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Cognitive impairment is associated with poor diabetic foot ulcer outcomes 认知障碍与糖尿病足溃疡预后不良相关。
IF 2.3 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-29 DOI: 10.1016/j.pcd.2025.07.008
Christopher Girgis , Stephanie Behme , Crystal Holmes , Sari Priesand , Evan L. Reynolds , Jihyun Park , Pearl G. Lee , Brian M. Schmidt

Background

Up to one-third of individuals with diabetes develop diabetic foot ulcers (DFU), and cognitive impairment affects up to 34 % of this population. This study evaluates the impact of cognitive impairment on ulcer outcomes.

Methods

This six-year retrospective study analyzed ICD-9/10 codes from a large tertiary health system. Eligible patients had DFU and at least six months of follow-up. Exclusions were made for those without an ulcer and not seen by a podiatrist. For the cohort without cognitive impairment, patients were excluded if they screened positive for cognitive impairment or dementia in the five years prior to diagnosis. Clinical outcomes were assessed using the Wound, Ischemic, Foot Infection classification, focusing on healing rates, time to healing, amputation events, and hospital admissions. Logistic regression determined associations between cognitive impairment and DFU outcomes.

Results

Of 631 charts reviewed, 123 patients were included: 56 with cognitive impairment (mean age 71.9) and 67 without (mean age 58). Healing rates at six months were lower for those with cognitive impairment (39 % vs. 72 %, p < 0.001). They had higher rates of major amputations (17.8 % vs. 5.9 %, odds ratio 4.5, p < 0.05) and foot-related admissions (p = 0.01).

Conclusions

Individuals with DFU and cognitive impairment were at higher risk of major amputation, foot-related admissions, and nonhealing, underscoring the need for targeted interventions.
背景:高达三分之一的糖尿病患者患有糖尿病足溃疡(DFU),认知障碍影响高达34% %的这一人群。本研究评估认知障碍对溃疡预后的影响。方法:这项为期六年的回顾性研究分析了来自大型三级卫生系统的ICD-9/10代码。符合条件的患者有DFU和至少6个月的随访。排除那些没有溃疡和没有看过足病医生的人。对于没有认知障碍的队列,如果患者在诊断前5年内认知障碍或痴呆筛查呈阳性,则排除在外。临床结果采用伤口、缺血、足部感染分类进行评估,重点关注愈合率、愈合时间、截肢事件和住院率。逻辑回归确定了认知障碍和DFU结果之间的关联。结果:在回顾的631张图表中,纳入123例患者:56例有认知障碍(平均年龄71.9岁),67例无认知障碍(平均年龄58岁)。认知障碍患者6个月的治愈率较低(39% %对72% %,p )。结论:DFU和认知障碍患者发生主要截肢、足部相关入院和不愈合的风险较高,强调了有针对性干预的必要性。
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引用次数: 0
The role of iron biomarkers in predicting type 2 Diabetes: An international, multi-cohort Study 铁生物标志物在预测2型糖尿病中的作用:一项国际多队列研究
IF 2.3 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-22 DOI: 10.1016/j.pcd.2025.07.004
Farnaz Khatami , Pien Rawee , Vlada Hanchar , Martin H. de Borst , Stephan J.L. Bakker , Milton Severo , Henrique Barros , Michele F. Eisenga , Taulant Muka , Pedro Marques-Vidal

Aims

We investigated whether adding iron biomarkers into existing type 2 diabetes risk models improves risk prediction.

Methods

Data from three population-based cohorts were used; CoLaus|PsyCoLaus in Switzerland (5250 participants, 54.9 % females, mean age± standard deviation 51.8 ± 10.5 years, median follow-up of 14.5 years; PREVEND in the Netherlands (4784 participants, 51.8 % females, 52.2 ± 11.5 years, follow-up 7.3 years); and EPIPorto in Portugal (806 participants, 40 % females, 62 ± 13 years, follow-up 7.8 years). The effect of adding iron, ferritin, and transferrin in seven type 2 diabetes risk models was examined.

Results

486 participants (9.3 %) in the CoLaus|PsyCoLaus, 170 (3.6 %) in PREVEND, and 22 (3.4 %) in EPIPorto developed diabetes. There was a substantial association between type 2 diabetes and all risk scores. In the CoLaus|PsyCoLaus and PREVEND, ferritin levels were positively and independently associated with the incidence of diabetes and considerably enhanced its prediction. Transferrin levels were positively and independently associated with the incidence of diabetes across all risk scores in all cohorts and improved its prediction in PREVEND, EpiPorto, and certain risk models in CoLaus|PsyCoLaus. There was found to be no association between iron levels and type 2 diabetes.

