Pub Date : 2025-12-01Epub Date: 2025-09-19DOI: 10.1016/j.pcd.2025.09.005
Angelica Cristello Sarteau , Nikhita R. Gopisetty , Jessica Sprinkles , Gabriella Ercolino , Angela Fruik , Rashmi Muthukkumar , Xiaorui Qu , Elizabeth Mayer-Davis , Anna R. Kahkoska
A cross-sectional survey (September-November 2023) among a clinic-based sample of American older adults aged 65 + with type 1 diabetes (n = 77, 95 % White, HbA1c 6.8 ± 1.1 %) suggests sub-optimal intakes of fruit, vegetables, whole grain, fiber, calcium, dairy, and added sugars according to the National Cancer Institute Dietary Screener Questionnaire.
{"title":"Nutrition among older adults with type 1 diabetes: Sub-optimal intakes of key dietary factors according to the Dietary Screener Questionnaire (DSQ)","authors":"Angelica Cristello Sarteau , Nikhita R. Gopisetty , Jessica Sprinkles , Gabriella Ercolino , Angela Fruik , Rashmi Muthukkumar , Xiaorui Qu , Elizabeth Mayer-Davis , Anna R. Kahkoska","doi":"10.1016/j.pcd.2025.09.005","DOIUrl":"10.1016/j.pcd.2025.09.005","url":null,"abstract":"<div><div>A cross-sectional survey (September-November 2023) among a clinic-based sample of American older adults aged 65 + with type 1 diabetes (n = 77, 95 % White, HbA1c 6.8 ± 1.1 %) suggests sub-optimal intakes of fruit, vegetables, whole grain, fiber, calcium, dairy, and added sugars according to the National Cancer Institute Dietary Screener Questionnaire.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 681-683"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093346","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}
Pub Date : 2025-12-01Epub Date: 2025-09-23DOI: 10.1016/j.pcd.2025.09.003
Nanna Husted Jensen , Inger Katrine Dahl-Petersen , Karoline Kragelund Nielsen , Dorte Møller Jensen , Peter Damm , Per Ovesen , Elisabeth R. Mathiesen , Ulla Kampmann , Christina Anne Vinter , Sharleen O’Reilly , Helle Terkildsen Maindal , On behalf of the Face-it Study Group
Aims
We evaluated the fidelity of the Face-it intervention and its impact on behaviour change mechanisms among women with recent gestational diabetes mellitus (GDM).
Methods
In this randomised controlled trial, 277 women were allocated to usual care or an intervention comprising three home visits, digital platform health coaching and cross-sectoral communication to support health behaviour change during the first year after delivery. Behaviour change mechanisms included social support, motivation, self-efficacy, risk perception and health literacy. High fidelity was defined as completing three home visits and ≥ 9 coaching contacts.
Results
Within the intervention group, 86.4 % completed ≥ 2 home visits, 88.6 % registered digitally with a median (IQR) of 10.0 (3.0–20.0) contacts. At one-year after delivery, the high-fidelity group (n = 73; 39.7 %) had higher odds of perceiving moderate/high diabetes risk (OR 2.42; 95 % CI 1.06–5.51) and higher health literacy (adjusted difference 0.20; 95 % CI 0.04–0.35), whereas no difference was found for social support, motivation and self-efficacy compared with usual care. No difference was observed between the low fidelity and the usual care group in behaviour change mechanisms.
Conclusions
The Face-it intervention achieved acceptable fidelity. High fidelity appears essential for improving risk perception, health literacy and supporting behaviour change mechanisms among women with recent GDM.
