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E-Newsletter • November 2025 |
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Editor's E-Note
The Ins and Outs of Diabetes Care
November is here and that means National Diabetes Awareness month is in full swing. Our November newsletter is all about diabetes research, education, and support. In a time when information about diabetes is more accessible than ever before, it may come as a surprise to see a large percentage of undiagnosed cases remain. According to the CDC, as of 2021, 8.7 million adults aged 18 years or older who met laboratory criteria for diabetes were not aware of or had undiagnosed diabetes. This number represents 3.4% of all US adults and 22.8% of all US adults with diabetes. And what about those who are at higher risk for developing prediabetes but may not know it? In this month’s E News Exclusive, we share new research looking at emerging markers for detecting heightened prediabetes risk before traditional markers may register an issue. Who can benefit from this technology? How will concerns about policy changes and care access impact current and future early diagnostic breakthroughs?
After reading the article, visit TD’s website at www.TodaysDietitian.com to read the digital edition of our November/December issue, featuring our cover story, “A Critical Look at Osteoporosis,” detailing important differences in approaches to prevention vs treatment. You’ll also find features on cognitive performance nutrition and personal stories from RDs who are taking charge in shaping AI in the field of nutrition.
Please enjoy the E-Newsletter and give us your feedback at TDeditor@gvpub.com, and don’t forget to like us on Facebook and follow us on X, formerly known as Twitter.
— Heather Davis, MS, RDN, LDN, editor |
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Using Metabolites for Predicting Early Prediabetes Risk
By Heather Davis, MS, RDN, LDN
Assessing an individual’s risk for prediabetes and, ultimately, type 2 diabetes (T2D), typically involves considering factors such as age, BMI/weight, ethnicity, family history, physical activity levels, and medical history of conditions like dyslipidemia, CVD, obstructive sleep apnea, polycystic ovarian syndrome, and gestational diabetes, among others. But what if there were other more precise methods and markers we could use to capture at-risk populations—especially earlier in life? Early detection is incredibly important for preventing diabetes and its many debilitating complications.
Nearly one in five adolescents and one in four young adults in the United States have prediabetes. Young people with prediabetes have a high T2D risk, and 8% develop young-onset T2D within three years of diagnosis. Lifestyle interventions for individuals with prediabetes can decrease T2D risk by 40% to 70%.1 With interventions involving dietary modification and physical activity acting as the most effective means for addressing these risks, it makes sense to direct efforts at those who are most in need.
Which Metabolites?
Many circulating metabolites have been shown to predict the risk of T2D and can also be impacted by lifestyle interventions. The Human Metabolome Database lists 21 unique plasma metabolites associated with T2D. These include certain amino acids, lipids, and sugar metabolites. For example, increased circulating concentrations of branched chain amino acids and aromatic amino acids have been associated with an increased risk for T2D, while increased levels of glycine, indolepropionic acid and phsophatidylcholines have been associated with a decreased risk. Some research has specifically looked at the impact of intervention studies, where N-acetyl-d-galactosamine, trimethylglycine, methionine sulfoxide, 7-methylguanine, propionylcarnitine, putrescine, and serine have been associated with regression of disease.2
In one longitudinal cohort study published in 2024 in Diabetes Care, researchers examined postprandial metabolite profiles and risk of prediabetes in Hispanic youth and young adults. This was the largest study to date to pinpoint predictive metabolites for risk of prediabetes in adolescents and young adults and the first to focus on Hispanic adolescents—a high-risk and understudied population for T2D. Authors of this study explain that since decreased metabolic flexibility and altered postprandial metabolite profiles may be present years before prediabetes develops, looking at metabolite levels after a glucose challenge may be more informative for prediabetes risk in young people than fasting metabolites.1
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New Research Raises Concerns About Metformin
A widely prescribed diabetes drug may be sabotaging one of the most trusted strategies for preventing the disease: exercise.
That is the conclusion of a Rutgers-led study published in The Journal of Clinical Endocrinology & Metabolism, which found that metformin may blunt critical improvements in blood vessel function, fitness, and blood sugar control that normally come from working out.
Since 2006, doctors have been advised to tell patients with high blood sugar to take metformin while engaging in exercise. Two proven therapies should deliver better results together, they reasoned. But Rutgers researchers say the math doesn’t add up.
