Tsvetalina Tankova

The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the consensus statement on the management of type 2 diabetes in nonpregnant adults, published since 2006 and last updated in 2022. The target audience is the multidisciplinary health care team providing diabetes care in the U.S. and Europe. A systematic examination of publications since 2022 informed new recommendations. This update has broadened the focus from the management of hyperglycemia to the holistic management of type 2 diabetes and its risk of associated multiple long-term conditions. Fundamental aspects of diabetes care include promoting healthy lifestyle behaviors (healthy eating, 24-h physical behaviors including sleep, and avoiding tobacco and substance use), alongside the provision of psychological support and weight management interventions. For the management of people living with type 2 diabetes, earlier use, potentially from diagnosis, of sodium–glucose cotransporter 2 (SGLT2) inhibitors and/or glucagon-like peptide 1 (GLP-1)-based therapies to offer organ protection and improve long-term outcomes in type 2 diabetes is advocated. Furthermore, earlier combination use of SGLT2 inhibitors and GLP-1–based therapies should be considered in people with concomitant cardiovascular disease, chronic kidney disease, and heart failure. Finally, the ability to transform outcomes for people living with type 2 diabetes is within our grasp through the consistent, equitable, and systematic implementation of strategies and therapies that are already available.

Background: Family‐based interventions offer a promising solution to the pressing global health concern of childhood obesity by addressing the interconnected behaviours of parents and children. Nevertheless, limited evidence identifies which families benefit most when outcomes are evaluated at the parent–child dyad level. Aim: To identify which parent–child dyads experienced clinically meaningful improvements in weight status over 1‐ and 2‐year periods within the Feel4Diabetes study, a school‐ and community‐based intervention targeting European families at risk for Type 2 diabetes. Methods: Data were drawn from 2402 high‐risk families across six European countries. For participants with overweight/obesity, improvement meant ≥ 5% parental weight loss and a ≥ 0.15‐unit child BMI‐ z reduction. Multiple logistic regression models identified socio‐demographic and contextual predictors of dyadic improvement. Results: After 2 years, 5.3% of families achieved improvements in both parent and child. Significant predictors of dyadic success included intervention group participation [OR = 2.56 (95% CI: 1.31–5.03)] and residing in high‐income countries under austerity measures [OR = 2.44 (1.00–6.02)]. Girls were more likely to improve than boys, while full‐time maternal employment was associated with lower odds of dyadic improvement. Conclusions: Sustained benefits were observed in a subset of families, highlighting the need for tailored, context‐sensitive family‐centred obesity prevention strategies.

Introduction: Obesity disproportionately affects children from socioeconomically disadvantaged backgrounds. This study assessed the effectiveness of the Feel4Diabetes intervention on weight outcomes among children from low socioeconomic settings. Methods: Feel4Diabetes was a randomised pragmatic trial implemented in real‐world school and community settings across Europe. Using a two‐stage screening procedure, families were recruited and categorised as either ‘all families’ or ‘high‐risk families’. The intervention included a 2‐year school‐based health promotion for all families and additional counselling for high‐risk families. Weight improvement was defined as a reduction of ≥ 0.2 BMI z‐score units among children with overweight/obesity. Multiple logistic regressions identified predictors of improvement. Results: Data from 2710 children from high‐risk families and 7625 children from all families were analysed. After 2 years, a higher proportion of children from high‐risk families in the intervention group reduced their BMI z‐score compared to the control group ( p = 0.002). Children from non–high‐risk families showed only a marginal improvement. Multivariate analyses identified predictors of improvement: randomisation in the intervention group (OR = 1.46; 95% CI: 1.14–1.87), baseline obesity (OR = 1.55; 95% CI: 1.16–2.08), residence in LMICs (OR = 2.33; 95% CI: 1.65–3.30) or HICs facing economic crisis (OR = 2.12; 95% CI: 1.54–2.91), and reported financial difficulties (OR = 1.36; 95% CI: 1.06–1.74). Interestingly, maternal obesity was positively associated with BMI z‐score improvement (OR = 1.31; 95% CI: 1.03–1.68), while higher maternal education was inversely related (OR = 0.64; 95% CI: 0.41–0.99). Conclusion: These findings underscore the importance of equity‐oriented, long‐term interventions addressing both behavioural and structural determinants of obesity.

