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Editorial Board and Aims & Scopes 编辑委员会和目标与范围
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-21 DOI: 10.1016/S1751-9918(24)00210-9
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引用次数: 0
Proactive total diet replacement referral for type 2 diabetes: A service evaluation 2 型糖尿病患者的主动全饮食替代转诊:服务评估。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-01 DOI: 10.1016/j.pcd.2024.10.004
Stephen Wormall , Karen Richardson

Aims

Type 2 Diabetes Mellitus morbidity disproportionally effects the most socioeconomically deprived 20 % of England. Total Diet Replacement (TDR) is a high impact intervention currently commissioned by Integrated Care Boards (ICB). Finding and referring eligible, motivated patients is a significant challenge. This study evaluates a 12-month population health management, proactive referral intervention commissioned by Nottingham and Nottinghamshire ICB during a 2-year TDR pilot designed to supplement referrals from primary care.

Methods

A Diabetes specialist nurse clinically reviewed a list of potentially eligible patients found by searching routinely collected health care data from 16 primary care centres in 3 PCNs.

Results

19.7 % (50/254) of potential patients were referred during the intervention period. 19.3 % (49/254) were uncontactable. 39.8 % (101/254) declined referral. 17.7 % (45/254) were ineligible after clinical review. An interrupted time series analysis suggests monthly referrals increased during the study period due to the intervetion (F (1,22) = 5.19 p=0.0345). Searching for patients from more socioeconomically deprived areas (index of multiple deprivation deciles 1–3) did not meaningfully alter the referral yield (19.6 %, 19/97).

Conclusions

Proactive care interventions could be used to facilitate referrals to the TDR or other high impact interventions by healthcare commissioning bodies.
目的:2 型糖尿病的发病率对英格兰社会经济最贫困的 20% 人口的影响尤为严重。全饮食替换(TDR)是目前由综合护理委员会(ICB)委托进行的一项高效干预措施。寻找和转诊符合条件、有积极性的患者是一项重大挑战。本研究评估了诺丁汉和诺丁汉郡综合医疗委员会在为期 2 年的全饮食替代试点期间委托开展的一项为期 12 个月的人口健康管理、主动转诊干预措施,该措施旨在补充来自初级保健的转诊:方法:一名糖尿病专科护士通过搜索 3 个 PCN 中 16 个初级保健中心的常规保健数据,对可能符合条件的患者名单进行临床审查:在干预期间,19.7%(50/254)的潜在患者被转诊。19.3%(49/254)的患者无法联系。39.8%的患者(101/254)拒绝转诊。17.7%(45/254)经临床审查不符合条件。间断时间序列分析表明,在研究期间,每月转诊人数因间断时间序列而增加(F (1,22) = 5.19 p=0.0345)。对来自社会经济较贫困地区(多重贫困指数1-3分位)的患者进行搜索并未显著改变转诊率(19.6%,19/97):结论:积极的护理干预措施可用于促进转诊至TDR或医疗委托机构的其他高效干预措施。
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引用次数: 0
Impact of lifestyle intervention on vitamin D, Adiponectin, Insulin-like growth factor 1 and Proneurotensin in overweight individuals from the Middle East 生活方式干预对中东地区超重人群维生素 D、脂肪连素、胰岛素样生长因子 1 和神经紧张素的影响。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-24 DOI: 10.1016/j.pcd.2024.10.006
Nadine Fadhel Dhaher , Kerstin Brismar , Miriam Pikkemaat , Nael Shaat , Anton Nilsson , Louise Bennet

Background

Immigrants from the Middle East (ME) have a higher prevalence of type 2 diabetes (T2D) compared to the native-born Swedish population. In individuals free from T2D, ME immigrants are more insulin resistant and have lower levels of adjusted insulin secretion (Disposition index, DIo) compared to Swedish-born individuals. The ethnic differences are not fully explained by traditional risk factors. This has raised the question as to whether hormonal factors other than insulin are involved, contributing to higher T2D risk in ME immigrants.

