Frontiers in clinical diabetes and healthcare最新文献

Background: Over the last decades, non-communicable diseases such as diabetes have remarkably increased due to rapid urbanization, unhealthy lifestyles, and ageing. The World Health Organization (WHO) indicates that the "diabetes epidemic" will continue in the coming decades, yielding enormous human and economic costs around the world. This study explores healthcare workers' views on social support groups and policy recommendations for managing type 2 diabetes in Ghana.

Method: This study utilized a facility-based cross-sectional qualitative research design to explore healthcare workers' views on social support groups and policy recommendations for managing type 2 diabetes in Ghana between January and May 2023. Health workers who worked in the three selected regional hospitals for at least one year and at the diabetic clinics of the three selected regional hospitals of the respective regions at the time of this study were included. The study used purposive sampling to select 12 health workers (Nurses) as key informants. One (1) facility head of each facility and three (3) health workers, each working in the diabetic clinic of each regional hospital, were selected for key informant interviews. The interviews were recorded and transcribed in English. Notes from the interview were transcribed after the key informant interview. Data was imported into the Nvivo 7 software. The results were presented as prose, analyzed, and discussed in themes.

Results: Major challenges facing people living with diabetes were the cost of medication, limited NHIS coverage, frequent morbidity and the chronic nature of the disease, putting psychological pressure on the patients. The policy recommendation was on mass education and the expansion of NHIS coverage.

Conclusion: The study has noted some significant challenges faced in managing type 2 diabetes mellitus in Ghana. Addressing the diabetes epidemic in Ghana requires a comprehensive and multi-pronged approach, focusing on prevention, early detection, access to care, and diabetes education. Implementing the policy recommendations outlined in this study can significantly improve diabetes management in Ghana, reduce the burden of the disease, and enhance the overall health and well-being of the population.

Background: Diabetic wounds are a serious complication for diabetic patients, characterized by refractoriness, high recurrence rates, and susceptibility to infection. Although current guidelines recommend evidence-based treatment strategies, clinical outcomes remain suboptimal. This paper reviews the current research status and development trends in diabetic wound treatment.

Methods: Articles on diabetic wound treatment published between 2014 and 2023 were identified using the Web of Science Core Collection database, resulting in a total of 9,099 articles. Bibliometric methods were employed to analyze authors, institutions, countries, journals, keywords and references using CiteSpace and VOSviewer.

Results: China has published the most articles in the field, followed by the United States. Shanghai Jiao Tong University is the leading institution in diabetic wound treatment research, and David G. Armstrong from the United States has made significant contributions to this field. "Wound Repair and Regeneration" was identified as the most influential journal. Cluster analysis of keywords revealed four main categories: (1) mechanisms of diabetic wound healing, (2) prognosis, (3) treatment, and (4) management.

Conclusion: This paper systematically reviews the research on diabetic wound treatment from 2014 to 2023, outlining and forecasting global research hotspots and trends. Future research is expected to focus on treatment strategies for diabetic wounds, while interdisciplinary collaboration and advancements in intelligent management technologies have the potential to improve patient outcomes.

Background: As the prevalence of diabetes and its related complications continues to rise, understanding the factors that influence glycemic control is crucial for improving patient outcomes. This study aimed to explore the roles of self-management, social support, and self-efficacy in moderating fasting blood glucose (FBG) levels in individuals with type 2 diabetes mellitus (T2DM).

Methods: A health facility-based cross-sectional study was conducted in Windhoek, Namibia with a sample size of 315 T2DM patients receiving follow-up care. Descriptive statistics and Pearson correlation analysis were conducted to examine the relationship between self-management and FBG. Linear regression and moderation analyses were used to determine the moderating effects.

Results: The study revealed 34.3% engaged in self-monitoring of FBG, while medication adherence was high at an average of 7 days. A significant negative correlation between self-management practices and FBG levels was identified (r = -0.349, p < 0.028). Self-management, self-efficacy, and social support accounted for 43.1% of FBG variation, with self-management emerging as a significant predictor (β = -0.903, p < 0.001). Additionally, social support and self-efficacy significantly moderated the relationship between self-management and FBG levels.

