Frontiers in clinical diabetes and healthcare最新文献

Background: The integration of digital health applications into type 2 diabetes mellitus (T2DM) management presents promising opportunities for optimizing glycemic control, enhancing adherence, and improving health outcomes. MyTatva's Glycemic Lifestyle Intervention in Diabetes Empowerment (GLIDE) program, which integrates dietary and exercise regimens, cognitive behavioral therapy (CBT), and Internet of Things (IoT) devices, potentiates this approach. This study aimed to evaluate the effectiveness of the GLIDE program's personalized, comprehensive approach in improving glycemic control over 90 days among T2DM patients.

Methods: During the study period, 30 diabetic patients completed their GLIDE journey with expert dieticians, physiotherapists, and behavior therapists. Each patient received a personalized root cause analysis based on lifestyle assessment and disease-specific parameters. Statistical analysis was conducted using a paired t-test on the deidentified HbA1c, FBS, and PPBS data at baseline and post-intervention.

Results: Throughout the study, 27 patients actively adhered to the GLIDE program. All the parameters showed statistically significant (p<0.05) changes post-intervention. HbA1c decreased by 11.79% from 8.43% ± 1.32 to 7.44% ± 0.64. Significant reductions were observed in PPBS (47.7%), decreasing from 260.89 mg/dL ± 36.31 to 136.27 mg/dL± 6.36, compared to FBS (31.1%), which decreased from 8.43 mg/dL± 1.32 to 7.44 mg/dL± 0.64.

Conclusions: The effectiveness of the GLIDE program is based on a comprehensive root cause analysis approach. The detailed analysis of the patient's clinical journey by health experts at regular intervals enables precise goal management, resulting in expected outcomes for better glycemic control. Therefore, personalized digital health plans are vital for achieving clinically significant changes.

Background: Utilization of diabetic care services remains a challenge among adult patients in low- and middle-income countries. Optimal utilization of diabetic care services could reduce morbidity and mortality and delay the development of long-term complications. This study assessed the utilization of basic diabetic care services and associated factors among diabetes mellitus patients at Mbarara Regional Referral Hospital in Western Uganda.

Methods: We enrolled 208 patients with either type 1 or 2 diabetes mellitus in a cross-sectional study between June and August 2022 at Mbarara Regional Referral Hospital, Uganda. Consecutive sampling was used to select patients with diabetes mellitus who attended the diabetes clinic based on their scheduled date of appointment. Optimal utilization of basic diabetic services was defined as receiving at least three of the four core services: health education, assessment of vital signs (blood sugar, blood pressure, and body mass index), assessment of diabetic complications, and diabetic drug refills. Modified Poisson regression analysis was used to assess the determinants of utilization of basic diabetic services in STATA version 14.0.

Results: Three-quarters of the study participants were female patients (75.0%), and the median (inter-quartile range, IQR) age was 52 (43, 56). Moreover, 62.0% [95% confidence interval (CI): 55.3-68.7] self-reported to have utilized basic diabetic care services. In the adjusted analysis, waiting longer than 120 min to receive any service [adjusted prevalence ratio (aPR) 0.46, 95% CI 0.27-0.80), being 45-54 years old (aPR 1.48, 95% CI:1.11-1.98), and being 55-60 years old (aPR, 1.38, 95% CI: 1.02 1.86)] were significantly associated with the utilization of basic diabetic care services.

Conclusion: Utilization of basic diabetic care services among adult patients remains sub-optimal. Age and waiting time were significantly associated with the utilization of diabetic care services. Interventions should be directed toward shortening the waiting time in service delivery at diabetes clinics.

Introduction: The prevalence of metabolic syndrome among type 2 diabetes mellitus patients was inconsistent in Ethiopia. Therefore, we aimed to pool the prevalence of metabolic syndrome among type 2 diabetes mellitus patients using a systematic review and meta-analysis.

