Diabetes Spectrum最新文献

Objective: The purpose of this article is to describe the processes for convening and engaging an advisory board to guide the conduct of a research study of the Type 1 Diabetes Wraparound Program (T1DWP) and associated outcomes.

Research design and methods: We recruited a diverse advisory board (n = 21) consisting of youth with type 1 diabetes, parents/advocates, and health system partners. The board met monthly over 2 years to discuss all phases of the T1DWP study. We evaluated aspects of engagement and satisfaction among advisory board members using a monthly experience survey on a five-point Likert scale (ranging from strongly disagree to strongly agree) and outcomes, including modifications to the research materials, the study protocol, and implementation.

Results: We received 10 ± 3 survey responses per meeting, with representation from every role at each meeting. The overall stakeholder satisfaction score increased from 4.5 at baseline to 5.0 at month 6 and was maintained at 5.0 at month 24 as the research team responded to feedback. Average scores for specific processes of engagement were high: expectation setting (4.6 ± 0.3), co-learning (4.6 ± 0.3), transparency (4.6 ± 0.3), and decision-making (4.7 ± 0.2). Changes to the T1DWP study resulting from advisory board input included adding nine additional patient-reported measures and specific diabetes resources and programming. Furthermore, the board contributed to hiring of T1DWP study staff, fundraising activities, and clinical integration of the T1DWP, demonstrating stakeholder empowerment and knowledge translation to the clinical setting.

Conclusion: Our processes led to several meaningful contributions to the research study. This experience illustrates the willingness and importance of partnering with stakeholders to help shape resources and programs in pediatric diabetes intervention research.

Objective: Managing preexisting diabetes during pregnancy requires considerable self-management skills to achieve recommended glycemic targets and reduce fetal and obstetrical risks. Given the demands during this time, many individuals may experience diabetes distress. This study aimed to determine the prevalence of diabetes distress and associated clinical factors of diabetes distress during pregnancy.

Research design and methods: A cross-sectional study was conducted involving 36 pregnant participants with type 1 diabetes and 40 pregnant participants with type 2 diabetes. Assessments of diabetes distress, the primary outcome, were performed, along with assessments of depressive symptoms, self-efficacy, self-management, and patient care satisfaction. Linear and logistic regression analyses were conducted to determine predictors of diabetes distress scores and positive diabetes distress.

Results: The prevalence of diabetes distress was 22.4%. Age ≥35 years of age and higher education levels were significantly associated with scores on the Problem Areas in Diabetes (PAID) scale, which measures diabetes-related emotional distress (decreases of 10.18 and 11.77 points, respectively, P = 0.04). Living with others was associated with a reduction in PAID score by 21.56 points (P = 0.05) and the Patient Assessment of Chronic Illness (PACIC) total score as well as PACIC Goal-Setting, and Problem-Solving/Contextual Counseling subscale scores were each associated with a decrease of ∼4 points in PAID score (P <0.05). Having a common-law partner or spouse, comorbid depression, depressive symptoms, and depression scores were all significantly associated with increased PAID scores (P <0.05).

Conclusion: The prevalence of diabetes distress in pregnancy is similar to estimates for nonpregnant adults with type 1 or type 2 diabetes, based on limited pregnancy literature. Further research is needed to establish diabetes distress rates using a validated tool for pregnancy to understand whether diabetes distress affects obstetrical and fetal outcomes and how diabetes distress levels can be alleviated in this population.