Conclusions

Adding ferritin or transferrin slightly improved most diabetes risk prediction models.
目的:我们研究在现有的2型糖尿病风险模型中加入铁生物标志物是否能改善风险预测。方法:采用三个基于人群的队列数据;CoLaus|瑞士PsyCoLaus(5250名参与者,54.9% %女性,平均年龄±标准差51.8 ± 10.5岁,中位随访14.5年;荷兰的PREVEND(4784名参与者,51.8 %女性,52.2 ± 11.5岁,随访7.3年);和葡萄牙的EPIPorto(806名参与者,40 %女性,62 ± 13岁,随访7.8年)。研究了添加铁、铁蛋白和转铁蛋白对7种2型糖尿病风险模型的影响。结果:CoLaus|PsyCoLaus组486名参与者(9.3 %),PREVEND组170名参与者(3.6 %),epporto组22名参与者(3.4 %)患糖尿病。2型糖尿病与所有风险评分之间存在实质性关联。在CoLaus|PsyCoLaus和PREVEND中,铁蛋白水平与糖尿病发病率呈正相关且独立相关,并显著增强其预测能力。在所有队列的所有风险评分中,转铁蛋白水平与糖尿病发病率呈正相关且独立相关,并且在PREVEND、EpiPorto和CoLaus|PsyCoLaus的某些风险模型中,转铁蛋白水平的预测得到了改善。研究发现,铁含量与2型糖尿病之间没有关联。结论:加入铁蛋白或转铁蛋白可略微改善大多数糖尿病风险预测模型。
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引用次数: 0
Achieving meaningful reduction of HgbA1c in pediatric type 1 diabetes requires an individualized approach 在儿童1型糖尿病中实现有意义的糖化血红蛋白降低需要个体化的方法。
IF 2.3 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-21 DOI: 10.1016/j.pcd.2025.07.005
Andrew Kanouse , Joanna S. Fishbein , Parissa Salemi

Objective

Individuals with diabetes often have difficulty attaining a goal hemoglobin A1c < 7.0 %. Diabetes care is multifactorial, including medications, education, and lifestyle intervention. Individuals with a hemoglobin A1c (HgbA1c) > 10 % are especially at risk for complications. The aim of this study was to evaluate the association of technological interventions [continuous glucose monitors (CGM) and/or continuous subcutaneous insulin infusion devices (CSII, i.e. insulin pumps)] and frequency of clinic visits with improvement of HgbA1c values in children with type 1 diabetes (T1D) who have a HgbA1c > 10 %.

Research design and methods

A chart review was performed for patients with T1D who had a HgbA1c > 10 % and a diagnosis of T1D for greater than 1 year between 2018 and 2019 analyzing demographic data, treatment modality, and frequency of visits to determine if a clinically meaningful HgbA1c reduction (>0.5 %) was achieved.

Results

One hundred and forty-seven children were evaluated. Altogether, 9 children (53 %) with CGM only, 18 (64 %) with CSII only, and 14 (78 %) with combination use achieved a clinically significant reduction as compared to 50 (60 %) with no technology. When evaluating number of visits, 41 children (61 %) with 1–2 visits, 40 (60 %) with 3, 19 (70 %) with 4, and 5 (50 %) with 5–6 achieved reduction.

