Diabetic Medicine最新文献_第10页

“I feel like I'm being talked to like an equal”: Diabetes language matters to adults with diabetes, a mixed-methods study "我感觉自己被平等地对待"：糖尿病语言对成年糖尿病患者的影响，一项混合方法研究。

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine

Pub Date : 2024-08-16 DOI: 10.1111/dme.15424

Eloise Litterbach, Elizabeth Holmes-Truscott, Shikha Gray, Jennifer Halliday, Renza Scibilia, Timothy Skinner, Jane Speight

Aim

To explore reactions to and preferences for words/phrases used in communications about diabetes among adults with diabetes and parents of children with diabetes.

Methods

Eligible adults (aged 18+ years) living with diabetes, or parenting a child with diabetes, were recruited via social media to complete an online cross-sectional, mixed-methods survey. Study-specific items were used to examine 22 commonly used diabetes words/phrases in terms of participants' cognitive perceptions (‘helpful’, ‘respectful’, ‘accurate’, ‘harmful’, ‘judgmental’ and ‘inaccurate’) and emotional reactions (‘optimistic’, ‘motivated’, ‘supported’, ‘understood’, ‘offended’, ‘blamed’, ‘distressed’ and ‘angry’). Open-ended questions invited further feedback on (non-)preferred language and its impact(s). Data were analysed using descriptive statistics and inductive thematic analysis.

Results

Participants (N = 865) included adults with diabetes (type 1: n = 519; type 2: n = 180, other types: n = 48) and parents of children with diabetes (n = 118). Words/phrases most commonly associated with negative perceptions/emotional responses were ‘non-compliant’ (60% judgmental; 47% felt blamed) and ‘…good/bad’ (54% judgmental; 43% blamed). Positive perceptions were reported for ‘managing diabetes’ (73% helpful, 47% felt understood), ‘person with diabetes’ (72% respectful; 49% understood), ‘…within/outside target range’ (60% helpful, 44% understood), and ‘condition’ (58% respectful; 43% understood). Participants' qualitative responses illuminated perceptions, experiences and impacts across five themes: (1) accuracy and simplicity; (2) identity; (3) blame, judgement and stigma; (4) respect and trust and; (5) support, hope and feeling understood. Themes were consistent across diabetes types.

Conclusions

These findings provide novel evidence into (non-)preferred, and potential (negative and positive) impacts of, commonly used diabetes words/phrases, supporting the international #LanguageMatters movement.

目的：探讨成年糖尿病患者和糖尿病患儿家长对糖尿病传播中使用的词汇/短语的反应和偏好：通过社交媒体招募符合条件的成年糖尿病患者（18 岁以上）或糖尿病患儿家长，完成一项在线横断面混合方法调查。调查采用特定研究项目，从参与者的认知感知（"有益的"、"尊重的"、"准确的"、"有害的"、"评判的 "和 "不准确的"）和情绪反应（"乐观的"、"积极的"、"支持的"、"理解的"、"冒犯的"、"责备的"、"痛苦的 "和 "愤怒的"）方面对 22 个常用糖尿病词汇/短语进行了研究。开放式问题还请与会者就（非）首选语言及其影响提供进一步反馈。采用描述性统计和归纳主题分析法对数据进行了分析：参与者（N = 865）包括成人糖尿病患者（1 型：n = 519；2 型：n = 180；其他类型：n = 48）和儿童糖尿病患者的父母（n = 118）。最常与负面看法/情绪反应相关的词语/短语是 "不遵守规定"（60%的人做出判断；47%的人感到自责）和"......好/坏"（54%的人做出判断；43%的人感到自责）。对 "管理糖尿病"（73% 有帮助，47% 感觉被理解）、"糖尿病患者"（72% 尊重；49% 理解）、"...在目标范围内/外"（60% 有帮助，44% 理解）和 "病情"（58% 尊重；43% 理解）的看法是积极的。参与者的定性回答揭示了五个主题的看法、经验和影响：(1) 准确性和简单性；(2) 身份；(3) 指责、评判和污名化；(4) 尊重和信任；(5) 支持、希望和感觉被理解。不同糖尿病类型的主题是一致的：这些研究结果提供了新的证据，证明了糖尿病常用词/短语的（非）首选性和潜在（消极和积极）影响，支持了国际 #LanguageMatters 运动。

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引用次数: 0

Protocol for the Australian Type 1 Diabetes National Screening Pilot: Assessing the feasibility and acceptability of three general population screening models in children 澳大利亚 1 型糖尿病全国筛查试点方案：评估三种儿童普通人群筛查模式的可行性和可接受性。

