Primary Care Diabetes最新文献_第2页

Effect of applying a diabetes risk score on lifestyle counselling and shared decision-making in primary care: A pragmatic cluster randomised trial 应用糖尿病风险评分对初级保健生活方式咨询和共同决策的影响：一项实用的集群随机试验。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-01 DOI: 10.1016/j.pcd.2024.12.009

Esther Seidel-Jacobs , Fiona Kohl , Joachim Rosenbauer , Matthias B. Schulze , Oliver Kuss , Wolfgang Rathmann

Aims

There is a lack of studies on the impact of diabetes risk scores on diabetes prevention. The aim of this study was to investigate the effect of applying a non-invasive diabetes risk score as component of routine health checks on counselling intensity and shared decision-making (SDM) in primary care.

Methods

Cluster randomised trial, in which primary care physicians (n = 30) enrolled participants (n = 315) with statutory health insurance without known diabetes, ≥ 35 years of age with a body mass index (BMI) ≥ 27.0 kg/m². In the intervention group, the German Diabetes Risk Score (GDRS) was applied as add-on to the standard routine health check. Outcomes were length and intensity of the counselling interview and the process of SDM. Analysis was by intention-to-treat using mixed models.

Results

In the intervention group, higher odds were found for a more intensive counselling interview regarding physical activity, healthy diet and body weight (e.g., participants` perspective: odds ratios between 1.8 and 2.5) compared to controls. Analysis of total SDM score showed a more participative counselling interview in the intervention than in the control group.

Conclusions

GDRS use in routine primary care improves intensity of lifestyle counselling and process of SDM already in people with moderate diabetes risk.

目的：目前缺乏糖尿病风险评分对糖尿病预防影响的研究。本研究的目的是调查应用非侵入性糖尿病风险评分作为常规健康检查的组成部分对初级保健咨询强度和共同决策（SDM）的影响。方法：聚类随机试验，初级保健医生（n = 30）入组参与者（n = 315），有法定健康保险，已知无糖尿病，年龄≥ 35岁，体重指数(BMI)≥ 27.0 kg/m2。在干预组，德国糖尿病风险评分（GDRS）作为标准常规健康检查的补充。结果是咨询访谈的长度和强度以及SDM的过程。采用意向治疗混合模型进行分析。结果：在干预组中，与对照组相比，在身体活动、健康饮食和体重方面进行更深入的咨询访谈的几率更高（例如，参与者的观点：比值比在1.8和2.5之间）。SDM总分分析显示，干预组的咨询访谈参与性高于对照组。结论：在常规初级保健中使用GDRS可以提高中等糖尿病风险人群生活方式咨询的强度和SDM的过程。

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引用次数: 0

Trends in type 2 diabetes medication use and guideline adherence in Belgian primary care (2019–2023) 比利时基层医疗机构 2 型糖尿病用药趋势和指南遵守情况（2019-2023 年）。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-01 DOI: 10.1016/j.pcd.2024.10.007

Willem Raat , Pavlos Mamouris , Chantal Mathieu , Geert Goderis , Bert Vaes

Aims

To assess the prevalence of atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD) among patients with type 2 diabetes (T2D) in Belgium. To analyze trends in medication use and adherence to guidelines from 2019 to 2023.

Methods

We conducted a retrospective cross-sectional analysis using data from the Intego primary care database, encompassing records from 431 general practitioners. We identified adults with T2D through diagnostic codes and glycated hemoglobin levels and analyzed subgroups with ASCVD, HF, and CKD for trends in medication use, particularly SGLT2 inhibitors (SGLT2-i) and GLP-1 receptor agonists (GLP-1).

Results

The T2D population increased from 20,766 in 2019 to 21,764 in 2023. The prevalence of ASCVD, HF, and CKD among T2D patients slightly increased to 27 %, 6.7 %, and 23.7 % by 2023 (from 25.2 %, 4.9 % and 21.5 % respectively). Medication prescription trends showed a tripling of SGLT2-i and GLP-1 prescribing in the study period to 6.2 % and 11.5 % respectively. Despite these increases, only 7.5 % of eligible patients received these medications as of 2023.