目的：我们评估Face-it干预的保真度及其对近期妊娠期糖尿病（GDM）妇女行为改变机制的影响。方法：在这项随机对照试验中，277名妇女被分配到常规护理或干预措施，包括三次家访、数字平台健康指导和跨部门沟通，以支持分娩后第一年的健康行为改变。行为改变机制包括社会支持、动机、自我效能、风险认知和卫生知识。高保真度定义为完成3次家访和≥ 9次辅导接触。结果：在干预组中，86.4%完成了≥ 2次家访，88.6% %进行了数字登记，中位数（IQR）为10.0（3.0-20.0）个接触者。在分娩后一年，高保真组（n = 73;39.7 %）有更高的察觉中度/高度糖尿病风险的几率（OR 2.42; 95 % CI 1.06-5.51）和更高的健康知识（调整差值0.20;95 % CI 0.04-0.35），而与常规护理相比，社会支持、动机和自我效能感没有差异。低保真度组和常规护理组在行为改变机制上没有差异。结论：Face-it干预达到了可接受的保真度。高保真度对于提高新近患GDM妇女的风险认知、健康知识和支持行为改变机制至关重要。
{"title":"Intervention fidelity and behaviour change mechanisms in a health promotion intervention for women following gestational diabetes mellitus: Secondary analysis of the Face-it RCT","authors":"Nanna Husted Jensen , Inger Katrine Dahl-Petersen , Karoline Kragelund Nielsen , Dorte Møller Jensen , Peter Damm , Per Ovesen , Elisabeth R. Mathiesen , Ulla Kampmann , Christina Anne Vinter , Sharleen O’Reilly , Helle Terkildsen Maindal , On behalf of the Face-it Study Group","doi":"10.1016/j.pcd.2025.09.003","DOIUrl":"10.1016/j.pcd.2025.09.003","url":null,"abstract":"<div><h3>Aims</h3><div>We evaluated the fidelity of the Face-it intervention and its impact on behaviour change mechanisms among women with recent gestational diabetes mellitus (GDM).</div></div><div><h3>Methods</h3><div>In this randomised controlled trial, 277 women were allocated to usual care or an intervention comprising three home visits, digital platform health coaching and cross-sectoral communication to support health behaviour change during the first year after delivery. Behaviour change mechanisms included social support, motivation, self-efficacy, risk perception and health literacy. High fidelity was defined as completing three home visits and ≥ 9 coaching contacts.</div></div><div><h3>Results</h3><div>Within the intervention group, 86.4 % completed ≥ 2 home visits, 88.6 % registered digitally with a median (IQR) of 10.0 (3.0–20.0) contacts. At one-year after delivery, the high-fidelity group (n = 73; 39.7 %) had higher odds of perceiving moderate/high diabetes risk (OR 2.42; 95 % CI 1.06–5.51) and higher health literacy (adjusted difference 0.20; 95 % CI 0.04–0.35), whereas no difference was found for social support, motivation and self-efficacy compared with usual care. No difference was observed between the low fidelity and the usual care group in behaviour change mechanisms.</div></div><div><h3>Conclusions</h3><div>The Face-it intervention achieved acceptable fidelity. High fidelity appears essential for improving risk perception, health literacy and supporting behaviour change mechanisms among women with recent GDM.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 584-591"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139951","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}
This study aimed to investigate healthcare professionals’ practices, attitudes, and challenges in assessing and managing urological complications, including lower urinary tract symptoms (LUTSs) and erectile dysfunction (ED), in male patients with diabetes.
Methods
A 12-question online survey, distributed between April 2023 and January 2024, gathered responses from 370 physicians in Turkey. Participants represented various specialties, including endocrinology, internal medicine, family medicine, and general practice. The survey evaluated how frequently physicians inquired about symptoms, their use of validated assessment tools, and their management strategies for ED and LUTSs in male patients with diabetes.
Results
Of the participants, 40.3 % frequently asked about LUTSs, whereas 42.4 % reported rarely or never addressing these symptoms. More than 20 years of experience was significantly associated with higher inquiry rates (p = 0.001). Only 0.8 % of participants used validated symptom assessment tools. Concerning ED, 89.5 % of physicians noted that male patients with diabetes seldom reported related complaints, and only 20.3 % routinely asked about ED. Endocrinologists were significantly more likely to inquire about ED, with 36.2 % reporting such inquiries compared to 10.5 % among other specialties (p < 0.001). Most participants (53.5 %) preferred referring patients with ED to urology specialists for further management.
Conclusion
Urological complications in male patients with diabetes are under-assessed, with significant gaps in the use of validated tools and structured approaches. The study underscores the importance of raising awareness and implementing multidisciplinary strategies, such as regular symptom screening and timely interventions, to enhance patient outcomes.
{"title":"Assessment of urological complications in male patients with diabetes: Insights from a survey of healthcare providers","authors":"Mesut Altan , Emre Albayrak , Müjdat Ayva , Uğur Ünlütürk , Tomris Erbas","doi":"10.1016/j.pcd.2025.09.007","DOIUrl":"10.1016/j.pcd.2025.09.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate healthcare professionals’ practices, attitudes, and challenges in assessing and managing urological complications, including lower urinary tract symptoms (LUTSs) and erectile dysfunction (ED), in male patients with diabetes.</div></div><div><h3>Methods</h3><div>A 12-question online survey, distributed between April 2023 and January 2024, gathered responses from 370 physicians in Turkey. Participants represented various specialties, including endocrinology, internal medicine, family medicine, and general practice. The survey evaluated how frequently physicians inquired about symptoms, their use of validated assessment tools, and their management strategies for ED and LUTSs in male patients with diabetes.</div></div><div><h3>Results</h3><div>Of the participants, 40.3 % frequently asked about LUTSs, whereas 42.4 % reported rarely or never addressing these symptoms. More than 20 years of experience was significantly associated with higher inquiry rates (p = 0.001). Only 0.8 % of participants used validated symptom assessment tools. Concerning ED, 89.5 % of physicians noted that male patients with diabetes seldom reported related complaints, and only 20.3 % routinely asked about ED. Endocrinologists were significantly more likely to inquire about ED, with 36.2 % reporting such inquiries compared to 10.5 % among other specialties (p < 0.001). Most participants (53.5 %) preferred referring patients with ED to urology specialists for further management.</div></div><div><h3>Conclusion</h3><div>Urological complications in male patients with diabetes are under-assessed, with significant gaps in the use of validated tools and structured approaches. The study underscores the importance of raising awareness and implementing multidisciplinary strategies, such as regular symptom screening and timely interventions, to enhance patient outcomes.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 667-670"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208921","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}
Pub Date : 2025-12-01Epub Date: 2025-09-22DOI: 10.1016/j.pcd.2025.09.002
Nurten Terkes , Hicran Bektas , Mustafa Aydemir
Aim
This study aimed to evaluate the effectiveness of a structured distance education program on metabolic control, self-care activities, and health literacy in patients with newly diagnosed type 2 diabetes mellitus.