Conclusions

These results show that while either use of technology or increased clinic visits may improve the ability to achieve meaningful HgbA1c reductions, this may not be true for all patients. While some patients may need numerous clinic visits, others may be able to make dramatic changes with only two visits. Similarly, while some may benefit from CGM use alone, others may improve their HgbA1c with a CSII or no technology. Given the intricacies of diabetes care, this data supports that patients would likely benefit from a tailored treatment plan catered to their individual needs to best optimize their HgbA1c.
目的:糖尿病患者通常难以达到目标血红蛋白A1c 10 %,特别有并发症的风险。本研究的目的是评估技术干预[连续血糖监测仪(CGM)和/或连续皮下胰岛素输注装置(CSII,即胰岛素泵)]和临床就诊频率与改善HgbA1c值的关系,1型糖尿病儿童(T1D)的HgbA1c为bb0 10 %。研究设计和方法:对2018年至2019年期间诊断为T1D的HgbA1c > 10 %超过1年的T1D患者进行图表回顾,分析人口统计学数据、治疗方式和就诊频率,以确定是否实现了临床有意义的HgbA1c降低(>0.5 %)。结果:对147名儿童进行了评估。总的来说,9名儿童(53 %)单独使用CGM, 18名儿童(64 %)单独使用CSII, 14名儿童(78 %)联合使用相比,50名儿童(60 %)没有技术实现了临床显著的降低。在评估就诊次数时,41名儿童(61 %)进行1-2次就诊,40名儿童(60 %)进行3次就诊,19名儿童(70 %)进行4次就诊,5名儿童(50 %)进行5-6次就诊。结论:这些结果表明,虽然使用技术或增加门诊就诊可以提高实现有意义的hba1c降低的能力,但这可能并不适用于所有患者。虽然有些病人可能需要多次就诊,但有些人可能只需要两次就诊就能产生巨大的变化。同样,虽然有些人可能从单独使用CGM中受益,但其他人可能通过CSII或不使用CSII技术来改善他们的hba1c。鉴于糖尿病护理的复杂性,该数据支持患者可能受益于针对其个人需求的量身定制的治疗计划,以最佳地优化其hba1c。
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引用次数: 0
Corrigendum to “Continuity of care across sectors in patients with type 2 diabetes: A nationwide register study in Denmark” [Prim. Care Diabetes 19 (2025) 261–269] “2型糖尿病患者跨部门护理的连续性:丹麦的一项全国性登记研究”[Prim. care diabetes 19(2025) 261-269]。
IF 2.3 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-16 DOI: 10.1016/j.pcd.2025.07.003
Anne Sofie Baymler Lundberg , Claus Høgstrup Vestergaard , Annelli Sandbæk , Anders Prior
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引用次数: 0
The Influence of Local Service Configuration on All-Cause Mortality: An Age- and Sex-Standardised Analysis 当地服务配置对全因死亡率的影响:年龄和性别标准化分析。
IF 2.3 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-15 DOI: 10.1016/j.pcd.2025.06.003
Mike Stedman , Mark Davies , Adam Robinson , John Warner-Levy , Martin Whyte , Martin Gibson , Ritwika Mallik , Adrian Heald

Aims

Public Health England mortality data shows that most deaths are associated with underlying longer-term health issues and could potentially be mitigated by more effective preventive and planned healthcare. General practitioner practices (GPPs) are the provider and gatekeeper to most NHS healthcare services and there are no direct publications of deaths at GPP level Our aim here was to determine how estimated mortality rate at GPP level may associate with the effectiveness of local services in delivering healthcare outcomes.

Methods

We used Office of National Statistics (ONS) data for January 2018-January 2020 (inclusive). From this an estimated Age Standardised Mortality Rate (SMR) for that Layer Super Output Areas (LSOA) was calculated. A linear link between local LSOA SMR and IMD was established so that the SMR_D could be calculated which assumes the practice was at median deprivation.
Risk Factors that were then included into the Analysis these included: demographic, medical conditions, local use of preventive Medication (prescriptions) and impact of local area health services, including diabetes. Stepwise (removing factors with p value > 0.05) multifactorial linear regression was applied to derive the impact of these factors on the SMR_D

Results

The analysis covered 5792 GPP where all the data was available, and where more than 2000 patients were on the practice list. There were 22 factors taken into consideration for the model, of which 17 remained significant. If all practices achieved at least the median level there might be as many as 30,000 (7 %) fewer deaths/year. IMD even after adjustment within the LSOA SMR continued to have a strong effect. The association of Cancer QOF registration rates was associated with a lower mortality rate. A higher rate of diabetes case identification did not associate with reduced mortality rate, rather with higher mortality rate. Practice size was not a factor. Practices with higher percentage of older patients had relative lower mortality rates as did those with higher rates of antihypertensive prescribing.

