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The improvement effect of apple cider vinegar as a functional food on anthropometric indices, blood glucose and lipid profile in diabetic patients: a randomized controlled clinical trial 苹果醋作为功能性食品对糖尿病患者人体测量指标及血糖、血脂的改善作用:一项随机对照临床试验
Pub Date : 2023-11-13 DOI: 10.3389/fcdhc.2023.1288786
Sima Jafarirad, Mohammad-Reza Elahi, Anahita Mansoori, Abdollah Khanzadeh, Mohammad-Hossein Haghighizadeh
Background Numerous medical costs are spent each year on treating and preventing the progression of diabetes. The positive effect of apple cider vinegar (ACV) has been shown on post-prandial hyperglycemia. This study aimed to evaluate the effects of prolonged consumption of ACV on blood glucose indices and lipid profile in patients with type 2 diabetes. Methods This study was a randomized clinical trial and the participants were adults with type 2 diabetes. Participants were divided into two groups: ACV and control. The ACV group was treated with 30 ml of ACV per day. Both the intervention and control groups received the same recommendation for a healthy diet. Before and after eight weeks, fasting blood glucose, insulin, hemoglobin A1C, insulin resistance, total cholesterol (Chol), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride were measured. Results Fasting blood glucose decreased after intervention in both groups, which was only significant in the ACV group (p = 0.01). There was a significant difference in hemoglobin A1C levels between the two groups (p < 0.001) after eight weeks. LDL was decreased in the ACV group (p < 0.001). Total Chol, LDL/HDL and Chol/HDL ratio decreased after the intervention period in the ACV group compared to the control group (p = 0.003, p = 0.001 and p = 0.001, respectively). Conclusion Daily consumption of ACV may have beneficial effects in controlling blood glucose indices and lipid profile in patients with type 2 diabetes. Clinical trial registration http://www.irct.ir , identifier IRCT20140107016123N13.
背景:每年在治疗和预防糖尿病的进展上花费了大量的医疗费用。苹果醋(ACV)对餐后高血糖有积极作用。本研究旨在评估长期服用ACV对2型糖尿病患者血糖指标和血脂的影响。方法本研究为随机临床试验,受试者为2型糖尿病成人患者。参与者被分为两组:ACV组和对照组。ACV组给予ACV 30 ml / d治疗。干预组和对照组都得到了同样的健康饮食建议。8周前后分别测定空腹血糖、胰岛素、血红蛋白A1C、胰岛素抵抗、总胆固醇(Chol)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、甘油三酯。结果两组干预后空腹血糖均有降低,仅ACV组有显著性差异(p = 0.01)。两组患者血红蛋白A1C水平差异有统计学意义(p <0.001)。ACV组LDL降低(p <0.001)。干预期后,ACV组的Total Chol、LDL/HDL、Chol/HDL比值均低于对照组(p = 0.003、p = 0.001、p = 0.001)。结论每日服用ACV对控制2型糖尿病患者血糖指标及血脂有有益作用。临床试验注册http://www.irct.ir,标识符IRCT20140107016123N13。
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引用次数: 0
Internet-based cognitive-behavioral therapy is effective in reducing depressive symptomatology in type 1 diabetes: results of a randomized controlled trial 基于网络的认知行为疗法在减少1型糖尿病患者抑郁症状方面是有效的:一项随机对照试验的结果
Pub Date : 2023-11-07 DOI: 10.3389/fcdhc.2023.1209236
Mónica Carreira, Ma Soledad Ruiz de Adana, José Luis Pinzón, María Teresa Anarte-Ortiz
Objective Depression in people with diabetes is associated with poorer health outcomes. Although web programs integrating cognitive-behavioral therapy with diabetes education have shown good results, no similar approach has been implemented in Spain. This aim of this study was to administer an Internet-based cognitive-behavioral therapy program (CBT) for the treatment of mild-moderate depressive symptomatology in individuals with type 1 diabetes (WEB_TDDI1 study) and evaluate the efficacy of this program. Research design and methods A pre-post randomized controlled study was conducted. The sample comprised 65 people with type 1 diabetes and mild-moderate depressive symptoms: 35 treatment group (TG) and 30 control group (CG). The following effects of the nine-session program were analyzed: