Primary Care Diabetes最新文献_第4页

Editorial Board and Aims & Scopes 编辑委员会和目标与范围

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-12-01 Epub Date: 2025-11-20 DOI: 10.1016/S1751-9918(25)00211-6

引用次数: 0

Comparison of resistance training among individuals living with diabetes, prediabetes, and without diabetes: 2017–2023 BRFSS 糖尿病、前驱糖尿病和非糖尿病患者抗阻训练的比较：2017-2023 BRFSS

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-12-01 Epub Date: 2025-09-09 DOI: 10.1016/j.pcd.2025.09.001

Anthony Figueroa , Ariella Palmieri , Lu Shi , Willie Leung

Aim

This study aims to compare the weekly resistance training (RT) frequency between people with diabetes, prediabetes, and without diabetes.

Methods

A total of 536,703 participants from 2017 to 2023 Behavioral Risk Factors Surveillance System were included in the analysis. Unadjusted and adjusted Poisson regression was performed to compare weekly resistance training frequency among participants with different diabetes statuses (without diabetes, prediabetes, and with diabetes).

Results

89.28 % (95 % CI [89.11, 89.45]) of participants did not have diabetes, 1.67 % (95 % CI [1.59, 1.73]) had prediabetes, and 9.10 % (95 % CI [8.91, 9.22]) had diabetes. Across the sample, the averages weekly RT frequency among the sample was 1.73 times (95 % CI [1.71, 1.74]). Participants without diabetes had the highest weekly RT frequency of 1.79 (95 % CI [1.71, 1.74]) times. Participants with prediabetes had the weekly RT frequency of 1.38 (95 % CI [1.26, 1.50]) times and participants with diabetes had the lowest average frequency between the three groups with 1.19 (95 % CI [1.15, 1.23]) times per week. The unadjusted and adjusted linear regression found that people with diabetes had less weekly RT frequency than participants without diabetes (β=-.60, p < .01; αβ=-.23, p < .01). Participants with prediabetes also had lower weekly RT frequency in the unadjusted regression compared to participants without diabetes (β=-.41, p < .01).

Conclusion

People with prediabetes and diabetes might face personal and environmental barriers in engaging in RT, leading to lower weekly RT frequency compared to those without diabetes. There is a need to overcome barriers and continue promote RT among people with and without diabetes.

目的：本研究旨在比较糖尿病患者、前驱糖尿病患者和非糖尿病患者每周阻力训练（RT）的频率。方法：将2017 - 2023年行为危险因素监测系统共536703名参与者纳入分析。采用未经调整和调整的泊松回归来比较不同糖尿病状态（无糖尿病、糖尿病前期和糖尿病）的参与者每周阻力训练频率。结果：89.28 %（95 % CI[89.11, 89.45]）的参与者没有糖尿病，1.67 %（95 % CI[1.59, 1.73]）患有糖尿病前期，9.10 %（95 % CI[8.91, 9.22]）患有糖尿病。在整个样本中，样本的平均每周RT频率为1.73次（95 % CI[1.71, 1.74]）。无糖尿病的参与者每周RT频率最高，为1.79次（95 % CI[1.71, 1.74]）。糖尿病前期患者的每周RT频率为1.38（95 % CI[1.26, 1.50]）次，糖尿病患者的平均频率最低，为1.19（95 % CI[1.15, 1.23]）次。未经调整和调整后的线性回归发现，糖尿病患者的每周RT频率低于非糖尿病患者（β=- 0.60, p ）。结论：糖尿病前期和糖尿病患者在进行RT时可能面临个人和环境障碍，导致每周RT频率低于非糖尿病患者。有必要克服障碍，继续在糖尿病患者和非糖尿病患者中推广RT。

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引用次数: 0

The effect of online health management on type 2 diabetes mellitus: A systematic review and meta-analysis 在线健康管理对2型糖尿病的影响：系统回顾和荟萃分析

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-12-01 Epub Date: 2025-10-04 DOI: 10.1016/j.pcd.2025.08.010

Yiwei Qiu , Yao Tang , Yixuan Li , Li Cheng , Xu Wang , Baofeng Du , Ruhai Bai

Background

Online health management has been implemented to improve glycemic control in patients with type 2 diabetes mellitus (T2DM). This study aims to evaluate the effectiveness of online health management interventions in managing T2DM through a systematic review and meta-analysis.

