Practical Diabetes最新文献

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Why do we continue to exclude the most vulnerable in our society in diabetes research and education? Addressing the challenges presented by people with intellectual disability 为什么我们在糖尿病研究和教育中继续排斥社会中最脆弱的群体？应对智障人士带来的挑战

IF 0.6 Q3 Medicine

Practical Diabetes

Pub Date : 2024-05-01 DOI: 10.1002/pdi.2499

Laurence Taggart

People with an intellectual disability are more likely to develop diabetes compared to their non‐disabled peers. There has been a history of exclusion of people with an intellectual disability from diabetes research and education: we must now challenge this from a human rights perspective. In challenging these perceptions, we must identify the ethical and methodological reasons for exclusion and offer practical solutions to these challenges.These barriers to inclusion focus on three core areas. Firstly, individual factors concerning the person with the disability (can the person give their own informed consent, can the person read/write, completion of self‐report measures?). Secondly, factors concerning the methodology and design of the research study (can studies recruit the numbers needed, can people with intellectual disability understand/accept randomisation?). And, thirdly, system/organisational factors pertaining to the enablers/barriers to engaging in and completing research studies (buy‐in from senior managers, staff acting as gatekeepers, maternalistic attitudes held by gatekeepers, fidelity of intervention delivery).This Janet Kinson paper will explore these intentional and unintentional exclusion criteria that are so often applied to people with an intellectual disability in research trial studies. This paper will dispel the myths and offer solutions for including people with an intellectual disability in diabetes research and education. Using the UK national diabetes structured education programme, DESMOND, this paper will highlight the types of reasonable adjustments that can be made to adapt this programme suitable for adults with an intellectual disability: called DESMOND‐ID. This paper will demonstrate how, with reasonable adjustments, this newly‐adapted DESMOND‐ID education programme then can be tested within a National Institute for Health and Care Research clinical randomised control trial across the UK investigating the programme's clinical and cost‐effectiveness. Copyright © 2024 John Wiley & Sons.

智障人士比非智障人士更容易患糖尿病。智障人士被排斥在糖尿病研究和教育之外已有一段历史：我们现在必须从人权的角度对这一现象提出挑战。在挑战这些观念的过程中，我们必须找出排斥的道德和方法原因，并针对这些挑战提出切实可行的解决方案。首先，与残疾人有关的个人因素（残疾人能否做出知情同意、能否读/写、能否完成自我报告措施？）第二，与研究方法和研究设计有关的因素（研究能否招募到所需的人数，智障人士能否理解/接受随机化？）第三，系统/组织因素，这些因素涉及参与和完成研究的有利因素/障碍（高级管理人员的认同、作为把关人的员工、把关人持有的母性态度、干预实施的忠实性）。珍妮特-金森的这篇论文将探讨这些有意和无意的排除标准，这些标准在研究试验中经常被应用于智障人士。本文将消除人们的误解，并提出将智障人士纳入糖尿病研究和教育的解决方案。本文将利用英国国家糖尿病结构化教育计划 DESMOND，重点介绍可以进行哪些类型的合理调整，以使该计划适合智障成人：即 DESMOND-ID。本文将展示如何通过合理调整，在英国国家健康与护理研究所的临床随机对照试验中测试新改编的 DESMOND-ID 教育计划，以调查该计划的临床和成本效益。版权所有 © 2024 约翰威利父子公司。

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Homeless but not hopeless: overcoming the challenges of managing diabetes in people with lived experience of homelessness 无家可归但不绝望：克服有无家可归经历者管理糖尿病的挑战

IF 0.6 Q3 Medicine

Practical Diabetes

Pub Date : 2024-05-01 DOI: 10.1002/pdi.2500

Jack Colley, Mustafa Mahdi, Ruth Poole

Using a case vignette by way of illustration, Dr Jack Colley, Dr Mustafa Mahdi and Dr Ruth Poole here provide key practical advice on how to manage diabetes in individuals with lived experience of homelessness.

