AI Blood Test Could Detect Early Eye Nerve Damage in People with Type 2 Diabetes
Key Takeaways:
- An AI tool called Pro-DRN uses a blood sample to flag people with type 2 diabetes at high risk of diabetic retinal neurodegeneration (DRN), before any damage shows on the retina.
- It was trained on 1,218 participants and validated in 502 people from UK Biobank, identifying 71 proteins linked to DRN – with ACTA2, COL6A3 and HSPG2 the strongest predictors.
- As retinal nerves are among the first tissues affected by diabetes, the test could also hint at wider nerve damage and help target earlier monitoring and future treatments.
A simple blood test to catch nerve damage early
Scientists have developed an AI-assisted prediction tool that can identify people with type 2 diabetes who are at high risk of developing diabetic retinal neurodegeneration (DRN) before symptoms appear. The findings were published in the journal PLOS Medicine.
The work was led by Wei Wang, MD, PhD, associate professor at the Guangdong Provincial Clinical Research Center for Ocular Diseases. According to the authors, the damage that diabetes inflicts on the delicate nerves of the eye appears to leave a detectable molecular trail in the bloodstream long before it becomes visible in the eye itself.
“Our study suggests that early retinal nerve damage in diabetes leaves measurable signals in the blood,” write the authors. “These findings suggest that a simple blood test analyzed with artificial intelligence may help identify people with diabetes who are at highest risk of early retinal nerve damage, well before visible damage appears on the retina.”
Why the retinal nerves matter in diabetes
Type 2 diabetes affects more than half a billion people worldwide, and it carries an increased risk of long-term complications, including progressive neurodegeneration – the gradual deterioration of nerve tissue over time.
The nerves of the retina are among the earliest tissues to be affected. As this damage advances, it can eventually lead to severe visual impairment and the loss of sight. The difficulty for clinicians is one of timing: current diagnostic methods can only detect DRN once the retina has already sustained irreversible damage. By the time the problem is visible, the window for early, protective intervention has often closed.
How the Pro-DRN tool was built
To address this, Wang and colleagues developed a machine learning algorithm called Pro-DRN. They drew on data from 1,218 participants in the Guangzhou Diabetic Eye Study, all of whom had been diagnosed with type 2 diabetes but had not yet developed DRN at the point of enrolment.
The model combined two distinct streams of information. The first was proteomics data – a detailed read-out of the proteins circulating in participants’ blood samples. The second was a series of yearly retinal images, capturing the state of the eye over a six-year follow-up period. By matching the molecular signals in the blood against how each person’s retina changed year on year, the algorithm learned which blood-borne patterns preceded the onset of nerve damage.
The proteins behind the predictions
The analysis surfaced 71 proteins associated with the development of DRN. Of these, three stood out as the most consistent drivers of accurate prediction: ACTA2, COL6A3 and HSPG2. These are key structural components involved in maintaining the integrity of the nerve and muscle tissue in the eye, which helps explain why disturbances in their levels might signal nerve tissue under strain.
Crucially, the team did not rely on a single dataset. The results were validated in an independent cohort of 502 people from UK Biobank, where the core effects and protein signals were reproduced – an important check that the findings were not simply a quirk of the original group.
From research tool to clinical aid
Pro-DRN has been made available as an interactive, web-based risk assessment tool that clinicians can use to support early DRN screening and to monitor how a person’s risk evolves over time. People identified as being at high risk could then benefit from more frequent check-ups and from early interventions aimed at preventing or slowing progressive neurodegeneration, rather than waiting for damage to become apparent.
A window into the wider nervous system
The potential significance of the test reaches beyond the eye. Because DRN is one of the first signs of nerve degeneration brought on by diabetes, detecting it early could also signal the onset of nerve injury elsewhere in the body.
Such damage can contribute to cognitive impairment, dementia and peripheral neuropathy – the latter causing loss of sensation and motor control in the hands, feet and other extremities. Viewed this way, a single eye-focused test could offer valuable insight into the overall health of a person’s nervous system.
New possibilities for treatment and trials
The discoveries also open up two further avenues. The proteins identified as being involved in DRN progression could be investigated as potential targets for the development of new therapies. In addition, the AI-based tool could prove useful for selecting and stratifying participants in clinical trials that are evaluating neuroprotective strategies designed to prevent or delay nerve damage – helping ensure such studies enrol the people most likely to show a measurable benefit.
Looking ahead
For the researchers, the broader ambition is a shift in how diabetic eye care is approached – from reacting to damage that has already occurred towards anticipating who is most vulnerable.
“Pro-DRN may help move diabetic eye care from detecting established damage toward earlier, molecularly informed risk stratification, so that closer monitoring and future neuroprotective interventions can be directed to the people most likely to benefit,” Wang and colleagues write.
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Weight Loss Drugs Linked to Lower Risk of Peptic Ulcer Disease in Adults with Diabetes
Key Takeaways:
- A large US study involving more than 66,000 adults found that people with type 2 diabetes using GLP-1 receptor agonists had significantly lower odds of developing peptic ulcer disease.
- Researchers observed a 44 percent lower likelihood of peptic ulcer disease among GLP-1 users overall, with a 56 percent lower risk seen in people who switched from metformin to a GLP-1 medication instead of insulin.
- The findings add to growing evidence that GLP-1 receptor agonists may have anti-inflammatory and gastrointestinal protective effects beyond blood sugar control and weight management.
Study suggests potential gut benefits of GLP-1 medications
Medications commonly prescribed for type 2 diabetes and obesity management may provide an additional benefit beyond blood sugar control and weight reduction. A large nationwide study led by researchers at Beth Israel Deaconess Medical Center (BIDMC) has found that people with type 2 diabetes who used GLP-1 receptor agonists were significantly less likely to develop peptic ulcer disease compared with those who did not use these medications.
The findings were published in Clinical Gastroenterology and Hepatology and were based on electronic health record data from more than 66,000 adults participating in the National Institutes of Health’s All of Us Research Program. The programme is considered one of the most diverse biomedical research datasets in the United States.
“Peptic ulcer disease remains a significant cause of illness and hospitalization, particularly among people with type 2 diabetes, yet large-scale clinical studies examining how newer diabetes medications affect ulcer risk have been lacking,” said Trisha Pasricha, MD, MPH, a gastroenterologist at BIDMC. “Our study was designed to address that gap and to better understand whether GLP1 receptor agonists are associated with meaningful differences in ulcer risk in this population.”
Understanding peptic ulcer disease in diabetes
Peptic ulcers are painful open sores that develop in the lining of the stomach or upper part of the small intestine. Symptoms can include ongoing abdominal pain, nausea, indigestion, and bloating. In more severe cases, ulcers can lead to complications such as gastrointestinal bleeding or perforation.
Globally, around four million people experience ulcer-related complications each year.
People living with type 2 diabetes are known to have a higher risk of developing peptic ulcer disease. Researchers believe this increased vulnerability may stem from a combination of chronic inflammation, metabolic stress, impaired tissue repair, and greater exposure to medications associated with ulcer formation, particularly nonsteroidal anti-inflammatory drugs (NSAIDs).