Methods

A comprehensive search was conducted in six databases—PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wanfang Data—from January 1, 2010, to September 1, 2024. Eligible studies included randomized controlled trials (RCTs) involving adults (≥ 18 years) diagnosed with T2DM. Two independent reviewers screened the studies and assessed the risk of bias. Meta-analyses were performed using Review Manager 5.4 (Cochrane Collaboration). The primary outcomes included glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and postprandial blood glucose (PBG).

Results

Out of 6283 records screened, 44 RCTs involving 27,178 T2DM patients were included (16,972 in the intervention group and 10,206 in the control group). Pooled results showed that online health management interventions significantly improved HbA1c, FBG, PBG, systolic blood pressure, diastolic blood pressure, and waist circumference. Improvements were also observed in dietary behavior, physical activity, and self-efficacy. However, no significant effects were found on body weight, body mass index, or lipid metabolism parameters, including total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Subgroup analyses indicated that interventions delivered by physicians, those targeting individuals aged ≥ 60 years, and those using digital coaching for less than six months were more effective in glycemic control.

Conclusion

Online health management interventions may effectively support glycemic and blood pressure control and self-management in T2DM patients. Nevertheless, additional research with larger sample sizes and more extended follow-up periods is justified due to the substantial heterogeneity and limitations across the included studies.

背景：在线健康管理已被用于改善2型糖尿病（T2DM）患者的血糖控制。本研究旨在通过系统回顾和荟萃分析来评估在线健康管理干预在管理2型糖尿病方面的有效性。方法：从2010年1月1日至2024年9月1日，对pubmed、Web of Science、Cochrane Library、Embase、中国知识基础设施和万方数据6个数据库进行综合检索。符合条件的研究包括诊断为T2DM的成年人（≥18岁）的随机对照试验（RCTs）。两名独立审稿人筛选了这些研究并评估了偏倚风险。meta分析采用Review Manager 5.4 （Cochrane Collaboration）进行。主要结局包括糖化血红蛋白（HbA1c）、空腹血糖（FBG）和餐后血糖（PBG）。结果：在筛选的6283份记录中，纳入44项随机对照试验，涉及27,178例T2DM患者（干预组16,972例，对照组10,206例）。综合结果显示，在线健康管理干预显著改善了HbA1c、FBG、PBG、收缩压、舒张压和腰围。在饮食行为、体育活动和自我效能方面也有改善。然而，没有发现对体重、体重指数或脂质代谢参数（包括总胆固醇、甘油三酯、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇）有显著影响。亚组分析表明，由医生提供的干预措施，针对年龄≥ 60岁的个体，以及使用数字指导少于6个月的干预措施在血糖控制方面更有效。结论：在线健康管理干预可有效支持T2DM患者血糖、血压控制和自我管理。然而，由于纳入研究的异质性和局限性，需要进行更大样本量和更长的随访期的额外研究。

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引用次数: 0

Trends and patterns in antidiabetic medication prescriptions: Insights from Greece’s electronic prescription database 抗糖尿病药物处方的趋势和模式：来自希腊电子处方数据库的见解。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-12-01 Epub Date: 2025-08-13 DOI: 10.1016/j.pcd.2025.08.004

Stefanos Karakolias , George Mavridoglou , Nikolaos Polyzos

Aims

This study aimed to analyze the patterns and trends of antidiabetic medication prescriptions in Greece using data from the National Electronic Prescription Database.

Methods

This retrospective observational study used real-world data from the Greek electronic prescription database from 2015 to 2021. The study population included all patients with a confirmed diagnosis of diabetes mellitus. Data on medication details, prescribing patterns, and costs were extracted and analyzed using descriptive statistical methods.

Results

The study revealed that blood glucose-lowering drugs, excluding insulins (A10B), accounted for 86.1 % of the total quantity prescribed, while insulins (A10A) contributed significantly to the total cost (28.3 %). Newer drug classes like DPP-4 inhibitors and GLP-1 analogues showed increasing trends, while some older medications declined in use. Prescribing patterns varied among medical specialties, with internal medicine and general practice physicians being the primary prescribers of these drugs.

