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The growing use of continuous glucose monitors in people without diabetes: an evidence‐free zone 持续血糖监测仪在非糖尿病人群中的应用:无证据区
Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-09-01 DOI: 10.1002/pdi.2475
Nicola Guess
Abstract The use of continuous glucose monitors (CGMs) is growing among people without diabetes, and is being encouraged by CGM manufacturers and personalised nutrition companies alike. This article critically discusses the issues that may arise from this new trend, including pathologising normal post‐prandial glucose excursions, the unnecessary avoidance of healthful foods and the risk of a glucocentric approach to nutrition which could inadvertently increase the risk of cardiometabolic diseases a person is trying to avoid. The theoretical benefits of CGMs in people without diabetes will be discussed, and recommendations for the evidence needed to help realise their potential will be made. Copyright © 2023 John Wiley & Sons.
连续血糖监测仪(CGM)的使用在非糖尿病人群中越来越多,并受到CGM制造商和个性化营养公司的鼓励。本文批判性地讨论了这种新趋势可能引起的问题,包括将正常的餐后血糖升高,不必要地避免健康食品,以及以糖为中心的营养方法的风险,这种方法可能会无意中增加人们试图避免的心脏代谢疾病的风险。将讨论无糖尿病人群中cgm的理论益处,并就帮助实现其潜力所需的证据提出建议。版权所有©2023 John Wiley &儿子。
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引用次数: 0
Using virtual reality based learning to provide education on the management of diabetes emergencies for doctors in training 利用基于虚拟现实的学习为培训中的医生提供糖尿病急诊管理教育
Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-09-01 DOI: 10.1002/pdi.2473
Ritwika Mallik, Jack Pottle, Ben Atkinson, Partha Kar, Mayank Patel
Abstract It is essential that all doctors in training feel confident in their ability to manage diabetes emergencies occurring in hospital settings. This is particularly pertinent when specialist expertise is not always immediately available, as well as at a time when diabetes prevalence in hospitals is rising. The project team created interactive, immersive scenarios and ran ‘DEVICE’ (Diabetes Emergencies: Virtual Interactive Clinical Education), a pilot study to test the feasibility of using virtual reality (VR) as a safe‐space learning medium for training medical staff on diabetes emergency management. Each study participant worked through two emergency scenarios, under the supervision of a consultant trainer. Analysis of the participants’ performance metrics showed improved clinical approaches and increased confidence in handling diabetes emergencies by these non‐specialist participants. Here we describe this pilot study development in more detail, as well as provide an update following the national roll‐out of these training resources across seven national postgraduate medical deaneries. The DEVICE initiative was found to be scalable and sustainable, with VR‐based learning deemed to be a popular, safe, and effective teaching tool for diabetes. We are now developing VR‐based training cases for use by other health care professionals within primary and secondary care. Copyright © 2023 John Wiley & Sons.
所有接受培训的医生对自己处理医院发生的糖尿病紧急情况的能力有信心是至关重要的。在不能立即获得专业知识的情况下,以及在医院糖尿病患病率上升的情况下,这一点尤为重要。项目团队创建了互动的沉浸式场景,并进行了“DEVICE”(糖尿病紧急情况:虚拟互动临床教育),这是一项试点研究,旨在测试使用虚拟现实(VR)作为安全空间学习媒介培训医务人员糖尿病紧急情况管理的可行性。每个研究参与者都在顾问培训师的监督下经历了两种紧急情况。对参与者表现指标的分析显示,这些非专业参与者改善了临床方法,增加了处理糖尿病紧急情况的信心。在这里,我们更详细地描述了这一试点研究的发展,并提供了在七个国家研究生医学学院推出这些培训资源后的最新情况。研究发现,DEVICE计划具有可扩展性和可持续性,基于VR的学习被认为是一种流行、安全、有效的糖尿病教学工具。我们现在正在开发基于虚拟现实的培训案例,供其他初级和二级医疗保健专业人员使用。版权所有©2023 John Wiley &儿子。
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引用次数: 0
The accuracy of capillary blood glucose testing versus real time and intermittently scanned continuous glucose monitoring 毛细管血糖检测与实时、间歇扫描连续血糖监测的准确性比较
Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-09-01 DOI: 10.1002/pdi.2479
Souha El‐Abd, Ruth Poole
In this sixth article in our ‘Test Tips’ series, Dr Souha El‐Abd and Dr Ruth Poole examine the benefits and limitations of traditional capillary blood glucose testing and the more technologically advanced continuous glucose monitoring in the management of glycaemic control.
