Primary Care Diabetes最新文献_第8页

Culturally appropriate care for indigenous people with type 2 diabetes mellitus (T2DM)- a scoping review 土著2型糖尿病（T2DM）患者文化上适当的护理——一项范围综述

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-03-06 DOI: 10.1016/j.pcd.2025.02.008

K. Kovanur Sampath , Yan Ann-Rong , S. Brownie

Background

Indigenous populations are disproportionately affected by type 2 diabetes mellitus (T2DM) and associated complications. However, the lack of cultural integration with the current management approach does not suit indigenous communities. Therefore, the aim of this scoping review is to map the existing literature related to culturally appropriate care and to establish the key characteristics of a culturally appropriate care provided to indigenous communities with T2D.

Methods

Electronic databases such as PubMed, CINAHL, Science Direct and Cochrane Library were searched from inception to September 2024. Identified records from database literature searches were imported into Covidence®. Two independent reviewers screened and extracted the data. Studies included Indigenous people with T2D, culturally appropriate care, measurable outcomes, and any design. The research team collectively created a data charting table/form to standardize data collection that included PICO elements and PROGRESS-Plus factors for equity lens. A narrative synthesis was used to summarize the evidence.

Results

Seven studies met our eligibility criteria and were included in this scoping review. Overall, there is clear evidence that a culturally appropriate care results in better physiological outcomes and higher rates of adherence and engagement with a treatment plan and disease management processes. However, future studies need to gather and report on other PROGRESS factors that can cause inequity such as Religion, Education, Socioeconomic status of participants.

Conclusion

The findings of this review emphasise that a culturally appropriate care is crucial in improving health outcomes and engagement among Indigenous people with T2D. However, systemic barriers still exist, highlighting the need for broader structural changes.

背景：土著人口不成比例地受到2型糖尿病（T2DM）及其相关并发症的影响。然而，缺乏与当前管理方法的文化融合并不适合土著社区。因此，本范围审查的目的是绘制与文化适宜护理相关的现有文献，并确定为T2D土著社区提供文化适宜护理的关键特征。方法：检索PubMed、CINAHL、Science Direct、Cochrane Library等自建库至2024年9月的电子数据库。从数据库文献检索中确定的记录被导入到covid®中。两名独立审稿人筛选并提取数据。研究包括土著T2D患者、文化上适当的护理、可测量的结果和任何设计。研究小组共同创建了一个数据图表表/表格，以标准化数据收集，其中包括PICO元素和PROGRESS-Plus因素。叙述综合法被用来总结证据。结果：7项研究符合我们的入选标准，并纳入本范围综述。总的来说，有明确的证据表明，文化上适当的护理可以产生更好的生理结果，并且对治疗计划和疾病管理过程的依从性和参与度更高。然而，未来的研究需要收集和报告其他可能导致不平等的进步因素，如宗教、教育、参与者的社会经济地位。结论：本综述的研究结果强调，文化上适当的护理对于改善土著T2D患者的健康结果和参与至关重要。然而，系统性障碍仍然存在，这突出表明需要进行更广泛的结构性改革。

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引用次数: 0

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

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-28 DOI: 10.1016/S1751-9918(25)00053-1

引用次数: 0

Intermittent fasting versus continuous caloric restriction for glycemic control and weight loss in type 2 diabetes: A traditional review 2型糖尿病患者间歇性禁食与持续热量限制对血糖控制和体重减轻的影响：传统综述

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-24 DOI: 10.1016/j.pcd.2025.02.006

Hairya Ajaykumar Lakhani , Deepanwita Biswas , Mahima Kuruvila , Manisha Sai Chava , Kshitij Raj , Joel Thomas Varghese , N.L. Swathi

