Diabetes Spectrum最新文献

Objective: Living with type 1 diabetes is challenging, but more barriers exist when one also identifies as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, or other gender-expansive identities). Acknowledging the importance of identifying this population and providing personalized care, the Health Resources and Services Administration mandated institutions to document sexual orientation and gender identity (SOGI) data. To understand the current state of SOGI documentation in the T1D Exchange Quality Improvement Collaborative, a survey assessing LGBTQ+ supportive and inclusive care practices was given to affiliated sites.

Research design and methods: Thirty-three pediatric and 21 adult care centers were surveyed via Qualtrics. The survey included questions about their electronic health record documentation of patient-identified gender, pronouns, sexual orientation, and sex assigned at birth (SAAB). Care centers also reported on the legality of gender-affirming care in their municipalities, as well as their willingness to change SAAB after patients meet requirements. Fisher exact tests were used to evaluate response frequencies.

Results: All 33 of the pediatric centers and 81% (17 of 21) of the adult centers responded to the survey. Sixty-four percent of pediatric centers had established strategies to support SOGI documentation, whereas only 50% of adult centers had implemented strategies. Some adult centers could not confirm whether they documented SOGI. Differences were seen between the pediatric and adult endocrinology centers in their documentation of gender identity (P = 0.04) and pronouns (P = 0.02).

Conclusion: Although most endocrinology centers documented gender identity and pronouns, fewer documented sexual orientation. Further work is needed to improve SOGI documentation and assess its impact on LGBTQ+ patients with diabetes.

This article was adapted from the address Dr. Trief delivered as the recipient of the American Diabetes Association's Richard R. Rubin Award for 2024. This award recognizes a behavioral researcher who has made outstanding, innovative contributions to the study and understanding of the behavioral aspects of diabetes in diverse populations. Dr. Trief delivered the address in June 2024 at the Association's 84th Scientific Sessions.

This article is adapted from a speech Ms. Urbanski delivered in June 2024 as President, Health Care & Education, of the American Diabetes Association. She delivered her address at the Association's 84th Scientific Sessions.

Objective: The prevalence of pregnancies affected by diabetes is increasing, with the Centers for Disease Control and Prevention reporting that 1-2% of pregnant women have type 1 or type 2 diabetes and up to 10% of pregnancies are affected by gestational diabetes as of 2018. Maternal glycemic management is directly related to fetal and neonatal outcomes, and aberrant maternal hyperglycemia has known negative outcomes. Although most of glycemic management centers on outpatient treatment, evidence exists to support the use of intravenous insulin drips during inpatient admissions. This study aimed to evaluate an intravenous insulin protocol specific to the obstetric (OB) population.

Research design and methods: This was a single-center retrospective pre-/post- cohort study of OB patients with diabetes admitted to an academic medical center. Groups were differentiated based on admission date and protocol implementation with a 6-month washout period. Included patients received an intravenous insulin drip around either antenatal corticosteroid administration or during labor and delivery. Those who were within 7 days of receiving a diabetic ketoacidosis diagnosis or who were admitted to an intensive care unit were excluded.

Results: Fifty-nine patients received 69 distinct insulin drip orders. Twelve drips were included in the group admitted before initiation of the insulin drip protocol (pre-group) and 57 in the group admitted after the protocol went into effect (post-group). Time spent within the goal glucose range while on an insulin drip in the pre-group was 1.63% compared with 39.30% in the post-group (P <0.001). Glucose levels <70 mg/dL was 0.00% in the pre-group compared with 3.23% in the post-group (P = 0.045). There were no differences in severe hypoglycemia (glucose <50 mg/dL), hyperglycemia (glucose >110 mg/dL), or neonatal outcomes.

Conclusion: Implementation of a nursing-driven, obstetrics-specific intravenous insulin drip protocol significantly improved maternal glycemic management within a goal glucose range of 70-110 mg/dL during antenatal corticosteroid administration and labor and delivery.

Objective: This study assessed the effects on type 2 diabetes self-management education provided in group courses with or without a supporting smartphone application (the DM2CUA app).

