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Gestational diabetes mellitus in Cameroon: prevalence, risk factors and screening strategies 喀麦隆的妊娠糖尿病:发病率、风险因素和筛查策略
Pub Date : 2024-01-09 DOI: 10.3389/fcdhc.2023.1272333
E. Sobngwi, Joelle Sobngwi-Tambekou, J. Katte, J. B. Echouffo-Tcheugui, E. Balti, A. Kengne, L. Fezeu, C. Ditah, A. Tchatchoua, M. Dehayem, Nigel C. Unwin, Judith Rankin, J. Mbanya, R. Bell
The burden of gestational diabetes (GDM) and the optimal screening strategies in African populations are yet to be determined. We assessed the prevalence of GDM and the performance of various screening tests in a Cameroonian population.We carried out a cross-sectional study involving the screening of 983 women at 24-28 weeks of pregnancy for GDM using serial tests, including fasting plasma (FPG), random blood glucose (RBG), a 1-hour 50g glucose challenge test (GCT), and standard 2-hour oral glucose tolerance test (OGTT). GDM was defined using the World Health Organization (WHO 1999), International Association of Diabetes and Pregnancy Special Group (IADPSG 2010), and National Institute for Health Care Excellence (NICE 2015) criteria. GDM correlates were assessed using logistic regressions, and c-statistics were used to assess the performance of screening strategies.GDM prevalence was 5·9%, 17·7%, and 11·0% using WHO, IADPSG, and NICE criteria, respectively. Previous stillbirth [odds ratio: 3·14, 95%CI: 1·27-7·76)] was the main correlate of GDM. The optimal cut-points to diagnose WHO-defined GDM were 5·9 mmol/L for RPG (c-statistic 0·62) and 7·1 mmol/L for 1-hour 50g GCT (c-statistic 0·76). The same cut-off value for RPG was applicable for IADPSG-diagnosed GDM while the threshold was 6·5 mmol/L (c-statistic 0·61) for NICE-diagnosed GDM. The optimal cut-off of 1-hour 50g GCT was similar for IADPSG and NICE-diagnosed GDM. WHO-defined GDM was always confirmed by another diagnosis strategy while IADPSG and GCT independently identified at least 66·9 and 41·0% of the cases.GDM is common among Cameroonian women. Effective detection of GDM in under-resourced settings may require simpler algorithms including the initial use of FPG, which could substantially increase screening yield.
妊娠糖尿病(GDM)在非洲人口中的负担和最佳筛查策略尚待确定。我们开展了一项横断面研究,对 983 名怀孕 24-28 周的妇女进行了妊娠糖尿病筛查,筛查方法包括空腹血浆 (FPG)、随机血糖 (RBG)、1 小时 50 克葡萄糖挑战试验 (GCT) 和标准 2 小时口服葡萄糖耐量试验 (OGTT)。GDM的定义采用世界卫生组织(WHO,1999年)、国际糖尿病与妊娠特别小组协会(IADPSG,2010年)和美国国家卫生保健卓越研究所(NICE,2015年)的标准。使用逻辑回归评估了 GDM 相关性,并使用 c 统计量评估了筛查策略的效果。根据 WHO、IADPSG 和 NICE 标准,GDM 患病率分别为 5-9%、17-7% 和 11-0%。既往死产[几率比:3-14,95%CI:1-27-7-76]是 GDM 的主要相关因素。诊断 WHO 定义的 GDM 的最佳临界值为 RPG 5-9 mmol/L(c-统计量 0-62)和 1 小时 50g GCT 7-1 mmol/L(c-统计量 0-76)。RPG的临界值同样适用于IADPSG诊断的GDM,而NICE诊断的GDM的临界值为6-5 mmol/L(c-统计量0-61)。对于 IADPSG 和 NICE 诊断的 GDM,1 小时 50g GCT 的最佳临界值相似。WHO定义的GDM总能通过另一种诊断策略得到证实,而IADPSG和GCT至少能独立发现66-9%和41-0%的病例。在资源匮乏的环境中有效检测 GDM 可能需要更简单的算法,包括最初使用 FPG,这可以大大提高筛查率。
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引用次数: 0
Participation in a multicomponent lifestyle intervention for people with obesity improves glycated hemoglobin (HbA1c) 参与针对肥胖症患者的多成分生活方式干预可改善糖化血红蛋白 (HbA1c)
Pub Date : 2023-12-22 DOI: 10.3389/fcdhc.2023.1274388
Mathias Høgsholt, Signe Kierkegaard-Brøchner, U. Sørensen, Lene Bastrup Lange, L. S. Mortensen, Jens Meldgaard Bruun
