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“When my son was diagnosed [with Type 1], I knew nothing about diabetes. I changed my research focus, thinking, as any parent would, ‘What am I going to do about this?’” says Douglas Melton.

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Breakthrough within reach for diabetes scientist and patients nearest to his heart

Harvard Correspondent

100 years after discovery of insulin, replacement therapy represents ‘a new kind of medicine,’ says Stem Cell Institute co-director Douglas Melton, whose children inspired his research

When Vertex Pharmaceuticals announced last month that its investigational stem-cell-derived replacement therapy was, in conjunction with immunosuppressive therapy, helping the first patient in a Phase 1/2 clinical trial robustly reproduce his or her own fully differentiated pancreatic islet cells, the cells that produce insulin, the news was hailed as a potential breakthrough for the treatment of Type 1 diabetes. For Harvard Stem Cell Institute Co-Director and Xander University Professor Douglas Melton, whose lab pioneered the science behind the therapy, the trial marked the most recent turning point in a decades-long effort to understand and treat the disease. In a conversation with the Gazette, Melton discussed the science behind the advance, the challenges ahead, and the personal side of his research. The interview was edited for clarity and length.

Douglas Melton

GAZETTE: What is the significance of the Vertex trial?

MELTON: The first major change in the treatment of Type 1 diabetes was probably the discovery of insulin in 1920. Now it’s 100 years later and if this works, it’s going to change the medical treatment for people with diabetes. Instead of injecting insulin, patients will get cells that will be their own insulin factories. It’s a new kind of medicine.

GAZETTE: Would you walk us through the approach?

MELTON: Nearly two decades ago we had the idea that we could use embryonic stem cells to make functional pancreatic islets for diabetics. When we first started, we had to try to figure out how the islets in a person’s pancreas replenished. Blood, for example, is replenished routinely by a blood stem cell. So, if you go give blood at a blood drive, your body makes more blood. But we showed in mice that that is not true for the pancreatic islets. Once they’re removed or killed, the adult body has no capacity to make new ones.

So the first important “a-ha” moment was to demonstrate that there was no capacity in an adult to make new islets. That moved us to another source of new material: stem cells. The next important thing, after we overcame the political issues surrounding the use of embryonic stem cells, was to ask: Can we direct the differentiation of stem cells and make them become beta cells? That problem took much longer than I expected — I told my wife it would take five years, but it took closer to 15. The project benefited enormously from undergraduates, graduate students, and postdocs. None of them were here for 15 years of course, but they all worked on different steps.

GAZETTE: What role did the Harvard Stem Cell Institute play?

MELTON: This work absolutely could not have been done using conventional support from the National Institutes of Health. First of all, NIH grants came with severe restrictions and secondly, a long-term project like this doesn’t easily map to the initial grant support they give for a one- to three-year project. I am forever grateful and feel fortunate to have been at a private institution where philanthropy, through the HSCI, wasn’t just helpful, it made all the difference.

I am exceptionally grateful as well to former Harvard President Larry Summers and Steve Hyman, director of the Stanley Center for Psychiatric Research at the Broad Institute, who supported the creation of the HSCI, which was formed specifically with the idea to explore the potential of pluripotency stem cells for discovering questions about how development works, how cells are made in our body, and hopefully for finding new treatments or cures for disease. This may be one of the first examples where it’s come to fruition. At the time, the use of embryonic stem cells was quite controversial, and Steve and Larry said that this was precisely the kind of science they wanted to support.

GAZETTE: You were fundamental in starting the Department of Stem Cell and Regenerative Biology. Can you tell us about that?

MELTON: David Scadden and I helped start the department, which lives in two Schools: Harvard Medical School and the Faculty of Arts and Science. This speaks to the unusual formation and intention of the department. I’ve talked a lot about diabetes and islets, but think about all the other tissues and diseases that people suffer from. There are faculty and students in the department working on the heart, nerves, muscle, brain, and other tissues — on all aspects of how the development of a cell and a tissue affects who we are and the course of disease. The department is an exciting one because it’s exploring experimental questions such as: How do you regenerate a limb? The department was founded with the idea that not only should you ask and answer questions about nature, but that one can do so with the intention that the results lead to new treatments for disease. It is a kind of applied biology department.