Type 2 Diabetes Mellitus (T2DM) represents a major global health issue, with its incidence anticipated to increase markedly in the forthcoming decades. Efficient non-pharmacological therapies, especially dietary approaches, are essential for regulating glycemic control and facilitating weight reduction. Intermittent Fasting (IF) and Continuous Caloric Restriction (CCR) are two well researched methodologies, but their relative effectiveness and enduring advantages continue to be topics of active discussion. This review systematically assesses and contrasts the impacts of intermittent fasting (IF) and continuous calorie restriction (CCR) on glycemic regulation and weight reduction in persons with type 2 diabetes mellitus (T2DM), highlighting their short-term and long-term effects, safety profiles, and adherence rates. A thorough literature analysis was performed utilizing PubMed and Google Scholar, concentrating on papers published from 2000 to 2024. The review encompassed randomized controlled trials and observational studies that investigated the effects of intermittent fasting (IF) and continuous calorie restriction (CCR) on glycemic indicators (HbA1c, fasting glucose) and body weight. IF shown substantial short-term advantages, encompassing marked decreases in HbA1c levels, fasting glucose, and body weight. Mechanistic discoveries emphasized better insulin sensitivity, augmented fat metabolism, and autophagy as key aspects. In contrast, CCR was linked to enduring metabolic enhancements, including decreased visceral fat and improved insulin sensitivity. Nevertheless, both dietary approaches demonstrated constraints.

2型糖尿病（T2DM）是一个主要的全球健康问题，其发病率预计在未来几十年将显著增加。有效的非药物治疗，特别是饮食方法，对于调节血糖控制和促进减肥是必不可少的。间歇性禁食（IF）和持续热量限制（CCR）是两种研究得很好的方法，但它们的相对有效性和持久优势仍然是积极讨论的话题。本综述系统地评估和对比了间歇性禁食（IF）和持续热量限制（CCR）对2型糖尿病（T2DM）患者血糖调节和体重减轻的影响，强调了它们的短期和长期效果、安全性和依从性。利用PubMed和b谷歌Scholar进行了全面的文献分析，重点分析了2000年至2024年发表的论文。该综述包括随机对照试验和观察性研究，这些研究调查了间歇性禁食（IF）和持续卡路里限制（CCR）对血糖指标（HbA1c、空腹血糖）和体重的影响。IF显示出明显的短期优势，包括显著降低HbA1c水平、空腹血糖和体重。机制的发现强调更好的胰岛素敏感性、增强的脂肪代谢和自噬是关键方面。相比之下，CCR与持久的代谢增强有关，包括内脏脂肪减少和胰岛素敏感性提高。然而，两种饮食方法都显示出局限性。

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引用次数: 0

The perspectives of healthcare professionals in providing care to women with GDM in high-income nations: A qualitative systematic review 高收入国家医疗保健专业人员为患有GDM的妇女提供护理的观点：一项定性系统评价。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-24 DOI: 10.1016/j.pcd.2024.11.005

Mary-Ellen Hooper , Ella Kurz , Cathy Knight-Agarwal , Mary-Jessimine Bushell , Elyse Ladbrook , Deborah Davis

Background

Gestational Diabetes Mellitus (GDM) represents a growing challenge worldwide, with significant risks to both women and their babies that extend beyond the duration of the pregnancy and immediate post-partum period. Healthcare professionals (HCPs) play important roles in the screening, diagnosis, treatment and management of women with GDM.

Methods

For this qualitative systematic review, a comprehensive search strategy explored the electronic databases Web of Science, CINAHL, Medline, and Scopus, as well as the reference lists of the included papers, for primary studies investigating the experiences, perspectives and practices of HCPs providing care to women with GDM in high-income healthcare settings. Studies were assessed with the Crowe Critical Appraisal Tool, and findings were synthesised using the approach described by Thomas and Harden.

Results

This review included 33 articles - 26 qualitative and seven mixed method studies, representing ten high-income nations. The total number of HCP participants represented across the studies is 989. This figure is constituted by medical professionals (n = 226), nurses and midwives (n = 583), allied health (n = 40) and other or not numerically specified HCPs (n = 140). From 149 findings, four major themes and 10 subthemes were constructed. The four major themes are: multidisciplinary collaboration; healthcare practice; organizational factors; and working with women.

Discussion and conclusion

There are barriers to providing optimal care to women with GDM. Including, time and resource constraints, a lack of consensus in practice guidelines, and variable multidisciplinary collaboration. Moving forward, there needs to be a focus on more explicit guidelines, multidisciplinary collaboration, and appropriate resources to support HCPs in providing care to women to manage the short-term and longer-term risks that are associated with a pregnancy affected by GDM.