Because of this elevated risk, researchers sought to investigate whether GLP-1 receptor agonists, which were first approved for diabetes treatment approximately two decades ago and are now widely used for both diabetes and obesity care, might influence ulcer risk.
GLP-1 use associated with lower ulcer risk
The researchers found that the use of GLP-1 medications was associated with substantially lower odds of being diagnosed with peptic ulcer disease.
Across the full study population, people with type 2 diabetes using GLP-1 receptor agonists had a 44 percent lower likelihood of receiving a peptic ulcer diagnosis compared with people not using these medications. The association remained even after adjusting for factors including age, sex, body mass index, medication use, and other clinical variables.
The investigators also carried out a more focused comparison involving people who had discontinued metformin, which remains the standard first-line therapy for type 2 diabetes. Researchers examined participants who then transitioned either to a GLP-1 medication or to insulin therapy.
In this head-to-head analysis, people who switched to a GLP-1 receptor agonist had a 56 percent lower risk of developing peptic ulcer disease compared with those who switched to insulin.
Researchers point to possible anti-inflammatory effects
Although GLP-1 receptor agonists are not currently prescribed for ulcer prevention, researchers believe the findings may reflect broader biological effects of the medications.
“Although these medications are not prescribed with ulcer prevention in mind, there is growing evidence that GLP1 receptor agonists may have broader biological effects, including anti-inflammatory properties and roles in gastrointestinal mucosal protection,” said senior author Pasricha, who is also an assistant professor of medicine at Harvard Medical School. “Those effects may help explain why we observed different ulcer risks compared with insulin.”
GLP-1 receptor agonists are best known for improving blood glucose control, supporting weight loss, and reducing cardiovascular risk in people with type 2 diabetes and obesity. However, a growing body of research suggests these drugs may also reduce inflammation and support tissue repair within the gastrointestinal tract.
The authors noted that more research is needed to determine whether these effects directly improve the stomach and small intestine’s ability to resist injury, particularly in people with diabetes who may already have impaired protective mechanisms.
Findings strengthened by known risk factors
The investigators also observed that medications already known to increase ulcer risk behaved as expected within the dataset. NSAIDs, corticosteroids, and blood thinners were all associated with increased ulcer risk, supporting the reliability of the study’s methodology.
Taken together, the researchers said the findings strengthen the observed association between GLP-1 receptor agonist use and lower rates of peptic ulcer disease.
Study authors and funding
Co-authors of the study included Philippa Seika, Jocelyn Chang, Su Min Hong, Sarah Ballou, Vikram Rangan, Chethan Ramprasad, Johanna Iturrino, Judy Nee, and Subhash Kulkarni of BIDMC; Christian Denecke of Charité Universitätsmedizin; and Anthony Lembo of Cleveland Clinic.
The study was funded by the American Gastroenterological Research Foundation’s Research Scholar Award, the National Institute on Aging, the Diacomp Foundation, a Pilot Grant from the Harvard Digestive Disease Core, and the Walter Benjamin Fellowship from the Deutsche Forschungsgemeinschaft.
The authors reported no conflicts of interest.
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GLP-1 Receptor Agonists Show Potential to Reduce Mental Health Risks in People with Diabetes and Obesity
Key Takeaways:
- GLP-1 receptor agonists were associated with a reduced risk of worsening mental illness in people living with diabetes and co-existing anxiety or depression
- Semaglutide and liraglutide showed the most notable effects, including reductions in depression, anxiety, and self-harm risk
- Findings from a large Swedish cohort study highlight potential dual benefits, though randomised trials are still needed
Growing interest in the mental health effects of GLP-1 therapies
A large national cohort study from Sweden, published in The Lancet Psychiatry, suggests that glucagon-like peptide-1 receptor agonists may offer benefits beyond metabolic control. The findings indicate that medications such as semaglutide and liraglutide could help reduce the risk of worsening mental illness in people living with diabetes and co-existing obesity, anxiety, or depression.
GLP-1 receptor agonists are widely used in the management of type 2 diabetes and obesity. However, their impact on mental health outcomes has remained uncertain, with previous research producing mixed results. This study contributes new large-scale evidence suggesting a potentially protective effect.
Mental illness and diabetes – a high-risk overlap
People living with diabetes are known to have a higher risk of mental health conditions, including depression, anxiety, and suicide. This overlap creates a complex clinical picture, where both metabolic and psychological factors influence outcomes.
The researchers emphasised that understanding how commonly prescribed antidiabetic medications affect mental health is essential, particularly in populations already at elevated psychiatric risk.
Study design and population
The study analysed data from Swedish national electronic health registers, covering the period from 2009 to 2022. Researchers identified individuals with diagnosed depression or anxiety who were also receiving antidiabetic treatment.
Participants who used GLP-1 receptor agonists were compared with those who did not use these medications, as well as with individuals taking other second-line antidiabetic therapies.
In total, nearly 95,500 people were included in the analysis. Approximately 60% of participants were female and 40% male, with a mean age of around 50 years. Data on ethnicity were not available.
During the follow-up period, almost 22,500 individuals used GLP-1 receptor agonists.
Outcomes measured
The study assessed several primary and secondary outcomes related to mental health.
Primary outcomes included:
- Psychiatric hospitalisation
- Sick leave exceeding 14 days due to psychiatric reasons
- Hospitalisation due to self-harm
- Death by suicide
Secondary outcomes included:
- Worsening symptoms of depression or anxiety
- Substance use disorder
- Self-harm
Reduced risk of worsening mental illness
The findings indicated that some GLP-1 receptor agonists were associated with a lower risk of worsening mental health outcomes.
Semaglutide and liraglutide were linked to a 42% and 18% lower risk of worsening mental illness, respectively, compared with people who did not use GLP-1 therapies.
When examining specific outcomes:
- Semaglutide was associated with a 44% lower risk of worsening depression
- A 38% reduced risk of worsening anxiety
- A 47% lower likelihood of worsening substance use disorder
Liraglutide showed a more limited effect, with a 26% reduction in the risk of worsening depression, but no significant impact on other mental health outcomes.
Other GLP-1 receptor agonists, including exenatide and dulaglutide, did not demonstrate meaningful changes in risk.
Impact on self-harm risk
One of the most notable findings was the association between GLP-1 receptor agonist use and a reduced risk of self-harm.
Overall, these medications were linked to a 44% lower risk of self-harm compared with non-use, suggesting a potentially important role in mitigating severe psychiatric outcomes in this population.
Implications for clinical practice
The results suggest that certain GLP-1 receptor agonists may provide dual therapeutic benefits for people living with diabetes and obesity, addressing both metabolic and mental health outcomes.
However, the authors cautioned that observational findings cannot establish causality. They highlighted the need for randomised controlled trials to confirm these associations and better understand the mechanisms involved.
Conclusion
This large Swedish cohort study provides evidence that some GLP-1 receptor agonists, particularly semaglutide and liraglutide, may be associated with reduced risks of worsening mental illness and self-harm in people living with diabetes and co-existing psychiatric conditions.
While further research is required, the findings point towards a potentially valuable role for these medications in addressing the interconnected challenges of metabolic and mental health.
