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[Personal View] Life stage transitions for people with type 1 diabetes

Type 1 diabetes affects individuals of all ages, with different clinical priorities and support needs at different stages of life. In this Personal View, we define the two major transitions that occur across the lifespan in type 1 diabetes: the emerging adult transition (typically occurring between age 18 years and age 25 years, as individuals transition to self-management and transfer to adult care), and the older adult transition (occurring at variable ages as individuals develop comorbidities and complications that could require increased assistance with management and customisation of glycaemic targets).

[Review] Recent advances in research and care of familial hypercholesterolaemia

Heterozygous familial hypercholesterolaemia is a common, autosomal semi-dominant condition characterised by elevation of LDL cholesterol from birth and early onset of atherosclerotic cardiovascular disease. With major advances in knowledge about the disease, familial hypercholesterolaemia has become an exemplar for the practice of precision and personalised medicine. Beyond genetics, developments in clinical risk prediction algorithms and cardiovascular imaging have enabled more accurate risk stratification of patients.

[Articles] Cycle characterisation and clinical complications in patients with cyclic Cushing's syndrome: insights from an international retrospective cohort study

Even in specialised centres, cCS diagnosis and management remain challenging with high rates of spontaneous adrenal insufficiency, inappropriate surgeries, and poor outcomes. Ectopic cCS showed the most frequent and severe peaks. These findings might help to guide imaging localisations or the timing of BIPSS in patients with active occult ACTH-dependent cCS. Hypercortisolism needs to be biochemically confirmed before BIPSS to enable correct tumour localisation. Patients with suspected or proven cCS should be equipped with salivary cortisol collection kits to capture dynamic changes as well as being prescribed glucocorticoids to be used as a precaution.

[Corrections] Correction to Lancet Diabetes Endocrinol 2025; 13: 909–10

Maltese G, Kar P, Gallen G, Hicks D, Sinclair AJ. Addressing the educational needs of older adults with type 1 diabetes. Lancet Diabetes Endocrinol 2025; 13: 909–10—In this Correspondence, the title should have been Addressing the educational needs of older adults with type 1 diabetes. This correction has been made as of Oct 21, 2025.

[Corrections] Correction to Lancet Diabetes Endocrinol 2022; 10: 623–33

Inagaki N, Takeuchi M, Oura T, et al. Efficacy and safety of tirzepatide monotherapy compared with dulaglutide in Japanese patients with type 2 diabetes (SURPASS J-mono): a double-blind, multicentre, randomised, phase 3 trial. Lancet Diabetes Endocrinol 2022; 10: 623–33—Appendix 2 of this Article has been corrected as of Oct 15, 2025.

[Correspondence] Has the WHO Model Essential Medicines List lost its way?

The WHO's Model Essential Medicines List (EML), created in the 1970s, remains one of WHO's most successful tools in guiding countries' evidence-based, rational medicine selection. WHO states, “Essential medicines are those that effectively and safely treat the priority health-care needs of the population. They are selected by taking into consideration public health relevance, evidence of benefits and harms, and with consideration of costs, affordability and other relevant factors.”1

[Correspondence] The urgent need for a diabetes data rights charter

Data generated by diabetes devices—including continuous glucose monitors, smart pens, and insulin pumps—are fundamental to the care and long-term health of people with diabetes. Yet, despite their centrality, users of these devices do not have full access to and control over their own data. Regulatory frameworks such as the General Data Protection Regulation in the EU and UK, and the EU Data Act, establish much needed rights for device users. However, in practice, mechanisms to exercise these rights are often missing.

[Correspondence] The evolutionary basis for type 2 diabetes prevalence in the Arabian Peninsula

Across the Arabian Peninsula, home to the Gulf Cooperation Council (GCC) states, societies have transformed within a century from nomadic and agrarian life to globalised, oil-driven economies. With shifts in diet, physical activity, and daily living came a surge in metabolic disease, especially type 2 diabetes, in which the prevalence now exceeds 20–25% in countries such as Kuwait and Qatar.1 Lifestyle alone cannot explain this vulnerability. A deeper perspective is emerging, one grounded in evolutionary biology: that ancestral adaptations to survive scarcity might now predispose these populations to metabolic disease in an era of abundance.

