Primary Care Diabetes最新文献_第7页

The promise of tirzepatide: A narrative review of metabolic benefits 替西肽的前景：代谢益处的叙述性回顾

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-04-11 DOI: 10.1016/j.pcd.2025.03.008

Sara Sokary, Hiba Bawadi

Obesity and type 2 diabetes mellites (T2DM) are intertwined epidemics that continue to pose significant challenges to global public health. We aim to review the available evidence on the metabolic effects of tirzepatide, focusing on weight loss and maintenance of lost weight, body composition alterations, appetite regulation, glycemic control, and lipid profile modulation. Tirzepatide administration for 72 weeks elicited significant weight reduction ranging from 5 % to 20.9 % across different trials in a dose-dependent manner. Furthermore, limited evidence showed that lost body weight may be primarily due to fat mass reduction. Tirzepatide also significantly decreased food intake, reduced overall appetite scores and increased fasting visual analog scale scores for satiety and fullness across different clinical trials. Moreover, tirzepatide exhibited favorable effects on glycemic control, with notable reductions in HbA1c levels ranging from 20.4 mmol/mol with the 5 mg dose to 28.2 mmol/mol with the 15 mg dose, following treatment durations lasting 40–52 weeks. Additionally, tirzepatide exerts a beneficial impact on lipid profile parameters, including reductions in total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels, while increasing high-density lipoprotein cholesterol concentrations. Despite its efficacy, tirzepatide is associated with gastrointestinal adverse effects, which requires dose escalation strategies to enhance tolerability. Mild to moderate adverse events are commonly reported at higher doses, with discontinuation rates ranging from 4 % to 10 % across different dosages. In conclusion, tirzepatide has shown multifaceted metabolic effects, along with manageable adverse profiles, which makes it a promising therapeutic agent for addressing both obesity and T2DM. However, further long-term randomized controlled trials are warranted to reveal long-term efficacy and safety outcomes, particularly in diverse patient populations.

肥胖和2型糖尿病（T2DM）是相互交织的流行病，继续对全球公共卫生构成重大挑战。我们的目的是回顾有关替西肽代谢作用的现有证据，重点是减肥和维持减肥，身体成分改变，食欲调节，血糖控制和血脂调节。在不同的试验中，替西帕肽给药72周可显著减轻体重，减轻幅度为5 %至20.9 %，呈剂量依赖性。此外，有限的证据表明，体重减轻可能主要是由于脂肪量减少。在不同的临床试验中，替西帕肽还显著减少食物摄入量，降低总体食欲评分，并增加空腹视觉模拟量表的饱腹感和饱腹感评分。此外，替西帕肽在血糖控制方面表现出良好的效果，在治疗持续40-52周后，HbA1c水平显著降低，从5 mg剂量的20.4 mmol/mol到15 mg剂量的28.2 mmol/mol。此外，替西帕肽对血脂参数有有益影响，包括降低总胆固醇、低密度脂蛋白胆固醇和甘油三酯水平，同时增加高密度脂蛋白胆固醇浓度。尽管疗效良好，但替西帕肽与胃肠道不良反应有关，这需要剂量递增策略来增强耐受性。轻度至中度不良事件通常在较高剂量下报告，不同剂量的停药率从4 %到10 %不等。总之，替西肽显示出多方面的代谢作用，以及可控的不良反应，这使其成为治疗肥胖和2型糖尿病的有希望的药物。然而，需要进一步的长期随机对照试验来揭示长期疗效和安全性结果，特别是在不同的患者群体中。

{"title":"The promise of tirzepatide: A narrative review of metabolic benefits","authors":"Sara Sokary, Hiba Bawadi","doi":"10.1016/j.pcd.2025.03.008","DOIUrl":"10.1016/j.pcd.2025.03.008","url":null,"abstract":"<div><div>Obesity and type 2 diabetes mellites (T2DM) are intertwined epidemics that continue to pose significant challenges to global public health. We aim to review the available evidence on the metabolic effects of tirzepatide, focusing on weight loss and maintenance of lost weight, body composition alterations, appetite regulation, glycemic control, and lipid profile modulation. Tirzepatide administration for 72 weeks elicited significant weight reduction ranging from 5 % to 20.9 % across different trials in a dose-dependent manner. Furthermore, limited evidence showed that lost body weight may be primarily due to fat mass reduction. Tirzepatide also significantly decreased food intake, reduced overall appetite scores and increased fasting visual analog scale scores for satiety and fullness across different clinical trials. Moreover, tirzepatide exhibited favorable effects on glycemic control, with notable reductions in HbA1c levels ranging from 20.4 mmol/mol with the 5 mg dose to 28.2 mmol/mol with the 15 mg dose, following treatment durations lasting 40–52 weeks. Additionally, tirzepatide exerts a beneficial impact on lipid profile parameters, including reductions in total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels, while increasing high-density lipoprotein cholesterol concentrations. Despite its efficacy, tirzepatide is associated with gastrointestinal adverse effects, which requires dose escalation strategies to enhance tolerability. Mild to moderate adverse events are commonly reported at higher doses, with discontinuation rates ranging from 4 % to 10 % across different dosages. In conclusion, tirzepatide has shown multifaceted metabolic effects, along with manageable adverse profiles, which makes it a promising therapeutic agent for addressing both obesity and T2DM. However, further long-term randomized controlled trials are warranted to reveal long-term efficacy and safety outcomes, particularly in diverse patient populations.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 229-237"},"PeriodicalIF":2.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143921560","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

The psychosis and type 2 diabetes service model (PODS) population profile study 精神病和 2 型糖尿病服务模式 (PODS) 人口概况研究。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-04-05 DOI: 10.1016/j.pcd.2025.03.007

Kirsty Winkley , Isabel Graham , Yvonne Tylor , Mark Chamley , Caroline Rook , Alan Simpson , Khalida Ismail

Objective

To describe diabetes care received and views of people with severe mental illness (SMI) and type 2 diabetes (T2D) in an inner-city primary care setting.

Design

A cross-sectional study of adults with SMI and T2D from two primary care localities in south London.

Methods

Medical record data was extracted on annual diabetes review and participants invited for telephone interview.