Conclusion

The study highlights a growing burden of ASCVD, HF, and CKD among T2D patients in Belgium and an increase in the use of guideline-recommended medications. However, there remains a substantial gap in the optimal use of these therapies, indicating a need for improved implementation of clinical guidelines in primary care.

目的：评估比利时2型糖尿病（T2D）患者中动脉粥样硬化性心血管疾病（ASCVD）、心力衰竭（HF）和慢性肾脏疾病（CKD）的患病率。分析2019年至2023年的用药趋势和指南遵守情况：我们使用 Intego 初级医疗数据库中的数据进行了一项回顾性横断面分析，该数据库包含来自 431 名全科医生的记录。我们通过诊断代码和糖化血红蛋白水平确定了患有 T2D 的成年人，并分析了患有 ASCVD、HF 和 CKD 的亚组的用药趋势，尤其是 SGLT2 抑制剂（SGLT2-i）和 GLP-1 受体激动剂（GLP-1）：T2D人群从2019年的20766人增加到2023年的21764人。到 2023 年，T2D 患者中的 ASCVD、HF 和 CKD 患病率分别从 25.2%、4.9% 和 21.5%略增至 27%、6.7% 和 23.7%。药物处方趋势显示，在研究期间，SGLT2-i 和 GLP-1 的处方量分别增加了两倍，达到 6.2% 和 11.5%。尽管如此，截至 2023 年，只有 7.5% 的合格患者接受了这些药物治疗：这项研究表明，比利时 T2D 患者的 ASCVD、HF 和 CKD 负担日益加重，指南推荐药物的使用也在增加。然而，在这些疗法的最佳使用方面仍存在巨大差距，这表明需要在初级保健中更好地实施临床指南。

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引用次数: 0

Association between periodontal disease and gestational diabetes: Systematic review and meta-analysis 牙周病与妊娠期糖尿病的关系：系统回顾和荟萃分析。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-01 DOI: 10.1016/j.pcd.2024.11.003

Juan Manuel García-Martos , Francisco Javier Valverde-Bolívar , María Teresa Campillo-López , Miguel Delgado-Rodríguez

Aim

Periodontal disease (PD) can aggravate insulin resistance during pregnancy and trigger the development of gestational diabetes mellitus (GDM).

Methods

A systematic review and meta-analysis was carried out. Two researchers carried out a literature search using internet databases. Studies that met the inclusion criteria were selected. OR was used as the measure of association. The fixed effects model was applied, and due to the presence of heterogeneity, the DerSimonian and Laird random effects model was applied. The level of significance was p < 0.05. The presence of biases was assessed using the Egger test and the funnel plot.

Results

Of the 176 articles found, 11 were included. 2032 pregnant women were analyzed, of which 572 developed GDM. It was found that PD was a risk factor for developing GDM when all studies were assessed (OR=1.83 95 % CI 1.25–2.69, p < 0.0017) and when analyzing only those that included an adjusted OR (OR= 1.83 95 % CI 1.31–2.56, p < 0.004).

Conclusions

PD poses a high risk of suffering from GDM. The development of oral health programs in women who wish to conceive is essential to improve metabolic control and reduce obstetric and perinatal complications.

