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Liraglutide and Robust A1C Reductions Among People With Type 2 Diabetes Requiring Appetite Control: A Review of Two Cases 利拉鲁肽和需要控制食欲的 2 型糖尿病患者的 A1C 显著降低:两个病例的回顾
Q3 Medicine Pub Date : 2023-12-14 DOI: 10.2337/ds23-0052
Mason A. Pitts, Ryanne H. Griggs, Macey R. Hall, McKinley S. Tankersley, Jeremy L. Johnson
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引用次数: 0
A Pragmatic Rethinking of Glucose Monitoring for the Incarcerated 务实地反思对被监禁者的血糖监测
Q3 Medicine Pub Date : 2023-12-05 DOI: 10.2337/ds23-0036
Rebecca E. Luethy, Renee C. Lipinski, Jennifer L. West
Using continuous glucose monitoring (CGM) improves diabetes-related outcomes in the community, yet the fingerstick blood glucose monitoring (BGM) method is the norm in prisons. The purpose of this study was to investigate the safety and patient perceptions of CGM in the carcerate environment, quantify changes in A1C after initiating CGM, and investigate rates of emergency department (ED) visits for diabetes-related complications comparing CGM users to patients using BGM. This pragmatic longitudinal analysis was conducted in two parts. A pilot program was carried out at a single women’s prison. A CGM program was initiated at men’s facilities within a single U.S. state, where A1C change and ED visit rates were investigated. Interested patients at an appropriate security level were invited to use CGM. Pre- and post-CGM surveys of glucose monitoring perceptions were administered during the pilot program. Security and perceptions were analyzed descriptively. A1C change was assessed using a t test. Fisher exact test, Barnard exact test, and post-hoc power analysis were applied to ED visits. Security was not disrupted. Patient perceptions of glucose monitoring improved with CGM use (n = 6). A1C declined by 0.60% with a medium effect size (Cohen’s d −0.45, n = 42). Power to detect a difference in ED visits was low; however, no CGM patients had an ED visit (n = 758). It is safe and efficacious to replace BGM with CGM in prisons when patients are engaged in their care and are at a security level allowing CGM devices in their cells.
在社区中,使用连续血糖监测(CGM)可以改善糖尿病相关的预后,但手指血糖监测(BGM)方法在监狱中仍是常态。本研究的目的是调查在碳化环境中CGM的安全性和患者的认知,量化启动CGM后A1C的变化,并调查CGM使用者与BGM患者的糖尿病相关并发症急诊(ED)就诊率。本文的语用纵向分析分为两部分。在一所女子监狱开展了一项试点方案。一项CGM计划在美国一个州的男性医院启动,调查了A1C变化和ED就诊率。邀请有兴趣且安全等级适当的患者使用CGM。在试点项目中,对cgm前后的血糖监测感知进行了调查。对安全性和感知进行描述性分析。采用t检验评估A1C变化。Fisher精确检验、Barnard精确检验和事后功效分析应用于急诊科就诊。安全没有受到干扰。使用CGM后,患者对血糖监测的感知得到改善(n = 6)。A1C下降0.60%,效果中等(Cohen’s d = - 0.45, n = 42)。在急诊科就诊中发现差异的能力很低;然而,没有CGM患者有ED就诊(n = 758)。在监狱中,当病人正在接受治疗并且处于允许在其牢房中使用CGM装置的安全级别时,用CGM代替BGM是安全有效的。
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引用次数: 0
Nondisclosure of Type 1 Diabetes in Adolescence: A Single-Center Experience 青春期未披露 1 型糖尿病:单中心经验
Q3 Medicine Pub Date : 2023-12-05 DOI: 10.2337/ds23-0006
Judith Nir, A. Liberman, M. Yackobovitch-Gavan, Drora Fraser, Moshe Phillip, Tal Oron
The aim of this study was to assess the extent of nondisclosure of type 1 diabetes in adolescents and investigate its association with several psychosocial parameters and clinical outcomes. This was a cross-sectional study based on data collected from 69 adolescents with type 1 diabetes who were 12–18 years of age and followed at our diabetes clinic. The degree of disclosure, demographics, diabetes management, and psychosocial issues were assessed via questionnaires. Clinical parameters were derived from medical records. Associations between nondisclosure status and clinical and psychosocial study variables were assessed. Fifty-three participants (77%) reported some extent of nondisclosure. Nondisclosure was associated with low self-esteem, reduced friend support, and increased diabetes-related worries. Nondisclosure was also found to be associated with diminished self-care behaviors related to insulin administration and with elevated A1C. Our results demonstrate that nondisclosure of type 1 diabetes in adolescents may be more common than initially recognized and is likely associated with unfavorable psychological outcomes and reduced self-care and diabetes management. Our results emphasize the importance of social interactions and disclosure in adolescents and may serve as a potential stepping stone to address other social barriers hindering diabetes management.