Aims

In ME immigrants at high risk of developing T2D, we aimed to study the effect of a randomized culturally adapted lifestyle intervention on the levels of Vitamin D (25(OH)D), insulin-like growth factor 1 (IGF-1), Pro-neurotensin (Pro-NT) and Adiponectin. Furthermore, we aimed to study if the effect of the intervention was associated to these hormones, or if a direct effect of the intervention remained after accounting for these.

Methods

In this culturally adapted randomized controlled trial of four months duration, eligible ME immigrants at high risk of developing T2D identified in the MEDIM cohort were invited to participate. The intervention group (N= 35) received a culturally adapted lifestyle intervention program consisting of seven group sessions and cooking classes. The control group (N= 32) were given treatment as usual with oral and written information to improve their lifestyle habits. Using mixed models’ linear regression analysis, the changes in the levels of 25(OH)D, IGF-1, Adiponectin and Pro-NT were assessed by comparing the groups and we further studied the effects of the changes on insulin action and secretion.

Results

The adjusted levels of 25(OH)D significantly increased in the intervention group compared to the control group (β for the effect of the intervention on 25(OH)D: 0.061, 95 % CI 0.009–0.113, P = 0.023). The increase in insulin sensitivity index (ISI) observed in the intervention compared to the control group was altered after adjusting for 25(OH)D: 0.129, 95 % CI −0.016–0.274, P = 0.078). IGF-1, Adiponectin and Pro-NT did not significantly influence the change over time concerning insulin secretion.

Conclusion

Lifestyle intervention increases the adjusted levels of 25(OH)D. Moreover, the effect of the lifestyle intervention on insulin action and secretion was altered when adjusting for 25(OH)D.
背景:与土生土长的瑞典人相比,来自中东地区(ME)的移民患 2 型糖尿病(T2D)的比例更高。与瑞典出生的人相比,中东移民对胰岛素的抵抗力更强,调整后的胰岛素分泌水平(处置指数,DIo)更低。传统的风险因素并不能完全解释这种种族差异。目的:我们的目标是研究随机文化适应性生活方式干预对维生素 D (25(OH)D)、胰岛素样生长因子 1 (IGF-1)、前神经紧张素 (Pro-NT) 和脂肪连素水平的影响。此外,我们还旨在研究干预效果是否与这些激素有关,或者在考虑了这些激素后,干预效果是否仍然是直接的:在这项为期 4 个月的文化适应性随机对照试验中,MEDIM 队列中确定的符合条件的 T2D 高危 ME 移民受邀参加。干预组(35 人)接受了文化适应性生活方式干预计划,包括七节小组课和烹饪课。对照组(32 人)则照常接受口头和书面信息,以改善他们的生活习惯。通过混合模型线性回归分析,我们比较了各组 25(OH)D、IGF-1、脂肪连接蛋白和 Pro-NT 水平的变化,并进一步研究了这些变化对胰岛素作用和分泌的影响:与对照组相比,干预组调整后的 25(OH)D 水平明显提高(干预对 25(OH)D 的影响 β:0.061,95 % CI 0.009-0.113,P = 0.023)。与对照组相比,干预组胰岛素敏感性指数(ISI)的增加在调整 25(OH)D 后发生了变化:0.129,95 % CI -0.016-0.274,P = 0.078)。IGF-1、脂肪连素和Pro-NT对胰岛素分泌随时间的变化没有显著影响:结论:生活方式干预可提高 25(OH)D 的调整水平。此外,在调整 25(OH)D 后,生活方式干预对胰岛素作用和分泌的影响发生了变化。
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引用次数: 0
Re-purposing SGLT-2 inhibitors for diabetic striatopathy 将 SGLT-2 抑制剂重新用于糖尿病纹状体病。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-24 DOI: 10.1016/j.pcd.2024.10.001
Subhankar Chatterjee , Ritwik Ghosh , Souvik Dubey , Richard I.G. Holt
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引用次数: 0
Psychometric properties of the Slovenian versions of the diabetes empowerment scale, long and short form, among the slovenian adults with type 2 diabetes 斯洛文尼亚成人 2 型糖尿病患者糖尿病赋权量表(长表和短表)的心理计量特性。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-20 DOI: 10.1016/j.pcd.2024.10.002
Tina Virtič Potočnik , Špela Miroševič , Matic Mihevc , Črt Zavrnik , Majda Mori Lukančič , Tonka Poplas Susič , Zalika Klemenc-Ketiš