CCH insight:
Yet more positive news about GLP-1 medications. This is very encouraging, particularly as there are so many drugs that have negative side-effects regarding mental health. However, this study only shows an association, and not causation, and did not adjust for the possible effects of losing weight – those on GLP-1 therapy may have experienced improved mood and mental health due to the fact they were losing weight, rather than as a direct effect of the drug. More research is needed to elucidate the complex interactions of obesity and mental health and the effects of GLP-1 medications.
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Algorithm-Guided Insulin Dosing Improves Blood Sugar Control in Type 2 Diabetes
Key Takeaways:
- An algorithm paired with continuous glucose monitoring significantly increased time in target glucose range compared with standard self-monitoring approaches
- The tool provides personalised weekly insulin dose recommendations based on recent glucose data, helping to simplify titration
- Early findings suggest strong patient acceptability and potential to enhance diabetes management at scale, though larger trials are needed
A data-driven approach to insulin adjustment
A novel algorithm developed by researchers at the University of Virginia Center for Diabetes Technology has demonstrated encouraging results in supporting people living with Type 2 Diabetes to better manage their blood glucose levels.
The system works in combination with a continuous glucose monitor and provides tailored recommendations for insulin dose adjustments. Rather than relying solely on manual interpretation of glucose readings, the algorithm analyses patterns over time and offers structured, data-informed guidance.
In a clinical trial involving 30 participants, individuals were randomly assigned to one of two approaches over a 16-week period:
- Algorithm-guided insulin adjustment using continuous glucose monitoring data
- Traditional self-monitoring of blood glucose with independent dose adjustment
The results showed a marked improvement in glycaemic control among those using the algorithm. Participants in this group increased their average time spent within a safe blood glucose range from 54.1% to 75.3%. By contrast, those relying on self-monitoring alone saw a more modest increase from 50.2% to 55.3%.
Moving beyond traditional insulin management
The findings highlight the growing role of digital health tools in diabetes care. According to Marc D. Breton, the study’s lead author:
“These results clearly show that diabetes technology and advanced algorithms can be leveraged to great effects, well beyond the classical paradigm of automated insulin delivery. As continuous glucose monitoring and connected medical devices become ubiquitous, we have the opportunity to provide highly personalized advice and monitoring to people with diabetes and guide their use of insulin and medications. Showing the impact of these technologies in early insulin therapy (only one dose a day) opens the door to helping the vast majority of people using insulin, well beyond what we were able to achieve with automated insulin delivery.”
This perspective reflects a broader shift towards personalised, technology-enabled care. Rather than fully automated systems alone, there is increasing interest in decision-support tools that augment clinical judgement and patient self-management.
Addressing the challenges of insulin titration
For many people living with type 2 diabetes, treatment often begins with oral or non-insulin therapies. However, as the condition progresses, insulin may become necessary to maintain adequate glycaemic control.
Adjusting insulin doses – a process known as titration – can be complex and burdensome. It typically requires frequent monitoring, interpretation of glucose patterns, and iterative dose changes. Importantly, there is no universally standardised titration protocol, which can create variability in care and outcomes.
To address this, Anas El Fathi developed the algorithm with the aim of streamlining and improving this process. The system evaluates two weeks of continuous glucose monitoring data and generates weekly recommendations for insulin dose adjustments, offering a structured and personalised approach.
Strong acceptance and clinical potential
The study also explored how well the technology was received by participants. According to Ralf Nass:
“From a medical point of view, it was fascinating to see that the algorithm was not only better than the standardized insulin titration recommendations, but also how well the technology was accepted by the participants with type 2 diabetes. This type of technology has the potential to help physicians enable their patients to achieve better glycemic control faster by using a personalized approach.”
This combination of improved outcomes and user acceptability is particularly important, as adherence and engagement remain key challenges in long-term diabetes management.
Future directions – towards more personalised diabetes care
While the results are promising, the researchers emphasise that further validation is required. Larger and longer clinical trials will be needed to confirm the effectiveness of the algorithm across more diverse populations.
Looking ahead, the integration of more advanced data-driven approaches may further enhance personalisation. Breton noted:
“It is only the very beginning of these efforts. With early demonstration behind us, we can focus on robust approaches that will be effective with more varied populations. Integrating recently developed data-driven methodologies, especially digital twins, to further improve our capacity to tailor diabetes managements to individuals is likely to once more revolutionize diabetes care.”
Such developments could represent a significant step forward in precision medicine for people living with diabetes.
Study publication and funding
The findings have been published in the peer-reviewed journal Diabetes Technology & Therapeutics, with the article available as open access.
The research team included El Fathi, Nass, Carol J. Levy, Camilla Levister, Grenye O’Malley, Nirali A. Shah, Shaziah Hassan, Cheryl Quainoo, Chaitanya L.K. Koravi, Taylor N. Nguyen, Giulio Matteo Santini, Emma Emory, Carlene Alix, Dillon K. Flanagan, David Fulkerson, Mary Clancy Oliveri, Christian Laugesen, Jonas K. Lineolov, Peter W. Hansen and Breton.
The clinical trial was supported by a grant from Novo Nordisk.
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Genetic Risk Scores Offer Improved Prediction of Obesity, Type 2 Diabetes and Long-Term Health Outcomes
Key Takeaways:
- A new polygenic risk score integrates genetic data from over 8.5 million people to better predict obesity and type 2 diabetes risk
- The model goes beyond traditional measures such as body mass index by incorporating multiple aspects of metabolic function
- Individuals with higher genetic risk were more likely to develop complications and require interventions such as GLP-1 therapy or bariatric surgery
A more comprehensive approach to metabolic risk
Obesity and type 2 diabetes are complex metabolic conditions influenced by a combination of environmental, behavioural and genetic factors. While traditional clinical measures such as body mass index have long been used to assess risk, they do not fully capture the biological complexity underlying these conditions.
In a new study published in Cell Metabolism, researchers from Mass General Brigham have developed an advanced polygenic risk score designed to improve prediction of both obesity and type 2 diabetes, as well as their long-term health consequences. Polygenic risk scores work by aggregating the effects of many genetic variants across the genome, providing an estimate of an individual’s predisposition to developing a given condition.
“Our intention was to not only capture the risk of being diagnosed with obesity or diabetes, but also to better predict health consequences across the life course by integrating many aspects of metabolic function,” said co-first author Min Seo Kim, MD, MSc. “In the future, this genomic approach could complement established clinical risk factors to inform patient care and preventative strategies.”
Building a next-generation polygenic risk score
The research team constructed two distinct metabolic risk scores – one optimised for obesity and another for type 2 diabetes. Unlike conventional models, these scores incorporate genetic signals linked to 20 different traits associated with metabolic health. These include factors such as fat distribution, insulin regulation and glucose control.
To build these models, the investigators drew on genome-wide association studies conducted across some of the largest biobank datasets globally, encompassing more than 8.5 million individuals. This scale allowed the researchers to capture a broad and diverse range of genetic influences.
Importantly, the model moves beyond reliance on body mass index alone, reflecting a growing recognition that metabolic health cannot be fully understood through weight-based measures in isolation.
Predicting disease progression and clinical outcomes
Beyond predicting the likelihood of developing obesity or type 2 diabetes, the new polygenic risk scores demonstrated the ability to forecast downstream health outcomes.