本研究的目的是评估青少年1型糖尿病的保密程度,并调查其与几个社会心理参数和临床结果的关系。这是一项横断面研究,收集了69名12-18岁的1型糖尿病青少年的数据,并在我们的糖尿病诊所进行了随访。通过问卷调查评估披露程度、人口统计、糖尿病管理和社会心理问题。临床参数来源于医疗记录。评估不披露状态与临床和社会心理研究变量之间的关系。53名参与者(77%)表示有一定程度的保密行为。隐瞒与低自尊、减少朋友支持和增加与糖尿病相关的担忧有关。研究还发现,不披露与胰岛素治疗相关的自我护理行为减少和糖化血红蛋白升高有关。我们的研究结果表明,1型糖尿病的隐瞒在青少年中可能比最初认识到的更常见,并且可能与不利的心理结果、自我保健和糖尿病管理的减少有关。我们的研究结果强调了社会互动和披露在青少年中的重要性,并可能作为解决其他阻碍糖尿病管理的社会障碍的潜在垫脚石。
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引用次数: 0
Novel Pharmacy Model: Pharmacy Diabetes Clinic in Abdominal Transplant Recipients 新颖的药房模式:腹部移植受者的糖尿病药房门诊
Q3 Medicine Pub Date : 2023-11-29 DOI: 10.2337/ds23-0025
Helen Sweiss, Reed Hall, Suverta Bhayana, Rupal Patel, Marcus Flores, Christina Long
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引用次数: 0
What Do Adolescents With Type 1 Diabetes Need to Thrive: Perspective of a 16-Year-Old With 4 Years of Experience Living With Type 1 Diabetes 患有 1 型糖尿病的青少年需要怎样才能茁壮成长?一位拥有 4 年 1 型糖尿病生活经验的 16 岁青少年的观点
Q3 Medicine Pub Date : 2023-11-16 DOI: 10.2337/ds23-0024
Nathan J. Bekelman
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引用次数: 0
About Richard M. Bergenstal: Guest Editor 关于Richard M. Bergenstal:客座编辑
Q3 Medicine Pub Date : 2023-11-01 DOI: 10.2337/ds23-ge04
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引用次数: 0
Electronic Health Interventions for Type 2 Diabetes and Obesity in Hispanic or Latino Adults: A Systematic Review of English and Spanish Studies 西班牙或拉丁裔成人2型糖尿病和肥胖的电子健康干预:英语和西班牙语研究的系统回顾
Q3 Medicine Pub Date : 2023-10-16 DOI: 10.2337/ds22-0083
Elizabeth Lorenzo, Alicia Lynn O’Neal, Lisbeth Cantu Garcia, Kenny Mendoza, Rebecca E. Lee
Objective The objective of this study was to synthesize English and Spanish literature to determine whether electronic health interventions (EHIs) such as telehealth, telemedicine, digital health, and mobile health (mHealth) improve A1C, blood glucose, BMI, and/or weight among Hispanic/Latino adults with type 2 diabetes or overweight/obesity in the Americas. Design and methods Searches were conducted in June 2021 using the Scientific Electronic Library Online, Cumulative Index of Nursing and Allied Health Literature, PubMed, and PsycInfo literature databases. Studies were identified that investigated the effect of an EHI on A1C, blood glucose, BMI, or weight in populations that were ≥12% Hispanic/Latino adults with type 2 diabetes or overweight/obesity, were conducted in the Americas, and were published in English or Spanish. Study quality was determined using the Quality Index Score. Data were extracted and synthesized, and themes were identified. Results Twenty-five studies met inclusion criteria, including 23 in English (from the United States) and two in Spanish (from Chile). A total of 22 investigated type 2 diabetes, and three investigated overweight/obesity. The studies encompassed 6,230 participants, including 3,413 Hispanic/Latino adults. Sixty-three percent of studies demonstrated significant improvements in A1C or blood glucose and 67% in weight. Thirteen studies offered an