Mahtab Tabesh, Julian W. Sacre, Kanika Mehta, Lei Chen, Seyedeh Forough Sajjadi, Dianna J. Magliano, Jonathan E. Shaw
Aims
To quantify prospective associations of glycaemia-related factors with cognitive decline and all-cause dementia and its subtypes in people with type 2 diabetes.
Methods
We systematically searched Embase and MEDLINE (January 2000–October 2024) for studies in people with diabetes reporting longitudinal associations of a relevant exposure (i.e. hypoglycaemia, HbA1c, HbA1c variability or diabetes duration) with any of these outcomes: cognitive decline, all-cause dementia, Alzheimer's disease (AD) or vascular dementia (VaD). Data were meta-analysed using a random-effects model followed by meta-regression if appropriate.
Results
Forty studies representing 7,076,724 individuals with diabetes were included. Hypoglycaemia was significantly associated with 49% and 31% higher risks of all-cause dementia and AD, respectively. The pooled effect size did not significantly vary according to age, sex, diabetes duration, smoking, follow-up length, comorbid hypertension, kidney disease, dyslipidaemia or stroke (all p > 0.05). A positive association existed between hypoglycaemia frequency and all-cause dementia, with maximum hazard ratios (HRs) of 2.36–2.60 in the highest exposure group. HbA1c showed a positive risk gradient for all-cause dementia, with maximum significant HRs of 1.40–3.88 for the highest category, while only three studies were available for meta-analysis, with a pooled HR (95% CI) of 1.18 (0.97, 1.45). HbA1c variability and diabetes duration were each significantly associated with a higher risk of dementia. Limited evidence supported a relationship between glycaemia-related factors and cognitive decline.
Conclusions
Having a history of hypoglycaemia, longer diabetes duration, and higher HbA1c levels and variability were related to higher dementia risk in people with type 2 diabetes.
{"title":"Associations of glycaemia-related risk factors with dementia and cognitive decline in individuals with type 2 diabetes: A systematic review and meta-analysis","authors":"Mahtab Tabesh, Julian W. Sacre, Kanika Mehta, Lei Chen, Seyedeh Forough Sajjadi, Dianna J. Magliano, Jonathan E. Shaw","doi":"10.1111/dme.70123","DOIUrl":"10.1111/dme.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To quantify prospective associations of glycaemia-related factors with cognitive decline and all-cause dementia and its subtypes in people with type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched Embase and MEDLINE (January 2000–October 2024) for studies in people with diabetes reporting longitudinal associations of a relevant exposure (i.e. hypoglycaemia, HbA1c, HbA1c variability or diabetes duration) with any of these outcomes: cognitive decline, all-cause dementia, Alzheimer's disease (AD) or vascular dementia (VaD). Data were meta-analysed using a random-effects model followed by meta-regression if appropriate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty studies representing 7,076,724 individuals with diabetes were included. Hypoglycaemia was significantly associated with 49% and 31% higher risks of all-cause dementia and AD, respectively. The pooled effect size did not significantly vary according to age, sex, diabetes duration, smoking, follow-up length, comorbid hypertension, kidney disease, dyslipidaemia or stroke (all <i>p</i> > 0.05). A positive association existed between hypoglycaemia frequency and all-cause dementia, with maximum hazard ratios (HRs) of 2.36–2.60 in the highest exposure group. HbA1c showed a positive risk gradient for all-cause dementia, with maximum significant HRs of 1.40–3.88 for the highest category, while only three studies were available for meta-analysis, with a pooled HR (95% CI) of 1.18 (0.97, 1.45). HbA1c variability and diabetes duration were each significantly associated with a higher risk of dementia. Limited evidence supported a relationship between glycaemia-related factors and cognitive decline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Having a history of hypoglycaemia, longer diabetes duration, and higher HbA1c levels and variability were related to higher dementia risk in people with type 2 diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate whether people with type 1 and type 2 diabetes respond adequately to hypoglycaemia symptoms after participating in a treatment and teaching programme. Additionally, it explored how hypoglycaemia impacts patients' everyday life and the differences between individuals with and without impaired awareness of hypoglycaemia (IAH).
Methods
This cross-sectional study included 340 adult participant with type 1 (n = 156) or type 2 diabetes (n = 184) undergoing insulin therapy at the University Hospital Jena. Participants completed validated questionnaires and participated in structured interviews about hypoglycaemia. Awareness of hypoglycaemia was measured using the Gold Score, and diabetes distress with the PAID Scale (PAID Score 0–100, the higher the score the higher the distress).
Results
23.8% of the participants treated hypoglycaemia adequately (type 1 diabetes 27.6% vs. type 2 diabetes 24.7%; p = 0.606). Significantly more people without IAH-treated hypoglycaemia adequately in type 2 (27.9% vs. 10.3%; p = 0.047) but not in type 1 diabetes (28.6% vs. 23.1%; p = 0.568). Hypoglycaemia altered daily routines for 26.2% of participants, particularly those with type 1 diabetes (type 1 diabetes 37.3% vs. type 2 diabetes 20.1%; p = 0.001). People with type 1 and type 2 diabetes reporting changes in daily routines had higher diabetes distress scores (PAID: 22.3 ± 16.0 vs. 13.8 ± 13.5; p < 0.001). Fear of hypoglycaemia was associated with higher HbA1c values due to people accepting elevated blood glucose levels.
Conclusions
Despite education programmes, the majority of participants do not treat hypoglycaemia adequately. Hypoglycaemic events significantly impact daily life and are associated with increased diabetes-related distress, especially in those with IAH.