Results

125 adults participated, 37 completed interviews. 43 % were female, 48 %, 35 % and 16 % were: Black African/Caribbean, White, Asian/other ethnicity. Mean age= 59.47 years (SD:12.68), diabetes duration= 8.62 years (SD:6.10), systolic blood pressure (BP)= 133.42 mmHg (SD:17.28), diastolic BP= 81.42 mmHg (SD:8.93), BMI= 33.17 m/kg² (SD:7.22), HbA1c= 61.64 mmol/mol (SD:25.18). Older age (OR:1.06, 95 % C.I.:1.0, 1.10), shorter diabetes duration (OR:0.90, 95 % C.I.:0.84, 0.97) were associated with target HbA1c< /= 58 mM. Younger age and Black ethnicity were associated with BP> 140 mmHg (OR:0.94, 95 % C.I.:0.90, 0.98; OR:0.08 (95 % C.I.:0.01, 0.56). Being older was associated with cholesterol, < 5.0 mmol/mol (OR:1.06, 95 % C.I.:1.01, 1.11). Questionnaires demonstrated low physical activity, alcohol/drug use, diabetes distress, psychiatric symptoms. Interviews indicated that > 50 % wanted more support with SMI and T2D.

Conclusions

Younger, black people with SMI and T2D are potentially at greater cardiometabolic risk. Interviews suggest people with T2D and SMI group require more mental health and diabetes support.

目的：描述在市中心初级保健机构中患有严重精神疾病（SMI）和2型糖尿病（T2D）的人接受的糖尿病护理和看法。设计：对伦敦南部两个初级保健地区患有重度精神障碍和T2D的成年人进行横断面研究。方法：抽取年度糖尿病回顾病历资料，并邀请参与者进行电话访谈。结果：125名成年人参与，37人完成访谈。43 %为女性，48 %，35 %和16 %为：非洲/加勒比黑人，白人，亚洲/其他种族。= 平均年龄59.47岁(SD: 12.68),糖尿病持续时间= 8.62年(SD: 6.10)、血压(BP) = 133.42  毫米汞柱(SD: 17.28),舒张压= 81.42 毫米汞柱(SD: 8.93),体重指数= 33.17  m / kg2 (SD: 7.22)、糖化血红蛋白= 61.64 更易与摩尔(SD: 25.18)。年龄较大（OR:1.06, 95 % ci:1.0, 1.10）、糖尿病病程较短（OR:0.90, 95 % ci:0.84, 0.97）与目标HbA1c 140 mmHg相关(OR:0.94, 95 % ci:0.90, 0.98；Or:0.08（95 % c.i.:0.01, 0.56）。年龄越大胆固醇越高， 50% %的人需要更多的SMI和T2D支持。结论：患有重度精神分裂症和T2D的年轻黑人可能有更大的心脏代谢风险。访谈显示，重度糖尿病和重度糖尿病患者需要更多的心理健康和糖尿病支持。

{"title":"The psychosis and type 2 diabetes service model (PODS) population profile study","authors":"Kirsty Winkley , Isabel Graham , Yvonne Tylor , Mark Chamley , Caroline Rook , Alan Simpson , Khalida Ismail","doi":"10.1016/j.pcd.2025.03.007","DOIUrl":"10.1016/j.pcd.2025.03.007","url":null,"abstract":"<div><h3>Objective</h3><div>To describe diabetes care received and views of people with severe mental illness (SMI) and type 2 diabetes (T2D) in an inner-city primary care setting.</div></div><div><h3>Design</h3><div>A cross-sectional study of adults with SMI and T2D from two primary care localities in south London.</div></div><div><h3>Methods</h3><div>Medical record data was extracted on annual diabetes review and participants invited for telephone interview.</div></div><div><h3>Results</h3><div>125 adults participated, 37 completed interviews. 43 % were female, 48 %, 35 % and 16 % were: Black African/Caribbean, White, Asian/other ethnicity. Mean age= 59.47 years (SD:12.68), diabetes duration= 8.62 years (SD:6.10), systolic blood pressure (BP)= 133.42 mmHg (SD:17.28), diastolic BP= 81.42 mmHg (SD:8.93), BMI= 33.17 m/kg<sup>2</sup> (SD:7.22), HbA1c= 61.64 mmol/mol (SD:25.18). Older age (OR:1.06, 95 % C.I.:1.0, 1.10), shorter diabetes duration (OR:0.90, 95 % C.I.:0.84, 0.97) were associated with target HbA1c< /= 58 mM. Younger age and Black ethnicity were associated with BP> 140 mmHg (OR:0.94, 95 % C.I.:0.90, 0.98; OR:0.08 (95 % C.I.:0.01, 0.56). Being older was associated with cholesterol, < 5.0 mmol/mol (OR:1.06, 95 % C.I.:1.01, 1.11). Questionnaires demonstrated low physical activity, alcohol/drug use, diabetes distress, psychiatric symptoms. Interviews indicated that > 50 % wanted more support with SMI and T2D.</div></div><div><h3>Conclusions</h3><div>Younger, black people with SMI and T2D are potentially at greater cardiometabolic risk. Interviews suggest people with T2D and SMI group require more mental health and diabetes support.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 329-333"},"PeriodicalIF":2.6,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797555","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

Effectiveness of a community intervention program on healthy lifestyles (PREDICOL) among adults with prediabetes in two Latin American cities: A quasi-experimental study 拉丁美洲两个城市成人糖尿病前期健康生活方式社区干预项目（PREDICOL）的有效性：一项准实验研究

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-03-29 DOI: 10.1016/j.pcd.2025.03.010

Yenifer Diaz Montes , Luis A. Anillo Arrieta , Juan Jose Espitia De La Hoz , Tania Acosta-Vergara , Jorge Acosta-Reyes , Karen C. Flórez Lozano , Rafael Tuesca Molina , Pablo Aschner , Sandra Rodríguez Acosta , Noël C. Barengo

Purpose

This study aimed to measure the impact of a community-based lifestyle modification intervention program on the Health-Related Quality of Life (HRQoL) of adults with prediabetes in two Latin American cities.

Methods

A quasi-experimental study was conducted with participants aged 30 and above in two Colombian cities between 2018 and 2022. The glycemic status of study participants was determined through the administration of an oral glucose tolerance test. Individuals exhibiting impaired glucose tolerance (IGT) were selected for inclusion in the intervention program. Of the 146 individuals identified with IGT, 91 completed the one-year intervention protocol. HRQoL was assessed utilizing the EQ-5D-3L questionnaire, both before and after the intervention. Logistic regression models were used to calculate the odds ratios (OR) and 95 % confidence intervals (CI), while classification models based on machine learning algorithms were utilized to identify factors associated with favorable changes in health-related quality of life (HRQoL).

