Diabetes Spectrum最新文献

Objective: We sought to examine barriers to diabetes technology use in underserved non-Hispanic Black and Hispanic youth with type 1 diabetes from the caregivers' perspectives and to co-create solutions to overcome barriers.

Research design and methods: Using user-centered design methodology, we held virtual workshops with caregivers to identify barriers and solutions associated with diabetes technology use. Three independent coders analyzed workshop recordings using an inductive coding approach.

Results: Twenty-three caregivers of non-Hispanic Black and Hispanic youth with type 1 diabetes participated. The majority of participants were mothers (n = 21), were publicly insured (n = 18), and had social needs (n = 13). We uncovered novel barriers to diabetes technology use, including 1) health-related social needs specific to diabetes technology use, 2) insufficient diabetes technology support at school, 3) disjointed care integration, and 4) the need for personalized diabetes device education. Proposed solutions included resources for social needs, more technology education for schools, enhanced care coordination, and a nonmedical person to deliver tailored device education.

Conclusion: This study revealed new approaches to support caregivers of non-Hispanic Black and Hispanic youth with type 1 diabetes with persistent barriers to device use. Integrating interventions that align with caregivers' needs will facilitate the adoption and sustained use of diabetes technology by non-Hispanic Black and Hispanic youth with type 1 diabetes.

Objective: Parent engagement is a frequently cited barrier to school health interventions. Little is known about what influences parent involvement in school health decisions for children with chronic conditions such as type 1 diabetes. We aimed to explore parent perspectives on the factors they believe affect their engagement in school-based type 1 diabetes management to identify potential targets for intervention design and implementation.

Research design and methods: We conducted semi-structured interviews with 27 parents of 28 school-aged children (6-15 years of age) with type 1 diabetes from a large academic center. Interview guide questions explored parents' experiences, communication, and relationships with school staff; the impact of diabetes technology; and perceptions of direct communication between schools and health systems. Interviews transcripts were analyzed using a consensus coding approach with thematic analysis to align with the social-ecological model.

Results: Parents identified four categories of factors that affected their engagement in school health decisions: 1) child-specific factors, such as proximity to diagnosis, self-management skills, and the use of technology; 2) family-specific factors, including personal motivations for their child's experience in school and external stressors and demands that may compete with their motivations; 3) interpersonal relationships, including parents' trust or mistrust in school health staff and the perceived role of school health staff within the medical team; and 4) school district factors, including health staffing and policies for device use.

Conclusion: Parental engagement in school-based diabetes care is complex and multifaceted. Using well-timed interventions that address parent priorities, foster trust, enhance communication, and engage technology may mitigate barriers.

Objective: The objectives of this study were to describe health care utilization by adolescents and young adults with type 1 diabetes after transfer from pediatric to adult care and to determine predictors of nonadherence to diabetes care visits after this transition.

Research design and methods: This was a prospective cohort study following adolescents with type 1 diabetes for 18 months after their last pediatric visit from 2017 to 2021. We assessed health care utilization using Quebec health administrative data. The primary exposure was delay in establishing adult diabetes care, defined as a delay of >6 months between the last pediatric and the first adult diabetes care visit. Secondary exposures were self-reported self-efficacy, transition readiness, and diabetes distress before transferring to adult care. The primary outcome was nonadherence, defined as having gap(s) of >6 months between adult diabetes care visits. Secondary outcomes were one or more diabetes-related emergency department (ED) visit and one or more diabetes-related hospitalization. We used multivariable logistic regression to identify predictors of nonadherence to diabetes care visits after transition to adult care.

Results: Fifteen of 74 participants (20%) had delays in establishing adult diabetes care. Twenty participants (27%) were nonadherent to adult diabetes care visits. Six participants (8.1%) had one or more ED visit, and one participant (1.4%) was hospitalized after transferring to adult care. Delay in establishing adult care was associated with subsequent nonadherence to adult diabetes care visits (adjusted odds ratio 29.9, 95% CI 5.3-169.9).

Conclusion: Health care utilization after transfer to adult care is suboptimal in young adults with type 1 diabetes. Delayed transfer of care puts young adults at risk of disengaging from adult diabetes care.

Objective: Continuous glucose monitoring (CGM) systems reduce self-monitoring burden compared with glucose meter use but have limitations when used after total pancreatectomy with islet autotransplantation (TPIAT). An example is false elevation of sensor readings after hydroxyurea (HU) administration, a medication often used after TPIAT. This study compared user experiences of CGM not affected by HU with CGM affected by HU in pediatric patients post-TPIAT.