The researchers found that individuals identified as high risk were more likely to go on to develop complications such as cardiovascular disease and stroke. Even among people who were initially healthy, those with a high genetic risk score were approximately twice as likely to require clinical interventions over time.
Specifically, individuals with higher polygenic risk scores were about twice as likely to receive GLP-1 receptor agonist medications or undergo bariatric surgery compared with those with average risk scores, over a median follow-up period of 5.5 years.
These findings suggest that genetic profiling could help identify people at risk earlier in the disease trajectory, potentially enabling more proactive and targeted care.
Improved performance across diverse populations
A notable strength of the study lies in its use of multi-ancestry genetic data. By incorporating genome-wide association studies from a wide range of populations, including African, East Asian, South Asian and Middle Eastern groups, the researchers were able to develop risk scores that performed better across diverse populations than earlier models.
Historically, many genetic prediction tools have been less accurate in non-European populations due to limited representation in genomic datasets. This study represents a step towards addressing that imbalance and improving equity in precision medicine.
Towards more personalised prevention and treatment
The research team emphasises that this work is part of a broader effort to refine understanding of the genetic subtypes of obesity and type 2 diabetes. Improved classification of these conditions could support more precise patient stratification in clinical trials and, ultimately, more tailored interventions in routine care.
“We want clinicians to be able to think about metabolic conditions in terms beyond body mass index, with a focus more broadly on underlying genetic susceptibility,” said co-senior author Akl Fahed, MD, MPH, of the Cardiovascular Research Center at Massachusetts General Hospital and an interventional cardiologist with the Mass General Brigham Heart and Vascular Institute. “Early identification of people who are likely to have a worse trajectory of poor metabolic health, before they even develop these conditions, can help us improve prevention and clinical interventions. That is how we can cure disease, and that is the bold mission that we are after.”
Implications for clinical practice
While further validation and implementation work will be required, the findings highlight the potential role of genomic tools in enhancing current approaches to metabolic disease prevention and management. By complementing existing clinical risk factors, polygenic risk scores could support earlier identification of people at risk and enable more personalised, proactive care pathways.
As healthcare systems increasingly move towards precision medicine, integrating genetic insights with clinical decision-making may become an important step in improving outcomes for people living with obesity and type 2 diabetes.
CCH insights:
This is exciting research, and a big step towards precision obesity prevention, as it gives us an individual risk score for obesity and diabetes for each patient. However, it is only half the story – ideally we’d also like to be able to determine what type of interventions will work best for each individual (in terms of diet, lifestyle and medicine) in order to optimise their chances of good metabolic health and achieving a healthy weight. Hopefully the ability to do this is not too far away.
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GLP-1 Receptor Agonists Linked to Lower Mortality After Diabetic Foot Ulcers, Nationwide French Study Finds
Key Takeaways:
- Nearly one in seven people experienced death within one year of a first diabetic foot ulcer, highlighting the severity of risk following ulcer onset.
- Treatment with GLP-1 receptor agonists was independently associated with improved survival, including after major lower-limb amputation.
- Multidisciplinary care and early specialist involvement were associated with better outcomes, reinforcing the importance of structured follow-up.
Background and study aims
Diabetic foot ulcers remain one of the most serious complications of diabetes, often signalling advanced disease and a high burden of comorbidity. Despite advances in diabetes care, mortality following a first diabetic foot ulcer continues to be substantial.
This nationwide observational study set out to identify factors associated with one-year mortality after a first recorded diabetic foot ulcer using data from the French National Health Data System (SNDS). A secondary objective was to examine mortality within one year following major lower-limb amputation in the same population.
Study design and data sources
Researchers conducted a retrospective cohort analysis using the SNDS, a comprehensive national database that captures hospital admissions, outpatient care, prescribed medications, and long-term disease registrations across France.
Adults with a first incident diabetic foot ulcer recorded between January 2017 and December 2018 were included. Case identification combined hospital discharge diagnoses and community care records, allowing capture of people diagnosed both in hospital and in outpatient settings. All individuals were followed for 12 months after ulcer identification.
To examine associations with mortality, the researchers used Cox proportional hazards models. These models adjusted for a wide range of variables, including demographic characteristics, clinical comorbidities, diabetes treatments, major amputation, and access to specialist care.
Mortality and amputation outcomes
In total, 133,791 people with a first diabetic foot ulcer were identified. Within one year of diagnosis, 14.6% died, underlining the high short-term mortality associated with this complication. During the same period, 3.5% underwent a major lower-limb amputation.
Outcomes following amputation were particularly poor. Among those who had a major amputation, 28.8% died within one year, indicating a markedly elevated risk compared with people who did not undergo amputation.
Factors associated with increased mortality
Several factors were independently associated with a higher risk of death within one year of a first diabetic foot ulcer. These included male sex, increasing age, and ulcers identified during a hospital admission rather than in the community.
Clinical and treatment-related predictors of higher mortality included insulin use, major lower-limb amputation, and a range of comorbid conditions. Cardiovascular disease, cancer, dementia, end-stage kidney disease, and liver disease were all strongly associated with poorer survival.
Similar patterns were observed when analysing mortality after major amputation, suggesting that underlying health status and disease severity play a central role in outcomes across the care pathway.
Protective factors and the role of GLP-1 receptor agonists
Several factors were associated with a lower risk of death. Use of lipid-lowering therapy emerged as a protective factor, as did prior contact with specialist healthcare professionals. People who had consulted diabetologists, ophthalmologists, or podiatrists before ulcer onset experienced better survival, pointing to the benefits of ongoing, multidisciplinary diabetes care.
Notably, treatment with glucagon-like peptide-1 receptor agonists was independently associated with reduced mortality at one year. This association persisted both in the overall cohort and among people who underwent major lower-limb amputation, suggesting a consistent survival benefit linked to this class of medication.
Interpretation and implications for care
The findings confirm that one-year mortality after a diabetic foot ulcer remains unacceptably high and is closely linked to age, comorbidity burden, and disease severity. Importantly, the inclusion of community-identified ulcers highlights that people with diabetic foot disease are highly vulnerable even outside hospital settings.
The observed association between GLP-1 receptor agonist use and improved survival adds to growing evidence that these therapies may offer benefits beyond glycaemic control. Alongside pharmacological treatment, structured follow-up and early involvement of specialist services appear to play a critical role in improving outcomes.
Conclusions
This nationwide study shows that mortality following a first diabetic foot ulcer is substantial, particularly among people with advanced comorbidities and those requiring major amputation. Glucagon-like peptide-1 receptor agonists and coordinated, multidisciplinary care were associated with better survival and should be prioritised in high-risk populations.
Together, these findings underscore the urgent need to strengthen preventive strategies, optimise care pathways, and ensure timely access to specialist diabetes and foot care services for people living with diabetes who are at risk of ulceration.
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Study Suggests GLP-1 Medications May Reduce Frailty Progression in Older Adults
Key Takeaways:
- Older adults with type 2 diabetes who begin SGLT-2 inhibitors or GLP-1 receptor agonists show slower frailty progression over one year compared with those starting other diabetes therapies.