Conclusion: This study showed the significant moderating roles of social support and self-efficacy in the relationship between self-management practices and FBG levels in patients with diabetes. These results highlight the importance of comprehensive diabetes management programs focusing on individual behavioral changes, enhancing social support networks, and boosting self-efficacy.

Background: Type 2 diabetic osteoporosis (T2DOP) has received considerable attention due to its accelerated bone deterioration and significantly increased fracture risk. Unlike classical osteoporosis, patients with T2DOP often exhibit a paradoxical pattern: they have normal or even elevated bone mineral density (BMD) in early stages despite deterioration in bone microarchitecture. This paradox highlights the clinical importance of identifying T2DOP as a distinct and critical subtype of secondary osteoporosis.

Methods: We conducted a bibliometric analysis of literature on T2DOP published over the past 20 Years(from 2001 to 2020), using data retrieved from the Web of Science Core Collection database. Bibliometric networks were visualized and analyzed using VOSviewer. Publication trends, geographic contributions, research hotspots, and keyword clusters were systematically examined.

Results: Over the past 20 Years, global research output on T2DOP steadily increased, with major contributions from North America, East Asia, and Western Europe. Identified research hotspots included risk prediction, biomarkers (e.g., advanced glycation end-products), complication management, population-specific characteristics (e.g., postmenopausal women), and therapeutic strategies (e.g., metformin). Notably, lifestyle intervention has recently emerged as an important new research direction.

Conclusions: This study provides the first comprehensive bibliometric analysis and visualization of global research trends and hotspots in T2DOP, highlighting critical insights for clinical practice, including the identification of at-risk populations, biomarker-guided risk assessment, and therapeutic optimization, which complements existing clinical meta-analyses. Future research efforts should emphasize multidisciplinary collaboration and validation of the long-term efficacy of lifestyle interventions. For clinical practice, integrating bone density evaluation with biomarker screening (e.g., osteocalcin) in diabetic patients could enhance early fracture prevention. Public health initiatives should prioritize lifestyle interventions in high-risk populations (e.g., postmenopausal women) to mitigate the growing burden of diabetic osteoporosis.

Background: The use of technologies in the health field has progressively increased. Within the context of a broader project funded by the Italian Ministry of Health (TELEMECHRON study), a randomised controlled trial (RCT) has been conducted in the Autonomous Province of Trento on type 2 diabetes individuals with an untargeted glycated haemoglobin (HbA1c) level.

Methods: The overall aim was to evaluate the impact of the "TreC Diabete" digital platform, including a smartphone application (app) and a dashboard. This open-label, parallel-group, 1:1 allocation ratio RCT in which the intervention group used the app for data entry, symptoms questionnaire, communication with healthcare staff and medication recording, while the control group received standard care. The primary endpoint was change in HbA1c levels at 12 months between groups.

Results: Between December 2022 and August 2023, 103 participants were enrolled (51 intervention; 52 control), with a median age of 67 years old, time from diabetes diagnosis to enrolment 13 years, and 72% male. At 12 months, the median change in HbA1c levels did not differ significantly between groups. Regarding app usage, data entries decreased significantly from the first quarter to the second quarter but subsequently stabilised (p = 0.001). System usability (from 42 responders in the intervention group) had a median score of 95 (range: 0-100), indicating a high level of satisfaction with the platform.

Discussion: The study faced several challenges, including platform technical issues, service interruption, data entry anomalies and difficulties in participant recruitment. Study generalisability may be limited by the sample's demographics, as the trial predominantly included younger male individuals with a specific HbA1c level.

Conclusion: The study highlighted key factors for future implementations, including understanding technology benefits, addressing adoption barriers, and providing education and support to both patients and healthcare providers.

