Diabetes Spectrum最新文献

Objective: We aimed to explore sex differences in type 1 diabetes management and investigate the perceived need for improved diabetes technology to mitigate the effect of the menstrual cycle on glycemic control in females with type 1 diabetes.

Research design and methods: A REDCap survey was designed to ask adults with type 1 diabetes about demographics, medical history, diabetes management, and, when applicable, the impact of the menstrual cycle on glycemic control and the extent to which currently available diabetes technology is successful at regulating blood glucose levels across cycle phases.

Results: A total of 299 respondents completed the survey. Of these, 218 (72.9%) reported being female. No significant sex differences were detected in reported A1C, glycemic time in range, or diabetes technology used (χ² tests, all P >0.3). One hundred and thirty-six female respondents reported actively menstruating. Of these, 97 (71.3%) indicated the luteal phase of the menstrual cycle to be the cycle phase that most affected their glycemic control, and 102 (75.0%) reported increased exposure to hyperglycemia during this phase. When asked about technology satisfaction, 68 respondents (50.0%) reported that their diabetes technology was not successful at regulating blood glucose levels across the menstrual cycle, and 88 (64.7%) indicated that the technology they used could be better at mitigating cycle-related metabolic variability.

Conclusion: Most investigated type 1 diabetes management outcomes showed no significant sex differences. Importantly, 65% of female respondents who were actively menstruating indicated the need for improved diabetes technology to stabilize glycemic control across the menstrual cycle.

Objective: Preconception planning can reduce complications in pregnancy with type 1 diabetes. However, high periconception A1C is not uncommon and increases maternal and fetal risks. Because of limited data regarding preconception counseling, questions about education and contraception use were added to the 2022 T1D Exchange Quality Improvement Collaborative (T1DX-QI) survey.

Research design and methods: The annual T1DX-QI survey was conducted in August and September 2022 with a center response rate of 94% of 50 centers, including 33 pediatric centers (66%) and 17 adult centers (34%). Representatives from each center answered questions relating to center resources and practices. The study includes females of reproductive age (13-50 years) diagnosed with type 1 diabetes who had at least one A1C value in 2022 in the T1DX-QI database.

Results: Most centers report discussing contraception (74%) and pregnancy planning (72%) at least once per year. Among pediatric centers, 42% report always asking about menstruation history, compared with 6% of adult centers. Only 12% of adult centers and 6% of pediatric centers have a formal preconception counseling protocol. Only 12% of adult centers and 9% of pediatric centers estimated that >80% of their patients of childbearing potential were using contraception. Of females aged 13-50 years of age with type 1 diabetes, 15% at pediatric centers and 24.4% at adult centers had an A1C <6.5% at the time of the survey.

Conclusion: Although most centers reported discussing contraception and pregnancy planning, estimated rates of formal preconception counseling programs, contraception use, and attaining goal A1C remain low. Quality improvement efforts are needed to determine rates of preconception counseling and implement best practices to improve pregnancy outcomes.

Objective: Negative social determinants of health (SDOH) are associated with greater kidney disease incidence and progression, partly because of suboptimal management. We studied the association of demographic, clinical, and individual- and contextual-level SDOH factors with sodium-glucose cotransporter 2 (SGLT2) inhibitor and glucagon-like peptide 1 (GLP-1) receptor agonist initiation in patients with type 2 diabetes and whether these associations were modified by the Kidney Coordinated HeAlth Management Partnership (K-CHAMP) population health management (PHM) program.

Research design and methods: Using data from the K-CHAMP trial, which cluster-randomized 101 primary care offices to a control arm or the PHM intervention (including nephology electronic consultation, chronic kidney disease education, and pharmacist medication review), we explored associations between SGLT2 inhibitor and GLP-1 receptor agonist initiation with a priori patient factors using adjusted Poisson regression. Enrolled patients with type 2 diabetes who were not prescribed an SGLT2 inhibitor or a GLP-1 receptor agonist at baseline were included. Effect modification by K-CHAMP was assessed using interaction terms.

Results: The cohort had 891 patients (402 receiving the PHM intervention and 489 in the control group). Of the participants, 55% were female and 89% were White; the cohort had a mean age of 73 ± 9 years, mean BMI of 33 ± 7 kg/m², mean A1C of 7.3 ± 1.5%, and mean estimated glomerular filtration rate of 37.4 ± 8.3 mL/min/1.73 m²; and 24% were rural living. Over a median follow-up of 17.7 months (interquartile range [IQR] 12.4-23.8 months), 238 (26.7%) initiated an SGLT2 inhibitor or GLP-1 receptor agonist. In adjusted analysis, age (incidence rate ratio [IRR] 0.92, 95% CI 0.85-0.99) and A1C (IRR 1.15, 95% CI 1.07-1.24) were significantly associated with SGLT2 inhibitor or GLP-1 receptor agonist initiation. The K-CHAMP PHM intervention did not significantly modify association of any factors.

Conclusion: Younger age and higher A1C were associated with increased likelihood of initiating an SGLT2 inhibitor or GLP-1 receptor agonist. Other demographic, clinical, and SDOH factors were not significantly associated with medication initiation. The K-CHAMP PHM intervention did not moderate the association of patient-level or SDOH factors with initiation of an SGLT2 inhibitor or GLP-1 receptor agonist.

Objective: Patients with type 2 diabetes are at an elevated risk for metabolic dysfunction-associated steatotic liver disease and advanced liver fibrosis. Multiple professional societies recommend initiating screening with a fibrosis-4 (FIB-4) index score calculation. This study aimed to evaluate the frequency of laboratory assessments necessary for FIB-4 score calculation in patients with type 2 diabetes.