目的：牙周病可加重妊娠期胰岛素抵抗，诱发妊娠期糖尿病（GDM）的发生。方法：进行系统综述和荟萃分析。两位研究人员利用互联网数据库进行了文献检索。选择符合纳入标准的研究。OR作为相关性的度量。采用固定效应模型，由于异质性的存在，采用DerSimonian and Laird随机效应模型。显著性水平为p 结果：在发现的176篇文章中，有11篇被纳入。对2032名孕妇进行了分析，其中572名发生了GDM。在对所有研究进行评估时发现，PD是发生GDM的危险因素（OR=1.83 95 % CI 1.25-2.69, p ）。结论：PD是发生GDM的高风险因素。希望怀孕的妇女的口腔健康计划的发展对于改善代谢控制和减少产科和围产期并发症是必不可少的。

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引用次数: 0

Editorial Board and Aims & Scopes

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-01 DOI: 10.1016/S1751-9918(25)00013-0

引用次数: 0

Association between insurance status and prevalence of diabetic retinopathy in patients with diabetes in the United States from 2011 to 2020 2011年至2020年美国糖尿病患者的保险状况与糖尿病视网膜病变患病率之间的关系

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-01 DOI: 10.1016/j.pcd.2024.12.007

Jordan Khorsandi , Daniel Kraversky , Jack Martinyan , Prashant Parekh , Grettel Castro , Noël Barengo

Aim

To determine whether an association exists between health insurance and diabetic retinopathy (DR) prevalence in adults with diabetes.

Methods

An analytical cross-sectional study was conducted utilizing the National Health and Nutrition Examination Survey database. 4530 Patients aged ≥ 18 with diabetes from 2011 to 2020 with various insurance types (no insurance, private, Medicare, Medicaid, or other) were evaluated for prevalence of DR, including covariates. Unadjusted and adjusted logistic regression analysis were conducted to calculate odds ratios (OR) and 95 % confidence intervals (CI).

Results

There was no significant association between insurance status and DR prevalence when adjusting for confounders. OR for DR in patients without insurance, Medicare, Medicaid, or other insurance compared to those with private insurance were 1.13 (95 % CI 0.74–1.71), 0.78 (95 % CI 0.54–1.13), 1.20 (95 % CI 0.80–1.81), and 0.81 (95 % CI 0.47–1.37) respectively. However, factors like age ≥ 65 and use of diabetes medication were associated with reduced DR prevalence.

Conclusion

Although insurance status alone does not have an association with the prevalence of DR, this study highlights several confounding variables that potentially influence previously reported associations between insurance status and DR.

目的：确定健康保险与成人糖尿病视网膜病变（DR）患病率之间是否存在关联。方法：利用国家健康与营养检查调查数据库进行分析性横断面研究。4530例年龄≥ 18岁的2011 - 2020年各种保险类型（无保险、私人、医疗保险、医疗补助或其他）的糖尿病患者进行了DR患病率评估，包括协变量。进行未校正和校正logistic回归分析，计算优势比（OR）和95% %置信区间（CI）。结果：在调整混杂因素后，保险状况与DR患病率之间没有显著关联。无保险、医疗保险、医疗补助或其他保险的患者与有私人保险的患者相比，DR的OR分别为1.13（95 % CI 0.74-1.71）、0.78（95 % CI 0.54-1.13）、1.20（95 % CI 0.80-1.81）和0.81（95 % CI 0.47-1.37）。然而，年龄≥ 65岁和使用糖尿病药物等因素与DR患病率降低有关。结论：虽然保险状况本身与DR患病率没有关联，但本研究强调了几个可能影响先前报道的保险状况与DR之间关联的混杂变量。

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引用次数: 0

Assessment of healthcare utilization in diabetes patients according to foot risk level 糖尿病患者足部危险程度对医疗保健利用的评价。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-01 DOI: 10.1016/j.pcd.2024.12.005

Cristina Blaya Fernández , Alba Gracia-Sánchez , Sara Zúnica-García , Esther Chicharro-Luna

Aims

To quantify healthcare service utilization over the past two years according to the foot risk level in patients with type 2 diabetes (T2DM).

Methodology

A descriptive observational study was conducted in a Primary Care Nursing consultation, evaluating patients with T2DM through examination and collection of sociodemographic and clinical data.