depression (Beck Depression Inventory Fast Screen, BDI-FS), metabolic variables (glycosilated hemoglobin, HbA1c), and other psychological variables including anxiety (State Trait Anxiety Inventory, STAI), fear of hypoglycemia (Fear of Hypoglycemia Questionnaire, FH-15), distress (Diabetes Distress Questionnaire (DDS), quality of life (Diabetes Quality of Life Questionnaire, DQOL),and treatment adherence (Diabetes Self-Care Inventory-Revised questionnaire, SCI-R). Results At the end of the treatment program, only 28 people were evaluated (TG=8; CG=20). However, a significant reduction was found in both groups in BDI-FS and STAI-T scores, which was significantly greater in the TG. Significant improvements were also found in the TG in DQOL, FH-15, DDS and SCI-R scores. The percentage change in these variables was also statistically significant in the TG versus the CG. However, no significant results were found in HbA1c. Conclusions The Internet-based cognitive-behavioral therapy program for the treatment of mild-moderate depressive symptomatology in people with type 1 diabetes (WEB_TDDI1 study) is effective in reducing depressive symptomatology in the sample that completed the study. Positive results are also produced in other variables associated with depression in this population such as diabetes-related distress, trait anxiety, fear of hypoglycemia, quality of life, and adherence to diabetes treatment. Although new studies would be necessary to support the results of this platform, the results obtained are positive and support the use of this platform as an appropriate treatment for this population. Clinical trial registration ClinicalTrials.gov; identifier NCT03473704.
目的糖尿病患者抑郁与较差的健康状况有关。尽管将认知行为疗法与糖尿病教育相结合的网络项目显示出良好的效果,但在西班牙还没有实施类似的方法。本研究的目的是实施一种基于网络的认知行为治疗方案(CBT)来治疗1型糖尿病患者的轻中度抑郁症状(WEB_TDDI1研究),并评估该方案的疗效。研究设计与方法采用前后随机对照研究。样本包括65名患有1型糖尿病和轻度-中度抑郁症状的人:35名治疗组(TG)和30名对照组(CG)。分析了九期课程的以下效果:抑郁(贝克抑郁量表快速筛查,BDI-FS)、代谢变量(糖化血红蛋白,HbA1c)和其他心理变量包括焦虑(状态-特质焦虑量表,STAI)、对低血糖的恐惧(低血糖恐惧问卷,FH-15)、焦虑(糖尿病焦虑问卷,DDS)、生活质量(糖尿病生活质量问卷,DQOL)和治疗依从性(糖尿病自我护理问卷-修订问卷,SCI-R)。结果在治疗方案结束时,只有28人接受了评估(TG=8;CG = 20)。然而,两组患者的BDI-FS和STAI-T评分均有显著下降,其中TG的下降幅度更大。TG、DQOL、FH-15、DDS和SCI-R评分均有显著改善。这些变量的百分比变化在TG和CG中也具有统计学意义。然而,在HbA1c方面没有发现显著的结果。基于网络的认知行为治疗方案治疗1型糖尿病患者的轻中度抑郁症状(WEB_TDDI1研究)在完成研究的样本中有效地减轻了抑郁症状。在这一人群中,与抑郁相关的其他变量也产生了积极的结果,如糖尿病相关的痛苦、特质焦虑、对低血糖的恐惧、生活质量和对糖尿病治疗的坚持。虽然需要新的研究来支持该平台的结果,但获得的结果是积极的,支持将该平台作为该人群的适当治疗方法。临床试验注册ClinicalTrials.gov;标识符NCT03473704。
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引用次数: 0
E670G PCSK9 polymorphism in HeFH & CAD with diabetes: is the bridge to personalized therapy within reach? E670G PCSK9多态性在HeFH中的应用冠心病合并糖尿病:个性化治疗的桥梁是否触手可及?
Pub Date : 2023-11-01 DOI: 10.3389/fcdhc.2023.1277288
Rano Alieva, Aleksandr Shek, Alisher Abdullaev, Khurshid Fozilov, Shovkat Khoshimov, Guzal Abdullaeva, Dariya Zakirova, Rano Kurbanova, Lilia Kan, Andrey Kim
Objective To assess the distribution of PCSK9 E670G genetic polymorphism and PCSK9 levels in patients with Coronary Artery Disease (CAD) and Heterozygous Familial Hypercholesterolemia (HeFH), based on the presence of type 2 Diabetes Mellitus (T2DM). Methods The study included 201 patients with chronic CAD, including those with HeFH (n=57, group I) and without it (n=144, group II). DLCN was used to diagnose HeFH. The PCSK9 E670G (rs505151) polymorphism was genetically typed using the PCR-RFLP procedure. In both the patient and control groups, the genotype frequency matched the Hardy-Weinberg equilibrium distribution (P&gt;0.05). Results There were twice more G alleles in group I (13, 11.4%) than in group II (17, 6.0%), and thrice more (1, 3.0%) than in the healthy control group; nevertheless, these differences weren’t statistically significant. Simultaneously, PCSK9 