Methods
A randomized controlled trial design with block randomization (1:1 allocation) was conducted at a university hospital's endocrine outpatient clinic. A total of 100 patients newly diagnosed with type 2 diabetes were randomly assigned to either an intervention group (n = 50), receiving structured weekly distance education via Zoom sessions (each 40 min) for four weeks, or a control group (n = 50) receiving routine outpatient care. Data were collected using metabolic control parameters (BMI, fasting blood sugar, HbA1c), Diabetes Self-Care Activities Questionnaire, and Health Literacy Scale at baseline and after three months.
Results
Significant improvements were observed in metabolic control parameters, self-care activities, and health literacy in the intervention group compared to the control group (p < 0.01). Positive correlations were identified between health literacy and diabetes self-care behaviors post-intervention.
Conclusion
Structured distance education significantly enhances metabolic control, self-care, and health literacy in newly diagnosed T2DM patients. The study highlights the importance and practicality of integrating telehealth technologies into routine diabetes management and patient education, offering effective strategies to overcome barriers inherent in traditional educational methods.
{"title":"Effectiveness of structured distance education on metabolic control, self-care, and health literacy in newly diagnosed type 2 diabetes: A randomized controlled trial","authors":"Nurten Terkes , Hicran Bektas , Mustafa Aydemir","doi":"10.1016/j.pcd.2025.09.002","DOIUrl":"10.1016/j.pcd.2025.09.002","url":null,"abstract":"<div><h3>Aim</h3><div>This study aimed to evaluate the effectiveness of a structured distance education program on metabolic control, self-care activities, and health literacy in patients with newly diagnosed type 2 diabetes mellitus.</div></div><div><h3>Methods</h3><div>A randomized controlled trial design with block randomization (1:1 allocation) was conducted at a university hospital's endocrine outpatient clinic. A total of 100 patients newly diagnosed with type 2 diabetes were randomly assigned to either an intervention group (n = 50), receiving structured weekly distance education via Zoom sessions (each 40 min) for four weeks, or a control group (n = 50) receiving routine outpatient care. Data were collected using metabolic control parameters (BMI, fasting blood sugar, HbA1c), Diabetes Self-Care Activities Questionnaire, and Health Literacy Scale at baseline and after three months.</div></div><div><h3>Results</h3><div>Significant improvements were observed in metabolic control parameters, self-care activities, and health literacy in the intervention group compared to the control group (p < 0.01). Positive correlations were identified between health literacy and diabetes self-care behaviors post-intervention.</div></div><div><h3>Conclusion</h3><div>Structured distance education significantly enhances metabolic control, self-care, and health literacy in newly diagnosed T2DM patients. The study highlights the importance and practicality of integrating telehealth technologies into routine diabetes management and patient education, offering effective strategies to overcome barriers inherent in traditional educational methods.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 577-583"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133213","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}
Pub Date : 2025-12-01Epub Date: 2025-10-07DOI: 10.1016/j.pcd.2025.10.001
Jannie Toft Damsgaard Nørlev , Thomas Kronborg , Morten Hasselstrøm Jensen , Peter Vestergaard , Stine Hangaard
Aims
Although telemonitoring has emerged as a strategy to overcome barriers related to poor adherence, insulin dose deviations remain common. Yet, the reason remains unclear. This study investigated the reasons for dose deviations in people with insulin-treated type 2 diabetes (T2D) receiving telemonitoring.
Methods
Data were provided from 331 participants with insulin-treated T2D (DiaMonT, NCT 04981808). Participants were either telemonitored using a continuous glucose monitor (CGM), a connected insulin pen, and an activity watch or treated according to standard of care, using blinded devices. Reasons for dose deviations were categorized, and descriptive statistics were used to summarize the findings.
Results
A total of 24 distinct reasons for insulin dose deviations were reported. These were grouped into: (1) actual deviations (40.1 %; n = 148) (e.g., limited understanding of T2D and access to CGM data), (2) justified deviations (40.7 %; n = 150) (e.g., illness and use of a non-connected pen), and (3) device-related deviations (19.2 %; n = 71) (e.g., technical issues).