在我们“测试提示”系列的第六篇文章中,Souha El - Abd博士和Ruth Poole博士研究了传统毛细血管血糖测试和技术更先进的连续血糖监测在血糖控制管理中的优点和局限性。
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引用次数: 0
Who owns health data anyway? 到底谁拥有健康数据?
Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-09-01 DOI: 10.1002/pdi.2472
Louise R Curtis
Data driven technologies have revolutionised the management of diabetes allowing people to take a greater role in their care; however, use of such systems creates tremendous quantities of data. We have become accustomed to the sharing of data within the health care professional relationship. For example, someone with type 1 diabetes who experiences hypoglycaemia may explore their glucose profile with their diabetes specialist team. This is acceptable to both parties as there is an implicit trust underpinned by confidentiality and a shared goal. What happens when a third party with their own business interest is introduced to that relationship? Who owns that data? There is an increasingly insistent call for people to take control of ‘their’ data framed as the right of ownership with quotes such as ‘Who owns the data owns the future’ becoming well-worn clichés where the alternatives include the risk of exploitation by ‘surveillance capitalism’.1 Health data is far more than that held in clinical records with collective health data being greater than the sum of its parts. All data can be seen as health data with an estimated 80–90% generated outside of the clinical setting.2 From grocery shopping to sleep habits, walking speed to typing speed, patient-generated health data (PGHD) combines all factors that can reflect an individual's health. Despite the concept of personal ownership of one's data coming into the public awareness following the Cambridge Analytica scandal,3 there has been a proliferation and ubiquity in data intensive software generating PGHD such as health and wellness apps, heart rate wrist monitors and nutrition programmes. This ‘self- tracking’ is marketed as a means to gain self-awareness and improved wellbeing.4 It has been shown that motion data from a smartphone can predict behaviour and mental state of the user,5 so how much more might the tremendous volume of data from continuous glucose monitoring, bolus advisors and insulin requirements in a hybrid closed-loop system predict? Cross reference this with an online calendar, geolocation, spending patterns, sleep and menstrual cycle and you gain an in-depth understanding into someone's life beyond the remit of their diabetes care. Ensuring that the collection, use and access of these data meets the expectations of the public is essential to maintain the professional relationship.6 From the perspective of UK law, health data does not have an extensive system of specific rules like those that govern intellectual property. Arguably, even if this were developed, the advantages of a property framework to govern health information may be limited. The monetary value of one person's data points is likely to be insignificant as value lies in collective data from a population. It is also unclear whether legal ownership would provide patients access to the data economy. Perhaps more pertinently from a health perspective is whether legal ownership of health data would enhance self-care and