杰克-科利（Jack Colley）博士、穆斯塔法-马赫迪（Mustafa Mahdi）博士和露丝-普尔（Ruth Poole）博士通过一个案例，就如何管理有无家可归经历者的糖尿病提供了重要的实用建议。

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Novel primary care research is showcased in Brighton at the latest Society for Academic Primary Care annual scientific meeting 新颖的初级保健研究在布赖顿举行的最新初级保健学术学会年度科学会议上得到展示

IF 0.6 Q3 Medicine

Practical Diabetes

Pub Date : 2024-05-01 DOI: 10.1002/pdi.2505

Steve Titmarsh

Is face‐to‐face better than a virtual consultation? How do people feel about artificial intelligence helping with diabetic eye screening? And, are there ethnic variations in infection risk in type 2 diabetes?These were just a small sample of questions that research presented at the 51st Annual Scientific Meeting of the Society for Academic Primary Care, held over two days in Brighton in July 2023, tried to address. Steve Titmarsh reports.

面对面咨询比虚拟咨询更好吗？人们对人工智能帮助糖尿病眼筛查有何看法？这些只是 2023 年 7 月在布莱顿举行的为期两天的第 51 届学术初级保健学会科学年会上发表的研究报告中试图解决的一小部分问题。Steve Titmarsh 报道。

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National Diabetes Audit: key findings from latest Diabetes in Pregnancy report 全国糖尿病审计：最新妊娠糖尿病报告的主要发现

IF 0.6 Q3 Medicine

Practical Diabetes

Pub Date : 2024-05-01 DOI: 10.1002/pdi.2504

Steve Chaplin

The use of continuous glucose monitoring technology has improved pregnancy outcomes for women with type 1 diabetes, according to the National Pregnancy in Diabetes audit report for the period 2021–2022. However, there were no such gains for women with type 2 diabetes. Steve Chaplin reports.

根据《2021-2022 年全国妊娠糖尿病审计报告》，使用连续血糖监测技术改善了 1 型糖尿病妇女的妊娠结局。然而，2型糖尿病妇女的妊娠结局却没有得到改善。史蒂夫-查普林（Steve Chaplin）报道。

引用次数: 0

Clinical characteristics, management and psychological outcomes of patients with diabetes secondary to chronic pancreatitis 慢性胰腺炎继发糖尿病患者的临床特征、管理和心理结果

IF 0.6 Q3 Medicine

Practical Diabetes

Pub Date : 2024-05-01 DOI: 10.1002/pdi.2501

Philip C Johnston, Aaron Herron, Mark Davies, Mark Taylor, Glynis Magee, Ailish Nugent, Judith Garrity, Ian Wallace, Judith Thompson

Aims: To determine the clinical characteristics, management, rates of complications and psychological outcomes of patients with diabetes mellitus secondary to chronic pancreatitis (DMsCP) referred to the Belfast Pancreatic Diabetes Clinic.Methods: Clinical and laboratory data were obtained from online health care records (NIECR). Psychological outcomes and a service‐based questionnaire were performed.Results: Baseline characteristics (n=63 patients [male: 41, female: 22]) at initial referral included: mean age 56.2 years (range 19–84); mean duration of chronic pancreatitis 10.7 years (range 1–40); mean duration of diabetes 7.2 years (range 1–40). Previous pancreatic surgery was performed in 19% (12/63) of patients. Initial mean HbA1c was 82mmol/mol (range 41–189); mean HbA1c at six and 12 months follow‐up was 69.9mmol/mol and 70.6mmol/mol, respectively. Rates of microvascular complications included: retinopathy (background and pre‐proliferative) 16%; microalbuminuria 17%; peripheral neuropathy 14%, with no foot ulceration/amputation occurring. Macrovascular disease occurred in 24% of patients. Sixteen (25%) had missed at least one outpatient diabetes appointment over the preceding year. Quality of life (QoL) as measured by the PANQOLI was low with a mean total score of 64.9/103; 59% (16/27) of the service cohort also breached clinical cut‐offs for the presence of both anxiety (GAD‐7) and depression (PHQ‐9).Summary: DMsCP in our cohort was characterised by significant micro‐ and macrovascular complications, sub‐optimal glycaemic control, reduced clinic attendance and impaired QoL as well as a significant component of anxiety and depression. The optimal care for these patients should consist of a collaborative approach that best meets their complex and multifaceted needs. Copyright © 2024 John Wiley & Sons.