Conclusions

We here describe associations that suggest that there are underlying themes to understanding the drivers to mortality in England. Our model can be applied to local practices to highlight those that have the largest gap. The association of general practice percentage identification of diabetes cases with increased practice mortality rate likely relates to the reality of type 2 diabetes being associated with many other conditions that can shorten life. The association of higher rates of prescription of antihypertensive agents in individuals over 65 years old with lower practice mortality, highlights the importance of effective identification and effective treatment of hypertension in this group.
目的:英格兰公共卫生部死亡率数据显示,大多数死亡与潜在的长期健康问题有关,可以通过更有效的预防和有计划的保健来缓解。全科医生(GPPs)是大多数NHS医疗服务的提供者和看门人,没有GPP水平的死亡直接出版物。我们的目的是确定GPP水平的估计死亡率如何与当地服务在提供医疗保健结果方面的有效性相关联。方法:我们使用国家统计局(ONS) 2018年1月至2020年1月(含)的数据。由此计算出该层超级输出区(LSOA)的年龄标准化死亡率(SMR)。建立了本地LSOA SMR和IMD之间的线性联系,以便可以计算假设实践处于中位数剥夺的SMR_D。随后纳入分析的风险因素包括:人口、医疗条件、当地使用预防性药物(处方)和当地卫生服务的影响,包括糖尿病。采用逐步(去除p值为> 0.05的因素)多因子线性回归来得出这些因素对SMR_D的影响结果:分析涵盖了所有数据可用的5792 GPP,其中超过2000名患者在实践名单上。该模型考虑了22个因素,其中17个仍然重要。如果所有做法至少达到中位数水平,每年的死亡人数可能减少多达3万人(7 %)。即使在LSOA SMR内调整后,IMD仍然具有很强的影响。癌症QOF登记率与较低的死亡率相关。较高的糖尿病病例识别率与降低的死亡率无关,而是与较高的死亡率相关。练习的大小不是一个因素。老年患者比例较高的诊所死亡率相对较低,抗高血压处方比例较高的诊所死亡率也相对较低。结论:我们在这里描述的关联表明,有潜在的主题来理解英国死亡率的驱动因素。我们的模型可以应用于当地实践,以突出那些差距最大的实践。糖尿病病例的全科诊断率与实际死亡率增加之间的关联可能与2型糖尿病与许多其他可缩短生命的疾病相关的现实有关。65岁以上人群降压药处方率高与实际死亡率低之间的关联,强调了有效识别和有效治疗该人群高血压的重要性。
{"title":"The Influence of Local Service Configuration on All-Cause Mortality: An Age- and Sex-Standardised Analysis","authors":"Mike Stedman ,&nbsp;Mark Davies ,&nbsp;Adam Robinson ,&nbsp;John Warner-Levy ,&nbsp;Martin Whyte ,&nbsp;Martin Gibson ,&nbsp;Ritwika Mallik ,&nbsp;Adrian Heald","doi":"10.1016/j.pcd.2025.06.003","DOIUrl":"10.1016/j.pcd.2025.06.003","url":null,"abstract":"<div><h3>Aims</h3><div>Public Health England mortality data shows that most deaths are associated with underlying longer-term health issues and could potentially be mitigated by more effective preventive and planned healthcare. General practitioner practices (GPPs) are the provider and gatekeeper to most NHS healthcare services and there are no direct publications of deaths at GPP level Our aim here was to determine how estimated mortality rate at GPP level may associate with the effectiveness of local services in delivering healthcare outcomes.</div></div><div><h3>Methods</h3><div>We used Office of National Statistics (ONS) data for January 2018-January 2020 (inclusive). From this an estimated Age Standardised Mortality Rate (SMR) for that Layer Super Output Areas (LSOA) was calculated. A linear link between local LSOA SMR and IMD was established so that the SMR_D could be calculated which assumes the practice was at median deprivation.</div><div>Risk Factors that were then included into the Analysis these included: demographic, medical conditions, local use of preventive Medication (prescriptions) and impact of local area health services, including diabetes. Stepwise (removing factors with p value &gt; 0.05) multifactorial linear regression was applied to derive the impact of these factors on the SMR_D</div></div><div><h3>Results</h3><div>The analysis covered 5792 GPP where all the data was available, and where more than 2000 patients were on the practice list. There were 22 factors taken into consideration for the model, of which 17 remained significant. If all practices achieved at least the median level there might be as many as 30,000 (7 %) fewer deaths/year. IMD even after adjustment within the LSOA SMR continued to have a strong effect. The association of Cancer QOF registration rates was associated with a lower mortality rate. A higher rate of diabetes case identification did not associate with reduced mortality rate, rather with higher mortality rate. Practice size was not a factor. Practices with higher percentage of older patients had relative lower mortality rates as did those with higher rates of antihypertensive prescribing.