Diabetes Spectrum最新文献_第3页

Novel Approach to Continuation of Elective Procedures in People at Risk for Sodium–Glucose Cotransporter 2 Inhibitor–Associated Euglycemic Ketoacidosis 对有钠-葡萄糖共转运体 2 抑制剂相关优生酮症酸中毒风险的人继续进行择期手术的新方法

Q3 Medicine

Diabetes Spectrum

Pub Date : 2024-03-15 DOI: 10.2337/ds23-0040

Matthew Verdone, Jonathan Bauman, Esben Iversen, Rifka C. Schulman-Rosenbaum, Anthony Antonacci, Sabatino Leffe, Joseph Simpson, Yael Tobi Harris, Joseph Marino

引用次数: 0

Diversity in Clinical Trials: A Complicated Issue, Not a Simple Solution 临床试验中的多样性：问题复杂，解决不易

Q3 Medicine

Diabetes Spectrum

Pub Date : 2024-03-14 DOI: 10.2337/ds24-0021

Janet Brown-Friday

This article is adapted from a speech Ms. Brown-Friday delivered in June 2023 as President, Health Care & Education of the American Diabetes Association. She delivered her address at the Association’s 83rd Scientific Sessions in San Diego, CA. A webcast of this speech is available for viewing on the DiabetesPro website (https://events.diabetes.org/live/25/page/186).

本文改编自布朗-弗里德女士 2023 年 6 月作为美国糖尿病协会医疗保健与教育总裁发表的演讲。她在加利福尼亚州圣地亚哥举行的该协会第 83 届科学会议上发表了讲话。您可以在 DiabetesPro 网站 (https://events.diabetes.org/live/25/page/186) 上观看此次演讲的网络直播。

引用次数: 0

Experiences With Outpatient Nutrition Services Among Caregivers of Youth With Type 1 Diabetes 1 型糖尿病青少年患者照顾者对门诊营养服务的体验

Q3 Medicine

Diabetes Spectrum

Pub Date : 2024-03-07 DOI: 10.2337/ds23-0051

Erin N. Gordon, Blair Dykeman, Kimberly F Greco, Enju Liu, E. Rhodes, Katharine C. Garvey

Many children with type 1 diabetes do not meet nutritional guidelines. Little is known about how caregivers perceive the necessity of registered dietitian (RD) visits or how satisfied they are with nutrition care. This study aimed to evaluate nutrition experiences and perceptions of care among caregivers of children with type 1 diabetes at an academic medical center. We analyzed 159 survey responses. Using multivariable logistic regression, we assessed factors associated with the perception of need for annual nutrition visits, satisfaction with RD care, and encouragement from a nurse or doctor to meet with an RD. Covariates included age (<13 vs. ≥13 years), type 1 diabetes duration (≤3 vs. >3 years), sex, race/ethnicity, and insulin pump and continuous glucose monitoring use. More than half of caregivers (56%) considered annual visits necessary. Shorter type 1 diabetes duration (odds ratio [OR] 1.92, 95% CI 1.02–3.63) was associated with this finding. Less than half (46.5%) reported satisfaction with nutrition care; higher satisfaction was also correlated with shorter type 1 diabetes duration (OR 2.20, 95% CI 1.17–4.15). Although 42% reported meeting with an RD in the past year, less than two-thirds (62%) reported receiving a medical provider recommendation for nutrition care. Leading reasons for not meeting with an RD were: “I am knowledgeable in nutrition and do not need to see an [RD]” (41%) and “I had a past visit with an [RD] that was not helpful” (40%). Our findings suggest that satisfaction with and perceived need for nutrition care may wane with longer type 1 diabetes duration. Improved strategies for therapeutic alliance between caregivers and RDs and engagement of families at later stages of type 1 diabetes are needed.