目的：确定转诊至贝尔法斯特胰腺糖尿病诊所的慢性胰腺炎继发性糖尿病（DMsCP）患者的临床特征、管理、并发症发生率和心理结果：临床和实验室数据来自在线医疗记录（NIECR）。结果：基线特征（63 名患者）（n=63）和心理结果（n=63）：首次转诊时的基线特征（63 名患者，男性 41 名，女性 22 名）包括：平均年龄 56.2 岁（19-84 岁不等）；慢性胰腺炎平均病程 10.7 年（1-40 年不等）；糖尿病平均病程 7.2 年（1-40 年不等）。19%的患者（12/63）曾接受过胰腺手术。初始平均 HbA1c 为 82mmol/mol（范围 41-189）；随访 6 个月和 12 个月时的平均 HbA1c 分别为 69.9mmol/mol 和 70.6mmol/mol。微血管并发症的发生率包括：视网膜病变（背景和增殖前）16%；微量白蛋白尿 17%；周围神经病变 14%，没有发生足部溃疡/截肢。24%的患者患有大血管疾病。16名患者（25%）在过去一年中至少错过了一次糖尿病门诊预约。根据 PANQOLI 测量，患者的生活质量（QoL）较低，平均总分为 64.9/103；59%（16/27）的患者还超过了焦虑症（GAD-7）和抑郁症（PHQ-9）的临床临界值。对这些患者的最佳治疗应包括一种协作方法，以最好地满足他们复杂和多方面的需求。版权所有 © 2024 约翰威利父子公司。

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引用次数: 0

Gestational diabetes mellitus care re‐imagined: women's experiences of a major model of care change at a large metropolitan hospital 妊娠糖尿病护理的再构想：一家大型都市医院对护理模式进行重大改革的妇女体验

IF 0.6 Q3 Medicine

Practical Diabetes

Pub Date : 2024-05-01 DOI: 10.1002/pdi.2502

Kaley Butten, Josephine G Laurie, M. Varnfield, Shelley A Wilkinson

Background: A gestational diabetes mellitus (GDM) pregnancy has significant psychological, time and resource impacts. In 2020–21, a digitally‐supported radical GDM service redesign was undertaken at a Brisbane tertiary centre, producing substantial cost savings without compromising clinical outcomes.Aims: To describe women's experiences within this new model of care (MOC), specifically the app user experience (MOC) (post), compared with a traditional MOC (pre).Methods: The new MOC was evaluated using a pre–post study design. This MOC included a smartphone app‐to‐clinician blood glucose communication platform. A convenience sample of women were surveyed about care experiences and app use pre‐ and post‐implementation. An additional survey queried user app experience at four weeks’ postpartum.Results: Within the service, 34% (n=24) and 22% (n=48) of women were surveyed pre and post MOC introduction, respectively. Pre‐implementation, 50% (n=12) of women missed work to attend appointments and 75% spent 30–120 minutes at the hospital. Questions regarding understanding GDM, initial dietary changes and glucometer use received similar or slightly lower ratings, pre‐ to post‐implementation. Nearly a quarter of women in the app‐experiences survey (24.2%; n=177) showed high levels of satisfaction with care received (91.5%) and with the app for managing GDM (87.1%). Two experience themes that emerged were Enhanced GDM management and Usability issues.Conclusions: The new MOC reduced time impositions associated with attending appointments. Despite the removal of face‐to‐face visits in the new MOC, women still established a connection with their treating team and maintained their understanding of their GDM management. Copyright © 2024 John Wiley & Sons.