Results

In Bogotá D.C., a significant improvement in HRQoL was documented (pre-intervention: 0.69 ± 0.17; post-intervention: 0.76 ± 0.16), attaining the threshold for clinically meaningful change (0.06). No changes in HRQoL were observed in the study participants. Logistic regression analysis revealed that the improvement in HRQoL was statistically significantly associated with sex (OR 8.75; 95 % CI 1.91–40.03), age (OR 11.61; 95 % CI 1.44–93.44), place of residence (OR 29.31; 95 % CI 5.26–163.54), and weight loss (OR 5.56; 95 % CI 1.15–26.76). According to the XGBoost model, return to normal glycemic status emerged as the most important variable for improvements in HRQoL.

Conclusion

Gender, age, place of residence, weight loss, and return to normoglycemic status were identified as significant predictors in lifestyle modification to improve HRQoL among participants at high risk of developing type 2 diabetes.

目的：本研究旨在衡量一项基于社区的生活方式调整干预计划对拉丁美洲两个城市的糖尿病前期成人健康相关生活质量（HRQoL）的影响：2018年至2022年期间，在哥伦比亚的两个城市对30岁及以上的参与者进行了一项准实验研究。研究参与者的血糖状况通过口服葡萄糖耐量测试来确定。筛选出糖耐量受损（IGT）的个体纳入干预计划。在确定的 146 名 IGT 患者中，有 91 人完成了为期一年的干预方案。利用 EQ-5D-3L 问卷对干预前后的 HRQoL 进行了评估。采用逻辑回归模型计算几率比（OR）和 95 % 的置信区间（CI），同时利用基于机器学习算法的分类模型确定与健康相关生活质量（HRQoL）的有利变化相关的因素：在哥伦比亚特区波哥大，HRQoL 有了显著改善（干预前：0.69 ± 0.17；干预后：0.76 ± 0.16），达到了有临床意义变化的临界值（0.06）。研究参与者的 HRQoL 没有发生变化。逻辑回归分析显示，HRQoL 的改善与性别（OR 8.75; 95 % CI 1.91-40.03）、年龄（OR 11.61; 95 % CI 1.44-93.44）、居住地（OR 29.31; 95 % CI 5.26-163.54）和体重减轻（OR 5.56; 95 % CI 1.15-26.76）有显著的统计学相关性。根据 XGBoost 模型，恢复正常血糖状态是改善 HRQoL 的最重要变量：结论：性别、年龄、居住地、体重减轻和血糖恢复正常被认为是改变生活方式以改善2型糖尿病高危人群HRQoL的重要预测因素。

{"title":"Effectiveness of a community intervention program on healthy lifestyles (PREDICOL) among adults with prediabetes in two Latin American cities: A quasi-experimental study","authors":"Yenifer Diaz Montes , Luis A. Anillo Arrieta , Juan Jose Espitia De La Hoz , Tania Acosta-Vergara , Jorge Acosta-Reyes , Karen C. Flórez Lozano , Rafael Tuesca Molina , Pablo Aschner , Sandra Rodríguez Acosta , Noël C. Barengo","doi":"10.1016/j.pcd.2025.03.010","DOIUrl":"10.1016/j.pcd.2025.03.010","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to measure the impact of a community-based lifestyle modification intervention program on the Health-Related Quality of Life (HRQoL) of adults with prediabetes in two Latin American cities.</div></div><div><h3>Methods</h3><div>A quasi-experimental study was conducted with participants aged 30 and above in two Colombian cities between 2018 and 2022. The glycemic status of study participants was determined through the administration of an oral glucose tolerance test. Individuals exhibiting impaired glucose tolerance (IGT) were selected for inclusion in the intervention program. Of the 146 individuals identified with IGT, 91 completed the one-year intervention protocol. HRQoL was assessed utilizing the EQ-5D-3L questionnaire, both before and after the intervention. Logistic regression models were used to calculate the odds ratios (OR) and 95 % confidence intervals (CI), while classification models based on machine learning algorithms were utilized to identify factors associated with favorable changes in health-related quality of life (HRQoL).</div></div><div><h3>Results</h3><div>In Bogotá D.C., a significant improvement in HRQoL was documented (pre-intervention: 0.69 ± 0.17; post-intervention: 0.76 ± 0.16), attaining the threshold for clinically meaningful change (0.06<strong>).</strong> No changes in HRQoL were observed in the study participants. Logistic regression analysis revealed that the improvement in HRQoL was statistically significantly associated with sex (OR 8.75; 95 % CI 1.91–40.03), age (OR 11.61; 95 % CI 1.44–93.44), place of residence (OR 29.31; 95 % CI 5.26–163.54), and weight loss (OR 5.56; 95 % CI 1.15–26.76). According to the XGBoost model, return to normal glycemic status emerged as the most important variable for improvements in HRQoL.</div></div><div><h3>Conclusion</h3><div>Gender, age, place of residence, weight loss, and return to normoglycemic status were identified as significant predictors in lifestyle modification to improve HRQoL among participants at high risk of developing type 2 diabetes.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 277-287"},"PeriodicalIF":2.6,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756974","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

Enhancing the follow-up for patients with type 2 diabetes mellitus using a proactive scheduling computer tool: A paired cohort study in primary care 利用主动排班计算机工具加强对 2 型糖尿病患者的随访：基层医疗机构的配对队列研究。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-03-28 DOI: 10.1016/j.pcd.2025.03.009

Carolina Guiriguet , Mercè Bustos , Roser Cantenys , Eduardo Hermosilla , Joan Camús , Manuel Medina , Carina Aguilar Martín , Alessandra Queiroga Gonçalves , Ester Gavaldà-Espelta , Francesc Xavier Cos , Núria Nadal , Mireia Fàbregas , Francesc Fina , Leonardo Méndez-Boo , Elisabet Balló , Margarita Garcia Canela , Magdalena Lladó , Ariadna Mas , Ermengol Coma , Sara Rodoreda

Aim

To assess the impact of an electronic scheduling tool (Planificat) on the management of type 2 diabetes mellitus (T2DM) in primary care settings.

Methods

This paired cohort study used data from the Catalan primary care electronic health records. The intervention cohort, using Planificat, included all patients aged 15 years or older with T2DM and was matched 1:1 with a control cohort. The study period lasted one year. Mixed general linear models estimated Odds Ratios (OR) and 95 % confidence intervals (95 %CI) for primary outcomes, including T2DM clinical tests (LDL cholesterol, HbA1c), visit frequency, and non-attendance rates.

