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Article History

Received: 19 August 2025

Accepted: 21 January 2026

First Online: 18 March 2026

Acknowledgements

: We express our gratitude to all participants of the HKDR, collaborating doctors, nurses and healthcare assistants for their contribution in establishing this 12-year cohort. An abstract from this study was presented at the International Diabetes Federation World Diabetes Congress of 2025 in Bangkok, Thailand, on 7–10 April 2025.

: The participant-level data used and/or analysed during the current study are not available, since consent was not been obtained for data sharing. Summary data may be available from the corresponding author on reasonable request.

: A general research fund (reference no. 14121723) supported by the Research Grant Committee was awarded to JNML. The study sponsor/funder was not involved in the design of the study, in the collection, analysis and interpretation of data or in writing the report, and did not impose any restrictions regarding the publication of the report.

: APSK has received research grants and/or speaker honoraria from Abbott, Astra Zeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Kyowa Kirin, Merck Serono, Nestle, Novo Nordisk, Pfizer and Sanofi. AOYL reported receiving grants and/or honoraria for consultancy or giving lectures from Amgen, AstraZeneca, Boehringer Ingelheim, Merck Sharp & Dohme, Novartis, Novo Nordisk and Sanofi. RCWM reported receiving grants and/or honoraria for consultancy or giving lectures from AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Pfizer and Takeda and is a member of the editorial board of Diabetologia . L-LL reported receiving grants and/or honoraria for consultancy or giving lectures from AstraZeneca, Abbott, Boehringer Ingelheim, GSK, Novartis, Novo Nordisk, Viatris and Zuellig Pharma. JCNC has received research grants through her affiliated institutions and/or honoraria for consultancy or giving lectures from Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Celltrion, Eli Lilly, Hua Medicine, Merck, Merck Sharp & Dohme, Novo Nordisk, Novartis, Pfizer, Servier, Sanofi and Viatris. JNML has received a research grant from Roche Diagnostics Hong Kong Limited for a project unrelated to this manuscript. All other authors declare that there are no relationships or activities that might bias, or be perceived to bias, their contribution to this manuscript.

: YD, MZ, AQYL, JCNC and JNML contributed to the concept and design. YD, MZ, JCNC and JNML conducted the analysis and drafted the manuscript. ESHL is the data manager of the HKDR and contributed to data curation and data cleaning. All authors contributed to data collection, interpretation of results and revision of the manuscript and approved the final version for submission. JCNC and JNML are the guarantors.

: The study adhered to the Declaration of Helsinki, and written informed consent was obtained from all participants. The study was approved by the Clinical Research Ethics Committees of The Chinese University of Hong Kong (reference no. 2009.421).