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine

Pub Date : 2024-08-11 DOI: 10.1111/dme.15419

Kirstine J. Bell, Shannon Brodie, Jennifer J. Couper, Peter Colman, Elizabeth Davis, Gary Deed, William Hagopian, Aveni Haynes, Christel Hendrieckx, Amanda Henry, Adrienne Gordon, Kirsten Howard, Tony Huynh, Bernadette Kerr, Kara Mikler, Natasha Nassar, Sarah Norris, Richard Oram, Dorota Pawlak, Antonia Shand, Richard O. Sinnott, Bethany Wadling, John M. Wentworth, Maria E. Craig, the Type 1 Diabetes National Screening Pilot Study Group

Aim

One third of Australian children diagnosed with type 1 diabetes present with life-threatening diabetic ketoacidosis (DKA) at diagnosis. Screening for early-stage, presymptomatic type 1 diabetes, with ongoing follow-up, can substantially reduce this risk (<5% risk). Several screening models are being trialled internationally, without consensus on the optimal approach. This pilot study aims to assess three models for a routine, population-wide screening programme in Australia.

Methods

An implementation science-guided pilot study to evaluate the feasibility, acceptability and costs of three screening models in children will be conducted between July 2022 and June 2024. These models are as follows: (1) Genetic risk-stratified screening using newborn heel prick dried bloodspots, followed by autoantibody testing from 11 months of age; (2) genetic risk-stratified screening of infant (6–12 months) saliva followed by autoantibody testing from 10 months of age; and (3) autoantibody screening using capillary dried bloodspots collected from children aged 2, 6 or 10 years. Cohorts for each model will be recruited from targeted geographic areas across Australia involving ≥2 states per cohort, with a recruitment target of up to 3000 children per cohort (total up to 9000 children). The primary outcome is screening uptake for each cohort. Secondary outcomes include programme feasibility, costs, parental anxiety, risk perception, satisfaction, well-being and quality of life, and health professional attitudes and satisfaction.

Conclusions

This pilot is the first direct comparison of three screening implementation models for general population screening. Findings will provide evidence to inform a potential national screening programme for Australian children.

Trial Registration

ACTRN12622000381785.

目的：三分之一被诊断为 1 型糖尿病的澳大利亚儿童在确诊时会出现危及生命的糖尿病酮症酸中毒（DKA）。对早期、无症状的 1 型糖尿病患者进行筛查，并持续进行随访，可大大降低这一风险（方法：一项由实施科学指导的试点研究，对筛查和随访两种方法进行了评估：将在 2022 年 7 月至 2024 年 6 月期间开展一项以实施科学为指导的试点研究，以评估三种儿童筛查模式的可行性、可接受性和成本。这些模式如下(1) 利用新生儿足跟刺干血迹进行遗传风险分层筛查，然后从 11 个月大开始进行自身抗体检测；(2) 利用婴儿（6-12 个月）唾液进行遗传风险分层筛查，然后从 10 个月大开始进行自身抗体检测；以及 (3) 利用从 2、6 或 10 岁儿童身上采集的毛细管干血迹进行自身抗体筛查。每种模式的队列将从澳大利亚的目标地理区域招募，每个队列涉及≥2个州，每个队列的招募目标是最多3000名儿童（总计最多9000名儿童）。主要结果是每个队列的筛查接受率。次要结果包括计划的可行性、成本、家长的焦虑、风险意识、满意度、幸福感和生活质量，以及医疗专业人员的态度和满意度：该试验首次直接比较了普通人群筛查的三种筛查实施模式。试验登记：ACTRN12622000381785。

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引用次数: 0

Very-low-calorie diet-based intensive lifestyle intervention for remission of type 2 diabetes: Real-world experience in a South Asian population 基于极低热量饮食的强化生活方式干预，缓解 2 型糖尿病：南亚人群的实际经验。

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine

Pub Date : 2024-08-08 DOI: 10.1111/dme.15422

H. A. Dissanayake, D. R. Fernando, A. I. Nilaweera, T. D. Munasinghe, C. M. A. U. Kaushalya, M. M. Pulukkody, P. Katulanda

Aims

Very low-calorie diet (VLCD) can induce weight loss and diabetes remission (DR) amongst people with obesity and recent-onset type 2 diabetes (T2D). We aimed to determine the effectiveness and acceptability of VLCD in achieving DR amongst Sri Lankan adults with T2D.

