec 31, 2024. They compared T1D incidence in children born before vs. after the September 2014 rotavirus vaccine introduction.

Main findings:

  • 846 children were diagnosed with T1D before age 5.
  • Using interrupted time series analysis, the observed incidence after vaccine introduction was 11% higher than the predicted trend based on pre-vaccination data.
  • When comparing fully vaccinated children [2 doses of Rotarix] to non-vaccinated children, the adjusted hazard ratio was 1.17, which was not statistically significant.

The authors stated: “This study found no evidence for a reduced risk of type 1 diabetes after introduction of rotavirus vaccination in infancy but found instead that the incidence… increased after rotavirus vaccination was introduced.”

Secondary / negative control analyses — why authors think vaccine is probably not the cause:

To test whether the increase was specific to rotavirus vaccine, they looked at two other unrelated changes to the Norwegian immunisation programme as negative controls:

  • Introduction of hepatitis B vaccine in 2016
  • Switch from 7-valent to 13-valent pneumococcal vaccine in 2011

Both of those changes were also followed by a similar magnitude increase in T1D incidence, despite no biological reason to expect them to affect T1D risk.

The authors conclude this pattern suggests the 11% increase seen after September 2014 is likely due to other, yet unknown environmental factors and not the rotavirus vaccine itself, and not explained by the combination of vaccine programme changes.

They also considered other potential explanations, including the COVID-19 pandemic — Norway saw a temporary T1D increase in 2022 — and a 2018 change in prenatal ferritin screening guidelines related to iron supplementation, but did not think these explained the findings.

Authors’ interpretation: “We do not believe that rotavirus vaccination increases the risk of type 1 diabetes. We believe there is a need for additional studies on rotavirus vaccination and type 1 diabetes in different settings with different vaccines before concluding anything.” They emphasized the need for more research on environmental factors influencing T1D, which has been generally increasing over past decades.

Study examines racial disparities in patients’ adherence to their diabetes medications

A new study led by UCLA Health, published in JAMA Network Open. Analyzed 2019 national health records of 587,000 Medicare Advantage patients:

Main Findings:

  • Overall adherence to diabetes medications was less than 60%. Patients were considered “adherent” if at least 80% of days were covered.
  • Black and Hispanic patients were less likely than White patients to adhere to medication protocols.
  • For metformin specifically, Black patients had significantly lower adherence than White patients — 46% vs. 56.5% — despite metformin being low-cost and widely available.

Medications Evaluated: metformin, insulin, and a combined group of SGLT2 inhibitors and GLP-1 RAs.

Role of Financial Assistance:

  • Assistance programs — Medicaid and Medicare’s Part D Low-Income Subsidy — significantly helped reduce treatment gaps.
  • The effect was most pronounced for high-cost treatments like insulin and newer drugs such as SGLT2 inhibitors and GLP-1 RAs.

Author Statements:
Lead author Dr. Utibe R. Essien, associate professor-in-residence at UCLA’s David Geffen School of Medicine, said consistent medication use is critical for preventing long-term complications, and that health plan rules and out-of-pocket costs strongly affect adherence. He said clinicians can help connect patients with financial support programs, and noted that non-financial factors — such as pharmacy closures, dosing complexity, side effects, or personal beliefs about treatment — may explain disparities in low-cost drugs and require further research.

Gut microbiome development may help predict type 1 diabetes in children at high risk

A new study:
What the study asked: Can how a child’s gut microbiome develops in early life help predict type 1 diabetes in children already at high genetic risk? Type 1 diabetes affects more than 9 million people worldwide, including 1.8 million children and adolescents.

Who did it and how: A prospective study led by Mass General Brigham, the Broad Institute of MIT and Harvard, and Harvard T.H. Chan School of Public Health, published in Nature Metabolism. It analyzed the TEDDY Study — 887 children at high genetic risk for type 1 diabetes from Finland, Germany, Sweden and the U.S., with more than 12,000 stool samples collected over their first 6 years of life.

The researchers counted a child as developing the disease process when blood tests first detected an immune attack on insulin-producing cells, or when they were clinically diagnosed.

Three microbiome patterns were found:

  1. Early-matured: rapid change in the first year, high bacterial diversity.
  2. Late-matured: slow start with low diversity around age 1, but caught up later.
  3. Early-plateaued: slow start that never caught up — low diversity through the first 3 years.