Aims

To determine the psychometric properties of the Slovenian versions of the Diabetes Empowerment Scale (DES), both the long form (S-DES-LF) and the short form (S-DES-SF).

Methods

Between April and September 2023, we recruited adults with type 2 diabetes (T2D) using convenient sampling in five primary health centres. We examined internal consistency, test-retest reliability, criterion validity, and discriminant validity. Confirmatory factor analysis (CFA) evaluated the fit of the one-and three-factor models for S-DES-SF and S-DES-LF, respectively.

Results

The results of 288 individuals, with a mean age of 67 ± 9.2 years, including 132 men and 156 women, showed excellent internal consistency and strong test-retest reliability for both the S-DES-LF (Cronbach’s α=0.90; ICC=0.95) and S-DES-SF (α=0.91; ICC=0.92). Criterion validity of the S-DES-LF was confirmed through known-groups validity, with higher education (p=0.016) and absence of comorbid hypertension (p=0.034) associated with greater empowerment. Discriminant validity was demonstrated by the lack of significant correlations between the S-DES-LF and S-DES-SF scores with age or gender. CFA confirmed a good fit for the S-DES-SF's one-factor model but not for S-DES-LF three-factor model.

Conclusions

S-DES-LF and S-DES-SF are valid and reliable tools for assessing diabetes empowerment in Slovenian people with T2D. Future research should further explore the convergent validity of scales.
目的:确定斯洛文尼亚版糖尿病赋权量表(DES)长表(S-DES-LF)和短表(S-DES-SF)的心理测量特性:方法:2023 年 4 月至 9 月期间,我们在五个初级保健中心采用方便抽样的方式招募了 2 型糖尿病(T2D)成人患者。我们研究了内部一致性、重测可靠性、标准效度和判别效度。确认性因子分析(CFA)分别评估了S-DES-SF和S-DES-LF的单因子模型和三因子模型的拟合情况:结果显示,S-DES-LF(Cronbach's α=0.90;ICC=0.95)和 S-DES-SF(α=0.91;ICC=0.92)的内部一致性极佳,测试-再测信度也很高。S-DES-LF的标准有效性通过已知组的有效性得到了证实,教育程度较高(p=0.016)和无合并高血压(p=0.034)与增强能力相关。S-DES-LF和S-DES-SF得分与年龄或性别之间没有明显的相关性,这证明了区分有效性。CFA证实S-DES-SF的单因素模型拟合良好,但S-DES-LF的三因素模型拟合不佳:结论:S-DES-LF 和 S-DES-SF 是评估斯洛文尼亚 T2D 患者糖尿病能力的有效、可靠工具。未来的研究应进一步探讨量表的收敛效度。
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引用次数: 0
Understanding primary care provider’s knowledge and perceptions of diabetes self-management education and support 了解初级保健提供者对糖尿病自我管理教育和支持的了解和看法。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-20 DOI: 10.1016/j.pcd.2024.10.005
Christina J. Dietz , Emily Doherty , John Emerson , Karen Kemper , Lior Rennert , Windsor Westbrook Sherrill

Objective

The American Diabetes Association Standards of Care recommends that individuals with diabetes receive self-management education, but the utilization of these services remains low. This study explores primary care providers’ knowledge and perceptions of diabetes self-management education and support (DSMES).

