Diabetic Medicine最新文献

{"title":"Comparing plantar shear strain in patients with a previous diabetes-related foot ulcer and those at low risk for ulceration using the STrain Analysis and Mapping of the Plantar Surface (STAMPS) system","authors":"Alexander D. Jones,&nbsp;Sarah Crossland,&nbsp;Jane E. Nixon,&nbsp;Heidi J. Siddle,&nbsp;Peter R. Culmer,&nbsp;David A. Russell","doi":"10.1111/dme.70164","DOIUrl":"10.1111/dme.70164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>STrain Analysis and Mapping of the Plantar Surface (STAMPS) is an innovative system using a plastically deformable insole with a stochastic speckle pattern, developed to measure peak plantar shear strain (S_MAG) in people with diabetes. The aim was to determine whether patients with a prior DFU exhibit higher S_MAG than low-risk patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants walked 20 steps with the STAMPS insole within a standardised shoe and 10 m with the Pedar-X™ (Novel, Inc.) measurement insole. S_MAG was compared in participants with either a recently healed diabetic foot ulcer (Prior DFU group) or diabetes and low risk for ulceration (NICE NG-19). Measurements were repeated three times. Images were analysed using the DIC software ‘GOM correlate’ (Zeiss, Inc.) and post-processed using MATLAB. Outcomes were overall and regional peak S_MAG and peak plantar pressure (PPP). Consenting prior DFU participants subsequently repeated the walking assessments wearing a diabetic below-knee walker-boot. Overall and regional peak S_MAG and PPP were compared between the standard shoe and walker-boot.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty participants with prior DFU and 14 at low risk were recruited. Overall peak S_MAG within the prior DFU and low-risk groups was 27.9% (IQR – 17.3–37.5%) and 11.5% (IQR 9.6–20.3%) respectively, <i>p</i> = 0.003. Within the prior DFU group, S_MAG was elevated at DFU sites compared with non-DFU sites; peak S_MAG was 11.7% (IQR 7.6–25.6%) and 7.70% (4.4–13.1%). Sixteen participants completed the offloading assessments. Peak S_MAG within the standard shoe and walker-boot was 27.4% (IQR 17.2–32.7) and 8.03% (IQR 6.3–12.2).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Participants with a recently healed DFU exhibited elevated strain characteristics compared with the low-risk group. Furthermore, prospective work will explore the relationship between S_MAG and DFU formation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145484612","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}

{"title":"Trends in admissions for hyperglycaemic emergencies and associated clinical factors in adults with type 2 diabetes in Singapore, 2013–2022","authors":"Gerald Gui Ren Sng,&nbsp;Gek Hsiang Lim,&nbsp;Kristy Jia Yi Tian,&nbsp;Yong Mong Bee,&nbsp;Ming Ming Teh","doi":"10.1111/dme.70167","DOIUrl":"10.1111/dme.70167","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Rates of diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS) have been rising in the US and Europe, but drivers remain unclear. Asian data are limited. This study examines trends and risk factors for DKA and HHS admissions among patients with type 2 diabetes (T2D) in Singapore.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed 47,489 adults (≥18 years) with T2D from a tertiary hospital in Singapore (2013–2022). DKA and HHS admissions were identified via diagnostic codes. Trends in standardized admission rates, HbA1c, and medication use were described. A nested case–control logistic regression model (1:2 incidence-density matched) was used to estimate the effect of HbA1c on the odds of admission for DKA and/or HHS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>DKA and HHS admissions increased from 2013 to 2022 despite declining mean HbA1c, though DKA rates decreased after 2020. Higher HbA1c was significantly associated with admission odds (OR 1.18, 95% CI 1.13–1.23). Other independent risk factors included younger age (OR 0.72, 95% CI 0.70–0.74), lower BMI (OR 0.96, 95% CI 0.95–0.98), social housing (OR 1.50, 95% CI 1.13–1.98), diabetes duration &gt;10 years (OR 1.58, 95% CI 1.14–2.21) and CKD stage ≥3A, with the highest odds in stage 4 (OR 5.81, 95% CI 4.13–8.17).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DKA and HHS admission rates rose despite improving HbA1c. High-risk groups may require closer monitoring and targeted interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145484608","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}