Conclusions
This study highlights the need for a nuanced interpretation of adherence data and suggests that telemonitoring should engage patients in treatment discussions and support education in diabetes self-management. These insights are key to maximizing the benefits of telemonitoring while avoiding misinterpretation or over-intervention.
{"title":"Understanding insulin dose deviations in people with type 2 diabetes receiving telemonitoring","authors":"Jannie Toft Damsgaard Nørlev , Thomas Kronborg , Morten Hasselstrøm Jensen , Peter Vestergaard , Stine Hangaard","doi":"10.1016/j.pcd.2025.10.001","DOIUrl":"10.1016/j.pcd.2025.10.001","url":null,"abstract":"<div><h3>Aims</h3><div>Although telemonitoring has emerged as a strategy to overcome barriers related to poor adherence, insulin dose deviations remain common. Yet, the reason remains unclear. This study investigated the reasons for dose deviations in people with insulin-treated type 2 diabetes (T2D) receiving telemonitoring.</div></div><div><h3>Methods</h3><div>Data were provided from 331 participants with insulin-treated T2D (DiaMonT, NCT 04981808). Participants were either telemonitored using a continuous glucose monitor (CGM), a connected insulin pen, and an activity watch or treated according to standard of care, using blinded devices. Reasons for dose deviations were categorized, and descriptive statistics were used to summarize the findings.</div></div><div><h3>Results</h3><div>A total of 24 distinct reasons for insulin dose deviations were reported. These were grouped into: (1) actual deviations (40.1 %; n = 148) (e.g., limited understanding of T2D and access to CGM data), (2) justified deviations (40.7 %; n = 150) (e.g., illness and use of a non-connected pen), and (3) device-related deviations (19.2 %; n = 71) (e.g., technical issues).</div></div><div><h3>Conclusions</h3><div>This study highlights the need for a nuanced interpretation of adherence data and suggests that telemonitoring should engage patients in treatment discussions and support education in diabetes self-management. These insights are key to maximizing the benefits of telemonitoring while avoiding misinterpretation or over-intervention.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 602-607"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246105","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}
Pub Date : 2025-12-01Epub Date: 2025-09-25DOI: 10.1016/j.pcd.2025.09.006
Jenifar Prashanthan , Amirthanathan Prashanthan
Background and aim
It is essential to identify the risk of developing Type 2 Diabetes Mellitus (T2DM) in women with a history of Gestational Diabetes Mellitus (GDM). This study seeks to create a machine learning (ML) model combined with explainable artificial intelligence (XAI) to predict and explain the risk of Type 2 Diabetes Mellitus (T2DM) in women with a history of Gestational Diabetes Mellitus (GDM).
Methods
A literature review found 28 risk factors, including pregnancy-related clinical risk factors, maternal characteristics, genetic risk factors, and lifestyle and modifiable risk factors. A synthetic dataset was generated utilizing subject expertise and clinical experience through Python programming. Various machine learning classification techniques were employed on the data to identify the optimal model, which integrates interpretability approaches (SHAP) to guarantee the transparency of model predictions.
Results
The developed machine learning model exhibited superior accuracy in predicting the risk of T2DM relative to conventional clinical risk scores, with notable contributions from factors such as insulin treatment during pregnancy, physical inactivity, obesity, breastfeeding, a history of recurrent GDM, an unhealthy diet, and ethnicity. Integrated XAI assists clinicians in comprehending the relevant risk factors and their influence on certain predictive outcomes.
Conclusions
Machine learning and explainable artificial intelligence provide a comprehensive methodology for individualized risk evaluation in women with a history of gestational diabetes mellitus. This methodology, by integrating extensive real-world data, offers healthcare clinicians actionable insights for early intervention.