Research design and methods: A retrospective analysis of de-identified electronic medical records from 337,094 patients aged 40-75 years with type 2 diabetes was conducted to evaluate the completion rate of FIB-4 scoring and adherence to other recommended measurements and medications, including urinary albumin measurement and statin use.

Results: Only 33% of patients with type 2 diabetes had all necessary components for FIB-4 score calculation, although this rate increased significantly over time (odds ratio 2.51, 95% CI 2.44-2.58) in the period from 2020 to April 2024 compared with 2010-2014. Urinary albumin measurements also increased but remained low at 13% during the period from 2020 to April 2024. Prescriptions for statin and newer antihyperglycemic medications significantly increased.

Conclusion: Our findings indicate that, although testing frequency for liver health in patients with type 2 diabetes is gradually increasing, substantial gaps in clinical practice persist.

There has been a systemic failure in type 1 diabetes. Regulatory barriers and clinical trial design challenges discourage development of new type 1 diabetes therapies and can compromise the potential for securing approval of new treatments. As a result, there continues to be a pervasive unmet need for those living with type 1 diabetes, resulting in long-term complications, extreme disease management burdens, and psychosocial consequences. People with type 1 diabetes continue to make multiple daily decisions about dosing insulin, a drug that can kill with a single mistake and that at best only manages symptoms without changing the underlying progression of the disease. Furthermore, beyond regulatory challenges, gaps in health care professionals' (HCPs') knowledge and understanding of the disease affect quality of care. The goal of this article is to educate stakeholders on the extent of this systemic failure and to encourage consideration and dialogue among industry, regulatory agencies, patients, and HCPs to expedite approval of breakthrough therapies that fundamentally change the equation in type 1 diabetes.

Objective: Multiple states have passed legislation limiting out-of-pocket insulin costs for individuals on private insurance, including Colorado in 2020. Because disruptions in insulin access are life-threatening for people with type 1 diabetes, this study examined the real-world impact of Colorado's law on patient/parent-reported outcomes.

Research design and methods: Patient/parent-reported frequency of insulin insecurity (insulin rationing, running out early, or finding alternative sources of insulin), cost concerns, and most recent insulin out-of-pocket cost were assessed by a clinic-developed survey. Demographics, A1C, and glycemic time in range (TIR; 70-180 mg/dL) were obtained from medical record review. Linear regression models were fit to compare out-of-pocket costs, A1C, and TIR, adjusting for sex, diabetes duration, race/ethnicity, insurance, and age.

Results: Of 184 enrolled participants, 149 responded to insulin insecurity questions, with 34% reporting at least one insulin insecurity behavior. Insulin insecurity was associated with higher monthly insulin costs ($77.60 vs. $19.30, P = 0.004) and A1C (+0.69 ± 0.23%, P = 0.003) and lower TIR (-9.78 ± 4.03%, P = 0.02) compared with insulin security. Similar rates of insecurity were seen in emerging adults (46%, n = 18/39) and those publicly insured (43.5%, n = 10/23). There was no difference in mean copayments between those on public versus private insurance ($39.40 vs. $38.00).

Conclusion: Despite costs falling below the out-of-pocket cap, insulin insecurity remains common among emerging adults and families of youth with type 1 diabetes and is associated with worse glycemia. Further research into root causes of insecurity, such as limitations on early refills, is required.

The prevalence of diabetes among older adults is steadily rising, especially in aging populations. Although the term "diabetes in older adults" is widely used in clinical guidelines and epidemiological research, it remains largely descriptive, lacking the precision needed to support the development of age-specific treatment strategies. This article proposes the term "older adult diabetes" as a distinct disease entity. By examining the conceptual and linguistic differences between the two terms, the article suggests that the broader adoption of "older adult diabetes" can enhance clinical decision-making, sharpen research focus, and more effectively inform policy development tailored to aging populations.

This study evaluated the use of real-time continuous glucose monitoring (CGM) versus blood glucose monitoring (BGM) with a glucose meter in pregnant patients with preexisting type 2 diabetes on insulin therapy. The use of CGM improved A1C and reduced infant morbidity and mortality compared with BGM alone.

Objective: Taking into account the potential link between oral hygiene and glycemic management in individuals with type 2 diabetes, this study aimed to investigate the relationship between oral hygiene practices, namely, tooth brushing, interdental cleaning, dental visits, and remaining teeth, and glycemic variability measured by continuous glucose monitoring (CGM) in people with type 2 diabetes, with a particular focus on the role of inflammation.

Research design and methods: This cross-sectional study included 104 adults with type 2 diabetes visiting an internal medicine clinic. Questionnaires were used to collect data on oral hygiene practices, dental visit frequency, and the number of remaining teeth. Blood and urine samples were obtained, and CGM was performed for 2 weeks. The relationship between oral hygiene practices and diabetes management indicators, as well as inflammation markers, was analyzed.

Results: The frequency of tooth brushing was negatively correlated with BMI, inflammation-related markers such as high-sensitivity C-reactive protein and tumor necrosis factor-α, and urine albumin-to-creatinine ratio. Interdental cleaning three or more times per week compared with less frequent cleaning was associated with lower fasting blood glucose, lower A1C, and improve CGM-related metrics, including greater time in range (TIR), lower glucose management indicator (GMI), and lower time above range. In logistic regression analysis, interdental cleaning showed associations with achieving TIR and GMI goals, even after adjusting for background factors and inflammatory markers.

Conclusion: This study highlights the crucial role of oral hygiene practices in type 2 diabetes. Regular dental visits and effective oral self-care are paramount for promoting optimal oral health and managing diabetes.