Conclusions

This study highlights significant shifts in antidiabetic medication prescribing patterns in Greece, with a trend towards newer drug classes. These findings have important implications for healthcare policy, including the need to promote the cost-effective use of newer medications, manage patient transitions between drug classes, and address insulin affordability and access.

目的：本研究旨在利用希腊国家电子处方数据库的数据分析希腊抗糖尿病药物处方的模式和趋势。方法：这项回顾性观察性研究使用了2015年至2021年希腊电子处方数据库中的真实数据。研究人群包括所有确诊为糖尿病的患者。使用描述性统计方法提取和分析有关药物细节、处方模式和费用的数据。结果：研究发现，降糖药（不包括胰岛素（A10B））占总处方量的86.1 %，而胰岛素（A10A）占总费用的28.3 %。DPP-4抑制剂和GLP-1类似物等较新的药物类别显示出增加的趋势，而一些旧药物的使用则有所减少。处方模式因医学专业而异，内科医生和全科医生是这些药物的主要开处方者。结论：这项研究突出了希腊抗糖尿病药物处方模式的重大转变，有向新药物类别发展的趋势。这些发现对医疗保健政策具有重要意义，包括需要促进具有成本效益的新药物的使用，管理患者在药物类别之间的转换，以及解决胰岛素的负担能力和获取问题。

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引用次数: 0

Microvascular disease burden and macrovascular outcomes in type 2 diabetes: Risk calculator in Taiwan 台湾2型糖尿病的微血管疾病负担与大血管预后：风险计算器。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-12-01 Epub Date: 2025-10-01 DOI: 10.1016/j.pcd.2025.09.004

Chih-Yuan Wang , Jung-Fu Chen , Shih-Te Tu , Chun-Chuan Lee , Horng-Yih Ou

The growing prevalence of type 2 diabetes mellitus (T2DM) poses a significant challenge to healthcare systems globally. Microvascular diseases, including diabetic kidney disease, retinopathy, and neuropathy, are frequent complications of T2DM and may signal an increased risk of macrovascular diseases, such as stroke and myocardial infarction. This study, based on prior findings from a nationwide cohort in Taiwan demonstrated that individuals with two or more macrovascular complications had elevated risks of cardiovascular events and mortality over a median follow-up of 3.3 years. Building on this, the current study develops a practical risk calculator for predicting 3-year cardiovascular risk. Shared pathogenic mechanisms, such as vascular injury, endothelial dysfunction, and autonomic neuropathy, may suggest these associations. In response, we developed a Risk Engine Calculator that incorporates the number of microvascular diseases, elevated HbA1c, systolic blood pressure, LDL cholesterol, and insulin use to estimate 3-year cardiovascular risk in patients with T2DM without established macrovascular complications. Patients are stratified into low, moderate, or high risk categories to guide clinical decision-making. While the calculator is practical and evidence-based, limitations include its additive design, potential simplification of risk relationships, and relatively short follow-up period. Overall, this study underscores the importance of integrating microvascular diseases burden into cardiovascular risk assessment and provides a user-friendly tool to support precision medicine in diabetes management.

2型糖尿病（T2DM）的日益流行对全球卫生保健系统提出了重大挑战。微血管疾病，包括糖尿病肾病、视网膜病变和神经病变，是T2DM的常见并发症，可能预示着大血管疾病（如中风和心肌梗死）的风险增加。本研究基于台湾一项全国性队列研究的先前发现，表明在中位随访3.3年期间，患有两种或两种以上大血管并发症的个体心血管事件和死亡率风险升高。在此基础上，本研究开发了一种实用的风险计算器，用于预测3年心血管风险。共同的致病机制，如血管损伤、内皮功能障碍和自主神经病变，可能提示这些关联。作为回应，我们开发了一个风险引擎计算器，将微血管疾病的数量、HbA1c升高、收缩压、低密度脂蛋白胆固醇和胰岛素的使用纳入其中，以估计无大血管并发症的T2DM患者3年心血管风险。患者被分为低、中、高风险三类，以指导临床决策。尽管该计算器具有实用性和循证性，但其局限性包括其累加式设计、可能简化风险关系以及相对较短的随访期。总之，本研究强调了将微血管疾病负担纳入心血管风险评估的重要性，并提供了一个用户友好的工具来支持糖尿病管理中的精准医学。