Study design

A convergent mixed methods study design grounded in the Theoretical Domains Framework was conducted with an initial provider survey, followed by semi-structured interview of a purposeful sub-sample of providers. The survey was distributed via REDCap and interviews were recorded and transcribed verbatim.

Results

A total of 140 PCP’s responded to the survey (response rate 37.63 %) and 17 participated in interviews. The average knowledge score of the correct selection of DSMES referral time points was 70.35 %. Five themes emerged in provider interviews: procedural knowledge, ability, beliefs, reinforcement, and cultural norms. Providers wanted bidirectional communication with the DSMES program and were more likely to refer if they had a cultural norm of referring.

Conclusion

Providers have limited knowledge of the appropriate time to refer to DSMES but expressed a willingness to refer. They emphasized the importance of providing their patients with appropriate self-management education and support.
目的:美国糖尿病协会护理标准》建议糖尿病患者接受自我管理教育,但这些服务的利用率仍然很低。本研究探讨了初级保健提供者对糖尿病自我管理教育和支持(DSMES)的认识和看法:研究设计:本研究以理论领域框架为基础,采用聚合混合方法进行研究设计,首先对医疗服务提供者进行调查,然后对特定的医疗服务提供者子样本进行半结构化访谈。调查表通过 REDCap 发布,访谈内容逐字记录和转录:共有 140 名初级保健医生回复了调查(回复率为 37.63%),17 人参加了访谈。正确选择 DSMES 转诊时间点的平均知识得分率为 70.35%。在与医疗服务提供者的访谈中出现了五个主题:程序性知识、能力、信念、强化和文化规范。医疗服务提供者希望与 DSMES 项目进行双向交流,如果他们有转介的文化规范,则更有可能进行转介:医疗服务提供者对转介到 DSMES 的适当时间了解有限,但表示愿意转介。他们强调了为患者提供适当的自我管理教育和支持的重要性。
{"title":"Understanding primary care provider’s knowledge and perceptions of diabetes self-management education and support","authors":"Christina J. Dietz ,&nbsp;Emily Doherty ,&nbsp;John Emerson ,&nbsp;Karen Kemper ,&nbsp;Lior Rennert ,&nbsp;Windsor Westbrook Sherrill","doi":"10.1016/j.pcd.2024.10.005","DOIUrl":"10.1016/j.pcd.2024.10.005","url":null,"abstract":"<div><h3>Objective</h3><div>The American Diabetes Association Standards of Care recommends that individuals with diabetes receive self-management education, but the utilization of these services remains low. This study explores primary care providers’ knowledge and perceptions of diabetes self-management education and support (DSMES).</div></div><div><h3>Study design</h3><div>A convergent mixed methods study design grounded in the Theoretical Domains Framework was conducted with an initial provider survey, followed by semi-structured interview of a purposeful sub-sample of providers. The survey was distributed via REDCap and interviews were recorded and transcribed verbatim.</div></div><div><h3>Results</h3><div>A total of 140 PCP’s responded to the survey (response rate 37.63 %) and 17 participated in interviews. The average knowledge score of the correct selection of DSMES referral time points was 70.35 %. Five themes emerged in provider interviews: procedural knowledge, ability, beliefs, reinforcement, and cultural norms. Providers wanted bidirectional communication with the DSMES program and were more likely to refer if they had a cultural norm of referring.</div></div><div><h3>Conclusion</h3><div>Providers have limited knowledge of the appropriate time to refer to DSMES but expressed a willingness to refer. They emphasized the importance of providing their patients with appropriate self-management education and support.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 637-643"},"PeriodicalIF":2.6,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pin-prick (Medipin) assessment for neuropathy in diabetes: Prospective screening study in primary care 糖尿病神经病变的针刺(Medipin)评估:基层医疗机构的前瞻性筛查研究。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-19 DOI: 10.1016/j.pcd.2024.10.003
Stacey Fisher , Hannah Gray , Nicci Kelsall , Donna Lowes , Leon Jonker

Aims

Diabetic patients are at elevated risk of neuropathy; early detection is desirable to minimise the risk of complications. The Medipin pin-prick device was appraised as a screening tool for diabetic neuropathy.