Children with the early-plateaued pattern had about 3 times the risk of developing type 1 diabetes or the early immune attack, compared to children whose microbiomes matured on a typical schedule. This was only visible through repeated sampling over time, not a single snapshot.

Biology behind it: The early-matured group shifted sooner from milk-adapted bacteria like Bifidobacterium to species that break down dietary fiber. The early-plateaued group stayed oriented toward digesting milk sugars even after solids were introduced, and relied on a narrower set of species for key functions.

Genetics mattered too: Lead author Danyue Dong, PhD, and co-corresponding author Daniel Wang, MD, ScD, found that genetic background influenced the link. Variants involved in antimicrobial and antiviral immune responses shaped how strongly the late-matured pattern related to risk. The early-plateaued pattern carried higher risk regardless of genetic background. Combining microbiome and genetic data gave a more accurate risk picture.

Limitations and next steps: This was an observational study in high-risk children, so it cannot prove cause and effect and may not apply to the general population. The authors suggest future pediatric visits could include gut microbiome testing in the first years of life, opening a window for microbiome-directed prevention strategies like dietary supplements — but clinical trials are needed first.

Regular exercise has greater impact on reducing risk of type 2 diabetes in younger adults, but the highest absolute benefit in older adults

Researchers from Leiden University Medical Centre analyzed 87,975 adults in the UK Biobank [average age 63, 57% female] with no history of diabetes. Participants wore wrist accelerometers for 7 days to measure moderate-to-vigorous physical activity [MVPA] — activity intense enough to leave you slightly out of breath, like brisk walking, running or cycling. They were followed for a median of 7.7 years, during which 2,140 people [2.4%] developed type 2 diabetes.[T2D]

1. Amount of activity matters most

  • People were split into lower vs higher activity groups within their age band.
  • Lower group: median 121 min MVPA/week — below the 150 min/week guideline.
  • Higher group: median 409 min/week.
  • Overall, the lower group had twice the relative risk of developing T2D compared to the higher group, after adjusting for age, sex, smoking, family history and other factors.

2. Relative vs absolute benefit — the key distinction

  • Younger adults [<63 years]: Lower activity was linked to >2x higher relative risk vs higher activity. The effect was strongest here.
  • Older adults [≥63 years]: Lower activity was linked to 65% higher relative risk.

However, because older adults have a much higher overall risk of T2D to begin with, the absolute difference in cases was larger in older groups. In public health terms, getting more older adults active would prevent more actual cases.

The same pattern was seen for prediabetes status: the relative benefit of activity was stronger in people without prediabetes [>2x risk if inactive] than in those with prediabetes [54% higher risk if inactive].

3. Timing of activity

People who did most of their MVPA later in the day [1pm to midnight] had a 10% lower relative risk than those who exercised mostly earlier [5am to before 1pm]. The timing effect was more pronounced in younger adults — 23% lower risk for late-day exercise vs 4% in older adults. Researchers say this does not support different timing recommendations for different groups.

What the authors conclude:

“All adults should be encouraged to be as active as they can… at the population level, we may see the greatest reduction in the number of new cases among older adults.” — Dr Diana van Heemst

And that both relative and absolute risk need to be looked at together to understand impact.

Limitations noted: UK Biobank participants tend to be healthier, wealthier and better educated than the general UK population [97% white in this sample]; prediabetes status was measured several years before activity; and 7-day accelerometer wear may not capture long-term habits.

Study suggests that people with diabetes who are controlling their blood sugar too strictly (within safe limits) could be experiencing less enjoyment in life

New research to be presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Milan (Sept 28 – Oct 2) — from Prof. Dominic Ehrmann, Research Institute Diabetes Academy Mergentheim, Germany, and colleagues.

Goal of the study:
To understand how day-to-day blood sugar patterns affect quality of life in people with diabetes. The PRO-MENTAL study, funded by the German Centre for Diabetes Research (DZD), looked at whether CGM data from one day predicts quality of life the next day.