Obesity is associated with compromised glucose metabolism. Hence, it is of interest to investigate if the lifestyle interventions used in the LIBRA-cohort, which aimed at not only weight loss, but also patient well-being, could also help obese patients improve glucose metabolism by evidence of reduced HbA1c. The aim of the study was to retrospectively investigate if patients who were referred to a lifestyle intervention for obesity, were able to alter HbA1c.Patients with a BMI≥30 undergoing a 6-month lifestyle intervention, who also completed physical and mental health surveys and whose baseline and 6-month blood samples were available, were included in the analysis. For changes in HbA1c and body weight a clinically relevant change of 5≥mmom/mol and 5%≥, respectively, was chosen. Participants were divided into groups according to their baseline HbA1c level: “Diabetes”: HbA1c of ≥6.5% (≥48 mmol/mol), “Prediabetes”: HbA1c of 5.7% to 6.4% (39-47.99 mmol/mol) or “Normal” HbA1c <5.7% (<39 mmol/mol).180 patients met the stated inclusion criteria and these patients were divided into groups (median age (25th;75th quartile): Diabetes: n=47, age 54 (43;60), 51% women, Prediabetes: n=68, age 60 (50;66), 71% women and Normal: n=65, median age 61 (50;66), 85% women. Significant reductions were found in all three groups and specifically in the diabetes group HbA1c was reduced (mean [95%CI]) -5[-8;-2] mmol/mol from baseline to the end of the intervention. Furthermore, 35% of patients with prediabetes normalized their HbA1c (<39) and 30% patients with diabetes reduced their HbA1c <48. All groups had clinically relevant (≥5%) reductions in body weight (p<0.01). There was an association between body weight reduction and HbA1c reduction in the diabetes group (p<0.01). All groups reported improvements in physical health (p<0.01).In this retrospective cohort study, all patients achieved clinically relevant weight loss after participation in the lifestyle intervention and obese patients with diabetes achieved clinically relevant reductions in HbA1c after 6-months. More than 1/3 of patients with prediabetes normalized their HbA1c.
肥胖与糖代谢受损有关。因此,研究 LIBRA 队列中使用的生活方式干预措施(不仅旨在减轻体重,还旨在改善患者健康)是否也能通过降低 HbA1c 的证据帮助肥胖患者改善糖代谢是很有意义的。这项研究的目的是回顾性调查因肥胖而接受生活方式干预的患者是否能够改变 HbA1c。BMI 指数≥30 的患者接受了为期 6 个月的生活方式干预,同时还完成了身体和心理健康调查,并提供了基线和 6 个月的血液样本,这些患者都被纳入了分析范围。HbA1c 和体重的临床相关变化分别为 5≥mmom/mol 和 5%≥。根据参与者的 HbA1c 基线水平将其分为几组:"糖尿病组HbA1c≥6.5%(≥48 mmol/mol),"糖尿病前期":180 名患者符合规定的纳入标准,这些患者被分为几组(年龄中位数(第 25 分位;第 75 分位):糖尿病:47 人,年龄 54(43;60)岁,51% 为女性;糖尿病前期:68 人,年龄 60(50;66)岁,71% 为女性;正常:65 人,中位年龄 61(50;66)岁,85% 为女性。所有三组患者的 HbA1c 均有显著降低,特别是糖尿病组,从基线到干预结束,HbA1c 降低了(平均值[95%CI])-5[-8;-2] mmol/mol。此外,35% 的糖尿病前期患者 HbA1c 降至正常值(<39),30% 的糖尿病患者 HbA1c 降至 <48。所有组别的体重都有临床意义上的(≥5%)下降(p<0.01)。在糖尿病组,体重减轻与 HbA1c 降低之间存在关联(p<0.01)。在这项回顾性队列研究中,所有患者在参与生活方式干预后都实现了临床相关的体重减轻,肥胖糖尿病患者在 6 个月后实现了临床相关的 HbA1c 降低。超过 1/3 的糖尿病前期患者 HbA1c 恢复正常。
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引用次数: 0
Exploring the progress of artificial intelligence in managing type 2 diabetes mellitus: a comprehensive review of present innovations and anticipated challenges ahead 探索人工智能在管理 2 型糖尿病方面的进展:对当前创新和未来预期挑战的全面回顾
Pub Date : 2023-12-15 DOI: 10.3389/fcdhc.2023.1316111
Farwa Tahir, Muhammad Farhan
A significant worldwide health issue, Type 2 Diabetes Mellitus (T2DM) calls for creative solutions. This in-depth review examines the growing severity of T2DM and the requirement for individualized management approaches. It explores the use of artificial intelligence (AI) in the treatment of diabetes, highlighting its potential for diagnosis, customized treatment plans, and patient self-management. The paper highlights the roles played by AI applications such as expert systems, machine learning algorithms, and deep learning approaches in the identification of retinopathy, the interpretation of clinical guidelines, and prediction models. Examined are difficulties with individualized diabetes treatment, including complex technological issues and patient involvement. The review highlights the revolutionary potential of AI in the management of diabetes and calls for a balanced strategy in which AI supports clinical knowledge. It is crucial to pay attention to ethical issues, data privacy, and joint research initiatives.