EHI in both English and Spanish, six offered the intervention in either English or Spanish alone. All EHIs involving mHealth exclusively and most (90%) involving more than one electronic modality demonstrated a higher number of significant findings compared with those having only one EHI modality, especially telehealth (44.4%). EHIs lasting ≤12 months had more significant findings (72.7%) than those lasting >12 months (50%). Six studies had industry-related funding, with 83.3% of those demonstrating significant improvements in outcomes. Conclusion EHIs improved A1C and weight in adults (n = 4,355), including 45.5% Hispanic/Latino adults. mHealth and EHIs using more than one electronic modality and those lasting ≤12 months were especially effective. However, overall study quality was modest. Future research should be conducted in Spanish-speaking countries in Latin America and should compare the effectiveness of different EHI modalities.
本研究的目的是综合英语和西班牙语文献,以确定电子健康干预(EHIs)如远程医疗、远程医疗、数字健康和移动健康(mHealth)是否能改善美洲西班牙裔/拉丁裔成人2型糖尿病或超重/肥胖患者的A1C、血糖、BMI和/或体重。设计和方法于2021年6月使用科学电子图书馆在线、护理和相关健康文献累积索引、PubMed和PsycInfo文献数据库进行检索。在美洲进行了以英语或西班牙语发表的研究,研究了EHI对≥12%患有2型糖尿病或超重/肥胖的西班牙裔/拉丁裔成年人的A1C、血糖、BMI或体重的影响。使用质量指数评分来确定研究质量。提取和综合数据,确定主题。结果25项研究符合纳入标准,其中23项为英语(来自美国),2项为西班牙语(来自智利)。共有22名研究了2型糖尿病,3名研究了超重/肥胖。这些研究包括6230名参与者,其中包括3413名西班牙裔/拉丁裔成年人。63%的研究表明糖化血红蛋白或血糖有显著改善,67%的研究表明体重有显著改善。13项研究同时提供英语和西班牙语的EHI, 6项研究只提供英语或西班牙语的干预。所有仅涉及移动医疗的EHI和大多数(90%)涉及一种以上电子模式的EHI,与只有一种EHI模式的EHI,特别是远程医疗(44.4%)相比,显示出更多的重要发现。持续≤12个月的EHIs(72.7%)比持续≤12个月的EHIs(50%)更显著。6项研究获得了与行业相关的资助,其中83.3%的研究表明结果有显著改善。结论EHIs改善了成人(n = 4355)的A1C和体重,其中包括45.5%的西班牙/拉丁裔成年人。使用一种以上电子方式的移动医疗和EHIs以及持续≤12个月的电子医疗尤其有效。然而,总体研究质量一般。未来的研究应在拉丁美洲的西班牙语国家进行,并应比较不同的EHI模式的有效性。
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引用次数: 0
Frequency and Causes of Nocturnal Alarms in Youth and Young Adults With Type 1 Diabetes Using a First-Generation Hybrid Closed-Loop System 使用第一代混合闭环系统研究青年和青年1型糖尿病患者夜间警报的频率和原因
Q3 Medicine Pub Date : 2023-09-19 DOI: 10.2337/ds23-0003
Erin C. Cobry, Tim Vigers, Cari Berget, Laurel H. Messer, R. Paul Wadwa, Laura Pyle, Gregory P. Forlenza
Background Meeting glycemic recommendations is challenging for youth with type 1 diabetes. Diabetes technology, including continuous glucose monitoring (CGM) and hybrid closed-loop (HCL) automated insulin delivery systems, significantly increase achievement of glycemic targets; however, many youth struggle to sustain use of early HCL systems. Nocturnal alarm fatigue contributes to disrupted sleep and device discontinuation. Methods We examined the frequency and causes of nocturnal (10:00 p.m. to 6:00 a.m.) alarms in pediatric patients (N = 76, median age 14.5 years [interquartile range 11.8–17.0 years, range 7–24 years]) starting on a first-generation HCL system in a prospective observational study. Device data were analyzed with linear mixed effects models to examine change across time at 3-month intervals for 12 months. Results At baseline (HCL system in nonautomated mode), participants