In an ancestrally diverse pediatric cohort with clinician-diagnosed type 2 diabetes (ProDiGY; 82% non-White; autoantibody-negative), investigators evaluated whether the adult-derived maturity-onset diabetes of the young (MODY) probability calculator could distinguish monogenic diabetes (MODY) from youth-onset type 2 diabetes. Exome sequencing across 10 ClinGen-endorsed MODY genes identified 100 MODY cases (3%) among 3,379 participants, most commonly in HNF1A (41%), GCK (27%), HNF4A (26%), with smaller contributions from PDX1 (4%) and INS (2%). Performance was assessed at the earliest post-diagnosis time point per calculator specifications, using participants from SEARCH, TODAY, and TODAY Genetics.

Among those with complete data (44 MODY; 694 type 2 diabetes), the MODY calculator failed to add clinical utility over simple anthropometrics: its variables achieved an area under the curve (AUC) of 0.82—no better than body mass index (BMI) alone (AUC 0.82). The adult trigger threshold (>25% probability) captured 98% of MODY but also 92% of type 2 cases, yielding only a 6.3% positive rate; even >75% probability had a 7% yield. BMI was the strongest single predictor, while age at diagnosis had modest discrimination (AUC 0.63) and HbA1c or “on any medication” had none (AUC ~0.51). Parental diabetes did not differentiate groups (≈74% in both), though having two affected parents was more common in type 2 diabetes. Lower BMI enriched for MODY (eg, ≤25 kg/m²), but this strategy would miss approximately 45% of cases, and most youth with MODY were still overweight/obese by pediatric percentiles. Other helpful markers included fasting insulin and waist circumference (both AUC 0.81), C-peptide (0.80), and fibrinogen (0.77). Overall, the adult-validated calculator underperforms in youth; BMI-based screening thresholds may be a pragmatic stopgap that should vary by ancestry, but new (ideally gene-specific) biomarkers are needed to reliably distinguish MODY from youth-onset type 2 diabetes.

Reference: Kreienkamp RJ, Shields BM, Pollin TI, et al. MODY Calculator and Clinical Features Routinely Used to Distinguish MODY From Type 2 Diabetes in Adults Perform Poorly for Youth Clinically Diagnosed With Type 2 Diabetes. Diabetes Care. 2025 Jan 1;48(1):e3-e5. doi: 10.2337/dc24-1565.

In the pediatric INHALE-1 trial (n=230; ages 4–17, ~98% with type 1 diabetes), technosphere inhaled insulin delivered HbA1c outcomes at 26 weeks that were comparable to injected rapid-acting analogs while all participants continued basal insulin and used continuous glucose monitor. Mean HbA1c was essentially similar between groups; a sensitivity analysis (excluding one nonadherent outlier) met noninferiority (Δ≈0.14%, P=.026). Time-in-range was not different (39% vs 41%; P=.38). Because technosphere insulin acts faster and clears sooner, effective use often required multiple inhalations per meal and dose “tune-ups.” Dosing units are not 1:1 with injections; participants ultimately averaged approximately 3 times the analog unit count by week 26.

Secondary outcomes favored inhaled insulin on patient-centered measures: adolescents and parents reported higher treatment satisfaction, and body mass index percentile was lower (Δ −4.2; P=.009), consistent with less weight gain. Safety signals were acceptable and broadly similar: severe hypoglycemia was rare (2 vs 1), no pulmonary function decline was detected, and cough during inhalation (typically mild) occurred in 17%. No diabetic ketoacidosis occurred with technosphere insulin (one event with analogs). While technosphere insulin is not yet FDA-approved for pediatric patients, investigators argued the data support considering an expanded indication and highlight use cases such as basal-plus-inhaled regimens and potential future integration with automated insulin delivery.

Reference: Monostra M. Inhaled insulin safe, effective for children with diabetes. Healio. Published June 22, 2025. Accessed December 16, 2025. https://www.healio.com/news/endocrinology/20250622/inhaled-insulin-safe-effective-for-children-with-diabetes

Early statin initiation after a new type 2 diabetes diagnosis appears to materially lower cardiovascular risk and should be framed as a “now and” (not “later or”) therapy alongside lifestyle change. In a Mass General Brigham analysis of routine care, investigators emphasize that statins are effective, safe, and inexpensive for rapidly lowering LDL-C and stabilizing plaque—mechanisms that translate into fewer myocardial infarctions and strokes, the leading causes of death in diabetes. Although nearly one in five patients initially declined statins to “try lifestyle first,” the authors argue that time is cardioprotective: delaying lipid-lowering while atherosclerosis progresses sacrifices early benefit that accrues within months. For frontline clinicians, the practical message is to pair diet, activity, and weight goals with an immediate, guideline-concordant statin, then titrate and monitor rather than deferring pharmacotherapy.

The cohort included 7,239 adults. About 17% delayed statins for a of median approximately 1.5 years and experienced higher event rates (heart attack or stroke in 8.5% with delay vs 6.4% with immediate start). That equates to about a 2.1-point absolute difference and roughly one-third higher relative risk with postponement—directionally consistent with a meaningful reduction when therapy begins promptly. The analysis used matching and adjusted models, and its findings align with long-standing trial and guideline data supporting statins as first-line atherosclerotic cardiovascular disease prevention in diabetes. Researchers recommend using these numbers in shared decision-making: reassure patients that lifestyle change remains essential, but it complements rather than replaces a statin—because, for heart and brain outcomes, earlier is better.

Reference: Seery C. Cardiovascular events among people with type 2 diabetes reduced by quick use of statins. Diabetes.co.uk. Published June 8, 2025. Accessed December 16, 2025. https://www.diabetes.co.uk/news/2025/jun/cardiovascular-events-among-people-with-type-2-diabetes-reduced-by-quick-use-of-statins.html#google_vignette