目的：调查1型和2型糖尿病患者在参加治疗和教学计划后是否对低血糖症状有充分的反应。此外，该研究还探讨了低血糖如何影响患者的日常生活，以及有和没有低血糖意识受损（IAH）的个体之间的差异。方法：这项横断面研究包括340名在耶拿大学医院接受胰岛素治疗的1型（n = 156）或2型糖尿病患者（n = 184）。参与者完成了有效的问卷调查，并参加了关于低血糖的结构化访谈。低血糖意识采用黄金评分法，糖尿病痛苦程度采用PAID评分法（PAID评分0-100，得分越高，痛苦程度越高）。结果：23.8%的参与者充分治疗了低血糖(1型糖尿病27.6% vs. 2型糖尿病24.7%；p = 0.606)。在2型糖尿病患者中，没有iah治疗的低血糖患者明显更多(27.9% vs. 10.3%；P = 0.047)，但在1型糖尿病中没有(28.6% vs. 23.1%；p = 0.568)。低血糖改变了26.2%的参与者的日常生活，特别是1型糖尿病患者(1型糖尿病37.3% vs. 2型糖尿病20.1%；p = 0.001)。报告日常生活改变的1型和2型糖尿病患者糖尿病窘迫评分较高(PAID: 22.3±16.0比13.8±13.5；由于接受血糖水平升高而导致的p1c值。结论：尽管有教育计划，大多数参与者没有充分治疗低血糖。低血糖事件显著影响日常生活，并与糖尿病相关的痛苦增加有关，特别是在IAH患者中。
{"title":"How do hypoglycaemias affect the everyday life of people with diabetes and are they able to treat them adequately?","authors":"Nicolle Müller, Christiane Kellner, Sebastian Schmidt, Nadine Kuniß, Gunter Wolf, Christof Kloos","doi":"10.1111/dme.70121","DOIUrl":"10.1111/dme.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To investigate whether people with type 1 and type 2 diabetes respond adequately to hypoglycaemia symptoms after participating in a treatment and teaching programme. Additionally, it explored how hypoglycaemia impacts patients' everyday life and the differences between individuals with and without impaired awareness of hypoglycaemia (IAH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study included 340 adult participant with type 1 (<i>n</i> = 156) or type 2 diabetes (<i>n</i> = 184) undergoing insulin therapy at the University Hospital Jena. Participants completed validated questionnaires and participated in structured interviews about hypoglycaemia. Awareness of hypoglycaemia was measured using the Gold Score, and diabetes distress with the PAID Scale (PAID Score 0–100, the higher the score the higher the distress).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>23.8% of the participants treated hypoglycaemia adequately (type 1 diabetes 27.6% vs. type 2 diabetes 24.7%; <i>p</i> = 0.606). Significantly more people without IAH-treated hypoglycaemia adequately in type 2 (27.9% vs. 10.3%; <i>p</i> = 0.047) but not in type 1 diabetes (28.6% vs. 23.1%; <i>p</i> = 0.568). Hypoglycaemia altered daily routines for 26.2% of participants, particularly those with type 1 diabetes (type 1 diabetes 37.3% vs. type 2 diabetes 20.1%; <i>p</i> = 0.001). People with type 1 and type 2 diabetes reporting changes in daily routines had higher diabetes distress scores (PAID: 22.3 ± 16.0 vs. 13.8 ± 13.5; <i>p</i> < 0.001). Fear of hypoglycaemia was associated with higher HbA<sub>1c</sub> values due to people accepting elevated blood glucose levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite education programmes, the majority of participants do not treat hypoglycaemia adequately. Hypoglycaemic events significantly impact daily life and are associated with increased diabetes-related distress, especially in those with IAH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Richard I. G. Holt, Heather Peyrot-Stuckey, Dankmar Böhning, Jo Taylor, Najma Siddiqi
Aims
People with severe mental illness (SMI) are 2–3 times more likely to have diabetes than the general population. Little is known about the impact of living with diabetes for people with SMI. This study investigates psychosocial problems and diabetes self management for people with SMI and diabetes.
Methods
We compared cross sectional survey data collected from 258 adults with diabetes and SMI in England with 500 adults with diabetes from the UK sample of the second Diabetes Attitudes, Wishes and Needs study (DAWN2). Effect size (ES) tests were used to quantify differences between the two samples adjusted for diabetes type, age, gender, treatment, treatment duration, diabetes complications and co-morbidities to achieve comparability of the two samples.
Results
Compared to the DAWN2-UK sample, people with diabetes and SMI reported poorer quality of life (WHOQOL ES −0.3 (CI −0.5, −0.1), p < 0.001), mental well-being (ES −13.4 (CI −17.3, −9.5), p < 0.001) and increased diabetes distress (PAID5 ES 1.6 (CI 0.9,2.3), p < 0.001). While people with diabetes and SMI reported a negative impact from diabetes, their SMI had a greater impact on their lives than diabetes (mental illness impact profile 2.6 ± 1.1 vs. diabetes impact profile 3.4 ± 1.0, p < 0.001). People with SMI reported being less engaged in self management than the DAWN2-UK population (SDSCA-6; ES −0.4 (CI −0.7, −0.1), p = 0.01).
Conclusions
The psychosocial impact of diabetes is greater for people with SMI. To reduce inequalities in diabetes outcomes, people with SMI and diabetes require tailored support for diabetes management that considers the additional challenges associated with living with a severe mental illness.