averaged 3.3 ± 0.6 alarms per night. In the 2 weeks after starting HCL (automated) mode, alarm frequency significantly increased to 5.4 ± 0.5 time per night (P <0.001). Alarm frequency decreased through the remainder of the observational period; however, CGM sensor and HCL system use also declined. The types of alarms were evenly distributed among sensor maintenance, sensor threshold, pump, and HCL-specific alarms. Conclusion These data show that HCL system nocturnal alarms are frequent and may be barriers to sleep quality and device use. Further research is needed to assess the impact of diabetes technology on sleep and to determine method to improve sleep quality with technology use.
背景:对于1型糖尿病青年患者来说,达到血糖推荐值是一项挑战。糖尿病技术,包括连续血糖监测(CGM)和混合闭环(HCL)自动胰岛素输送系统,显著提高了血糖目标的实现;然而,许多年轻人难以维持早期HCL系统的使用。夜间警报疲劳导致睡眠中断和设备中断。方法:在一项前瞻性观察研究中,研究了开始使用第一代HCL系统的儿童患者(N = 76,中位年龄14.5岁[四分位数范围11.8-17.0岁,范围7-24岁])夜间(晚上10:00至早上6:00)报警的频率和原因。使用线性混合效应模型分析设备数据,以每隔3个月检查12个月的时间变化。结果在基线(非自动化模式下的HCL系统),参与者平均每晚报警3.3±0.6次。在启动HCL(自动)模式2周后,报警频率显著增加至每晚5.4±0.5次(P <0.001)。在剩余的观测期内,报警频率下降;然而,CGM传感器和HCL系统的使用也有所下降。告警类型均匀分布在传感器维护告警、传感器阈值告警、泵告警和盐酸告警中。结论HCL系统夜间报警频繁,可能影响睡眠质量和设备使用。需要进一步的研究来评估糖尿病技术对睡眠的影响,并确定使用技术改善睡眠质量的方法。
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引用次数: 0
Association Between Health Insurance Type and Adverse Outcomes for Children and Young Adults With Type 1 Diabetes and Coronavirus Disease 2019 2019年1型糖尿病和冠状病毒病儿童和年轻人健康保险类型与不良后果之间的关系
Q3 Medicine Pub Date : 2023-09-19 DOI: 10.2337/ds23-0002
Brian Miyazaki, Osagie Ebekozien, Saketh Rompicherla, Amy Ohmer, Ines Guttman-Bauman, Andrea Mucci, Alissa Guarneri, Vandana Raman, Allison Smego, Jane K. Dickinson
Background Health insurance coverage type differs significantly by socioeconomic status and racial group in the United States. The aim of this study was to determine whether publicly insured children and young adults with type 1 diabetes were more likely to experience adverse outcomes compared with privately insured patients with acute coronavirus disease 2019 (COVID-19) infections. Methods Data from 619 patients with previously established type 1 diabetes who were &lt;24 years of age with acute COVID-19 infections were analyzed from the T1D Exchange COVID-19 surveillance registry. Data for the registry was collected from 52 endocrinology clinics across the United States using an online survey tool. Each site completed the survey using electronic health record data between April 2020 and December 2021. Results Of the 619 patients included in this study, 257 had public insurance, and 362 had private insurance. Of the 257 publicly insured patients with COVID-19, 57 reported severe adverse outcomes (22%), defined as diabetic ketoacidosis (DKA) or severe hypoglycemia. In comparison, there were 25 reported adverse outcomes (7%) among the 362 privately insured patients. Conclusion Our data reveal high rates of hospitalization and DKA among publicly insured racial/ethnic minority children and young adults with type 1 diabetes and COVID-19.