2 型糖尿病(T2DM)是一个重大的全球健康问题,需要创造性的解决方案。这篇深度综述探讨了 T2DM 日益严重的问题以及对个性化管理方法的需求。它探讨了人工智能(AI)在糖尿病治疗中的应用,强调了人工智能在诊断、定制治疗计划和患者自我管理方面的潜力。论文强调了专家系统、机器学习算法和深度学习方法等人工智能应用在识别视网膜病变、解释临床指南和预测模型方面发挥的作用。文章还探讨了个体化糖尿病治疗的困难,包括复杂的技术问题和患者参与。综述强调了人工智能在糖尿病管理中的革命性潜力,并呼吁采取平衡的策略,让人工智能为临床知识提供支持。关注伦理问题、数据隐私和联合研究计划至关重要。
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引用次数: 0
Factors associated with diabetes concordant comorbidities among adult diabetic patients in Central Ethiopia: a cross-sectional study 埃塞俄比亚中部成年糖尿病患者糖尿病并发症的相关因素:一项横断面研究
Pub Date : 2023-12-13 DOI: 10.3389/fcdhc.2023.1307463
Y. Negussie, Mihiret Shawel Getahun, Nardos Tilahun Bekele
Diabetes comorbidities are a serious public health issue that raises the risk of adverse health effects and complicates diabetes management. It also harms emotional health, medication adherence, self-management, and general quality of life. However, evidence is scarce in Ethiopia, particularly in the study area. Thus, this study aimed to estimate the prevalence of diabetes concordant comorbidities and identify factors associated with the presence of concordant comorbidities among adult diabetic patients in central Ethiopia.A health facility-based cross-sectional study was conducted among 398 adult diabetic patients. A computer-generated simple random sampling was used to select study participants. Data were collected using a structured data extraction checklist. The collected data were entered into Epi info version 7.2 and exported to SPSS version 27 for analysis. A binary logistic regression model was used to analyze the association between dependent and independent variables. An adjusted odds ratio with the corresponding 95% confidence interval was used to measure the strength of the association and statistical significance was declared at a p-value < 0.05.The prevalence of diabetes-concordant comorbidities was 41% (95% CI: 36.2-46.0). The multivariable logistic regression model showed that age 41–60 (AOR = 2.86, 95% CI: 1.60–5.13), place of residence (AOR = 2.22, 95% CI: 1.33–3.70), having type two diabetes (AOR = 3.30, 95% CI: 1.21–8.99), and having positive proteinuria (AOR = 2.64, 95% CI: 1.47–4.76) were significantly associated with diabetes concordant comorbidities.The prevalence of diabetes-concordant comorbidities was relatively high. Age, place of residence, type of diabetes, and positive proteinuria were factors associated with diabetes-concordant comorbidities. Prevention, early identification, and proper management of diabetes comorbidities are crucial.