Results

A total of 153 patients were included. The prevalence of underdiagnosis was 71.2 % for neuropathy and 59.5 % for peripheral arterial disease. Patients with a high foot risk level had more consultations in PC Nursing for foot-related issues (2022 y 2023; p=<0.001). The number of hospitalization days in 2022 was also higher in patients with a high foot risk. Patients with diagnosed neuropathy consistently utilized healthcare services more frequently than those with undiagnosed or no neuropathy across most categories.

Conclusion

Patients with a high foot risk level consume more healthcare resources. Early detection and management of diabetic foot is crucial to avoid underdiagnosis, optimize resource use, and prevent serious complications.

目的：根据2型糖尿病（T2DM）患者足部风险水平，量化过去两年的医疗保健服务利用情况。方法：在初级保健护理咨询中进行了一项描述性观察研究，通过检查和收集社会人口学和临床数据来评估2型糖尿病患者。结果：共纳入153例患者。神经病变的漏诊率为71.2%，外周动脉疾病为59.5%。高足部风险水平的患者在PC护理中有更多的足部相关问题咨询(2022 - 2023；p=结论：足部危险程度高的患者消耗更多的医疗资源。糖尿病足的早期发现和管理对于避免漏诊、优化资源利用和预防严重并发症至关重要。

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引用次数: 0

Incidence and factors associated with new depressive episodes in adults with newly treated type 2 diabetes: A cohort study 新治疗的成人2型糖尿病患者新发抑郁发作的发生率和相关因素：一项队列研究

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-01 DOI: 10.1016/j.pcd.2024.12.001

Jessica Kuntz, Candace Necyk, Scot H. Simpson

Aims

Several methods are available to help identify people with depression; however, there is little guidance on when to start screening. This study estimated the incidence of new depressive episodes and identified factors associated with onset in adults with newly treated type 2 diabetes.

Methods

Administrative health data from Alberta, Canada was used to identify people starting metformin between April 2011 and March 2015. People with a history of depression before metformin initiation were excluded. Person-time analysis was used to calculate the incidence rate of new depressive episodes over the next 3 years, stratified by sex, age, and year. Multivariable logistic regression was used to identify factors independently associated with a new depressive episode.

Results

42,694 adults initiated metformin; mean age 56 years, 38 % female. A new depressive episode occurred in 2752 (6 %) individuals, mean time to onset was 1.4 years and overall incidence rate was 22.3/1000 person-years. Factors associated with a new depressive episode were female sex, younger age, previous mental health conditions, frequent healthcare utilization, and multiple comorbid conditions.

Conclusions

Screening for depression should begin within 1–2 years of metformin initiation and focus on females, those < 55 years old, those with a history of mental health conditions, and those with multiple comorbid conditions.

目的：有几种方法可以帮助识别抑郁症患者；然而，关于何时开始筛查的指导很少。本研究估计了新治疗的2型糖尿病成人患者新发抑郁发作的发生率，并确定了与发病相关的因素。方法：采用加拿大艾伯塔省的行政卫生数据，确定2011年4月至2015年3月期间开始使用二甲双胍的人群。在开始使用二甲双胍之前有抑郁史的人被排除在外。根据性别、年龄和年份，采用人-时间分析计算未来3年内新发抑郁发作的发生率。使用多变量逻辑回归来确定与新抑郁发作独立相关的因素。结果：42,694名成人开始使用二甲双胍；平均年龄56岁，38% %女性。2752人（6 %）出现新的抑郁发作，平均发病时间为1.4年，总发病率为22.3/1000人年。与新发抑郁发作相关的因素为女性、年龄较小、既往精神健康状况、频繁的医疗保健利用和多种合并症。结论：抑郁症筛查应在开始服用二甲双胍1-2年内开始，并以女性为重点

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引用次数: 0

Glycemic and weight control in people with type 2 diabetes: A real-world observational study in primary care 2型糖尿病患者血糖和体重控制：一项现实世界初级保健观察性研究

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-01 DOI: 10.1016/j.pcd.2024.12.002

D Orozco-Beltran , M Mata-Cases , S Artola-Menéndez , F Álvarez-Guisasola , AM Cebrián-Cuenca , A Pérez , DIAMOND2 Study Coordinating Group. On behalf of the study investigators

Aims

To analyze glycemic and bodyweight control in people with type 2 diabetes mellitus (T2DM), and prescribing patterns in primary care.