背景:在美国,健康保险覆盖类型因社会经济地位和种族群体而有显著差异。本研究的目的是确定与私人保险的急性冠状病毒病2019 (COVID-19)感染患者相比,公共保险的1型糖尿病儿童和年轻人是否更容易出现不良后果。方法分析来自T1D Exchange COVID-19监测注册表的619例既往确诊的24岁急性COVID-19感染1型糖尿病患者的数据。登记处的数据是通过在线调查工具从美国52家内分泌诊所收集的。每个站点在2020年4月至2021年12月期间使用电子健康记录数据完成了调查。结果本研究纳入的619例患者中,257例有公共保险,362例有私人保险。在257名公开投保的COVID-19患者中,57人报告了严重的不良后果(22%),定义为糖尿病酮症酸中毒(DKA)或严重低血糖。相比之下,在362名私人保险患者中,有25例报告了不良后果(7%)。结论我们的数据显示,公共保险的少数民族儿童和青少年1型糖尿病和COVID-19的住院率和DKA率很高。
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引用次数: 0
Romantic Relationships Among Emerging Adults With and Without Type 1 Diabetes 有和没有1型糖尿病的新生成人的恋爱关系
Q3 Medicine Pub Date : 2023-09-18 DOI: 10.2337/ds23-0026
Vicki S. Helgeson
We compared the romantic relationships of emerging adults with type 1 diabetes to those without type 1 diabetes. We examined whether there were group differences in romantic relationships and relationship quality and whether aspects of romantic relationships were connected to psychological and diabetes health. Emerging adults (mean age 27 years) with (n = 88) and without (n = 99) type 1 diabetes took part in the study. Participants completed an online questionnaire that assessed romantic relationships, psychological health, and diabetes health. Results showed that males with type 1 diabetes were significantly less likely than males without diabetes and either group of females to be involved in a romantic relationship. Among those in a relationship, there were no group differences in relationship quality. For both groups, being in a relationship was associated with less loneliness and greater life satisfaction. Among those in a romantic relationship, the quality of the relationship was more strongly related to psychological outcomes for those with than for those without diabetes. There was modest evidence that relationship quality was linked to better diabetes outcomes. When partner supportive and unsupportive diabetes interactions were examined, there was more evidence that unsupportive interactions were harmful (i.e., related to worse psychological and diabetes outcomes) than there was evidence that supportive interactions were beneficial. These findings underscore the importance of romantic relationships for health among emerging adults in general and suggest that there may be an even greater impact for those with type 1 diabetes.
我们比较了刚成年的1型糖尿病患者和非1型糖尿病患者的恋爱关系。我们研究了在恋爱关系和恋爱质量方面是否存在群体差异,以及恋爱关系的某些方面是否与心理健康和糖尿病健康有关。新成人(平均年龄27岁)有(n = 88)和没有(n = 99) 1型糖尿病参加了这项研究。参与者完成了一份评估恋爱关系、心理健康和糖尿病健康状况的在线问卷。结果显示,与没有糖尿病的男性和两组女性相比,患有1型糖尿病的男性谈恋爱的可能性要低得多。在那些处于恋爱关系中的人当中,在关系质量上没有群体差异。对于两组人来说,处于恋爱关系中都能减少孤独感,提高生活满意度。在恋爱关系中,与没有糖尿病的人相比,患有糖尿病的人的关系质量与心理结果的关系更为密切。有适度的证据表明,关系质量与更好的糖尿病预后有关。当对伴侣支持和不支持的糖尿病互动进行检查时,有更多的证据表明,不支持的互动是有害的(即,与更糟糕的心理和糖尿病结果相关),而不是支持的互动是有益的。这些发现强调了恋爱关系对初出期成年人健康的重要性,并表明对1型糖尿病患者的影响可能更大。
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引用次数: 0
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Diabetes Spectrum
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