许多患有 1 型糖尿病的儿童达不到营养指南的要求。人们对护理人员如何看待注册营养师（RD）就诊的必要性以及他们对营养护理的满意度知之甚少。本研究旨在评估一家学术医疗中心的 1 型糖尿病患儿护理人员的营养经验和对护理的看法。我们对 159 份调查回复进行了分析。通过多变量逻辑回归，我们评估了与年度营养就诊需求感知、对营养师护理的满意度以及护士或医生鼓励与营养师会面相关的因素。协变量包括年龄（3 岁）、性别、种族/民族以及胰岛素泵和持续葡萄糖监测的使用情况。半数以上的护理人员（56%）认为有必要进行年度访视。1 型糖尿病病程较短（几率比 [OR] 1.92，95% CI 1.02-3.63）与这一结论有关。不到一半（46.5%）的人对营养护理表示满意；满意度越高也与 1 型糖尿病病程越短相关（OR 2.20，95% CI 1.17-4.15）。尽管有 42% 的人表示在过去一年中与营养师见过面，但只有不到三分之二（62%）的人表示接受过医疗服务提供者的营养护理建议。不与营养学家会面的主要原因是"我的营养知识很丰富，不需要看营养师"（41%）和 "我以前看过营养师，但没有帮助"（40%）。我们的研究结果表明，随着 1 型糖尿病病程的延长，对营养护理的满意度和感知需求可能会减弱。在 1 型糖尿病的后期阶段，需要改进护理人员与营养师之间的治疗联盟策略和家庭参与策略。

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引用次数: 0

A Qualitative Study of Barriers to Medication-Taking Among People With Type 2 Diabetes Using the Theoretical Domains Framework. 利用理论领域框架对 2 型糖尿病患者服药障碍的定性研究。

Q3 Medicine

Diabetes Spectrum

Pub Date : 2024-03-05 eCollection Date: 2024-01-01 DOI: 10.2337/ds23-0038

Michael Vallis, Susie Jin, Agnieszka Klimek-Abercrombie, Ginnie Ng, Noah M Ivers

Objective: We aimed to better understand the challenges related to type 2 diabetes medication-taking through Theoretical Domains Framework (TDF)-guided interviews with people with type 2 diabetes with varying degrees of medication-taking.

Methods: One-on-one qualitative interviews following a semistructured discussion guide informed by the TDF were conducted. Thirty people with type 2 diabetes in Canada were interviewed, with representation from across the country, of both sexes (47% female), of people with various diabetes durations (mean 12.9 ± 7.9 years), with different types of medication plans (n = 15 on polypharmacy), and with various medication-taking levels (n = 10 each for low-, medium-, and high-engagement groups).

Results: Themes related to medication-taking from interviews mapped to 12 of the 14 TDF theme domains, with the exclusion of the knowledge and skills domains. The most prominent domains, as determined by high-frequency themes or themes for which people with low and high medication-taking had contrasting perspectives, were 1) emotion; 2) memory, attention, and decision processes; 3) behavioral regulation; 4) beliefs about consequences; 5) goals; and 6) environmental context and resources.

Conclusion: Through our interviews, several areas of focus emerged that may help efforts to increase medication-taking. To validate these findings, future quantitative research is warranted to help support people with type 2 diabetes in overcoming psychological and behavioral barriers to medication-taking.

目的：我们旨在通过理论领域框架（TDF）指导下的访谈，更好地了解与 2 型糖尿病服药相关的挑战：方法：按照以 TDF 为基础的半结构化讨论指南进行一对一定性访谈。30 名加拿大 2 型糖尿病患者接受了访谈，他们来自全国各地，男女均有（47% 为女性），糖尿病病程长短不一（平均为 12.9 ± 7.9 年），有不同类型的用药计划（15 人使用多种药物），服药水平各异（低、中、高参与组各 10 人）：访谈中与服药相关的主题与 14 个 TDF 主题领域中的 12 个相吻合，但不包括知识和技能领域。根据高频主题或药物服用量低和药物服用量高的人观点截然不同的主题，最突出的领域是：1）情绪；2）记忆、注意力和决策过程；3）行为调节；4）对后果的信念；5）目标；6）环境背景和资源：通过访谈，我们发现了几个可能有助于提高服药率的重点领域。为了验证这些发现，我们有必要在未来开展定量研究，帮助 2 型糖尿病患者克服服药过程中的心理和行为障碍。