数据倡议将每个患者与NHS提供商联系的数据链接起来,以计划和设计服务。由于未能充分解决公众对健康数据隐私的担忧,该计划随后于2016年暂停在过去十年中,探索公众对数据二次使用的态度或可接受性的研究数量稳步增加。令人惊讶的是,英国公众通常并不关心他们的数据去了哪里,这可能是由于他们的数据所购买的服务很方便。在引起关注的地方,与行为存在差异;例如,尽管零售商收集了丰富的数据集,但商店忠诚卡的使用率很高。然而,就健康数据而言,一致的主题是担心这些信息可以追溯到个人,从而导致歧视或剥削Wellcome Trust开展了关于商业获取健康数据的公众意见的广泛工作,发现公众普遍表示他们不希望他们的健康记录与私人公司共享,因为他们认为这个行业完全是由利润驱动的。“这是一面单向镜子;他们知道你的一切,但我们不知道他们用这些做什么。15一些与会者认为,私营部门的参与暗示了NHS私有化的更广泛议程。更多的知识、学科接触、教育程度、对数据使用的认识和社会等级都与接受商业访问有关具体来说,当研讨会讨论第三方受数据保护立法的约束,他们的商业利益包括开发、维护和支持他们的产品,从而使人们受益时,人们更容易接受。如果认为对个人或公共健康没有好处,则认为商业途径是不可接受的,保险和营销被视为对个人最有害对25项调查公众对共享或联系卫生数据态度的定性研究进行的系统审查发现,在研究中使用数据得到广泛支持;然而,为了获得公众的接受,提出了一些条件在所有讲习班中,与会者都表示相信,数据的有效利用应能够为人民和社区带来更广泛、积极的社会成果,而不仅仅是给个人和服务提供者带来好处有人建议采取保障措施,确保这是为了公共利益、可选、非剥削和互惠。在临床试验未发表或非数据共享的情况下,获取透明度是不可接受的使用方式的一个意想不到的例子,因为这违反了参与者关于研究将有助于医学知识的假设。18 .虽然保密受到保护,但同意讨论和表格很少披露调查人员关于共享去识别数据或公布试验结果的意图最近的O 'Shaughnessy报告对英国商业临床试验进行了委托,因为在过去五年中,NHS招募的患者几乎减少了一半,导致总直接成本在3.6亿英镑左右。报告强调了未能充分利用国民保健服务庞大的数据资产以及投资卫生数据基础设施的必要性。数字平台和制药公司之间的合作所带来的分散临床试验机会被强调为一种创新方法。数据可以从参与者舒适的家中收集,减少旅行的需要,并使患者群体更加多样化可以说,1型糖尿病的研究非常适合这种模式,因为患者、数字平台和临床医生之间的合作关系已经融入了日常实践。CamAPS FX™混合闭环系统的真实证据分析使用了这种分散的方法。超过1800名系统用户同意在分析中使用他们的数据,其中终点是应用程序常规收集的葡萄糖指标。来自这一大型队列的数据增加了对实际疗效的信心,与报告的随机对照试验数据一致在英国成为科技超级大国的愿望之前,政府承诺在2022年投入2亿英镑,通过投资于数据基础设施,改善研究卫生数据的获取卫生和社会保障部目前的数据战略“数据拯救生命”有七项关键原则:增进信任;利用数据改善护理;告知国家决策者;与行业合作伙伴进行研究;赋予创新者权力,同时确保数据伙伴关系的公平条款;让公众在如何使用数据方面有更大的发言权;改善公众获取他们自己数据的途径这意味着卫生数据被决策者视为有利于社会的集体资源。 虽然隐私和匿名是核心,但个人数据所有权的概念似乎并不是优先考虑的。从政府高层到数据生成方,都渴望将健康数据用于共同的社会利益。然而,考虑到先前国家政策的隐私问题,积极寻求和解决糖尿病患者的意见至关重要。23 .总而言之,健康数据类似于核废料:如果能在管理良好、高度安全的设施中处理,它就很有价值,但如果处理不当,或者更糟的是任其泄漏到环境中,它就很危险没有宣布任何利益冲突。参考资料可在实用糖尿病在线:https://wchh.onlinelibrary.wiley.com。
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引用次数: 0
Digital enabled learning for people with diabetes post COVID‐19 pandemic COVID - 19大流行后糖尿病患者的数字化学习
Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-09-01 DOI: 10.1002/pdi.2477
Joan RS McDowell, Salma Mehar, Raj S Chandok, Wendy A Watson
Abstract The COVID‐19 pandemic was the catalyst for a rapid increase in digital learning for people with diabetes. This paper aims to discuss the research on digital learning and the impact and synergy of COVID‐19 on health inequalities, and present some digital educational resources. Copyright © 2023 John Wiley & Sons.
COVID - 19大流行是糖尿病患者数字学习快速增长的催化剂。本文旨在讨论数字学习研究以及COVID - 19对健康不平等的影响和协同作用,并介绍一些数字教育资源。版权所有©2023 John Wiley &儿子。
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引用次数: 0
Health literacy, self‐management and glycaemic control in persons living with type 2 diabetes mellitus: a cross‐sectional study 2型糖尿病患者的健康素养、自我管理和血糖控制:一项横断面研究
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-07-01 DOI: 10.1002/pdi.2467
Tiffany Lori Nugent, A. Galea, R. Sammut
Aims. The aim of this study was to explore the relationship between health literacy and diabetes self‐management and control among adults living with type 2 diabetes.
目标本研究旨在探讨成人2型糖尿病患者的健康素养与糖尿病自我管理和控制之间的关系。
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引用次数: 0
Predicting gestational diabetes mellitus by first trimester HbA1c: a retrospective study in women with moderate to severe obesity 通过妊娠早期HbA1c预测妊娠糖尿病:一项对中度至重度肥胖妇女的回顾性研究
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-07-01 DOI: 10.1002/pdi.2466
J. Balani, S. Hyer, Antoinette Johnson, H. Shehata
This study aimed to investigate the utility of first trimester HbA1c in predicting gestational diabetes mellitus (GDM) in obese women with Grade II–III obesity. HbA1c was measured during the first trimester in 160 obese women. A 75g oral glucose tolerance test (OGTT) was performed between 24–28 weeks gestation and GDM diagnosed by WHO criteria.