Methods

A retrospective analysis was conducted in a diabetes practice where VLCD-based Diabetes Remission Programme (VDRP) was offered for adults (>18 years) with T2D for <3 years and body mass index over 25 kg/m². VLCD (~800 kcal/day, provided with/without diet replacement formula) was offered for 8–12 weeks, followed by gradual food reintroduction and exercise. DR was defined as HbA1c <6.5% at least 3 months after stopping glucose-lowering medications.

Results

A total of 170 participants who enrolled in the VDRP (mean age 38.4 years [±11.1], men 68%, mean baseline HbA1c 86.9 [±18.1] mmol/mol (10.1 [±2.1]%), median duration of T2D 2 years [IQR 1–2]) and 87 (51%) of them followed the programme (attended at least one follow-up visit). Amongst the individuals who followed the VDRP, 40.2% achieved DR (35/87), compared with 2.4% (2/83) amongst those who did not follow the VDRP (aHR 9.3, 95% CI 2.2–16.4, p = 0.002). The proportion achieving normoglycaemia (HbA1c < 6.5%) but continued to take glucose-lowering medication was 20/87 among VDRP followers and 20/85 amongst VDRP non-followers. The commonest reasons for not following the VDRP were too restrictive dietary quantity (92%) and difficulties in finding recommended food items (67%). Majority (79%) would recommend VDRP to others.

Conclusions

VDRP is effective in achieving T2D remission amongst Sri Lankan adults with recently diagnosed T2D and obesity. Over half of the participants followed the programme and over 75% would recommend it to others, indicating good acceptability.

目的：超低卡路里饮食（VLCD）可促使肥胖和新近发病的 2 型糖尿病（T2D）患者减轻体重和缓解糖尿病（DR）。我们旨在确定 VLCD 在斯里兰卡成年 2 型糖尿病患者中实现糖尿病缓解的有效性和可接受性：方法：我们在一家糖尿病诊所进行了一项回顾性分析，该诊所为患有 T2D 的成年人（18 岁以上）提供了基于 VLCD 的糖尿病缓解计划（VDRP），为期 2 年。提供的 VLCD（约 800 千卡/天，提供/不提供饮食替代配方）为期 8-12 周，随后逐步重新引入食物并进行锻炼。DR 的定义是 HbA1c 结果：共有 170 人参加了 VDRP（平均年龄为 38.4 岁 [±11.1]，男性占 68%，平均基线 HbA1c 为 86.9 [±18.1] mmol/mol（10.1 [±2.1] %），T2D 中位持续时间为 2 年 [IQR 1-2]），其中 87 人（51%）参加了该计划（至少参加了一次随访）。在实施 VDRP 的患者中，40.2% 的患者（35/87）实现了 DR，而在未实施 VDRP 的患者中，只有 2.4% 的患者（2/83）实现了 DR（aHR 9.3，95% CI 2.2-16.4，p = 0.002）。达到正常血糖水平的比例（HbA1c在新近确诊患有 T2D 和肥胖症的斯里兰卡成年人中，VDRP 可有效缓解 T2D。超过半数的参与者参与了该计划，超过 75% 的参与者会向他人推荐该计划，这表明该计划具有良好的可接受性。

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引用次数: 0

A comparison of the safety and effectiveness of insulin aspart with other bolus insulins in women with pre-existing Type 1 diabetes during pregnancy: A post hoc analysis of a prospective cohort study 比较天冬胰岛素与其他栓塞式胰岛素对妊娠期原有 1 型糖尿病妇女的安全性和有效性：前瞻性队列研究的事后分析。

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine

Pub Date : 2024-08-08 DOI: 10.1111/dme.15411

Elisabeth R. Mathiesen, Amra Ciric Alibegovic, Gayathri Anil, Fidelma Dunne, Tariq Halasa, Marina Ivanišević, David R. McCance, Rikke Baastrup Nordsborg, Peter Damm, the EVOLVE study group

Aims

The safety and efficacy of insulin analogue insulin aspart (IAsp) have been demonstrated in a randomised clinical trial in pregnant women with Type 1 diabetes (T1D), and IAsp is widely used during pregnancy. The aim of this study was to assess glycaemic control and safety of IAsp versus other bolus insulins in Type 1 diabetic pregnancy in a real-world setting.

Methods

This was a post hoc analysis of a prospective cohort study of 1840 pregnant women with T1D, treated with IAsp (n = 1434) or other bolus insulins (n = 406) in the Diabetes Pregnancy Registry. The primary (composite) outcome was the proportion of pregnancies resulting in major congenital malformations or perinatal or neonatal death. Secondary outcomes included all HbA_1c values measured immediately before and during pregnancy and major hypoglycaemia, as well as abortion, pre-eclampsia, pre-term delivery, large for gestational age at birth, stillbirth and fetal malformations.