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引用次数: 0

Optimizing Diabetes Care Through Listening To Multiple Voices 倾听多方声音，优化糖尿病护理

Q3 Medicine

Diabetes Spectrum

Pub Date : 2024-02-22 DOI: 10.2337/ds24-0015

A. E. Caballero

This article is adapted from the address Dr. Caballero delivered as the recipient of the American Diabetes Association’s Outstanding Educator in Diabetes Award for 2023. He delivered the address in June 2023 during the Association’s 83rd Scientific Sessions in San Diego, CA. A webcast of this speech is available for viewing on the DiabetesPro website (https://events.diabetes.org/live/25/page/186).

本文改编自卡瓦列罗博士作为 2023 年度美国糖尿病协会糖尿病杰出教育家奖获得者发表的演讲。他于 2023 年 6 月在加利福尼亚州圣地亚哥举行的美国糖尿病协会第 83 届科学会议上发表了这一演讲。该演讲的网络直播可在 DiabetesPro 网站 (https://events.diabetes.org/live/25/page/186) 上观看。

引用次数: 0

Grading Acanthosis Nigricans Using a Smartphone and Color Analysis: A Novel Noninvasive Method to Screen for Impaired Glucose Tolerance and Type 2 Diabetes 利用智能手机和色彩分析对黑棘皮病进行分级：筛查糖耐量受损和 2 型糖尿病的新型无创方法

Q3 Medicine

Diabetes Spectrum

Pub Date : 2024-02-05 DOI: 10.2337/ds23-0042

A. Dhanoo, Sterling Ramroach, Felicia Hill-Briggs, Brian N. Cockburn

The objective of this study was to develop ANcam, a novel method for identifying acanthosis nigricans (AN) using a smartphone camera and computer-aided color analysis for noninvasive screening of people with impaired glucose tolerance (IGT). Adult and juvenile participants with or without diagnosed type 2 diabetes were recruited in Trinidad and Tobago. After obtaining informed consent, participants’ history, demographics, anthropometrics, and A1C were collected and recorded. Three subject-matter experts independently graded pictures of the posterior neck and upper back using the ANcam smartphone application and Burke methods. A correlation matrix investigated 25 color channels for association with hyperpigmentation, and the diagnostic thresholds were determined with a receiver operating characteristic curve analysis. For the 227 participants with captured images and A1C values, the cyan/magenta/yellow/black (CMYK) model color channel CMYK_K was best correlated with IGT at an A1C cut-off of 5.7% [39 mmol/mol] (R = 0.45, P <0.001). With high predictive accuracy (area under the curve = 0.854), the cut-off of 7.67 CMYK_K units was chosen, with a sensitivity of 81.1% and a specificity of 70.3%. ANcam had low interrater variance (F = 1.99, P = 0.137) compared with Burke grading (F = 105.71, P <0.001). ANcam detected hyperpigmentation on the neck at double the self-reported frequency. Elevated BMI was 2.9 (95% CI 1.9–4.3) times more likely, elevated blood pressure was 1.7 (95% CI 1.2–2.4) times more likely, and greater waist-to-hip ratio was 2.3 (95% CI 1.4–3.6) times more likely with AN present. ANcam offers a sensitive, reproducible, and user-friendly IGT screening tool to any smartphone user that performs well with most skin tones and lighting conditions.