背景：妊娠期糖尿病（GDM）对孕妇的心理、时间和资源都有重大影响。2020-21 年，布里斯班的一家三级医疗中心在数字化支持下对 GDM 服务进行了彻底的重新设计，在不影响临床效果的前提下节省了大量成本。目的：描述妇女在这种新护理模式（MOC）中的体验，特别是应用程序用户体验（MOC）（后）与传统 MOC（前）的比较：方法：采用前后研究设计对新的 MOC 进行了评估。该 MOC 包括一个智能手机应用程序与临床医生之间的血糖交流平台。对方便抽样的妇女进行了关于实施前后护理经验和应用程序使用情况的调查。另外还对产后四周的用户应用体验进行了调查：在服务范围内，分别有 34% （样本数=24）和 22% （样本数=48）的产妇在 MOC 推出前后接受了调查。实施前，50% 的产妇（12 人）因赴约而缺勤，75% 的产妇在医院花费了 30-120 分钟。关于了解 GDM、初步饮食改变和血糖仪使用的问题，实施前和实施后的评分相似或略低。在应用程序体验调查中，近四分之一的妇女（24.2%；n=177）对所接受的护理（91.5%）和应用程序管理 GDM 的满意度很高（87.1%）。出现的两个体验主题是加强 GDM 管理和可用性问题：新的MOC减少了与预约相关的时间要求。尽管新的 MOC 取消了面对面的访问，但妇女们仍与治疗团队建立了联系，并保持了对 GDM 管理的了解。版权所有 © 2024 约翰威利父子公司。

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引用次数: 0

Dapagliflozin 达帕格列净

IF 0.6 Q3 Medicine

Practical Diabetes

Pub Date : 2024-05-01 DOI: 10.1002/pdi.2503

David Morris

引用次数: 0

Hands in diabetes 糖尿病患者的双手

IF 0.6 Q3 Medicine

Practical Diabetes

Pub Date : 2024-05-01 DOI: 10.1002/pdi.2498

R. Hillson

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Spironolactone 螺内酯

IF 0.6 Q3 Medicine

Practical Diabetes

Pub Date : 2024-02-01 DOI: 10.1002/pdi.2496

Fatima Saeed, A. Llano, G. Mckay

引用次数: 0

Diabetes in pregnancy: from preconception to postnatal 孕期糖尿病：从孕前到产后

IF 0.6 Q3 Medicine

Practical Diabetes

Pub Date : 2024-02-01 DOI: 10.1002/pdi.2490

Emer O’Donnell, Jennifer Bisland, Donna Fincham

Diabetes is a worldwide problem that has a growing prevalence. With advancing maternal age and rising rates of obesity, diabetes in pregnancy is on the rise. The complications it brings to antenatal, intrapartum and postnatal care are causing an increase to maternal and fetal mortality and morbidity.Two‐thirds of the women who died in the UK in pregnancy (2018–2020) were known to have a pre‐existing medical condition such as diabetes. This highlights the need for excellence in preconception care and counselling, to enable the optimisation of glycaemic control and therefore pregnancy outcomes.Without a multidisciplinary team approach, the optimisation of glycaemic management of these patients cannot occur, which will increase complications and therefore the overall financial burden to the NHS. Copyright © 2024 John Wiley & Sons.

糖尿病是一个世界性问题，发病率越来越高。随着孕产妇年龄的增长和肥胖率的上升，妊娠糖尿病的发病率也在不断上升。它给产前、产中和产后护理带来的并发症导致孕产妇和胎儿的死亡率和发病率上升。据了解，英国三分之二死于妊娠期（2018-2020 年）的妇女在怀孕前就患有糖尿病等疾病。如果没有多学科的团队合作，就无法对这些患者进行优化的血糖管理，这将增加并发症，从而加重国家医疗服务体系的整体经济负担。版权所有 © 2024 约翰威利父子公司。

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