Diabetic Medicine最新文献

Aims

In the general population, individuals who self-identify as girls and women are typically less active and report more barriers to physical activity (PA), often influenced by gender stereotypes and sociocultural norms. These barriers may be accentuated in individuals with type 1 diabetes (T1D), who face additional diabetes-related barriers to engaging in PA.

Methods

In this narrative review, electronic databases were searched using keywords related to PA barriers and T1D. Titles, abstracts and full texts were screened to select articles analysing gender effects or reporting specific data on girls/women with T1D versus peers without diabetes.

Results

While many studies have examined gender effects on PA levels in T1D (consistently reporting lower overall and vigorous-intensity PA in girls/women), few have explored gender effects on barriers to PA. Among the ten barrier-related studies, some (but not all) suggest that girls/women report higher overall PA barrier scores and diabetes-related concerns, such as fear of hypoglycaemia, hyperglycaemia or losing control over diabetes management, compared with boys/men. The interactions between PA barriers and PA levels appear complex and may vary between adults and children. However, these interactions remain understudied from a gender perspective.

Conclusions

Fear of glycaemic challenges related to PA appears to be a greater barrier for girls/women with T1D versus boys/men. However, further research is needed to examine universal barriers to PA. Interactions between diabetes-related or universal barriers with lower habitual PA also require exploration as a first step towards developing appropriate PA promotion initiatives, whether focused on glycaemic management education or social factors.

Aims

Our study described incidence and prevalence trends of type 1 diabetes in children and youth under 20 years of age from 1997 to 2023 in the Canadian province of British Columbia (BC) and assessed for a 4-, 5-, or 6-year cyclicity or increase in incidence during the COVID-19 pandemic.

Methods

Using linked population-level databases and a validated case-finding and diabetes differentiating algorithm, we identified children with type 1 diabetes diagnosed between 1997 and 2023. Data sources included hospital admissions, outpatient physician visits, and dispensed prescriptions. Population denominators were based on annual age- and sex-stratified population estimates. We calculated incidence per 100,000 and prevalence per 100 cases, using JoinPoint regression to identify trend changes. Cyclical patterns were tested using sine and cosine terms.

Results

From 1997 to 2023, the incidence of paediatric type 1 diabetes increased markedly until 2008 and then declined very gradually, with similar patterns across age and sex. Incidence was higher in boys, highest among children aged 5 to 14 years, and lowest in those aged 15 to 19 years. After 2012, prevalent cases stabilized in those under 10 and decreased in those over 10 years old. There was no evidence of cyclical trends or changes in incidence or prevalence during or after the COVID-19 pandemic.

Conclusions/Interpretation

We report a stabilization of type 1 diabetes incidence and prevalence, along with the absence of pandemic-related increases. These trends may in part reflect demographic changes in British Columbia's paediatric population, including a growing proportion of children from immigrant backgrounds with historically lower type 1 diabetes risk. Unfortunately, our data sources do not include ethnicity, limiting our ability to explore these patterns directly. This study will support the optimization of resource allocation and inform healthcare improvement and long-term management of childhood type 1 diabetes.

Aims

This study aimed to assess the impact of the Omnipod 5 automated insulin delivery (AID) system on continuous glucose monitoring (CGM) metrics, HbA1c, and weight in a real-world setting. Additionally, independent predictors of glycaemic response were assessed.

Methods

Observational analysis of adults with type 1 diabetes using Omnipod 5 (n = 353). Paired data on CGM metrics (n = 268), HbA1c (n = 193), and weight (n = 173) were collected at baseline and compared after median of 191, 120, and 221 days, respectively. Independent predictors of TIR response (≥5%) and HbA1c (≥5 mmol/mol) were assessed.

Results

Omnipod 5 use was associated with improved TIR (+16%, p < 0.001) and a reduction in HbA1c (−3 mmol/mol, p < 0.001). The greatest improvements (−7 mmol/mol, p < 0.001) were observed in individuals with elevated baseline HbA1c (≥58 mmol/mol). Sensor choice (Dexcom G6 vs. Freestyle Libre 2 Plus) influenced time in full auto mode (94% vs. 96%, p < 0.001) but did not affect the likelihood of improved TIR or HbA1c. Logistic regression identified baseline HbA1c (OR 1.24 per mmol/mol, p < 0.001) as the main association with improved HbA1c. Similarly, baseline TIR was associated with improvement in TIR (OR 0.83 per %, p < 0.001). Greater time in automation and using the lowest glucose target were also associated with improved outcomes.

Conclusions

Omnipod 5 is associated with significant and sustained improvements in CGM metrics and HbA1c, particularly in individuals with higher baseline HbA1c. The results suggest the potential benefits of prioritizing AID for individuals at greatest risk of complications.

Aims

To investigate the impact of a multidisciplinary preoperative diabetes clinic on glycaemic and clinical outcomes in adults undergoing elective noncardiac surgery.

Methods

Seventy-nine adults scheduled for elective noncardiac surgery with haemoglobin A1c (HbA_1c) levels ≥64 mmol/mol (8.0%) were prospectively recruited. Participants received regular preoperative consultations with a pharmacist, diabetes nurse and diabetologist. Changes in HbA_1c and serum fructosamine levels between baseline and the day of surgery were compared using a paired t-test and linear regression.

Results

Mean HbA_1c at baseline was 83 mmol/mol (9.7%). There was a significant reduction in HbA_1c levels measured on the day of surgery, with mean HbA_1c being 63 mmol/mol (7.9%), equating to a mean reduction of −21 mmol/mol (95% CI −24, −16, p < 0.001). Linear regression analysis identified a significant negative relationship between baseline HbA_1c and change in HbA_1c, whereby each 1% increase in baseline HbA_1c predicted a −0.759% decrease in day of surgery HbA_1c. Median baseline fructosamine level was 361 μmol/L, and the median reduction on the day of surgery was −53 μmol/L (IQR −87 to −26 μmol/L, p < 0.001). Fructosamine levels measured 4 weeks postsurgery showed no significant change compared with the day of surgery. Median length of stay was 2 days (IQR 1–5), and there was a low incidence of in-hospital infections and readmissions in the cohort.

Conclusions

The multidisciplinary clinic was effective in improving participants' glycaemic control before elective noncardiac surgery. Individuals with the highest baseline HbA_1c levels had the greatest preoperative improvement. This study highlights the meaningful impact on glycaemic management that can be achieved in the preoperative period. Parts of this work were previously presented at the 13th Australasian Symposium of the Perioperative Medicine Special Interest Group in collaboration with Summit III and the Perioperative Quality Initiative (POQI), 22–24 November 2024, Melbourne, Australia.

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.