GAZETTE: This pancreatic islet work was patented by Harvard and then licensed to your biotech company, Semma, which was acquired by Vertex. Can you explain how this reflects your personal connection to the research?

MELTON: Semma is named for my two children, Sam and Emma. Both are now adults, and both have Type 1 diabetes. My son was 6 months old when he was diagnosed. And that’s when I changed my research plan. And my daughter, who’s four years older than my son, became diabetic about 10 years later, when she was 14.

When my son was diagnosed, I knew nothing about diabetes and had been working on how frogs develop. I changed my research focus, thinking, as any parent would, “What am I going to do about this?” Again, I come back to the flexibility of Harvard. Nobody said, “Why are you changing your research plan?”

GAZETTE: What’s next?

MELTON: The stem-cell-derived replacement therapy cells that have been put into this first patient were provided with a class of drugs called immunosuppressants, which depress the patient’s immune system. They have to do this because these cells were not taken from that patient, and so they are not recognized as “self.” Without immunosuppressants, they would be rejected. We want to find a way to make cells by genetic engineering that are not recognized as foreign.

I think this is a solvable problem. Why? When a woman has a baby, that baby has two sets of genes. It has genes from the egg, from the mother, which would be recognized as “self,” but it also has genes from the father, which would be “non-self.” Why does the mother’s body not reject the fetus? If we can figure that out, it will help inform our thinking about what genes to change in our stem cell-derived islets so that they could go into any person. This would be relevant not just to diabetes, but to any cells you wanted to transplant for liver or even heart transplants. It could mean no longer having to worry about immunosuppression.

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Diabetes Core Update: Special Editions

American Diabetes Association

April 2, 2024

Diabetes Core Update April 2024

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Total Time: 53:52 | File Size: 74 MB

A Phase 3, Randomized, Controlled Trial of Resmetirom in NASH with Liver Fibrosis. Harrison et al. N Engl J Med 2024;390(6):497–509. https://www.nejm.org/doi/10.1056/NEJMoa2309000 .

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February 27, 2024

Diabetes Core Update March 2024

Total Time: 24:05 | File Size: 33 MB

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January 24, 2024

Diabetes Core Update February 2024

Total Time: 33:28 | File Size: 46 MB

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Occurrence of Gastrointestinal Adverse Events Upon GLP-1 Receptor Agonist Initiation With Concomitant Metformin Use: A Post Hoc Analysis of LEADER, STEP 2, SUSTAIN-6, and PIONEER 6. Klein et al. Diabetes Care;2024;47(2):280–284. https://doi.org/10.2337/dc23-1791 .

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December 27, 2023

Diabetes Core Update January 2024

Total Time: 35:10 | File Size: 49 MB

Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. Lincoff et al. N Engl J Med 2023;389(24):2221–2232. https://doi.org/10.1056/nejmoa2307563 .

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Intensive Lifestyle Intervention for Remission of Early Type 2 Diabetes in Primary Care in Australia: DiRECT-Aus. Hocking et al. Diabetes Care 2023;47(1):66–70. https://doi.org/10.2337/dc23-0781 .

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Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Ndumele et al. Circulation 2023;148(20):1606–1635. https://doi.org/10.1161/cir.0000000000001184 .

November 24, 2023

Diabetes Core Update December 2023

Total Time: 38:28 | File Size: 53 MB

Tirzepatide vs Insulin Lispro Added to Basal Insulin in Type 2 Diabetes: The SURPASS-6 Randomized Clinical Trial. Rosenstock et al. JAMA 2023;330(17):1631–1640. https://doi.org/10.1001/jama.2023.20294 .

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The Effectiveness of Shared Decision-making for Diabetes Prevention: 24- and 36-Month Results From the Prediabetes Informed Decision and Education (PRIDE) Trial. Duru et al. Diabetes Care 2023;46(12):2218–2222. https://doi.org/10.2337/dc23-0829 .

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October 25, 2023

Diabetes Core Update November 2023

Total Time: 31:20 | File Size: 43 MB

Association Between Changes in Carbohydrate Intake and Long Term Weight Changes: Prospective Cohort Study. Wan et al. BMJ. 2023;382:e073939. https://doi.org/10.1136/bmj-2022-073939 .