糖尿病并发症是一个严重的公共卫生问题,它增加了不良健康影响的风险,并使糖尿病管理复杂化。它还会损害情绪健康、服药依从性、自我管理和总体生活质量。然而,在埃塞俄比亚,尤其是在本研究地区,相关证据还很少。因此,本研究旨在估算埃塞俄比亚中部成年糖尿病患者中糖尿病并发症的患病率,并确定与并发症相关的因素。研究采用计算机生成的简单随机抽样来选择参与者。使用结构化数据提取清单收集数据。收集到的数据被输入 Epi info 7.2 版,并导出到 SPSS 27 版进行分析。采用二元逻辑回归模型分析因变量和自变量之间的关联。用调整后的几率和相应的 95% 置信区间来衡量相关性的强弱,当 p 值小于 0.05 时即为统计学意义。糖尿病合并症的患病率相对较高。年龄、居住地、糖尿病类型和蛋白尿阳性是糖尿病并发症的相关因素。预防、早期识别和妥善处理糖尿病合并症至关重要。
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引用次数: 0
Dysregulated coagulation system links to inflammation in diabetic kidney disease 凝血系统失调与糖尿病肾病的炎症有关
Pub Date : 2023-12-08 DOI: 10.3389/fcdhc.2023.1270028
Mengyun Xiao, D. Tang, Shaodong Luan, Bo Hu, Wenyu Gong, Wolfgang Pommer, Yong Dai, Lianghong Yin
Diabetic kidney disease (DKD) is a significant contributor to end-stage renal disease worldwide. Despite extensive research, the exact mechanisms responsible for its development remain incompletely understood. Notably, patients with diabetes and impaired kidney function exhibit a hypercoagulable state characterized by elevated levels of coagulation molecules in their plasma. Recent studies propose that coagulation molecules such as thrombin, fibrinogen, and platelets are interconnected with the complement system, giving rise to an inflammatory response that potentially accelerates the progression of DKD. Remarkably, investigations have shown that inhibiting the coagulation system may protect the kidneys in various animal models and clinical trials, suggesting that these systems could serve as promising therapeutic targets for DKD. This review aims to shed light on the underlying connections between coagulation and complement systems and their involvement in the advancement of DKD.
糖尿病肾病(DKD)是世界范围内终末期肾脏疾病的重要贡献者。尽管进行了广泛的研究,但其发展的确切机制仍然不完全清楚。值得注意的是,糖尿病和肾功能受损的患者表现出高凝状态,其特征是血浆中凝血分子水平升高。最近的研究表明,凝血酶、纤维蛋白原和血小板等凝血分子与补体系统相互关联,引起炎症反应,可能加速DKD的进展。值得注意的是,在各种动物模型和临床试验中,研究表明抑制凝血系统可以保护肾脏,这表明这些系统可以作为DKD的有希望的治疗靶点。这篇综述旨在阐明凝血和补体系统之间的潜在联系及其在DKD进展中的参与。
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引用次数: 0
The benefits of GLP1 receptors in cardiovascular diseases GLP1 受体对心血管疾病的益处
Pub Date : 2023-12-08 DOI: 10.3389/fcdhc.2023.1293926
L. Ferhatbegović, Denis Mršić, Amra Macić-Džanković
Glucagon like peptide-1 (GLP-1) receptor agonists are well established drugs for the treatment of type 2 diabetes (T2D). In addition to glycemic control, GLP-1 receptor agonists have beneficial other effects. They act by binding to GLP-1 receptors, which are widely distributed in the body, including cardiomyocytes and blood vessels. The aim of this article is to provide a comprehensive review of GLP-1 receptor agonists impact on cardiovascular outcomes and risk reduction. In the last decade, several cardiovascular outcomes trials (CVOT) have been conducted in order to explore cardiovascular benefit of GLP-1 receptor agonists. CVOTs primarily proved cardiovascular safety and tolerability of different GLP-1 receptor agonists, but also showed cardiovascular benefit of specific drugs. CVOTs have shown that GLP-1 receptor agonists reduce MACE in patients with T2D compared to placebo. In addition, they have positive impact on several cardiovascular risk factors such as obesity by promoting weight loss, blood pressure and blood lipid levels. Also, they stimulate the endothelium to produce nitric oxide, reduce oxidative stress, and have antiatherogenic and antiinflammatory effects. Studies have shown their positive impact on kidney outcomes in patients with T2D compared to placebo. The results of previous trials are encouraging in terms of multiple positive effects of GLP-1 receptor agonists. However, further research is needed to understand their full potential and all details of their mechanism of action, which will enable to expand the therapeutic indications and to determine their optimal use in clinical practice.