</div></div><div><h3>Conclusions</h3><div>We here describe associations that suggest that there are underlying themes to understanding the drivers to mortality in England. Our model can be applied to local practices to highlight those that have the largest gap. The association of general practice percentage identification of diabetes cases with increased practice mortality rate likely relates to the reality of type 2 diabetes being associated with many other conditions that can shorten life. The association of higher rates of prescription of antihypertensive agents in individuals over 65 years old with lower practice mortality, highlights the importance of effective identification and effective treatment of hypertension in this group.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 5","pages":"Pages 540-544"},"PeriodicalIF":2.3,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651676","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
A primary care guide to the screening and pharmacologic management of chronic kidney disease in people living with type 2 diabetes 2型糖尿病患者慢性肾脏疾病筛查和药物治疗的初级保健指南
IF 2.3 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-10 DOI: 10.1016/j.pcd.2025.05.005
Eugene E. Wright , Ana Cebrian , Daniel Ngui
This paper reports the expert opinions and recommendations made by primary care physicians (PCPs) to optimize screening and management of chronic kidney disease (CKD) associated with diabetes and presents algorithms to provide a practical and simplified guide for PCPs. Individuals living with type 2 diabetes (T2D) should be screened early and at regular intervals for CKD using both estimated glomerular filtration rate and urinary albumin-to-creatinine ratio testing. The risk of CKD assessed using the Kidney Disease: Improving Global Outcomes heatmap should be reviewed at least annually to optimize treatment to slow progression of CKD. Lifestyle modifications form the foundation of reducing CKD risk in individuals with T2D. A pillared approach to pharmacotherapy (renin–angiotensin system inhibitors, sodium-glucose cotransporter 2 inhibitors, a nonsteroidal mineralocorticoid receptor antagonist [finerenone], and glucagon-like peptide-1 receptor agonists) is recommended in individuals with CKD and T2D.
本文报道了初级保健医生(pcp)对优化糖尿病相关慢性肾脏疾病(CKD)筛查和管理的专家意见和建议,并提出了算法,为pcp提供实用和简化的指南。2型糖尿病(T2D)患者应通过肾小球滤过率和尿白蛋白与肌酐比值检测,尽早并定期筛查CKD。使用肾脏疾病评估CKD的风险:改善全球结果热图应至少每年进行一次审查,以优化治疗以减缓CKD的进展。生活方式的改变是降低T2D患者CKD风险的基础。推荐在CKD和T2D患者中使用药物治疗(肾素-血管紧张素系统抑制剂,钠-葡萄糖共转运蛋白2抑制剂,非甾体矿皮质激素受体拮抗剂[细烯酮]和胰高血糖素样肽-1受体激动剂)。
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引用次数: 0
Evaluating the mySugr diabetes app: A randomised controlled trial exploring changes in HbA1c and psychological outcomes in adults with type 1 diabetes 评估mysugar糖尿病应用程序:一项探索成人1型糖尿病患者HbA1c变化和心理结局的随机对照试验。
IF 2.3 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-08 DOI: 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。
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引用次数: 0
Managing type 1 diabetes at work – A qualitative meta-synthesis 在工作中管理1型糖尿病-定性综合。
IF 2.3 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-08 DOI: 10.1016/j.pcd.2025.06.009
Emma Victoria Shiel , Steve Hemingway , Rajeeb Kumar Sah , Kim Burton