Results

There were no significant differences found in any of the pregnancy outcomes between treatment with IAsp and other bolus insulins in either the crude or propensity score-adjusted analyses. However, maternal HbA_1c was lower in the IAsp group at the end of the third trimester (adjusted difference, −0.16% point [95% CI −0.28;−0.05]; −1.8 mmol/mol [95% CI −3.1;−0.6]; p = 0.0046).

Conclusions

No significant differences in safety or pregnancy outcomes were demonstrated when comparing treatment with IAsp versus other bolus insulins in women with T1D during pregnancy. The observed improvement in HbA_1c with IAsp in late pregnancy should be confirmed in other studies.

目的：在一项随机临床试验中，1 型糖尿病（T1D）孕妇使用的胰岛素类似物天冬胰岛素（IAsp）的安全性和有效性已得到证实，IAsp 在孕期得到广泛应用。本研究的目的是在实际环境中评估 1 型糖尿病孕妇使用 IAsp 与其他栓剂胰岛素的血糖控制情况和安全性：这是一项前瞻性队列研究的事后分析，研究对象是糖尿病妊娠登记处的1840名T1D孕妇，她们接受了IAsp（1434人）或其他栓剂胰岛素（406人）治疗。主要（复合）结果是导致重大先天性畸形或围产期或新生儿死亡的妊娠比例。次要结果包括孕前和孕期测量的所有 HbA1c 值、严重低血糖、流产、先兆子痫、早产、胎龄过大、死胎和胎儿畸形：无论是粗略分析还是倾向得分调整分析，均未发现使用IAsp和其他栓剂胰岛素治疗的妊娠结局有明显差异。然而，IAsp组孕妇在妊娠三个月结束时的HbA1c较低（调整后差异为-0.16%点[95% CI -0.28;-0.05]；-1.8 mmol/mol [95% CI -3.1;-0.6]；P = 0.0046）：妊娠期T1D妇女使用IAsp治疗与使用其他栓剂胰岛素治疗相比，在安全性和妊娠结局方面没有明显差异。在妊娠晚期使用IAsp可改善HbA1c，这一点应在其他研究中得到证实。

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引用次数: 0

Trends in rates of hospitalisation for infection in people with diabetes and the general population 糖尿病患者和普通人群感染住院率的变化趋势。

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine

Pub Date : 2024-08-08 DOI: 10.1111/dme.15421

Berhanu Elfu Feleke, Jonathan E. Shaw, Dianna J. Magliano

Aim

To describe the trends of hospitalisation for infections in people with diabetes and in the general population.

Methods

People with diabetes were identified from the Australian National Diabetes Services Scheme linked to hospitalisation datasets from 2010/11 to 2018/19. Data on hospitalisations in the general population were obtained from the Australian Institute of Health and Welfare. Joinpoint regression software was used to calculate the annual percentage change (APC) of rates.

Results

The rate of hospitalisation for total infections increased with an APC of 2.6% (95% CI: 1.5, 3.7) among people with type 1 diabetes, 3.6% (2.6, 4.6) among people with type 2 diabetes, and 2.5% (1.3, 3.9) in the general population. Increasing rates were observed for sepsis, influenza, kidney infections, osteomyelitis, cellulitis, and foot infections in all groups. The rate of hospitalisation for urinary tract infection declined among people with type 2 diabetes though it was stable in other groups. The rate of hospitalisation for respiratory tract infections was stable among people with type 1 diabetes but increased in other groups. The rate of hospitalisation for gastrointestinal infection was stable in all cohorts.

Conclusion

Hospitalisation rates for infection have increased more rapidly over time in people with diabetes than in the general population.

目的：描述糖尿病患者和普通人群因感染住院的趋势：从澳大利亚国家糖尿病服务计划（Australian National Diabetes Services Scheme）链接到2010/11年至2018/19年的住院数据集，确定糖尿病患者。普通人群的住院数据来自澳大利亚卫生与福利研究所。使用连接点回归软件计算感染率的年度百分比变化（APC）：结果显示：1型糖尿病患者的总感染住院率上升了2.6% (95% CI: 1.5, 3.7)，2型糖尿病患者的总感染住院率上升了3.6% (2.6, 4.6)，普通人群的总感染住院率上升了2.5% (1.3, 3.9)。在所有人群中，败血症、流感、肾脏感染、骨髓炎、蜂窝织炎和足部感染的发病率都在上升。2 型糖尿病患者的尿路感染住院率有所下降，但其他组别的住院率保持稳定。1 型糖尿病患者的呼吸道感染住院率保持稳定，但其他组别则有所上升。所有组群的胃肠道感染住院率均保持稳定：结论：随着时间的推移，糖尿病患者的感染住院率比普通人群增长得更快。