{"title":"Isoastragaloside I improves hyperglycaemia and increases β-cell mass in mice","authors":"Ankang Pan,&nbsp;Huan Wu,&nbsp;Qian Wang,&nbsp;Shuting Zhang,&nbsp;Yuhan Chen,&nbsp;Tongsheng Zhang,&nbsp;Miao Liu,&nbsp;Chun-Bo Teng","doi":"10.1111/dme.70162","DOIUrl":"10.1111/dme.70162","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aims to investigate the effects of isoastragaloside I (IAS-I) on improving diabetic symptoms and its impact on endogenous β-cell mass, and further explore the origins of increased β-cells.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Healthy and diabetic mice received IAS-I treatment (5 or 0.5 mg/kg, respectively) via tail veil injection. The blood glycaemic control, body weight, and glucose/insulin tolerance were evaluated. Safety was assessed via complete blood count and histopathological analysis. Uniformly sampled pancreatic sections (spanning the entire pancreas) were immunohistochemically stained for β-cells, imaged, and analysed by point-counting morphometry to estimate β-cell mass. Furthermore, SOX9-CreER^T2; R26-LSL-tdTomato mice were used to trace the pancreatic ductal cell, and conduct multiplex immunohistochemistry to explore the conversion of pancreatic ductal cells into β-cells.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In both healthy and diabetic mice, IAS-I could increase the β-cell mass; especially 0.5 mg/kg IAS-I significantly increased the small islet mass. Using lineage tracing, we demonstrated that IAS-I promoted the generation of β-cells from ductal cells. We also found that IAS-I could improve the fasting blood glucose and insulin resistance in diabetic mice, and the safety of IAS-I in vivo had also been preliminarily demonstrated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results suggest that IAS-I increases β-cell mass and promotes the formation of β-cells from pancreatic ductal cells in vivo. It is also speculated to possess islet-protective activity. These findings provide insight into the potential application of <i>Astragalus membranaceus</i> monomers in diabetic treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145484626","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}

{"title":"Towards better Diabetes Data Rights: Data protection, data ‘ownership’, and developing a patient charter","authors":"Ruby Reed-Berendt,&nbsp;Jessica Bell,&nbsp;Louise Hatherall,&nbsp;Holly Hayes,&nbsp;Shane O'Donnell,&nbsp;Muireann Quigley","doi":"10.1111/dme.70160","DOIUrl":"10.1111/dme.70160","url":null,"abstract":"<p>An important implication of the increasing availability and use of technologies to support care for people with diabetes is that huge quantities of data are now being generated about them on a routine basis. This has led to calls for people with diabetes to have greater access to and control over how ‘their’ health data are used. In this article, we analyse some of the legal challenges arising in this context. Focusing on the United Kingdom and European Union, we point to the lack of a clear legal framework to balance the different interests in the context of diabetes data, noting that calls for ‘data ownership’, while understandable, do not fit easily within existing legal frameworks and would not offer the kind of protections that some within the diabetes community are advocating for. We offer suggestions for supporting such calls. We first note the existing, but perhaps under-utilised, legal mechanisms available to people with diabetes over their data, such as data subject rights under the General Data Protection Regulation. Then, drawing inspiration from existing and emergent frameworks, we argue that the interests of people with diabetes could be bolstered by something like the Diabetes Data Rights Charter currently being co-developed by researchers and members of the diabetes community.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461226","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}