Methods

We reviewed the electronic medical records of 5009 randomly selected T2DM patients, from 70 health centers in Spain. We analyzed results by age group and presence/absence of obesity. All data were collected in 2022.

Results

Regarding treatment, 13.2 % of the sample were on lifestyle therapy only, 76.5 % received metformin, 37.6 % SGLT2 inhibitors, 32.2 % DPP-4 inhibitors, 12.2 % GLP-1 agonists, 18.9 % insulin, 6.5 % sulfonylureas, and 1.3 % glitazones. Glycated Hemoglobin (HbA1c) was below 7 % in 57.7 % of patients, and 62.3 % met their individualized HbA1c targets. Overall, 42 % of the population was obese (45.6 % of women vs 39.1 % of men; p = 0.001). Obesity rates decreased with age in both sexes. We found no association between obesity and poor glycemic control (HbA1c<7 %) (43,5 % vs 41,4 %; p = 0,17).

Conclusions

In 2022, over 60 % of people with T2DM treated by family doctors in Spain met their individualized glycemic control targets, but only one in three had good glycemic control without obesity. The use of drugs with cardiorenal benefits (particularly SGLT2 inhibitors) is higher than previous published data in our setting.

目的：分析2型糖尿病（T2DM）患者的血糖和体重控制，以及初级保健的处方模式。方法：我们回顾了5009名随机选择的T2DM患者的电子病历，这些患者来自西班牙70个卫生中心。我们按年龄组和有无肥胖来分析结果。所有数据于2022年收集。结果：在治疗方面，13.2 %的样本只接受生活方式治疗，76.5 %的样本接受二甲双胍、37.6% %的SGLT2抑制剂、32.2% %的DPP-4抑制剂、12.2 %的GLP-1激动剂、18.9% %的胰岛素、6.5 %的磺脲类药物和1.3 %的格列酮。57.7% %的患者糖化血红蛋白（HbA1c）低于7 %，62.3% %的患者达到个体化HbA1c目标。总体而言，42% %的人口肥胖(女性为45.6% %，男性为39.1% %； = 0.001页)。无论男女，肥胖率都随着年龄的增长而下降。我们发现肥胖和血糖控制不良（hba1）之间没有关联。结论：2022年，西班牙家庭医生治疗的2型糖尿病患者中，超过60% %达到了他们的个体化血糖控制目标，但只有三分之一的人血糖控制良好，没有肥胖。在我们的研究中，对心肾有益的药物（尤其是SGLT2抑制剂）的使用高于之前发表的数据。

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引用次数: 0

Diabetic myonecrosis: A rare complication of long-standing diabetes mellitus 糖尿病肌坏死：长期糖尿病的罕见并发症。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-01 DOI: 10.1016/j.pcd.2024.11.001

Rosamaria Dias , Ovie Enaohwo , Richard Felli , Aman Garg , Meet Shah , Kathleen Beebe

Background

Diabetes mellitus is a rapidly growing health illness worldwide and its incidence is expected to continue rising. Various complications have been cited including retinopathy, nephropathy, peripheral artery disease and ulceration among others. However, rarer complications such as diabetic myonecrosis are limited in literature. This case report demonstrates the presentation of this complication to allow for earlier detection and treatment by providers.

Case report

This case highlights a 49-year-old man with an extensive past medical history inclusive of diabetes mellitus type 2, who presented with acute onset left thigh pain and swelling. On presentation, the patient has an HbA1c of 8 % and hyperpigmented spots were noted bilaterally on the lower extremities. Initial management was centered around infectious etiologies and management which failed to improve his symptoms. Further work-up included a negative lower extremity duplex ultrasound and a CT scan showing a hypodense lesion in the left lower extremity. Following unsuccessful drainage of the lesion to assess for a possible abscess, MRI of the lower extremities showed bilateral myositis and myonecrosis centered in the left vastus medialis.