How it was done:

  • 400 people with diabetes: 72% type 1, 28% type 2, 55% female, average age 47, average HbA1c 7.6%
  • 14 consecutive days of monitoring
  • Quality of life was rated daily using ecological momentary assessment (EMA) based on the WHO-5 questionnaire, which asks about feeling cheerful, calm, active, rested, and interested in daily life. Sleep quality, perceived stress, mood and energy (0-10 scale) were also recorded daily.
  • CGM parameters analyzed: time below range (<70 mg/dL), time above range (>180 mg/dL), time in normal range (70-140 mg/dL), and glucose variability.
  • Models adjusted for age, sex, diabetes type, and previous-day quality of life.

Key findings:

  1. More time in the normal range (70-140 mg/dL) on one day was associated with better quality of life the next day.
  2. Higher glucose variability — while still within safe limits — on one day was also associated with better quality of life the next day.
  3. Time above range and time below range showed no significant link to next-day quality of life.
  4. Better sleep quality the previous night and higher energy levels the previous day were also linked to better next-day quality of life.
  5. Same-day glucose parameters were not associated with same-day quality of life.

Authors’ interpretation:
The researchers suggest that while good blood sugar control is important for well-being, trying to minimise fluctuations too strictly — even when staying within safe limits — may carry a burden that reduces enjoyment. The constant effort and restriction needed to keep glucose completely flat could prevent people from engaging in activities they enjoy.

The study does not suggest that looser control is better, but that the psychological and practical burden of very strict control may affect day-to-day quality of life.

This is conference research that has not yet been through full peer-reviewed publication, so findings should be considered preliminary.

Risk groups for a severe side effect of SGLT2 inhibitors

A class of medicines used for type 2 diabetes that also reduces risk of heart and kidney disease. They carry a rare but serious side effect: ketoacidosis — where lack of insulin leads to high ketone production, disrupting the body’s acid-base balance and potentially becoming life-threatening.

What the study did:
Published in The Lancet Diabetes & Endocrinology, researchers analyzed national health registry data from Sweden, Denmark and Norway. It included more than 280,000 patients with type 2 diabetes treated with SGLT2 inhibitors, looking at how often ketoacidosis occurred and what factors increased risk. Collaboration with Statens Serum Institut (Denmark) and NTNU (Norway).

Key findings on who is at higher risk:

  • Highest risk factors: history of previous ketoacidosis, high blood glucose levels, low body weight or signs of malnutrition
  • Also linked to higher risk: previous episodes of hypoglycaemia (low blood sugar)
  • Most common trigger: infection was the most common triggering or co-occurring event when ketoacidosis happened
  • Other acute conditions were more common in affected patients, including kidney impairment, stroke, and major surgery

Timing of risk:
Previous studies focused on the early months of treatment. This study found risk is highest in the first few months, but remains elevated throughout the entire time a patient is on the medication.

What it means for clinical care:
Lead author Peter Ueda, Assistant Professor at Department of Medicine, Solna, Karolinska Institutet, said the goal is not to avoid treatment — SGLT2 inhibitors benefit many patients — but to better identify high-risk patients and use the drugs more safely.

Researchers hope the findings help clinicians with treatment decisions and with guidance on when to temporarily pause the medication, for example during acute illness or before surgery.

Next steps are to study in more detail the patients who do develop ketoacidosis on treatment, and to investigate other rare but serious side effects of modern diabetes medicines.

A New Approach to Weight Loss and Diabetes That Burns Energy Instead of Suppressing Appetite

Researchers at UC Berkeley have identified a compound that could treat obesity, diabetes, and fatty liver disease differently than current GLP-1 drugs like Ozempic, Wegovy, Mounjaro and Zepbound.

How it works:

  • GLP-1s work by reducing appetite and food intake, which can cause side effects like nausea, nutritional deficiencies, and muscle loss.
  • The new compound, 5-tetradecyloxy-2-furoic acid (TOFA), works on the other side of the energy equation: it increases energy expenditure.
  • TOFA has a dual mechanism. It is an ACC inhibitor that blocks production of lipids like cholesterol and triglycerides, AND it activates cellular receptors PPARα and PPARδ that turn on genes to help cells take up fat and burn it for energy.