{"title":"Physical activity (20 min) is a powerful adjunct to insulin for correcting hyperglycaemia in Type 1 diabetes: A paradigm shift","authors":"John S. Pemberton,&nbsp;Catherine L. Russon,&nbsp;Richard M. Pulsford,&nbsp;Brad S. Metcalf,&nbsp;Emma Cockcroft,&nbsp;Michael J. Allen,&nbsp;Anne M. Frohock,&nbsp;Rob C. Andrews","doi":"10.1111/dme.70163","DOIUrl":"10.1111/dme.70163","url":null,"abstract":"&lt;p&gt;Achieving target glucose remains one of the most persistent challenges in Type 1 diabetes (T1D),&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; especially postprandially, where insulin cannot match rapid carbohydrate absorption.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In our recent publication in &lt;i&gt;Diabetic Medicine&lt;/i&gt;, we applied a causal matched-pairs analysis to continuous glucose monitoring data, enabling comparisons of periods with and without physical activity under otherwise equivalent conditions.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; When glucose was above 10 mmol/L (180 mg/dL), about 20 minutes of everyday activity lowered levels by approximately 2 mmol/L (40 mg/dL), with hypoglycaemia risk under 2%. These findings support a simple heuristic for education—‘20 by 2’ in mmol/L, or ‘20 by 40’ in mg/dL—reframing physical activity as an acute, real-time adjunct to insulin therapy for hyperglycaemia.&lt;/p&gt;&lt;p&gt;This commentary places these findings in historical and clinical context, highlights the methodological advance of causal inference through matched-pair analysis and outlines the guardrails needed for safe translation into practice.&lt;/p&gt;&lt;p&gt;The glucose-lowering effects of physical activity (PA) have been recognised for decades, but variability in individual responses has often been viewed as a barrier. In a pivotal analysis, Riddell and colleagues reported steep glucose declines in 120 adolescents with T1D undertaking 45–60 minutes of moderate walking or cycling within 4 h of prandial insulin, with hypoglycaemia in 44%.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; This gave rise to the familiar phrase, ‘the higher they start, the harder they fall’. Yet their secondary analysis, limited to PA events starting above 10.6 mmol/L (190 mg/dL) (&lt;i&gt;n&lt;/i&gt; = 41), found that activity was effective at rapidly bringing glucose back into range, with hypoglycaemia risk under 10%.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The first structured approach using PA to reduce hyperglycaemia was introduced at Birmingham Children's Hospital in 2019. Building on Riddell's findings,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; young people and families were taught: if glucose is above 10 mmol/L, ‘15 minutes lowers it by 2 mmol/L’. In 2023, evaluation of this programme showed that those most engaged achieved the greatest time in range (TIR 3.9–10.0 mmol/L; 70–180 mg/dL) without more hypoglycaemia.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The next step was to test whether these findings held in larger, more diverse populations. The Type 1 Diabetes Exercise Initiative (T1DEXI) adult and paediatric cohorts (T1DEXIP) provided this opportunity. Analysis of nearly 2000 bouts lasting 10–60 minutes confirmed that when started above 10 mmol/L, PA consistently lowered glucose into the target range.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; This effect was consistent across age, sex, regimen and activity type, establishing real-world evidence for PA in correcting hyperglycaemia.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;But this analysis lacked a control condition. To address this, in our analysis in this editio","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454388","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}

