From the literature

BACKGROUND: One in 4 young adults has prediabetes, and improving diet is a key step to lowering the risk of diabetes. Existing standard-of-care diet approaches show short-term efficacy but lack long-term effectiveness, including in young adults. Greater fiber intake is associated with a reduced risk of diabetes; however, fiber is not well targeted using existing interventions. Many young adults may be reluctant to consume fiber given the coexistence with digestible carbohydrates and concerns over gastrointestinal effects. Targeting these factors more explicitly may improve uptake and lower diabetes risk, and doing so via a mobile health (mHealth) intervention may be particularly responsive to young adult demands. OBJECTIVE: This study aims to establish and preliminarily test the feasibility of a highly innovative and scalable mHealth-based intervention to improve fiber intake among young adults with prediabetes. METHODS: This single-arm feasibility study includes 2 phases to preliminarily test an mHealth-based fiber intervention (phase 1) and elucidate factors that impact sustained behavior change and fiber intake after intervention end using ecological momentary assessment (EMA; phase 2). The intervention is 3 months in length and features daily EMAs with responsive text-based coping messages to target key predictors of fiber intake. EMAs will also be paired with brief (ie, <1 minute) educational videos on fiber delivered once per day. Participants will also receive weekly home-delivered high-fiber food packages and wear a continuous glucose monitor at 2 time points during the intervention as a form of biofeedback. At the baseline and postintervention time points, fasting blood glucose, hemoglobin A, and insulin resistance (Homeostatic Model Assessment of Insulin Resistance) will be assessed. After the postintervention time point, participants will continue with daily EMAs to assess factors associated with sustained fiber intake. Diet will be assessed using Automated Self-Administered 24-hour dietary recalls at the baseline and postintervention time point and after the phase 2 EMA. RESULTS: This study was initiated in July 2025. As of March 2026, the mHealth intervention content is being built, with app completion and trial enrollment both slated to begin in April 2026. CONCLUSIONS: The results of this study will provide pivotal evidence on the utility of a fiber-focused intervention delivered via mHealth with biofeedback and home-delivered foods to lower the risk of diabetes in young adults with prediabetes.

OBJECTIVE: To compare the risk of renal deterioration under treatment with glucagon-like peptide-1 (GLP-1) receptor agonists or sodium-glucose contransporter-2 (SGLT-2) inhibitors versus other second line treatments in people with type 2 diabetes with and without albuminuria (albumin to creatinine ratio ≥30 mg/g). DESIGN: Target trial emulation. SETTINGS: Linkage of electronic health records and claims data from 10 health systems and two national health insurance plans-data from BESTMED (observational evaluation of second line therapy medications in diabetes) study. PARTICIPANTS: People with type 2 diabetes and moderate cardiovascular risk and estimated glomerular filtration rate ≥45 mL/min/1.73 m on metformin monotherapy who started treatment with a GLP-1 receptor agonist or SGLT-2 inhibitor, a sulfonylurea, or a dipeptidyl peptidase-4 (DPP-4) inhibitor after metformin between 2014 and 2022. MAIN OUTCOME MEASURE: Deterioration of kidney function defined as doubling of serum creatinine or estimated glomerular filtration rate <15 mL/min/1.73 m. RESULTS: Among 75 455 eligible people (61 583 (81.76%) without albuminuria), median age was 60 years (interquartile range 51-68), 36 231 (48%) were women, median haemoglobin A was 7.8% (interquartile range 7.3-8.5%), and median estimated glomerular filtration rate was 92 mL/min/1.73 m (interquartile range 77-102). People were followed for a median of 32 months (interquartile range 18-57). The estimated five year risk of the renal outcome was 2.4% (95% confidence interval 2.1% to 2.7%) for people taking GLP-1 receptor agonists or SGLT-2 inhibitors versus 2.1% (1.8% to 2.6%) for people taking DPP-4 inhibitors among those without albuminuria; and 3.2% (2.3% to 4.1%) versus 5.4% (4.2% to 6.7%), respectively, among people with albuminuria. The estimated five year risk ratio comparing the GLP-1 receptor agonist or SGLT-2 inhibitor group with the DPP-4 inhibitor group was 1.10 (95% confidence interval 0.90 to 1.38) among people without albuminuria and 0.60 (0.42 to 0.82) among people with albuminuria. CONCLUSIONS: Compared with DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors reduce the risk of deterioration of renal function in people with albuminuria. Little evidence of renal benefit among people without albuminuria was observed over the study follow-up period.

BACKGROUND: Islet xenotransplantation is a strategy for treatment of Type 1 Diabetes, but immune-mediated rejection limits graft survival. This study investigated a strategy with flow cytometry-based immune monitoring to evaluate immunosuppressive therapy and provide indicators of graft rejection. METHODS: Porcine neonatal islet cell clusters (NICC) from GTKO-hCD55-hCD59 transgenic pigs were transplanted into streptozotocin-induced diabetic baboons (n = 10). Recipients received anti-CD2 induction with anti-CD154, Belatacept, and full-dose (n = 7) or reduced/no dose Tacrolimus (n = 3). Leukocyte subsets and activation status were monitored using multiplex flow cytometry. Graft function was assessed by blood glucose measurements, porcine C-peptide ELISA, and histological analysis. RESULTS: Porcine C-peptide was detected in all recipients. Seven animals receiving full-dose Tacrolimus maintained NICC function for up to 675 days, whereas three experienced acute rejection within two months. Flow cytometry generated absolute leukocyte counts equivalent to standard full blood counts (Deming regression slope 0.91-1.03, p<0.001), while requiring less blood (50 µl vs ∼500 µl) and processing time (50±15 vs 150±30 min). Anti-CD2 treatment significantly reduced unoccupied surface CD2 on circulating T cells (mean 73.21%, range 55.26-91.16%, p<0.001). Long-term graft survival was associated with greater first-month T-cell suppression (36.47%, 13.35-50.75%) than acute rejection (176.28%, 171.26-181.31%). Following immunosuppression withdrawal, lymphocyte counts increased by 40%-142% in all recipients. Multiplex immunofluorescence of endpoint grafts from these IS-free animals revealed cell-mediated destruction with increased lymphocyte infiltration and activated cytotoxic CD8 T cells. CONCLUSION: Multiplex flow cytometry provides a reliable method for immune monitoring in islet xenotransplantation and may help predict graft rejection.