Clinical Diabetes最新文献

Guidelines for the treatment of diabetes-related ketoacidosis (DKA) recommend adding i.v. dextrose or enteral glucose when a patient's blood glucose level has decreased sufficiently to help prevent hypoglycemia. This study sought to determine whether a delay in this intervention was associated with a higher incidence of hypoglycemia. It found that patients are at increased risk for hypoglycemia during the active treatment window of DKA, as well as during the entire hospitalization, when the addition of dextrose or glucose is delayed.

This article reports on a retrospective study examining associations between neighborhood opportunity and glycemic trajectory and health care utilization among youth with diabetes using current Child Opportunity Index (COI) data linked to ZIP codes. The study found that glycemic control and health care utilization were worse in the setting of adverse COI and individual social determinants of health, but both were also independently associated with race.

Although patient preferences are heterogeneous, the out-of-pocket cost and accuracy of continuous glucose monitoring (CGM) systems are the two most important attributes for patients with type 2 diabetes. Surprisingly, receiver screen information is not considered important when choosing a CGM system. Identifying important attributes could facilitate patient-provider communications in choosing a preferred CGM system and potentially increase adherence. Improving patient education on interpreting the information on the receiver screen could enhance the benefit of using CGM.

Glucagon-like peptide 1 (GLP-1) receptor agonists are prescribed as an adjunct to diet and exercise for the management of type 2 diabetes, yet adherence to healthy nutrition and physical activity is often suboptimal. As the use of these agents continues to rise, there are some concerns about the negative aspects of associated weight loss, including loss of muscle mass. This article highlights the benefits of healthy nutrition and physical activity for type 2 diabetes management irrespective of GLP-1 receptor agonist use or associated weight loss, identifies barriers to healthy nutrition and physical activity, and provides guidance for primary care clinicians to further educate and advise their patients on these important topics when initiating GLP-1 receptor agonist treatment.

Treatment decisions for type 2 diabetes are complex and multifactorial. This study evaluated the utility of OpenAI's generative pre-trained transformer-4 (GPT-4) large language model in enhancing treatment plans for people with diabetes. The authors assessed GPT-4's ability to extract and critically evaluate diabetologist-developed treatment plans from patients' clinical notes. GPT-4 accurately discerned personalized treatment goals but performed suboptimally when identifying plans that could be further improved and personalized. However, 40% of GPT-4's reasoning and explanations were still considered helpful by experienced academic diabetologists, suggesting a potential broad benefit to less expert physicians, such as those in primary care settings.

This systematic review describes factors associated with transition readiness and the transfer of care from pediatric to adult health care services among adolescents and young adults with diabetes. Overall, thirty-three international nonintervention, nonqualitative studies were identified between 2018 and 2023. Collectively, this review's findings identify targets for intervention and may inform policies and care practices related to transition, such as transition readiness, family and peer support, mental health support, and engagement in pediatric care.

This article provides an overview for primary care physicians of recently published evidence-based clinical practice guidelines for managing the risks of atherosclerotic cardiovascular disease and chronic kidney disease in people with type 2 diabetes. The authors also share practical guidance and example case studies on how to initiate effective communication with patients to mitigate these risks.

Youth with type 2 diabetes are at a higher risk of adverse pregnancy outcomes than their adult counterparts, and addressing contraception in this population at puberty onset is strongly recommended. This retrospective study at an academic pediatric type 2 diabetes clinic found that 30% of youth achieved the primary composite outcome of documented preconception and contraceptive counseling, contraception prescription, and gynecology referral. Only 1.4% of youth aged 12-21 years had documented preconception counseling, and 27% had documented contraception counseling. By comparison, 18% of adults with preexisting diabetes at the same academic campus met the primary outcome. Adults had a higher rate of preconception counseling (14%) but a lower rate of contraception counseling (4%). This study identifies major gaps in preconception counseling and contraception education for youth with type 2 diabetes.