Frontiers in clinical diabetes and healthcare最新文献

Introduction: Diabetes and hypertension (HTN) are non-communicable chronic diseases that pose a significant challenge to global public health. However, substantial disparities in the performance of these essential check-ups among diagnosed patients have been identified.

Objective: 1) To determine the existing disparities in the check-ups of patients with diabetes and HTN, 2) To observe the trend of these check-ups over the years through a Peruvian national survey.

Methods: A cross-sectional analytical study using information from Peru's Demographic and Family Health Survey between 2014 and 2022. The main variables were performance in the last year of ophthalmic, blood pressure, and glucose check-ups.

Results: Regarding the prevalence of check-ups in the last year, it was high for ophthalmic examinations (HTN: 65.46%, diabetes: 70.54%), blood pressure measurements (HTN: 81.82%, diabetes: 79.92%), and glucose measurements (HTN: 56.72%, diabetes: 83.76%). In the trend analysis for patients with diabetes, minimal variation was observed between the evaluations from 2014 to 2019, with a notable decrease in 2020 and 2021, particularly in ophthalmic check-ups, followed by a recovery in 2022. The most consistent determinants of check-up performance across both conditions were older age (≥60 years), higher educational level, higher socioeconomic status, and having health insurance. Female sex was associated with higher check-up rates in patients with HTN. Geographic and ethnic disparities were also observed, with urban residents and certain ethnic groups showing different check-up patterns.

Conclusions: This study has revealed significant disparities in the performance of essential health check-ups among Peruvian patients with diabetes and HTN, showing that various determinants play a crucial role in the frequency of these check-ups.

Background: Type 2 diabetes mellitus (T2DM) remains a global health challenge, often associated with poor self-care, inadequate glycemic control, and reduced quality of life. Conventional diabetes education mainly focuses on biomedical aspects, with limited attention to psychological self-regulation and family support, resulting in suboptimal outcomes.

Aim: This study aimed to evaluate the effectiveness of a self-regulation intervention based on the Individual and Family Self-Management Theory (IFSMT) in improving self-care ability, Glycemic control (HbA1c), and quality of life in patients with type 2 diabetes mellitus (T2DM).

Method: A quasi-experimental pretest-posttest design with a control group was used to evaluate 90 patients with T2DM recruited from primary health centers. Participants were randomly assigned to either the intervention or control groups. The intervention group received a 12-week IFSMT-based self-regulation module, while the control group received standard diabetes education. Outcomes measured included self-care ability (knowledge, belief, skills, stress management), HbA1c levels, and quality of life. Data were analyzed using chi-square, Wilcoxon Signed Rank Test, and the Mann-Whitney U Test statistical tests with a significance level of p < 0.05.

Result: The intervention group showed significant improvements in self-care ability (p < 0.001) and quality of life (p < 0.01), as well as a significant reduction in HbA1c levels (p < 0.05) compared with the control group. These findings suggest that applying self-regulation principles can enhance diabetes management beyond conventional education.

Conclusion: The IFSMT-based self-regulation intervention was effective in improving self-care, glycemic control, and quality of life in patients with type 2 diabetes mellitus (T2DM). Integration of this intervention into nursing practice and diabetes education programs may strengthen long-term management and reduce the risk of complications.

Diabetic foot ulcer (DFU) is one of the most severe complications of diabetes; its healing is typically protracted and marked by a high rate of recurrence. In recent years, electrical-stimulation (ES) therapy has emerged as a novel adjunct to conventional approaches such as debridement, negative-pressure wound therapy, and moist dressings. By applying an exogenous electric field that mimics the skin's endogenous wound currents, ES provides directional cues for cells and signaling molecules involved in repair, guiding them toward the wound bed. The external field reconstructs the bioelectric landscape, inducing oriented migration and proliferation of keratinocytes, fibroblasts, and endothelial cells, while up-regulating factors such as HIF-1α and VEGF to relieve local ischemia and promote neovascularization. Cathodal currents can also dampen the inflammatory cascade and facilitate the shift of macrophages from the M1 to the pro-healing M2 phenotype. The advent of nanogenerators, conductive hydrogels, and wireless "smart" bandages is gradually freeing ES from hard-wired leads, paving the way for home-based, closed-loop wound care. This review summarizes the latest mechanistic insights and device innovations, providing a reference for future clinical optimization and multicenter trials.

Introduction: A significant increase in HOMA-IR values has been reported in children after the COVID-19 pandemic. This study aimed to investigate how the changes of HOMA-IR after COVID-19 was post-pandemic (2023-2024).

Materials and methods: The study included 462 students aged 14-15 from Tsunan Town, Japan, who underwent health examinations between 2015 and 2024 (258 boys, 204 girls). The students' HOMA-IR, BMI, and obesity levels were studied, and temporal changes were assessed using the Kruskal-Wallis test. IR was defined as HOMA-IR ≥2.5 and temporal changes were assessed using the chi-square test.

