Diabetes Spectrum最新文献_第6页

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

Diabetes Spectrum

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 <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

Diabetes Spectrum

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

Demographic Variables Associated With Diabetes Technology Awareness or Use in Adults With Type 2 Diabetes 与成人2型糖尿病患者糖尿病技术认知或使用相关的人口统计学变量

Q3 Medicine

Diabetes Spectrum

Pub Date : 2023-09-12 DOI: 10.2337/ds23-0013

Yuting Ye, Bernardo A. Acevedo Mendez, Stephanie Izard, Alyson K. Myers

Background Studies in populations with type 1 diabetes highlight racial/ethnic disparities in the use of diabetes technology; however, little is known about disparities among those with type 2 diabetes. This project investigates the racial/ethnic and socioeconomic disparities in diabetes technology awareness and use in adults with type 2 diabetes in the ambulatory setting. Methods Adults ≥40 years of age with type 2 diabetes in ambulatory care were invited to participate via an e-mail link to a de-identified REDCap (Research Electronic Data Capture) questionnaire. Variables, including awareness and use of continuous glucose monitoring (CGM) and insulin pumps, were summarized descriptively using frequencies and percentages and were compared across racial/ethnic groups, education level, and income using Pearson χ2 or Fisher exact tests. Results The study included 116 participants, most of whom (62%) were White, elderly Medicare recipients. Compared with White participants, those of racially/ethnically minoritized groups were less likely to be aware of CGM (P = 0.013) or insulin pumps (P = 0.001). Participants with a high school education or less were also less likely to be aware of insulin pumps (P = 0.041). Interestingly, neither awareness nor use of CGM or insulin pumps was found to be associated with income. Conclusion This cross-sectional analysis suggests that racially/ethnically minoritized groups and individuals with lower education have less awareness of CGM or insulin pumps.

背景:对1型糖尿病人群的研究强调了糖尿病技术使用中的种族差异;然而，人们对2型糖尿病患者的差异知之甚少。本项目调查了2型糖尿病成人患者在门诊环境中糖尿病技术认知和使用方面的种族/民族和社会经济差异。方法通过电子邮件链接，邀请年龄≥40岁的门诊2型糖尿病患者参与REDCap(研究电子数据采集)问卷调查。变量，包括持续血糖监测(CGM)和胰岛素泵的认知和使用，使用频率和百分比进行描述性总结，并使用Pearson χ2或Fisher精确检验对种族/民族、教育水平和收入进行比较。结果该研究包括116名参与者，其中大多数(62%)是白人，老年医疗保险接受者。与白人参与者相比，少数种族/少数民族的参与者不太可能意识到CGM (P = 0.013)或胰岛素泵(P = 0.001)。受教育程度在高中或以下的参与者也不太可能知道胰岛素泵(P = 0.041)。有趣的是，认知和使用CGM或胰岛素泵与收入无关。结论本横截面分析表明，少数民族和受教育程度较低的个体对CGM或胰岛素泵的认识较低。

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引用次数: 0

Ethnicity Affects A1C Levels in Patients With Diagnosed Type 2 Diabetes in Southern Israel 种族影响以色列南部2型糖尿病患者的A1C水平

Q3 Medicine

Diabetes Spectrum

Pub Date : 2023-09-12 DOI: 10.2337/ds23-0009

Yulia Treister-Goltzman, Idit F. Liberty, Roni Peleg

Purpose To assess whether ethnicity affects the association between A1C and fasting glucose in people with type 2 diabetes. Methods An epidemiological, cross-sectional study based on computerized medical records of the Southern District of Clalit Health Services. The study population comprised patients ≥40 years of age with type 2 diabetes who underwent blood tests between 8 August 2015 and 20 July 2020. A normal-error multiple linear regression model was used to assess differences in associations among ethnic groups (i.e., Arabs, Ethiopian Jews, and non-Ethiopian Jews) and A1C. Results A total of 59,432 patients with type 2 diabetes were included in the study. Of these, 1,804 were Jews of Ethiopian origin, 49,296 were non-Ethiopian Jews, and 8,332 were Arabs. Compared with non-Ethiopian Jews, A1C levels were increased by 0.1% (1 mmol/mol) among Ethiopian Jews and by 0.3% (3 mmol/mol) among Arabs. Ethnicity was a strong predictor of A1C, explaining 0.6% of its variance. An A1C level of 7% (53 mmol/mol) correlated with fasting glucose levels of 141, 136, and 126 mg/dL in non-Ethiopian Jews, Ethiopian Jews, and Arabs, respectively. Conclusion Ethnic differences in A1C should be considered by clinicians, researchers, and policymakers.