胰高血糖素样肽-1 (GLP-1)受体激动剂是治疗2型糖尿病(T2D)的公认药物。除了血糖控制,GLP-1受体激动剂还有其他有益的作用。它们通过与GLP-1受体结合而起作用,GLP-1受体广泛分布在体内,包括心肌细胞和血管。本文的目的是提供GLP-1受体激动剂对心血管结局和风险降低的影响的全面综述。在过去的十年中,为了探索GLP-1受体激动剂对心血管的益处,已经进行了几项心血管结局试验(CVOT)。CVOTs主要证明了不同GLP-1受体激动剂的心血管安全性和耐受性,但也显示了特定药物的心血管益处。CVOTs显示,与安慰剂相比,GLP-1受体激动剂可降低T2D患者的MACE。此外,它们通过促进体重减轻、血压和血脂水平,对肥胖等几种心血管风险因素有积极影响。此外,它们刺激内皮细胞产生一氧化氮,减少氧化应激,并具有抗动脉粥样硬化和抗炎作用。研究表明,与安慰剂相比,它们对T2D患者肾脏预后有积极影响。在GLP-1受体激动剂的多重积极作用方面,先前的试验结果令人鼓舞。然而,需要进一步的研究来了解它们的全部潜力和作用机制的所有细节,这将有助于扩大治疗适应症并确定它们在临床实践中的最佳使用。
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引用次数: 0
Evaluating consistency of physical activity and exercise prescription in the UK for people with diabetes – a Delphi study 评估英国糖尿病患者体育锻炼和运动处方的一致性--德尔菲研究
Pub Date : 2023-12-07 DOI: 10.3389/fcdhc.2023.1278597
Clare Strongman, Francesca Cavallerio, Matthew A. Timmis, Andrew Morrison
Increased physical activity is recommended as a cost-effective measure to tackle long-term management of people with diabetes, but research on interventions lacks consistency in terms of effective duration and modality. The aim of this study was to evaluate expert consensus on exercise and physical activity prescription via a three-round Delphi study conducted with 45 UK-based health and fitness professionals experienced in prescribing exercise or physical activity to people with diabetes.The majority of items put forward to the panel reached consensus with 70% or above voting these items as important, but the details of the type, duration and/or modality of exercise or physical activity prescription within these items often contradicted each other, suggesting that patients are receiving inconsistent advice. The range of different exercise prescription found in this study suggests that patients are being given inconsistent and potentially confusing advice, which may affect their participation in exercise and long-term lifestyle change.More consistent promotion of advice from healthcare and fitness professionals may help with increasing physical activity in this participant group and achieving long term behavior change, reducing patient symptoms as well as reducing the cost to the National Health Service (NHS).
增加身体活动被推荐为解决糖尿病患者长期管理问题的一种具有成本效益的措施,但有关干预措施的研究在有效持续时间和方式方面缺乏一致性。本研究的目的是通过一项三轮德尔菲研究来评估专家对运动和体育活动处方的共识,该研究由45名英国健康和健身专业人士进行,他们在为糖尿病患者开运动或体育活动处方方面经验丰富。提交给专家组的大多数项目都达成了共识,70%或以上的人认为这些项目很重要,但这些项目中关于运动或体育活动处方的类型、持续时间和/或方式的细节往往相互矛盾,表明患者接受了不一致的建议。在这项研究中发现的各种不同的运动处方表明,患者得到的建议不一致,甚至可能令人困惑,这可能会影响他们参与运动和长期改变生活方式。更一致地推广医疗保健和健身专业人员的建议可能有助于增加这一参与者群体的身体活动,实现长期的行为改变,减轻患者的症状,并减少国家卫生服务(NHS)的成本。
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引用次数: 0
Editorial: Current understanding of complications associated with diabetes 社论:目前对糖尿病并发症的认识
Pub Date : 2023-12-06 DOI: 10.3389/fcdhc.2023.1338656
S. Srivastava
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引用次数: 0
A co-designed, community-based intensive health behavior intervention promotes participation and engagement in youth with risk factors for type 2 diabetes 共同设计、以社区为基础的强化健康行为干预措施可促进存在 2 型糖尿病风险因素的青少年的参与和投入
Pub Date : 2023-12-01 DOI: 10.3389/fcdhc.2023.1264312