Once-Weekly Insulin Icodec With Dosing Guide App Versus Once-Daily Basal Insulin Analogues in Insulin-Naive Type 2 Diabetes (ONWARDS 5) : A Randomized Trial. Bajaj et al. Ann Intern Med. 2023;Epub ahead of print. https://doi.org/10.7326/m23-1288 .

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Tight Blood-Glucose Control without Early Parenteral Nutrition in the ICU. Gunst et al. N Engl J Med 2023;389(13):1180–1190. https://doi.org/10.1056/nejmoa2304855 .

Oral Semaglutide 50 mg Taken Once Per Day in Adults With Overweight or Obesity (OASIS 1): A Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial. Knop et al. Lancet 2023;402(10403):705–719. https://doi.org/10.1016/s0140-6736(23)01185-6 .

September 26, 2023

Diabetes Core Update October 2023

Total Time: 37:57 | File Size: 52 MB

Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. Kosiborod et al. N Engl J Med. 2023;389(12):1069–1084. https://www.nejm.org/doi/10.1056/NEJMoa2306963 .

Real-world Accuracy of CGM in Inpatient Critical and Noncritical Care Settings at a Safety-Net Hospital. Finn et al. Diabetes Care 2023;46(10):1825–1830. https://doi.org/10.2337/dc23-0089 .

Leisure-Time Physical Activity and Risk of Microvascular Complications in Individuals With Type 2 Diabetes: A UK Biobank Study. Kristensen et al. Diabetes Care 2023;46(10):1816–1824. https://doi.org/10.2337/dc23-0937 .

Teplizumab: A Disease-Modifying Therapy for Type 1 Diabetes That Preserves β-Cell Function. Herold et al. Diabetes Care 2023;46(10):1848–1856. https://doi.org/10.2337/dc23-0675 .

Daily Oral GLP-1 Receptor Agonist Orforglipron for Adults with Obesity. Wharton et al. N Engl J Med. 2023;389(10):877–888. https://www.nejm.org/doi/10.1056/NEJMoa2302392 .

Risk Assessment of Kidney Disease Progression and Efficacy of SGLT2 Inhibition in Patients With Type 2 Diabetes. Moura et al. Diabetes Care 2023;46(10):1807–1815. https://doi.org/10.2337/dc23-0492 .

August 28, 2023

Diabetes Core Update September 2023

Total Time: 38:41 | File Size: 53 MB

Efficacy and safety of co-administered once-weekly cagrilintide 2·4 mg with once-weekly semaglutide 2·4 mg in type 2 diabetes: a multicentre, randomised, double-blind, active-controlled, phase 2 trial. Frias et al. Lancet 2023;402(10403):720-730. https://doi.org/10.1016/S0140-6736(23)01163-7 .

Association Between Diabetes Technology Use and Glycemic Outcomes in Adults With Type 1 Diabetes Over a Decade. Kalus et al. Diabetes Care 2023;46(9):1646–1651. https://doi.org/10.2337/dc23-0495 .

A Randomized Controlled Trial Comparing the Efficacy and Safety of IDegLira Versus Basal-Bolus in Patients With Poorly Controlled Type 2 Diabetes and Very High HbA 1c ≥9–15%: DUAL HIGH Trial. Galindo et al. Diabetes Care 2023;46(9):1640–1645. https://doi.org/10.2337/dc22-2426 .

Retatrutide, a GIP, GLP-1 and glucagon receptor agonist, for people with type 2 diabetes: a randomised, double-blind, placebo and active-controlled, parallel-group, phase 2 trial conducted in the USA. Rosenstock et al. Lancet 2023;402(10401):529-544. https://doi.org/10.1016/S0140-6736(23)01053-X .

July 26, 2023

Diabetes Core Update August 2023

Total Time: 38:50 | File Size: 54 MB

Weekly Icodec versus Daily Glargine U100 in Type 2 Diabetes without Previous Insulin. Rosenstock et al. N Engl J Med 2023;Epub ahead of print. https://www.nejm.org/doi/10.1056/NEJMoa2303208 .