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引用次数: 0

‘We're taught green is good’: Perspectives on time in range and time in tight range from youth with type 1 diabetes, and parents of youth with type 1 diabetes 我们接受的教育是'绿色是好的'：1 型糖尿病青少年患者和 1 型糖尿病青少年患者父母对范围内时间和狭小范围内时间的看法。

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine

Pub Date : 2024-08-08 DOI: 10.1111/dme.15423

Molly L. Tanenbaum, Erica Pang, Rachel Tam, Franziska K. Bishop, Priya Prahalad, Dessi P. Zaharieva, Ananta Addala, Jessie J. Wong, Diana Naranjo, Korey K. Hood, David M. Maahs

Aims

Continuous glucose monitoring (CGM) systems are standard of care for youth with type 1 diabetes with the goal of spending >70% time in range (TIR; 70–180 mg/dL, 3.9–10 mmol/L). We aimed to understand paediatric CGM user experiences with TIR metrics considering recent discussion of shifting to time in tight range (TITR; >50% time between 70 and 140 mg/dL, 3.9 and 7.8 mmol/L).

Methods

Semi-structured interviews and focus groups with adolescents with type 1 diabetes and parents of youth with type 1 diabetes focused on experiences with TIR goals and reactions to TITR. Groups and interviews were audio-recorded, transcribed and analysed using content analysis.

Results

Thirty participants (N = 19 parents: age 43.6 ± 5.3 years, 79% female, 47% non-Hispanic White, 20 ± 5 months since child's diagnosis; N = 11 adolescents: age 15.3 ± 2 years, 55% female, 55% non-Hispanic White, 16 ± 3 months since diagnosis) attended. Participants had varying levels of understanding of TIR. Some developed personally preferred glucose ranges. Parents often aimed to surpass 70% TIR. Many described feelings of stress and disappointment when they did not meet a TIR goal. Concerns about TITR included increased stress and burden; risk of hypoglycaemia; and family conflict. Some participants said TITR would not change their daily lives; others said it would improve their diabetes management. Families requested care team support and a clear scientific rationale for TITR.

Conclusions

The wealth of CGM data creates frequent opportunities for assessing diabetes management and carries implications for management burden. Input from people with type 1 diabetes and their families will be critical in considering a shift in glycaemic goals and targets.

目的：连续葡萄糖监测（CGM）系统是 1 型糖尿病患者的标准治疗方法，其目标是 70% 以上的时间在范围内（TIR；70-180 mg/dL，3.9-10 mmol/L）。考虑到最近关于转向时间在严格范围内（TITR；>50% 的时间在 70-140 毫克/分升，3.9-7.8 毫摩尔/升之间）的讨论，我们旨在了解儿科 CGM 用户对 TIR 指标的体验：方法：对 1 型糖尿病青少年和 1 型糖尿病青少年的父母进行半结构式访谈和焦点小组讨论，重点讨论 TIR 目标的经验和对 TITR 的反应。对小组和访谈进行了录音、转录并使用内容分析法进行了分析：30 名参与者（N = 19 名家长：年龄 43.6 ± 5.3 岁，79% 为女性，47% 为非西班牙裔白人，孩子确诊后 20 ± 5 个月；N = 11 名青少年：年龄 15.3 ± 2 岁，55% 为女性，55% 为非西班牙裔白人，孩子确诊后 16 ± 3 个月）参加了此次活动。参与者对 TIR 的理解程度各不相同。有些人制定了个人偏好的血糖范围。家长通常以超过 70% 的 TIR 为目标。许多人描述了当他们没有达到 TIR 目标时的压力感和失望感。对 TITR 的担忧包括增加压力和负担、低血糖风险和家庭冲突。一些参与者表示 TITR 不会改变他们的日常生活；另一些人则表示 TITR 会改善他们的糖尿病管理。家人要求护理团队提供支持，并为 TITR 提供明确的科学依据：丰富的 CGM 数据为评估糖尿病管理创造了频繁的机会，并对管理负担产生了影响。在考虑改变血糖目标和指标时，1 型糖尿病患者及其家属的意见至关重要。