目的：重度精神疾病（SMI）患者患糖尿病的可能性是一般人群的2-3倍。患有糖尿病对重度精神障碍患者的影响知之甚少。本研究探讨重度精神病人和糖尿病患者的社会心理问题和糖尿病自我管理。方法：我们比较了英国258名成人糖尿病和重度精神障碍患者和英国500名成人糖尿病患者的横断面调查数据，这些数据来自第二届糖尿病态度、愿望和需求研究（DAWN2）。采用效应量（ES）检验来量化两个样本之间的差异，调整糖尿病类型、年龄、性别、治疗、治疗持续时间、糖尿病并发症和合并症，以实现两个样本的可比性。结果：与DAWN2-UK样本相比，糖尿病和重度精神障碍患者报告的生活质量较差（WHOQOL ES -0.3 (CI -0.5, -0.1), p）。结论：糖尿病对重度精神障碍患者的社会心理影响更大。为了减少糖尿病预后的不平等，重度精神障碍患者和糖尿病患者需要为糖尿病管理提供量身定制的支持，以考虑与严重精神疾病患者生活相关的额外挑战。
{"title":"The Diabetes Attitudes Wishes and Needs (DAWN)-SMI study: A cross sectional comparison of the psychosocial impact of diabetes in adults with and without severe mental illness","authors":"Richard I. G. Holt, Heather Peyrot-Stuckey, Dankmar Böhning, Jo Taylor, Najma Siddiqi","doi":"10.1111/dme.70126","DOIUrl":"10.1111/dme.70126","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>People with severe mental illness (SMI) are 2–3 times more likely to have diabetes than the general population. Little is known about the impact of living with diabetes for people with SMI. This study investigates psychosocial problems and diabetes self management for people with SMI and diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We compared cross sectional survey data collected from 258 adults with diabetes and SMI in England with 500 adults with diabetes from the UK sample of the second Diabetes Attitudes, Wishes and Needs study (DAWN2). Effect size (ES) tests were used to quantify differences between the two samples adjusted for diabetes type, age, gender, treatment, treatment duration, diabetes complications and co-morbidities to achieve comparability of the two samples.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to the DAWN2-UK sample, people with diabetes and SMI reported poorer quality of life (WHOQOL ES −0.3 (CI −0.5, −0.1), <i>p</i> < 0.001), mental well-being (ES −13.4 (CI −17.3, −9.5), <i>p</i> < 0.001) and increased diabetes distress (PAID5 ES 1.6 (CI 0.9,2.3), <i>p</i> < 0.001). While people with diabetes and SMI reported a negative impact from diabetes, their SMI had a greater impact on their lives than diabetes (mental illness impact profile 2.6 ± 1.1 vs. diabetes impact profile 3.4 ± 1.0, <i>p</i> < 0.001). People with SMI reported being less engaged in self management than the DAWN2-UK population (SDSCA-6; ES −0.4 (CI −0.7, −0.1), <i>p</i> = 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The psychosocial impact of diabetes is greater for people with SMI. To reduce inequalities in diabetes outcomes, people with SMI and diabetes require tailored support for diabetes management that considers the additional challenges associated with living with a severe mental illness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70126","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hood Thabit, Jonathan Lim, Malgorzata E. Willinska, Catherine Fullwood, Roman Hovorka, Lalantha Leelarathna
Aims
Ultra-rapid insulin lispro (URIL) is associated with faster insulin absorption and earlier offset than standard insulin lispro (IL). This study evaluated whether URIL improves glucose control in a fully closed-loop setting over an 8-h period compared to IL under conditions simulating a missed meal bolus.
Methods
In this open-label, randomised crossover trial, 18 adults with type 1 diabetes using insulin pump therapy [12 females, age 39.1 (14.2) yrs., HbA1c 57.9 (8.7) mmol/mol] completed two 8-h inpatient sessions (09:00 to 17:00 h). Glucose levels were managed using the CamAPS FX closed-loop system with either URIL or IL, in random order. Participants received a standardised meal at 11:00 h without a meal bolus. The primary endpoint was the percentage of time in range (TIR; 3.9–10 mmol/L) based on sensor glucose.
Results
Data related to the 8-h study period from 17 participants were analysed. TIR was numerically higher but not statistically significant with URIL than IL [49.3 (15.6) vs. 39.9 (18.9)%; p = 0.072], with lower time spent in Level 1 (>10 mM) [50.7 (15.6) vs. 59.5 (19.1)%; p = 0.098] and Level 2 hyperglycaemia (>13.9) [18.7 (17.1) vs. 27.9 (19.8)%; p = 0.136]. Similar trends were observed in the 4-h post-meal period. Time in hypoglycaemia was low and comparable between both periods (p > 0.05).
Conclusion
URIL in a fully closed-loop setting showed a clinically meaningful trend towards improved TIR and reduced hyperglycaemia compared to IL. Further advancements in faster-acting insulins are needed to alleviate the burden of pre-meal bolusing and enhance fully closed-loop performance in the future.
