Diabetes Care

Current Issue Highlights

Excess Burden of Inpatient Admissions and Emergency Department Visits Associated With Diabetes Across the Age Spectrum
October 2026: 49(10):1904-1912
OBJECTIVE
The epidemiology of diabetes and its complications is changing due to increasingly younger ages of diagnosis and increased life expectancy. How this changing landscape affects health care use, and for which conditions, is unclear. We examined age-specific excess burdens of cause-specific inpatient and emergency department (ED) visits associated with diabetes.
RESEARCH DESIGN AND METHODS
We used 2019 Behavioral Risk Factor Surveillance System, National Inpatient Sample, and Nationwide Emergency Department Sample data to derive national U.S. estimates of inpatient admissions and ED visits in adults with and without diabetes. Complications were categorized as traditional, conditions emerging as diabetes associated, or other conditions co-occurring with diabetes. We calculated age-standardized absolute risk differences (ARDs) in people with versus without diabetes to identify leading causes of diabetes-related hospital use by age and setting.
RESULTS
Traditional complications were dominated by sepsis, cardiorenal disease, acute kidney failure, myocardial infarction, and stroke, with ARDs ranging from 296 to 2,623 per 100,000 people with diabetes. Emerging conditions included pneumonia, device- and procedure-related complications (ARD range 125–473), and schizoaffective or other mental health disorders in younger adults only (ARD range 80–312). Other conditions included respiratory and fluid/electrolyte disorders across all ages (ARD range 100–363), while digestive and urinary disorders were more prominent in older adults (ARD range 229–482). ED visits showed a similar pattern, with lower ARD than inpatient admissions (ARD range 101–707).
CONCLUSIONS
Diabetes drives substantial, age-specific excess inpatient and ED use, increasingly due to nontraditional rather than classic vascular and renal complications.
Adult Complications of Childhood-Onset Type 1 Diabetes Vary With Age at Diagnosis
October 2026: 49(10):1896-1903
OBJECTIVE
To examine incidence of long-term complications among people with childhood-onset type 1 diabetes, focusing on age at diabetes onset.
RESEARCH DESIGN AND METHODS
A registry of children diagnosed with type 1 diabetes aged <16 years in New South Wales, Australia, between 1990 and 2009 linked to hospital, emergency department, public insurance, and death data from 2001 to 2019 to identify complications. Age at onset was categorized as <7 years, 7 to <13 years, and 13 to <16 years. Incidence rates and hazard ratios (HR), with 95% CI, for the risk of complications, were calculated from multivariable Cox regression models by 1) duration of diabetes 0 to <20 years and 2) attained age of 16–34 years, with HR adjusted for diagnosis year, sociodemographics, and acute diabetes complications.
RESULTS
Of 5,202 people identified, 1,694 (32.6%) were diagnosed at age <7 years, 2,538 (48.8%) age 7 to <13 years, and 970 (18.6%) age 13 to <16 years. Within 20 years of onset, incidence ranged from 9.2 per 10,000 person-years (95% CI 7.2, 11.7) for cardiac complications to 53.4 per 10,000 person-years (95% CI 48.2, 59.0) for kidney complications. Diabetes onset at age <7 years (vs. 13 to <16 years) was associated with lower 20-year risk of complications, except lower-limb infections; cardiac adjusted HR (aHR) was 0.32 (95% CI 0.15, 0.66), severe retinopathy aHR was 0.25 (0.17, 0.36), lower-limb vascular complications aHR was 0.41 (0.24, 0.69), peripheral neuropathy aHR was 0.16 (0.08, 0.32), and kidney complications aHR was 0.40 (0.30, 0.53). Risk of complications did not differ by attained age.
CONCLUSIONS
Children with type 1 diabetes onset at age <7 years had lower chronic complication risk in the first 20 years postdiagnosis, supporting a slower time to develop complications with prepubertal onset.
Gestational Diabetes Mellitus Subtypes and Maternal Cardiometabolic Outcomes 10–14 Years After Delivery
October 2026: 49(10):1891-1895
OBJECTIVE
The association of gestational diabetes mellitus (GDM) subtypes with maternal cardiometabolic health is not known. We examined whether GDM subtypes were differentially associated with cardiometabolic health 10–14 years after delivery.