这项研究的目的是开发 ANcam，这是一种利用智能手机摄像头和计算机辅助色彩分析来识别黑棘皮病（AN）的新方法，用于对糖耐量受损（IGT）患者进行无创筛查。研究人员在特立尼达和多巴哥招募了患有或未患有 2 型糖尿病的成人和青少年参与者。在获得知情同意后，对参与者的病史、人口统计学、人体测量学和 A1C 进行了收集和记录。三位主题专家使用 ANcam 智能手机应用程序和 Burke 方法对颈部后侧和上背部的照片进行了独立评分。相关矩阵调查了 25 种颜色通道与色素沉着的相关性，并通过接收器操作特征曲线分析确定了诊断阈值。在 227 位拍摄了图像和 A1C 值的参与者中，在 A1C 临界值为 5.7% [39 mmol/mol]时，青色/品红/黄色/黑色（CMYK）模型颜色通道 CMYK_K 与 IGT 的相关性最好（R = 0.45，P <0.001）。由于预测准确性高（曲线下面积 = 0.854），因此选择 7.67 CMYK_K 单位为临界值，灵敏度为 81.1%，特异性为 70.3%。与伯克分级法（F = 105.71，P <0.001）相比，ANcam 的评分者间差异较小（F = 1.99，P = 0.137）。ANcam 检测出颈部色素沉着的频率是自我报告频率的两倍。出现 ANcam 时，体重指数升高的可能性是自述的 2.9 倍（95% CI 1.9-4.3），血压升高的可能性是自述的 1.7 倍（95% CI 1.2-2.4），腰臀比升高的可能性是自述的 2.3 倍（95% CI 1.4-3.6）。 ANcam 为任何智能手机用户提供了一种灵敏、可重复、用户友好的 IGT 筛查工具，在大多数肤色和光照条件下均表现良好。

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引用次数: 0

Grading Acanthosis Nigricans Using a Smartphone and Color Analysis: A Novel Noninvasive Method to Screen for Impaired Glucose Tolerance and Type 2 Diabetes 利用智能手机和色彩分析对黑棘皮病进行分级：筛查糖耐量受损和 2 型糖尿病的新型无创方法

Q3 Medicine

Diabetes Spectrum

Pub Date : 2024-02-05 DOI: 10.2337/ds23-0042

A. Dhanoo, Sterling Ramroach, Felicia Hill-Briggs, Brian N. Cockburn

The objective of this study was to develop ANcam, a novel method for identifying acanthosis nigricans (AN) using a smartphone camera and computer-aided color analysis for noninvasive screening of people with impaired glucose tolerance (IGT). Adult and juvenile participants with or without diagnosed type 2 diabetes were recruited in Trinidad and Tobago. After obtaining informed consent, participants’ history, demographics, anthropometrics, and A1C were collected and recorded. Three subject-matter experts independently graded pictures of the posterior neck and upper back using the ANcam smartphone application and Burke methods. A correlation matrix investigated 25 color channels for association with hyperpigmentation, and the diagnostic thresholds were determined with a receiver operating characteristic curve analysis. For the 227 participants with captured images and A1C values, the cyan/magenta/yellow/black (CMYK) model color channel CMYK_K was best correlated with IGT at an A1C cut-off of 5.7% [39 mmol/mol] (R = 0.45, P <0.001). With high predictive accuracy (area under the curve = 0.854), the cut-off of 7.67 CMYK_K units was chosen, with a sensitivity of 81.1% and a specificity of 70.3%. ANcam had low interrater variance (F = 1.99, P = 0.137) compared with Burke grading (F = 105.71, P <0.001). ANcam detected hyperpigmentation on the neck at double the self-reported frequency. Elevated BMI was 2.9 (95% CI 1.9–4.3) times more likely, elevated blood pressure was 1.7 (95% CI 1.2–2.4) times more likely, and greater waist-to-hip ratio was 2.3 (95% CI 1.4–3.6) times more likely with AN present. ANcam offers a sensitive, reproducible, and user-friendly IGT screening tool to any smartphone user that performs well with most skin tones and lighting conditions.