- The analysis, based on a large national Medicare dataset, suggests these medications may offer benefits beyond glycaemic and cardiovascular control, potentially supporting strength, mobility, and functional independence.
- The protective effect was not fully explained by fewer cardiovascular or safety events, indicating a possible direct influence of these drug classes on frailty itself.
Emerging evidence that newer diabetes drugs may protect against frailty
A new study has found that older adults living with type 2 diabetes who initiate treatment with sodium–glucose cotransporter-2 (SGLT-2) inhibitors or glucagon-like peptide-1 (GLP-1) receptor agonists experience significantly slower progression of frailty over a 12-month period compared with those starting alternative diabetes medications. The findings point to a potential added advantage of these therapies in helping older adults maintain physical resilience, strength, and independence, complementing their established effects on blood glucose regulation and cardiovascular risk reduction.
Study overview and methods
The research, published in Diabetes Care and titled “Sodium–Glucose Cotransporter-2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, and Frailty Progression in Older Adults With Type 2 Diabetes”, examined a large national cohort of older adults in the United States who had recently begun different classes of diabetes medication.
The investigators analysed a 7 per cent sample of Medicare claims data, enabling real-world tracking of over one year of health outcomes. Frailty progression was assessed using a validated claims-based Frailty Index (CFI), which ranges from 0 to 1 and reflects the cumulative presence of age-related health deficits. Higher CFI scores indicate more severe frailty.
Key findings – slower frailty progression with SGLT-2 and GLP-1 therapies
Older adults newly prescribed a GLP-1 receptor agonist, such as semaglutide (Ozempic) or liraglutide (Victoza), demonstrated a mean CFI change of –0.007 (95 per cent CI: –0.011 to –0.004) compared with matched new users of DPP-4 inhibitors. Those initiating SGLT-2 inhibitors, including empagliflozin (Jardiance) and dapagliflozin (Farxiga), experienced a mean change of –0.005 (95 per cent CI: –0.008 to –0.002).
These figures represent a statistically significant slowing in frailty progression over the study period. In contrast, people beginning sulfonylureas did not show a meaningful difference relative to DPP-4 inhibitor users.
Importantly, the study found that cardiovascular events and other safety-related health issues explained only a small proportion of the protective association. This suggests that these classes of medications may exert a more direct biological effect on mechanisms related to frailty, such as inflammation, physical function, or metabolic stress.
Why frailty matters in older adults with type 2 diabetes
Frailty is common among older adults and especially prevalent in people living with type 2 diabetes. Previous research indicates that 10–15 per cent of adults over the age of 65 meet criteria for frailty, with substantially higher rates among those with diabetes. Multiple factors contribute to this increased vulnerability, including chronic low-grade inflammation, accelerated muscle loss, cardiovascular disease, and the overall physiological strain of managing a long-term condition.
Frailty is linked to an elevated risk of falls, disability, hospital admission, diminished quality of life, and reduced survival. Because frailty is difficult to reverse once it becomes established, clinicians and researchers have prioritised strategies that can delay or slow its progression. The study’s findings therefore hold particular significance for geriatric diabetes care.
Clinical implications – a possible shift in medication decision-making
The results may encourage clinicians to consider the broader health trajectory of older adults when selecting diabetes medications, especially as SGLT-2 inhibitors and GLP-1 receptor agonists are increasingly used for combined glycaemic, cardiovascular, and renal protection.
Chanmi Park, MD, MPH, the study’s lead author and Assistant Scientist I at the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, highlighted this point:
“While SGLT-2 inhibitors and GLP-1 receptor agonists are primarily prescribed for blood sugar control and heart protection, our findings show they may also help older adults with diabetes stay stronger and less vulnerable to health setbacks. Because frailty is common, serious, and hard to reverse, this could meaningfully change how clinicians think about medication choices for ageing patients.”
A promising step towards more holistic diabetes care
The study adds to a growing body of literature suggesting that newer diabetes medications may offer multidimensional benefits. By potentially supporting physical resilience in addition to metabolic and cardiovascular health, SGLT-2 inhibitors and GLP-1 receptor agonists could become central tools in promoting healthier ageing for people living with type 2 diabetes.
Further research will be needed to better understand the biological mechanisms at play and to determine whether similar benefits appear in more diverse patient populations and longer-term studies.
CCH insight:
The results of this study are very encouraging from the perspective of GLP-1 medications and muscle mass/strength. There are currently concerns in some quarters about potential excess loss of muscle mass and sarcopenia accompanying weight loss from these drugs. However, this study points towards a positive impact on physical strength and function from GLP-1 therapy.
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Scientists Discover Key Protein Triggering Inflammation Linked to Obesity and Type 2 Diabetes
Key Takeaways:
- Researchers have identified FAM20C as a protein that triggers inflammation and insulin resistance in fat cells, a process linked to type 2 diabetes.
- Blocking or removing the FAM20C gene in mice improved insulin sensitivity and reduced inflammation, even without weight loss.
- High levels of FAM20C in human fat tissue are associated with insulin resistance, suggesting a potential new therapeutic target.
Early trigger identified in obesity-related inflammation
Investigators at Weill Cornell Medicine have uncovered an early step in the chain of events that links obesity to inflammation and insulin resistance – key contributors to the development of type 2 diabetes.
Their findings, published on 28 October in the Journal of Clinical Investigation, identify a protein known as FAM20C as a critical “switch” that initiates inflammation within fat cells. The study, conducted in mice, shows that when this protein is removed or blocked, metabolic health improves markedly, even without weight loss.
“By inhibiting or getting rid of FAM20C in fat cells, the mice became healthier even at the same body weight,” said senior author Dr James Lo, the Rohr Family Clinical Scholar and an Associate Professor of Medicine in the Division of Cardiology at Weill Cornell Medicine. “Their fat becomes metabolically healthier, reducing harmful inflammation in fat cells that can lead to chronic diseases like type 2 diabetes, fatty liver disease and heart disease.”
FAM20C: A molecular switch for inflammation
The research team, led by first author Dr Ankit Gilani, a Research Associate in Medicine at Weill Cornell Medicine, discovered FAM20C while screening genes that were switched on in the fat cells of mice with obesity and inflammation. FAM20C belongs to a class of enzymes known as kinases, which work by adding phosphate groups to other proteins – a process that can alter their activity and influence gene expression.
When the researchers increased the production of FAM20C in fat cells, the cells began releasing inflammatory molecules and became resistant to insulin. In contrast, blocking or deleting the gene in mice with obesity had the opposite effect – it reduced inflammation, improved insulin sensitivity, and decreased the accumulation of visceral fat (fat surrounding internal organs), even when total body weight remained unchanged.
“During obesity, when this gene is switched on in the adipose tissue, it causes inflammation,” Dr Gilani explained. “It drives the expression of other inflammatory genes, and then it causes insulin resistance, which can lead to type 2 diabetes.”
Evidence from human fat tissue
To determine whether the same mechanism operates in humans, the researchers analysed visceral fat tissue samples from individuals living with obesity. They found that higher levels of FAM20C were associated with insulin resistance – a key driver of type 2 diabetes – while people with lower FAM20C levels tended to exhibit better metabolic health despite having overweight or obesity.