RESEARCH DESIGN AND METHODS
We used data from the prospective Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study. The exposure was GDM subtype (insulin deficient, insulin resistant, mixed defect, unclassified). The outcomes were prediabetes or diabetes and, secondarily, hypertension, dyslipidemia, metabolic syndrome, and predicted cardiovascular disease.
RESULTS
Of 4,693 women, 3.0% had insulin-deficient, 9.0% insulin-resistant, 1.6% mixed-defect, and 0.7% unclassified GDM. Compared with no GDM, all GDM subtypes except unclassified were associated with higher risk of prediabetes or diabetes (adjusted risk ratios 2.14–2.88), metabolic syndrome, and predicted cardiovascular disease. Only insulin-resistant GDM was associated with dyslipidemia.
CONCLUSIONS
All GDM subtypes were associated with an increased risk of prediabetes or diabetes, metabolic syndrome, and high predicted cardiovascular disease 10–14 years after delivery.
Glucose in Motion
October 2026: 49(10):1883-1890
OBJECTIVE
To identify and characterize daily and weekly patterns in glycemic management in longitudinal real‐world continuous glucose monitoring (CGM) data from people with diabetes to enhance clinical interpretation and support more effective personalized diabetes management.
RESEARCH DESIGN AND METHODS
This observational, retrospective study used two independent, multiyear, real-world CGM cohorts (T1DiabetesGranada and Connected Pen), comprising 86,779 participants with diabetes. Their mean age (SD) was 40.3 (15.8) and 44.0 (15.9), respectively, and there was a total of 21,011,021 measurement days. Weekly variations in CGM metrics and bolus insulin dose were examined using linear mixed-effects models, and daily temporal patterns were assessed.
RESULTS
Weekly and daily glycemic patterns emerged. Mid‐week time in range was consistently higher (e.g., Wednesday: +0.96 percentage points [%-points]; 95% CI 0.93–0.99; P < 0.001), with deterioration during weekends and Mondays (e.g., Sunday: –1.74%-points; 95% CI –1.77, –1.72; P < 0.001), mirrored by shifts in other CGM metrics. Bolus insulin dose increased on weekend days (e.g., Sunday: +0.69 units; 95% CI 0.64–0.74; P < 0.001). Daily analyses revealed distinct diurnal profiles, with the most favorable glycemic control during morning and midday hours on weekdays and consistently poorer control during evening and nighttime periods, particularly on weekends.
CONCLUSIONS
Daily and weekly glycemic patterns revealed statistically robust and consistent temporal variations in glycemic control across two large real-world cohorts. Although the magnitude of these differences was small, the findings provide novel population-level evidence and underscore the value of longer-term CGM perspectives in routine care.
Housing Instability Associated With Cost-Related Nonadherence and Financial Toxicity in People With Uncontrolled Diabetes
October 2026: 49(10):1877-1882
OBJECTIVE
To assess the prevalence of housing instability and its associations with cost-related nonadherence and financial toxicity among adults with uncontrolled diabetes.
RESEARCH DESIGN AND METHODS
We analyzed baseline randomized controlled trial data from 600 adults with uncontrolled diabetes and cost-related barriers to care. Logistic and linear regression assessed associations of housing instability with cost-related nonadherence and financial toxicity.
RESULTS
Half (n = 298) reported housing instability, which was associated with greater odds of cost-related nonadherence (adjusted odds ratio 1.64; 95% CI 1.05, 2.56) and worse financial toxicity (B = −4.64; 95% CI −6.20, −3.09). Cost-related nonadherence was not significant after adjusting for diabetes distress and symptoms of depression and anxiety; financial toxicity remained significant. In sensitivity analyses, worry about housing costs, not housing or utility needs, was associated with financial toxicity.
CONCLUSIONS
Housing instability was associated with financial toxicity and, in primary models, with cost-related nonadherence. Findings should be validated in longitudinal, nationally representative samples.