{"title":"Assessment of the added value of a tubeless pump: A time trade-off (TTO) study for utility elicitation of insulin delivery systems in type 1 diabetes mellitus (T1D)","authors":"Jackie Elliott,&nbsp;Colin Hopley,&nbsp;Danielle Riley,&nbsp;Olivia Dodd,&nbsp;Luis Val Maranes,&nbsp;Marko Tomas,&nbsp;Melanie Littlewood","doi":"10.1111/dme.70156","DOIUrl":"10.1111/dme.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Automated insulin delivery (AID) systems continuously deliver insulin subcutaneously, reducing the burden of managing type 1 diabetes mellitus (T1D). However, there are limited data comparing different insulin delivery modalities, particularly regarding their impact on health-related quality of life (HRQoL). This study aimed to quantify the disutility associated with conventional insulin delivery modalities and utility gains associated with wearable, on-body, AID systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Health state vignettes representing different insulin delivery modalities were developed based on interviews with people with T1D alongside published literature and validated by experts. Utility values were elicited via the time trade-off (TTO) method from the general population in the United Kingdom (UK) (<i>n</i> = 110).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The lowest mean utility values were observed for tubed non-AID systems (0.727), while the highest mean utility value was observed for tubeless systems with AID (0.909). The use of tubeless systems rather than tubed systems was associated with a significant increase in utility between + 0.082 and + 0.086 (<i>p</i> &lt; 0.005), and the use of AID was associated with a significant increase in utility of between +0.096 and +0.100 versus the corresponding alternatives (<i>p</i> &lt; 0.0005). The use of a tubeless and AID system was associated with a significantly increased utility versus all other health states (<i>p</i> &lt; 0.0001), indicating significantly higher HRQoL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study elicited utility values for health states representing insulin delivery modalities in T1D. Results suggested that tubeless and AID systems are associated with higher health state utility in T1D, indicating that people with T1D using such systems may experience improved HRQoL.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 12","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403275","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}

{"title":"An RCT of a family intervention for adolescents living with type 1 diabetes: Who benefits most?","authors":"Jessie J. Wong,&nbsp;Selma A. Alamarie,&nbsp;Sarah J. Hanes,&nbsp;Haley Flores,&nbsp;Jessica Ngo,&nbsp;Aika K. Schneider-Utaka,&nbsp;Korey K. Hood","doi":"10.1111/dme.70151","DOIUrl":"10.1111/dme.70151","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The current study sought to evaluate a family-based programme designed for adolescents with type 1 diabetes and their parents and identify which families benefited most.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A randomized controlled trial with a waitlist control with 157 parent–adolescent dyads collected data via online surveys and glycaemic measures at baseline and 3- and 6-month post-baseline. Regression models tested main and moderated effects on primary outcomes of percent time-in-range (% TIR) and diabetes health-related quality of life (HRQOL) and secondary outcomes of HbA1c and adolescent and parent diabetes distress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Beneficial intervention effects included improved parent report of supportive parenting (<i>β</i> = 0.151, <i>p</i> = 0.007, <i>d</i> = 0.31) and both parent (<i>β</i> = −0.177, <i>p</i> = 0.002, <i>d</i> = −0.36) and adolescent (<i>β</i> = −0.150, <i>p</i> = 0.024, <i>d</i> = −0.30) report of unsupportive parenting immediately after the intervention for the full sample. Improvements in HRQOL (<i>β</i> = 0.308, <i>p</i> = 0.002, <i>d</i> = 0.81) at 3-month post-baseline among racial and ethnic minoritized adolescents, HRQOL at 3-month (<i>β</i> = 0.261, <i>p</i> = 0.003, <i>d</i> = 0.94) and 6-month (<i>β</i> = 0.220, <i>p</i> = 0.005, <i>d</i> = 0.58) post-baseline among adolescents not using automated insulin delivery systems. The intervention also reduced parent diabetes distress among parents with high baseline distress (<i>β</i> = −0.200, <i>p</i> = 0.006, <i>d</i> = −0.54).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While family dynamics improved for all, adolescents' quality of life improved among youth with fewer resources and from marginalized racial and ethnic backgrounds, whereas parents with higher distress benefited most. For adolescents, socioeconomic context may drive intervention response.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395908","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}

{"title":"Forging a path forward in NARS2-related neonatal diabetes: A new horizon with artificial intelligence and digital health","authors":"Wenjuan Sun,&nbsp;Kunpeng Yang,&nbsp;Bao Wang,&nbsp;Le Yang","doi":"10.1111/dme.70142","DOIUrl":"10.1111/dme.70142","url":null,"abstract":"","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 12","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370611","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}