These findings suggest that the FAM20C pathway could play a pivotal role in determining whether fat tissue becomes inflamed and metabolically harmful or remains relatively benign.
Next Steps: Targeting FAM20C and its downstream pathways
The research team now plans to investigate how FAM20C influences other tissues involved in metabolism and metabolic disease. They are particularly interested in a protein called CNPY4, which is activated by FAM20C and appears to be central to the inflammatory process.
“CNPY4 is going to be a major focus of future research to see how strongly it affects insulin resistance, and whether it could be a target for therapies to treat or prevent insulin resistance,” said Dr Lo, who is also a member of the Weill Center for Metabolic Health and the Cardiovascular Research Institute at Weill Cornell Medicine, and a cardiologist at NewYork-Presbyterian/Weill Cornell Medical Center.
Ultimately, the team hopes to develop small-molecule drugs that can block FAM20C or CNPY4 activity. Such therapies could reduce inflammation, lower visceral fat levels, improve insulin sensitivity, and help prevent or treat type 2 diabetes. Dr Lo noted that these treatments might one day be used alongside weight loss medications, or to support people who continue to experience metabolic inflammation and cardiovascular risk even after losing weight.
Funding and support
This research was supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH), through grants R01DK121140 and R01DK121844.
CCH insights
For a long time now we have known that inflammation in visceral adipose tissue is a major factor in insulin resistance, but it is still unknown why some people with obesity experience this adipose tissue inflammation and subsequent metabolic dysfunction, while other people with obesity do not. This research suggests that the FAM20C protein may contribute to this switch from healthy adipose tissue to inflamed, dysfunctional adipose tissue, and could offer an exciting new therapeutic pathway for type 2 diabetes and other cardiometabolic conditions.
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Weight Training Outperforms Running in Blood Sugar Control, Virginia Tech Mice Study Shows
Key Takeaways:
- Researchers at Virginia Tech found that resistance training was more effective than running in improving glucose tolerance and reducing insulin resistance in mice fed a high-fat diet.
- Both endurance and resistance exercise reduced body fat and improved blood sugar regulation, but resistance training yielded stronger metabolic benefits.
- The study suggests that strength training could play a particularly valuable role in preventing and managing Type 2 diabetes.
Weightlifting may offer unique metabolic benefits
Running is widely recognised for its cardiovascular and calorie-burning benefits, but new preclinical findings from the Fralin Biomedical Research Institute at Virginia Tech Carilion suggest that lifting weights may be even more effective for controlling blood sugar and reducing body fat.
Published on 30 October in the Journal of Sport and Health Science, the study compared the effects of endurance and resistance exercise in mice fed a high-fat diet, a common experimental model for obesity, hyperglycaemia, and Type 2 diabetes.
The team, led by Professor Zhen Yan, an exercise medicine researcher and director of the institute’s Centre for Exercise Medicine Research, found that while both running and weight training improved the body’s ability to clear excess glucose from the bloodstream, resistance training had a stronger impact on reducing both subcutaneous and visceral fat, improving glucose tolerance, and lowering insulin resistance.
“We all want to live a long, healthy life,” said Yan. “We all know the benefits of regular exercise. There is plenty of evidence in humans that both endurance exercise, such as running, and resistance exercise, such as weightlifting, are effective in promoting insulin sensitivity.”
Although both types of activity are known to improve metabolic function, the researchers noted that there had previously been no rigorous, controlled comparison between them.
Developing a model for ‘mouse weightlifting’
To address this gap, the Virginia Tech team created a first-of-its-kind preclinical model of resistance training in mice.
In their experiment, the mice lived in custom-built cages where food was available only through a hinged, weighted lid. To eat, the mice had to lift the lid while wearing a small shoulder collar, performing a movement similar to a human squat. The load was gradually increased over time, effectively replicating progressive strength training.
Meanwhile, the endurance group of mice was given unrestricted access to a running wheel, a standard model for voluntary aerobic exercise. Control groups included sedentary mice maintained on either a normal or high-fat diet.
Over an eight-week period, the researchers monitored changes in body weight, fat distribution, and body composition. They measured exercise capacity with treadmill tests, assessed cardiovascular and muscular performance, and evaluated blood sugar regulation. Muscle tissue samples were also analysed to study insulin signalling at the molecular level.
Using their novel resistance training model, the team could directly compare the metabolic outcomes of running and strength exercise under controlled conditions.
“Our data showed that both running and weightlifting reduce fat in the abdomen and under the skin and improve blood glucose maintenance with better insulin signalling in skeletal muscle,” Yan said. “Importantly, weightlifting outperforms running in these health benefits.”
Implications for obesity and diabetes prevention
Obesity and Type 2 diabetes remain among the most pressing public health challenges, driven largely by high-fat diets and sedentary lifestyles. The new study supports existing clinical evidence showing that endurance, resistance, and high-intensity interval training all contribute to better long-term blood sugar control, reduced body mass index, lower blood pressure, and improved overall well-being.
However, this Virginia Tech study fills a critical gap by directly comparing the two types of exercise in a controlled model of diet-induced obesity. The findings may have important implications for exercise recommendations and diabetes prevention strategies.
“The findings also bring good news for people who, for any number of reasons, cannot engage in endurance-type exercise,” Yan explained. “Weight training has equal, if not better, anti-diabetes benefits.”
Exploring new mechanisms and future therapies
The researchers also observed molecular changes in skeletal muscle that may help explain the enhanced benefits of resistance training. These shifts in insulin signalling pathways could, according to the team, inform the development of new drug therapies for managing Type 2 diabetes.
Interestingly, the improvements seen with resistance training were not directly linked to increased muscle mass or superior exercise performance, suggesting that unique metabolic mechanisms may be at work.
Yan emphasised that although pharmacological interventions such as GLP-1 receptor agonists are valuable tools in diabetes management and weight loss, they cannot replace the broad, systemic benefits of physical activity.
“The take-home message is that you should do both endurance and resistance exercise, if possible, to get the most health benefit,” he said.
The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health and by the Red Gates Foundation, with collaborators from the University of Virginia contributing to the work.
CCH insights
This is an interesting study, but it is important to note it was conducted in mice, not humans. Having said that, perhaps the most reassuring thing about these results is that both types of exercise provided metabolic health benefits. The critical thing about physical activity is that any amount and type is better than doing none, and while a combination of endurance and resistance is probably best, if you can only manage one type or the other, it will have a positive impact.
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Novo Nordisk’s Oral Semaglutide Shows Cardiovascular Benefits Comparable to Wegovy Injection
Key Takeaways:
- Novo Nordisk’s new oral semaglutide 25 mg pill improved blood glucose control and reduced cardiovascular risk factors, matching the effects of its injectable counterpart, Wegovy.
- Data from the OASIS 4 trial showed significant weight loss and normalisation of blood glucose in people with prediabetes.
- The company expects U.S. regulatory approval for the first oral GLP-1 treatment for weight management by the end of 2025.