Results: A significant change in the median HOMA-IR was observed over the 10-year period (p < 0.001). The proportion of IR was significantly higher in 2020, 2021, and 2022 (p < 0.001). Conversely, no significant differences were observed in the median BMI and obesity levels over the 10-year period (p = 0.18, p = 0.13). Significant correlations were observed between HOMA-IR and BMI as well as obesity levels throughout the entire observation period and from 2015 to 2019. However, no significant correlations were observed in the years 2020-2024.

Discussion: The significant increase in HOMA-IR observed after 2020 significantly decreased to values similar to pre-COVID-19 levels by 2023. However, BMI and obesity levels showed no temporal changes. Our findings suggest that changes in lifestyle due to the COVID-19 pandemic during 2020-2022 may have influenced IR in 14-15-year-old students, irrespective of obesity status.

Introduction: A pilot study of a multilevel, 6-month intervention (MAP) designed to increase patient portal use among patients with type 2 diabetes at community health centers (CHCs) showed promising results. The aim of this implementation analysis is to (1) describe the nurse-patient interactions and documentation of care during MAP, (2) report MAP implementation successes and challenges, and (3) describe participants' use of other online health resources.

Methods: Data were collected from MAP nurses (n = 3) and participants (n = 22).

Results: The content of portal messages between nurses and participants was educational and supportive. Numerous health-related social needs that influence participant diabetes self-management were identified, many of which were handled with relevant referrals. Participant-reported challenges changed over time, with technical barriers decreasing and competing demands increasing. Participants increased their use of online resources for health improvement.

Discussion: Addressing implementation challenges may allow the expansion of programs like MAP in CHCs and ultimately improve diabetes outcomes.

Clinical trial registration: clinicaltrials.gov, identifier NCT05180721.

Aims/introduction: This study aimed to evaluate the real-world effectiveness and safety of imeglimin in individuals with type 2 diabetes.

Materials and methods: We retrospectively reviewed 79 individuals (52 men, 27 women) with type 2 diabetes who newly initiated imeglimin (1,000 mg twice daily) and were followed for 12 months at the Central Japan International Medical Center between September 2022 and December 2023. Individuals were stratified by age (<65, 65-74, ≥75 years) and by the presence or absence of biguanide dose reduction at imeglimin initiation. The primary endpoint was the change in HbA1c from baseline to 12 months. Secondary endpoints included the achievement rate of glycemic targets, incidence of adverse events, and changes in body weight, blood pressure, liver and renal function, lipid profile, and uric acid.

Results: HbA1c significantly decreased one month after initiation and the improvement was sustained through 12 months (mean change from baseline -0.8 ± 1.2%). Effectiveness and safety did not differ significantly among age groups. Gastrointestinal symptoms were the most common adverse events (21.5%), with no age-related differences. HbA1c reduction was greater in individuals without biguanide dose reduction compared with those with dose reduction (-1.5 ± 1.7% vs -0.5 ± 0.7%, p=0.019), although adverse event frequency was comparable. Importantly, gastrointestinal disturbances were more frequent when imeglimin was combined with metformin ≥1,000 mg/day (p=0.032). Significant reductions were also observed in body weight, triglycerides, and liver enzymes at 12 months.

Conclusions: Imeglimin demonstrated sustained glycemic effectiveness and favorable tolerability in real-world practice, including among elderly individuals with type 2 diabetes. These findings suggest imeglimin as a valuable therapeutic option for older adults with type 2 diabetes. Caution is warranted when co-administered with high-dose metformin, whereas combination with <1,000 mg/day appears relatively safe.

Background: Adolescence is marked by significant changes. The presence of type 1 and type 2 diabetes mellitus (T1D and T2D) amplifies these challenges, with diabetes being the second most common chronic disease among adolescents worldwide. Adolescents with diabetes are at heightened risk for mental health issues, which escalate the risk of complications. eHealth interventions using Information and Communication Technologies show promise in improving diabetes management and psychological well-being. However, research has predominantly focused on adults, leaving gaps in understanding the efficacy of these interventions for adolescents. Medical management often prioritizes physical health, neglecting psychosocial aspects.

Objective: This meta-analysis aims to provide evidence on eHealth interventions' efficacy in supporting the psychosocial well-being of adolescents with T1D and T2D, and to investigate their impact on Hemoglobin A1c (HbA1c), quality of life, diabetes distress, anxiety, and depression symptoms.

Method: A PRISMA-guided systematic search was conducted. Randomized Controlled Trials (RCTs) regarding eHealth interventions for adolescents with diabetes were included. Data were pooled using Standard Mean Difference (SMD). Outcomes were quality of life and HbA1c. Intervention acceptability was assessed using the Odds Ratio (OR) of dropout rates.