{"title":"Predicting the future risk of developing type 2 diabetes in women with a history of gestational diabetes mellitus using machine learning and explainable artificial intelligence","authors":"Jenifar Prashanthan , Amirthanathan Prashanthan","doi":"10.1016/j.pcd.2025.09.006","DOIUrl":"10.1016/j.pcd.2025.09.006","url":null,"abstract":"<div><h3>Background and aim</h3><div>It is essential to identify the risk of developing Type 2 Diabetes Mellitus (T2DM) in women with a history of Gestational Diabetes Mellitus (GDM). This study seeks to create a machine learning (ML) model combined with explainable artificial intelligence (XAI) to predict and explain the risk of Type 2 Diabetes Mellitus (T2DM) in women with a history of Gestational Diabetes Mellitus (GDM).</div></div><div><h3>Methods</h3><div>A literature review found 28 risk factors, including pregnancy-related clinical risk factors, maternal characteristics, genetic risk factors, and lifestyle and modifiable risk factors. A synthetic dataset was generated utilizing subject expertise and clinical experience through Python programming. Various machine learning classification techniques were employed on the data to identify the optimal model, which integrates interpretability approaches (SHAP) to guarantee the transparency of model predictions.</div></div><div><h3>Results</h3><div>The developed machine learning model exhibited superior accuracy in predicting the risk of T2DM relative to conventional clinical risk scores, with notable contributions from factors such as insulin treatment during pregnancy, physical inactivity, obesity, breastfeeding, a history of recurrent GDM, an unhealthy diet, and ethnicity. Integrated XAI assists clinicians in comprehending the relevant risk factors and their influence on certain predictive outcomes.</div></div><div><h3>Conclusions</h3><div>Machine learning and explainable artificial intelligence provide a comprehensive methodology for individualized risk evaluation in women with a history of gestational diabetes mellitus. This methodology, by integrating extensive real-world data, offers healthcare clinicians actionable insights for early intervention.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 658-666"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180734","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}
Pub Date : 2025-10-01Epub Date: 2025-06-16DOI: 10.1016/j.pcd.2025.06.005
Rodrigo M. Carrillo-Larco , Wilmer Cristobal Guzman-Vilca , Xiaolin Xu , Antonio Bernabe-Ortiz
Background
The extent to which people with newly diagnosed diabetes exhibit similar insulin resistance profiles across countries is unknown. Understanding the heterogeneity in glycemic and cardiometabolic profiles at the time of diabetes diagnosis could provide insights for precision medicine.
Methods
We analyzed 14 nationally representative surveys (STEPS). We used anthropometric measures, fasting glucose, triglycerides and HDL cholesterol to calculate eight non-insulin-based markers of insulin resistance: triglyceride and glucose ratio (TyG), TyG with BMI (TyGBMI), TyG with waist circumference (TyGwaist), TyG with waist-to-height ratio (TyGWHtR), triglyceride-to-HDL ratio (TGHDL_r), metabolic score for insulin resistance (METS-IR), lipid accumulation product (LAP), and visceral adiposity index (VAI). We only included subjects with newly diagnosed diabetes. Age- and sex-adjusted multilevel linear regression models were used to estimate country-specific margins of the z-scores for each insulin resistance surrogate (_z suffix refers to predicted z-score margins).
Results
A total of 2531 individuals were analyzed (mean age 47.4 years; 56.6 % were women). The widest disparities across countries in predicted z-scores were observed for TyG-based markers. For instance, the predicted margins for TyGBMI_z ranged from −0.985 (Ethiopia) to 0.682 (Kuwait). In contrast, narrower disparities were noted for other markers, with the smallest gap observed for VAI_z ranging from −0.688 (Bhutan) to 0.491 (Guyana).
Conclusions
The study highlights heterogeneity in metabolic profiles at diabetes diagnosis across countries. These findings emphasize the importance of incorporating population-specific factors into strategies for understanding and addressing the global diabetes burden, particularly in recognizing the diverse cardiometabolic profiles at the time of diagnosis.
{"title":"Non-insulin-based markers of insulin resistance at diabetes diagnosis: A pooled analysis of 14 national health surveys","authors":"Rodrigo M. Carrillo-Larco , Wilmer Cristobal Guzman-Vilca , Xiaolin Xu , Antonio Bernabe-Ortiz","doi":"10.1016/j.pcd.2025.06.005","DOIUrl":"10.1016/j.pcd.2025.06.005","url":null,"abstract":"<div><h3>Background</h3><div>The extent to which people with newly diagnosed diabetes exhibit similar insulin resistance profiles across countries is unknown. Understanding the heterogeneity in glycemic and cardiometabolic profiles at the time of diabetes diagnosis could provide insights for precision medicine.</div></div><div><h3>Methods</h3><div><span><span>We analyzed 14 nationally representative surveys (STEPS). We used anthropometric measures, fasting glucose, </span>triglycerides<span> and HDL cholesterol to calculate eight non-insulin-based markers of insulin resistance: triglyceride and glucose ratio (TyG), TyG with </span></span>BMI<span><span><span> (TyGBMI), TyG with waist circumference (TyGwaist), TyG with waist-to-height ratio (TyGWHtR), triglyceride-to-HDL ratio (TGHDL_r), metabolic score for insulin resistance (METS-IR), lipid accumulation product (LAP), and visceral </span>adiposity index (VAI). We only included subjects with newly diagnosed diabetes. Age- and sex-adjusted multilevel </span>linear regression models were used to estimate country-specific margins of the z-scores for each insulin resistance surrogate (_z suffix refers to predicted z-score margins).</span></div></div><div><h3>Results</h3><div>A total of 2531 individuals were analyzed (mean age 47.4 years; 56.6 % were women). The widest disparities across countries in predicted z-scores were observed for TyG-based markers. For instance, the predicted margins for TyGBMI_z ranged from −0.985 (Ethiopia) to 0.682 (Kuwait). In contrast, narrower disparities were noted for other markers, with the smallest gap observed for VAI_z ranging from −0.688 (Bhutan) to 0.491 (Guyana).</div></div><div><h3>Conclusions</h3><div>The study highlights heterogeneity in metabolic profiles at diabetes diagnosis across countries. These findings emphasize the importance of incorporating population-specific factors into strategies for understanding and addressing the global diabetes burden, particularly in recognizing the diverse cardiometabolic profiles at the time of diagnosis.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 5","pages":"Pages 497-503"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319078","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}
To evaluate the correlation between continuous glucose monitoring (CGM)-derived metrics such as time in range (TIR) and time below range (TBR) and clinical parameters in Indian patients with type 2 diabetes mellitus (T2DM), providing insights into the effectiveness of CGM in this population.