Oral GLP-1 pill shows comparable benefits to injection
Novo Nordisk has presented new findings suggesting that its experimental oral obesity medication delivers cardiovascular and metabolic benefits similar to those achieved with its blockbuster injectable, Wegovy. The results were shared at the ObesityWeek 2025 conference in Atlanta and strengthen the Danish company’s case for approval of the pill in the United States later this year.
The oral semaglutide 25 mg tablet, part of the company’s glucagon-like peptide-1 receptor agonist (GLP-1RA) portfolio, was shown to improve blood sugar regulation and reduce cardiovascular risk factors. These results could mark a milestone in obesity care, as the pill would become the first oral GLP-1 therapy approved for weight management.
OASIS 4 trial results
The data come from the OASIS 4 clinical trial, which compared oral semaglutide 25 mg with placebo in adults with overweight or obesity. After 64 weeks, 71.1% of participants with prediabetes who received the treatment achieved normal blood glucose levels, compared with 33.3% in the placebo group.
Participants who lost at least 15% of their body weight experienced additional health benefits, including reductions in blood pressure, inflammatory markers, and triglycerides. Overall, the trial demonstrated both significant weight loss and improvements in cardiometabolic health outcomes.
The primary OASIS 4 results, published in September in the New England Journal of Medicine, reported an average weight loss of 16.6% among participants taking the oral semaglutide.
Comparable outcomes with Wegovy injection
An indirect comparison between OASIS 4 and Novo Nordisk’s earlier STEP 1 trial, which evaluated injectable semaglutide (Wegovy), found the two formulations delivered comparable outcomes in weight reduction and improvements across key cardiometabolic markers.
These findings suggest that people who prefer not to use injectables could soon have an equally effective oral alternative. As demand for obesity pharmacotherapy continues to rise, an oral formulation may further expand access and adherence to GLP-1 treatments.
Regulatory outlook and market plans
The U.S. Food and Drug Administration (FDA) accepted Novo Nordisk’s application for oral Wegovy in May and is expected to deliver a decision by the end of the fourth quarter of 2025. The company has stated that, if approved, it intends to launch the product shortly thereafter.
Despite a recent dip in share price and slower sales growth, Novo Nordisk’s prospects have been buoyed by positive trial outcomes and an improved pricing arrangement under Medicare. The company is also undergoing leadership changes, including a new Chief Executive Officer and a restructured board, amid efforts to stabilise growth.
Novo Nordisk has indicated that, once approved, the pill will be made available through telehealth platforms such as Ro and WeightWatchers, with a potential subscription model offering discounted pricing. Additionally, Hims & Hers Health recently confirmed it is in discussions with Novo to provide both injectable and oral forms of Wegovy through its digital platform.
A step forward in accessible obesity care
If approved, Novo Nordisk’s oral semaglutide could redefine accessibility and adherence in obesity care. The convenience of a pill that matches the efficacy of an injectable treatment offers a compelling new option for people managing obesity and related cardiometabolic risks.
By broadening the range of treatment modalities within the GLP-1 class, Novo Nordisk continues to shape the evolving landscape of obesity pharmacotherapy — a field that is rapidly transforming the management of metabolic health worldwide.
CCH insights
This news about oral semaglutide is very welcome, but shouldn’t come as a surprise. Oral semaglutide is the exact same compound as injectable semaglutide, and as long as the dose administered orally is sufficient to deliver a similar blood concentration as the injectable form, then the effects should be very similar. It’s the same drug, just a cheaper and easier, but less efficient, route of administration.
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Strawberries May Support Glucose Control and Reduce Inflammation in Prediabetes, Study Finds
Key Takeaways:
- Daily intake of freeze-dried strawberries for 12 weeks improved fasting glucose and reduced inflammation in adults with prediabetes.
- Antioxidant biomarkers including superoxide dismutase, glutathione, and β-carotene significantly increased during strawberry supplementation.
- Findings suggest strawberries could serve as a practical, food-based intervention to prevent progression to type 2 diabetes.
Strawberries and prediabetes: A promising link
A new randomised controlled trial published in Antioxidants has found that consuming freeze-dried strawberries (FDS) daily may help reduce fasting blood glucose and vascular inflammation in adults with prediabetes. The research also showed marked improvements in antioxidant status, highlighting the potential of strawberries as a simple dietary intervention for metabolic health.
The authors concluded that “strawberries may represent a practical dietary intervention that improves fasting glucose and strengthens antioxidant defence in adults with prediabetes.”
Understanding prediabetes and oxidative stress
Prediabetes represents a critical stage between normal glucose metabolism and type 2 diabetes mellitus (T2DM). It is characterised by mildly elevated blood glucose levels, which contribute to oxidative stress and low-grade inflammation.
High glucose levels increase reactive oxygen species (ROS), impairing insulin function and damaging pancreatic β-cells. Proinflammatory cytokines such as tumour necrosis factor-alpha (TNF-α) further aggravate insulin resistance by interfering with glucose uptake and triggering inflammatory pathways. Over time, these effects contribute to vascular dysfunction and atherosclerosis through increased endothelial adhesion molecules and reduced antioxidant enzyme activity.
Dietary antioxidants – including vitamins, polyphenols, and carotenoids – can neutralise oxidative stress. However, studies using supplements have produced inconsistent results due to differences in absorption and bioavailability. Evidence from clinical trials and meta-analyses indicates that plant-based antioxidants can improve total antioxidant capacity and glycaemic outcomes in people with prediabetes or T2DM.
Berries, particularly strawberries, are rich in polyphenols such as anthocyanins and ellagic acid, which are known to enhance antioxidant enzyme activity and improve insulin sensitivity. Previous studies using FDS have already shown benefits for inflammation and oxidative stress in metabolic disorders, providing a foundation for this new research.
Study design and methodology
Researchers at the University of Nevada, Las Vegas, conducted a 28-week randomised controlled crossover trial involving 25 adults who met the American Diabetes Association’s diagnostic criteria for prediabetes.
Each participant completed two 12-week phases: one with daily FDS intake and another control period without strawberries, separated by a four-week washout. Participants were randomly assigned to begin with either the FDS or control phase.
During the intervention, participants consumed 32 grams of FDS powder per day – equivalent to roughly 2.5 servings of fresh strawberries – containing dietary fibre, polyphenols, flavonols, and anthocyanins. They were instructed to maintain their usual diet and physical activity throughout the trial.
Compliance was carefully monitored using dietary logs, returned powder packets, and plasma ellagic acid levels. Blood samples were collected at baseline, 12, 16, and 28 weeks to measure fasting glucose, antioxidant enzyme activity, total antioxidant capacity, and vascular adhesion molecules using standardised assays. Carotenoid levels were analysed via high-performance liquid chromatography (HPLC).
A mixed-model analysis of variance (ANOVA) was used to evaluate treatment effects while accounting for treatment period, randomisation order, age, sex, fasting glucose, and baseline values. Power analysis confirmed the study was adequately powered to detect meaningful changes in metabolic and antioxidant markers.
Improvements in antioxidant and metabolic markers
Results showed high adherence rates, with more than 85% compliance confirmed by elevated plasma ellagic acid during the FDS phase.
Compared with the control period, strawberry supplementation produced significant improvements in several antioxidant biomarkers, including superoxide dismutase, glutathione (GSH), total antioxidant capacity (AC), and β-carotene. No significant changes were observed in catalase, glutathione reductase, glutathione peroxidase, or α-carotene.