Aims

To interpret the available qualitative research findings on people’s experiences of managing type 1 diabetes at work.

Methods

A qualitative meta-synthesis was conducted using constant comparative methods, reciprocal analysis, and a line of argument synthesis, which were expressed narratively.

Results

The study included thirteen articles, revealing a complex relationship between type 1 diabetes and work. People with type one diabetes want minimal interference in their daily routines while balancing health and work responsibilities. The concept of 'containment' emerged as a key strategy, where self-management is integrated alongside work demands. However, this approach may inadvertently lead to psychosocial conflicts and detrimental health outcomes.

Conclusions

The findings highlight the importance of creating supportive and empowering workplaces to reduce the tensions between type one diabetes and work. Enabling people with type one diabetes to self-manage effectively while maintaining autonomy requires support that both fosters self-management and avoids isolation. This sort of supportive and empowering work environment for workers with type one diabetes could contribute to facilitating [re]entry and retention in the workforce. This synthesis adds to contemporary knowledge, particularly in qualitative areas, yet further study is needed to identify specific actions that can create more accommodating workplaces for people with type one diabetes.
目的:对工作中管理1型糖尿病经验的定性研究结果进行解释。方法:采用恒比较法、互反分析和论述线综合等方法进行定性综合。结果:该研究包括13篇文章,揭示了1型糖尿病与工作之间的复杂关系。1型糖尿病患者希望在平衡健康和工作责任的同时,尽量减少对日常生活的干扰。“遏制”的概念成为一项关键战略,将自我管理与工作要求结合起来。然而,这种做法可能在不经意间导致社会心理冲突和有害的健康后果。结论:研究结果强调了创造支持性和赋权工作场所的重要性,以减少1型糖尿病患者与工作之间的紧张关系。使1型糖尿病患者在保持自主性的同时有效地进行自我管理,需要既促进自我管理又避免孤立的支持。这种为1型糖尿病患者提供支持和授权的工作环境有助于促进[重新]进入和留在劳动力市场。这种综合增加了当代知识,特别是在定性领域,但需要进一步研究确定具体行动,为1型糖尿病患者创造更便利的工作场所。
{"title":"Managing type 1 diabetes at work – A qualitative meta-synthesis","authors":"Emma Victoria Shiel ,&nbsp;Steve Hemingway ,&nbsp;Rajeeb Kumar Sah ,&nbsp;Kim Burton","doi":"10.1016/j.pcd.2025.06.009","DOIUrl":"10.1016/j.pcd.2025.06.009","url":null,"abstract":"<div><h3>Aims</h3><div>To interpret the available qualitative research findings on people’s experiences of managing type 1 diabetes at work.</div></div><div><h3>Methods</h3><div>A qualitative meta-synthesis was conducted using constant comparative methods, reciprocal analysis, and a line of argument synthesis, which were expressed narratively.</div></div><div><h3>Results</h3><div>The study included thirteen articles, revealing a complex relationship between type 1 diabetes and work. People with type one diabetes want minimal interference in their daily routines while balancing health and work responsibilities. The concept of 'containment' emerged as a key strategy, where self-management is integrated alongside work demands. However, this approach may inadvertently lead to psychosocial conflicts and detrimental health outcomes.</div></div><div><h3>Conclusions</h3><div>The findings highlight the importance of creating supportive and empowering workplaces to reduce the tensions between type one diabetes and work. Enabling people with type one diabetes to self-manage effectively while maintaining autonomy requires support that both fosters self-management and avoids isolation. This sort of supportive and empowering work environment for workers with type one diabetes could contribute to facilitating [re]entry and retention in the workforce. This synthesis adds to contemporary knowledge, particularly in qualitative areas, yet further study is needed to identify specific actions that can create more accommodating workplaces for people with type one diabetes.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 5","pages":"Pages 426-433"},"PeriodicalIF":2.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593292","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
Performance of the finnish diabetes risk score in screening for undiagnosed type 2 diabetes among adults without prior diagnosis: A Kharameh Cohort Study, Iran 芬兰糖尿病风险评分在未确诊的成人2型糖尿病筛查中的表现:伊朗Kharameh队列研究
IF 2.3 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-08 DOI: 10.1016/j.pcd.2025.07.001
Andishe Hamedi , Mozhgan Seif , Mohammad Hossein Sharifi , Abbas Rezaianzadeh , Jafar Hassanzadeh

Aims

To evaluate the effectiveness of the Finnish Diabetes Risk Score (FINDRISC) as a potentially valuable tool for diabetes screening and prevention.

Methods

This study utilized data from the Kharameh Cohort Study, which included 10,663 participants. Of these, 1600 individuals with known diabetes were excluded. Participants were assessed using the FINDRISC questionnaire and a fasting blood glucose test to determine their glucose metabolism status. Receiver Operating Characteristic curves evaluated the effectiveness of FINDRISC in identifying Undiagnosed Diabetes Mellitus (UDM).

Results

The prevalence of individuals with UDM was 2.2 %. The FINDRISC score was 14.18 ± 4.46 for those with UDM, compared to 9.51 ± 4.69 for those without. Women had a mean FINDRISC score of 10.99 ± 4.42, significantly higher than the mean score of 8.07 ± 4.60 for men. The overall AUC-ROC curve for diagnosing UDM was 0.767 (95 % CI: 0.735–0.800). For men, it was 0.809 (95 % CI: 0.764–0.853), while for women, it was 0.737 (95 % CI: 0.689–0.785).