Methods: PubMed, EMBASE, and Cochrane Library databases were systematically searched for relevant articles from January 2023 to January 2024. In addition, a manual search was conducted using published articles' reference lists. The random-effects model was used to pool prevalence from individual studies. All analysis was performed using R software.

Results: A total of nine articles met the inclusion criteria and were included in the analysis. The participants' average age was 59.8 ± 3.84 years old. The pooled prevalence of MetS in T2DM patients was 53% (95% CI: 47-58). A significant heterogeneity was found across the included studies (P < 0.001, I2 = 92%). Based on diagnostic criteria, the prevalence of MetS in T2DM patients was 49% (95% CI: 43-56), 57% (95% CI: 47-67), 57% (95% CI: 43-77), and 44% (95% CI: 20-58) based on IDF, NCEP-ATP II, 2009 harmonized, and WHO criteria. By gender, the prevalence of MetS in T2DM patients was 48% (95% CI: 28-68) for females and 32% (95% CI: 17-49) for males.

Conclusion: This study found that over half of type 2 diabetes mellitus patients in Ethiopia are affected by metabolic syndrome, with a higher prevalence observed in females compared to males. The NCEP-ATP II and 2009 harmonized criteria consistently yielded similar prevalence rates of metabolic syndrome. These findings highlight the importance of educating T2DM patients on preventing and managing cardiovascular disease and its related complications.

Introduction: Diabetic retinopathy (DR) is a highly prevalent microvascular disease among diabetic patients, resulting in irreversible blindness. However, there is a dearth of evidence on diabetic retinopathy (DR) and its associated factors in eastern Ethiopia. The study aimed to determine the prevalence of diabetic retinopathy (DR) and its associated factors among type 1 and type 2 diabetic patients at public hospitals in eastern Ethiopia.

Method: A hospital-based comparative cross-sectional was conducted among 520 diabetic patients. Epidata software was used for data entry, and STATA version 17 was used for statistical analysis. Multivariate binary logistic regression was computed to identify factors associated with DR. The Hosmer and Lemeshow chi-square test assessed goodness of fit.

Results: The overall prevalence of DR was 43.5%. The prevalence of diabetic retinopathy among type 1 DM was 38.5%, and the prevalence of DR among type 2 DM was 48.5%. Age >60 [AOR = 4.64 95% CI (1.60, 13.51)], being male [AOR = 4.05 95% CI (1.51, 10.97)], and having complications [AOR = 0.01 95% CI (0.003, 0.04)] were significantly associated with DR among type 1 diabetes. Having a family history of DM [AOR = 1.57 95% CI (1.76, 3.24)], poor glycemic status [AOR = 1.91 95% CI (1.56, 2.83)], and having complications [AOR = 11.07 95% CI (4.89, 25.13)] were significantly associated with DR among type 2 diabetes.

Conclusions: In the current study, the prevalence of DR was 43.5%. The prevalence was higher among type 2 diabetes compared to type 1 diabetes. Factors such as poor glycemic control, older age, male sex, a family history of diabetes, and complications related to diabetes were significantly associated with DR. To minimize the impact of diabetics, it requires regular screening programs for diabetic patients, especially those with poor glycemic control and other identified risk factors.

Aim: To explore parents' experiences of using continuous glucose monitoring (CGM) in their young children with early-stage type 1 diabetes, being followed in the Australian Environmental Determinants of Islet Autoimmunity (ENDIA) study.

Methods: Parents of children with persistent islet autoimmunity who enrolled in the ENDIA CGM sub-study were invited to participate in an optional interview. Semi-structured phone interviews were conducted by a single researcher using an interview guide developed by a multi-disciplinary team. Interviews were conducted following a single CGM monitoring period and prior to parents receiving feedback on their child's glycemic status. Following transcription, thematic analysis was conducted to determine common themes.

Results: Nine parents (8 mothers, 1 father) were interviewed corresponding to ten children, with a mean (SD) age of 5.6 (2.2) years, who wore CGM for 97 (0.1)% of the time during their monitoring period. Three main themes were identified: (1) Information empowers and helps to reduce uncertainty; (2) Families' acceptance of using CGM; and (3) Involvement in research provides support and preparation for the unknown.