这项研究的目的是开发 ANcam，这是一种利用智能手机摄像头和计算机辅助色彩分析来识别黑棘皮病（AN）的新方法，用于对糖耐量受损（IGT）患者进行无创筛查。研究人员在特立尼达和多巴哥招募了患有或未患有 2 型糖尿病的成人和青少年参与者。在获得知情同意后，对参与者的病史、人口统计学、人体测量学和 A1C 进行了收集和记录。三位主题专家使用 ANcam 智能手机应用程序和 Burke 方法对颈部后侧和上背部的照片进行了独立评分。相关矩阵调查了 25 种颜色通道与色素沉着的相关性，并通过接收器操作特征曲线分析确定了诊断阈值。在 227 位拍摄了图像和 A1C 值的参与者中，在 A1C 临界值为 5.7% [39 mmol/mol]时，青色/品红/黄色/黑色（CMYK）模型颜色通道 CMYK_K 与 IGT 的相关性最好（R = 0.45，P <0.001）。由于预测准确性高（曲线下面积 = 0.854），因此选择 7.67 CMYK_K 单位为临界值，灵敏度为 81.1%，特异性为 70.3%。与伯克分级法（F = 105.71，P <0.001）相比，ANcam 的评分者间差异较小（F = 1.99，P = 0.137）。ANcam 检测出颈部色素沉着的频率是自我报告频率的两倍。出现 ANcam 时，体重指数升高的可能性是自述的 2.9 倍（95% CI 1.9-4.3），血压升高的可能性是自述的 1.7 倍（95% CI 1.2-2.4），腰臀比升高的可能性是自述的 2.3 倍（95% CI 1.4-3.6）。 ANcam 为任何智能手机用户提供了一种灵敏、可重复、用户友好的 IGT 筛查工具，在大多数肤色和光照条件下均表现良好。

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引用次数: 0

Retrospective Analysis of Once-Daily Versus Twice-Daily Insulin Glargine Dosing in Noncritically Ill Individuals 非危重病人每日一次与每日两次胰岛素格拉贡剂量的回顾性分析

Q3 Medicine

Diabetes Spectrum

Pub Date : 2024-02-05 DOI: 10.2337/ds23-0029

Deasiah Hogue, Jennifer Clements, Adrienne Wright

Insulin is the treatment of choice for diabetes care in the hospital. There is some debate regarding the efficacy and safety of once-daily versus twice-daily insulin glargine in the hospital, particularly in the critically ill population. The purpose of this pilot study was to evaluate the efficacy and safety of insulin glargine administered as a once-daily versus twice-daily regimen in the noncritically ill population. A retrospective chart review was conducted from 1 June 2020 to 31 May 2021. Inclusion criteria were age ≥18 years and on a regimen of either once-daily or twice-daily insulin glargine for ≥72 hours during the specified time frame. The primary end point was a comparison of the number of days with all blood glucose measurements within the range of 70–180 mg/dL throughout a 24-hour period. Secondary end points included the number of hyperglycemic (>180 mg/dL) and hypoglycemic (<70 mg/dL) events that occurred in each study group. Group 1 included 101 individuals who received once-daily dosing, and group 2 included 103 individuals who received twice-daily dosing. Baseline characteristics were similar between the groups except for a higher BMI at admission (P = 0.01) and a higher pre-admission A1C (P = 0.02) in group 2. No differences were found for the primary end point (P = 0.5) or for hypoglycemic (P = 0.6) or hyperglycemic (P = 0.7) events. There were no significant differences in efficacy or safety between once-daily and twice-daily insulin glargine in the noncritically ill population. A larger prospective study could confirm these results.

胰岛素是医院糖尿病治疗的首选。关于每日一次与每日两次格列卫胰岛素在医院的疗效和安全性存在一些争议，尤其是在重症患者中。本试验研究的目的是评估在非危重病人中每日一次与每日两次胰岛素格列卫的疗效和安全性。研究对 2020 年 6 月 1 日至 2021 年 5 月 31 日期间的病历进行了回顾性分析。纳入标准为年龄≥18岁，在规定时间内使用格列卫胰岛素每日一次或每日两次方案≥72小时。主要终点是比较 24 小时内所有血糖测量值均在 70-180 毫克/分升范围内的天数。次要终点包括各研究组发生高血糖（>180 毫克/分升）和低血糖（<70 毫克/分升）事件的次数。第一组包括101名每日服药一次的患者，第二组包括103名每日服药两次的患者。除了第 2 组入院时的体重指数较高 (P = 0.01) 和入院前的 A1C 较高 (P = 0.02) 外，两组的基线特征相似。在主要终点 (P = 0.5) 或低血糖 (P = 0.6) 或高血糖 (P = 0.7) 事件方面均未发现差异。在非危重病人群中，每日一次和每日两次的格列卫胰岛素在疗效和安全性方面没有明显差异。更大规模的前瞻性研究可以证实这些结果。