Results in mice, published in Science Advances:

  • Cells burned up to 18% more energy with no change in food intake, physical activity, or body temperature.
  • Obese mice lost weight from fat with no significant loss of lean muscle mass.
  • Improved insulin sensitivity, glucose control, lowered triglycerides, and improved features of fatty liver disease.
  • Unlike other ACC inhibitors that reached mid-stage clinical trials, TOFA did not raise triglycerides, a major heart risk that has prevented approval of others in this class.

Combination potential:

  • When researchers gave mice two separate drugs to replicate TOFA’s two actions, it was less effective than TOFA alone.
  • When combined with GLP-1 drugs semaglutide and tirzepatide, TOFA worked additively or synergistically, leading to greater improvements in weight, glucose, insulin, and triglycerides than either alone. Researchers view it as complementary, not a replacement.

TOFA was first discovered in the 1970s. The study was led by senior author Anders Näär, professor of metabolic biology and nutrition at UC Berkeley, and first author Justin Y. Lee.

Women with endometriosis face 46% higher risk of type 2 diabetes

A new peer-reviewed study led by researchers at George Mason College of Public Health, published in Diabetologia, found that women with endometriosis have a 46% higher risk of developing type 2 diabetes than women without the condition.

It is the largest study to date on this link:

  • Scale: Analyzed health records of nearly 3 million women in the Utah Population Database from 1996-2021, including nearly 100,000 women diagnosed with endometriosis.
  • Lead researchers: Doctoral student Maggie Fuzak Nunziato and Professor Anna Pollack.
  • Key findings:
    • Risk varied by type of endometriosis, with the strongest association seen in women with extra-pelvic endometriosis (disease found outside the pelvis).
    • The association was strongest among premenopausal women and women without obesity — groups not traditionally considered high-risk for type 2 diabetes.
    • This differs from previous, smaller studies that treated endometriosis as a single condition and found little or no association.

Why it matters: Endometriosis affects about 1 in 10 women of reproductive age. The findings suggest it may have health implications beyond the reproductive system — including chronic pelvic pain and infertility — potentially due to chronic inflammation affecting metabolic health.

The researchers stress this shows an association, not causation, and more research is needed to understand the biological mechanisms and whether earlier diabetes screening or prevention could benefit women with endometriosis.

Rethinking diabetes prevention: a life-course approach

An international research team led by University Hospital Tübingen and the DZD published an article in Nature Medicine calling for a fundamental shift in how we prevent type 2 diabetes.

The core argument:
Type 2 diabetes develops over decades, but prevention usually starts only when blood sugar is already high. The team argues prevention needs to start much earlier and continue across the entire life course.

They identify 6 critical windows:

  1. Before pregnancy – both parents’ metabolic health matters
  2. Pregnancy
  3. Early childhood
  4. Adolescence
  5. Young adulthood
  6. Midlife to older adulthood

The release notes pregnancy and breastfeeding are key opportunities to shape health for both generations.

A new central goal: remission, not just slowing disease

Instead of just trying to slow progression, the authors say the goal should be to restore metabolic health and keep it.

This is especially important for prediabetes — when blood sugar is elevated but not yet at diabetes levels. The panel stresses prediabetes is not irreversible, and that lifestyle interventions can return glucose to normal. People who achieve this “prediabetes remission” have a substantially lower long-term risk.

“Prediabetes remission—meaning a return to normal blood glucose levels—should therefore become a central goal of prevention,” says senior author Prof. Andreas L. Birkenfeld.

The ten-point framework

The paper presents the first international expert consensus with ten priorities for the future of prevention, including:

  • Life-course risk assessment that accounts for biological, social, and behavioral factors
  • Personalized prevention strategies instead of one-size-fits-all
  • Making prediabetes remission a central prevention target
  • Using digital and AI-supported tools
  • Reducing health inequities
  • Focusing research, prevention, and healthcare on maintaining metabolic health long-term

Led by Prof. Birkenfeld and first author Yiying Wang from Tübingen, the framework was developed with leading experts in basic research, clinical medicine, and diabetes prevention.

Immune memory mechanism emerges as a promising target in diabetes and its complications

A new review published in Genes & Diseases identifies trained immunity — a long-lasting adaptation of the innate immune system — as a key mechanism in diabetes and its complications.

Here is a summary of the press release:

What is trained immunity?
It’s a form of immune memory where innate immune cells like monocytes and macrophages undergo lasting changes after exposure to metabolic stress or inflammation. They become primed to react more aggressively to future triggers, creating a state of chronic, low-grade inflammation that can persist even after blood sugar normalizes.