{"title":"Navigating cultural diversity in diabetes care: Insights from Australian healthcare professionals","authors":"Diane Gargya,&nbsp;Vincent Chan,&nbsp;Thilini Thrimawithana,&nbsp;Kimmi Keum Hee Ko,&nbsp;Ieva Stupans,&nbsp;Barbora de Courten,&nbsp;Chiao Xin Lim","doi":"10.1111/dme.70149","DOIUrl":"10.1111/dme.70149","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To address the growing challenge of diabetes management in culturally and linguistically diverse (CALD) populations, this study explores healthcare professionals' (HCPs) knowledge, attitudes, and practices on providing culturally appropriate diabetes care to people with diabetes of CALD backgrounds. With diabetes disproportionately affecting CALD populations, understanding how care can be tailored to socio-cultural context is critical for improving diabetes outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative design was employed, using semi-structured interviews with Australian HCPs involved in diabetes care. Eleven participants were purposively sampled to ensure diverse professional perspectives, including general practitioners, endocrinologists, nurses, pharmacists, dieticians, and a podiatrist. Data collection, conducted between April and October 2024, included face-to-face and virtual interviews. Reflexive thematic analysis, informed by critical realist ontology, was used to identify themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thematic analysis identified four themes: (1) The Compassionate Carer, focusing on empathy and building trust to provide individualised care; (2) The Lifelong Learner, emphasising cultural humility and the importance of ongoing learning; (3) The Person-Centred Provider, highlighting shared decision-making and flexible, person-driven approaches; and (4) The Culturally Attuned Provider, addressing the need for HCPs to understand the contexts of people with diabetes. HCPs demonstrated a commitment to continuous learning, adaptability, and respectful communication tailored to individuals' unique cultural contexts, with health technology supporting active engagement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights the critical role of compassion, cultural humility, and understanding in providing culturally responsive diabetes care. Supporting HCPs through ongoing learning and reflective practice, while fostering empathy and humility, is essential. Insights generated underscore the need for structural support, including organisational flexibility, interpreters, culturally tailored resources, and digital tools to improve access and communication. Aligning system-level support alongside HCPs' commitment to person-centred care is essential for providing equitable and sustainable diabetes care for CALD populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 12","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145351230","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}

{"title":"Insights into the effective use of the Smart MDI system: Data from the first 1852 type 1 diabetes users","authors":"Andrea Laurenzi,&nbsp;Shannon N Edd,&nbsp;Peter Adolfsson,&nbsp;Fabio Di Piazza,&nbsp;Benedikt Voelker,&nbsp;Glen Im,&nbsp;Tim van den Heuvel,&nbsp;Ohad Cohen","doi":"10.1111/dme.70161","DOIUrl":"10.1111/dme.70161","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The study analysed real-world data of people with type 1 diabetes (PWT1D) using the Smart Multiple Daily Insulin (MDI) system with the aim of assessing associations between user interaction behaviours and parameters of glycaemic control to provide educational insights for optimal system use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort analysis was conducted using data from 1852 PWT1D users of the Smart MDI system across 21 countries. The system comprises the InPen™ insulin injector, Simplera™ CGM, and the InPen™ phone application. Users were included if they had at least 10 days of InPen and CGM data. Glycaemic outcomes were correlated with user interaction, focusing on responses to missed dose alerts (MDA) and correct high glucose alerts (CHGA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean time in range (TIR) was 55.7%, with users responding with a bolus dose to 49.3% of MDA and 46.6% of CHGA. However, those users who responded within 1 h to over 75% of alerts with a bolus dose achieved higher TIRs of 67.2% (MDA) and 71.5% (CHGA). Prompt responses (within 10 min) showed greater TIR. The study highlighted significant associations between alert responsiveness and better glycaemic outcomes without increased hypoglycaemia risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>User engagement with the Smart MDI system is crucial for optimal glycaemic outcomes. The study underscores the need for structured education on system use and alert responses. While causality cannot be confirmed, the findings suggest that proactive user interactions contribute to meeting glycaemic targets. Further research is needed to explore these relationships and enhance educational strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 12","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70161","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288168","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}