About us

For Authors

For Reviewers

Cover gallery

For Copy-editors

Welcome to Diabetologia

Metformin series

Also in Diabetologia

Inside this issue Up front
Precision Medicine Series 50 Years Forward
Twitter Sign up for eTOC

In the News

Younger age at diabetes diagnosis is linked to higher risk of death from heart disease and stroke, yet lower risk of cancer death

Read this new research by Professor Dianna Magliano and Professor Jonathan Shaw (Baker Heart and Diabetes Institute, Melbourne, Australia) and colleagues.
For further information contact Professor Dianna Magliano and Professor Jonathan Shaw via Suzana Talevski in the Baker Press Office (Suzana.talevski@baker.edu.au).

Current issue: April

April 2018 cover

Click here to view this month's contents

The image on the cover symbolises how the fetal environment may affect fetal DNA. Offspring of women with diabetes in pregnancy have a markedly higher risk of developing metabolic diseases, but the underlying mechanisms are unknown. Telomeres (non-coding TTAGGG repeats located on the ends of the chromosomes) protect genome integrity during replication. Reduced telomere length has been linked to a range of metabolic diseases, including type 2 diabetes, and to all-cause mortality. In this issue of Diabetologia, Hjort et al report that female, adolescent offspring of women with gestational diabetes have 14% shorter telomeres than control offspring.

Cover credit:
Concept: Line Hjort (Department of Endocrinology, Copenhagen University Hospital)
Design: Indigo Medical Illustration

Download the high resolution cover image

Up front

Sally Marshall

Competition for publication in Diabetologia is greater than ever, and less than 20% of papers are accepted. Of all the high-quality papers that appear in this month's issue I want to share with you some articles that I find to be of particular interest. These will be featured 'up front' in the print issue and here on our website. Sally Marshall, Editor

Impaired hypoglycaemia awareness in type 1 diabetes: lessons from the lab
by Alison D. McNeilly, Rory J. McCrimmon

Our understanding of the mechanisms by which the body detects, then responds to, developing hypoglycaemia is gradually increasing. However, the reasons why these fundamental homeostatic mechanisms are disrupted in diabetes, especially following recurrent hypoglycaemia, remain elusive. In this issue, McNeilly and McCrimmon (https://doi.org/10.1007/s00125-018-4548-8) summarise our basic understanding of the glucose-sensing mechanisms used by the brain, and normal counterregulation via the activation of neural circuits. A failure to clear exogenous insulin, and abnormal alpha cell glucagon responses to low glucose together create a situation where hypoglycaemia is common in people with diabetes. Repeated exposure to hypoglycaemia progressively lowers the glucose level at which the counterregulatory response is triggered, reducing awareness and increasing the risk of severe hypoglycaemia. The authors propose that this latter phenomenon may result from habituation, a form of adaptive memory that occurs within key glucose-sensing regions of the brain.
The figures from this review are available as a downloadable slideset. [Text supplied by the authors.]

Download a pdf


The role of structured education in the management of hypoglycaemia
by Ahmed Iqbal, Simon R. Heller

Hypoglycaemia prevents many individuals with diabetes from reaching therapeutic targets. Despite therapeutic advances, severe hypoglycaemia remains common in clinical practice and rates have not fallen over 20 years. In a review in this issue, Iqbal and Heller (https://doi.org/10.1007/s00125-017-4334-z) outline that data showing that providing structured education in self-management reduces the risk of hypoglycaemia to the same extent as modern technology. Evidence both from trials and observational studies, generally obtained in people with type 1 diabetes, demonstrates a subsequent reduction in rates of severe hypoglycaemia of around 50%, accompanied by decreases in HbA1c. Thus, these programmes may abolish the exponential rise in the risk of severe hypoglycaemia, despite reductions in HbA1c. Some individuals continue to experience recurrent hypoglycaemia and impaired hypoglycaemia awareness even with structured education; these individuals may benefit from educational interventions that also address psychological issues. The authors argue that structured education should be part of routine management in all individuals with type 1 diabetes, but that it is particularly important to ensure that those undertaking flexible intensive insulin therapy complete programmes that teach these complex skills.
The figures from this review are available as a downloadable slideset. [Text supplied by the authors.]

Download a pdf


Hypoglycaemia in type 1 diabetes: technological treatments, their limitations and the place of psychology
by Pratik Choudhary, Stephanie A. Amiel

In this issue, Choudhary and Amiel (https://doi.org/10.1007/s00125-018-4566-6) discuss how new technologies in diabetes treatments, especially continuous glucose monitors and insulin pumps that can respond to the readings, are reducing the risks of hypoglycaemia in people with type 1 diabetes. However, these have not been shown to restore endogenous defences or provide protection from severe hypoglycaemia when not being worn. As the technologies improve, their potential benefit also improves; but dislike of their physical presence, time delays in producing a reading and alarm fatigue are barriers to overcome. Impaired awareness of hypoglycaemia, which is a key risk factor for severe hypoglycaemia, may reduce the ability of an individual to engage with technological solutions. It is suggested that managing expectations and providing informed educational and, sometimes, psychological support may help more people to get the most out of technology in the battle against hypoglycaemia in type 1 diabetes management.
The figure from this review is available as a downloadable slide. [Text supplied by the authors.]