目的评估种族是否影响2型糖尿病患者A1C和空腹血糖之间的关系。方法以克拉利特南区卫生服务中心的计算机病历为基础进行流行病学横断面研究。研究人群包括年龄≥40岁的2型糖尿病患者，他们在2015年8月8日至2020年7月20日期间接受了血液检查。采用正态误差多元线性回归模型评估不同族群(即阿拉伯人、埃塞俄比亚犹太人和非埃塞俄比亚犹太人)与糖化血红蛋白相关性的差异。结果共纳入59,432例2型糖尿病患者。其中1 804人为埃塞俄比亚裔犹太人，49 296人为非埃塞俄比亚裔犹太人，8 332人为阿拉伯人。与非埃塞俄比亚犹太人相比，埃塞俄比亚犹太人的A1C水平升高0.1% (1 mmol/mol)，阿拉伯人的A1C水平升高0.3% (3 mmol/mol)。种族是A1C的一个强有力的预测因子，可以解释0.6%的变异。在非埃塞俄比亚犹太人、埃塞俄比亚犹太人和阿拉伯人中，A1C水平为7% (53 mmol/mol)与空腹血糖水平分别为141、136和126 mg/dL相关。结论临床医生、研究人员和政策制定者应考虑A1C的种族差异。

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引用次数: 0

A Scoping Review of the Relation Between Toothbrushing and Diabetes Knowledge, Glycemic Control, and Oral Health Outcomes in People With Type 2 Diabetes 2型糖尿病患者刷牙与糖尿病知识、血糖控制和口腔健康结局之间关系的综述

Q3 Medicine

Diabetes Spectrum

Pub Date : 2023-06-05 DOI: 10.2337/ds22-0089

Ruth D. Lipman, Kelly K. O’Brien, Joan K. Bardsley, Michelle F. Magee

OBJECTIVE Given the bidirectional relationship between type 2 diabetes and periodontal disease, this study sought to compile the available data regarding the relationship between home oral hygiene, specifically toothbrushing, and glycemic control and oral health in people with type 2 diabetes. METHODS A systematic scoping review was conducted using a combination of controlled vocabulary and keyword terms for type 2 diabetes and home oral care in PubMed and CINHAL. Publications from the past 20 years were considered for inclusion. Study data were summarized. RESULTS A total of 11 studies met our inclusion criteria. In all survey research identified, self-report of more frequent toothbrushing in people with type 2 diabetes was always found to be associated with self-report of better glycemic control and was often associated with better clinician-conducted measures oral health. In the interventional studies identified, health coaching about oral health was associated with improvements in glycemic control, and health coaching compared with health education was found to be associated with enhanced improvement in glycemic control and self-reported toothbrushing behavior. CONCLUSION The available data suggest that improved engagement in toothbrushing behavior may be associated with improved oral health and better glycemic control in people with type 2 diabetes. Whether improvement in glycemic control is a direct result of change to the oral environment, succeeding with one behavior change stimulating engagement in other health behavior changes, a combination of the two, or something else cannot be determined from this review. Additional studies are needed to further explore the potential for oral health coaching to improve the well-being of people with type 2 diabetes.

考虑到2型糖尿病和牙周病之间的双向关系，本研究试图收集关于2型糖尿病患者家庭口腔卫生(特别是刷牙)与血糖控制和口腔健康之间关系的现有数据。方法采用PubMed和CINHAL中2型糖尿病和家庭口腔护理的受控词汇和关键词进行系统的范围综述。过去20年的出版物也被列入考虑范围。总结研究数据。结果共有11项研究符合我们的纳入标准。在所有已确定的调查研究中，2型糖尿病患者自我报告的更频繁刷牙总是与自我报告的更好的血糖控制有关，并且通常与更好的临床指导的口腔健康措施有关。在已确定的干预性研究中，有关口腔健康的健康指导与血糖控制的改善有关，与健康教育相比，健康指导与血糖控制和自我报告的刷牙行为的改善有关。结论现有数据表明，改善2型糖尿病患者的刷牙行为可能与改善口腔健康和更好的血糖控制有关。血糖控制的改善是否是口腔环境改变的直接结果，一种行为改变的成功刺激了其他健康行为的改变，两者的结合，或者其他什么不能从这篇综述中确定。需要进一步的研究来进一步探索口腔健康指导的潜力，以改善2型糖尿病患者的健康。

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引用次数: 1

Medication Adherence in American Indians With Type 2 Diabetes: An Integrative Review. 美国印第安人2型糖尿病患者的药物依从性:一项综合综述。

Q3 Medicine

Diabetes Spectrum

Pub Date : 2023-05-01 Epub Date: 2022-12-08 DOI: 10.2337/ds21-0096

Tarah Nelson, Diana J Wilkie, Lisa Scarton

引用次数: 0

Trends and Self-Management Predictors of Glycemic Control During Pregnancy in Women With Preexisting Type 1 or Type 2 Diabetes: A Cohort Study. 已有 1 型或 2 型糖尿病的妇女在怀孕期间血糖控制的趋势和自我管理预测因素：一项队列研究。

