Issues and Events

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Werner Syndrome and Diabetes: Opportunities for Precision Medicine

The precision diagnosis of diabetes is an increasingly important part of understanding the full spectrum of disease heterogeneity, and several groups have recently outlined current and future roles for precision medicine approaches in diabetes (1–4). Patients with monogenic or syndromic diabetes are often misdiagnosed as having type 1 or type 2 diabetes (5,6), so it remains a pressing question how patients with atypical presentations of diabetes should be evaluated and what role precision medicine should have in their care. This exact question is raised in the thought-provoking case report presented by Spira et al. (7) in this issue of Diabetes Care, who describe a patient found to have a previously unidentified variant in the WRN gene, which is associated with Werner syndrome (WS) as well as diabetes, insulin resistance, and hirsutism.


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Comment on Beato-Víbora et al. A Multicenter Prospective Evaluation of the Benefits of Two Advanced Hybrid Closed-Loop Systems in Glucose Control and Patient-Reported Outcomes in a Real-World Setting. Diabetes Care 2024;47:216–224

We have read with great interest in Diabetes Care the results from the recent multicenter real-world prospective study conducted by Beato-Víbora et al. (1), comparing glucose and patient-reported outcomes 3 months after advanced hybrid closed-loop (AHCL) insulin delivery system initiation (either Medtronic SmartGuard 780G and Tandem T-Slim Control-IQ users). The authors concluded, based on continuous glucose monitoring from 150 participants (87% of whom are aged ≥25 years), that the AHCL systems provided significant and similar improvement in glucose control, partly in line with a recent publication from our group (2). Although we thank the authors for acknowledging our study, we believe a few clarifications need to be made regarding our cohort description and study design. First, our cohort consisted of 48 adolescents and 183 adults (contrary to the 75 participants mentioned in the article), with a median (95% CI) observation period of 283 (270.5–296) days. Throughout follow-ups, we found that 780G users had consistently better continuous glucose monitoring outcome improvements, including percent time in range (%TIR) (70–180 mg/dL), than Control-IQ users, while laboratory HbA1c improvements were similar between the two groups. We attributed these results to differences in algorithms, sensors, and/or amounts of automated insulin boluses between AHCL systems. In addition, we found that %TIR improvements remained lower in younger participants (


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Plant-Based Diets and Diabetes Risk: Which Foods, What Mechanisms?

Increasing recognition of the dire impact of poor nutrition on global cardiometabolic health has created new urgency to identify optimal diets to address these burdens. Among various outcomes, type 2 diabetes is particularly diet sensitive, serving as an obvious marker for a population’s nutritional health.


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Timing of Moderate to Vigorous Physical Activity, Mortality, Cardiovascular Disease, and Microvascular Disease in Adults With Obesity

OBJECTIVETo assess the association between timing of aerobic moderate to vigorous physical activity (MVPA) and risk of cardiovascular disease (CVD), microvascular disease (MVD), and all-cause mortality in adults with obesity and a subset with obesity and type 2 diabetes (T2D).RESEARCH DESIGN AND METHODSParticipants included adults with obesity (BMI ≥30 kg/m2) and a subset of those with T2D from the UK Biobank accelerometry substudy. Aerobic MVPA was defined as bouts of MVPA lasting ≥3 continuous minutes. Participants were categorized into morning, afternoon, or evening MVPA based on when they undertook the majority of their aerobic MVPA. The reference group included participants with an average of less than one aerobic MVPA bout per day. Analyses were adjusted for established and potential confounders.RESULTSThe core sample included 29,836 adults with obesity, with a mean age of 62.2 (SD 7.7) years. Over a mean follow-up period of 7.9 (SD 0.8) years, 1,425 deaths, 3,980 CVD events, and 2,162 MVD events occurred. Compared with activity in the reference group, evening MVPA was associated with the lowest risk of mortality (hazard ratio [HR] 0.39; 95% CI 0.27, 0.55), whereas afternoon (HR 0.60; 95% CI 0.51, 0.71) and morning MVPA (HR 0.67; 95% CI 0.56, 0.79) demonstrated significant but weaker associations. Similar patterns were observed for CVD and MVD incidence, with evening MVPA associated with the lowest risk of CVD (HR 0.64; 95% CI 0.54, 0.75) and MVD (HR 0.76; 95% CI 0.63, 0.92). Findings were similar in the T2D subset (n = 2,995).CONCLUSIONSAerobic MVPA bouts undertaken in the evening were associated with the lowest risk of mortality, CVD, and MVD. Timing of physical activity may play a role in the future of obesity and T2D management.


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