Type 2 diabetes mellitus (T2DM) is a chronic, progressive disease driven by a complex interplay of genetic, biological, behavioural and social factors. The epidemiology of T2DM has shifted considerably, largely attributable to increasing obesity rates. Furthermore, T2DM prevalence is increasing in younger people (diagnosis <40 years of age; early-onset T2DM), which is associated with more aggressive disease progression, higher risk factor burden, earlier and more severe complications, and greater lifetime morbidity than later-onset T2DM. T2DM is traditionally associated with a high risk of microvascular and macrovascular complications, although rates of cardiovascular complications have reduced in some high-income countries. Currently, emerging and non-traditional diabetes complications, such as those related to mental health and cognitive function, are being recognized, and people with T2DM increasingly experience multimorbidity and reduced quality of life. Additionally, a growing prevalence of obesity has resulted in high rates of obesity-related complications. Novel therapies and technologies may offer considerable benefit, although socioeconomic disparities may exacerbate barriers to effective prevention and equitable access. The complex nature of T2DM and its comorbidities underscores the urgent need for a person-centred, holistic approach that integrates glucose and weight management with broader attention to comorbidities, 24-h physical behaviours, psychosocial well-being and social determinants of health.

Background: Parental weight status is a key predictor of childhood obesity. However, limited evidence exists on how longitudinal changes in parental BMI influence children's weight trajectories, particularly in families at elevated risk for type 2 diabetes. Objectives: To investigate children's body mass index‐for‐age z ‐score (BMIz) changes over a 2‐year period, associated with independent and cumulative changes in parents' BMI. Methods: In the Feel4Diabetes study, data from 12 280 children (age: 8.2 ± 1.0 years) and their parents were analysed to assess changes in child BMI‐for‐age z ‐scores over 2 years in relation to parental BMI changes. Analyses were adjusted for study design and baseline socio‐demographic factors and were conducted in both the total sample (all‐families) and high‐risk for type 2 diabetes families (HR‐families). Results: In the all‐families dataset, a 1 kg/m ² independent decrease in maternal and paternal BMI was associated with a −0.037 (−0.041, −0.033) and −0.027 (−0.031, −0.023) change in child's BMIz [mean (95% CI)]. The joint parental effect was stronger [−0.32 (−0.36, −0.28)], particularly in HR‐families [−0.34 (−0.42, −0.26)]. Conclusions: Parental BMI reductions, especially when both parents are involved, contribute to favourable BMI changes in children. The changes were more pronounced in HR‐families, underscoring the need for interventions targeting the whole family in populations at elevated risk for type 2 diabetes.

Introduction: Previous studies suggest that children from lower socioeconomic status may be at higher risk of unhealthy eating. This study aims to examine the cumulative socioeconomic vulnerabilities and their association with dietary patterns and obesity levels in European children. Methods: A total of 9664 parent‐child dyads (79% mothers; 50.8% girls) from six European countries participated in the study. Families provided baseline information on energy balance‐related behaviours and socioeconomic factors through questionnaires. Children's dietary habits were evaluated using semi‐quantitative food frequency questionnaires, and anthropometric data were collected. Vulnerabilities were quantified through a composition of variables based on household income, parental education and employment. Multivariable and logistic regression analyses were performed. Results: The study found significant associations between socioeconomic vulnerability and children's dietary habits and body mass index. Higher vulnerability was linked to a lower probability of fruit and vegetable intake, and a higher probability of consuming red meat, and energy‐dense snacks. Children with the highest vulnerability had nearly four times higher odds of overweight/obesity (OR = 3.82, 95% CI: 3.05–4.76). Conclusions: The findings of this study indicate that European children from families with a high socioeconomic vulnerability tend to have an unhealthy dietary profile and a higher degree of obesity. Therefore, public health programs should prioritise families facing high socioeconomic vulnerabilities promoting healthy eating to prevent childhood obesity at early stages. Trial Registration: Clinical trials registry http://clinicaltrials.gov : NCT02393872

Background: Endocrine science remains underrepresented in European Union research programmes despite the fundamental role of hormone health in human well-being. Analysis of the CORDIS database reveals a persistent gap between the societal impact of endocrine disorders and their research prioritization. At national funding level, endocrine societies report limited or little attention of national research funding towards endocrinology. The EndoCompass project—a joint initiative between the European Society of Endocrinology and the European Society of Paediatric Endocrinology, aimed to identify and promote strategic research priorities in endocrine science to address critical hormone-related health challenges. Methods: Research priorities were established through comprehensive analysis of the EU CORDIS database covering the Horizon 2020 framework period (2014-2020). Expert consultation was conducted to identify key research priorities, followed by broader stakeholder engagement including society members and patient advocacy groups. Results: Research priorities include: genetic/epigenetic factors, brain–periphery communication, and environmental influences. Key therapeutic areas include innovative approaches for monogenic disorders, incretin mimetics, dual receptor agonists, microbiome analysis, and improved behavioural interventions. For type 1 diabetes, priorities focus on early detection, insulin delivery systems, and disease-modifying therapies. Conclusions: This component of the EndoCompass project provides an evidence-based roadmap for strategic research investment. This framework identifies crucial investigation areas into diabetes and obesity pathophysiology, prevention, and treatment strategies, ultimately aimed at reducing the burden of metabolic disorders on individuals and society. The findings support the broader EndoCompass objective of aligning research funding with areas of highest potential impact in endocrine health.