Results

A total of 51,619 patients (mean age 68.3 years, 42.1 % of female sex) and their paired controls were included. In the primary analysis, significant increases were observed in the Planificat group (N = 18,542) regarding several measures: cholesterol tests performed (83.5 % vs. 75.4 %; OR: 1.65 [95 %CI: 1.57–1.74]), HbA1c tests performed (83.7 % vs. 75.4 %; OR: 1.7 [95 %CI: 1.61–1.79]), and electrocardiograms (65 % vs. 52 %; OR: 1.72 [95 %CI: 1.65–1.8]). Additionally, there was a 36 % increase in patients achieving HbA1c levels < 8 % (OR: 1.36 [95 %CI: 1.3–1.42]). Statistically significant improvements of 30 % and 40 % were also observed in foot and retinopathy screenings, respectively. Face-to-face visits with general practitioners and non-attendance rates remained comparable between cohorts, while face-to-face nurse visits increased by 7 %.

Conclusions

Planificat significantly improved T2DM management indicators, promoting proactive scheduling and enhancing follow-up in primary care without impacting face-to-face visits. These findings support its integration as a complementary strategy for optimizing chronic disease management.

目的：评估电子排班工具（Planificat）对初级保健机构2型糖尿病（T2DM）管理的影响。方法：这项配对队列研究使用了来自加泰罗尼亚初级保健电子健康记录的数据。使用Planificat的干预队列包括所有年龄在15岁或以上的T2DM患者，并与对照队列进行1:1匹配。研究期为一年。混合一般线性模型估计了主要结局的优势比（OR）和95% %置信区间（95% %CI），包括T2DM临床试验（LDL胆固醇、HbA1c）、就诊频率和不出勤率。结果：共纳入51,619例患者（平均年龄68.3岁，女性占42.1 %）及其配对对照。在初步分析中，Planificat组（N = 18542）在几项测量中观察到显著增加：进行胆固醇测试(83.5% %对75.4 %；OR: 1.65[95 %CI: 1.57-1.74])，进行HbA1c检测(83.7 % vs. 75.4 %；OR: 1.7[95 %CI: 1.61-1.79])和心电图(65 % vs. 52 %；Or: 1.72[95 % ci: 1.65-1.8])。此外，达到HbA1c水平的患者增加了36% %。结论：Planificat显著改善了T2DM管理指标，促进了主动安排和加强了初级保健的随访，而不影响面对面就诊。这些发现支持将其整合为优化慢性疾病管理的补充策略。

{"title":"Enhancing the follow-up for patients with type 2 diabetes mellitus using a proactive scheduling computer tool: A paired cohort study in primary care","authors":"Carolina Guiriguet , Mercè Bustos , Roser Cantenys , Eduardo Hermosilla , Joan Camús , Manuel Medina , Carina Aguilar Martín , Alessandra Queiroga Gonçalves , Ester Gavaldà-Espelta , Francesc Xavier Cos , Núria Nadal , Mireia Fàbregas , Francesc Fina , Leonardo Méndez-Boo , Elisabet Balló , Margarita Garcia Canela , Magdalena Lladó , Ariadna Mas , Ermengol Coma , Sara Rodoreda","doi":"10.1016/j.pcd.2025.03.009","DOIUrl":"10.1016/j.pcd.2025.03.009","url":null,"abstract":"<div><h3>Aim</h3><div>To assess the impact of an electronic scheduling tool (Planificat) on the management of type 2 diabetes mellitus (T2DM) in primary care settings.</div></div><div><h3>Methods</h3><div>This paired cohort study used data from the Catalan primary care electronic health records. The intervention cohort, using Planificat, included all patients aged 15 years or older with T2DM and was matched 1:1 with a control cohort. The study period lasted one year. Mixed general linear models estimated Odds Ratios (OR) and 95 % confidence intervals (95 %CI) for primary outcomes, including T2DM clinical tests (LDL cholesterol, HbA1c), visit frequency, and non-attendance rates.</div></div><div><h3>Results</h3><div>A total of 51,619 patients (mean age 68.3 years, 42.1 % of female sex) and their paired controls were included. In the primary analysis, significant increases were observed in the Planificat group (N = 18,542) regarding several measures: cholesterol tests performed (83.5 % vs. 75.4 %; OR: 1.65 [95 %CI: 1.57–1.74]), HbA1c tests performed (83.7 % vs. 75.4 %; OR: 1.7 [95 %CI: 1.61–1.79]), and electrocardiograms (65 % vs. 52 %; OR: 1.72 [95 %CI: 1.65–1.8]). Additionally, there was a 36 % increase in patients achieving HbA1c levels < 8 % (OR: 1.36 [95 %CI: 1.3–1.42]). Statistically significant improvements of 30 % and 40 % were also observed in foot and retinopathy screenings, respectively. Face-to-face visits with general practitioners and non-attendance rates remained comparable between cohorts, while face-to-face nurse visits increased by 7 %.</div></div><div><h3>Conclusions</h3><div>Planificat significantly improved T2DM management indicators, promoting proactive scheduling and enhancing follow-up in primary care without impacting face-to-face visits. These findings support its integration as a complementary strategy for optimizing chronic disease management.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 334-340"},"PeriodicalIF":2.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744540","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

Barriers to glucagon use in patients with type 1 diabetes 1 型糖尿病患者使用胰高血糖素的障碍。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-03-22 DOI: 10.1016/j.pcd.2025.03.004

Emma Mason, Kagan E. Karakus, Halis K. Akturk

Glucagon use has been shown to be low in severe hypoglycemia events among adults with type 1 diabetes. In this study, we aimed to explore the barriers to using glucagon. We surveyed 576 adults with type 1 diabetes and demonstrated the barriers in using glucagon and speculated possible solutions.

在 1 型糖尿病成人严重低血糖事件中，胰高血糖素的使用率较低。本研究旨在探讨使用胰高血糖素的障碍。我们对 576 名 1 型糖尿病成人患者进行了调查，展示了使用胰高血糖素的障碍，并推测了可能的解决方案。

引用次数: 0

Social isolation, loneliness, and incidence of type 2 diabetes mellitus: A systematic review and meta-analysis 社会隔离、孤独与 2 型糖尿病的发病率：系统回顾和荟萃分析。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-03-20 DOI: 10.1016/j.pcd.2025.03.006

Maheen Asif , Aliza Asif , Ummi Aiman Rahman , Hafsa Ajmal , Uzair Jafar , Oshaz Fatima

Objective

Social isolation and loneliness are forms of social disconnection that have been linked to increased risk of many metabolic disorders, including Type 2 Diabetes Mellitus (T2DM). However, evidence to support this relation is lacking. This study aims to investigate the association between social isolation, loneliness, and the incidence risk of T2DM.

