Diabetes Spectrum最新文献

Objective: Despite their documented significance in type 2 diabetes management, social determinants of health (SDOH), including material needs security and quality of life (QoL), are understudied in the Middle East and North Africa (MENA) region. Material needs security refers to the consistent availability of essential material resources required to sustain health and manage diseases. This study aimed to assess the relation between material needs security and QoL in Lebanese adults with type 2 diabetes.

Research design and methods: Using convenience sampling, 300 participants with type 2 diabetes were recruited. Demographic and material need variables were self-reported, and QoL was assessed using the abbreviated World Health Organization Quality of Life Scale (WHOQOL-BREF). WHOQOL-BREF score was the outcome variable used. Regression models were used to examine associations between material needs security and WHOQOL-BREF score, controlling for relevant confounding variables.

Results: Most of the participants were men and married and had lower education levels. Multivariate analyses revealed that having material needs security was associated with physical health (β = 0.32, 95% CI 0.14-0.51), psychological health (β = 0.33, 95% CI 0.15-0.50), social relationships (β = 0.29, 95% CI 0.08-0.50), environment (β = 0.53, 95% CI 0.39-0.67), and overall perception of QoL (β = 0.09, 95% CI 0.04-0.14) after controlling for all relevant confounding variables. Other significant correlates of good QoL included lower age, higher education, higher income, and being employed.

Conclusion: This study highlights the important influence of material needs security on QoL in adults with type 2 diabetes in the MENA region. Further research is needed to understand potential pathways and mechanisms, as well as options for effective interventions.

Few studies have examined associations of social support with blood glucose control in American Indians (AIs), a population with a high burden of type 2 diabetes and related complications. This study examined the association of perceived social support with A1C among AIs in the Strong Heart Study. This cross-sectional study included 431 AI participants. Social support was measured using questions adapted from the National Comorbidity Survey and validated for use in AIs. A1C was measured using high-performance liquid chromatography. Generalized estimating equations were used to examine the association of social support with A1C. Participants who reported greater levels of social support had lower A1C levels. After adjustment for potential confounders, for every 1-SD increase in social support (6.8 points), A1C was 0.21% lower (β = -0.21%, 95% CI -0.40 to -0.01, P = 0.04). These data suggest that higher levels of social support are associated with better control of blood glucose. Further studies are needed to determine the mechanism by which perceived social support affects A1C.

Advancements in automated insulin delivery (AID) systems have transformed type 1 diabetes management, making AID the most effective technology for improving metabolic outcomes and quality of life in individuals with the disease. In this article, we review the available AID systems and their key features through case vignettes that illustrate their real-world applications in type 1 diabetes management. We then examine existing gaps in technology and explore future advancements to further enhance AID functionality and adoption.

Advances in insulin pumps and dosing algorithms have improved the regulation of blood glucose concentrations, reduced the frequency of hyperglycemic and hypoglycemic episodes, and improved quality of life for people with diabetes and their families. Whereas nonautomated or standard insulin pumps may work with a smartphone app to provide information to reduce the workload of users, major advances have been made in automated insulin delivery (AID) system pumps that adjust insulin infusion rates via proprietary algorithms in real time based on data from a continuous glucose monitoring sensor that communicates with the AID pump to take over additional tasks. Improvements in these algorithms are reducing the burden on users today, while the next generation of AID systems, with full automation, are under development.

Inpatient insulin calculators offer the potential to improve blood glucose management, simplify workflow, and address the growing demand for inpatient diabetes care. Implementation of computerized insulin protocols remains a challenge at individual institutions.

In recent years, an increasing number of studies have focused on the use of insulin pump therapy for managing type 2 diabetes. This article explores the various insulin pump therapy options, summarizes the current literature, and discusses key clinical considerations, including device selection, patient eligibility, and special populations such as young adults, older adults, and women during pregnancy. The authors provide a table outlining the benefits and barriers of commercially available pump systems to assist clinicians in making informed decisions about starting insulin pump therapy in adults with type 2 diabetes.

With the availability of connected insulin pens and pen caps, the most used insulin delivery method around the world has entered the digital age and enabled data-informed care for a broader population. Data from these devices are revealing gaps in care for people on multiple daily injection insulin therapy. Incorporating connected insulin pens and pen caps can significantly improve diabetes management for the people who use them by supporting precision insulin injection management. Health care providers are encouraged to embrace these capabilities and develop person-centric practice protocols for their use. Doing so will expand access to and adoption of diabetes technology for all individuals on insulin therapy, regardless of how they choose to administer their insulin.

Objective: Automated insulin delivery (AID) systems have been shown to improve glycemic time in range (TIR) and A1C; however, there are limited data on their use among historically marginalized groups, technology-naive individuals, and young children. This study evaluated whether certain patient features affect the influence of tubeless AID on glycemic metrics in youth with type 1 diabetes.

Research design and methods: This was a retrospective chart review involving patients 2-26 years of age with type 1 diabetes who were prescribed a tubeless AID system between January 2021 and May 2023. Demographic and diabetes treatment data were abstracted from the electronic medical record system. Cluster analysis methodology was used to identify clinically relevant patient groups based on demographics and medical history. Generalized mixed-effects modeling was used to compare TIR and A1C between groups.

Results: Through review of cluster-identified patient characteristics, 133 participants were assigned to one of four groups. Group 1 (n = 42) was predominantly White and privately insured, group 2 (n = 26) had public insurance or was uninsured and was largely non-White, group 3 (n = 44) had the lowest prior pump usage, and group 4 (n = 21) had the youngest median age at diagnosis and at pump initiation. All groups had an increase in TIR and a decrease in A1C after pump initiation, and there was no difference in the improvement between groups (TIR from 46-47 to 60%, P <0.001 for all groups, and A1C from 8.41-8.44 to 7.45-7.49%, P <0.05 for all groups).

Conclusion: Improvements in glycemic management were consistent across groups, despite intragroup differences historically associated with barriers to diabetes management. These findings suggest the importance and potential impact of offering tubeless AID in mitigating care disparities and support its implementation for all youth with type 1 diabetes.