While the advantages of flash glucose monitoring, also known as dynamic interstitial glucose monitoring (DIGM), are established in outpatient diabetes care, evidence of its impact within hospital settings remains limited. This study compared the efficiency of use and healthcare staff perception of DIGM monitoring versus traditional finger-prick testing in a simulated hospital environment. Twenty-five healthcare professionals (52% nurses, 48% allied healthcare professionals [AHCPs]) participated in simulated clinical scenarios involving glucose monitoring tasks using a high-fidelity mannequin. Participants performed three tasks: (A) applying a flash sensor, (B) scanning the sensor to obtain a glucose reading, and (C) performing a finger-prick test. Task durations and staff perceptions were assessed, with statistical analyses conducted using Python (version 3). DIGM was significantly faster than finger-prick testing. Sensor application took 75.4 ± 22.4 seconds, flash scanning took 26.4 ± 11.5 seconds, and finger-prick testing required 132.8 ± 37 seconds (p < 0.05 for all comparisons). DIGM saved approximately 106 seconds per glucose check based on these timings. Furthermore, a scenario of 20 readings per hospitalized patient translates to an average of 34.2 minutes saved per patient. While staff with greater experience performed tasks slightly faster, the overall time-saving benefit of DIGM remained substantial across all levels of experience. In addition, survey responses revealed a strong staff preference for DIGM, highlighting perceived benefits in workflow efficiency, patient comfort, and infection control. In conclusion, DIGM was significantly more efficient than finger-prick testing and strongly preferred by clinical staff. These technologies offer time-saving benefits that could improve patient experience, streamline clinical workflows, and potentially enhance diabetes management outcomes.

Background: For successful glycemic control, diabetes control requires a comprehensive management plan in which patients are educated and supported to make informed decisions about diet, exercise, weight control, blood glucose monitoring, taking medication, and regular screening for complications. Current evidence on the effectiveness of diabetes self-management education and support (D-SMES) interventions on blood glucose control is mixed, with some studies pointing to significant glycemic control benefits, whereas others have shown no significant benefits.

Objective: This systematic review and meta-analysis (SRMA) was conducted to evaluate the effectiveness of D-SMES interventions compared with usual care in controlling blood glucose levels among people living with type 2 diabetes (T2DM) in the World Health Organization (WHO) Africa Region and to describe the core components of D-SMES interventions.

Methods: We performed a SRMA of D-SMES interventions for managing T2DM in the WHO Africa Region. We searched PubMed, CINAHL, the Cochrane Central Register of Controlled Trials (CCRCT), and Google Scholar from inception to May 5, 2025, for studies that were randomized control trials that reported glycated hemoglobin (HbA1c) or fasting blood sugar (FBS) as outcome measures and were delivered to adults with T2DM. The methodological quality of the included studies was assessed via the Cochrane risk of bias tool (RoB2). Random effects model meta-analysis was used to estimate the population average pooled standard mean difference (Hedges' g) for HbA1c with 95% CIs.

Results: We screened the title/abstract records of 350 studies, of which 19 studies with a total of 3759 participants (1866 in the D-SMES group and 1893 in the usual care group) were included in the meta-analysis of HbA1c. The meta-analysis revealed a significant overall effect of D-SMES interventions on HbA1c among people living with T2DM in the WHO African Region (SMD = -0.468 with a 95% CI of -0.658 to -0.279, I2 = 85.5%). nine of the nineteen included studies reported significant effects. We would expect that in some 95% of all populations comparable to those in the analysis, the true effect size would fall between -1.27 and 0.34 (prediction interval). Of the 19 included studies, 15 had a low risk of bias, two had high risk, and two raised some concerns based on the Cochrane RoB 2 tool.

Conclusions: Diabetes self-management education and support interventions are moderately effective in controlling blood glucose levels in T2DM patients within the WHO African region.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42022375732.

Type 1 diabetes (T1D) is not only a disorder of insulin production from beta cell destruction, but also a progressive condition that brings about life-threatening complications such as diabetic nephropathy, impaired wound recovery, and cardiovascular disease. Mesenchymal stromal cell (MSC) use has recently become an encouraging new way to treat these complications and can result in better health outcomes for T1D patients. Some research has shown that MSC injections into mice and rat models have resulted in reduced mesangial cell thickening, inflammatory mediator recruitment, proteinuria, and fibrosis normally seen in diabetic nephropathy. Other studies have demonstrated that MSCs aid wound healing by increasing anti-inflammatory M2 macrophage differentiation, stimulating angiogenesis and collagen synthesis, and signaling the proliferation and migration of dermal fibroblasts toward injury sites. Additionally, there is evidence that MSCs are capable of activating the PI3K pathway and exhibiting antioxidant effects in murine models experiencing diabetic-related heart disease. However, given these efforts, further research is needed to establish the prolonged safety and efficacy of MSC use in humans to treat T1D.