背景：妊娠期糖尿病（GDM）在世界范围内是一个日益严峻的挑战，对妇女及其婴儿都有重大风险，其风险延伸到怀孕期间和产后期间。医疗保健专业人员（HCPs）在筛查、诊断、治疗和管理女性GDM方面发挥着重要作用。方法：在这一定性系统综述中，采用全面的搜索策略，探索了电子数据库Web of Science、CINAHL、Medline和Scopus，以及所纳入论文的参考文献列表，以调查高收入医疗机构中医护人员为GDM女性提供护理的经验、观点和实践的初步研究。使用Crowe关键评估工具对研究进行评估，并使用Thomas和Harden描述的方法对研究结果进行综合。结果：本综述包括33篇文章——26篇定性研究和7篇混合方法研究，代表了10个高收入国家。所有研究中HCP参与者的总人数为989人。这一数字由医疗专业人员（ = 226）、护士和助产士（ = 583）、专职保健人员（ = 40）和其他或未按数字指定的医护人员（ = 140）组成。从149项调查结果中，构建了4个主要主题和10个次要主题。四大主题是：多学科合作；医疗实践;组织因素;和女性一起工作。讨论与结论：为患有GDM的妇女提供最佳护理存在障碍。包括时间和资源的限制，在实践指南中缺乏共识，以及多变的多学科合作。展望未来，需要关注更明确的指南、多学科合作和适当的资源，以支持医疗服务提供者向妇女提供护理，以管理与GDM影响的妊娠相关的短期和长期风险。

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引用次数: 0

Td2Ast project: A pragmatic intervention on diet and physical activity for patients with type 2 diabetes mellitus Td2Ast项目：对2型糖尿病患者饮食和身体活动的实用干预。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-21 DOI: 10.1016/j.pcd.2025.02.003

Maria del Mar Fernandez-Alvarez , Cristina Papín-Cano , Shelini Surendran , Ruben Martin-Payo

Aim

The purpose of this study was to assess the efficacy of an educational intervention based on the Behavior Change Wheel (BCW) framework for individuals with type 2 diabetes mellitus (T2DM) on dietary and physical activity recommendations in a Spanish region.

Methods

A two-arm pragmatic randomized pilot trial was developed. The intervention consisted of a 6-month period with three components: face-to-face counseling, a phone call, and specially designed written guidelines focusing on dietary and physical activity recommendations The primary outcome was changes in dietary and physical activity recommendations. The secondary outcome, the impact of the intervention on HbA1c levels, body mass index, and the frequency of consultations to primary care.

Results

n = 208 patients were recruited. Individuals in the intervention experienced a significative improvement in adherence to dietary recommendations (+0.52; p-value<0.001), physical activity (+0.79; p-value<0.001), and a decrease in HbA1c levels (0.11 %; p-value=0.04).

Conclusion

The 6-month intervention, designed for T2DM patients and based on the BCW model, has demonstrated effectiveness in improving adherence to healthy dietary and physical activity recommendations, as well as reducing HbA1c levels.

目的：本研究的目的是评估基于行为改变轮（BCW）框架的教育干预对西班牙地区2型糖尿病（T2DM）患者饮食和身体活动建议的效果。方法：采用两组实用随机先导试验。干预包括六个月的三个组成部分：面对面咨询，电话和特别设计的书面指南，重点是饮食和体育活动建议。主要结果是饮食和体育活动建议的变化。次要结果是干预对HbA1c水平、体重指数和初级保健咨询频率的影响。结果：共纳入患者208例。干预组患者对饮食建议的依从性显著提高(+0.52；结论：基于BCW模型，针对T2DM患者设计的为期6个月的干预，已证明在提高对健康饮食和身体活动建议的依从性以及降低HbA1c水平方面有效。

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引用次数: 0

Comparing quality of diabetes care between immigrants and non-immigrants within dimensions of marginalization: A population-based cohort study 比较移民和非移民在边缘化维度内的糖尿病护理质量：一项基于人群的队列研究。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-21 DOI: 10.1016/j.pcd.2025.02.007

Shadia Adekunte , Yu Qing Bai , Gillian L. Booth , Ghazal Fazli , Calvin Ke , Lorraine L. Lipscombe , Sarah M. Mah , Laura C. Rosella , Walter P. Wodchis , Baiju R. Shah

Aims

Immigrants in western countries face an increased risk of developing diabetes and have been shown to receive lower quality of diabetes care. However, it is uncertain whether this disparity in care persists when comparing immigrants and non-immigrants with similar levels of marginalization with respect to the social determinants of health.