Download a pdf


HbA1c, diabetes and cognitive decline: the English Longitudinal Study of Ageing
by Fanfan Zheng, Li Yan, Zhenchun Yang, Baoliang Zhong, Wuxiang Xie

Consistent evidence from longitudinal studies and clinical trials indicates that the risk of dementia is increased in individuals with diabetes. As there is currently no specific cure for dementia, early interventions targeting modifiable risk factors may offer an important way of preventing the cognitive decline that occurs over a long period prior to the onset of dementia. However, the associations of HbA1c and diabetes with subsequent cognitive decline are not well established. In this issue, Zheng et al (https://doi.org/10.1007/s00125-017-4541-7) report that, compared with individuals with normoglycaemia, people with diabetes or prediabetes (defined as HbA1c levels in the range 38.8-46.4 mmol/mol [5.7-6.4%]) had significantly faster rates of long-term cognitive decline. Further HbA1c levels were linearly associated with subsequent cognitive decline, irrespective of diabetes status at baseline. These findings indicate that diabetes status is longitudinally associated with the trajectory of cognitive decline over the long term and provide further support for recommending HbA1c as a marker of glucose management in clinical practice. [Text supplied by the authors.]

Download a pdf

Back to top

Inside this issue

Up front

Up front April 2018

List of Referees

Referees 2017


Impaired hypoglycaemia awareness in type 1 diabetes: lessons from the lab
Alison D. McNeilly, Rory J. McCrimmon

The role of structured education in the management of hypoglycaemia
Ahmed Iqbal, Simon R. Heller

Hypoglycaemia in type 1 diabetes: technological treatments, their limitations and the place of psychology
Pratik Choudhary, Stephanie A. Amiel


Organ donor pancreases for the study of human islet cell histology and pathophysiology: a precious and valuable resource
Piero Marchetti, Mara Suleiman, Lorella Marselli

A post-translational balancing act: the good and the bad of SUMOylation in pancreatic islets
Patrick E. MacDonald


Clinical Science and Care

Haemoglobin glycation index and risk for diabetes-related complications in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial
Sigrid C. van Steen, Mark Woodward, John Chalmers, Qiang Li, Michel Marre, Mark E. Cooper, Pavel Hamet, Giuseppe Mancia, Stephen Colagiuri, Bryan Williams, Diederick E. Grobbee, J. Hans DeVries, on behalf of the ADVANCE Collaborative Group

Group cognitive behavioural therapy and weight regain after diet in type 2 diabetes: results from the randomised controlled POWER trial
Kirsten A. Berk, Hanneke I. M. Buijks, Adrie J. M. Verhoeven, Monique T. Mulder, Behiye Özcan, Adriaan van ’t Spijker, Reinier Timman, Jan J. Busschbach, Eric J. Sijbrands

New diagnostic criteria for gestational diabetes mellitus and their impact on the number of diagnoses and pregnancy outcomes
Sarah H. Koning, Jelmer J. van Zanden, Klaas Hoogenberg, Helen L. Lutgers, Alberdina W. Klomp, Fleurisca J. Korteweg, Aren J. van Loon, Bruce H. R. Wolffenbuttel, Paul P. van den Berg

Back to top of this issue list


Aberrant intestinal microbiota in individuals with prediabetes
Kristine H. Allin, Valentina Tremaroli, Robert Caesar, Benjamin A. H. Jensen, Mads T. F. Damgaard, Martin I. Bahl, Tine R. Licht, Tue H. Hansen, Trine Nielsen, Thomas M. Dantoft, Allan Linneberg, Torben Jørgensen, Henrik Vestergaard, Karsten Kristiansen, Paul W. Franks, the IMI-DIRECT consortium, Torben Hansen, Fredrik Bäckhed, Oluf Pedersen

Association of NEFA composition with insulin sensitivity and beta cell function in the Prospective Metabolism and Islet Cell Evaluation (PROMISE) cohort
Luke W. Johnston, Stewart B. Harris, Ravi Retnakaran, Adria Giacca, Zhen Liu, Richard P. Bazinet, Anthony J. Hanley

Increasing risk of psychiatric morbidity after childhood onset type 1 diabetes: a population-based cohort study
Daniel Dybdal, Janne S. Tolstrup, Stine M. Sildorf, Kirsten A. Boisen, Jannet Svensson, Anne Mette Skovgaard, Grete K. Teilmann

HbA1c, diabetes and cognitive decline: the English Longitudinal Study of Ageing
Fanfan Zheng, Li Yan, Zhenchun Yang, Baoliang Zhong, Wuxiang Xie