{"title":"Fully closed-loop control with ultra-rapid versus standard insulin lispro: A randomised crossover study simulating missed meal boluses","authors":"Hood Thabit, Jonathan Lim, Malgorzata E. Willinska, Catherine Fullwood, Roman Hovorka, Lalantha Leelarathna","doi":"10.1111/dme.70122","DOIUrl":"10.1111/dme.70122","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Ultra-rapid insulin lispro (URIL) is associated with faster insulin absorption and earlier offset than standard insulin lispro (IL). This study evaluated whether URIL improves glucose control in a fully closed-loop setting over an 8-h period compared to IL under conditions simulating a missed meal bolus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this open-label, randomised crossover trial, 18 adults with type 1 diabetes using insulin pump therapy [12 females, age 39.1 (14.2) yrs., HbA1c 57.9 (8.7) mmol/mol] completed two 8-h inpatient sessions (09:00 to 17:00 h). Glucose levels were managed using the CamAPS FX closed-loop system with either URIL or IL, in random order. Participants received a standardised meal at 11:00 h without a meal bolus. The primary endpoint was the percentage of time in range (TIR; 3.9–10 mmol/L) based on sensor glucose.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data related to the 8-h study period from 17 participants were analysed. TIR was numerically higher but not statistically significant with URIL than IL [49.3 (15.6) vs. 39.9 (18.9)%; <i>p</i> = 0.072], with lower time spent in Level 1 (>10 mM) [50.7 (15.6) vs. 59.5 (19.1)%; <i>p</i> = 0.098] and Level 2 hyperglycaemia (>13.9) [18.7 (17.1) vs. 27.9 (19.8)%; <i>p</i> = 0.136]. Similar trends were observed in the 4-h post-meal period. Time in hypoglycaemia was low and comparable between both periods (<i>p</i> > 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>URIL in a fully closed-loop setting showed a clinically meaningful trend towards improved TIR and reduced hyperglycaemia compared to IL. Further advancements in faster-acting insulins are needed to alleviate the burden of pre-meal bolusing and enhance fully closed-loop performance in the future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anjana Rathan, Alisa Boucsein, Hamish Crocket, Benjamin J. Wheeler
Aims
Continuous glucose monitoring (CGM) is increasingly popular in the management of type 1 diabetes (T1D). These devices have a remote monitoring function that allows for a third-party individual to monitor the user's glucose levels. While remote monitoring in CGM devices is widely used in T1D management, especially in paediatric populations, there are some individuals with T1D that do not utilise this function. This study aimed to explore the reasons behind some adults not using the remote following function on their real-time CGM (rtCGM) devices.
Methods
Adults with T1D who had been using rtCGM without the remote monitoring function were invited to participate in a semi-structured interview. Interviews explored the participants' experiences using CGM and their reasons on why remote monitoring was not for them. Interviews were analysed thematically.
Results
Interviews were conducted with fifteen people with T1D. Mean age was 27.3 years ± 9.34 SD. Thematic analysis identified three remote monitoring themes: (1) anxiety/concern regarding sharing data; (2) independence with diabetes management; and (3) desire for more customised sharing. There was a universal appeal of the efficacy, ease and practicality of glucose management with CGM devices among participants, particularly when compared to their past experiences with finger-prick testing.
Conclusions
Remote monitoring can be a valuable complement to CGM, but it may not appeal to all individuals with T1D, particularly some adults. These findings offer insights for healthcare teams and provide feedback to help CGM manufacturers develop a more customised remote monitoring experience. Some users clearly wish to prioritise privacy and autonomy while still gaining a safety net in critical situations.
{"title":"Continuous glucose monitoring remote monitoring does not meet the needs of all adult users: A qualitative study of adults with type 1 diabetes who do not use remote monitoring","authors":"Anjana Rathan, Alisa Boucsein, Hamish Crocket, Benjamin J. Wheeler","doi":"10.1111/dme.70120","DOIUrl":"10.1111/dme.70120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Continuous glucose monitoring (CGM) is increasingly popular in the management of type 1 diabetes (T1D). These devices have a remote monitoring function that allows for a third-party individual to monitor the user's glucose levels. While remote monitoring in CGM devices is widely used in T1D management, especially in paediatric populations, there are some individuals with T1D that do not utilise this function. This study aimed to explore the reasons behind some adults not using the remote following function on their real-time CGM (rtCGM) devices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults with T1D who had been using rtCGM without the remote monitoring function were invited to participate in a semi-structured interview. Interviews explored the participants' experiences using CGM and their reasons on why remote monitoring was not for them. Interviews were analysed thematically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Interviews were conducted with fifteen people with T1D. Mean age was 27.3 years ± 9.34 SD. Thematic analysis identified three remote monitoring themes: (1) anxiety/concern regarding sharing data; (2) independence with diabetes management; and (3) desire for more customised sharing. There was a universal appeal of the efficacy, ease and practicality of glucose management with CGM devices among participants, particularly when compared to their past experiences with finger-prick testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Remote monitoring can be a valuable complement to CGM, but it may not appeal to all individuals with T1D, particularly some adults. These findings offer insights for healthcare teams and provide feedback to help CGM manufacturers develop a more customised remote monitoring experience. Some users clearly wish to prioritise privacy and autonomy while still gaining a safety net in critical situations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Berhanu Elfu Feleke, Agus Salim, Dianna J. Magliano, Jonathan E. Shaw
Aims
This study was conducted to describe the annual bed-day rate and excess bed-day rate related to diabetes and to investigate the main diagnoses that account for the excess bed-days in people with diabetes in Australia.
Methods
For the diabetes population, we linked data from the Australian National Diabetes Services Scheme to the National Morbidity Inpatient Register (NMIR) and the National Death Index from 2014 to 2017. General population data were sourced from the NMIR. We used quasi-Poisson regression to estimate rates by adjusting for age, sex and fiscal year.
Results
The adjusted annual all-cause bed-day rate per 100,000 people was 323,087 (95% CI: 303,186, 344,295) for the diabetes cohort and 196,363 (192,178, 200,639) for the general population. This resulted in an annual all-cause excess bed-day rate of 126,724 (106,003, 147,445) per 100,000 people with diabetes. Approximately 42% of excess bed-days were attributed to infections, endocrine disorders and cardiovascular diseases. Foot infection had the largest single-disease annual excess bed-day rate for foot infection at 8787 (7976, 9597) per 100,000 people with diabetes and accounted for more excess bed-days than most broad disease categories. Excess bed-days were greater among women with diabetes compared to men with diabetes (p-value <0.01).
Conclusion
People with diabetes experienced a higher rate of bed-days compared to the general population, with traditional complications significantly explaining most of the excess number of bed-days observed. The major impact of foot infection on hospital burden demands greater attention be paid to the prevention and early management of foot complications.