Methods

We searched various electronic databases including MEDLINE (via PubMed), Embase, the Cochrane Library, and Google scholar to retrieve qualitative studies comparing the incidence of T2DM in patients with social isolation or loneliness. We performed statistical analysis on RevMan 5.4 using the random effect model.

Results

Loneliness was associated with a significantly increased incidence of T2DM (OR: 1.44; 95 % CI: 1.19–1.73; P:0.0001), with high heterogeneity (I² = 95 %). Sensitivity analysis indicated potential variability due to differences in loneliness measurements. Social isolation also showed a significant association with T2DM (OR: 1.88; 95 % CI: 1.38–2.58; P:<0.0001) with high heterogeneity (I² = 98 %).

Conclusion

In conclusion, we found social isolation and loneliness are independently associated with a higher incidence of T2DM. These findings underscore the need to address psychosocial elements like social isolation and loneliness in the management of T2DM. However, further studies with larger sample sizes, longer follow-up durations, and uniform criteria is warranted to better understand the association between social isolation, loneliness and T2DM.

目的：社会隔离和孤独是社会脱节的形式，与许多代谢紊乱的风险增加有关，包括2型糖尿病（T2DM）。然而，缺乏支持这种关系的证据。本研究旨在探讨社会隔离、孤独感与2型糖尿病发病风险之间的关系。方法：我们检索了各种电子数据库，包括MEDLINE（通过PubMed）、Embase、Cochrane图书馆和谷歌scholar，以检索比较社会隔离或孤独感患者中T2DM发病率的定性研究。我们采用随机效应模型对RevMan 5.4进行统计分析。结果：孤独感与T2DM发病率显著增加相关(OR: 1.44；95 % ci: 1.19-1.73；P:0.0001)，异质性高（I²= 95 %）。敏感性分析表明，由于孤独感测量的差异，潜在的可变性。社会孤立也与T2DM有显著关联(OR: 1.88；95 % ci: 1.38-2.58；结论：总之，我们发现社会孤立和孤独与T2DM的高发病率独立相关。这些发现强调了在T2DM管理中需要解决社会隔离和孤独等社会心理因素。然而，进一步的研究需要更大的样本量、更长的随访时间和统一的标准来更好地了解社会隔离、孤独感和2型糖尿病之间的关系。

{"title":"Social isolation, loneliness, and incidence of type 2 diabetes mellitus: A systematic review and meta-analysis","authors":"Maheen Asif , Aliza Asif , Ummi Aiman Rahman , Hafsa Ajmal , Uzair Jafar , Oshaz Fatima","doi":"10.1016/j.pcd.2025.03.006","DOIUrl":"10.1016/j.pcd.2025.03.006","url":null,"abstract":"<div><h3>Objective</h3><div>Social isolation and loneliness are forms of social disconnection that have been linked to increased risk of many metabolic disorders, including Type 2 Diabetes Mellitus (T2DM). However, evidence to support this relation is lacking. This study aims to investigate the association between social isolation, loneliness, and the incidence risk of T2DM.</div></div><div><h3>Methods</h3><div>We searched various electronic databases including MEDLINE (via PubMed), Embase, the Cochrane Library, and Google scholar to retrieve qualitative studies comparing the incidence of T2DM in patients with social isolation or loneliness. We performed statistical analysis on RevMan 5.4 using the random effect model.</div></div><div><h3>Results</h3><div>Loneliness was associated with a significantly increased incidence of T2DM (OR: 1.44; 95 % CI: 1.19–1.73; P:0.0001), with high heterogeneity (I² = 95 %). Sensitivity analysis indicated potential variability due to differences in loneliness measurements. Social isolation also showed a significant association with T2DM (OR: 1.88; 95 % CI: 1.38–2.58; P:<0.0001) with high heterogeneity (I² = 98 %).</div></div><div><h3>Conclusion</h3><div>In conclusion, we found social isolation and loneliness are independently associated with a higher incidence of T2DM. These findings underscore the need to address psychosocial elements like social isolation and loneliness in the management of T2DM. However, further studies with larger sample sizes, longer follow-up durations, and uniform criteria is warranted to better understand the association between social isolation, loneliness and T2DM.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 221-228"},"PeriodicalIF":2.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675055","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

Estimation of the population atributable fraction due a to excess body fat in primary care patients: IBERICAN study 估计初级保健患者体内脂肪过多的人群可归因比例：伊比利亚研究。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-03-19 DOI: 10.1016/j.pcd.2025.02.009

Jesús Iturralde-Iriso , Aitana Lertxundi-Manterola , Iosu Delgado-Naranjo , Alfonso Barquilla-García , Rafael Manuel Micó-Pérez , José Polo-García , Sonsoles M. Velilla-Zancada , Naiara Cubelos-Fernández , Antonio Segura-Fragoso , Leovigildo Ginel-Mendoza , Vicente Pallares-Carratala , Miguel A. Prieto-Díaz , Sergio Cinza-Sanjurjo , Vicente Martín-Sanchez

The burden of disease attributable to excess body fat (EBF) in type 2 diabetes mellitus (T2DM) may be underestimated due to problems correlating BMI with body fat. The aim of this study is to compare the population attributable fraction (PAF) of EBF in T2DM assessed with various parameters.

Material and methods

Prevalence study based on the baseline visit of the IBERICAN study. Mixed unconditional logistic regression models were used to estimate the risk of T2DM for the various categories of BMI, of the estimation of EBF according to the CUN-BAE (Clínica Universidad de Navarra-Body Adiposity Estimator) and of waist circumference (WC), stratifying by sex. The PAF was calculated for each of the EBF estimates.

Results

A total of 7752 patients from IBERICAN study were eligible, of them 1536 (19.8 %) achieved T2DM criterion, The prevalence of diabetes was higher in men, in those with a lower level of education, and in those who reported a low level of physical activity. Subjects with diabetes were older, had a higher BMI, a higher CUN-BAE-estimated body fat percentage (eBFP) and a higher waist circumference. One in three cases T2DM risk was attributed to elevated BMI, whereas in the CUN-BAE case it was attributed to 9 out of 10 men and 2 out of 3 women. One out of two cases of T2DM in women, and less in men, was attributed to an excess WC.

Conclusions

The burden of disease attributable to EBF in the case of T2DM may be underestimated. Therefore, EBF should be used, together with BMI, WC -especially in women-, and the CUN-BAE to better estimate the risk of T2DM and to adapt dietary or lifestyle recommendations in daily clinical practice.