Methods

Using population-based healthcare administrative data linked to immigration and neighbourhood census data, we conducted a retrospective cohort study of all people aged ≥ 40 years with diabetes in Ontario, Canada on 1 April 2019. Process measures (testing for HbA1c, LDL-cholesterol and urine albumin-creatinine ratio; eye examinations; and appropriate prescriptions) and outcome measures (achieving guideline-recommended targets for laboratory tests) over the following year were ascertained. They were compared between immigrants and non-immigrants overall and within the highest and lowest quintiles of three measures of marginalization: material deprivation, residential instability and dependency.

Results

There were 1,449,589 people with diabetes included in the study (22.6 % immigrants). Immigrants were less likely than non-immigrants to achieve many of the process quality indicators and were less likely to achieve both HbA1c and LDL-cholesterol targets. These findings were similar when stratified within the highest and lowest quintiles of material deprivation, residential instability and dependency.

Conclusions

Even within similar levels of marginalization, immigrants were less likely to achieve many quality indicators for diabetes care than non-immigrants. This finding suggests that the gap in quality of care between immigrants and non-immigrants is not simply due to differences in these social determinants of health, and highlights the intersecting impact of immigration and marginalization. However, the disparities were relatively small, so the greater issue is the overall low achievement of these quality indicators among all people with diabetes.

目的：西方国家的移民患糖尿病的风险增加，并且得到的糖尿病护理质量较低。然而，在比较在健康的社会决定因素方面边缘化程度相似的移民和非移民时，尚不确定这种护理方面的差距是否仍然存在。方法：利用与移民和社区人口普查数据相关的基于人口的医疗保健管理数据，我们于2019年4月1日对加拿大安大略省所有年龄≥ 40岁的糖尿病患者进行了回顾性队列研究。过程测量(HbA1c、ldl -胆固醇、尿白蛋白-肌酐比值检测；眼睛考试;确定了今后一年的适当处方和结果措施（实现指南建议的实验室检测目标）。他们在移民和非移民之间进行了总体比较，并在物质剥夺、居住不稳定和依赖这三种边缘化措施的最高和最低五分之一范围内进行了比较。结果：共纳入14449589例糖尿病患者（22.6% %为移民）。与非移民相比，移民达到许多过程质量指标的可能性更小，同时达到HbA1c和ldl -胆固醇目标的可能性更小。在物质匮乏、居住不稳定和依赖的最高和最低五分位数中，这些发现是相似的。结论：即使在相似的边缘化水平下，移民也比非移民更不可能达到糖尿病护理的许多质量指标。这一发现表明，移民和非移民之间保健质量的差距不仅仅是由于这些健康社会决定因素的差异，并突出了移民和边缘化的交叉影响。然而，这些差异相对较小，因此更大的问题是所有糖尿病患者对这些质量指标的总体满意度较低。