Conclusions

The FINDRISC score demonstrates good accuracy in identifying individuals with UDM, making it a valuable and simple screening tool, especially in resource-limited settings. Significant gender differences were observed in the risk scores between women and men. Therefore, we recommend that screening tools be adapted to account for these gender differences, with particular attention to individuals with a family history of diabetes to improve early detection and prevention strategies.
目的:评估芬兰糖尿病风险评分(FINDRISC)作为糖尿病筛查和预防的潜在有价值工具的有效性。方法:本研究利用了Kharameh队列研究的数据,其中包括10,663名参与者。其中,1600名已知糖尿病患者被排除在外。使用FINDRISC问卷和空腹血糖测试对参与者进行评估,以确定他们的葡萄糖代谢状态。受试者工作特征曲线评估FINDRISC识别未确诊糖尿病(UDM)的有效性。结果:UDM个体患病率为2.2% %。UDM患者的FINDRISC评分为14.18 ± 4.46,而非UDM患者的FINDRISC评分为9.51 ± 4.69。女性的FINDRISC平均得分为10.99 ± 4.42,显著高于男性的平均得分8.07 ± 4.60。诊断UDM的总体AUC-ROC曲线为0.767(95 % CI: 0.735-0.800)。对于男性,它是0.809(95 % CI: 0.764-0.853),而对于女性,它是0.737(95 % CI: 0.689-0.785)。结论:FINDRISC评分在识别UDM个体方面具有良好的准确性,使其成为一种有价值且简单的筛查工具,特别是在资源有限的情况下。在风险评分上,男女之间存在显著的性别差异。因此,我们建议调整筛查工具以考虑这些性别差异,特别注意有糖尿病家族史的个体,以改善早期发现和预防策略。
{"title":"Performance of the finnish diabetes risk score in screening for undiagnosed type 2 diabetes among adults without prior diagnosis: A Kharameh Cohort Study, Iran","authors":"Andishe Hamedi ,&nbsp;Mozhgan Seif ,&nbsp;Mohammad Hossein Sharifi ,&nbsp;Abbas Rezaianzadeh ,&nbsp;Jafar Hassanzadeh","doi":"10.1016/j.pcd.2025.07.001","DOIUrl":"10.1016/j.pcd.2025.07.001","url":null,"abstract":"<div><h3>Aims</h3><div>To evaluate the effectiveness of the Finnish Diabetes Risk Score (FINDRISC) as a potentially valuable tool for diabetes screening and prevention.</div></div><div><h3>Methods</h3><div><span>This study utilized data from the Kharameh Cohort Study, which included 10,663 participants. Of these, 1600 individuals with known diabetes were excluded. Participants were assessed using the FINDRISC questionnaire and a fasting blood </span>glucose test<span> to determine their glucose metabolism status. Receiver Operating Characteristic curves evaluated the effectiveness of FINDRISC in identifying Undiagnosed Diabetes Mellitus (UDM).</span></div></div><div><h3>Results</h3><div>The prevalence of individuals with UDM was 2.2 %. The FINDRISC score was 14.18 ± 4.46 for those with UDM, compared to 9.51 ± 4.69 for those without. Women had a mean FINDRISC score of 10.99 ± 4.42, significantly higher than the mean score of 8.07 ± 4.60 for men. The overall AUC-ROC curve for diagnosing UDM was 0.767 (95 % CI: 0.735–0.800). For men, it was 0.809 (95 % CI: 0.764–0.853), while for women, it was 0.737 (95 % CI: 0.689–0.785).</div></div><div><h3>Conclusions</h3><div>The FINDRISC score demonstrates good accuracy in identifying individuals with UDM, making it a valuable and simple screening tool, especially in resource-limited settings. Significant gender differences were observed in the risk scores between women and men. Therefore, we recommend that screening tools be adapted to account for these gender differences, with particular attention to individuals with a family history of diabetes to improve early detection and prevention strategies.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 5","pages":"Pages 517-521"},"PeriodicalIF":2.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602701","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
Clinical characteristics and mortality in novel subgroups of adult-onset diabetes in an Australian population-based cohort of men 在澳大利亚以人群为基础的男性队列中,成人发病糖尿病新亚组的临床特征和死亡率。
IF 2.3 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-04 DOI: 10.1016/j.pcd.2025.06.007
Jacob W. Harland , Zoe Shih-Jung Liu , Kimberly Cukier , Spiros Fourlanos , Courtney Swinton , Briana Spolding , Mark A. Kotowicz , Julie A. Pasco , Kara L. Holloway-Kew

Aims

To determine the prevalence of the novel diabetes subgroups in a population-based study, and investigate clinical characteristics and mortality in these subgroups compared to participants without diabetes.

Methods

Men from the Geelong Osteoporosis study (n = 895) were categorised according to diabetes status. Men with diabetes (n = 105) were categorised into the severe auto-immune diabetes (SAID) subgroup based on islet antibody seropositivity. The remaining men were then classified into the other subgroups using k-means clustering. ANOVA and chi-squared tests were used to determine differences in demographics, lifestyle factors and comorbidities between the novel diabetes subgroups and normoglycaemia (n = 790). Cox proportional hazard models were used to compare mortality over a median of 11.8 years (IQR 9.7–11.3). A p-value< 0.05 was considered significant, models were adjusted for age, physical activity, and systolic blood pressure.