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引用次数: 0

Pre-Ramadan education decreases hypoglycemic events in fasting group 斋月前教育减少了禁食组的低血糖事件。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-12-01 Epub Date: 2025-08-14 DOI: 10.1016/j.pcd.2025.08.003

Muhammad Mohid Haroon

引用次数: 0

Validation of the IDF-DAR risk tool for fasting in Ramadan for adults with diabetes mellitus in primary care: A nationwide multicentre study in Malaysia IDF-DAR风险工具在初级保健中用于成年糖尿病患者斋月禁食的验证：马来西亚的一项全国性多中心研究

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-12-01 Epub Date: 2025-08-15 DOI: 10.1016/j.pcd.2025.08.002

Jazlan Jamaluddin , Nik Aminah Nik Abdul Kadir , Lin Xiang Goh , Dayang Haniffa Abang Hashim , Nur Athirah Rosli , Nurfauzani Ibrahim , Sharifah Syadiyah Syed Saffi , Siti Nur Hidayah Abd Rahim

Introduction

Fasting during Ramadan is a religious obligation for Muslims but poses health risks for individuals with diabetes mellitus. The International Diabetes Federation–Diabetes and Ramadan Alliance (IDF-DAR) introduced a risk stratification tool in 2021 to guide clinicians, though its utility in primary care settings remains limited.

Methods

A retrospective observational study was conducted on adults with diabetes attending government health clinics in Malaysia from April 15 to June 15, 2024. Medical records of those who attempted fasting during Ramadan were reviewed. The primary outcome was a composite of hypoglycaemia, hyperglycaemia, diabetes-related hospitalization, or dehydration leading to breaking the fast. Discriminative performance of the IDF-DAR tool was evaluated using area under the receiver operating characteristic curve (AUC). Calibration was assessed via the Hosmer-Lemeshow test.

Results

A total of 310 patients were included (99 % with type 2 diabetes). The mean age was 61 years and the median diabetes duration was 7 years. Adverse fasting outcomes were observed in 18.4 % of patients, with hypoglycaemia being the most common (13.5 %). The IDF-DAR risk stratification tool demonstrated good discriminative ability, achieving an area under the ROC curve (AUC) of 0.78 (95 % CI: 0.72–0.84). At the recommended cut-off for distinguishing low-moderate from high-risk categories, the tool achieved a sensitivity of 92.9 % and a specificity of 40.9 %. The Hosmer-Lemeshow goodness-of-fit test indicated poor agreement between observed and predicted adverse outcomes, with a statistically significant result (P < 0.05).

Conclusion

The IDF-DAR risk stratification tool identifies high-risk patients fasting during Ramadan in primary care. However, its poor calibration and specificity as highlights the need for refinement of the model to improve its predictive accuracy. Enhancing the tool's calibration could allow for better individual risk estimation and more precise clinical decision-making in diverse primary care settings.

简介：斋月期间禁食是穆斯林的宗教义务，但对糖尿病患者有健康风险。国际糖尿病联合会-糖尿病和斋月联盟（IDF-DAR）于2021年引入了一种风险分层工具来指导临床医生，尽管其在初级保健机构中的实用性仍然有限。方法：对2024年4月15日至6月15日在马来西亚政府卫生诊所就诊的成年糖尿病患者进行回顾性观察研究。审查了在斋月期间试图禁食的人的医疗记录。主要结局是低血糖、高血糖、糖尿病相关住院或脱水导致断食的复合结局。利用接收机工作特性曲线下面积（AUC）评估IDF-DAR工具的判别性能。通过Hosmer-Lemeshow检验评估校准。结果：共纳入310例患者（99% %为2型糖尿病）。平均年龄61岁，糖尿病病程中位数为7年。在18.4% %的患者中观察到不良的空腹结果，其中低血糖最为常见（13. %）。IDF-DAR风险分层工具表现出良好的判别能力，ROC曲线下面积（AUC）为0.78（95 % CI: 0.72-0.84）。在区分低、中、高风险类别的推荐截止点上，该工具的灵敏度为92.9 %，特异性为40.9 %。Hosmer-Lemeshow拟合优度检验显示，观察到的不良结果与预测的不良结果不一致，结果具有统计学意义（P ）。结论：IDF-DAR风险分层工具可识别初级保健中斋月禁食的高危患者。然而，其较差的校准和特异性突出了需要改进模型以提高其预测准确性。加强该工具的校准可以在不同的初级保健环境中进行更好的个人风险估计和更精确的临床决策。