Triple-Hormone-Receptor Agonist Retatrutide for Obesity - A Phase 2 Trial. Jastreboff et al. N Engl J Med 2023;Epub ahead of print. https://www.nejm.org/doi/10.1056/NEJMoa2301972 .

Effects of Tirzepatide Versus Insulin Glargine on Cystatin C–Based Kidney Function: A SURPASS-4 Post Hoc Analysis. Heerspink et al. Diabetes Care 2023;46(8):1501–1506. https://doi.org/10.2337/dc23-0261 .

Relationship Among Diabetes, Obesity, and Cardiovascular Disease Phenotypes: A UK Biobank Cohort Study. Brown et al. Diabetes Care 2023;46(8):1531–1540. https://doi.org/10.2337/dc23-0294 .

Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Garvey et al. Lancet 2023;Epub ahead of print. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01200-X/fulltext .

June 30, 2023

Diabetes Core Update July 2023

Total Time: 31:19 | File Size: 43 MB

Long-term effect of intensive lifestyle intervention on cardiometabolic risk factors and microvascular complications in patients with diabetes in real-world clinical practice: a 10-year longitudinal study. Tomah et al. BMJ Open Diabetes Res Care 2023;11(3):e003179. https://doi.org/10.1136/bmjdrc-2022-003179 .

Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis. Karam et al. BMJ 2023; 380:e072003. https://doi.org/10.1136/bmj-2022-072003 .

Beverage consumption and mortality among adults with type 2 diabetes: prospective cohort study. Ma et al. BMJ 2023;381:e073406. https://doi.org/10.1136/bmj-2022-073406 .

Severe Mental Illness and Type 2 Diabetes Outcomes and Complications: A Nationwide Cohort Study. Fleetwood et al. Diabetes Care 2023;46(7):1363–1371. https://doi.org/10.2337/dc23-0177 .

High Prevalence of NASH and Advanced Fibrosis in Type 2 Diabetes: A Prospective Study of 330 Outpatients Undergoing Liver Biopsies for Elevated ALT, Using a Low Threshold. Castera et al. Diabetes Care 2023;46(7):1354–1362. https://doi.org/10.2337/dc22-2048 .

Is COVID-19 to Blame? Trends of Incidence and Sex Ratio in Youth-Onset Type 2 Diabetes in Germany. Denzer et al. Diabetes Care 2023;46(7):1379–1387. https://doi.org/10.2337/dc22-2257 .

June 8, 2023

Diabetes Core Update June 2023

Total Time: 30:42 | File Size: 43 MB

Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients. Nissen et al. N Engl J Med 2023;388(15):1353-1364. https://www.nejm.org/doi/10.1056/NEJMoa2215024 .

Cardiovascular and Renal Benefits of Novel Diabetes Drugs by Baseline Cardiovascular Risk: A Systematic Review, Meta-analysis, and Meta-regression. Rodriguez-Valadez et al. Diabetes Care 2023;46(6):1300–1310. https://doi.org/10.2337/dc22-0772 .

A National Physician Survey of Deintensifying Diabetes Medications for Older Adults With Type 2 Diabetes. Pilla et al. Diabetes Care 2023;46(6):1164–1168. https://doi.org/10.2337/dc22-2146 .

Higher Neighborhood Drivability Is Associated With a Higher Diabetes Risk in Younger Adults: A Population-Based Cohort Study in Toronto, Canada. den Braver et al. Diabetes Care 2023;46(6):1177–1184. https://doi.org/10.2337/dc22-1549 .

Quantifying the Relationship Between Physical Activity Energy Expenditure and Incident Type 2 Diabetes: A Prospective Cohort Study of Device-Measured Activity in 90,096 Adults. Strain et al. Diabetes Care 2023;46(6):1145–1155. https://doi.org/10.2337/dc22-1467 .

Glycemic Control Over Multiple Decades and Dementia Risk in People With Type 2 Diabetes. Moran et al. JAMA Neurol Published online April 17, 2023. https://jamanetwork.com/journals/jamaneurology/article-abstract/2803244 .

April 26, 2023

Diabetes Core Update May 2023

Total Time: 33:17 | File Size: 46 MB

Cardiovascular Safety in Type 2 Diabetes With Sulfonylureas as Second-line Drugs: A Nationwide Population-Based Comparative Safety Study. Wang et al. Diabetes Care 2023;46(5):967–977. https://doi.org/10.2337/dc22-1238 .