由于BMI与体脂相关的问题，2型糖尿病（T2DM）中归因于体脂过多（EBF）的疾病负担可能被低估。本研究的目的是比较不同参数评估的T2DM患者EBF的人群归因分数（PAF）。材料和方法：基于伊比利亚研究基线访问的患病率研究。使用混合无条件逻辑回归模型对不同类别BMI、根据cune - bae （Clínica universsidad de Navarra-Body obesity Estimator）估计EBF和腰围（WC）进行T2DM风险的估计，并按性别分层。PAF是为每个EBF估计计算的。结果：IBERICAN研究共纳入7752例患者，其中1536例（19.8% %）达到T2DM标准，糖尿病患病率在男性、低教育水平人群和低体力活动人群中较高。糖尿病患者年龄较大，BMI指数较高，un - bae估计体脂率（eBFP）较高，腰围较高。三分之一的2型糖尿病风险归因于BMI升高，而在con - bae病例中，10个男性中有9个，3个女性中有2个。1 / 2的女性2型糖尿病患者归因于过量的WC，而男性较少。结论：在T2DM病例中，EBF引起的疾病负担可能被低估。因此，EBF应与BMI、WC（尤其是女性）和un - bae一起使用，以更好地估计2型糖尿病的风险，并在日常临床实践中调整饮食或生活方式建议。

{"title":"Estimation of the population atributable fraction due a to excess body fat in primary care patients: IBERICAN study","authors":"Jesús Iturralde-Iriso , Aitana Lertxundi-Manterola , Iosu Delgado-Naranjo , Alfonso Barquilla-García , Rafael Manuel Micó-Pérez , José Polo-García , Sonsoles M. Velilla-Zancada , Naiara Cubelos-Fernández , Antonio Segura-Fragoso , Leovigildo Ginel-Mendoza , Vicente Pallares-Carratala , Miguel A. Prieto-Díaz , Sergio Cinza-Sanjurjo , Vicente Martín-Sanchez","doi":"10.1016/j.pcd.2025.02.009","DOIUrl":"10.1016/j.pcd.2025.02.009","url":null,"abstract":"<div><div>The burden of disease attributable to excess body fat (EBF) in type 2 diabetes mellitus (T2DM) may be underestimated due to problems correlating BMI with body fat. The aim of this study is to compare the population attributable fraction (PAF) of EBF in T2DM assessed with various parameters.</div></div><div><h3>Material and methods</h3><div>Prevalence study based on the baseline visit of the IBERICAN study. Mixed unconditional logistic regression models were used to estimate the risk of T2DM for the various categories of BMI, of the estimation of EBF according to the CUN-BAE (Clínica Universidad de Navarra-Body Adiposity Estimator) and of waist circumference (WC), stratifying by sex. The PAF was calculated for each of the EBF estimates.</div></div><div><h3>Results</h3><div>A total of 7752 patients from IBERICAN study were eligible, of them 1536 (19.8 %) achieved T2DM criterion, The prevalence of diabetes was higher in men, in those with a lower level of education, and in those who reported a low level of physical activity. Subjects with diabetes were older, had a higher BMI, a higher CUN-BAE-estimated body fat percentage (eBFP) and a higher waist circumference. One in three cases T2DM risk was attributed to elevated BMI, whereas in the CUN-BAE case it was attributed to 9 out of 10 men and 2 out of 3 women. One out of two cases of T2DM in women, and less in men, was attributed to an excess WC.</div></div><div><h3>Conclusions</h3><div>The burden of disease attributable to EBF in the case of T2DM may be underestimated. Therefore, EBF should be used, together with BMI, WC -especially in women-, and the CUN-BAE to better estimate the risk of T2DM and to adapt dietary or lifestyle recommendations in daily clinical practice.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 302-311"},"PeriodicalIF":2.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672189","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

Deprescribing of preventive medications in palliative care patients living with multiple long-term conditions in their final 12 months of life: A retrospective cohort Clinical Practice Research Datalink study 在临终前12个月患有多种长期疾病的姑息治疗患者中减少预防性药物处方：一项回顾性队列临床实践研究数据链研究

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-03-18 DOI: 10.1016/j.pcd.2025.03.005

Elizabeth Hickman , Clare Gillies , Kamlesh Khunti , Samuel Seidu

Objectives

To investigate the patterns and trends associated with deprescribing of preventive medications in the final 12 months of life in palliative patients living with multiple long-term conditions using the Clinical Practice Research Datalink.

Participants

All patients with a medcode/readcode for palliative care assigned to their profile with a medcode/readcode for a cardiometabolic condition. All patients were on therapeutic interventions for their condition/s.

Primary and secondary outcome measures

the trends of medication deprescribing of preventive medications in the final twelve months of life in those known to be end-of-life.

Results

Preventive medication deprescribing was only observed in a very small cohort of patients. The findings were consistent across all six medication groups tested. Deprescribing was observed in a range of 2–60 patients with the most deprescribing efforts being associated with antihypertensive medications (n = 177), and antiplatelet medications (n = 70), and antihyperglycaemic medications (n = 10).

Conclusions

Deprescribing practices are not commonplace in patients with a known end-of-life designation with low patient numbers (range 2–60) undergoing the intervention, thus potentially reducing the quality of life in these patients final twelve months of life.

CPRD ID

#22_002253, linkage request 2914

目的：利用临床实践研究数据链（Clinical Practice Research Datalink）调查患有多种长期疾病的姑息治疗患者生命最后12个月预防性药物处方的模式和趋势。参与者：所有患有姑息治疗的医疗编码/阅读编码的患者，分配给他们的医疗编码/阅读编码为心脏代谢疾病。所有患者均接受治疗干预。主要和次要结果测量：在已知生命结束的患者生命的最后12个月，预防性药物处方的趋势。结果：预防性药物处方解除仅在一小部分患者中观察到。这一发现在所有六个药物组的测试中都是一致的。在2-60例患者中，降压药物（n = 177）、抗血小板药物（n = 70）和抗高血糖药物（n = 10）的降压程度最高。结论：在接受干预的已知临终患者数量较少（范围2-60）的患者中，减处方做法并不常见，因此可能降低这些患者最后12个月的生活质量。CPRD ID: #22_002253，联动请求2914。