Conclusions: Parents reported a positive experience of their young child wearing blinded CGM, and the children tolerated wearing CGM very well. Parents were empowered by knowing they would receive information on their child's glucose levels and patterns and felt well supported. This study provides novel insights into parents' experiences of using CGM in very young children with early-stage type 1 diabetes.

The purpose of the study is to investigate the importance of education and re-education for the proper use of the insulin pump (IP) in order to maintain stable glycemic control over an extended period.

Methods: The study was designed as a cross-sectional retrospective study. A total of 168 patients participated in a five-day structured education program in a small group. Following the initial education, 42 patients who met the criteria for continuation of IP treatment continued to be monitored every six months (period I). After six years of follow-up (period II) data from 36 patients were taken and analyzed. The data from the IP were downloaded from the IP Paradigm 754 "VEO" (Medtronic Inc., Illinois, USA) on the personal computer via the CareLink Pro software (Medtronic, Inc., Illinois).

Results: The number of patients using the bolus calculator (BC+) for at least 50% of all administered boluses remained high in both periods. However, BC+ patients statistically significantly increased their A1C value in period II. The average number of hypoglycemias was statistically significantly increased in the group of BC+ patients in period II compared to period I (p=0.009). The continuous glucose monitors (CGM) were used only in period II, so the number of hypoglycemias in period I were roughly estimated.

Conclusions: The long-term success of IP therapy primary depends on the proper use of the device, highlighting the importance of good education and regular re-education for both patients and health professionals. Advanced hybrid technology systems could be particularly in settings with poorly organized healthcare, where re-education is not routinely provided and diabetes control relies heavily on the patient engagement.

Diabetic foot ulcers (DFUs) and infections are common complications that frequently result in reduced quality of life and even morbidity for patients with diabetes. This paper highlights significant findings in DFU treatments and emerging advanced technologies for monitoring ulceration in patients with diabetes. The management of DFUs requires a multidisciplinary approach that involves patient education. It is well-established that poor glycemic control significantly contributes to diabetic foot ulcer complications, presenting global challenges in quality of life, economics, and resource allocation, affecting approximately half a billion people and potentially leading to lower limb amputation or mortality. Therefore, effective DFU management necessitates a multidisciplinary approach that includes patient education. However, current clinical guidelines for DFU treatment are not performing effectively, resulting in unnecessary increases in financial and emotional burden on patients. Researchers have experimented with advanced technologies and methods, including traditional approaches, to address complications related to DFU healing. This paper also presents the evolution of patents in the field of DFU medication and advanced diagnostic methods, showcasing relevant innovations that may benefit a wide range of researchers.

Purpose: The purpose of this study is to identify the use of coping strategies employed by adults with type 1 and type 2 diabetes to manage diabetes distress, using data provided by persons with lived experiences.

Methods: Adults with diabetes completed an anonymous online survey on Diabetes.co.uk, describing their coping strategies. A follow-up survey assessed the frequency of use and perceived usefulness of these strategies. Statistical analyses, including Mann-Whitney U tests, compared strategy use and usefulness between participants with low vs. high diabetes distress.

Results: 625 adults with T1D or T2D completed the survey (mean age 56.3 years; 58.9% were female). Problem-focused strategies, "Taking care of my diabetes" and "Eating healthy," were most frequently used and perceived as useful. Emotion-focused strategies such as "Expressing my emotions (crying or being angry)" were less used and perceived less useful. Participants with low vs. diabetes distress showed differences in strategy use.

Conclusions: Adults with T1D and T2D use various coping strategies for diabetes distress, with problem-focused coping being more common and found useful than emotion-focused coping. Providing individuals with a list of effective coping strategies can enhance their awareness and adoption of new strategies. Integrating personalized coping strategies into interventions can better support diabetes management.