Noninvasive Hypoglycemia Detection in People With Diabetes Using Smartwatch Data. Lehmann et al. Diabetes Care 2023;46(5):993–997. https://doi.org/10.2337/dc22-2290 .

Trial of Hybrid Closed-Loop Control in Young Children with Type 1 Diabetes. Wadwa et al. N Engl J Med. 2023;388(11):991–1001. https://www.nejm.org/doi/10.1056/NEJMoa2210834 .

Safety and efficacy of an oral insulin (Capsulin) in patients with early-stage type 2 diabetes: A dose-ranging phase 2b study. New et al. Diabetes Obes Metab 2023;25(4):953–960. https://doi.org/10.1111/dom.14922 .

Once-Weekly Basal Insulin Fc Demonstrated Similar Glycemic Control to Once-Daily Insulin Degludec in Insulin-Naive Patients With Type 2 Diabetes: A Phase 2 Randomized Control Trial. Bue-Valleskey et al. Diabetes Care 2023;46(5):1060–1067. https://doi.org/10.2337/dc22-2396 .

Recommended and Prevalent Use of Glucagon-like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter-2 Inhibitors in a National Population-Based Sample. Tang et al. Ann Intern Med 2023;176(4):582-583. https://doi.org/10.7326/M22-3051 .

March 31, 2023

Diabetes Core Update April 2023

Total Time: 30:23 | File Size: 42 MB

Initiation of Continuous Glucose Monitoring Is Linked to Improved Glycemic Control and Fewer Clinical Events in Type 1 and Type 2 Diabetes in the Veterans Health Administration. Reaven et al. Diabetes Care 2023;46(4):854–863. https://doi.org/10.2337/dc22-2189 .

Trends in the Prevalence of Lean Diabetes Among U.S. Adults, 2015–2020. Adesoba and Brown. Diabetes Care 2023;46(4):885–889. https://doi.org/10.2337/dc22-1847 .

Vitamin D and Risk for Type 2 Diabetes in People With Prediabetes : A Systematic Review and Meta-analysis of Individual Participant Data From 3 Randomized Clinical Trials. Pittas et al. Ann Intern Med 2023;176(3):355-363. https://doi.org/10.7326/M22-3018 .

Low-Carbohydrate Diet Scores and Mortality Among Adults With Incident Type 2 Diabetes. Hu et al. Diabetes Care 2023;46(4):874–884. https://doi.org/10.2337/dc22-2310 .

Trends in baseline HbA1c and body-mass index in randomised placebo-controlled trials of type 2 diabetes from 1987 to 2022: A systematic review and meta-analysis. Hu et al. EClinicalMedicine 2023;57:101868. https://doi.org/10.1016/j.eclinm.2023.101868 .

How sweet is your love? Disentangling the role of marital status and quality on average glycemic levels among adults 50 years and older in the English Longitudinal Study of Ageing. Ford and Robitaille et al. BMJ Open Diabetes Res Care 2023. https://doi.org/10.1136/bmjdrc-2022-003080 .

February 27, 2023

Diabetes Core Update March 2023

Total Time: 29:23 | File Size: 41 MB

Efficacy of Dapagliflozin by Baseline Diabetes Medications: A Prespecified Analysis From the DAPA-CKD Study. Beernink et al. Diabetes Care 2023;46(3):602-607. https://doi.org/10.2337/dc22-1514 .

An Examination of Whether Diabetes Control and Treatments Are Associated With Change in Frailty Index Across 8 Years: An Ancillary Exploratory Study From the Action for Health in Diabetes (Look AHEAD) Trial. Simpson et al. Diabetes Care 2023;46(3):519-525. https://doi.org/10.2337/dc22-1728 .

Semaglutide Improves Cardiometabolic Risk Factors in Adults With Overweight or Obesity: STEP 1 and 4 Exploratory Analyses. Kosiborod et al. Diabetes Obes Metab 2023;25(2):468-478. https://doi.org/10.1111/dom.14890 .