Conclusion

This case report highlights a rare complication of diabetes mellitus known as diabetic myonecrosis (DMN). The gold-standard diagnostic tool is a muscle biopsy, however, sensitive imaging like MRI and clinical context are sufficient for a diagnosis. Supportive care centered around pain management remains the standard of care. While this remains as a diagnosis of exclusion, early identification may decrease the number of unnecessary treatments and should remain as a differential in patients with this presentation.

背景：糖尿病是全球迅速增长的健康疾病，其发病率预计将继续上升。各种并发症包括视网膜病变、肾病、外周动脉疾病和溃疡等。然而，像糖尿病肌坏死这样罕见的并发症在文献中却很少见。本病例报告展示了这种并发症的表现形式，以便医疗人员及早发现和治疗：本病例重点描述了一名 49 岁的男性患者，既往病史丰富，患有 2 型糖尿病，因急性发作的左大腿疼痛和肿胀而就诊。就诊时，患者的 HbA1c 为 8%，双侧下肢出现色素沉着斑。最初的治疗以感染病因为中心，但未能改善症状。进一步的检查包括下肢双频超声检查呈阴性，CT 扫描显示左下肢有低密度病变。在对病灶进行引流以评估是否可能存在脓肿未果后，下肢核磁共振成像显示双侧肌炎和以左内侧阔肌为中心的肌坏死：本病例报告强调了糖尿病的一种罕见并发症--糖尿病肌坏死（DMN）。金标准诊断工具是肌肉活检，然而，敏感的成像（如核磁共振成像）和临床背景足以做出诊断。以疼痛管理为中心的支持性治疗仍然是标准的治疗方法。虽然这仍是一种排除性诊断，但早期识别可减少不必要的治疗次数，因此仍应作为有这种表现的患者的鉴别诊断。

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引用次数: 0

Factors influencing the uptake of culturally tailored diabetes self-management education and support programmes among ethnic minority patients with type 2 diabetes: A systematic review

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-01 DOI: 10.1016/j.pcd.2025.01.010

Sariata Abu , Sofia Llahana

Purpose

This systematic review aimed to evaluate the factors influencing the uptake of culturally-tailored Diabetes Self-Management Education and Support (DSMES) programmes among ethnic minority patients diagnosed with type 2 diabetes mellitus (T2DM).

Methods

A systematic review, following PRISMA guidelines, was conducted, including quantitative research studies published in peer-reviewed journals from January 2013 to January 2023. Studies were extracted via the following databases, AMED, MEDLINE, CINAHL, EMBASE, EMCARE, PSYCHINFO, Ovid Nursing, and grey literature. Studies were selected based on eligibility criteria including the evaluation of DSMES programmes tailored for ethnic minorities and involving adult participants with T2DM. The factors affecting the uptake of these programs were mapped against the three categories of the Andersen's Behavioural Model of Health Services Use: predisposing, enabling, and need factors. The quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) checklist, and a narrative synthesis was conducted to analyse the findings.

Results

Nine studies met the inclusion criteria, demonstrating that culturally-tailored DSMES programmes significantly improve uptake among ethnic minorities. Key factors influencing participation included demographic characteristics, diabetes knowledge, emotional support, and cultural beliefs. Barriers such as language proficiency, cost, and diabetes fatalism were identified, while enablers included the use of local champions and culturally specific strategies.

Conclusions

This systematic review highlights the effectiveness of culturally-tailored DSMES programmes in improving health outcomes among ethnic minority groups. It suggests that more research is needed to explore these barriers and develop strategies to enhance the uptake of DSMES programmes among underserved populations.

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引用次数: 0