{"title":"Total and excess bed-days in people with diabetes in Australia","authors":"Berhanu Elfu Feleke, Agus Salim, Dianna J. Magliano, Jonathan E. Shaw","doi":"10.1111/dme.70118","DOIUrl":"10.1111/dme.70118","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study was conducted to describe the annual bed-day rate and excess bed-day rate related to diabetes and to investigate the main diagnoses that account for the excess bed-days in people with diabetes in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>For the diabetes population, we linked data from the Australian National Diabetes Services Scheme to the National Morbidity Inpatient Register (NMIR) and the National Death Index from 2014 to 2017. General population data were sourced from the NMIR. We used quasi-Poisson regression to estimate rates by adjusting for age, sex and fiscal year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The adjusted annual all-cause bed-day rate per 100,000 people was 323,087 (95% CI: 303,186, 344,295) for the diabetes cohort and 196,363 (192,178, 200,639) for the general population. This resulted in an annual all-cause excess bed-day rate of 126,724 (106,003, 147,445) per 100,000 people with diabetes. Approximately 42% of excess bed-days were attributed to infections, endocrine disorders and cardiovascular diseases. Foot infection had the largest single-disease annual excess bed-day rate for foot infection at 8787 (7976, 9597) per 100,000 people with diabetes and accounted for more excess bed-days than most broad disease categories. Excess bed-days were greater among women with diabetes compared to men with diabetes (<i>p</i>-value <0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>People with diabetes experienced a higher rate of bed-days compared to the general population, with traditional complications significantly explaining most of the excess number of bed-days observed. The major impact of foot infection on hospital burden demands greater attention be paid to the prevention and early management of foot complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 12","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144824813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study investigated the real-world clinical outcomes of switching from intermittently scanned continuous glucose monitoring (isCGM) to real-time CGM (rtCGM) in adults with type 1 diabetes (T1D) from a large Canadian speciality care population.
Methods
This retrospective observational study examined data from January 1, 2018, through July 31, 2023, in the Canadian LMC Diabetes Registry. The analysis measured 6–12-month change in HbA1c in adults with T1D who switched from isCGM to rtCGM and compared changes to a propensity score-matched isCGM cohort. Changes in number of hypoglycaemic events, CGM metrics, body weight, and total daily dose (TDD) of insulin were also evaluated at 6–12-month follow-up.
Results
The full T1D rtCGM switch cohort comprised of 136 adults (mean: age 43 years, diabetes duration 20.9 years, baseline HbA1c 67 mmol/mol [8.2%]). For the full cohort, HbA1c was significantly lower at follow-up compared to baseline (∆-7 mmol/mol [∆-0.6%], p < 0.001). The propensity score-matched subset (n = 84) of these participants had a greater HbA1c reduction compared to the matched isCGM cohort (n = 84; adjusted mean difference, 5 mmol/mol [0.5%]; p = 0.002). The matched rtCGM switch subset had significantly higher time in range 3.9–10.0 mmol/L and lower time above range >10.0 mmol/L, time below range <3.9 mmol/L, and mean glucose compared to the isCGM cohort. There were no significant differences in hypoglycaemic events, body weight, and insulin TDD between the matched cohorts.
Conclusions
This real-world analysis of adults with T1D showed that switching from isCGM to rtCGM use led to significant improvements in HbA1c and CGM metrics.
{"title":"Effect of switching from intermittently scanned to real-time continuous glucose monitoring on glycaemic outcomes in adults with type 1 diabetes: A real-world, Canadian retrospective study","authors":"Lisa Chu, Alexander Abitbol","doi":"10.1111/dme.70119","DOIUrl":"10.1111/dme.70119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study investigated the real-world clinical outcomes of switching from intermittently scanned continuous glucose monitoring (isCGM) to real-time CGM (rtCGM) in adults with type 1 diabetes (T1D) from a large Canadian speciality care population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study examined data from January 1, 2018, through July 31, 2023, in the Canadian LMC Diabetes Registry. The analysis measured 6–12-month change in HbA1c in adults with T1D who switched from isCGM to rtCGM and compared changes to a propensity score-matched isCGM cohort. Changes in number of hypoglycaemic events, CGM metrics, body weight, and total daily dose (TDD) of insulin were also evaluated at 6–12-month follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The full T1D rtCGM switch cohort comprised of 136 adults (mean: age 43 years, diabetes duration 20.9 years, baseline HbA1c 67 mmol/mol [8.2%]). For the full cohort, HbA1c was significantly lower at follow-up compared to baseline (∆-7 mmol/mol [∆-0.6%], <i>p</i> < 0.001). The propensity score-matched