Q3 Medicine

Diabetes Spectrum

Pub Date : 2023-05-01 Epub Date: 2022-12-23 DOI: 10.2337/ds22-0046

Katelyn Sushko, Holly Tschirhart Menezes, Michelle Butt, Kara Nerenberg, Patricia Strachan, Muhammad Ali Usman, Diana Sherifali

Background: Because much of diabetes management during pregnancy occurs at home, self-management factors such as self-efficacy, self-care activities, and care satisfaction may affect glycemia. Our objective was to explore trends in glycemic control during pregnancy in women with type 1 or type 2 diabetes; assess self-efficacy, self-care, and care satisfaction; and examine these factors as predictors of glycemic control.

Methods: We conducted a cohort study from April 2014 to November 2019 at a tertiary center in Ontario, Canada. Self-efficacy, self-care, care satisfaction, and A1C were measured three times during pregnancy (T1, T2, and T3). Linear mixed-effects modeling explored trends in A1C and examined self-efficacy, self-care, and care satisfaction as predictors of A1C.

Results: We recruited 111 women (55 with type 1 diabetes and 56 with type 2 diabetes). Mean A1C significantly decreased by 1.09% (95% CI -1.38 to -0.79) from T1 to T2 and by 1.14% (95% CI -1.43 to -0.86) from T1 to T3. Self-efficacy significantly predicted glycemic control for women with type 2 diabetes and was associated with a mean change in A1C of -0.22% (95% CI -0.42 to -0.02) per unit increase in scale. The exercise subscore of self-care significantly predicted glycemic control for women with type 1 diabetes and was associated with a mean change in A1C of -0.11% (95% CI -0.22 to -0.01) per unit increase in scale.

Conclusion: Self-efficacy significantly predicted A1C during pregnancy in a cohort of women with preexisting diabetes in Ontario, Canada. Future research will continue to explore the self-management needs and challenges in women with preexisting diabetes in pregnancy.

背景：由于孕期糖尿病管理的大部分工作是在家中进行的，因此自我管理因素（如自我效能、自我护理活动和护理满意度）可能会影响血糖。我们的目的是探索 1 型或 2 型糖尿病女性患者孕期血糖控制的趋势；评估自我效能、自我护理和护理满意度；并研究这些因素对血糖控制的预测作用：我们于 2014 年 4 月至 2019 年 11 月在加拿大安大略省的一家三级中心开展了一项队列研究。在孕期对自我效能、自我护理、护理满意度和 A1C 进行了三次测量（T1、T2 和 T3）。线性混合效应模型探讨了 A1C 的变化趋势，并研究了作为 A1C 预测因素的自我效能、自我护理和护理满意度：我们招募了 111 名女性（55 名 1 型糖尿病患者和 56 名 2 型糖尿病患者）。平均 A1C 从 T1 到 T2 显著下降了 1.09% (95% CI -1.38 到 -0.79)，从 T1 到 T3 显著下降了 1.14% (95% CI -1.43 到 -0.86)。自我效能感对女性 2 型糖尿病患者的血糖控制有明显的预测作用，并且与量表每增加一个单位，A1C 平均变化-0.22% (95% CI -0.42 to -0.02)相关。自我保健的运动分值可显著预测1型糖尿病女性患者的血糖控制情况，每增加一个量表单位，A1C的平均变化幅度为-0.11%（95% CI -0.22至-0.01）：结论：在加拿大安大略省的一组已患糖尿病的妇女中，自我效能感对孕期 A1C 有明显的预测作用。未来的研究将继续探索妊娠期糖尿病妇女的自我管理需求和挑战。

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引用次数: 0

About Michael C. Riddell: Guest Editor. 关于Michael C. Riddell:客座编辑。

Q3 Medicine

Diabetes Spectrum

Pub Date : 2023-05-01 DOI: 10.2337/ds23-ge02

引用次数: 0

SweetMama: Usability Assessment of a Novel Mobile Application Among Low-Income Pregnant People to Assist With Diabetes Management and Support. SweetMama：低收入孕妇使用新型移动应用程序协助糖尿病管理和支持的可用性评估。

Q3 Medicine

Diabetes Spectrum

Pub Date : 2023-05-01 Epub Date: 2022-10-06 DOI: 10.2337/ds22-0014

Lynn M Yee, Karolina Leziak, Jenise Jackson, Charlotte Niznik, Rana Saber, Chen Yeh, Melissa A Simon

Background: Mobile health tools may be effective strategies to improve engagement, education, and diabetes-related health during pregnancy. We developed SweetMama, a patient-centered, interactive mobile application (app) designed to support and educate low-income pregnant people with diabetes. Our objective was to evaluate the SweetMama user experience and acceptability.