Julie M Pike, Kathryn M Haberlin-Pittz, Basmah S. Alharbi, Susan M. Perkins, Tamara S. Hannon
Obesity among youth (children and adolescents) is associated with increased risk for youth-onset type 2 diabetes. Lifestyle change can delay or prevent the development of type 2 diabetes, yet real-world implementation of health behavior recommendations is challenging. We previously engaged youth with risk factors for type 2 diabetes, their caregivers, and professionals in a human-centered design study to co-design a lifestyle change program. Here we report the outcomes for this 16-week co-designed lifestyle change program for youth at risk for T2D and their caregivers.This single-arm family-based cohort study included youth aged 7-18 years, with BMI ≥85th percentile (overweight or obese) and at least one additional risk factor for type 2 diabetes, and their caregivers. Clinical (BMI, HbA1c), self-reported physical activity, and quality of life outcomes were evaluated at baseline (B), post-intervention (M4), and 1 year (M12) following the intervention.Seventy-eight youth (mean age 12.4 ± 2.7y, 67% female, 37.8% white) and 65 caregivers were included in the data analysis. Youth baseline BMI z-scores (2.26 ± 0.47) and HbA1c (5.3 ± 0.3) were unchanged at follow up time points [BMI z-scores M4 (2.25 ± 0.52), M12 (2.16 ± 0.58), p-value 0.46], [HbA1c M4 (5.3 ± 0.3), M12 (5.2 ± 0.3), p-value (0.04)]. Youth reported increased physical activity at M4 (p = 0.004), but not at M12. Youth quality of life scores increased at M12 (p=0.01). Families who attended at least one session (n=41) attended an average of 9 out of 16 sessions, and 37 percent of families attended 13 or more sessions.A co-designed, community-based lifestyle intervention promotes increased physical activity, improved quality of life, maintenance of BMI z-scores and HbA1c, and engagement in youth with risk factors for T2D.
青少年(儿童和青少年)肥胖与青年发病2型糖尿病的风险增加有关。生活方式的改变可以延缓或预防2型糖尿病的发展,但在现实生活中实施健康行为建议是具有挑战性的。我们之前在一项以人为中心的设计研究中招募了有2型糖尿病危险因素的年轻人、他们的照顾者和专业人员,共同设计了一个生活方式改变项目。在这里,我们报告了这项为期16周的共同设计的生活方式改变计划的结果,该计划针对有T2D风险的青少年及其照顾者。这项以家庭为基础的单臂队列研究纳入了年龄在7-18岁、BMI≥85百分位(超重或肥胖)且至少有一个额外的2型糖尿病危险因素的青少年及其照顾者。在基线(B)、干预后(M4)和干预后1年(M12)对临床(BMI、HbA1c)、自我报告的身体活动和生活质量结果进行评估。数据分析纳入78名青年(平均年龄12.4±2.7岁,女性67%,白人37.8%)和65名护理人员。青年基线BMI z-评分(2.26±0.47)和HbA1c(5.3±0.3)在随访时间点不变[BMI z-评分M4(2.25±0.52),M12(2.16±0.58),p值0.46],[HbA1c M4(5.3±0.3),M12(5.2±0.3),p值(0.04)]。青少年报告说,在M4组体力活动增加(p = 0.004),但在M12组则没有。青少年生活质量评分在M12时升高(p=0.01)。至少参加一次会议的家庭(n=41)平均参加了16次会议中的9次,37%的家庭参加了13次或更多的会议。共同设计的以社区为基础的生活方式干预促进了身体活动的增加,生活质量的提高,BMI z-评分和HbA1c的维持,以及有t2dm危险因素的年轻人的参与。
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引用次数: 0
Editorial: New e-health interventions and diabetes: effects on self-management, psychological well-being and quality of life. 社论:新的电子健康干预措施与糖尿病:对自我管理、心理健康和生活质量的影响。
Pub Date : 2023-11-29 eCollection Date: 2023-01-01 DOI: 10.3389/fcdhc.2023.1340396
María Teresa Anarte-Ortiz
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引用次数: 0
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Frontiers in clinical diabetes and healthcare
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