Methods
This is a single-center, retrospective-observational study of T2DM patients aged 18 or older years using the Freestyle Libre/Libre Pro CGM system. Demographic and clinical data of these patients were extracted from medical records, and glycemic metrics from CGM profiles.
Results
The study included 248 T2DM patients, of whom 72.98 % were male, with a mean age of 60.48 years and a mean HbA1c value of 8.319 %. Linear regression analysis revealed that TIR was significantly negatively associated with HbA1c values (coefficient=-6.746) and duration of diabetes (coefficient=-0.425). The body mass index (BMI) showed a positive association with TIR (coefficient=0.649; P = 0.032). For TBR, only HbA1c values showed a significant negative association (coefficient=-1.051; P = 0.009), whereas age, duration of diabetes, and BMI were not significant predictors.
Conclusion
The study highlights the significant relationships between CGM-derived metrics (TIR and TBR), and clinical parameters in Indian patients with T2DM, and their effectiveness in identifying patients at risk of inadequate glycemic control.
背景：评估印度2型糖尿病（T2DM）患者连续血糖监测（CGM）衍生指标（如范围内时间（TIR）和范围下时间（TBR））与临床参数之间的相关性，为CGM在该人群中的有效性提供见解。方法：这是一项使用Freestyle Libre/Libre Pro CGM系统的18岁及以上T2DM患者的单中心、回顾性观察研究。这些患者的人口学和临床数据从医疗记录中提取，血糖指标从CGM档案中提取。结果：研究纳入T2DM患者248例，其中男性72.98 %，平均年龄60.48岁，平均HbA1c值8.319 %。线性回归分析显示，TIR与HbA1c值（系数=-6.746）和糖尿病病程（系数=-0.425）呈显著负相关。体质指数（BMI）与TIR呈正相关(系数=0.649； = 0.032页)。对于TBR，只有HbA1c值呈显著负相关(系数=-1.051；P = 0.009)，而年龄、糖尿病病程和BMI不是显著的预测因子。结论：该研究强调了cgm衍生指标（TIR和TBR）与印度T2DM患者临床参数之间的显著关系，以及它们在识别血糖控制不足风险患者方面的有效性。
{"title":"Association between continuous glucose monitoring derived metrics and clinical parameters in Indian people living with type 2 diabetes","authors":"Purvi Chawla , Alpana Sowani , Rakesh Parikh , Amit Gupta , Jothydev Kesavadev , Rutul Gokalani , Banshi Saboo , Manoj Chawla","doi":"10.1016/j.pcd.2025.06.004","DOIUrl":"10.1016/j.pcd.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate the correlation between continuous glucose monitoring (CGM)-derived metrics such as time in range (TIR) and time below range (TBR) and clinical parameters in Indian patients with type 2 diabetes mellitus (T2DM), providing insights into the effectiveness of CGM in this population.</div></div><div><h3>Methods</h3><div>This is a single-center, retrospective-observational study of T2DM patients aged 18 or older years using the Freestyle Libre/Libre Pro CGM system. Demographic and clinical data of these patients were extracted from medical records, and glycemic metrics from CGM profiles.</div></div><div><h3>Results</h3><div>The study included 248 T2DM patients, of whom 72.98 % were male, with a mean age of 60.48 years and a mean HbA1c value of 8.319 %. Linear regression analysis revealed that TIR was significantly negatively associated with HbA1c values (coefficient=-6.746) and duration of diabetes (coefficient=-0.425). The body mass index (BMI) showed a positive association with TIR (coefficient=0.649; <em>P</em> = 0.032). For TBR, only HbA1c values showed a significant negative association (coefficient=-1.051; <em>P</em> = 0.009), whereas age, duration of diabetes, and BMI were not significant predictors.</div></div><div><h3>Conclusion</h3><div>The study highlights the significant relationships between CGM-derived metrics (TIR and TBR), and clinical parameters in Indian patients with T2DM, and their effectiveness in identifying patients at risk of inadequate glycemic control.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 5","pages":"Pages 453-461"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512962","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}
Pub Date : 2025-10-01Epub Date: 2025-07-08DOI: 10.1016/j.pcd.2025.07.002
Ashley Anjali Singh , Katie M. Babbott , Simon Young , Zhenqiang Wu , Anna Serlachius
Aim
The present study sought to explore if engagement with a commercially available diabetes app, mySugr, could facilitate improvement in glycaemic outcomes, diabetes self-care behaviours and psychological wellbeing compared to standard care among adults with type 1 diabetes (T1D).
