Diabetes Spectrum最新文献

Objective: Automated insulin delivery (AID) systems improve glycemic outcomes in youth with type 1 diabetes and are now the recommended mode of insulin delivery. Previous studies highlighted racial disparities in the use of continuous glucose monitoring and insulin pump therapy. The purpose of this study was to evaluate the use of AID systems and A1C outcomes in youth with type 1 diabetes by race.

Research design and methods: This was a single-center cross-sectional study. We included youth and young adults with type 1 diabetes aged 2-21 years who had at least two clinic visits between December 2022 and December 2023. Demographics, diabetes device use, and A1C data were gathered from chart review, based on the latest office visit records available in the electronic medical record system for 2023.

Results: Out of 668 youth aged 3.1-19.9 years with type 1 diabetes, 435 (65%) were AID users. The prevalence of AID use was 70% (341 of 483) in White youth compared with 47% (60 of 129) among Black youth and 62% (34 of 55) among youth of other racial groups (P <0.001). Black youth using AID achieved significantly lower A1C levels (median 8%, interquartile range [IQR] 7.5-8.8%) compared with Black youth who did not use an AID system (median 9.6%, IQR 8.1-11.6%) (P <0.001).

Conclusion: These findings support the persistence of racial disparities in diabetes technology utilization.

This article explores the neurological impacts of hypoglycemia and hyperglycemia on cognitive function in type 1 diabetes. It reviews how fluctuating glucose levels disrupt critical brain metabolic pathways, impairing various cognitive processes such as memory, attention, and executive functioning. The authors highlight both the acute and long-term effects of glycemic variability on critical brain regions, including the hippocampus, prefrontal cortex, and occipital lobes. Notably, both hyperglycemia and hypoglycemia contribute to cognitive dysfunction but through different mechanisms. Hypoglycemia induces an energy crisis in the brain, triggering increased oxidative stress and neuronal vulnerability, with repeated episodes leading to cumulative hippocampal and prefrontal damage. Hyperglycemia results in vascular compromise, disrupting cerebral blood flow and leading to various states of neurotransmitter dysregulation, with chronic exposure being associated with structural changes such as reduced gray matter volume. Diabetes technology devices such as continuous glucose monitoring systems may reduce cognitive impairments associated with glucose fluctuations, but their benefits underscore the limitations of A1C alone and the need for metrics that better capture glycemic variability. This review underscores the need to prioritize glucose control to protect cognitive health in patients with type 1 diabetes.

Young adults with type 1 diabetes face challenges transitioning from pediatric to adult health care, often resulting in gaps in or disengagement from care and suboptimal health outcomes. Longitudinal research during this period is critical to improve health outcomes, but is challenging. This study aimed to empirically evaluate technology-driven, stakeholder-informed strategies to improve longitudinal research study retention during the transition from pediatric to adult health care. In phase 1, we partnered with young-adult stakeholders to co-develop potential digital retention strategies. In phase 2, we enrolled 24 young adults with type 1 diabetes at their final pediatric diabetes clinic visit and assigned them to one of three retention strategy cohorts: weekly text messages, a digital study newsletter, or live virtual meetups. We followed participants for 12 months and assessed retention via completion of three study tasks: surveys, A1C kits, and glucose device downloads. All three strategies supported moderately high retention (71% at 12 months), but engagement in the strategies varied. The weekly text message cohort had the highest completion rates across tasks and required the least amount of research staff effort. In contrast, the digital study newsletter and virtual meetup strategies, although highly rated in phase 1, were labor-intensive and resulted in lower engagement. This study demonstrates the value of empirically testing stakeholder-informed digital retention strategies. Low-burden digital approaches such as text messaging may be both effective and scalable. Investing in small, pragmatic studies can improve the feasibility and impact of future longitudinal research in young adults with type 1 diabetes and other populations that are underrepresented in research.

Type 2 diabetes self-management behaviors (SMBs) can be time-consuming, necessitating effective time-management strategies. This scoping review synthesized evidence on the role of time and how time is conceptualized in diabetes self-management and identified strategies to address time-related barriers. Forty-eight peer-reviewed studies spanning 25 countries and published between 2013 and 2024 were included. Time scarcity, largely because of family, work, social, and caregiving responsibilities, was consistently identified as a barrier to SMBs, particularly physical activity (50% of studies), general self-management (21%), and dietary modifications (17%). Half of the studies proposed strategies to overcome time constraints, including structured routines, support from family and social networks, workplace accommodations, and digital health technologies. Five studies (10%) tested interventions, all of which used digital technologies. These findings emphasize that time-related barriers are pervasive and limit type 2 diabetes SMBs, highlighting an important consideration for diabetes educators and clinicians. Addressing time-related barriers will require multilevel approaches, including supporting individual time-management skills, leveraging interpersonal networks, and enacting structural changes in health care delivery and workplace policies. Greater investment in interventions, especially those extending beyond digital health, is needed to reduce the impact of time constraints on diabetes self-management.

Objective: Hypoglycemia is a serious complication in people with diabetes. Risk factors include increased age, certain comorbidities, and certain glucose-lowering medications. Although the American Diabetes Association recommends prescribing glucagon to individuals at high risk for hypoglycemia for use in emergent episodes, glucagon use remains low. This is particularly concerning in federally qualified health centers (FQHCs), where patients face socioeconomic barriers that may exacerbate this gap in care. This study evaluated glucagon-prescribing rates among high-risk patients with diabetes in a FQHC.

Research design and methods: A retrospective chart review was conducted of patients with diabetes seen between March 2022 and March 2023 who were prescribed a high-risk medication and/or had a history of hypoglycemia. Demographics and clinical characteristics such as history of hypoglycemia, high-risk medications, and active glucagon prescriptions were analyzed using descriptive statistics and comparative tests to determine characteristics associated with glucagon prescriptions.

Results: Of the 7,304 patients, 95% had type 2 diabetes, and 61.5% were prescribed insulin, but only 4.4% had an active glucagon prescription. Among 65 individuals with documented hypoglycemia, 80% were prescribed a high-risk medication, yet only 13.8% were prescribed glucagon. Patients with type 1 diabetes were more likely to have glucagon prescribed (P = 0.002).

Conclusion: Glucagon was significantly under-prescribed in this high-risk population, highlighting gaps in applying clinical guidelines to practice as well as gaps in access to preventive care. These findings will inform provider education and interventions to improve glucagon-prescribing practices.