Research design and methods: This was a retrospective study of 20 TPIAT patients. Caregivers were informed of known limitations and chose the CGM system for postoperative use. Ten chose a Dexcom, and 10 chose a FreeStyle Libre CGM system. Demographic data and caregiver-reported CGM concerns were collected up to 16 weeks after discharge.

Results: Half of Dexcom users reported false hypoglycemia alerts that resolved with repositioning, recalibration, or sensor change. False hyperglycemia was an anticipated outcome and therefore not reported as concerning. Eight FreeStyle Libre users reported false hypoglycemia and frequent alarms that persisted despite sensor changes, which limited device supply. These concerns could not be independently resolved, contributed to caregiver distress, and interrupted sleep. More FreeStyle Libre patients switched to Dexcom than Dexcom patients who switched to a FreeStyle Libre system (70 vs. 10%, P = 0.02) by a median of 2.9 weeks after discharge.

Conclusion: Caregivers reported frequent false alarms on both systems. The frequency of false hypoglycemia with FreeStyle Libre was an unexpected limitation with an unclear cause. The inability to calibrate the FreeStyle Libre likely contributed to frequent sensor changes and supply depletion. The ability to recalibrate the Dexcom system may provide an advantage, but not for people taking HU. Knowledge of CGM limitations post-TPIAT can help individuals make informed decisions.

Objective: The purpose of this study was to assess the impact of an interdisciplinary diabetes care team approach using continuous glucose monitoring (CGM) on glycemic outcomes in a population of adults with type 2 diabetes with suboptimal glycemic control.

Research design and methods: This 6-month, longitudinal observational study was conducted at the outpatient endocrinology clinic of Carilion Clinic in Roanoke, VA. The intervention included use of CGM and weekly interactions either virtually or by telephone by one of the team members. The primary outcomes were changes in A1C, average glucose, and glycemic time in range (TIR; 70-180 mg/dL) over the 6-month observation period. Changes in diabetes medications were also assessed.

Results: Twenty-one adults with type 2 diabetes and a baseline A1C >9% were included in the analysis. At 6 months, A1C levels decreased from 11.3 to 7.6%, average glucose decreased from 212.8 to 159.5 mg/dL, and TIR increased from 44.5 to 67.7%.

Conclusion: These results suggest that an interdisciplinary team approach in combination with CGM and frequent interaction is effective in improving glycemic outcomes in a high-risk population. Studies of longer duration are needed to further elucidate the efficacy of this intervention.

Objective: The Integrated Perinatal Diabetes Education and Management Program (IP-DEMP) was launched to improve outcomes of pregnant and postpartum individuals with diabetes at a large, urban academic hospital system. The purpose of this study was to evaluate treatment outcomes achieved by program participants.

Research design and methods: This retrospective cohort study compared diabetes treatment received by participants in the IP-DEMP with diabetes treatment in a historical comparison group at the same health care facility just before implementation of the IP-DEMP. Logistic regression was used to model the association of participation in the intervention with treatment, adjusting for covariates.

Results: A total of 355 people were included in the analysis. Descriptive characteristics were similar between the intervention and comparison groups. Among participants with gestational diabetes mellitus (GDM), participation in the intervention group significantly increases the likelihood of receiving insulin, the gold-standard therapy during pregnancy. No significant differences in therapy received were observed among participants with different racial and ethnic identities.

Conclusion: People with GDM who participated in the IP-DEMP were more likely to receive insulin therapy. Treatment received was not different for participants from historically marginalized groups.

Diabetes is a complex and highly heterogeneous disease, and its traditional division into broad diagnostic categories such as type 1 diabetes and type 2 diabetes fails to capture its underlying pathology, which can lead to diagnostic misclassification and suboptimal treatment. Growing evidence of the genetic components of diabetes combined with advancements in and availability of genomic technologies have created high expectations for precision medicine in the field of diabetes, which have yet to be met. Successfully implementing genomic precision medicine in the clinical setting requires bridging the translational gap between research and practice. At the core of this effort lies the concept of actionability, which lacks a clear, cross-disciplinary definition and robust and broadly accepted criteria to assess when and in which contexts a genetic variant is actionable. This work is a collaborative effort between philosophy of medicine and biomedical science disciplines that seeks to provide a framework to assess the actionability of genetic variants in the treatment and management of diabetes. Building on the scientific, medical, and philosophical literature and using an example case study, the authors describe core aspects of actionability and evaluate the tensions between research and practice, diagnosis and discovery, and clinical actionability and relevance.