levels were higher in HeFH patients (P&lt;0.05) compared to non-HeFH patients not taking statins (n=63). T2DM was equally represented in groups I and II (31.6% vs. 33.3%). But carriers of AG+GG genotypes in group I had a higher chance of having a history of T2DM (RR 4.18; 95%CI 2.19-8.0; P&lt;0.001), myocardial infarction (RR 1.79; 95%CI 1.18-2.73; P&lt;0.05), and revascularization (RR 12.6; 95%CI 4.06-38.8; P&lt;0.01), than AA carriers. T2DM was also more common among G allele carriers (RR 1.85; 95% CI 1.11-3.06; P&lt;0.05) in patients with non-HeFH. Conclusion T2DM in patients with CAD, both with HeFH and non-HeFH, in the Uzbek population was significantly more often associated with the presence of the “gain-of-function” G allele of the PCSK9 E670G genetic polymorphism.
目的探讨PCSK9 E670G基因多态性在伴有2型糖尿病(T2DM)的冠心病(CAD)和杂合子家族性高胆固醇血症(HeFH)患者中的分布及PCSK9水平。方法201例慢性CAD患者,包括合并HeFH患者(n=57,组I)和未合并HeFH患者(n=144,组II),采用DLCN诊断HeFH。采用PCR-RFLP方法对PCSK9 E670G (rs505151)多态性进行遗传分型。在患者和对照组中,基因型频率均符合Hardy-Weinberg平衡分布(P>0.05)。结果ⅰ组G等位基因数量(13,11.4%)比ⅱ组(17,6.0%)多2倍,比健康对照组(1,3.0%)多3倍;然而,这些差异在统计学上并不显著。同时,与未服用他汀类药物的非HeFH患者(n=63)相比,HeFH患者的PCSK9水平较高(P<0.05)。T2DM在I组和II组中的比例相等(31.6%对33.3%)。而ⅰ组AG+GG基因型携带者有T2DM病史的几率更高(RR 4.18;95%可信区间2.19 - -8.0;P<0.001),心肌梗死(RR 1.79;95%可信区间1.18 - -2.73;P<0.05),血运重建术(RR 12.6;95%可信区间4.06 - -38.8;P<0.01)。T2DM在G等位基因携带者中也更为常见(RR 1.85;95% ci 1.11-3.06;非hefh患者P<0.05)。结论乌兹别克斯坦人群中伴有HeFH和非HeFH的冠心病患者的T2DM与PCSK9 E670G基因多态性的“功能获得性”G等位基因的存在显著相关。
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引用次数: 0
Developing type 1 diabetes resources: a qualitative study to identify resources needed to upskill and support community sport coaches 开发1型糖尿病资源:一项定性研究,以确定提高技能和支持社区体育教练所需的资源
Pub Date : 2023-11-01 DOI: 10.3389/fcdhc.2023.1284783
Rachel J. Lim, Alison G. Roberts, Joanne M. O’Dea, Vinutha B. Shetty, Heather C. Roby, Elizabeth A. Davis, Shaun Y. M. Teo
Introduction Community sport coaches in Western Australia lack an understanding, the confidence, and knowledge in supporting young people with Type 1 diabetes (T1D). This study aims to identify what T1D educational resources are required to upskill coaches in Western Australia. Methods Semi-structured online interviews were conducted with i) young people living with T1D, ii) parents of young people living with T1D and iii) community sport coaches. The questions explored i) past experiences of T1D management in community sport ii) the T1D information coaches should be expected to know about and iii) the format of resources to be developed. Thematic analysis of interview transcripts was performed, and the themes identified were used to guide resource development. Results Thirty-two participants (16 young people living with T1D, 8 parents, 8 coaches) were interviewed. From the interviews, young people wanted coaches to have a better understanding of what T1D is and the effect it has on their sporting performance, parents wanted a resource that explains T1D to coaches, and sports coaches wanted to know the actions to best support a player living with T1D. All groups identified that signs and symptoms of hypoglycaemia and hyperglycaemia needed to be a key component of the resource. Sports coaches wanted a resource that is simple, quick to read and available in a variety of different formats. Conclusion The interviews resulted in valuable information gained from all groups and have reinforced the need for the development of specific resources to increase community knowledge and provide support for players with T1D, parents and sport coaches.