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引用次数: 0

Feasibility of caregiver diabetes distress screening in routine clinical care of youth with type 1 diabetes 在 1 型糖尿病青少年患者的常规临床护理中进行护理人员糖尿病困扰筛查的可行性。

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine

Pub Date : 2024-08-07 DOI: 10.1111/dme.15416

Einas H. Alkhatib, Lauren Clary, Angelica Eddington, Randi Streisand, Shideh Majidi

Aims

Caregiver diabetes distress (DD) consists of feeling overwhelmed, sad, and/or concerned; one-third of parents of youth with type 1 diabetes (T1D) report severe distress up to 4 years after T1D diagnosis. PAID-PR (Problem Areas in Diabetes Survey—Parent Revised) assesses DD primarily in research settings; however, less is known about its clinical utility. We aimed to identify the feasibility of implementing PAID-PR screening at a diverse, academic US paediatric diabetes center during routine clinic follow-up visits through quality improvement methodologies.

Methods

The PAID-PR was intended to be offered in English to caregivers at all paediatric T1D appointments, by the front desk during appointment check-in, or through REDCap prior to telehealth appointments or at local sites to all eligible caregivers. Adult psychosocial resources were provided to all, regardless of score. Forms were scored after appointments; scores ≥80 were referred to Diabetes Psychology providers for follow-up.

Results

A total of 391 caregivers completed the PAID-PR, though only half of eligible caregivers received it in person. Response rates were highest in person (90%), compared to REDCap (25%). In total, 27% (n = 107) scored ≥56 (DD). Of those with DD, 21% (n = 23) scored ≥80 and were referred to psychology. Demographics are reported in Table 1. PAID-PR score was positively correlated to A1c (p = 0.038) and inversely to child age (p = 0.014).

Conclusion

Clinic caregiver DD screening was implemented with higher response rates in person; however, expanding in-person screening to all eligible caregivers is necessary. Furthermore, since the PAID-PR was in English, some caregivers with DD were likely missed. Future directions include screening in additional languages.

目的：照顾者的糖尿病困扰（DD）包括感到不知所措、悲伤和/或担忧；三分之一的 1 型糖尿病（T1D）青少年患者的父母在确诊 T1D 长达 4 年后报告了严重的困扰。PAID-PR（糖尿病问题领域调查--家长修订版）主要是在研究环境中对 DD 进行评估，但对其临床实用性了解较少。我们旨在通过质量改进方法，确定在美国一家多元化的学术性儿科糖尿病中心的常规门诊随访中实施 PAID-PR 筛查的可行性：PAID-PR 计划在所有儿科 T1D 预约时以英语提供给护理人员，由前台在预约签到时提供，或在远程医疗预约前通过 REDCap 或在当地站点提供给所有符合条件的护理人员。无论得分高低，均向所有人提供成人社会心理资源。预约后对表格进行评分；得分≥80 分的护理人员将被转介给糖尿病心理服务提供者进行后续治疗：共有 391 名护理人员填写了 PAID-PR，但只有一半符合条件的护理人员亲自填写。与 REDCap（25%）相比，亲自填写的回复率最高（90%）。总计有 27% （n = 107）的人得分≥56（DD）。在 DD 患者中，21%（n = 23）的评分≥80 分，并被转介至心理科。人口统计学数据见表 1。PAID-PR 评分与 A1c 成正相关（p = 0.038），与儿童年龄成反相关（p = 0.014）：结论：门诊护理人员 DD 筛查的亲自筛查响应率较高；但是，有必要将亲自筛查扩大到所有符合条件的护理人员。此外，由于 PAID-PR 使用的是英语，因此可能会遗漏一些患有 DD 的照顾者。未来的发展方向包括使用其他语言进行筛查。

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引用次数: 0

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine

Pub Date : 2024-08-07 DOI: 10.1111/dme.15418

Hayley Smith, Steven James, Fran Brown, Michele Gaca, David O'Neal, An Tran-Duy, Nancy Devlin, Ray Kelly, Elif I. Ekinci

Aim

Incorporating health-related quality of life (HRQoL) measures into health economic analyses can help to provide evidence to inform decisions about how to improve patient outcomes in the most cost-effective manner. The aim of this narrative review was to assess which HRQoL instruments have been used in economic evaluations of type 2 diabetes management including in Indigenous communities.

Method

MEDLINE (Ovid), Embase (Ovid) and Cochrane were searched from inception to June 2022. Studies included patients with type 2 diabetes; economic evaluations, derived scores from direct questioning of individuals; and were in English. Records were assessed for bias using the JBI critical appraisal tools.

