Diabetology

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Aim: Assess transition readiness of adolescents with Type 1 Diabetes (T1D) from adolescent, parental, and clinician perspectives. Methods: Cross-sectional study (n = 36, 20 Male/16 Female, 16–18 years, June 2023–June 2024, metropolitan paediatric centre). Adolescents had diabetes knowledge, self-efficacy, and diabetes distress measured. Parents had an assessment of knowledge, diabetes-related distress, and estimated the adolescent’s self-efficacy. Clinicians estimated adolescent self-efficacy. Results: Median HbA1c was 7.4% (IQR 6.6–8.4). One adolescent met the guidelines for multidisciplinary team (MDT) appointments. Paired sample t-tests showed that adolescents’ knowledge was comparable to parent levels (t(24) = −1.69, p = 0.10). Adolescents’ knowledge was strongly associated with higher self-efficacy (r = 0.80 p < 0.001). Higher adolescent self-efficacy was associated with lower adolescent distress (r = −0.368, p = 0.03). Adolescent distress was lower than parent distress (t(24) = −3.13, p = 0.005). Although adolescent self-efficacy was strongly correlated with parent and clinician evaluation (r = 0.76, p < 0.001; r = 0.80, p < 0.001), adolescents reported higher self-efficacy than estimates by parents (t(24) = 4.76, p < 0.001) or clinicians (t(24) = 8.39, p < 0.001). Parent knowledge was moderately correlated with adolescent self-efficacy (r = 0.62, p = 0.001). Conclusions: Diabetes knowledge may confer greater self-efficacy and reduce diabetes distress in adolescents. Distress levels are higher in parents than in adolescents. Engagement with MDT is poor. Transition efforts should focus on parents and adolescents while increasing engagement with MDT.

Objective: The aim was to characterize the real-world use of GLP-1 receptor agonists (GLP-1 RAs) and/or SGLT2 inhibitors in kidney transplant recipients (KTRs) with diabetes and to compare the clinical management, safety, and effectiveness between patients with type 2 diabetes mellitus (T2DM) and post-transplant diabetes mellitus (PTDM). Methods: This retrospective longitudinal cohort study included 141 adult KTRs (T2DM: 52; PTDM: 89) who initiated GLP-1 RA and/or SGLT2 inhibitor (SGLT2i) therapy between August 2013 and April 2024. Metabolic control, medication use, and safety outcomes were assessed from baseline to end follow-up, with a mean treatment exposure of 2.4 years. Results: Overall, 69% were treated with an SGLT2i and 59% with a GLP-1 RA; because the groups were not mutually exclusive, 28% received both agents. Treatment was associated with significant reductions in body weight (−3.38 kg; p < 0.001) and BMI (−1.28 kg/m²; p < 0.001) in both subgroups. HbA1c showed a non-significant overall decline (−0.31%; p = 0.21), with a greater reduction in the T2DM subgroup (−0.50%; p < 0.01). Significant improvements were also observed in lipid profile and blood pressure. Renal allograft function remained stable in both groups. The overall safety profile of the therapies was favorable, with mild urinary tract infections (18%) and manageable nausea (6%) reported in the entire cohort. No episodes of acute rejection or severe hypoglycemia occurred during the study period. Conclusions: In real-world practice, GLP-1 RAs and SGLT2is were associated with improved cardiometabolic parameters and stable renal function in KTRs, with a manageable safety profile. Similar effectiveness and safety across T2DM and PTDM support the use of these agents throughout the spectrum of diabetes in transplant recipients.