subset (<i>n</i> = 84) of these participants had a greater HbA1c reduction compared to the matched isCGM cohort (<i>n</i> = 84; adjusted mean difference, 5 mmol/mol [0.5%]; <i>p</i> = 0.002). The matched rtCGM switch subset had significantly higher time in range 3.9–10.0 mmol/L and lower time above range >10.0 mmol/L, time below range <3.9 mmol/L, and mean glucose compared to the isCGM cohort. There were no significant differences in hypoglycaemic events, body weight, and insulin TDD between the matched cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This real-world analysis of adults with T1D showed that switching from isCGM to rtCGM use led to significant improvements in HbA1c and CGM metrics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ana Victoria Santos Castro, Karina O. Caneca, Paula M. Garcia, Veridiana Tischer, Luciana C. Theodoro, Isabella S Leão, Letícia B. Cunha, Julia B. Vieira, Ludmila N.R. Campos, Jorge L. Luescher, Joana R. Dantas, Lenita Zajdenverg, Melanie Rodacki
<p>We read with great interest the article by Dlugatch et al., recently published in <i>Diabetic Medicine</i>, which addresses inequalities in the access and use of diabetes technology among children and young people with type 1 diabetes (T1D) in the UK.<span><sup>1</sup></span> Their findings resonate strongly with the reality faced in low- and middle-income countries, particularly Brazil, where barriers to diabetes technology are even more pronounced.</p><p>Insulin pumps and continuous glucose monitoring (CGM) systems are expensive and are not currently provided by Brazil's public healthcare system (SUS), nor do private insurance routinely cover them. This creates socioeconomic inequities in diabetes care. While wealthier individuals with T1D can access and benefit from advanced technologies, those reliant on public healthcare are deprived of these tools, resulting in disparities in glycaemic control, complication risk and overall quality of care.</p><p>Even intermittent CGM (isCGM), the least costly CGM option, remains out of reach for most patients. In addition, long-acting insulin analogues are not universally provided, and many patients are still treated with neutral protamine hagedorn (NPH) insulin in combination with rapid-acting analogues. The absence of CGM impairs the ability to make informed insulin adjustments and to obtain key glycaemic control metrics, such as time in range (TIR), time above range (TAR) and time below range (TBR), which are increasingly recognized as important predictors of outcomes in T1D.</p><p>To evaluate the glycaemic patterns in patients without routine CGM access, we conducted an observational study involving 92 individuals (45 children and 47 adults) with T1D at a public diabetes clinic in Brazil. None of the participants had regular access to CGM; they relied exclusively on four to five daily capillary glucose measurements in a public healthcare clinic in Brazil. Their mean age, diabetes duration and HbA1c were 18.95 ± 10.06 years, 11.15 ± 8.48 years and 61 mmol/mol (7.7% ± 1.2%), respectively. Of these, 81.5% used long-acting insulin analogues, while 18.5% were using NPH insulin with rapid-acting analogues. After 14 days of isCGM, the mean TIR was 50.9% ± 15.1%, TAR 31.7% ± 19.1% and TBR 16.2% ± 11.4%. All metrics were outside the recommended targets. Notably, among individuals with HbA1c < 53 mmol/mol (7%), mean TBR was 21.13% ± 14.1%, with TIR and TAR at 51.9% ± 16.1% and 26.9% ± 18.1%, respectively.<span><sup>2</sup></span></p><p>In a separate case, a 24-year-old woman with T1D using NPH and rapid-acting insulin analogues, an HbA1c of 57 mmol/mol (7.4%) and satisfactory capillary glucose records, underwent a 15-day real-time CGM analysis with no recommended interventions based on CGM data. The report showed a TIR of 55%, TAR of 30% and TBR of 15%, including 10% of readings <3.9 mmol/L (<70 mg/dL) and 5% < 3.0 mmol/L (<54 mg/dL), with significant episodes of asymptomatic nocturnal hypoglyc
我们非常感兴趣地阅读了德鲁加奇等人最近发表在《糖尿病医学》（diabetes Medicine）上的文章，该文章论述了英国1型糖尿病儿童和青少年（T1D）在获取和使用糖尿病技术方面的不平等。他们的发现与中低收入国家（尤其是巴西）面临的现实产生了强烈共鸣，在这些国家，糖尿病技术的障碍更加明显。胰岛素泵和连续血糖监测（CGM）系统价格昂贵，目前巴西的公共医疗保健系统（SUS）不提供，私人保险也不经常覆盖它们。这造成了糖尿病护理方面的社会经济不平等。虽然富裕的T1D患者可以获得并受益于先进技术，但那些依赖公共医疗保健的人却无法获得这些工具，从而导致血糖控制、并发症风险和整体护理质量方面的差异。即使是间歇性CGM (isCGM)，最便宜的CGM选择，对大多数患者来说仍然是遥不可及的。此外，长效胰岛素类似物尚未普遍提供，许多患者仍使用中性鱼精蛋白hagedorn （NPH）胰岛素联合速效类似物治疗。缺乏CGM会损害患者做出明智的胰岛素调整和获得关键血糖控制指标的能力，如范围内时间（TIR）、范围以上时间（TAR）和范围以下时间（TBR），这些指标越来越被认为是T1D预后的重要预测指标。为了评估没有常规CGM治疗的患者的血糖模式，我们在巴西一家公共糖尿病诊所进行了一项观察性研究，涉及92名T1D患者（45名儿童和47名成人）。所有参与者都没有定期接触CGM；他们完全依赖于巴西一家公共医疗诊所每天四到五次的毛细血管葡萄糖测量。平均年龄18.95±10.06岁，糖尿病病程11.15±8.48岁，糖化血红蛋白61 mmol/mol（7.7%±1.2%）。其中，81.5%的患者使用长效胰岛素类似物，18.5%的患者使用NPH胰岛素和速效胰岛素类似物。isCGM治疗14天后，平均TIR为50.9%±15.1%，TAR为31.7%±19.1%，TBR为16.2%±11.4%。所有指标都超出了建议的目标。值得注意的是，在HbA1c和lt为53 mmol/mol（7%）的个体中，平均TBR为21.13%±14.1%，TIR和TAR分别为51.9%±16.1%和26.9%±18.1%。在另一个单独的病例中，一名24岁的T1D女性使用NPH和速效胰岛素类似物，HbA1c为57 mmol/mol(7.4%)，毛细血管血糖记录令人满意，接受了15天的实时CGM分析，没有基于CGM数据的推荐干预措施。报告显示，TIR为55%，TAR为30%，TBR为15%，其中10%的读数为3.9 mmol/L (70 mg/dL)， 5%的读数为3.0 mmol/L (54 mg/dL)，伴有明显的无症状夜间低血糖发作，但在常规护理中均未发现。这些数据强调了CGM在识别次优和潜在危险的血糖模式方面的关键作用，即使在HbA1c水平达到目标范围的患者中也是如此。他们进一步强调了完全依赖毛细血管血糖检测如何掩盖低血糖的风险。先前的研究表明，在T1D诊断后不久，早期开始CGM可显著改善预后，并提供持续的益处。尽管国际上越来越多的人认同转基因的好处，但巴西国家卫生技术合并委员会（CONITEC）最近建议不要将转基因纳入公共卫生保健系统这一决定反映了一个更广泛的挑战：确保在资源有限的情况下公平获得拯救生命的糖尿病技术。正如德鲁盖奇等人在英国所强调的那样，仅仅是技术的存在是不够的：获取和支持的公平是必要的。解决T1D患者在技术使用方面的差异是全世界关注的一个主要问题在巴西和其他发展中国家，克服这些差距需要协调一致的政策行动、公共投资和将服务不足的人口纳入决策过程。如果没有这些措施，改变糖尿病治疗的技术承诺将继续分配不均。这项工作得到了CNPq （Conselho Nacional de Desenvolvimento Científico e Tecnológico）的资助。作者声明无利益冲突。