Methods
Participants were randomised to the intervention (n = 31) or control group (n = 32) and assessed at 12 weeks after baseline. Changes to blood glucose levels (HbA1c) was the primary outcome of interest in the present study. Secondary outcomes included diabetes self-care behaviours, diabetes self-efficacy, diabetes distress, psychological well-being and general stress. These outcomes were quantitatively assessed via self-report questionnaires. Qualitative accounts of user engagement with the app were also explored.
Results
Fifty-five participants completed the 12-week follow-up questionnaires. The intervention group demonstrated a lower HbA1c than the control group at 12-weeks, however this change was not statistically significant (adjusted mean difference 4.20 mmol/mol, 95 % CI [-0.39,8.79], p = 0.072). Additionally, no significant changes across time or between-group differences were observed for secondary outcomes at 12 weeks. However, close to 80 % of participants in the intervention group reported using the app daily for 12 weeks, suggesting good user engagement. Further, users scored the app on average favourably on the uMARS scale (objective quality M=3.93, SD=0.55, subjective quality M=3.31, SD=0.99, perceived impact M=3.15, SD=1.25).
Conclusion
Results suggest that mySugr is an engaging diabetes app. Preliminary findings suggest that the mySugr app may assist users in improving glycaemic levels over 12 weeks, but the trends found in the present study did not reach statistical significance. Thus, the study needs to be replicated in a larger sample size with a longer follow-up period to more robustly ascertain the effects of mySugr on glycaemic outcomes and diabetes self-management
目的：本研究旨在探索与标准治疗相比，使用市售糖尿病应用程序mysugar是否可以促进1型糖尿病（T1D）成人血糖结局、糖尿病自我护理行为和心理健康的改善。方法：参与者被随机分为干预组（n = 31）或对照组（n = 32），并在基线后12周进行评估。血糖水平（HbA1c）的变化是本研究的主要目的。次要结局包括糖尿病自我护理行为、糖尿病自我效能、糖尿病困扰、心理健康和一般压力。这些结果通过自我报告问卷进行定量评估。我们还探讨了用户粘性的定性描述。结果：55名参与者完成了为期12周的随访问卷。干预组在12周时HbA1c低于对照组，但差异无统计学意义（调整后平均差异4.20 mmol/mol, 95 % CI [-0.39,8.79], p = 0.072）。此外，在12周时，次要结果在时间上或组间没有显著变化。然而，在干预组中，接近80% %的参与者报告说，他们在12周内每天都使用该应用程序，这表明用户粘性很好。此外，用户在uMARS量表上对该应用的平均评分为好评（客观质量M=3.93， SD=0.55，主观质量M=3.31， SD=0.99，感知影响M=3.15， SD=1.25）。结论：结果表明mysugar是一款引人关注的糖尿病应用程序。初步研究结果表明，mysugar应用程序可以帮助用户在12周内改善血糖水平，但本研究中发现的趋势没有达到统计学意义。因此，该研究需要在更大的样本量和更长的随访期内进行重复，以更有力地确定mysugar对血糖结局和糖尿病自我管理的影响。
{"title":"Evaluating the mySugr diabetes app: A randomised controlled trial exploring changes in HbA1c and psychological outcomes in adults with type 1 diabetes","authors":"Ashley Anjali Singh , Katie M. Babbott , Simon Young , Zhenqiang Wu , Anna Serlachius","doi":"10.1016/j.pcd.2025.07.002","DOIUrl":"10.1016/j.pcd.2025.07.002","url":null,"abstract":"<div><h3>Aim</h3><div>The present study sought to explore if engagement with a commercially available diabetes app, mySugr, could facilitate improvement in glycaemic outcomes, diabetes self-care behaviours and psychological wellbeing compared to standard care among adults with type 1 diabetes (T1D).</div></div><div><h3>Methods</h3><div>Participants were randomised to the intervention (<em>n</em> = 31) or control group (<em>n</em> = 32) and assessed at 12 weeks after baseline. Changes to blood glucose levels (HbA1c) was the primary outcome of interest in the present study. Secondary outcomes included diabetes self-care behaviours, diabetes self-efficacy, diabetes distress, psychological well-being and general stress. These outcomes were quantitatively assessed via self-report questionnaires. Qualitative accounts of user engagement with the app were also explored.</div></div><div><h3>Results</h3><div>Fifty-five participants completed the 12-week follow-up questionnaires. The intervention group demonstrated a lower HbA1c than the control group at 12-weeks, however this change was not statistically significant (adjusted mean difference 4.20 mmol/mol, 95 % CI [-0.39,8.79], <em>p</em> = 0.072). Additionally, no significant changes across time or between-group differences were observed for secondary outcomes at 12 weeks. However, close to 80 % of participants in the intervention group reported using the app daily for 12 weeks, suggesting good user engagement. Further, users scored the app on average favourably on the uMARS scale (objective quality <em>M</em>=3.93, <em>SD</em>=0.55, subjective quality <em>M</em>=3.31, <em>SD</em>=0.99, perceived impact <em>M</em>=3.15, SD=1.25).</div></div><div><h3>Conclusion</h3><div>Results suggest that mySugr is an engaging diabetes app. Preliminary findings suggest that the mySugr app may assist users in improving glycaemic levels over 12 weeks, but the trends found in the present study did not reach statistical significance. Thus, the study needs to be replicated in a larger sample size with a longer follow-up period to more robustly ascertain the effects of mySugr on glycaemic outcomes and diabetes self-management</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 5","pages":"Pages 446-452"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602700","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}