Semaglutide and tirzepatide have recently been approved for obesity and found to achieve ≥15% weight loss in clinical trials. These drugs have been referred to as second-generation medications because the unprecedented degree of weight loss they afford is sufficient to treat or prevent a broad array of obesity complications and related diseases. Many other medications are in development based on the actions of nutrient-regulated hormones (NRHs), including mono-, dual-, and triple-receptor agonists/antagonists for glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide, amylin, peptide tyrosine-tyrosine, and glucagon. Clinical trial evidence is accumulating that these medications ameliorate multiple biomechanical, metabolic, and vascular complications of obesity. These tools enable a comprehensive complications-centric approach to care within the contextual framework of the diagnostic term adiposity-based chronic disease (ABCD). The potential to reduce patient suffering and the huge social burden of ABCD is profound. The current era of drug development based on NRHs could represent a landmark in the history of medicine provided that societies ensure access to these medications for the patients who need them.

The development of second-generation anti-obesity medications (AOMs) has transformed the treatment of obesity. However, the first-generation AOMs are still essential tools in the treatment of obesity. The decision of which AOM to initiate must be individualized taking into account patient preference, safety, tolerability, cost, and supply.

Prevalence rates of pediatric obesity and diabetes are rising, and pediatric health care professionals are ideally situated to address these chronic diseases using a patient- and family-centered approach. This article reviews key elements of evaluation that can inform treatment and emphasizes a comprehensive, team-based strategy. Treatment begins with motivational interviewing and building a foundation of intensive health behavior and lifestyle treatment, followed by pharmacotherapy and metabolic and bariatric surgery, when indicated.

Second-generation anti-obesity medications are more effective than their first-generation predecessors, resulting in an average weight loss of 15% when combined with lifestyle modifications. This article examines the efficacy and therapeutic implications of the three currently approved second-generation medications: setmelanotide for individuals with monogenic forms of obesity, semaglutide 2.4 mg, and tirzepatide. Particular emphasis is placed on the concurrent treatment of obesity and type 2 diabetes with semaglutide 2.4 mg and tirzepatide.

This article summarizes and compares 18 sets of guidelines for adult obesity treatment, highlighting key recommendations for patient evaluation, lifestyle intervention, anti-obesity medications (AOMs), and metabolic and bariatric surgery. Guidelines are consistent in many regards, although there is divergence regarding preferred AOMs. Metabolic and bariatric surgery is still recognized as the most durable form of obesity treatment, and newer guidelines suggest these procedures at lower BMI thresholds for people with uncontrolled type 2 diabetes. Overall, guidelines for obesity treatment show a high degree of agreement, although updates are needed to incorporate new treatment innovations.

Background: Managing bolus insulin dosing can be a significant burden for people with diabetes, many of whom have limited numeracy skills. Insulin bolus calculators (IBCs) may improve glycemia as well as treatment satisfaction.

Objective: The purpose of this study was to demonstrate the safety of a novel, continuous glucose monitoring (CGM)-informed IBC mobile device app that applies trend arrow adjustments to bolus insulin dose recommendations.

Research design and methods: This clinical trial was an open-label, industry-sponsored single-arm study conducted at two sites. Fifty-four participants with type 1 or type 2 diabetes were enrolled and used the IBC app on their mobile device for 30 days. Study participants were adults who were already using CGM and dosing bolus insulin. The analysis examined both noninferiority and superiority of time in range (TIR) during the study period compared with baseline. Other important end points included hypoglycemia, glucose variability, nocturnal and diurnal TIR, and diabetes distress. The per-protocol (PP) group was defined as participants who used the IBC >30 times during the study.

Results: Mean TIR improved by 3.8% (95% CI 0.7-6.9%) from 69.2 to 73.0% (P = 0.017) in the PP group. This TIR corresponds to a mean of 0.9 more hours per day spent in range, and the improvement was driven by those with type 2 diabetes. There was no increase in measures of hypoglycemia or diabetes distress. Exploratory analysis revealed a reduction in measures of glucose variability. In addition, individuals with type 1 diabetes had greater improvements in diurnal TIR than in nocturnal TIR.

Conclusion: A CGM-informed IBC app that applies trend arrow adjustments to bolus insulin dose recommendations improved TIR without increasing hypoglycemia or diabetes distress in individuals with type 1 or type 2 diabetes.