{"title":"Validation of the IDF-DAR risk tool for fasting in Ramadan for adults with diabetes mellitus in primary care: A nationwide multicentre study in Malaysia","authors":"Jazlan Jamaluddin , Nik Aminah Nik Abdul Kadir , Lin Xiang Goh , Dayang Haniffa Abang Hashim , Nur Athirah Rosli , Nurfauzani Ibrahim , Sharifah Syadiyah Syed Saffi , Siti Nur Hidayah Abd Rahim","doi":"10.1016/j.pcd.2025.08.002","DOIUrl":"10.1016/j.pcd.2025.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Fasting during Ramadan is a religious obligation for Muslims but poses health risks for individuals with diabetes mellitus. The International Diabetes Federation–Diabetes and Ramadan Alliance (IDF-DAR) introduced a risk stratification tool in 2021 to guide clinicians, though its utility in primary care settings remains limited.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted on adults with diabetes attending government health clinics in Malaysia from April 15 to June 15, 2024. Medical records of those who attempted fasting during Ramadan were reviewed. The primary outcome was a composite of hypoglycaemia, hyperglycaemia, diabetes-related hospitalization, or dehydration leading to breaking the fast. Discriminative performance of the IDF-DAR tool was evaluated using area under the receiver operating characteristic curve (AUC). Calibration was assessed via the Hosmer-Lemeshow test.</div></div><div><h3>Results</h3><div>A total of 310 patients were included (99 % with type 2 diabetes). The mean age was 61 years and the median diabetes duration was 7 years. Adverse fasting outcomes were observed in 18.4 % of patients, with hypoglycaemia being the most common (13.5 %). The IDF-DAR risk stratification tool demonstrated good discriminative ability, achieving an area under the ROC curve (AUC) of 0.78 (95 % CI: 0.72–0.84). At the recommended cut-off for distinguishing low-moderate from high-risk categories, the tool achieved a sensitivity of 92.9 % and a specificity of 40.9 %. The Hosmer-Lemeshow goodness-of-fit test indicated poor agreement between observed and predicted adverse outcomes, with a statistically significant result (P < 0.05).</div></div><div><h3>Conclusion</h3><div>The IDF-DAR risk stratification tool identifies high-risk patients fasting during Ramadan in primary care. However, its poor calibration and specificity as highlights the need for refinement of the model to improve its predictive accuracy. Enhancing the tool's calibration could allow for better individual risk estimation and more precise clinical decision-making in diverse primary care settings.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 608-612"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862749","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

Adherence to gout treatment guidelines in patients with diabetes: A Danish prospective cohort study with 4 years of follow-up 糖尿病患者对痛风治疗指南的依从性：一项丹麦前瞻性队列研究，随访4年。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-12-01 Epub Date: 2025-08-26 DOI: 10.1016/j.pcd.2025.08.006

Claus Rasmussen , Jesper Walther Larsen , Peter Clement Waldhauer Holm , Søren Terpager Jepsen , Gunnar Lauge Nielsen

Aims

Diabetes affects about 6 % of the global population, with 20 % developing foot ulcers. Gout impacts approximately 3 %, but fewer than 40 % receive adequate urate-lowering therapy to prevent or dissolve tophi in the feet. This study assessed adherence to recommended gout treatment in patients with diabetes.

Methods

From a prospective cohort of gout patients, confirmed by microscopy-identified urate crystals, we identified those with concomitant diabetes. Patients were treated in various real-life healthcare settings. The primary outcome was achieving target serum urate levels four years post-diagnosis: < 0.36 mmol/L for general gout management and < 0.30 mmol/L for tophi patients.

