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Background Evidence is limited on whether alterations in diabetes-related health parameters are detectable before clinical diagnosis in novel diabetes subtypes. We investigated trajectories of diabetes-related health parameters in individuals with recently diagnosed type 2 diabetes (T2D). Methods Using data from the Stockholm Diabetes Prevention Programme cohort (SDPP) participants (n = 215) with recent onset T2D were classified as having severe insulin-deficient diabetes (SIDD, 9%), severe insulin-resistant diabetes (SIRD, 15%), mild obesity-related diabetes (MOD, 14%) and mild age-related diabetes (MARD, 62%). Participants without a family history of diabetes who remained diabetes-free throughout the study served as the controls (n = 2531). Multilevel longitudinal mixed-effects models were used to analyse the trajectories of fasting plasma glucose (FPG) and insulin, body mass index (BMI), homeostasis model assessment estimates of beta-cell function (HOMA2-B) and insulin resistance (HOMA2-IR), waist-to hip-ratio (WHR), diastolic blood pressure (DBP) and systolic blood pressure (SBP) up to 20 years before and 10 years after T2D diagnosis. Pairwise comparisons of the estimated marginal means were used to assess differences between all groups. Results Individuals with SIDD consistently exhibited the highest FPG concentrations ( P  < 0.001) and the steepest decline in HOMA2-B levels among all subtypes. BMI was higher in MOD and SIRD than in SIDD and MARD throughout the study period ( P  < 0.01). Individuals with SIRD showed the highest fasting insulin concentrations and higher HOMA2-IR than those with MOD and MARD ( P  < 0.001). WHR and DBP were comparable between subgroups, while SIDD had higher SBP than MOD ( P  = 0.03). The control group exhibited the mildest trajectories across all parameters except for HOMA2-B. Notably, these changes were visible up to 20 years prior to diagnosis. Conclusions In a Swedish population, trajectories of diabetes-related health parameters differed up to 20 years before diagnosis between the T2D-related subtypes and controls. This might support early prediction of subtype-specific risks for long-term complications, allowing early initiation of personalized treatment strategies. Graphical abstract

IntroductionPregnancy is a known independent risk factor for a severe course of COVID-19. The relationship of SARS-CoV-2 infection and gestational diabetes mellitus (GDM) on neonatal outcomes is unclear. Our aim was to determine if SARS-CoV-2 infection represents an independent risk factor for adverse perinatal outcomes in pregnancy with GDM.Research design and methodsWe compared data from two German registries including pregnant women with GDM, established during the SARS-CoV-2 pandemic (COVID-19-Related Obstetric and Neonatal Outcome Study (CRONOS), a multicenter prospective observational study) and already existing before the pandemic (German registry of pregnant women with GDM; GestDiab). In total, 409 participants with GDM and SARS-CoV-2 infection and 4598 participants with GDM, registered 2018–2019, were eligible for analyses. The primary fetal and neonatal outcomes were defined as: (1) combined: admission to neonatal intensive care unit, stillbirth, and/or neonatal death, and (2) preterm birth before 37+0 weeks of gestation. Large and small for gestational age, maternal insulin therapy, birth weight >4500 g and cesarean delivery were considered as secondary outcomes.ResultsWomen with SARS-CoV-2 infection were younger (32 vs 33 years) and had a higher median body mass index (28 vs 27 kg/m²). In CRONOS, more neonates developed the primary outcome (adjusted OR (aOR) 1.48, 95% CI 1.11 to 1.97) and were born preterm (aOR 1.50, 95% CI 1.07 to 2.10). Fasting glucose was higher in women in CRONOS versus GestDiab (5.4 vs 5.3 mmol/L) considering each 0.1 mmol/L increase was independently associated with a 5% higher risk of preterm birth among women in CRONOS only (aOR 1.05, 95% CI 1.01 to 1.09).ConclusionsGDM with SARS-CoV-2 infection in pregnancy is associated with an increased risk of adverse fetal and neonatal outcomes as compared with GDM without SARS-CoV-2 infection.

The behavior change technique taxonomy v1 (BCTTv1; Michie and colleagues, 2013) is a comprehensive tool to characterize active ingredients of interventions and includes 93 labels that are hierarchically clustered into 16 hierarchical clusters. The aim of this study was to identify the active ingredients in electronic health (eHealth) interventions targeting patients with poorly controlled type 2 diabetes mellitus (T2DM) and relevant outcomes. We conducted a scoping review using the BCTTv1. Randomized controlled trials (RCTs), studies with or pre-post-test designs, and quasi-experimental studies examining efficacy and effectiveness of eHealth interventions for disease management or the promotion of relevant health behaviors were identified by searching PubMed, Web of Science, and PsycINFO. Reviewers independently screened titles and abstracts for eligibility using predetermined eligibility criteria. Data were extracted following a data extraction sheet. The BCTTv1 was used to characterize active ingredients of the interventions reported in the included studies. Of the 1404 unique records screened, 32 studies fulfilled the inclusion criteria and reported results on the efficacy and or or effectiveness of interventions. Of the included 32 studies, 18 (56%) were Web-based interventions delivered via personal digital assistant (PDA), tablet, computer, and/or mobile phones; 7 (22%) were telehealth interventions delivered via landline; 6 (19%) made use of text messaging (short service message, SMS); and 1 employed videoconferencing (3%). Of the 16 hierarchical clusters of the BCTTv1, 11 were identified in interventions included in this review. Of the 93 individual behavior change techniques (BCTs), 31 were identified as active ingredients of the interventions. The most common BCTs identified were instruction on how to perform behavior, adding objects to the environment, information about health consequences, self-monitoring of the outcomes and/or and prefers to be explicit to avoid ambiguity. Response: Checked and avoided of a certain behavior Author: Please note that the journal discourages the use of parenthesis to denote either and/or and prefers to be explicit to avoid ambiguity. Response: Checked and avoided \"and/or\" and prefers to be explicit to avoid ambiguity. Response: Checked and avoided, and feedback on outcomes of behavior. Our results suggest that the majority of BCTs employed in interventions targeting persons with T2DM revolve around the promotion of self-regulatory behavior to manage the disease or to assist patients in performing health behaviors necessary to prevent further complications of the disease. Detailed reporting of the BCTs included in interventions targeting this population may facilitate the replication and further investigation of such interventions.