西澳大利亚的社区体育教练缺乏对1型糖尿病(T1D)青少年的理解、信心和知识。本研究旨在确定哪些T1D教育资源需要提高西澳大利亚州教练的技能。方法采用半结构化的在线访谈方法,对青少年T1D患者、青少年T1D患者的父母和社区体育教练进行访谈。探讨的问题是:(1)社区体育T1D管理的过去经验;(2)T1D教练应该了解的信息;(3)需要开发的资源形式。对访谈记录进行专题分析,并利用确定的主题指导资源开发。结果共访谈32人,其中青少年T1D患者16人,家长8人,教练员8人。从采访中可以看出,年轻人希望教练能更好地了解什么是T1D以及它对他们的运动表现的影响,父母想要一个向教练解释T1D的资源,而体育教练想知道如何最好地支持患有T1D的球员。所有组都确定低血糖和高血糖的体征和症状需要成为资源的关键组成部分。体育教练想要的是一种简单、易于阅读并能以多种不同格式提供的资源。结论访谈从所有群体中获得了有价值的信息,并加强了开发特定资源的必要性,以增加社区知识,并为患有T1D的球员,家长和体育教练提供支持。
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引用次数: 0
HbA1c control in type 2 diabetes mellitus patients with coronary artery disease: a retrospective study in a tertiary hospital in South Africa 2型糖尿病合并冠状动脉疾病患者HbA1c控制:南非某三级医院回顾性研究
Pub Date : 2023-10-30 DOI: 10.3389/fcdhc.2023.1258792
Lona Mhlaba, Dineo Mpanya, Nqoba Tsabedze
Background Type 2 diabetes mellitus (T2DM) patients with coronary artery disease (CAD) have an increased risk of recurrent cardiovascular events. These patients require optimal glucose control to prevent the progression of atherosclerotic cardiovascular disease (ASCVD). Contemporary guidelines recommend an HbA1c ≤7% to mitigate this risk. The aim of this study was to evaluate HbA1c control in T2DM patients with angiographically proven ASCVD. Methods We conducted a cross-sectional, retrospective study on consecutive T2DM patients with acute and chronic coronary syndromes managed in a tertiary academic hospital in South Africa. Glycaemic control was assessed by evaluating the glycated haemoglobin (HbA1c) level measured at index presentation with acute and chronic coronary syndromes and during the most recent follow-up visit. Results The study population comprised 262 T2DM patients with a mean age of 61.3 ± 10.4 years. At index presentation, 110 (42.0%) T2DM patients presented with ST-segment elevation myocardial infarction, 69 (26.3%) had non-ST-segment elevation myocardial infarction, 43 (16.4%) had unstable angina, and 40 (15.3%) had stable angina. After a median duration of 16.5 months (IQR: 7-29), 28.7% of the study participants had an HbA1c ≤7%. On multivariable logistic regression analysis, females were less likely to have poor glycaemic control (HbA1c above 7%) [odds ratio (OR): 0.42, 95% confidence interval (CI): 0.19-0.95, p=0.038]. Also, T2DM patients prescribed metformin monotherapy (OR: 0.34, 95% CI: 0.14-0.82, p=0.017) and patients with ST-segment depression on the electrocardiogram (OR: 0.39, 95% CI: 0.16-0.96, p=0.041) were less likely to have poor glycaemic control. Conclusion After a median duration of 16.5 months, only 28.7% of T2DM patients with CAD had an HbA1c ≤7%. This finding underscores the substantial unmet need for optimal diabetes control in this very high-risk group.
背景2型糖尿病(T2DM)合并冠状动脉疾病(CAD)的患者心血管事件复发的风险增加。这些患者需要最佳的血糖控制,以防止动脉粥样硬化性心血管疾病(ASCVD)的进展。现代指南建议HbA1c≤7%以减轻这种风险。本研究的目的是评估T2DM合并血管造影证实的ASCVD患者的HbA1c控制。方法:我们对在南非一家三级学术医院治疗的连续T2DM急性和慢性冠状动脉综合征患者进行了横断面、回顾性研究。通过评估急性和慢性冠状动脉综合征指数表现时以及最近随访期间测量的糖化血红蛋白(HbA1c)水平来评估血糖控制。结果T2DM患者262例,平均年龄61.3±10.4岁。T2DM患者有110例(42.0%)表现为st段抬高型心梗,69例(26.3%)表现为非st段抬高型心梗,43例(16.4%)表现为不稳定型心绞痛,40例(15.3%)表现为稳定型心绞痛。中位持续时间为16.5个月(IQR: 7-29)后,28.7%的研究参与者HbA1c≤7%。在多变量logistic回归分析中,女性血糖控制不良(HbA1c高于7%)的可能性较小[优势比(OR): 0.42, 95%可信区间(CI): 0.19-0.95, p=0.038]。此外,使用二甲双胍单药治疗的T2DM患者(OR: 0.34, 95% CI: 0.14-0.82, p=0.017)和心电图上st段下降的患者(OR: 0.39, 95% CI: 0.16-0.96, p=0.041)血糖控制不良的可能性较小。结论中位病程16.5个月后,只有28.7%的T2DM合并CAD患者HbA1c≤7%。这一发现强调了在这一高危人群中对最佳糖尿病控制的大量未满足需求。
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引用次数: 0
Factors associated with chronic kidney disease in patients with diabetes in French Guiana. 法属圭亚那糖尿病患者慢性肾脏疾病的相关因素
Pub Date : 2023-10-25 eCollection Date: 2023-01-01 DOI: 10.3389/fcdhc.2023.1167852
Christopher Sacareau, Mathieu Nacher, Kinan Drak Alsibai, Andre Ntoutoum, Antoine Adenis, Marianne Hounnou, Marion Liebart, Clara Salasar Cardoso, Jean-Markens Aurelus, Magalie Demar, Olivier Casse, Samia Amokrane, Jean-François Carod, Nezha Hafsi, Nadia Sabbah