Methods

Prospective cross-sectional comparative screening study in primary care setting, involving 389 participants with type 2 diabetes mellitus. The Medipin pin-prick method, involving dorsal application on the hallux of both feet, was compared to 10 g monofilament testing.

Results

The ternary and semi-quantitative approach for scoring Medipin pin-prick sensation give very similar results (Spearman rho 0.67, P < 0.001). A total of 59 % patients had no signs of neuropathy (sharp sensation), 38 % reported impaired sensation (dull sensation), and an absence of sensation occurred in 3 % of patients. For the monofilament dorsal method, the figures were 79 % no neuropathy, 14 % elevated risk, and 7 % neuropathy respectively, and with the monofilament plantar method 87 % of patients had no neuropathy and 13 % did. Correlation analyses showed that taller patients and those with existing neuropathic pain are at very modest increased risk of neuropathy.

Conclusions

The Medipin pin-prick device can identify diabetic neuropathy and detects (first signs of) neuropathy in relatively more patients than 10 g monofilament testing. The differential targeting of nerve types, namely predominant small (Medipin) versus large (monofilament) fibre, likely underpins the difference in outcomes.
目的:糖尿病患者罹患神经病变的风险较高;为了将并发症的风险降至最低,最好能及早发现。我们对 Medipin 针刺器作为糖尿病神经病变筛查工具进行了评估:方法:在基层医疗机构开展前瞻性横断面比较筛查研究,共有 389 名 2 型糖尿病患者参与。结果:三元和半定量分析结果表明,Medipin 针刺法和 10 g 单丝检测法均可用于糖尿病神经病变的筛查:三元法和半定量法对 Medipin 针刺感觉的评分结果非常相似(Spearman rho 0.67,P < 0.001)。共有 59% 的患者没有神经病变迹象(感觉敏锐),38% 的患者感觉受损(感觉迟钝),3% 的患者没有感觉。采用单丝背侧法时,79%的患者没有神经病变,14%的患者风险升高,7%的患者出现神经病变;采用单丝跖侧法时,87%的患者没有神经病变,13%的患者出现神经病变。相关分析表明,身高较高的患者和已有神经病理性疼痛的患者发生神经病变的风险略有增加:结论:与 10 克单丝测试相比,Medipin 针刺设备能识别糖尿病神经病变,并能检测到更多患者的神经病变(首发症状)。不同的神经类型,即主要的小纤维(Medipin)和大纤维(单丝),可能是结果差异的基础。
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引用次数: 0
Erectile dysfunction as a predictive indicator of asymptomatic diabetes and prediabetes 勃起功能障碍是无症状糖尿病和糖尿病前期的预测指标。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-10 DOI: 10.1016/j.pcd.2024.09.008
Sebastian Becker , Kadri Suija , Antti Valpas , Markku Koiranen , Juha Auvinen , Hannu Uusitalo , Esko Hussi , Sirkka Keinänen-Kiukaanniemi , Jaakko Tuomilehto , Jouko Saramies

Aims

Both erectile dysfunction (ED) and diabetes (DM) are common health problems that share risk factors. The aim of this study was to investigate whether ED can predict glucose metabolism dysfunctions in men at the primary care level.

Methods

An 11-year population-based cohort study was conducted in men born between 1933 and 1956. The baseline survey was conducted in 2007–2008, with a follow-up examination 11 years later. The International Index of Erectile Function (IIEF-5) questionnaire was used to assess erectile function. Dysglycemia was evaluated using and a 2-hour oral glucose tolerance test (2hOGTT), in combination with health registry data.