Methods: SweetMama is a mobile app with static and dynamic features. Static features include a customized homepage and resource library. Dynamic features include delivery of a theory-driven diabetes-specific curriculum via 1) motivational, tip, and goal-setting messages aligning with treatment and gestational age; 2) appointment reminders; and 3) ability to mark content as "favorite." In this usability assessment, low-income pregnant people with gestational or type 2 diabetes used SweetMama for 2 weeks. Participants provided qualitative feedback (via interviews) and quantitative feedback (via validated usability/satisfaction measures) on their experience. User analytic data detailed the duration and type of interactions users had with SweetMama.

Results: Of 24 individuals enrolled, 23 used SweetMama and 22 completed exit interviews. Participants were mostly non-Hispanic Black (46%) or Hispanic (38%) individuals. Over the 14-day period, users accessed SweetMama frequently (median number of log-ins 8 [interquartile range 6-10]), for a median of 20.5 total minutes, and engaged all features. A majority (66.7%) rated SweetMama as having moderate or high usability. Participants emphasized design and technical strengths and beneficial effects on diabetes self-management and also identified limitations of the user experience.

Conclusion: Pregnant people with diabetes found SweetMama to be user-friendly, informative, and engaging. Future work must study its feasibility for use throughout pregnancy and its efficacy to improve perinatal outcomes.

背景：移动医疗工具可能是改善孕期参与、教育和糖尿病相关健康的有效策略。我们开发了一款以患者为中心的交互式移动应用程序（SweetMama），旨在为低收入糖尿病孕妇提供支持和教育。我们的目标是评估 SweetMama 的用户体验和可接受性：SweetMama 是一款具有静态和动态功能的移动应用程序。静态功能包括定制的主页和资源库。动态功能包括通过以下方式提供理论驱动的糖尿病特定课程：1）与治疗和妊娠年龄相一致的激励、提示和目标设定信息；2）预约提醒；以及 3）将内容标记为 "最爱"。在这次可用性评估中，患有妊娠期糖尿病或 2 型糖尿病的低收入孕妇使用 SweetMama 两周。参与者就使用体验提供了定性反馈（通过访谈）和定量反馈（通过有效的可用性/满意度测量）。用户分析数据详细说明了用户与 SweetMama 互动的持续时间和类型：在 24 名注册者中，23 人使用了 SweetMama，22 人完成了退出访谈。参与者大多为非西班牙裔黑人（46%）或西班牙裔美国人（38%）。在 14 天的时间里，用户经常访问 SweetMama（登录次数中位数为 8 次[四分位间范围为 6-10 次]），总时长中位数为 20.5 分钟，并使用了所有功能。大多数人（66.7%）认为 SweetMama 具有中等或高等可用性。参与者强调了设计和技术上的优势以及对糖尿病自我管理的有益影响，同时也指出了用户体验的局限性：结论：怀孕的糖尿病患者认为 SweetMama 对用户友好、信息丰富且具有吸引力。未来的工作必须研究其在整个孕期使用的可行性及其改善围产期预后的功效。

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引用次数: 0

Practical Aspects and Exercise Safety Benefits of Automated Insulin Delivery Systems in Type 1 Diabetes. 1型糖尿病自动胰岛素输送系统的实用方面和运动安全益处。

Q3 Medicine

Diabetes Spectrum

Pub Date : 2023-05-01 DOI: 10.2337/dsi22-0018

Dessi P Zaharieva, Dale Morrison, Barbora Paldus, Rayhan A Lal, Bruce A Buckingham, David N O'Neal

Regular exercise is essential to overall cardiovascular health and well-being in people with type 1 diabetes, but exercise can also lead to increased glycemic disturbances. Automated insulin delivery (AID) technology has been shown to modestly improve glycemic time in range (TIR) in adults with type 1 diabetes and significantly improve TIR in youth with type 1 diabetes. Available AID systems still require some user-initiated changes to the settings and, in some cases, significant pre-planning for exercise. Many exercise recommendations for type 1 diabetes were developed initially for people using multiple daily insulin injections or insulin pump therapy. This article highlights recommendations and practical strategies for using AID around exercise in type 1 diabetes.

定期锻炼对1型糖尿病患者的整体心血管健康和健康至关重要，但锻炼也会导致血糖紊乱加剧。自动胰岛素输送(AID)技术已被证明可以适度改善成人1型糖尿病患者的血糖范围时间(TIR)，并显着改善青年1型糖尿病患者的TIR。现有的辅助训练系统仍然需要用户主动改变设置，在某些情况下，还需要对锻炼进行大量的预先规划。许多针对1型糖尿病的运动建议最初是针对每天多次注射胰岛素或胰岛素泵治疗的人制定的。本文重点介绍了在1型糖尿病患者运动中使用AID的建议和实用策略。

引用次数: 3