Introduction: With over half of the population living under the poverty threshold, the social and health context in French Guiana is more difficult than in mainland France. The prevalence of diabetes is twice as great and end-stage renal failure is 45% higher than in mainland France.

Objective: Our objective was to describe the profile of diabetic patients with chronic kidney disease in French Guiana and search for possible risk factors.

Method: We conducted a multicenter cross-sectional observational study based on the CODIAM cohort (Cohort of Diabetes in French Amazonia). We analyzed 1,287 patients followed up between May 2019 and June 2021 at Cayenne Hospital, Saint Laurent Hospital, and delocalized health centers.

Results: In our cohort, chronic kidney disease was present after an average of 12 years of diabetes. Compared with the French population, 41% of diabetic patients had chronic kidney disease (i.e., 12% more), and had an average age of 56 years (i.e., 10 years younger). Forty-eight per cent of these patients were obese (i.e., 7% more). Seventy-four per cent of patients were precarious and 45% were foreigners but neither was associated with chronic kidney disease, contrary to countries where the health system is not universal.

Conclusion: Screening of patients with chronic kidney disease among diabetics in French Guiana remains a real challenge. Patients were younger and more obese than in other French territories. In this cohort, precariousness and immigration were not associated with the presence of chronic kidney disease. However, particular attention should be paid to hypertensive patients and those over 65 years of age, which are, with diabetes itself, the two most obvious risk factors for developing chronic kidney disease among diabetic patients in our territory.

导言:由于半数以上的人口生活在贫困线以下,法属圭亚那的社会和卫生状况比法国大陆更为困难。糖尿病的患病率是法国大陆的两倍,终末期肾衰竭的发生率比法国大陆高45%。目的:我们的目的是描述法属圭亚那糖尿病合并慢性肾病患者的概况,并寻找可能的危险因素。方法:我们进行了一项基于CODIAM队列(法国亚马逊地区糖尿病队列)的多中心横断面观察性研究。我们分析了2019年5月至2021年6月期间在卡宴医院、圣罗兰医院和地方卫生中心随访的1287名患者。结果:在我们的队列中,慢性肾脏疾病在平均12年的糖尿病后出现。与法国人口相比,41%的糖尿病患者患有慢性肾脏疾病(即多12%),平均年龄为56岁(即年轻10岁)。这些患者中有48%的人肥胖(即多出7%)。74%的患者不稳定,45%是外国人,但都与慢性肾脏疾病无关,这与卫生系统不普及的国家相反。结论:在法属圭亚那糖尿病患者中筛查慢性肾脏疾病患者仍然是一个真正的挑战。患者比法国其他地区更年轻,更肥胖。在这个队列中,不稳定性和移民与慢性肾脏疾病的存在无关。然而,应特别注意高血压患者和65岁以上的患者,这些患者加上糖尿病本身,是我国糖尿病患者中发生慢性肾脏疾病的两个最明显的危险因素。
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引用次数: 0
Evaluating a systematic intensive therapy using continuous glucose monitoring and intermittent scanning glucose monitoring in clinical diabetes care: a protocol for a multi-center randomized clinical trial. 在临床糖尿病护理中使用连续血糖监测和间歇性扫描血糖监测评估系统强化治疗:一项多中心随机临床试验的方案。
Pub Date : 2023-10-18 eCollection Date: 2023-01-01 DOI: 10.3389/fcdhc.2023.1247616
Arndís F Ólafsdóttir, Marcus Lind

Introduction: As many people with type 1 diabetes find it hard to reach the recommended glycemic goals, even with CGM, this study aims to determine if a closer, digitally supported collaboration on interpreting CGM data together with a diabetes nurse can improve glycemic control.

Methods and analysis: A total of 120 individuals, 18 years and older and with HbA1c ≥ 58 mmol/mol will be included in the study at 8 different sites in Sweden and Norway. To be included, the participants must use a CGM or isCGM and be able to upload the data to the appropriate online service for their clinic and sensor. Both those with insulin pumps and insulin pens will be included in the study. Participants will be randomized into two different groups, that is, the intensive therapy group and the control group. The intensive therapy group will upload their glucose data weekly for the first 4 months and have telephone contact with their diabetes care team to receive support in interpreting CGM data and taking appropriate actions if their mean blood glucose level is above 8.4 mmol/L. After the 4-month-long intensive treatment phase, both randomized groups will have the same number of clinical visits and receive the same type of diabetes support.

Discussion: It is of great importance to find new ways to help people with type 1 diabetes manage their condition as well as they can to help them achieve better glycemic control so that hopefully more people can achieve the recommended glycemic goals, which are associated with fewer diabetes complications. If it is shown that people with type 1 diabetes achieve better glycemic control with intensive therapy, then this can be incorporated into clinical praxis as an option for those not currently reaching the recommended glycemic goals.

Clinical trial registration: https://clinicaltrials.gov/study/NCT03474393?locStr=Uddevalla,%20Sweden&country=Sweden&distance=50&cond=Diabetes&aggFilters=ages:adult%20older&state=V%C3%A4stra%20G%C3%B6taland%20County&city=Uddevalla&page=4&rank=34, identifier 03474393.