{"title":"Deprescribing of preventive medications in palliative care patients living with multiple long-term conditions in their final 12 months of life: A retrospective cohort Clinical Practice Research Datalink study","authors":"Elizabeth Hickman , Clare Gillies , Kamlesh Khunti , Samuel Seidu","doi":"10.1016/j.pcd.2025.03.005","DOIUrl":"10.1016/j.pcd.2025.03.005","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the patterns and trends associated with deprescribing of preventive medications in the final 12 months of life in palliative patients living with multiple long-term conditions using the Clinical Practice Research Datalink.</div></div><div><h3>Participants</h3><div>All patients with a medcode/readcode for palliative care assigned to their profile with a medcode/readcode for a cardiometabolic condition. All patients were on therapeutic interventions for their condition/s.</div></div><div><h3>Primary and secondary outcome measures</h3><div>the trends of medication deprescribing of preventive medications in the final twelve months of life in those known to be end-of-life.</div></div><div><h3>Results</h3><div>Preventive medication deprescribing was only observed in a very small cohort of patients. The findings were consistent across all six medication groups tested. Deprescribing was observed in a range of 2–60 patients with the most deprescribing efforts being associated with antihypertensive medications (n = 177), and antiplatelet medications (n = 70), and antihyperglycaemic medications (n = 10).</div></div><div><h3>Conclusions</h3><div>Deprescribing practices are not commonplace in patients with a known end-of-life designation with low patient numbers (range 2–60) undergoing the intervention, thus potentially reducing the quality of life in these patients final twelve months of life.</div></div><div><h3>CPRD ID</h3><div>#22_002253, linkage request 2914</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 288-295"},"PeriodicalIF":2.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665441","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

Prevalence of depression and anxiety among pregnant women with gestational diabetes mellitus in South Asia 南亚妊娠期糖尿病孕妇抑郁和焦虑的患病率

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-03-15 DOI: 10.1016/j.pcd.2025.03.002

Saite Hemavathy , Mohan Deepa , Ram Uma , Ramesh Gowri , Rajendra Pradeepa , Wesley Hannah , Chockalingam Shivashri , Radhakrishnan Subashini , Duraivel Mohaneswari , Yonas Ghebremichael-Weldeselassie , Ponnusamy Saravanan , Viswanathan Mohan , Ranjit Mohan Anjana

Aim

To determine the prevalence of depression and anxiety during pregnancy and its association with GDM.

Methods

A total of 2141 pregnant women were recruited before 16 weeks of gestation (mean gestational age: 10.5 ± 2.9 weeks) from the STRiDE study in south India. Early GDM (eGDM) was detected in the first trimester, and late GDM (lGDM) during 24–28 weeks, both diagnosed using IADPSG criteria. Depression and anxiety were assessed using the PHQ-9 (score≥10) and GAD-7 (score≥7) scales, respectively.

Results

Overall, 14.9 % had depression and 17.5 % had anxiety in early pregnancy. eGDM was diagnosed in 474 (20.4 %) and lGDM in 321 (19.3 %) women. Women with eGDM had higher prevalence of depression (20.9 %) than those with lGDM (15.6 %, p = 0.06) and those without GDM (13.3 %, p < 0.01). Anxiety was also higher in eGDM (21.1 %) compared to IGDM (15.3 %, p < 0.05) and women without GDM (16.6 %, p < 0.05). eGDM was significantly associated with depression (aOR=1.84, 95 % CI:1.37–2.47, p < 0.001) and anxiety (aOR=1.36, 95 % CI:1.03–1.79, p = 0.03) after adjusting for age, systolic blood pressure, BMI, socioeconomic status, and family history of diabetes.

Conclusion

Women with early GDM have a higher prevalence of depression and anxiety compared to those with late GDM and women without GDM. Early and universal screening for GDM should be done and its association with mental health wellbeing should be explored and supported.

目的：了解妊娠期抑郁和焦虑的患病率及其与GDM的关系。方法：从印度南部的STRiDE研究中招募了2141名妊娠16周前的孕妇（平均胎龄：10.5 ± 2.9周）。早期GDM （eGDM）在妊娠早期被检测到，晚期GDM （lGDM）在24-28周被检测到，两者都使用IADPSG标准诊断。抑郁和焦虑分别采用PHQ-9（评分≥10）和GAD-7（评分≥7）量表进行评估。结果：总体而言，14.9 %的孕妇有抑郁，17.5 %的孕妇有焦虑。474名（20.4 %）女性被诊断为eGDM， 321名（19.3 %）女性被诊断为lGDM。eGDM患者的抑郁患病率（20.9 %）高于lGDM患者（15.6 %,p = 0.06）和非GDM患者（13.3 %,p ）。结论：早期GDM患者的抑郁和焦虑患病率高于晚期和非GDM患者。应该对GDM进行早期和普遍筛查，并探索和支持其与心理健康的关系。

{"title":"Prevalence of depression and anxiety among pregnant women with gestational diabetes mellitus in South Asia","authors":"Saite Hemavathy , Mohan Deepa , Ram Uma , Ramesh Gowri , Rajendra Pradeepa , Wesley Hannah , Chockalingam Shivashri , Radhakrishnan Subashini , Duraivel Mohaneswari , Yonas Ghebremichael-Weldeselassie , Ponnusamy Saravanan , Viswanathan Mohan , Ranjit Mohan Anjana","doi":"10.1016/j.pcd.2025.03.002","DOIUrl":"10.1016/j.pcd.2025.03.002","url":null,"abstract":"<div><h3>Aim</h3><div>To determine the prevalence of depression and anxiety during pregnancy and its association with GDM.</div></div><div><h3>Methods</h3><div>A total of 2141 pregnant women were recruited before 16 weeks of gestation (mean gestational age: 10.5 ± 2.9 weeks) from the STRiDE study in south India. Early GDM (eGDM) was detected in the first trimester, and late GDM (lGDM) during 24–28 weeks, both diagnosed using IADPSG criteria. Depression and anxiety were assessed using the PHQ-9 (score≥10) and GAD-7 (score≥7) scales, respectively.</div></div><div><h3>Results</h3><div>Overall, 14.9 % had depression and 17.5 % had anxiety in early pregnancy. eGDM was diagnosed in 474 (20.4 %) and lGDM in 321 (19.3 %) women. Women with eGDM had higher prevalence of depression (20.9 %) than those with lGDM (15.6 %, p = 0.06) and those without GDM (13.3 %, p < 0.01). Anxiety was also higher in eGDM (21.1 %) compared to IGDM (15.3 %, p < 0.05) and women without GDM (16.6 %, p < 0.05). eGDM was significantly associated with depression (aOR=1.84, 95 % CI:1.37–2.47, p < 0.001) and anxiety (aOR=1.36, 95 % CI:1.03–1.79, p = 0.03) after adjusting for age, systolic blood pressure, BMI, socioeconomic status, and family history of diabetes.</div></div><div><h3>Conclusion</h3><div>Women with early GDM have a higher prevalence of depression and anxiety compared to those with late GDM and women without GDM. Early and universal screening for GDM should be done and its association with mental health wellbeing should be explored and supported.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 322-328"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639949","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