Results

Compared to men with normoglycaemia, mean blood pressure and cardiovascular comorbidities were higher in the mild obesity-related diabetes (MOD), mild age-related diabetes (MARD), and severe insulin-resistant diabetes (SIRD) subgroups. The MARD subgroup was associated with higher mortality in unadjusted models (HR 5.5, 95 %CI 3.6–8.4); although this was attenuated after adjustment. In unadjusted models, mortality was not different in the SIRD subgroup, however, after adjustment this subgroup had higher mortality (HR 2.0; 95 %CI 1.0–3.9).

Conclusions

These data may influence choice of antihyperglycaemic medication and management of cardiovascular risk factors in men with type 2 diabetes particularly in the SIRD subgroup which is associated with cardiovascular-related comorbidities, and mortality.
目的:在一项基于人群的研究中确定新型糖尿病亚组的患病率,并与无糖尿病的参与者相比,调查这些亚组的临床特征和死亡率。方法:来自Geelong骨质疏松研究的男性(n = 895)根据糖尿病状况进行分类。根据胰岛抗体血清阳性将男性糖尿病患者(n = 105)分为严重自身免疫性糖尿病(SAID)亚组。然后使用k-means聚类将其余男性分类到其他亚组。采用方差分析和卡方检验来确定新的糖尿病亚组和正常血糖之间的人口统计学、生活方式因素和合并症的差异(n = 790)。采用Cox比例风险模型比较中位11.8年的死亡率(IQR为9.7-11.3)。p值结果:与血糖正常的男性相比,轻度肥胖相关糖尿病(MOD)、轻度年龄相关糖尿病(MARD)和严重胰岛素抵抗型糖尿病(SIRD)亚组的平均血压和心血管合并症更高。在未调整的模型中,MARD亚组与较高的死亡率相关(HR 5.5, 95 %CI 3.6-8.4);虽然调整后减弱。在未调整的模型中,SIRD亚组的死亡率没有差异,然而,调整后该亚组的死亡率更高(HR 2.0;95 %可信区间1.0 - -3.9)。结论:这些数据可能会影响2型糖尿病男性患者抗高血糖药物的选择和心血管危险因素的管理,特别是与心血管相关合并症和死亡率相关的SIRD亚组。
{"title":"Clinical characteristics and mortality in novel subgroups of adult-onset diabetes in an Australian population-based cohort of men","authors":"Jacob W. Harland ,&nbsp;Zoe Shih-Jung Liu ,&nbsp;Kimberly Cukier ,&nbsp;Spiros Fourlanos ,&nbsp;Courtney Swinton ,&nbsp;Briana Spolding ,&nbsp;Mark A. Kotowicz ,&nbsp;Julie A. Pasco ,&nbsp;Kara L. Holloway-Kew","doi":"10.1016/j.pcd.2025.06.007","DOIUrl":"10.1016/j.pcd.2025.06.007","url":null,"abstract":"<div><h3>Aims</h3><div>To determine the prevalence of the novel diabetes subgroups in a population-based study, and investigate clinical characteristics and mortality in these subgroups compared to participants without diabetes.</div></div><div><h3>Methods</h3><div>Men from the Geelong Osteoporosis study (n = 895) were categorised according to diabetes status. Men with diabetes (n = 105) were categorised into the severe auto-immune diabetes (SAID) subgroup based on islet antibody seropositivity. The remaining men were then classified into the other subgroups using k-means clustering. ANOVA and chi-squared tests were used to determine differences in demographics, lifestyle factors and comorbidities between the novel diabetes subgroups and normoglycaemia (n = 790). Cox proportional hazard models were used to compare mortality over a median of 11.8 years (IQR 9.7–11.3). A p-value&lt; 0.05 was considered significant, models were adjusted for age, physical activity, and systolic blood pressure.</div></div><div><h3>Results</h3><div>Compared to men with normoglycaemia, mean blood pressure and cardiovascular comorbidities were higher in the mild obesity-related diabetes (MOD), mild age-related diabetes (MARD), and severe insulin-resistant diabetes (SIRD) subgroups. The MARD subgroup was associated with higher mortality in unadjusted models (HR 5.5, 95 %CI 3.6–8.4); although this was attenuated after adjustment. In unadjusted models, mortality was not different in the SIRD subgroup, however, after adjustment this subgroup had higher mortality (HR 2.0; 95 %CI 1.0–3.9).</div></div><div><h3>Conclusions</h3><div>These data may influence choice of antihyperglycaemic medication and management of cardiovascular risk factors in men with type 2 diabetes particularly in the SIRD subgroup which is associated with cardiovascular-related comorbidities, and mortality.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 5","pages":"Pages 545-551"},"PeriodicalIF":2.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568290","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
期刊
Primary Care Diabetes
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