引言:由于许多1型糖尿病患者发现,即使使用CGM,也很难达到推荐的血糖目标,本研究旨在确定与糖尿病护士在解释CGM数据方面进行更密切的数字支持合作是否可以改善血糖控制。方法和分析:在瑞典和挪威的8个不同地点,共有120名18岁及以上、HbA1c≥58 mmol/mol的个体将被纳入研究。参与者必须使用CGM或isCGM,并能够将数据上传到其诊所和传感器的适当在线服务。这项研究将包括那些使用胰岛素泵和胰岛素笔的人。参与者将被随机分为两组,即强化治疗组和对照组。强化治疗组将在前4个月每周上传他们的血糖数据,并与他们的糖尿病护理团队进行电话联系,以获得解释CGM数据的支持,并在他们的平均血糖水平高于8.4 mmol/L时采取适当行动。在为期4个月的强化治疗阶段后,两个随机组的临床访视次数相同,并接受相同类型的糖尿病支持。讨论:找到新的方法来帮助1型糖尿病患者控制病情,帮助他们实现更好的血糖控制,这一点非常重要,希望更多的人能够实现推荐的血糖目标,从而减少糖尿病并发症。如果有证据表明,1型糖尿病患者通过强化治疗实现了更好的血糖控制,那么这可以作为目前尚未达到推荐血糖目标的患者的一种选择纳入临床实践。临床试验注册:https://clinicaltrials.gov/study/NCT03474393?locStr=Uddevalla,%20瑞典和国家=瑞典和距离=50&cond=糖尿病和aggFilters=年龄:成年人%20老年人和州=V%C3%A4stra%20G%C3%B6taland%20县和市=乌德瓦拉和页面=4&rank=34,标识符03474393。
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引用次数: 0
"I want to be there for my children": fatherhood, diabetes and temporality among Peruvian men. “我想陪伴我的孩子”:父亲身份、糖尿病和秘鲁男性的暂时性。
Pub Date : 2023-10-12 eCollection Date: 2023-01-01 DOI: 10.3389/fcdhc.2023.1207028
M Amalia Pesantes, Isabella Ferrazza, J Jaime Miranda

Introduction: Living with a chronic condition is a challenging experience, as it can disrupt your capacity to function and fulfill social roles such as being a father. Fatherhood constitutes an important component of masculinity that has not received significant attention in studies aimed at understanding the role of gender norms in health-related behaviors. Fatherhood refers to the set of social expectations placed on men to provide, protect, and care for those considered his children. Our paper aims to show the importance of understanding men's perspectives around fatherhood and its relevance for staying healthy.

Methods: In-depth semi-structured interviews with men living with Type 2 diabetes in Peru to explore their experiences with diabetes management.

Results: Eighteen Peruvian men, diagnosed with Type 2 diabetes for at least one year and with ages between 27 and 59 years old were interviewed. They had an average of three children each and were all insured under the national insurance plan aimed at low-income groups in Peru. Their accounts described their concern of not being able to fulfill their roles as fathers as a result of their condition. They mentioned the importance of being physically and emotionally present in the lives of their children, taking care of them, and being an example. These concerns varied depending on the age of their children: those with younger children were more preoccupied with ensuring they stayed healthy. Temporality provides a relevant analytical approach to understand the interplay of fatherhood and motivation for diabetes management.

Discussion: Our study advances the research around the intersection between health and gender norms and argues that a more nuanced understanding of the construction of masculinity and the relevance of fatherhood in the lives of men could be useful to design and identify better health promotion strategies tailored to men with diabetes.

引言:患有慢性病是一种具有挑战性的经历,因为它会破坏你的功能和履行社会角色的能力,比如做父亲。父亲身份是男性气质的一个重要组成部分,在旨在了解性别规范在健康相关行为中的作用的研究中,父亲身份没有得到显著关注。父亲身份是指对男性的一系列社会期望,以提供、保护和照顾那些被认为是他的孩子的人。我们的论文旨在展示理解男性对父亲身份的看法及其与保持健康的相关性的重要性。方法:对秘鲁2型糖尿病患者进行深入的半结构化访谈,探讨他们的糖尿病管理经验。结果:对18名秘鲁男性进行了访谈,他们被诊断患有2型糖尿病至少一年,年龄在27岁至59岁之间。他们平均每人有三个孩子,都参加了针对秘鲁低收入群体的国家保险计划。他们的叙述描述了他们对由于自身状况而无法履行父亲职责的担忧。他们提到了在孩子的生活中,在身体和情感上都要在场,照顾他们,并以身作则的重要性。这些担忧因孩子的年龄而异:那些有年幼孩子的人更专注于确保自己保持健康。暂时性提供了一种相关的分析方法来理解父亲身份和糖尿病管理动机之间的相互作用。讨论:我们的研究推进了围绕健康和性别规范之间交叉点的研究,并认为对男性气质的构建和父亲身份在男性生活中的相关性进行更细致的理解,可能有助于设计和确定更好的针对糖尿病男性的健康促进策略。
{"title":"\"I want to be there for my children\": fatherhood, diabetes and temporality among Peruvian men.","authors":"M Amalia Pesantes,&nbsp;Isabella Ferrazza,&nbsp;J Jaime Miranda","doi":"10.3389/fcdhc.2023.1207028","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1207028","url":null,"abstract":"<p><strong>Introduction: </strong>Living with a chronic condition is a challenging experience, as it can disrupt your capacity to function and fulfill social roles such as being a father. Fatherhood constitutes an important component of masculinity that has not received significant attention in studies aimed at understanding the role of gender norms in health-related behaviors. Fatherhood refers to the set of social expectations placed on men to provide, protect, and care for those considered his children. Our paper aims to show the importance of understanding men's perspectives around fatherhood and its relevance for staying healthy.</p><p><strong>Methods: </strong>In-depth semi-structured interviews with men living with Type 2 diabetes in Peru to explore their experiences with diabetes management.</p><p><strong>Results: </strong>Eighteen Peruvian men, diagnosed with Type 2 diabetes for at least one year and with ages between 27 and 59 years old were interviewed. They had an average of three children each and were all insured under the national insurance plan aimed at low-income groups in Peru. Their accounts described their concern of not being able to fulfill their roles as fathers as a result of their condition. They mentioned the importance of being physically and emotionally present in the lives of their children, taking care of them, and being an example. These concerns varied depending on the age of their children: those with younger children were more preoccupied with ensuring they stayed healthy. Temporality provides a relevant analytical approach to understand the interplay of fatherhood and motivation for diabetes management.</p><p><strong>Discussion: </strong>Our study advances the research around the intersection between health and gender norms and argues that a more nuanced understanding of the construction of masculinity and the relevance of fatherhood in the lives of men could be useful to design and identify better health promotion strategies tailored to men with diabetes.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"4 ","pages":"1207028"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10603236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Vascular deficits contributing to skeletal fragility in type 1 diabetes. 血管缺陷导致1型糖尿病患者骨骼脆弱。
Pub Date : 2023-10-06 eCollection Date: 2023-01-01 DOI: 10.3389/fcdhc.2023.1272804
Adina E Draghici, Bita Zahedi, J Andrew Taylor, Mary L Bouxsein, Elaine W Yu