Results: Of 286 gout patients, 85 (30 %) had diabetes. The median age was 71 years, and 76 % were male, with common comorbidities. Urate levels sufficient to prevent new tophi were maintained by 58 %. However, 45 % had tophi at diagnosis, and only 46 % of these achieved levels low enough to dissolve tophi.

Conclusions

Gout in patients with diabetes is often inadequately managed, potentially leading to persistent tophi, which may ulcerate and contribute to foot ulcers. These findings likely reflect typical treatment settings. Affordable and effective gout treatment could prevent tophi formation and improve outcomes. Consideration of gout screening in diabetes management guidelines is recommended.

目的：糖尿病影响全球约6% %的人口，其中20% %的人患有足部溃疡。痛风影响约3 %，但只有不到40% %的患者接受了适当的降尿酸治疗，以防止或溶解足部的痛风石。这项研究评估了糖尿病患者对推荐的痛风治疗的依从性。方法：从前瞻性队列的痛风患者，通过显微镜鉴定尿酸盐晶体证实，我们确定了那些伴有糖尿病。患者在不同的现实医疗环境中接受治疗。主要结局是诊断后四年达到目标血清尿酸水平：结果：286例痛风患者，85例（30 %）患有糖尿病。中位年龄为71岁，76% %为男性，有常见合并症。尿酸水平足以防止新的tophi维持在58% %。然而，45 %的患者在诊断时含有痛风石，其中只有46 %的患者达到足以溶解痛风石的水平。结论：糖尿病患者的痛风往往管理不当，可能导致持续性痛风，这可能导致溃疡并导致足部溃疡。这些发现可能反映了典型的治疗环境。负担得起和有效的痛风治疗可以防止痛风石的形成和改善预后。建议在糖尿病管理指南中考虑痛风筛查。

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引用次数: 0

A structured education program for improving cardiovascular risk and glycaemic control in type 2 diabetes mellitus (the SUGAR study) 一项改善2型糖尿病心血管风险和血糖控制的结构化教育计划（SUGAR研究）。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-12-01 Epub Date: 2025-10-01 DOI: 10.1016/j.pcd.2025.09.008

Mark P. Ranasinghe , Marly Ranasinghe , Mayurathan Balachandran , Vinay Goel , Sulochi Subasinghe , Shane Nanayakkara

Aims

Structured community-based diabetes education programs may improve cardiometabolic outcomes, yet objective evidence remains limited. We evaluated the efficacy of a multidisciplinary education program in improving glycaemic control and cardiovascular risk factors in adults with type 2 diabetes mellitus (T2DM).

Methods

Adults with T2DM participated in a four-week program comprising weekly two-hour sessions on diabetes and cardiovascular disease, nutrition, exercise, and mental health. HbA1c, body mass index (BMI), weight, blood pressure, and lipid profile were assessed at baseline and at 3, 6, and 12 months. Outcomes were analysed using pooled linear mixed-effects models with multiple imputation, with sensitivity analyses excluding participants requiring pharmacotherapy escalation.

Results

Fifty participants (median age 49 years; 38 % female) completed the program. HbA1c improved significantly and was sustained at 12 months (−1.57 % (95 %CI(-1.96, −1.17), p < 0.001). LDL cholesterol (-0.51 mmol/L (95 %CI(-0.71,-0.30), p < 0.001), triglycerides (-0.86 mmol/L (95 %CI(-1.34,-0.39), p = 0.001), and BMI (−1.45 kg/m², 95 %CI(-1.99,-0.91), p < 0.001) also improved at 12 months. These findings were supported by sensitivity analysis for HbA1c, but attenuated for other cardiometabolic parameters at 12 months.

Conclusions

A structured, multidisciplinary community-based education program was associated with significant improvements in glycaemic control and key parameters of cardiometabolic risk. As a cost-efficient model, it offers a scalable strategy for T2DM management in primary care, warranting further evaluation of interactions with pharmacotherapy.