Fasting blood glucose levels also decreased significantly during the FDS period, indicating better glycaemic control. Moreover, markers of vascular inflammation – particularly intercellular adhesion molecule (ICAM) and vascular cell adhesion molecule (VCAM) – were notably reduced. Levels of P-selectin and E-selectin remained unchanged.
Correlation analyses revealed modest inverse relationships between ICAM and GSH, AC, and β-carotene, and between VCAM and AC, suggesting that stronger antioxidant status was associated with reduced vascular inflammation.
Only minor side effects were reported, such as mild gastrointestinal discomfort and headaches.
Implications and limitations
The findings suggest that incorporating strawberries into the diet could help strengthen antioxidant defences, lower inflammation, and improve fasting glucose regulation in people with prediabetes. These benefits may be linked to polyphenols enhancing glutathione synthesis and superoxide dismutase activity, alongside carotenoids and anthocyanins reducing oxidative stress and endothelial dysfunction.
The study’s strengths include its randomised crossover design, objective biomarker measurements, and the use of a realistic dietary dose of strawberries. However, the relatively small and predominantly female sample, the absence of a placebo control drink, lack of participant blinding, and single-site recruitment limit the generalisability of results.
The study was funded by the California Strawberry Commission.
A food-based approach to diabetes prevention
In summary, consuming a daily portion of freeze-dried strawberries for 12 weeks led to measurable improvements in antioxidant capacity, fasting glucose, and vascular inflammation among adults with prediabetes.
While further research in larger, more diverse populations is needed, these results point to strawberries as a simple, accessible dietary strategy that could help prevent the progression from prediabetes to type 2 diabetes in everyday clinical and public health settings.
CCH insights
It is great to have research that shows health benefits from eating strawberries, because nearly everyone loves strawberries and there aren’t many foods that are extremely popular and good for us. However, the amount of freeze-dried strawberries consumed in this study would set you back about £20 per week – not a huge amount, but during a cost-of-living crisis might not be feasible for many people. This study was, unsurprisingly, funded by the California Strawberry Commission, and it begs the question whether eating other berries or certain other foods might not have a similar effect – but credit to the strawberry industry for making the effort to do the research.
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New Study Tests Virtual Mindfulness Therapy to Ease Stress in Young People Living with Diabetes
Key Takeaways:
- A three-year, $941,418 NIH-funded study will assess whether virtual reality–enhanced mindfulness can reduce stress in young people living with type 1 diabetes.
- Researchers from Wayne State University and Johns Hopkins University aim to improve coping and mental health outcomes through immersive, accessible virtual sessions.
- If effective, the intervention could be scaled to benefit other young adults with chronic conditions and high stress levels.
Exploring virtual reality for stress reduction
Researchers from Wayne State University and Johns Hopkins University are investigating how virtual reality (VR) might help young adults living with type 1 diabetes better manage stress. The study, titled “Feasibility of MBSR-VR to Reduce Stress among Emerging Adults with T1D,” is supported by a three-year grant of $941,418 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH).
April Idalski Carcone, Ph.D., Professor of Family Medicine and Public Health Sciences at Wayne State University’s School of Medicine, serves as co-principal investigator on the project alongside Dr Erica Sibinga, M.D., M.H.S., Associate Professor of Paediatrics at the Johns Hopkins University School of Medicine.
The impact of stress on young people with diabetes
Dr Carcone explained the importance of the research:
“We’ve been collaborating with Johns Hopkins University on this line of research for more than 10 years. Diabetes is a chronic illness that creates additional stress in young people who are already going through a lot of anxiety figuring out their lives and deciding what to do after high school and so forth.”
She noted that stress can significantly worsen physical health:
“Stress can exacerbate health issues, particularly for those already going through physical challenges. Cortisol increases as a result of stress, and stress can essentially wear out the body. So if your body is already going through difficulties, it can make your health even worse.”
Young people living with type 1 diabetes must manage demanding self-care routines and fluctuating glucose levels, often while navigating major life transitions. These pressures contribute to a higher risk of anxiety, depression, and burnout.
Mindfulness meets virtual reality
The research team aims to evaluate the feasibility and acceptability of delivering Mindfulness-Based Stress Reduction (MBSR) through virtual reality, referred to as MBSR-VR. The approach integrates traditional mindfulness practices with immersive VR environments designed to foster relaxation and focus.
Dr Carcone said:
“One of the challenges we had with an earlier version of this research was that we were gathering people onto campus for group intervention sessions, but it was logistically difficult to bring everyone to campus at the same time in the same place. Instead, we decided to try this in a virtual format.”
She added that the virtual environment offers greater engagement and flexibility:
“People coming together in a VR space sounded very exciting and provided us with a format that was a little more engaging. We can utilise different virtual environments as opposed to the split-screen Zoom-style call that we are all so familiar with. You can virtually gather people around a campfire, in a pool where you can toss a virtual beachball around, and so forth.”
Research collaboration and goals
Alongside Dr Carcone and Dr Sibinga, the project includes Dr Deborah Ellis, Associate Department Chair of Research for the Department of Family Medicine and Public Health Sciences at Wayne State University, and Dr Angulique Outlaw, Associate Professor of Behavioural Sciences within the same department.
The study will explore whether MBSR-VR can:
- Improve coping mechanisms for stress among individuals aged 16–20 with type 1 diabetes and high stress reactivity.
- Enhance mindfulness and emotional well-being.
- Positively influence glycaemic control and reduce psychological distress, including symptoms of depression and anxiety.
If successful, the intervention could be adapted for broader use across other chronic conditions where stress significantly impacts health outcomes.
Reaching young adults where they are
Dr Carcone highlighted how the virtual approach could make mindfulness training more accessible and socially engaging:
“Youths between ages 16 and 20 are very motivated by their social life, peers and significant others. These techniques allow us to bring people together who might not otherwise be able to come together.”
She emphasised that the programme could reach those living in rural or remote areas:
“In Detroit, you can gather patients at a hospital, but this method will also allow us to help those living in more rural communities. There’s often not another person who has type 1 diabetes if you live in a small Upper Peninsula community, for instance. This will let them touch base with others their own age who are going through something similar and share experiences that they might not be comfortable talking about with a friend who isn’t going through the same thing.”
Supporting research innovation
Ezemenari M. Obasi, Ph.D., Vice President for Research & Innovation at Wayne State University, praised the project:
“This award from the National Institutes of Health is an excellent example of the important research that our faculty are engaged in that are seeking solutions for complex challenges. The work of Dr Carcone and her collaborators could assist the lives of countless young people in Detroit, across Michigan and around the globe.”
Looking ahead
With stress recognised as a major barrier to effective diabetes management, this study may pave the way for new digital mental health interventions that combine accessibility, engagement, and clinical impact. Should MBSR-VR prove feasible and effective, it could form part of a new generation of evidence-based tools that empower young adults with chronic conditions to manage stress and improve their overall health and well-being.
Grant number: 1R01DK141816 (National Institute of Diabetes and Digestive and Kidney Diseases, NIH)