Glucagon Prescribing and Costs Among U.S. Adults With Diabetes, 2011–2021. Herges et al. Diabetes Care 2023;46(3):620-627. https://doi.org/10.2337/dc22-1564. .

Two-Year Follow-up From the T1GER Study: Continued Off-Therapy Metabolic Improvements in Children and Young Adults With New-Onset T1D Treated With Golimumab and Characterization of Responders. Rigby et al. Diabetes Care 2023;46(3):561–569. https://doi.org/10.2337/dc22-0908 .

Youth-Onset Type 2 Diabetes: The Epidemiology of an Awakening Epidemic. Perng et al. Diabetes Care 2023;46(3):490-499. https://doi.org/10.2337/dci22-0046 .

January 25, 2023

Diabetes Core Update February 2023

Total Time: 28:47 | File Size: 40 MB

Dietary Factors and All-Cause Mortality in Individuals With Type 2 Diabetes: A Systematic Review and Meta-analysis of Prospective Observational Studies. Barbaresko et al. Diabetes Care 2023;46(2):469-477. https://doi.org/10.2337/dc22-1018 .

Prevalence and Predictors of Household Food Insecurity and Supplemental Nutrition Assistance Program Use in Youth and Young Adults With Diabetes: The SEARCH for Diabetes in Youth Study. Malik et al. Diabetes Care 2023;46(2):278-285. https://doi.org/10.2337/dc21-0790 .

Association of Sodium–Glucose Cotransporter 2 Inhibitors With Time to Dementia: A Population-Based Cohort Study. Wu et al. Diabetes Care 2023;46(2):297-304. https://doi.org/10.2337/dc22-1705 .

Concomitant Use of Sulfonylureas and β-Blockers and the Risk of Severe Hypoglycemia Among Patients With Type 2 Diabetes: A Population-Based Cohort Study. Dimakos et al. Diabetes Care 2023;46(2):377-383. https://doi.org/10.2337/dc22-1584 .

LY3437943, A Novel Triple GIP, GLP-1, and Glucagon Receptor Agonist in People With Type 2 Diabetes: A Phase 1b, Multicentre, Double-Blind, Placebo-Controlled, Randomised, Multiple-Ascending Dose Trial. Urva et al. Lancet 2022;400(10366):1869-1881. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02033-5/fulltext .

Different Types of Industry-Produced and Ruminant Trans Fatty Acid Intake and Risk of Type 2 Diabetes: Findings From the NutriNet-Santé Prospective Cohort. Wendeu-Foyet et al. Diabetes Care 2023;46(2):321-330. https://doi.org/10.2337/dc22-0900 .

December 28, 2022

Diabetes Core Update January 2023

Total Time: 27:52 | File Size: 39 MB

Long-term Weight Training and Mortality in U.S. Male Health Professionals With and Without Type 2 Diabetes. Lee et al. Diabetes Care 2023;46(1):138–148. https://doi.org/10.2337/dc21-2420 .

Trajectories of Cognition and Daily Functioning Before and After Incident Diabetes. Ji et al. Diabetes Care 2023;46(1):75–82. https://doi.org/10.2337/dc22-1190 .

The Portfolio Diet and Incident Type 2 Diabetes: Findings From the Women's Health Initiative Prospective Cohort Study. Glenn et al. Diabetes Care 2023;46(1):28–37. https://doi.org/10.2337/dc22-1029 .

Racial Disparities in Access and Use of Diabetes Technology Among Adult Patients With Type 1 Diabetes in a U.S. Academic Medical Center. Kanbour et al. Diabetes Care 2023;46(1):56–64. https://doi.org/10.2337/dc22-1055 .

Deficits and Disparities in Early Uptake of Glucagon-Like Peptide 1 Receptor Agonists and SGLT2i Among Medicare-Insured Adults Following a New Diagnosis of Cardiovascular Disease or Heart Failure. Cromer et al. Diabetes Care 2023;46(1):65–74. https://doi.org/10.2337/dc22-0383 .

Sleep Duration and Risks of Incident Cardiovascular Disease and Mortality Among People With Type 2 Diabetes. Han et al. Diabetes Care 2023;46(1):101–110. https://doi.org/10.2337/dc22-1127 .

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