{"title":"Type 1 diabetes technology gap between high-income and developing countries: Continuous glucose monitoring access remains a challenge in Brazil","authors":"Ana Victoria Santos Castro, Karina O. Caneca, Paula M. Garcia, Veridiana Tischer, Luciana C. Theodoro, Isabella S Leão, Letícia B. Cunha, Julia B. Vieira, Ludmila N.R. Campos, Jorge L. Luescher, Joana R. Dantas, Lenita Zajdenverg, Melanie Rodacki","doi":"10.1111/dme.70116","DOIUrl":"10.1111/dme.70116","url":null,"abstract":"<p>We read with great interest the article by Dlugatch et al., recently published in <i>Diabetic Medicine</i>, which addresses inequalities in the access and use of diabetes technology among children and young people with type 1 diabetes (T1D) in the UK.<span><sup>1</sup></span> Their findings resonate strongly with the reality faced in low- and middle-income countries, particularly Brazil, where barriers to diabetes technology are even more pronounced.</p><p>Insulin pumps and continuous glucose monitoring (CGM) systems are expensive and are not currently provided by Brazil's public healthcare system (SUS), nor do private insurance routinely cover them. This creates socioeconomic inequities in diabetes care. While wealthier individuals with T1D can access and benefit from advanced technologies, those reliant on public healthcare are deprived of these tools, resulting in disparities in glycaemic control, complication risk and overall quality of care.</p><p>Even intermittent CGM (isCGM), the least costly CGM option, remains out of reach for most patients. In addition, long-acting insulin analogues are not universally provided, and many patients are still treated with neutral protamine hagedorn (NPH) insulin in combination with rapid-acting analogues. The absence of CGM impairs the ability to make informed insulin adjustments and to obtain key glycaemic control metrics, such as time in range (TIR), time above range (TAR) and time below range (TBR), which are increasingly recognized as important predictors of outcomes in T1D.</p><p>To evaluate the glycaemic patterns in patients without routine CGM access, we conducted an observational study involving 92 individuals (45 children and 47 adults) with T1D at a public diabetes clinic in Brazil. None of the participants had regular access to CGM; they relied exclusively on four to five daily capillary glucose measurements in a public healthcare clinic in Brazil. Their mean age, diabetes duration and HbA1c were 18.95 ± 10.06 years, 11.15 ± 8.48 years and 61 mmol/mol (7.7% ± 1.2%), respectively. Of these, 81.5% used long-acting insulin analogues, while 18.5% were using NPH insulin with rapid-acting analogues. After 14 days of isCGM, the mean TIR was 50.9% ± 15.1%, TAR 31.7% ± 19.1% and TBR 16.2% ± 11.4%. All metrics were outside the recommended targets. Notably, among individuals with HbA1c < 53 mmol/mol (7%), mean TBR was 21.13% ± 14.1%, with TIR and TAR at 51.9% ± 16.1% and 26.9% ± 18.1%, respectively.<span><sup>2</sup></span></p><p>In a separate case, a 24-year-old woman with T1D using NPH and rapid-acting insulin analogues, an HbA1c of 57 mmol/mol (7.4%) and satisfactory capillary glucose records, underwent a 15-day real-time CGM analysis with no recommended interventions based on CGM data. The report showed a TIR of 55%, TAR of 30% and TBR of 15%, including 10% of readings <3.9 mmol/L (<70 mg/dL) and 5% < 3.0 mmol/L (<54 mg/dL), with significant episodes of asymptomatic nocturnal hypoglyc","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MaryJane S. Campbell, Alexandra Monzon, Ryan J. McDonough, Susana R. Patton
Objective
Parents of children with type 1 diabetes (T1D) frequently endorse fear of hypoglycaemia (FH) overnight when blood glucose (BG) values may be variable. We aimed to understand how fear of nighttime hypoglycaemia (FoNH) was associated with BG data, parent-reported sleep quality and the role of diabetes technology in these associations.
Methods
One hundred and thirty-six parents (M age = 43.00[6.44] years, 89% female) completed surveys. Continuous glucose monitoring data were obtained from 116 youth (M age = 12.97[2.58] years, 47.8% female) to examine blood glucose values during the day and overnight.
Results
Frequency of hypoglycaemic events overnight was not associated with parent sleep quality nor with parent FoNH, but glucose variability overnight was associated with poorer sleep quality and higher FoNH. Higher parent-reported FoNH was associated with lower sleep quality. Findings were mixed regarding the role of diabetes technology and FoNH and sleep quality. FoNH explained 26% of the variance in the association between glucose variability and parent sleep quality.
Conclusions
FoNH is a challenge for parents of youth with T1D. Targeted behavioural intervention to reduce FoNH and improve sleep may be beneficial. Future research should include objective measures of parent sleep and specific diabetes technology use overnight to disentangle mixed findings.