“Most health care providers assume one plus one equals two,” says Steven Malin, a professor in the Department of Kinesiology and Health in the School of Arts and Sciences and the lead author of the study. “The problem is that most evidence shows metformin blunts exercise benefits.”
To test the theory, Malin’s team recruited 72 adults at risk for metabolic syndrome—a cluster of conditions that raise the risk of diabetes and heart disease. They divided the trial participants into four groups: people performing high-intensity exercise while taking a placebo, high-intensity exercise with metformin, low-intensity exercise with placebo, and low-intensity exercise with metformin.
Early Diabetes Treatment Makes a Measurable Difference
Nearly a decade of research leads to the development of a landmark model that could shape how clinicians and researchers understand and manage diabetes across the United States.
When she was a fellow in clinic, Neda Laiteerapong, MD, MS, a professor of medicine and chief of general internal medicine at the University of Chicago, had a patient—an experienced nurse—who asked a deceptively simple question. She had been living with elevated blood sugar for about three years and had not yet started treatment. “Did I harm myself by waiting?” she asked.
At the time, Laiteerapong did not have an answer. “I wanted to say, ‘Yes, absolutely,’ but I didn’t have any evidence to support that,” she recalls. “The challenge with diabetes is that the benefits of treatment—like controlling blood sugar, blood pressure, cholesterol, weight, or quitting smoking—often don’t show up until many years later. For example, controlling blood sugar today may prevent complications 10 or even 20 years from now. But not everyone with diabetes develops complications, so there’s a lot of uncertainty.”
That unanswered question led Laiteerapong on a mission to understand just how much treatment matters, what it costs to delay treatment in the early stages of diabetes, and how much each treatment can benefit a patient’s health over time. Using real-world patient data from Kaiser Permanente, Laiteerapong and her team have now created a model to predict not only the traditional complications of diabetes, such as heart attacks, kidney failure, and amputations, but also outcomes such as depression and dementia, which have begun to receive more attention in recent years.
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CPE Monthly
In the November/December issue of Today’s Dietitian, learn about the impact of vitamin D on diabetes. Vitamin D and calcium homeostasis may play direct and indirect roles in the development of diabetes and vitamin D can affect numerous complications associated with this disease state. Read the CPE Monthly article, take the 10-question online test at CE.TodaysDietitian.com/CPEmonthly, and earn two CPEUs!
Upcoming Webinars
Get ready for 2026 with a variety of CE webinars! Check out the latest live presentations, including sessions that focus on compassion in diabetes care, nutrition personas, metabolic surgery for T2D, and parts 2, 3, and 4 of our Microdoses of Mindfulness series. Check out our full list of upcoming live and recorded offerings here.
2026 Spring Symposium
The Today’s Dietitian Spring Symposium continues to set the standard for evidence-based learning, real-world application, and professional connection Join a distinguished lineup of presenters sharing insight on the trends, technologies, and topics defining modern dietetics. From clinical nutrition and food literacy to communication, technology, and leadership, these sessions deliver the knowledge and inspiration to elevate your practice and career.
Check out our expert speaker lineup here.
Register now to take advantage of Advance Registration savings!
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Smart Insulin Management
Smart insulin pens offer a host of benefits to people with diabetes, and can work in tandem with a phone app. Tempo Pen (Lilly Diabetes), InPen (Medtronic), NovoPen Echo (NovoNordisk), and Unity Pen (Abbott) are some of the available options to choose from. Learn more »
Snaq Attack
Snaq helps users count carbohydrates in their meals with a snap of their phone’s camera. It also helps take the guesswork out of meal-time insulin boluses to make more data-driven decisions and to bring more peace of mind, freedom, and choice to people with diabetes. Learn more » |
In the January/February Issue
• Nutrition Therapy for Chronic Critical Illness
• Great Debates: Metabolic Health and Weight
• Beyond the Prison Bars
• Flexible Meal Planning for Autism and ADHD
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COVER STORY
A Critical Look at Osteoporosis
With the growing food as medicine movement, it’s important for dietitians to know the limits of nutrition and lifestyle interventions so they can support their patients and clients who may be dealing with bone loss or at risk for it.
FEATURE
Cognitive Performance Nutrition
Young adults are seeking ways to enhance focus, mental clarity, and mental stamina, yet nutrition is often overlooked as a key factor in cognitive performance. Dietitians can integrate brain-focused nutrition education to empower this population to make more informed dietary decisions in ways that align with their values.
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