Over 1 million Americans are currently living with T1D and improvements in diabetes management have increased the number of adults with T1D living into later decades of life. This growing population of older adults with diabetes is more susceptible to aging comorbidities, including both vascular disease and osteoporosis. Indeed, adults with T1D have a 2- to 3- fold higher risk of any fracture and up to 7-fold higher risk of hip fracture compared to those without diabetes. Recently, diabetes-related vascular deficits have emerged as potential risks factors for impaired bone blood flow and poor bone health and it has been hypothesized that there is a direct pathophysiologic link between vascular disease and skeletal outcomes in T1D. Indeed, microvascular disease (MVD), one of the most serious consequences of diabetes, has been linked to worse bone microarchitecture in older adults with T1D compared to their counterparts without MVD. The association between the presence of microvascular complications and compromised bone microarchitecture indicates the potential direct deleterious effect of vascular compromise, leading to abnormal skeletal blood flow, altered bone remodeling, and deficits in bone structure. In addition, vascular diabetic complications are characterized by increased vascular calcification, decreased arterial distensibility, and vascular remodeling with increased arterial stiffness and thickness of the vessel walls. These extensive alterations in vascular structure lead to impaired myogenic control and reduced nitric-oxide mediated vasodilation, compromising regulation of blood flow across almost all vascular beds and significantly restricting skeletal muscle blood flow seen in those with T1D. Vascular deficits in T1D may very well extend to bone, compromising skeletal blood flow control, and resulting in reduced blood flow to bone, thus negatively impacting bone health. Indeed, several animal and ex vivo human studies report that diabetes induces microvascular damage within bone are strongly correlated with diabetes disease severity and duration. In this review article, we will discuss the contribution of diabetes-induced vascular deficits to bone density, bone microarchitecture, and bone blood flow regulation, and review the potential contribution of vascular disease to skeletal fragility in T1D.

目前,超过100万美国人患有T1D,糖尿病管理的改善增加了成年T1D患者的数量,使他们能够活到晚年。越来越多的老年糖尿病患者更容易患上衰老合并症,包括血管疾病和骨质疏松症。事实上,与没有糖尿病的人相比,患有T1D的成年人发生任何骨折的风险要高出2到3倍,髋关节骨折的风险高出7倍。最近,糖尿病相关的血管缺陷已成为骨血流量受损和骨骼健康状况不佳的潜在风险因素,并且有人假设T1D的血管疾病和骨骼结果之间存在直接的病理生理学联系。事实上,微血管疾病(MVD)是糖尿病最严重的后果之一,与没有微血管疾病的老年人相比,患有T1D的老年人的骨微结构更差。微血管并发症的存在与骨骼微结构受损之间的关联表明,血管受损可能会产生直接的有害影响,导致骨骼血流量异常、骨骼重塑改变和骨骼结构缺陷。此外,血管性糖尿病并发症的特征是血管钙化增加,动脉扩张性降低,血管重塑,动脉硬度和血管壁厚度增加。血管结构的这些广泛变化导致肌源性控制受损,一氧化氮介导的血管舒张减少,影响几乎所有血管床的血流调节,并显著限制T1D患者的骨骼肌血流。T1D的血管缺陷很可能会延伸到骨骼,影响骨骼血流控制,并导致流向骨骼的血流减少,从而对骨骼健康产生负面影响。事实上,一些动物和离体人类研究报告称,糖尿病诱导的骨内微血管损伤与糖尿病疾病的严重程度和持续时间密切相关。在这篇综述文章中,我们将讨论糖尿病诱导的血管缺陷对骨密度、骨微结构和骨血流调节的贡献,并回顾血管疾病对T1D骨骼脆性的潜在贡献。
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引用次数: 0
A holistic approach to preventing type 2 diabetes in Asian women with a history of gestational diabetes mellitus: a feasibility study and pilot randomized controlled trial. 在有妊娠期糖尿病史的亚洲女性中预防2型糖尿病的整体方法:一项可行性研究和试点随机对照试验。
Pub Date : 2023-09-28 eCollection Date: 2023-01-01 DOI: 10.3389/fcdhc.2023.1251411
Seaw Jia Liew, Chun Siong Soon, Yu Chung Chooi, Mya Thway Tint, Johan Gunnar Eriksson