{"title":"Comparing quality of diabetes care between immigrants and non-immigrants within dimensions of marginalization: A population-based cohort study","authors":"Shadia Adekunte , Yu Qing Bai , Gillian L. Booth , Ghazal Fazli , Calvin Ke , Lorraine L. Lipscombe , Sarah M. Mah , Laura C. Rosella , Walter P. Wodchis , Baiju R. Shah","doi":"10.1016/j.pcd.2025.02.007","DOIUrl":"10.1016/j.pcd.2025.02.007","url":null,"abstract":"<div><h3>Aims</h3><div>Immigrants in western countries face an increased risk of developing diabetes and have been shown to receive lower quality of diabetes care. However, it is uncertain whether this disparity in care persists when comparing immigrants and non-immigrants with similar levels of marginalization with respect to the social determinants of health.</div></div><div><h3>Methods</h3><div>Using population-based healthcare administrative data linked to immigration and neighbourhood census data, we conducted a retrospective cohort study of all people aged ≥ 40 years with diabetes in Ontario, Canada on 1 April 2019. Process measures (testing for HbA1c, LDL-cholesterol and urine albumin-creatinine ratio; eye examinations; and appropriate prescriptions) and outcome measures (achieving guideline-recommended targets for laboratory tests) over the following year were ascertained. They were compared between immigrants and non-immigrants overall and within the highest and lowest quintiles of three measures of marginalization: material deprivation, residential instability and dependency.</div></div><div><h3>Results</h3><div>There were 1,449,589 people with diabetes included in the study (22.6 % immigrants). Immigrants were less likely than non-immigrants to achieve many of the process quality indicators and were less likely to achieve both HbA1c and LDL-cholesterol targets. These findings were similar when stratified within the highest and lowest quintiles of material deprivation, residential instability and dependency.</div></div><div><h3>Conclusions</h3><div>Even within similar levels of marginalization, immigrants were less likely to achieve many quality indicators for diabetes care than non-immigrants. This finding suggests that the gap in quality of care between immigrants and non-immigrants is not simply due to differences in these social determinants of health, and highlights the intersecting impact of immigration and marginalization. However, the disparities were relatively small, so the greater issue is the overall low achievement of these quality indicators among all people with diabetes.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 296-301"},"PeriodicalIF":2.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473393","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

Risk of onset of chronic kidney disease in type 2 diabetes mellitus (ROCK-DM): Development and validation of a 4-variable prediction model 2型糖尿病慢性肾病发病风险（ROCK-DM）：一个4变量预测模型的建立和验证

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-18 DOI: 10.1016/j.pcd.2025.02.005

Jie Ming Nigel Fong , Serena Low , Yang Xu , Pek Siang Edmund Teo , Gek Hsiang Lim , Huili Zheng , Keven Ang , Ngiap Chuan Tan , Cheng Boon Poh , Hui Boon Tay , Allen Yan Lun Liu , Choong Meng Chan , Chieh Suai Tan , Su Chi Lim , Yong Mong Bee , Jia Liang Kwek

Aims

The aim of this study was to develop and validate a prediction model for incident chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM), defined as eGFR < 60 ml/min/1.73m2 and/or urine albumin:creatinine ratio (UACR) > 3 mg/mmol in ≥ 2 consecutive readings ≥ 3 months apart.

Methods

Model derivation was performed in the SingHealth Diabetes Registry, including patients aged ≥ 21 years diagnosed with T2DM without pre-existing CKD. External validation was performed in a single-center prospective observational cohort. Cox Proportional Hazard model was created to evaluate predictors associated with time-to-onset of incident CKD. Increasingly parsimonious models were assessed for discrimination and calibration. Models underwent external validation, benchmarking against existing models, and decision curve analysis.

Results

25,142 (59 %) of 42,552 patients in the derivation cohort developed CKD over a median 4.0 years (IQR 2.1–7.7) follow up. An 18-variable model, 12-variable model, and 4-variable model (including age, duration of T2DM, eGFR, and previous non-persistent albuminuria) was developed. The 4-variable model had a C-statistic of 0.78 and good calibration on plots of observed-versus-predicted risk. The 12-variable and 18-variable models performed similarly. In the external validation cohort of 2249 patients, of whom 1035 (46 %) developed incident CKD, the 4-variable model had a C-statistic of 0.87. All models had better discrimination than existing benchmarks. Decision curve analysis of the 4-variable model showed positive net benefit for any threshold probability above 16 % for 2-year and 28 % for 5-year CKD risk.

Conclusion

The 4-variable model for prediction of incident CKD in T2DM demonstrates good performance, predicts both eGFR and albuminuria endpoints, and is simple-to-use. This may guide personalized care, resource allocation and population health.