本研究旨在探讨妊娠早期HbA1c在预测II-III级肥胖女性妊娠糖尿病(GDM)中的应用。在160名肥胖妇女的妊娠早期测量了HbA1c。在妊娠24-28周和WHO标准诊断的GDM之间进行75g口服葡萄糖耐量试验(OGTT)。
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引用次数: 0
The importance of asking about wellbeing in a diabetes foot clinic 在糖尿病足诊所询问健康状况的重要性
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-07-01 DOI: 10.1002/pdi.2465
C. Bewsey
The onset of diabetes foot complications signals a new stage of diabetes progression. Amputation may be the result of such difficulties and can impact upon all aspects of a person's life such as mobility, independence, relationships, and possible loss of earning potential, all likely triggers of distress.
糖尿病足并发症的发生标志着糖尿病进展进入了一个新的阶段。截肢可能是这些困难的结果,并可能影响到一个人生活的方方面面,如行动能力、独立性、人际关系,以及可能失去的收入潜力,所有这些都可能引发痛苦。
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引用次数: 0
Managing diabetes and dementia, a challenging duo: a scoping review 管理糖尿病和痴呆,一个具有挑战性的二人组:范围审查
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-07-01 DOI: 10.1002/pdi.2469
Florence Sharkey, V. Coates
This paper aims to describe experiences and challenges when managing diabetes along with dementia from the perspectives of those living with these conditions, their informal carers and health care professionals.
本文旨在从生活在这些条件下的人,他们的非正式护理人员和卫生保健专业人员的角度描述管理糖尿病和痴呆的经验和挑战。
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引用次数: 0
Action4Diabetes: a non‐profit organisation bridging the type 1 diabetes gap in Southeast Asia Action4Diabetes:一个在东南亚弥合1型糖尿病鸿沟的非营利性组织
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-07-01 DOI: 10.1002/pdi.2463
Sze May Ng
Global incidence and challenges of type 1 diabetes Type 1 diabetes (T1D) is a chronic disease that affects millions of people around the world. The International Diabetes Federation (IDF) reports that the global incidence of T1D is estimated to be around 15 cases per 100,000 population per year.1 There has been a global increase in the incidence of T1D over the past few decades, particularly in children under the age of five. The reasons for this increase in incidence are not well understood, but it is thought to be due to a combination of genetic and environmental factors. In the UK, around 400,000 people are affected by T1D and life expectancy is reduced in people with T1D.2 Diabetes remains a leading cause of blindness in people of working age, the leading cause of renal failure and second most common cause of lower limb amputation. While the condition can be managed with proper treatment and care, those living in low-middle income countries (LMICs) often lack access to the necessary resources, resulting in poor health outcomes for many living with T1D.1 In LMICs, T1D is often diagnosed late due to limited access to health care services and diagnostic tools. This delay in diagnosis can result in high mortality rates from diabetic ketoacidosis (DKA). Once diagnosed, managing T1D in LMICs can be a challenge. The cost of insulin and other medications can be prohibitively expensive, and many people do not have access to blood glucose monitoring devices, blood glucose strips or other essential diabetes supplies. As a result, many people with T1D in these countries must rely on inadequate treatment options putting their health at risk of lifelong complications such as nerve damage, blindness, and kidney failure.3
1型糖尿病(T1D)是一种影响全球数百万人的慢性疾病。国际糖尿病联合会(IDF)报告称,全球T1D发病率估计为每年每10万人中约有15例1在过去的几十年里,T1D的发病率在全球范围内呈上升趋势,尤其是在5岁以下的儿童中。发病率增加的原因尚不清楚,但人们认为这是遗传和环境因素共同作用的结果。在英国,大约有40万人受到T1D的影响,T1D患者的预期寿命缩短糖尿病仍然是导致工作年龄人群失明的主要原因,是肾衰竭的主要原因,也是导致下肢截肢的第二大常见原因。虽然这种疾病可以通过适当的治疗和护理得到控制,但生活在中低收入国家的患者往往无法获得必要的资源,导致许多t1d患者的健康状况不佳在中低收入国家,由于获得保健服务和诊断工具的机会有限,T1D往往诊断较晚。这种诊断延误可导致糖尿病酮症酸中毒(DKA)的高死亡率。一旦确诊,中低收入人群的T1D治疗可能是一项挑战。胰岛素和其他药物的成本可能高得令人望而却步,而且许多人无法获得血糖监测设备、血糖试纸或其他必要的糖尿病用品。因此,这些国家的许多T1D患者必须依赖不充分的治疗方案,使他们的健康面临终身并发症的风险,如神经损伤、失明和肾衰竭
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引用次数: 0
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Practical Diabetes
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