Research design and methods: This open-label, cluster-randomized, controlled, multicenter pilot study involved three Austrian diabetes educational group courses. People with type 2 diabetes in the control group received a regular educational group course, whereas those in the intervention group received the same course plus the use of the DM2CUA app. The app prompted participants to carry out educational tasks that were discussed in the course. After the last lesson, the app provided participants with relevant messages for another 4 weeks. The primary outcome measure was the Diabetes Self-Management Questionnaire score assessed at four time points. Secondary outcome measures included scores on the Diabetes Distress Scale and the Health Education Impact Questionnaire and A1C levels.

Results: Participants in the intervention group already had a higher level of diabetes self-management at the start, but the median score showed further improvement during the entire study period.

Conclusion: Findings from this pilot study suggest that the DM2CUA app may have a positive impact on diabetes self-management.

Objective: This study assessed rural-urban differences in the uptake and use of glucagon-like peptide 1 (GLP-1) receptor agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors, and sodium-glucose cotransporter 2 (SGLT2) inhibitors among U.S. adults with diabetes.

Research design and methods: We calculated person-level annual total and out-of-pocket (OOP) expenditures for new, other, and all diabetes medications in the Medical Expenditure Panel Survey. We defined newer diabetes medications as GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT2 inhibitors. The primary outcome was whether a person received a new diabetes medication during the year, and secondary outcomes were medication expenditures. The key independent variable was metropolitan statistical area (MSA) status. Logistic regression was used to estimate use rates of new diabetes medications by MSA status, and a two-part model was used to estimate individual-level annual total and OOP expenditures on new, other, and all diabetes medications.

Results: We observed no significant difference (adjusted odds ratio 0.943, P = 0.37) in newer diabetes medication use. Individuals with diabetes in non-MSAs were more likely to have spending (probit coefficient 0.058, P = 0.06) and to spend more on other diabetes medications (combined marginal effect $103.13, P = 0.09), although this result was not statistically significant. This imbalance increased from $81.33 (P = 0.09) in 2003-2006 to $136.66 (P = 0.08) in 2017-2020.

Conclusions: Rural-urban diabetes outcome disparities are not likely to be the result of differences in the uptake of GLP-1 receptor agonist, DPP-4 inhibitor, and SGLT2 inhibitor medications.

Objective: This qualitative study explored the challenges and knowledge gaps among Danish youth with type 1 diabetes and subsequently introduced an information program to empower these youth in their diabetes self-management.

Research design and methods: Nine young patients 18-25 years of age who were diagnosed with type 1 diabetes, living independently, or cohabiting with a partner were included. Relevant participants were invited by mail or telephone. Group interviews were conducted to uncover the specific knowledge requirements essential for improving their diabetes health literacy. Based on these interviews, four education sessions were held.

Results: The participants identified pertinent topics, including alcohol consumption, blood glucose control, educational and employment aspects, nutrition, sexuality, pregnancy, relationships, and interactions with health care professionals (HCPs). Notably, the participants expressed a preference for personalized interactions over information dissemination through digital platforms such as mobile applications. Building on this insight, we organized four sessions to provide education on the identified subjects. These sessions were designed to facilitate networking among participants and offer them the opportunity for discussion. Although invitations were extended to all individuals aged 18-25 years with type 1 diabetes (n = 52), only 13 patients and seven relatives participated. The feedback from attendees was overwhelmingly positive. Reasons for nonparticipation included forgetfulness or a reluctance to engage in group settings.

Conclusion: Young people with type 1 diabetes appreciate personal contact with HCPs. They do not want to receive knowledge via digital apps and virtual media but instead to meet with equals. However, it remains difficult to involve them in social events. The problem of how to create contact with young people with type 1 diabetes to strengthen their health literacy remains unsolved, and there is a need for further innovative initiatives.

People with diabetes receiving inpatient rehabilitation have multiple unique care needs. Although the condition, event, or disability resulting in admission to an inpatient rehabilitation facility (IRF) may not have a causal relationship with chronic conditions such as diabetes, the condition precipitating referral to IRF care may increase a person's risk for worsening cardiometabolic disease. Furthermore, diabetes management in the IRF setting may be complicated by stress hyperglycemia from illness and/or drug-induced hyperglycemia from the use of glucocorticoids or other offending medications. The availability of a multidisciplinary team of clinicians and therapists in the IRF setting holds great opportunity for development of robust diabetes care and education programs to optimize therapy, teach or reinforce diabetes self-management survival skills, and facilitate safe transitions of care to individuals' next setting of care.