Pub Date : 2025-10-01Epub Date: 2025-08-06DOI: 10.1016/j.pcd.2025.07.007
Muhammad Saad , Muhammad Umer Sohail , Saad Ahmed Waqas , Zainab Siddiqua Ibrahim , Muhammad Sameer Arshad , Peter Collins , Raheel Ahmed
Background
Hypertension frequently coexists with diabetes, affecting over two-thirds of diabetic patients and significantly increasing cardiovascular (CV) risk. While blood pressure (BP) reduction offers substantial benefits in this population, the optimal systolic blood pressure (SBP) target remains controversial. This meta-analysis evaluates the effects of intensive SBP lowering (<130 mmHg) versus standard therapy (<150 mmHg) on key CV outcomes in hypertensive patients with diabetes.
Methods
This systematic review and meta-analysis adhered to PRISMA guidelines and included randomized controlled trials (RCTs) assessing SBP targets in diabetic patients. Electronic databases were searched through December 2024. Hazard ratios (HRs) for all-cause mortality, CV death, heart failure (HF), stroke, major adverse cardiovascular events (MACE), and major coronary heart disease events were pooled using a random-effects model. Risk of bias was evaluated using the Cochrane Risk of Bias Tool.
Results
Four RCTs involving 21,169 patients were included. Intensive SBP control significantly reduced stroke (HR: 0.71; p = 0.01), HF (HR: 0.69; p = 0.02), CV death (HR: 0.76; p = 0.04), and MACE (HR: 0.82; p < 0.0001) but showed no significant impact on all-cause mortality (HR: 0.90; p = 0.24) or major coronary heart disease events (HR: 0.93; p = 0.16). Heterogeneity was minimal across outcomes.
Conclusion
Intensive BP control reduces stroke, HF, CV death, and MACE in hypertensive diabetic patients, highlighting its role in CV risk management. Future research should explore subgroup effects.
{"title":"Effects of intensive blood pressure control on cardiovascular outcomes in patients with diabetes: A systematic review and meta-analysis","authors":"Muhammad Saad , Muhammad Umer Sohail , Saad Ahmed Waqas , Zainab Siddiqua Ibrahim , Muhammad Sameer Arshad , Peter Collins , Raheel Ahmed","doi":"10.1016/j.pcd.2025.07.007","DOIUrl":"10.1016/j.pcd.2025.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Hypertension frequently coexists with diabetes, affecting over two-thirds of diabetic patients and significantly increasing cardiovascular (CV) risk. While blood pressure (BP) reduction offers substantial benefits in this population, the optimal systolic blood pressure (SBP) target remains controversial. This meta-analysis evaluates the effects of intensive SBP lowering (<130 mmHg) versus standard therapy (<150 mmHg) on key CV outcomes in hypertensive patients with diabetes.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis adhered to PRISMA guidelines and included randomized controlled trials (RCTs) assessing SBP targets in diabetic patients. Electronic databases were searched through December 2024. Hazard ratios (HRs) for all-cause mortality, CV death, heart failure (HF), stroke, major adverse cardiovascular events (MACE), and major coronary heart disease events were pooled using a random-effects model. Risk of bias was evaluated using the Cochrane Risk of Bias Tool.</div></div><div><h3>Results</h3><div>Four RCTs involving 21,169 patients were included. Intensive SBP control significantly reduced stroke (HR: 0.71; p = 0.01), HF (HR: 0.69; p = 0.02), CV death (HR: 0.76; p = 0.04), and MACE (HR: 0.82; p < 0.0001) but showed no significant impact on all-cause mortality (HR: 0.90; p = 0.24) or major coronary heart disease events (HR: 0.93; p = 0.16). Heterogeneity was minimal across outcomes.</div></div><div><h3>Conclusion</h3><div>Intensive BP control reduces stroke, HF, CV death, and MACE in hypertensive diabetic patients, highlighting its role in CV risk management. Future research should explore subgroup effects.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 5","pages":"Pages 422-425"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796583","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}
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