目的：有组织的社区糖尿病教育项目可能改善心脏代谢结果，但客观证据仍然有限。我们评估了多学科教育项目在改善成人2型糖尿病（T2DM）患者血糖控制和心血管危险因素方面的效果。方法：成年T2DM患者参加了一个为期四周的项目，包括每周两小时的糖尿病和心血管疾病、营养、运动和心理健康会议。在基线、3个月、6个月和12个月时评估HbA1c、体重指数（BMI）、体重、血压和血脂。结果分析使用多重归因的合并线性混合效应模型，并进行敏感性分析，排除需要增加药物治疗的参与者。结果：50名参与者（中位年龄49岁；38% %女性）完成了该计划。HbA1c显著改善并持续12个月(-1.57 %（95 %CI(-1.96, -1.17), p ）结论：一个结构化的、多学科的社区教育项目与血糖控制和心脏代谢风险关键参数的显著改善有关。作为一种具有成本效益的模式，它为初级保健中的T2DM管理提供了一种可扩展的策略，值得进一步评估与药物治疗的相互作用。

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引用次数: 0

Identifying high glucose variability using non-glycemic factors in low continuous glucose monitoring use settings 在低连续血糖监测中使用非血糖因子识别高血糖变异性。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-12-01 Epub Date: 2025-08-28 DOI: 10.1016/j.pcd.2025.08.008

Suresh Rama Chandran , Ming Ming Teh , Hong Chang Tan , May Zin Oo , Alcey Ang Li Chang , Daphne Gardner

Aims

Identifying non-glycemic factors associated with high Glucose variability (GV).

Methods

A cross-sectional observational study recruited people with type 2 diabetes, who wore a Freestyle Libre Pro CGM. Independent variables: Age, sex, BMI, diabetes medication, diabetes duration, HbA1c and estimated glomerular filtration rate (eGFR). CGM-derived variables calculated included Time-in-Range (TIR, 70–180 mg/dl), below-range 1 (TBR1, <70 mg/dl), -below-range 2 (TBR2, <54 mg/dl) and -above-range (TAR, >180 mg/dl), coefficient of variation (%CV). A logistic regression model examined independent variables associated with high GV (CV ≥36 %). All analysis was done on R version 4.3.1

Results

T2D cohort (n = 403), 46 % women, had median age of 61 y, BMI of 26.5 kg/m², diabetes duration 14 y, HbA1c 7.8 %(62 mmol/mol) and creatinine of 75 µmol/L. Using sulphonylurea, premixed or basal-bolus insulin had an odds ratio (OR) of 4.7 – 5.2 for CV ≥ 36 %. Longer diabetes duration [OR 1.2], and lower eGFR [OR 1.2] were associated with higher odds and older age [OR 0.8]and higher BMI [0.8] were associated with lower odds of CV≥ 36 %. Sex and HbA1c had no association with high GV.

Conclusion

Nonglycemic-factors like medication type, diabetes duration and eGFR can aid in identification of high GV even in low-CGM use settings.

目的：确定与高葡萄糖变异性（GV）相关的非血糖因子。方法：一项横断面观察性研究招募了2型糖尿病患者，他们佩戴了Freestyle Libre Pro CGM。自变量：年龄、性别、BMI、糖尿病药物、糖尿病病程、HbA1c和估计的肾小球滤过率（eGFR）。计算的cgm衍生变量包括Time-in-Range (TIR, 70-180 mg/dl)，低于范围1 (TBR1, 180 mg/dl)，变异系数（%CV）。logistic回归模型检验了与高GV相关的自变量（CV≥36 %）。结果：T2D队列（n = 403），46 %女性，中位年龄61 y， BMI 26.5 kg/m2，糖尿病病程14 y， HbA1c 7.8 %(62 mmol/mol)，肌酐75µmol/L。当CV≥ 36 %时，使用磺脲、预混胰岛素或基础胰岛素的比值比（or）为4.7 - 5.2。较长的糖尿病病程[OR 1.2]和较低的eGFR [OR 1.2]与较高的几率相关，年龄较大[OR 0.8]和较高的BMI[0.8]与CV≥ 36 %的较低几率相关。性别和HbA1c与高GV无关。结论：非血糖因素如药物类型、糖尿病病程和eGFR可以帮助识别高GV，即使在低cgm使用环境中。

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引用次数: 0