Background: Gestational Diabetes Mellitus (GDM) exposes women to future risk of Type 2 Diabetes. Previous studies focused on diet and physical activity, less emphasis was given to tackle intertwined risk factors such as sleep and stress. Knowledge remains scarce in multi-ethnic Asian communities. This study explored the: (1) feasibility of a holistic digital intervention on improving diet, physical activity (PA), sleep and stress of Asian women with a history of GDM, and (2) preliminary efficacy of the holistic intervention on women's physical and mental well-being via a pilot randomized controlled trial.

Methods: Female volunteers with a history of GDM but without pre-existing diabetes were recruited from multi-ethnic Singaporean community. Each eligible woman was given a self-monitoring opportunity using Oura Ring that provided daily feedback on step counts, PA, sleep and bedtime heart rate. Intervention group additionally received personalized recommendations aimed to reinforce healthy behaviors holistically (diet, PA, sleep and stress). Dietary intake was evaluated by a research dietitian, while step counts, PA, sleep and bedtime heart rate were evaluated by health coaches based on Oura Ring data. Perceived physical and mental health and well-being were self-reported. Clinical outcomes included glycemic status determined by HbA1c and OGTT tests, body mass index, blood pressures and lipid profile.

Results: Of 196 women from the community, 72 women completed diabetes screening, 61 women were eligible and 56 women completed the study. The 56 completers had mean age of 35.8 ± 3.7 years, predominantly Chinese, majority had their first GDM diagnosed at least 2 years ago and had two GDM-affected pregnancies. After intervention period, more women in the Intervention group achieved at least 8,000 steps/day and had at least 6 hours of sleep per night. Noticeable reduction of added sugar in their food and beverages were observed after the dietary intervention. Changes in body weight and mental well-being were observed but group differences were not statistically significant.

Conclusions: The holistic approach appeared feasible for personalizing lifestyle recommendations to promote physical and mental well-being among women with a history of GDM. Larger studies with sufficient assessment timepoints and follow-up duration are warranted to improve the evaluation of intervention effects on clinical outcomes.

Clinical trial registration number: https://clinicaltrials.gov/show/NCT05512871, NCT05512871.

背景:妊娠期糖尿病(GDM)使女性未来面临2型糖尿病的风险。先前的研究侧重于饮食和体育活动,而较少强调解决睡眠和压力等相互交织的风险因素。在多民族的亚洲社区,知识仍然匮乏。本研究探讨了:(1)整体数字干预对有GDM病史的亚洲女性改善饮食、体育活动(PA)、睡眠和压力的可行性,以及(2)通过一项试点随机对照试验,整体干预对女性身心健康的初步疗效。方法:从新加坡多民族社区招募有GDM病史但没有糖尿病病史的女性志愿者。每个符合条件的女性都有机会使用Oura Ring进行自我监测,该环每天提供步数、PA、睡眠和就寝心率的反馈。干预组还收到了旨在全面强化健康行为(饮食、PA、睡眠和压力)的个性化建议。膳食摄入由研究营养师评估,而步数、PA、睡眠和就寝心率则由健康教练根据Oura Ring数据进行评估。自我报告感知的身心健康和幸福感。临床结果包括通过HbA1c和OGTT测试确定的血糖状况、体重指数、血压和血脂状况。结果:在来自社区的196名女性中,72名女性完成了糖尿病筛查,61名女性符合条件,56名女性完成研究。56名完成者的平均年龄为35.8±3.7岁,主要是中国人,大多数人至少在2年前首次诊断出GDM,并有两次妊娠受GDM影响。干预期结束后,干预组中更多的女性每天至少走8000步,每晚至少睡6小时。在饮食干预后,观察到他们的食物和饮料中添加的糖显著减少。观察到体重和心理健康的变化,但组间差异无统计学意义。结论:在有GDM病史的女性中,个性化生活方式建议以促进身心健康的整体方法似乎是可行的。有充分评估时间点和随访时间的大型研究有必要改进干预对临床结果的影响评估。临床试验注册号:https://clinicaltrials.gov/show/NCT05512871,NCT05512871。
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引用次数: 0
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Frontiers in clinical diabetes and healthcare
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