Results

At baseline, men with ED but without a history of known DM exhibited a significantly higher prevalence of undetected DM, odds ratio (OR) 4.7 (95 % CI 1.6, 14.4), and preDM, OR 1.9 (1.1, 3.2), compared with men without ED. Over an 11-year follow-up period, a significantly increased cumulative incidence of DM was observed in men who reported symptoms of ED at the start of the study.

Conclusions

The symptoms of ED appear to be an early warning sign of existing DM and preDM and predict an increased risk of developing abnormal glucose metabolism in the future.
目的:勃起功能障碍(ED)和糖尿病(DM)都是常见的健康问题,两者有共同的风险因素。本研究旨在探讨在初级保健层面,勃起功能障碍能否预测男性的糖代谢功能障碍:方法:对 1933 年至 1956 年间出生的男性进行了一项为期 11 年的人群队列研究。基线调查于 2007-2008 年进行,11 年后进行随访检查。采用国际勃起功能指数(IIEF-5)问卷评估勃起功能。结合健康登记数据,使用2小时口服葡萄糖耐量试验(2hOGTT)对血糖异常进行评估:结果:与无勃起功能障碍的男性相比,有勃起功能障碍但无已知糖尿病史的男性在基线时未检测到糖尿病的发病率明显更高,比值比 (OR) 为 4.7 (95 % CI 1.6, 14.4),糖尿病前期的比值比 (OR) 为 1.9 (1.1, 3.2)。在长达11年的随访期间,观察到在研究开始时报告有ED症状的男性的DM累积发病率明显增加:结论:ED症状似乎是现有糖尿病和糖尿病前期的早期预警信号,可预测未来发生糖代谢异常的风险增加。
{"title":"Erectile dysfunction as a predictive indicator of asymptomatic diabetes and prediabetes","authors":"Sebastian Becker ,&nbsp;Kadri Suija ,&nbsp;Antti Valpas ,&nbsp;Markku Koiranen ,&nbsp;Juha Auvinen ,&nbsp;Hannu Uusitalo ,&nbsp;Esko Hussi ,&nbsp;Sirkka Keinänen-Kiukaanniemi ,&nbsp;Jaakko Tuomilehto ,&nbsp;Jouko Saramies","doi":"10.1016/j.pcd.2024.09.008","DOIUrl":"10.1016/j.pcd.2024.09.008","url":null,"abstract":"<div><h3>Aims</h3><div>Both erectile dysfunction (ED) and diabetes (DM) are common health problems that share risk factors. The aim of this study was to investigate whether ED can predict glucose metabolism dysfunctions in men at the primary care level.</div></div><div><h3>Methods</h3><div>An 11-year population-based cohort study was conducted in men born between 1933 and 1956. The baseline survey was conducted in 2007–2008, with a follow-up examination 11 years later. The International Index of Erectile Function (IIEF-5) questionnaire was used to assess erectile function. Dysglycemia was evaluated using and a 2-hour oral glucose tolerance test (2hOGTT), in combination with health registry data.</div></div><div><h3>Results</h3><div>At baseline, men with ED but without a history of known DM exhibited a significantly higher prevalence of undetected DM, odds ratio (OR) 4.7 (95 % CI 1.6, 14.4), and preDM, OR 1.9 (1.1, 3.2), compared with men without ED. Over an 11-year follow-up period, a significantly increased cumulative incidence of DM was observed in men who reported symptoms of ED at the start of the study.</div></div><div><h3>Conclusions</h3><div>The symptoms of ED appear to be an early warning sign of existing DM and preDM and predict an increased risk of developing abnormal glucose metabolism in the future.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 618-623"},"PeriodicalIF":2.6,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development, feasibility, and preliminary effects of a culturally adapted, evidence-based, and theory-driven diabetes self-management programme for Chinese adults with type 2 diabetes receiving insulin injection therapy 针对接受胰岛素注射治疗的中国成年 2 型糖尿病患者,开发了一项适应中国文化、以证据为基础、以理论为驱动的糖尿病自我管理计划,该计划的可行性和初步效果。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-05 DOI: 10.1016/j.pcd.2024.09.010
Wei Liang , Ka Ming Chow , Xiaoying Ni , Yetunde Oluwafunmilayo Tola , Suzanne Hoi Shan Lo