What triggers it in diabetes?
The review found that common diabetes-related factors can activate these pathways, including:

  • Hyperglycemia (high blood sugar)
  • Obesity
  • Lipid abnormalities
  • Changes in the gut microbiome

Why it matters for disease progression:
This sustained inflammatory response can:

  • Promote insulin resistance
  • Impair insulin-producing beta cell function
  • Accelerate tissue damage

Beyond diabetes itself, trained immunity may help explain major complications, including atherosclerosis and cardiovascular disease, diabetic kidney disease, delayed wound healing, tissue fibrosis, and vascular dysfunction.

New treatment opportunities:
The authors suggest future therapies should target the immune mechanism itself, not just blood glucose. Promising directions highlighted include:

  • Targeting inflammatory pathways like the NLRP3 inflammasome
  • Modifying cellular metabolism (immunometabolism)
  • Improving gut microbial balance through diet and microbiome-focused therapies
  • Exploring vaccination strategies that reprogram immune responses

The overall shift is from viewing diabetes as purely a metabolic disorder to understanding it as a disease with a persistent innate immune component — opening new avenues for prevention and treatment of its long-term complications.

Gestational diabetes diagnoses rise sharply in England

A major study of NHS maternity data found gestational diabetes is rising rapidly in England:

  • Scale of rise: 1 in 8 mothers in England is now diagnosed, up 60% in five years — from ~8% of pregnancies in 2018 to over 12% in 2022.
  • Study size: Researchers analyzed routinely collected data on over 2.3 million mothers and 2.8 million births across 184 hospitals between 2018-2022. This is the first time GDM prevalence has been estimated at this scale in the UK.
  • Who is most affected: The sharpest rises were in Asian women — rates reached ~23% — and women in the most deprived areas, where rates reached ~14%.
  • Linked outcomes and inequalities: Gestational diabetes mellitus (GDM) increases risks of preterm birth, emergency C-section, and babies born large or small for gestational age. The study also found wider inequalities: Black mothers were more likely to have an emergency C-section, women in deprived areas more likely to give birth preterm, and Asian mothers more likely to have babies small for gestational age. In these higher-risk groups, a GDM diagnosis further increased preterm birth risk.
  • Why cases are rising: Researchers point to rising maternal age, increasing obesity rates, and better data capture. Changes to screening during the COVID-19 pandemic did not meaningfully affect the overall trend.
  • Long-term implications: Experts warn the rise will strain already challenged maternity services. GDM often resolves after pregnancy but raises long-term risk of type 2 diabetes and cardiovascular disease for both mother and child.

Prof. Rebecca Reynolds, University of Edinburgh, called the rise concerning and said better postpartum prevention is needed. Dr. Sonya Babu-Narayan, British Heart Foundation, said clinicians should routinely ask women about pregnancy-related risk factors when assessing heart attack and stroke risk, and women with a history of GDM should attend health checks.

Home delivered, medically tailored groceries improve diabetes control

A randomized controlled trial published in Circulation found that medically tailored grocery deliveries improved blood sugar control in adults with type 2 diabetes who have public insurance.

The study was conducted by researchers at Kaiser Permanente, Tufts University’s Food is Medicine Institute, and The George Institute for Global Health within Kaiser Permanente Southern California.

Study design:

  • 460 Medicaid-insured patients with persistently elevated blood sugar from 12 medical offices in Southern California
  • Recruited Nov 2021 – July 2022 and followed for 6 months
  • Randomized to usual care or one of two levels of monthly medically tailored groceries (averaging about $135 or $175)
  • The grocery intervention included weekly home deliveries scaled to household size, culturally tailored recipes, and phone-based nutrition counseling

Key findings:

  • Blood sugar: Participants who received groceries had an additional 0.40 point reduction in HbA1c over 6 months compared to usual care
  • Food security: Odds of food security increased by nearly 215% and nutrition security by 365% among those who received groceries
  • Dose: Improvements in blood sugar were similar whether participants received the $135 or $175 level of support

The authors said the results provide RCT-level evidence that integrating Food is Medicine approaches into clinical care can improve both diabetes outcomes and food/nutrition security, particularly for low-income patients facing economic and social barriers. They suggested the findings support incorporating medically tailored grocery programs into Medicaid benefits.

