Diabetic Medicine最新文献

Background

Recessive loss-of-function NARS2 variants causing the multi-system disorder Combined oxidative phosphorylation deficiency 24 (COXPD24) have recently been reported in 3 individuals with diabetes diagnosed between 3 days and 14 months of age. In this study, we investigate the presence of NARS2 variants in a large cohort of individuals with early-onset diabetes.

Methods

We used genome and targeted next-generation sequencing to screen for rare, coding biallelic NARS2 variants in a cohort of 397 individuals diagnosed with diabetes <24 months of age of unknown genetic cause.

Results

We identified 8 individuals with homozygous disease-causing missense variants in NARS2 (4 individuals with the p.(Phe216Leu) variant, 3 with p.(Thr180Asn) and one with p.(Val440Leu)).

All 8 individuals were diagnosed with insulin-dependent diabetes before 6 months of age (neonatal diabetes, NDM) with the median age at diagnosis being 4 weeks (range: 1 to 20 weeks). 7/8 probands had low birthweight (median Z-score: −2.43, range: −4.17 to 0.86). Neurological features were common, with epilepsy and developmental delay each identified in 7/8 and 6/8 participants, respectively.

Conclusion

Taken together with previously published cases, this study shows that NDM is an important feature of COXPD-24 and highlights a critical role for NARS2 in the insulin-secreting pancreatic β-cell.

Aims

To explore the acceptability to adults with diabetes of LISTEN (Low Intensity Mental Health Support via a Telehealth Enabled Network), a brief problem-solving intervention to reduce diabetes distress, facilitated by diabetes health professionals, and identify areas for refinement.

Methods

Semi-structured interviews were conducted with 24 adults with type 1 or type 2 diabetes experiencing diabetes distress (Problem Areas in Diabetes [PAID-20] score ≥ 25, or ≥2 on three or more items) who had participated in LISTEN. Data were analysed using deductive thematic analysis, applying the theoretical framework of acceptability.

Results

Participants reported that LISTEN was valuable, supporting them with the emotional side of their diabetes and equipping them with skills to address challenges experienced in managing their diabetes. They valued the diabetes-specific knowledge the health professional brought to the sessions. Key factors associated with their satisfaction with LISTEN were their positive rapport with the health professional and accountability. Telehealth delivery was acceptable due to its convenience and anonymity. They reported that participating in LISTEN required minimal effort. Most would be willing to pay a small fee to take part, though they believe that all people with diabetes should have equitable access to LISTEN. Minor areas for refinement include flexible delivery and clearly articulating the structured, stepwise nature of the programme in pre-program information.

Conclusions

These findings indicate that LISTEN, delivered by diabetes health professionals via telehealth, is acceptable to this sample of Australian adults experiencing elevated diabetes distress and provides evidence-based strategies to strengthen engagement, delivery and implementation of LISTEN.

Aims

Self-management interventions effectively improve health outcomes in adults with Type 2 diabetes. Young adults living with Type 2 diabetes are at a higher risk of diabetes-related complications, hospitalisation and reduced quality of life. While self-management is key in diabetes care, its effectiveness in young adults with Type 2 diabetes remains unclear. This review assessed self-management interventions' impact on health outcomes in young adults (18–45 years) with Type 2 diabetes.

Methods

Five electronic databases were searched from inception to May 2024. Trials evaluating self-management interventions versus usual care in young adults were included. Outcomes of interest were clinical, self-care behaviour and psychological health. Meta-analysis used a random effects model; study quality was assessed using the Cochrane risk of bias tool (RoB2) and the JBI checklist for quasi-experimental studies. The review followed PRISMA guidelines and was registered on PROSPERO (CRD42024522979).

Results

Ten studies were included, nine in the meta-analysis, which reported no significant differences between the intervention and control groups in HbA1c, body mass index, weight, waist circumference, blood pressure, lipids, depression or self-efficacy outcomes. Nevertheless, these findings are imprecise due to few studies, missing data and small sample sizes. Commonly used behaviour change techniques were goals and planning, shaping knowledge and feedback/monitoring.

Conclusions

Existing self-management interventions did not improve clinical and psychological outcomes among young adults (18–45 years) living with Type 2 diabetes. More effective strategies are needed for this priority population.

Aims

Emerging adults with chronic diseases like diabetes often experience a decline in health during the process of transition from paediatric to adult healthcare. This study assesses the impact of transition on healthcare quality of people with diabetes, focusing on glycated haemoglobin (HbA_1c).

Methods

We conducted a systematic review and meta-analysis of the difference in HbA_1c before and after transition following the PRISMA guidelines. A comprehensive search across four databases for studies of diabetes type 1 and 2 published between 2018 and 2024 was conducted. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies.

Results

Twenty studies were included in the systematic review, fifteen to the meta-analysis. Eleven studies considered a structured or semi-structured transition programme: three reported a reduction in HbA_1c (improved glycaemic control) and eight no significant difference. Nine studies considered no transition programme: four showed a worsening of glycaemic control and five no significant difference. Overall, the meta-analysis showed a worsening of glycaemic control post-transition with mean difference (MD) −1.75 mmol/mol (−0.16%) [95% confidence interval (CI) –5.24–1.75 mmol/mol (−0.48%–0.16%)], with considerable heterogeneity, where negative values indicate higher HbA_1c post-transition. Subgroup analysis for transition programmes and usual care showed, respectively, significant improvement and worsening of glycaemic control with MD of 3.28 mmol/mol (0.30%) [95% CI 0.44–6.12 mmol/mol (0.04%–0.56%)] and −6.99 mmol/mol (−0.64%) [95% CI −11.79 to −2.19 mmol/mol (−1.08% to −0.20%)].

Conclusions

Findings suggest that the transition to adult care may negatively affect glycaemic control in emerging adults with diabetes, whereas structured transition programmes can neutralize this effect and prevent consequences. Further investigations are needed to develop evidence-based guidelines for optimizing transition interventions.

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.

Aims

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 HbA_1c 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.

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.

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.

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.

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.