Results

A total of 3737 records were identified, with 22 publications meeting the criteria for inclusion. Across those 22 articles, nine HRQoL instruments had been utilised. Generic tools were most frequently used to measure HRQoL, including EQ-5D (−3 L and −5 L) (n = 10, 38%); SF-12 (n = 5, 19%); and SF-36 (n = 4, 15%). Two tools addressing the specific stressors faced by people with type 2 diabetes were utilised: Problem Areas In Diabetes tool (n = 1, 4%) and Diabetes Distress Scale (n = 1, 4%). Two publications reported whether the study population included Indigenous peoples.

Conclusion

A wide range of HRQoL instruments are used in economic evaluations of type 2 diabetes management, with the most frequent being varying forms of the EQ-5D. Few economic evaluations noted whether Indigenous peoples were featured in the study population. More research into HRQoL in people living with type 2 diabetes is urgently needed to improve evidence on effectiveness and cost-effectiveness of interventions.

目的：将与健康相关的生活质量（HRQoL）测量纳入卫生经济分析有助于提供证据，为如何以最具成本效益的方式改善患者预后提供决策依据。本综述旨在评估哪些 HRQoL 工具已用于 2 型糖尿病管理（包括土著社区）的经济评估：方法：检索了从开始到 2022 年 6 月的 MEDLINE (Ovid)、Embase (Ovid) 和 Cochrane。研究对象包括 2 型糖尿病患者、经济评估、通过直接询问个人得出的分数、英语。使用 JBI 关键评估工具对记录进行偏倚评估：结果：共发现 3737 条记录，其中 22 篇符合纳入标准。在这 22 篇文章中，共使用了 9 种 HRQoL 工具。通用工具最常用于测量 HRQoL，包括 EQ-5D（-3 L 和 -5 L）（n = 10，38%）、SF-12（n = 5，19%）和 SF-36（n = 4，15%）。针对 2 型糖尿病患者面临的特定压力，使用了两种工具：糖尿病问题领域工具（n = 1，4%）和糖尿病压力量表（n = 1，4%）。两篇出版物报告了研究人群中是否包括土著居民：结论：在 2 型糖尿病管理的经济评价中使用了多种 HRQoL 工具，其中最常用的是不同形式的 EQ-5D 工具。很少有经济评价指出研究人群中是否包括土著居民。迫切需要对 2 型糖尿病患者的 HRQoL 进行更多的研究，以提高干预措施的有效性和成本效益。

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引用次数: 0

Patient-reported outcomes in diabetes-related foot conditions: Is patient experience influenced by ethnicity? A mixed-methods systematic review 糖尿病足相关疾病的患者报告结果：患者体验是否受种族影响？混合方法系统综述。

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine

Pub Date : 2024-08-05 DOI: 10.1111/dme.15420

Patrick Highton, Shavez Jeffers, Ayesha Butt, Lauren O'Mahoney, Sian Jenkins, Ruksar Abdala, Louise Haddon, Clare Gillies, Ffion Curtis, Michelle Hadjiconstantinou, Kamlesh Khunti

Aims

Research in diabetes-related foot conditions (DRFC) often focuses on ulcer-related care, whilst the patient experience and influence of sociodemographic factors are under-researched. This systematic review investigated patient-reported outcomes and experience in people with DRFC.

Methods

Multiple databases were searched from inception to 16 August 2023. All original articles that assessed any patient-reported outcome or experience in DRFC and reported participant ethnicity were included. Data were synthesized using a sequential contingent approach. Study quality was assessed using study design-specific tools.

Results

Twenty-three studies were included (11 qualitative, 11 quantitative and one mixed-methods). DRFC had a largely negative impact on various life dimensions, including social and daily life, work, emotional and psychological well-being, necessitating dependence on others in the form of emotional, social and/or religious support, which were experienced differently by different groups. Patient DRFC knowledge and self-care habits were typically suboptimal, and levels of hope and feeling of control over their condition varied between groups. Outcomes varied slightly between ethnicities across studies, with some ethnicity-specific themes identified such as beliefs about disease cause and footwear habits. Quantitative and qualitative findings were mostly congruent.

Conclusions

DRFC profoundly and negatively impacts patient-reported outcomes and experience, with limited evidence suggesting an influence of ethnicity.