目的：本研究旨在开发和验证 2 型糖尿病（T2DM）患者慢性肾脏病（CKD）的预测模型：模型推导在新加坡保健集团糖尿病登记处进行，包括年龄≥ 21 岁、确诊为 T2DM 但无原有 CKD 的患者。外部验证在单中心前瞻性观察队列中进行。建立了 Cox 比例危险模型，以评估与 CKD 发病时间相关的预测因素。对越来越简化的模型进行了判别和校准评估。结果：在中位随访 4.0 年（IQR 2.1-7.7）的 42,552 名衍生队列患者中，有 25,142 人（59%）发展为 CKD。建立了一个 18 变量模型、12 变量模型和 4 变量模型（包括年龄、T2DM 持续时间、eGFR 和既往非持续性白蛋白尿）。4 变量模型的 C 统计量为 0.78，在观察风险与预测风险图上校准良好。12 变量模型和 18 变量模型的表现类似。在由 2249 名患者组成的外部验证队列中，有 1035 名患者（46%）发生了慢性肾脏病，4 变量模型的 C 统计量为 0.87。所有模型的区分度均优于现有基准。4 变量模型的决策曲线分析表明，任何阈值概率超过 16% 的 2 年期 CKD 风险和 28% 的 5 年期 CKD 风险都会带来正的净收益：预测 T2DM 患者发生 CKD 的 4 变量模型性能良好，可预测 eGFR 和白蛋白尿终点，而且简单易用。这可以为个性化护理、资源分配和人口健康提供指导。

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引用次数: 0

Continuity of care across sectors in patients with type 2 diabetes: A nationwide register study in Denmark 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

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-15 DOI: 10.1016/j.pcd.2025.02.004

Anne Sofie Baymler Lundberg , Claus Høstrup Vestergaard , Annelli Sandbæk , Anders Prior

Aims

Our aims were to describe health care utilisation patterns across sectors in patients with type 2 diabetes(T2D), and to identify patient characteristics associated with low continuity of care.

Methods

A nationwide register-based cohort study including all Danish citizens recorded with a diagnosis of T2 diabetes in 2017. The outcome was continuity of care as measured by three different indices: the Continuity of Care Index (COCI), the Usual Provider of Care Index (UPC), and the Sequential Continuity Index (SECON).

Results

The median of patients with T2D had 75 % of their contacts to their usual health care provider. The strongest association with low continuity of care was the number of comorbidities, showing a dose response trend. Other patient characteristics associated with low continuity of care were duration of T2 diabetes (>10.3 years), lower age group (40–49 years), having a high education level (>15 years) and having a cancer comorbidity.

Conclusions

Our study was the first step to flag patients at potential risk of fragmented care due to many transitions between providers. This is of importance for the general practitioners, who are the coordinators of the patients with T2D and their various health conditions and contacts.

目的：我们的目的是描述2型糖尿病（T2D）患者的医疗保健利用模式，并确定与低连续性护理相关的患者特征。方法：一项全国性的基于登记的队列研究，包括2017年诊断为T2糖尿病的所有丹麦公民。结果是通过三个不同的指数来衡量护理的连续性：护理的连续性指数（COCI），通常的护理提供者指数（UPC）和顺序连续性指数（SECON）。结果：T2D患者的中位数有75% %与他们通常的卫生保健提供者接触。与低护理连续性的最强关联是合并症的数量，呈现剂量反应趋势。与低连续性护理相关的其他患者特征是T2糖尿病病程（bb0 10.3年）、年龄较小（40-49岁）、教育程度较高（bb1 15年）和有癌症合并症。结论：我们的研究是第一步，以标记患者的潜在风险碎片化护理，由于许多转换之间的提供者。这对全科医生很重要，因为他们是T2D患者及其各种健康状况和接触者的协调者。

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引用次数: 0

Family-based interventions for adults with type 2 diabetes mellitus: A systematic review and meta-analysis 以家庭为基础的成人2型糖尿病干预：系统回顾和荟萃分析。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-08 DOI: 10.1016/j.pcd.2025.01.006

Khadija A. Matrook , David L. Whitford , Susan M. Smith , Sinead McGilloway , Mapa Prabhath Piyasena , Seamus Cowman

Family-based interventions involve family members in caring for patients with diabetes, but it is unclear whether they are effective in improving outcomes for type 2 diabetes (T2DM). This systematic review and meta-analysis aim to determine the effectiveness of family-based interventions in improving glycaemic control in T2DM patients. We identified 6163 abstracts. Eleven RCTs (n = 1421) met our inclusion criteria. The overall findings suggest that family-based interventions are effective in improving HbA1c, at 3–4 months follow-up and when the intervention is delivered by nurses, with modest effects. Consideration should be given to integrating family-based interventions in the primary care among cultures with greater family cohesion.