{"title":"Parent sleep quality and fear of nighttime hypoglycaemia","authors":"MaryJane S. Campbell, Alexandra Monzon, Ryan J. McDonough, Susana R. Patton","doi":"10.1111/dme.70110","DOIUrl":"10.1111/dme.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Parents of children with type 1 diabetes (T1D) frequently endorse fear of hypoglycaemia (FH) overnight when blood glucose (BG) values may be variable. We aimed to understand how fear of <i>nighttime</i> hypoglycaemia (FoNH) was associated with BG data, parent-reported sleep quality and the role of diabetes technology in these associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One hundred and thirty-six parents (<i>M</i> age = 43.00[6.44] years, 89% female) completed surveys. Continuous glucose monitoring data were obtained from 116 youth (<i>M</i> age = 12.97[2.58] years, 47.8% female) to examine blood glucose values during the day and overnight.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Frequency of hypoglycaemic events overnight was not associated with parent sleep quality nor with parent FoNH, but glucose variability overnight was associated with poorer sleep quality and higher FoNH. Higher parent-reported FoNH was associated with lower sleep quality. Findings were mixed regarding the role of diabetes technology and FoNH and sleep quality. FoNH explained 26% of the variance in the association between glucose variability and parent sleep quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>FoNH is a challenge for parents of youth with T1D. Targeted behavioural intervention to reduce FoNH and improve sleep may be beneficial. Future research should include objective measures of parent sleep and specific diabetes technology use overnight to disentangle mixed findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chantal M. Hulshof, Jaap J. van Netten, Tessa E. Busch-Westbroek, Louise W. E. Sabelis, Edgar J. G. Peters, Mirjam Pijnappels, Sicco A. Bus
Aims
Plantar foot ulcers are a burdensome complication of diabetes caused by abnormal foot biomechanics. Predicting foot ulcers aids in their prevention, but the value of peak pressure—the most used biomechanical parameter—is only moderate. We aimed to improve prediction based on the more comprehensive load measure cumulative plantar tissue stress (CPTS).
Methods
We prospectively observed 60 participants with diabetes at high foot ulcer risk for 12 months. At baseline, we assessed demographic and clinical characteristics—including plantar pre-ulcers (i.e., abundant callus, haemorrhage, blister, fissure)—and measured barefoot and in-shoe plantar pressures during walking and standing. Daily-life weight-bearing activity and adherence to prescribed footwear were assessed over 7 days after baseline. The primary outcome was plantar foot ulceration during the 12-month follow-up. CPTS was calculated (in GPa.s/day) from the above foot-loading factors and analysed for predicting foot ulcers and its association with pre-ulcers, using multivariate regression analyses.
Results
Twenty-two participants (37%) developed a plantar forefoot ulcer. CPTS was not a significant predictor (odds ratio (OR) = 0.90 (95% confidence interval (CI): 0.50–1.59)) but pre-ulcers at baseline (OR = 9.97, 95%CI: 1.41–70.65) and walking speed (in m/s) (OR = 0.01, 95%CI: 0.00–0.32) were. CPTS was significantly associated with pre-ulcers (OR = 2.38, 95%CI: 1.02–5.54).
Conclusions
CPTS did not predict plantar foot ulceration in our high-risk participants, but our findings support the mechanical pathway of plantar foot ulceration through pre-ulcer development and indicate lower walking speed as an important predictor. Assessing walking speed and early identifying and treating pre-ulcers will help predict and prevent plantar foot ulcers in high-risk people with diabetes.
{"title":"The predictive value of cumulative plantar tissue stress on future plantar foot ulceration in people with diabetes—A 12-month prospective observational study","authors":"Chantal M. Hulshof, Jaap J. van Netten, Tessa E. Busch-Westbroek, Louise W. E. Sabelis, Edgar J. G. Peters, Mirjam Pijnappels, Sicco A. Bus","doi":"10.1111/dme.70099","DOIUrl":"10.1111/dme.70099","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Plantar foot ulcers are a burdensome complication of diabetes caused by abnormal foot biomechanics. Predicting foot ulcers aids in their prevention, but the value of peak pressure—the most used biomechanical parameter—is only moderate. We aimed to improve prediction based on the more comprehensive load measure cumulative plantar tissue stress (CPTS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We prospectively observed 60 participants with diabetes at high foot ulcer risk for 12 months. At baseline, we assessed demographic and clinical characteristics—including plantar pre-ulcers (i.e., abundant callus, haemorrhage, blister, fissure)—and measured barefoot and in-shoe plantar pressures during walking and standing. Daily-life weight-bearing activity and adherence to prescribed footwear were assessed over 7 days after baseline. The primary outcome was plantar foot ulceration during the 12-month follow-up. CPTS was calculated (in GPa<sup>.</sup>s/day) from the above foot-loading factors and analysed for predicting foot ulcers and its association with pre-ulcers, using multivariate regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-two participants (37%) developed a plantar forefoot ulcer. CPTS was not a significant predictor (odds ratio (OR) = 0.90 (95% confidence interval (CI): 0.50–1.59)) but pre-ulcers at baseline (OR = 9.97, 95%CI: 1.41–70.65) and walking speed (in m/s) (OR = 0.01, 95%CI: 0.00–0.32) were. CPTS was significantly associated with pre-ulcers (OR = 2.38, 95%CI: 1.02–5.54).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CPTS did not predict plantar foot ulceration in our high-risk participants, but our findings support the mechanical pathway of plantar foot ulceration through pre-ulcer development and indicate lower walking speed as an important predictor. Assessing walking speed and early identifying and treating pre-ulcers will help predict and prevent plantar foot ulcers in high-risk people with diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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