Aims

To describe the development of a culturally adapted, evidence-based, and theory-driven diabetes self-management programme for Chinese adults with type 2 diabetes receiving insulin injection therapy and to assess the feasibility, acceptability, and preliminary effects of the newly developed intervention.

Methods

The Medical Research Council framework was adopted to guide the intervention development and a feasibility study. A prospective, two-arm, parallel-group, assessor-blinded randomised controlled trial was conducted. Participants were randomly allocated to receive either the newly developed intervention or parallel attention control contact from community nurses. Between-group differences in changes in outcome variables were analysed using the Mann-Whitney U test.

Results

The newly developed intervention consists of one individual interview session, three group-based education sessions, and two telephone-based maintenance sessions. A total of 24 participants were recruited with the recruitment rate and overall retention rate of 77.4 % and 95.8 %, respectively. The results indicated that the intervention participants reported significantly greater improvements in self-efficacy (Hedge’s g = 1.69) and self-management behaviours (Hedge’s g = 3.24), and reductions in diabetes-related distress (Hedge’s g = 1.49) compared with those in the control group (all p < 0.05).

Conclusion

The diabetes self-management programme was feasible and acceptable. The intervention showed promising patient-centred benefits. A future large-scale randomised controlled trial is warranted.
目的:介绍针对接受胰岛素注射治疗的中国成年2型糖尿病患者开发的适应文化、循证和理论驱动的糖尿病自我管理项目,并评估新开发的干预措施的可行性、可接受性和初步效果:方法:采用医学研究委员会的框架来指导干预措施的开发和可行性研究。进行了一项前瞻性、双臂、平行组、评估者盲法随机对照试验。参与者被随机分配到接受新开发的干预措施或接受社区护士提供的平行注意力对照接触。试验结果采用 Mann-Whitney U 检验分析结果变量变化的组间差异:新开发的干预措施包括一次个人访谈、三次小组教育和两次电话维护。共招募了 24 名参与者,招募率和总体保留率分别为 77.4 % 和 95.8 %。结果表明,与对照组相比,干预参与者的自我效能(Hedge's g = 1.69)和自我管理行为(Hedge's g = 3.24)均有明显改善,与糖尿病相关的困扰(Hedge's g = 1.49)也有所减少(所有数据均小于 0.05):结论:糖尿病自我管理计划是可行和可接受的。结论:糖尿病自我管理计划是可行和可接受的,干预措施显示了以患者为中心的良好效果。未来有必要进行大规模随机对照试验。
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引用次数: 0
Cardiovascular effectiveness of newer glucose-lowering agents, with and without baseline lipid-lowering therapy in type 2 diabetes: A systematic meta-analysis of cardiovascular outcome trials and real-world evidence 新型降糖药物对 2 型糖尿病患者心血管的疗效,包括使用或不使用基线降脂治疗:心血管疗效试验和真实世界证据的系统荟萃分析。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-03 DOI: 10.1016/j.pcd.2024.09.007
Setor K. Kunutsor , Borenyi S. Seidu , Samuel Seidu

Background

Whether the cardiovascular treatment benefits of sodium–glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) differ by baseline use of statins/lipid lowering therapy is unclear. This systematic review and meta-analysis investigated whether baseline statin use (users vs non-users) influences the cardiovascular and kidney benefits of SGLT-2is and GLP-1RAs in patients with type 2 diabetes (T2D).