Muscles matter for diabetes risk

A large international study led by Curtin University and published in Diabetes Care tracked nearly 480,000 adults who were diabetes-free at the start for 14 years.

The researchers looked at sarcopenic obesity — having both excess body fat and low muscle mass/strength.

Key findings:

  • Much higher risk: People with sarcopenic obesity were more than 3.5 times as likely to develop type 2 diabetes compared to people with healthy body composition.
  • Worse than obesity alone: They were 19% more likely to develop type 2 diabetes than people with obesity alone, and 91% more likely than people with low muscle mass alone (sarcopenia).
  • Absolute rates: Within 10 years, nearly 15% of people with sarcopenic obesity developed type 2 diabetes, compared to around 11% with obesity alone and just 3% without either condition.
  • Who is most affected: The link was particularly strong among women and adults under 60.

The authors say the results challenge the idea that diabetes risk is driven mainly by weight on the scales. Because muscle uses a lot of glucose and helps regulate insulin resistance, preserving muscle mass and strength through regular physical activity may be just as important as managing weight for prevention.

Lead author was PhD candidate Zhongyang Guan, senior lead Professor Mario Siervo, with comment from Diabetes WA on how physical activity helps use blood glucose and reduce insulin resistance.

GLP-1 agonists may help people with diabetes and long COVID

A new mouse study published this week in the Journal of Virology suggests that GLP-1 agonists — drugs commonly used for type 2 diabetes and weight loss — could help prevent pulmonary fibrosis in diabetic patients with Long COVID.

Key findings:

  • The problem: People with type 2 diabetes have ∼4x higher risk of severe Long COVID symptoms than non-diabetics. Pulmonary fibrosis, a severe Long COVID condition where lung tissue becomes scarred and thickened, is driven by immune cells called macrophagesAmerican Society for Microbiology.
  • The research: Led by virologist Runhong Zhou, Ph.D., at the University of Hong Kong, researchers compared blood samples from COVID-19 patients with and without diabetes months after hospitalization. Diabetic patients showed increased monocyte activity and genetic pathways linked to fibrosis.
  • The mouse experiments: Mice with diabetes and SARS-CoV-2 infection developed overactive fibrosis-related genes. When treated with GLP-1 agonists, those genes normalized and macrophages were “reprogrammed,” leading to reduced lung scarring compared to untreated mice.
  • Why GLP-1s?: The GLP-1 receptor is highly expressed in lung cells, and earlier lab work hinted at anti-inflammatory effects against pneumonia-related fibrosis. This is the first test in animal models after severe COVID-19 infection.

Caveats: Zhou notes the results are preliminary and only involved a small number of mice. But the team sees it as proof of concept worth further investigation, especially since Long COVID continues to affect many people, particularly the elderly.

The study was announced by the American Society for Microbiology on 9 July 2026.

Gut microbiota can predict risk of type 2 diabetes years before it develops

Researchers at Chalmers University of Technology led a large Swedish study of 4,685 adults and discovered that changes in gut microbiota and metabolism can show up years before type 2 diabetes develops. Participants gave stool samples, and 383 developed diabetes after ∼5 years of follow-up.

Key bacterial links:

  1. 9 specific bacteria were associated with future diabetes risk.
  2. Akkermansia muciniphila – usually seen as beneficial – was high in people who later developed diabetes. Researchers think that with low fiber intake, it eats the gut’s protective mucus instead of fiber, causing inflammation and insulin resistance.
  3. Coprococcus catus – very low levels were linked to diabetes risk, but above a certain level the risk disappeared.
  4. Diet mattered: whether certain gut bacteria were helpful or harmful depended on a person’s eating habits.

Why it matters: The findings suggest gut microbiome changes come before diabetes, not as a result of it. This means stool samples could eventually be used as biomarkers, alongside obesity, genetics, and blood glucose, to identify people at risk earlier and start preventive measures.

Next steps: Results still need validation in larger studies. If confirmed, the microbiome could become a target for personalized prevention through diet and lifestyle, since it can be modified. The study supports current advice to eat fiber-rich foods like fruit, vegetables, legumes, and whole grains.