Plasma metabolites associated with type 2 diabetes in a Swedish population: a case–control study nested in a prospective cohort
Lin Shi, Carl Brunius, Marko Lehtonen, Seppo Auriola, Ingvar A. Bergdahl, Olov Rolandsson, Kati Hanhineva, Rikard Landberg

Back to top of this issue list


A type 1 diabetes genetic risk score can discriminate monogenic autoimmunity with diabetes from early-onset clustering of polygenic autoimmunity with diabetes
Matthew B. Johnson, Kashyap A. Patel, Elisa De Franco, Jayne A. L. Houghton, Timothy J. McDonald, Sian Ellard, Sarah E. Flanagan, Andrew T. Hattersley

Telomere length is reduced in 9- to 16-year-old girls exposed to gestational diabetes in utero
Line Hjort, Regan Vryer, Louise G. Grunnet, David Burgner, Sjurdur F. Olsen, Richard Saffery, Allan Vaag

Back to top of this issue list

Islet Studies

Both conditional ablation and overexpression of E2 SUMO-conjugating enzyme (UBC9) in mouse pancreatic beta cells result in impaired beta cell function
Xiaoyu He, Qiaohong Lai, Cai Chen, Na Li, Fei Sun, Wenting Huang, Shu Zhang, Qilin Yu, Ping Yang, Fei Xiong, Zhishui Chen, Quan Gong, Boxu Ren, Jianping Weng, Décio L. Eizirik, Zhiguang Zhou, Cong-Yi Wang

Early deficits in insulin secretion, beta cell mass and islet blood perfusion precede onset of autoimmune type 1 diabetes in BioBreeding rats
Anya Medina, Saba Parween, Sara Ullsten, Neelanjan Vishnu, Yuk Ting Siu, My Quach, Hedvig Bennet, Alexander Balhuizen, Lina Åkesson, Nils Wierup, Per Ola Carlsson, Ulf Ahlgren, Åke Lernmark, Malin Fex

SIRT6-mediated transcriptional suppression of Txnip is critical for pancreatic beta cell function and survival in mice
Kunhua Qin, Ning Zhang, Zhao Zhang, Michael Nipper, Zhenxin Zhu, Jake Leighton, Kexin Xu, Nicolas Musi, Pei Wang

Back to top of this issue list


Arctic berry extracts target the gut–liver axis to alleviate metabolic endotoxaemia, insulin resistance and hepatic steatosis in diet-induced obese mice
Fernando F. Anhê, Thibault V. Varin, Mélanie Le Barz, Geneviève Pilon, Stéphanie Dudonné, Jocelyn Trottier, Philippe St-Pierre, Cory S. Harris, Michel Lucas, Mélanie Lemire, Éric Dewailly, Olivier Barbier, Yves Desjardins, Denis Roy, André Marette

Acute loss of adipose tissue-derived adiponectin triggers immediate metabolic deterioration in mice
Jonathan Y. Xia, Kai Sun, Chelsea Hepler, Alexandra L. Ghaben, Rana K. Gupta, Yu A. An, William L. Holland, Thomas S. Morley, Andrew C. Adams, Ruth Gordillo, Christine M. Kusminski, Philipp E. Scherer

Unique metabolic activation of adipose tissue macrophages in obesity promotes inflammatory responses
Lily Boutens, Guido J. Hooiveld, Sourabh Dhingra, Robert A. Cramer, Mihai G. Netea, Rinke Stienstra

Back to top of this issue list

Pathophysiology and Complications

Hospital time prior to death and pancreas histopathology: implications for future studies
Irina Kusmartseva, Maria Beery, Tiffany Philips, Stephen Selman, Priyanka Jadhav, Clive Wasserfall, Axel Muller, Alberto Pugliese, Jeffrey A. Longmate, Desmond A. Schatz, Mark A. Atkinson, John S. Kaddis

Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort
Simon G. Anderson, Haika Shoo, Sushant Saluja, Christian D. Anderson, Adnan Khan, Mark Livingston, Edward B. Jude, Mark Lunt, George Dunn, Adrian H. Heald

The Adolescent Cardio-Renal Intervention Trial (AdDIT): retinal vascular geometry and renal function in adolescents with type 1 diabetes
Paul Z. Benitez-Aguirre, Tien Y. Wong, Maria E. Craig, Elizabeth A. Davis, Andrew Cotterill, Jennifer J. Couper, Fergus J. Cameron, Farid H. Mahmud, Tim W. Jones, Lauren A. B. Hodgson, R. Neil Dalton, David B. Dunger, Kim C. Donaghue, The Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT)

Plasma concentrations of 8-hydroxy-2'-deoxyguanosine and risk of kidney disease and death in individuals with type 1 diabetes
Manuel Sanchez, Ronan Roussel, Samy Hadjadj, Abdul Moutairou, Michel Marre, Gilberto Velho, Kamel Mohammedi

Back to top of this issue list

Back to top