Methods

We identified relevant cardiovascular outcome trials (CVOTs) and observational cohort studies from MEDLINE, Embase, the Cochrane Library, and bibliographic searches up to March 2024. The analysis pooled study-specific hazard ratios (HRs) with 95 % confidence intervals (CIs) for outcomes, categorized by baseline statin use status. We also assessed the interactions between these medications and baseline statin use by calculating and pooling the ratio of HRs (RHRs) within each trial.

Results

Twenty-five articles (13 articles comprising 6 unique CVOTs and 12 articles comprising 9 unique cohort studies) were eligible. In CVOTs of SGLT-2is, the HRs (95 % CIs) of MACE; composite of CVD death or hospitalisation for heart failure; stroke; and kidney events in statin users were 0.90 (0.82–1.00), 0.78 (0.60–1.02), 1.00 (0.77–1.31), and 0.60 (0.53–0.69), respectively. The corresponding estimates were similar in non-statin users. In CVOTs of GLP-1RAs, the HRs (95 % CIs) for MACE in statin and non-statin users were 0.81 (0.73–0.90) and 0.92 (0.77–1.11), respectively. In observational cohort studies, SGLT-2is similarly reduced the risk of several cardiovascular and kidney outcomes in both statin and non-statin users. The estimated RHRs and p-values for interaction indicated that baseline statin use status did not significantly modify the cardio-kidney benefits of SGLT-2is and GLP-1RAs.

Conclusions

Aggregate analyses of intervention and real-world evidence show that SGLT-2is and GLP-1RAs provide comparable cardio-kidney benefits in patients with T2D, regardless of baseline statin use status. PROSPERO Registration: CRD42024498939
背景:钠-葡萄糖协同转运体 2 抑制剂(SGLT-2is)和胰高血糖素样肽 1 受体激动剂(GLP-1RAs)的心血管治疗效果是否因他汀类药物/降脂疗法的基线使用情况而有所不同,目前尚不清楚。本系统综述和荟萃分析研究了他汀类药物的基线使用(使用与未使用)是否会影响 SGLT-2is 和 GLP-1RAs 对 2 型糖尿病(T2D)患者心血管和肾脏的益处:我们从 MEDLINE、Embase、Cochrane 图书馆和截至 2024 年 3 月的文献检索中确定了相关的心血管结局试验 (CVOT) 和观察性队列研究。分析汇总了按他汀类药物基线使用状况分类的研究特异性危险比(HRs)及95%置信区间(CIs)。我们还通过计算和汇总每项试验中的HRs比值(RHRs),评估了这些药物与他汀类药物基线使用之间的相互作用:符合条件的文章有 25 篇(13 篇包括 6 项独特的 CVOT,12 篇包括 9 项独特的队列研究)。在 SGLT-2is 的 CVOTs 中,他汀类药物使用者的 MACE、心血管疾病死亡或心衰住院复合死亡率、中风和肾脏事件的 HRs(95 % CIs)分别为 0.90 (0.82-1.00)、0.78 (0.60-1.02)、1.00 (0.77-1.31) 和 0.60 (0.53-0.69)。非他汀类药物使用者的相应估计值与之相似。在 GLP-1RA 的 CVOT 研究中,他汀类药物和非他汀类药物使用者的 MACE HRs(95 % CIs)分别为 0.81(0.73-0.90)和 0.92(0.77-1.11)。在观察性队列研究中,SGLT-2is 同样降低了他汀类药物和非他汀类药物使用者发生多种心血管和肾脏疾病的风险。估计的RHRs和交互作用的P值表明,他汀类药物的基线使用状况并不会显著改变SGLT-2is和GLP-1RAs对心血管和肾脏的益处:对干预和真实世界证据的综合分析表明,SGLT-2is 和 GLP-1RAs 可为 T2D 患者带来类似的心肾获益,而与他汀类药物的基线使用情况无关。PROSPERO 注册:CRD42024498939。
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Primary Care Diabetes
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