Incorporating sedentary behaviour for identifying risk of type 2 diabetes: Implications for primary care 结合久坐行为识别2型糖尿病风险：对初级保健的影响。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-03-10 DOI: 10.1016/j.pcd.2025.03.001

Francesc Alòs , Anna Puig-Ribera , Judit Bort-Roig , Emilia Chirveches-Pérez , Anna Berenguera , Carlos Martin-Cantera , Ma Àngels Colomer

Introduction

Type 2 diabetes mellitus (DM2) is one of the main public health threats of the 21st century. Half of the people with DM2 worldwide are not diagnosed. The high prevalence, underdiagnosis and complications of diabetes highlight the need for identifying people at risk. Sedentary behaviour (SB) or prolonged sitting is a major predisposing risk factor for the increasing prevalence of DM2. Incorporating SB measures into clinical practice systems for identifying individuals more likely to have DM2 should be considered.

Objective

To develop a mathematical model for clinical practice that allows early identification of office employees at risk of DM2 based on objective data on SB.

Methods

A cross-sectional study with a cross-validation procedure was conducted. Anthropometric variables (sex, age and body mass index, BMI), sleep time (hours; measured by ActivPAL3M devices), and SB patterns (sedentary breaks and time spent in sedentary bouts of four different lengths; measured by ActivPAL3M devices) of two groups of office employees (adults with and without diabetes) were compared. Eighty-one participants had DM2 and 132 had normal glucose metabolism (NGM). The risk of having DM2 was modelled using generalized linear models (GLM), particularly a logistic regression model.

Results

Five non-invasive clinical variables that were significantly correlated to DM2 with no collinearity were included in the mathematical model: sex, age, BMI, sleep time (hours) and sedentary breaks < 20 minutes (number/day). The validated model correctly classified 94.58 % of the participants with DM2 and 97.99 % of participants with NGM. The sensitivity was 94.58 % and the specificity 97.99 %. Additionally, the model allowed the design of a preventive tool to recommend changes in the SB pattern based on the participant’s anthropometric profile, aiming to reduce the risk of developing DM2 in office employees.

Conclusion

This study highlights the importance of incorporating SB measures in primary care clinical practice. Our mathematical model suggests that including SB could enhance the early identification of adults at risk of DM2. Further research is needed to validate these findings and assess the practical application of the mathematical model in clinical practice.

2型糖尿病（DM2）是21世纪主要的公共卫生威胁之一。全世界有一半的DM2患者没有被诊断出来。糖尿病的高患病率、诊断不足和并发症突出了确定高危人群的必要性。久坐行为（SB）或久坐是DM2患病率增加的主要易感危险因素。应考虑将SB测量纳入临床实践系统，以识别更可能患有DM2的个体。目的：建立一个数学模型，以临床实践为基础，根据客观数据早期识别办公室员工的DM2风险。方法：采用交叉验证程序进行横断面研究。人体测量变量（性别、年龄和身体质量指数，BMI）、睡眠时间(小时数；通过ActivPAL3M设备测量)和SB模式(久坐休息时间和四种不同长度的久坐时间；通过ActivPAL3M设备测量)，比较两组办公室员工（有糖尿病和没有糖尿病的成年人）的健康状况。81名参与者有DM2, 132名有正常的糖代谢（NGM）。使用广义线性模型（GLM），特别是逻辑回归模型对DM2的风险进行建模。结果：数学模型中纳入了与DM2显著相关且无共线性关系的5个非侵入性临床变量：性别、年龄、BMI、睡眠时间（小时）和久坐休息时间。结论：本研究强调了将SB测量纳入初级保健临床实践的重要性。我们的数学模型表明，包括SB可以提高成人DM2风险的早期识别。需要进一步的研究来验证这些发现，并评估数学模型在临床实践中的实际应用。

{"title":"Incorporating sedentary behaviour for identifying risk of type 2 diabetes: Implications for primary care","authors":"Francesc Alòs , Anna Puig-Ribera , Judit Bort-Roig , Emilia Chirveches-Pérez , Anna Berenguera , Carlos Martin-Cantera , Ma Àngels Colomer","doi":"10.1016/j.pcd.2025.03.001","DOIUrl":"10.1016/j.pcd.2025.03.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Type 2 diabetes mellitus (DM2) is one of the main public health threats of the 21st century. Half of the people with DM2 worldwide are not diagnosed. The high prevalence, underdiagnosis and complications of diabetes highlight the need for identifying people at risk. Sedentary behaviour (SB) or prolonged sitting is a major predisposing risk factor for the increasing prevalence of DM2. Incorporating SB measures into clinical practice systems for identifying individuals more likely to have DM2 should be considered.</div></div><div><h3>Objective</h3><div>To develop a mathematical model for clinical practice that allows early identification of office employees at risk of DM2 based on objective data on SB.</div></div><div><h3>Methods</h3><div>A cross-sectional study with a cross-validation procedure was conducted. Anthropometric variables (sex, age and body mass index, BMI), sleep time (hours; measured by ActivPAL3M devices), and SB patterns (sedentary breaks and time spent in sedentary bouts of four different lengths; measured by ActivPAL3M devices) of two groups of office employees (adults with and without diabetes) were compared. Eighty-one participants had DM2 and 132 had normal glucose metabolism (NGM). The risk of having DM2 was modelled using generalized linear models (GLM), particularly a logistic regression model.</div></div><div><h3>Results</h3><div>Five non-invasive clinical variables that were significantly correlated to DM2 with no collinearity were included in the mathematical model: sex, age, BMI, sleep time (hours) and sedentary breaks < 20 minutes (number/day). The validated model correctly classified 94.58 % of the participants with DM2 and 97.99 % of participants with NGM. The sensitivity was 94.58 % and the specificity 97.99 %. Additionally, the model allowed the design of a preventive tool to recommend changes in the SB pattern based on the participant’s anthropometric profile, aiming to reduce the risk of developing DM2 in office employees.</div></div><div><h3>Conclusion</h3><div>This study highlights the importance of incorporating SB measures in primary care clinical practice. Our mathematical model suggests that including SB could enhance the early identification of adults at risk of DM2. Further research is needed to validate these findings and assess the practical application of the mathematical model in clinical practice.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 214-220"},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607535","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