以家庭为基础的干预涉及家庭成员照顾糖尿病患者，但尚不清楚它们是否有效改善2型糖尿病（T2DM）的预后。本系统综述和荟萃分析旨在确定以家庭为基础的干预措施在改善T2DM患者血糖控制方面的有效性。我们确定了6163篇摘要。11项rct （n = 1421）符合我们的纳入标准。总体结果表明，在3-4个月的随访中，以家庭为基础的干预措施在改善HbA1c方面是有效的，当干预措施由护士提供时，效果一般。应考虑在家庭凝聚力较强的文化之间将以家庭为基础的干预措施纳入初级保健。

引用次数: 0

Effectiveness of cardiometabolic health education interventions in populations with lower educational attainment: A systematic review and meta-analysis 低学历人群心脏代谢健康教育干预的有效性：一项系统回顾和荟萃分析。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes

Pub Date : 2025-02-07 DOI: 10.1016/j.pcd.2025.01.008

A.K. Woolley , A. Sumner , M. Gupta , H. Sathanapally , D. Bodicoat , K. Khunti , S. Seidu

Background

Health education is integral to cardiometabolic disease (CMD) management. Certain populations, such as people with lower educational attainment have higher risk of CMD and worse outcomes. They are also known to have differing preferences for health education formats and delivery compared with the general population. This study assessed the efficacy of CMD educational interventions in populations with lower educational attainment.

Methods

Four databases (Medline, Proquest, CINAHL, and Google Scholar) were systematically searched to identify studies using an educational intervention, targeting CMD-related outcomes, in a population with low educational attainment, in a community or primary care setting. A random-effects meta-analysis was conducted to calculate pooled mean differences.

Results

Educational interventions were associated with statistically significant improvements at approximately 3 months, compared with baseline, in terms of BMI (mean difference [95 % confidence interval] = −0.27 [-0.42, −0.12] kg/m²; p < 0.001), weight (-0.20 [-0.35, −0.06] kg; p = 0.007), % fat in diet (-2.45 [-3.08, −1.81]; p < 0.001), systolic blood pressure (-0.51 [-0.98, −0.05] mmHg; p = 0.031), total cholesterol (-0.54 [-0.70, −0.38] mg/dL; p < 0.001), HbA1c (-0.46 [-0.74, −0.17] %; p = 0.002), physical activity (1.04 [0.43, 1.66] hours/week; p < 0.001), and CES depression score (-0.72 [-1.16, −0.27]; 0.002). However, where 12 or 24 month follow-up data were available, there were no statistically significant differences compared with baseline.

Conclusion

CMD education interventions can improve multiple outcomes in the short term in people with lower educational attainment. Further work is needed around how such benefits may be maintained.

背景：健康教育是心血管代谢疾病（CMD）管理不可或缺的一部分。某些人群，如受教育程度较低的人患CMD的风险较高，结果也较差。众所周知，与一般人群相比，他们对健康教育的形式和提供方式有不同的偏好。本研究评估CMD教育干预在低受教育程度人群中的效果。方法：系统检索四个数据库（Medline、Proquest、CINAHL和谷歌Scholar），以确定在低受教育程度人群、社区或初级保健环境中使用教育干预、针对cmd相关结果的研究。随机效应荟萃分析计算合并平均差异。结果：与基线相比，教育干预与大约3个月时BMI的统计学显著改善相关(平均差异[95 %置信区间]= -0.27 [-0.42,-0.12]kg/m2；p 结论：CMD教育干预可在短期内改善受教育程度较低人群的多项预后。如何维持这些好处需要进一步的工作。

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引用次数: 0