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引用次数: 0

Retrospective Analysis of Once-Daily Versus Twice-Daily Insulin Glargine Dosing in Noncritically Ill Individuals 非危重病人每日一次与每日两次胰岛素格拉贡剂量的回顾性分析

Q3 Medicine

Diabetes Spectrum

Pub Date : 2024-02-05 DOI: 10.2337/ds23-0029

Deasiah Hogue, Jennifer Clements, Adrienne Wright

Insulin is the treatment of choice for diabetes care in the hospital. There is some debate regarding the efficacy and safety of once-daily versus twice-daily insulin glargine in the hospital, particularly in the critically ill population. The purpose of this pilot study was to evaluate the efficacy and safety of insulin glargine administered as a once-daily versus twice-daily regimen in the noncritically ill population. A retrospective chart review was conducted from 1 June 2020 to 31 May 2021. Inclusion criteria were age ≥18 years and on a regimen of either once-daily or twice-daily insulin glargine for ≥72 hours during the specified time frame. The primary end point was a comparison of the number of days with all blood glucose measurements within the range of 70–180 mg/dL throughout a 24-hour period. Secondary end points included the number of hyperglycemic (>180 mg/dL) and hypoglycemic (<70 mg/dL) events that occurred in each study group. Group 1 included 101 individuals who received once-daily dosing, and group 2 included 103 individuals who received twice-daily dosing. Baseline characteristics were similar between the groups except for a higher BMI at admission (P = 0.01) and a higher pre-admission A1C (P = 0.02) in group 2. No differences were found for the primary end point (P = 0.5) or for hypoglycemic (P = 0.6) or hyperglycemic (P = 0.7) events. There were no significant differences in efficacy or safety between once-daily and twice-daily insulin glargine in the noncritically ill population. A larger prospective study could confirm these results.

胰岛素是医院糖尿病治疗的首选。关于每日一次与每日两次格列卫胰岛素在医院的疗效和安全性存在一些争议，尤其是在重症患者中。本试验研究的目的是评估在非危重病人中每日一次与每日两次胰岛素格列卫的疗效和安全性。研究对 2020 年 6 月 1 日至 2021 年 5 月 31 日期间的病历进行了回顾性分析。纳入标准为年龄≥18岁，在规定时间内使用格列卫胰岛素每日一次或每日两次方案≥72小时。主要终点是比较 24 小时内所有血糖测量值均在 70-180 毫克/分升范围内的天数。次要终点包括各研究组发生高血糖（>180 毫克/分升）和低血糖（<70 毫克/分升）事件的次数。第一组包括101名每日服药一次的患者，第二组包括103名每日服药两次的患者。除了第 2 组入院时的体重指数较高 (P = 0.01) 和入院前的 A1C 较高 (P = 0.02) 外，两组的基线特征相似。在主要终点 (P = 0.5) 或低血糖 (P = 0.6) 或高血糖 (P = 0.7) 事件方面均未发现差异。在非危重病人群中，每日一次和每日两次的格列卫胰岛素在疗效和安全性方面没有明显差异。更大规模的前瞻性研究可以证实这些结果。

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引用次数: 0

About Kenneth Cusi: Guest Editor 关于肯尼斯-库西：客座编辑

Q3 Medicine

Diabetes Spectrum

Pub Date : 2024-02-01 DOI: 10.2337/ds24-ge01

引用次数: 0