目的：糖尿病足相关疾病（DRFC）的研究通常侧重于溃疡相关护理，而对患者体验和社会人口因素的影响研究不足。本系统性综述调查了患者报告的结果以及 DRFC 患者的经历：方法：检索了从开始到 2023 年 8 月 16 日的多个数据库。纳入了所有评估患者报告的任何 DRFC 结果或体验的原始文章，并报告了参与者的种族。采用顺序或然法对数据进行综合。使用研究设计专用工具对研究质量进行评估：共纳入 23 项研究（11 项定性研究、11 项定量研究和 1 项混合方法研究）。DRFC 在很大程度上对生活的各个方面产生了负面影响，包括社交和日常生活、工作、情感和心理健康，因此需要以情感、社交和/或宗教支持的形式依赖他人，不同群体对这些方面的体验各不相同。患者的 DRFC 知识和自我护理习惯通常不够理想，不同群体对病情的希望和控制感也各不相同。各项研究的结果在不同种族之间略有不同，并发现了一些特定种族的主题，如对疾病原因和鞋袜习惯的看法。定量和定性研究结果大多一致：结论：DRFC 对患者报告的结果和体验产生了深远的负面影响，只有有限的证据表明这与种族有关。

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引用次数: 0

Healthcare costs attributable to diabetes in pregnancy: A cost of illness study in Tasmania, Australia 妊娠期糖尿病的医疗成本：澳大利亚塔斯马尼亚州疾病成本研究。

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine

Pub Date : 2024-08-02 DOI: 10.1111/dme.15417

Thi Thu Ngan Dinh, Barbara de Graaff, Julie A. Campbell, Matthew D. Jose, John Burgess, Timothy Saunder, Alex Kitsos, Andrew J. Palmer

Aims

To estimate the direct costs during the prenatal, delivery and postpartum periods in mothers with diabetes in pregnancy, compared to those without.

Methods

This study used a population-based dataset from 2004 to 2017, including 57,090 people with diabetes and 114,179 people without diabetes in Tasmania, Australia. Based on diagnostic codes, delivery episodes with gestational diabetes mellitus (GDM) were identified and matched with delivery episodes without diabetes in pregnancy. A group of delivery episodes with pre-existing diabetes was identified for comparison. Hospitalisation, emergency department and pathology costs of these groups were calculated and adjusted to 2020–2021 Australian dollars.

Results

There were 2774 delivery episodes with GDM, 2774 delivery episodes without diabetes and 237 delivery episodes with pre-existing diabetes identified. Across the 24-month period, the pre-existing diabetes group required the highest costs, totalling $23,536/person. This was followed by the GDM ($13,210/person), and the no diabetes group ($11,167/person). The incremental costs of GDM over the no diabetes group were $890 (95% CI 635; 1160) in the year preceding delivery; $812 (616; 1031) within the delivery period and $341 (110; 582) in the year following delivery (p < 0.05). Within the year preceding delivery, the incremental costs in the prenatal period were $803 (579; 1058) (p < 0.05). Within the year following delivery, the incremental costs in the postpartum period were $137 (55; 238) (p < 0.05).

Conclusions

Our results emphasised the importance of proper management of diabetes in pregnancy in the prenatal and postpartum periods and highlighted the significance of screening and preventative strategies for diabetes in pregnancy.

目的：与未患糖尿病的母亲相比，估算妊娠期糖尿病母亲在产前、分娩和产后期间的直接成本：这项研究使用了 2004 年至 2017 年的人口数据集，其中包括澳大利亚塔斯马尼亚州的 57090 名糖尿病患者和 114179 名非糖尿病患者。根据诊断代码，确定了患有妊娠期糖尿病（GDM）的分娩事件，并与没有妊娠期糖尿病的分娩事件进行了配对。同时还确定了一组患有糖尿病的分娩病例进行比较。计算了这些群体的住院、急诊和病理成本，并将其调整为 2020-2021 年澳元：结果：共发现 2,774 例患有 GDM 的分娩病例、2,774 例无糖尿病的分娩病例和 237 例患有糖尿病的分娩病例。在 24 个月期间，原有糖尿病组所需费用最高，共计 23,536 澳元/人。其次是 GDM 组（13,210 美元/人）和无糖尿病组（11,167 美元/人）。与无糖尿病组相比，GDM 在分娩前一年的增量成本为 890 美元（95% CI 635；1160），在分娩期为 812 美元（616；1031），在分娩后一年为 341 美元（110；582）（P 结论：我们的研究结果表明，在分娩前、分娩期、分娩后和分娩后一年中，适当控制血糖是非常重要的：我们的研究结果强调了在产前和产后对妊娠糖尿病进行适当管理的重要性，并强调了妊娠糖尿病筛查和预防策略的重要性。

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引用次数: 0