[Comment] From reproduction to metabolism: FSH as a key modulator in menopause

Follicle-stimulating hormone (FSH), a glycoprotein secreted by gonadotroph cells of the anterior pituitary, is classically known as a key regulator of reproduction in both sexes, acting mainly on the gonads. It is a heterodimer with a common α-subunit and a hormone-specific β-subunit, signalling through the G protein-coupled FSH receptor. In females, FSH drives ovarian function by promoting follicle growth and maturation, supporting ovulation and luteinisation alongside luteinising hormone, and regulating essential gonadal processes, including development, gametogenesis, and steroidogenesis.

[Comment] Primary aldosteronism and plasma renin targets

Over the past two decades there have been tremendous advancements in the understanding of both the prevalence and the clinical significance of primary aldosteronism. Where previously only the most extreme cases were likely to be diagnosed and referred for management, primary aldosteronism is now known to be common, though it often remains under-recognised, with a 5–14% prevalence of primary aldosteronism in patients with hypertension who are seen in primary care settings.1 The relative risk of cardiovascular and renal disease in people with primary aldosteronism compared with primary hypertension is well described, and even subclinical primary aldosteronism has been associated with an increased rate of major adverse cardiovascular events.

[Comment] The road towards standardisation in cyclic Cushing's syndrome

Endogenous Cushing's syndrome is a severe, potentially lethal, endocrine condition. It is well known for its pleomorphic clinical manifestations that often overlap with those of frequent endocrine and non-endocrine disorders like arterial hypertension, type 2 diabetes, obesity, polycystic ovary syndrome, or postmenopausal osteoporosis.1 The absence of specific signs and symptoms leads to both over-testing and delayed diagnosis in patients with metabolic syndrome. Most clinical and biochemical manifestations are produced by excessive cortisol production from the adrenal glands, driven by autonomous adrenal tumours or by adrenocorticotropic hormone of pituitary or ectopic origin.

[Comment] Empagliflozin in chronic kidney disease: evidence for early, inclusive, and confident use

The scenario of chronic kidney disease (CKD) management has been transformed by the advent of sodium glucose co-transporter-2 (SGLT2) inhibitors, a class of drugs with benefits extending well beyond glycaemic control. In The Lancet Diabetes & Endocrinology, William G Herrington and colleagues1 present an individual participant-level meta-analysis encompassing 23 340 participants from four landmark placebo-controlled empagliflozin trials, representing a step forward in our understanding of the renal effects of empagliflozin across a spectrum of populations.

[Editorial] Diabetes support at work: an unmet need

According to the latest edition of the IDF Diabetes Atlas, 589 million people around the world were living with diabetes in 2024, with 70% being of working age. People with diabetes face many challenges in the workplace and have specific needs; however, these are often overlooked, and available support structures are either inadequate or absent. Aiming to close this critical gap, World Diabetes Day, 2025, continues the theme of diabetes and wellbeing with a specific focus on diabetes in the workplace, and calls on employers and employees to “Know more and do more for diabetes at work”.

[Personal View] Managing adults with screen-detected islet autoantibody positivity: a pragmatic framework

New disease-modifying therapies, such as teplizumab, offer opportunities to delay the clinical onset of type 1 diabetes but require islet autoantibody screening to identify individuals at increased risk of progression to diabetes. As type 1 diabetes screening programmes expand, clinicians will increasingly encounter a new group of people: adults who test positive for islet autoantibodies but have not yet been diagnosed with diabetes. Although international guidelines outline management for both children and adults, considerable uncertainties remain, particularly for adults.

[Review] Glucocorticoid-induced osteoporosis: novel concepts and clinical implications

Despite advances in targeted therapies, treatment with glucocorticoids remains a mainstay in the management of various immune-mediated diseases. High cumulative doses of exogenous glucocorticoids lead to a spectrum of side-effects, in particular increased fracture risk. Fragility fractures might result in immobility, frequent admission to hospitals, and loss of quality of life. Glucocorticoid excess impairs bone microarchitecture and bone strength and can cause multiple vertebral fractures. Fracture risk at other skeletal sites is also enhanced and triggered by an increased risk for falls.