Results: A total of ten RCTs involving only adolescents with T1D (aged 10-22) were included in the analysis. The interventions resulted in significant improvements in quality of life (SMD = 0.73; 95% CI [0.08, 1.38]; k = 6), indicating a moderate positive effect, as well as in satisfaction with life, a subscale of the overall quality of life (SMD = 0.51, 95% CI [0.08, 0.95]; k = 3). For HbA1c levels, however, the effect was small and not statistically significant (SMD = -0.21; 95% CI [-0.69, 0.27]; k = 8). Additionally, the interventions were well accepted, as suggested by the OR of 0.47 (95% CI [-0.07, 1.01]; k = 7), indicating no significant difference in dropout rates between intervention and control groups.

Conclusion: These results underscore the potential of eHealth interventions to enhance the quality of life and satisfaction with life in adolescents with T1D. Future research should continue to explore and refine eHealth interventions, ensuring an integrated approach that addresses both the medical and psychosocial needs of adolescents with diabetes.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021218623.

Background: The correlation between TREM-1 and vascular complications in patients with type 2 diabetes was a subject of debate. This study aimed to investigate the potential correlation between TREM-1 and flow-mediated dilatation (FMD) in patients with type 2 diabetes mellitus.

Methods: In this retrospective cohort research, 201 patients with type 2 patients diabetes were enrolled. The FMD Vascular Endothelial Cell Function Test Instrument was used to evaluate endothelial dysfunction. The serum levels of TREM-1 were measured using enzyme-linked immunosorbent assay. The Spearman correlation test was employed to determine the association between TREM-1 and FMD. Univariable logistic regression analysis was conducted to assess the relationship between TREM-1 and FMD. Additionally, receiver operating characteristic curve analysis was used to determine the TREM-1's predictive value. The statistical significance was evaluated using a two-tailed P-value >0.05.

Results: The study involved dichotomizing diabetic patients into low FMD (n = 138) and high FMD (n = 63) groups. The results showed that serum TREM-1 levels were significantly higher in the low FMD group than in the high FMD group (33.6 vs 58.0 pg/ml, P<0.001). A univariate logistic regression analysis revealed a statistically significant association between FMD and TREM-1 (P<0.05). The area under the curve for the receiver operating characteristic curve for model 1 (TREM-1) analysis was 0.66 (0.58-0.74) (P 0.001). Using the criteria of maximal Youden index, the threshold value for TREM-1 was found to be 38.16 ng/ml. This value showed a sensitivity of 75.4% and a specificity of 54% in predicting endothelial dysfunction in patients with type 2 diabetes mellitus.

Conclusion: Serum TREM-1 levels were associated with FMD, indicating that TREM-1 could be a valuable biomarker for assessing endothelial function in T2DM patients.

Introduction: There are conflicting results and limited data regarding the individual effectiveness of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors and their combined action in preventing type 2 diabetes mellitus (T2DM) in high-risk adults. An updated investigation is warranted. We aimed to explore their effectiveness in preventing T2DM in high-risk patients and assess changes in body weight/body mass index (BMI), glycemic parameters, and safety.

Materials and methods: PubMed, Cochrane Library Central Register of Controlled Trials, and Scopus were searched for eligible randomized controlled trials (RCTs), and a systematic review (SR) and meta-analysis (MA) were conducted. GRADE assessment was conducted for rating the overall certainty of evidence.

Results: All 24,157 participants in 10 GLP-1 RA RCTs were overweight/obese. Compared to placebo, GLP-1 RAs reduced T2DM incidence (OR 0.51; 95% CI 0.28, 0.94; P-value 0.03), and 2.4 mg of semaglutide was overall effective (OR 0.38; 95% CI 0.16, 0.94; P-value < 0.0001). Subgroup analysis indicated effectiveness in patients more than 50 years across the world, in cardiovascular disease, after 100 weeks, and during the post-intervention period. Liraglutide was not overall effective. However, subgroup analyses demonstrated effectiveness for studies that were performed worldwide, for women more than 40 years, at 3.0 mg daily, after 55 weeks of administration, and only during intervention. Exenatide was not effective. Heterogeneity was large (Q 54.56, P-value < 0.0001; I² 84%, 95% CI 74%, 89%), and MA was performed using the random-effects model. Heterogeneity was explained by countries' performance in semaglutide- and liraglutide-based RCTs and participants' mean age, dosage, duration, and post-intervention evaluation in liraglutide-based RCTs. Sensitivity analyses considering studies with post-intervention assessment and studies with the largest sample size and dropout rate more than 5% in semaglutide-based RCTs explain further heterogeneity. The quality of evidence was low. Compared to placebo, GLP-1 RAs reduced weight (kg) and BMI (kg/m²) (mean difference -6.35, P-value < 0.00001 and -2.46, P-value < 0.00001, respectively). Finally, GLP-1 RAs were safe (OR for adverse events 1.01; P-value 0.95).

Conclusions: GLP-1 RAs may prevent diabetes in high-risk adults and ameliorate body and glycemic factors. Their effectiveness should be considered carefully due to the low quality of evidence. No safety issues were identified. Future investigation is necessary to provide consistency of estimations.

Systematic review registration: OSF Registration, identifier DOI 10.17605/OSF.IO/8XH4.