Frontiers in clinical diabetes and healthcare最新文献

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.

Background: Diabetic retinopathy (DR) is the leading cause of vision loss among adults with diabetes aged between 20 to 70 years. Lack of knowledge about Diabetic retinopathy is one of the reasons for treatment delays, which can lead to the development of sight-threatening DR. The aim of this study is to assess knowledge of diabetic retinopathy and associated factor among adults with diabetes mellitus at public hospitals in Addis Ababa, Ethiopia.

Methods: An institution-based cross-sectional study was conducted at five public hospitals in Addis Ababa from 27 February to 27 March 2023.Systematic random sampling was used to select 421 diabetes patients. Data was collected using a pretested interviewer-administered questionnaire using Kobo Collect version 2022.4.4. The data was then exported to SPSS version 27 for cleaning and analysis. Multiple linear regression analysis with a p-value < 0.05 and corresponding 95% confidence interval (CI) was used to identify factors associated with knowledge of DR.

Results: The respondents' mean percentage score for DR knowledge was 61.42% ± 28.75%. Longer years lived with diabetes (B = 0.157, p = 0.001) and older age (B = 0.022, p = 0.044) were associated with better DR knowledge score, whereas having no formal education (β = -0.166, p = 0.001) and secondary school education (β = -0.165, p = 0.001) compared to the other groups had lower DR knowledge score.

Conclusion: Longer years lived with diabetes, older age and higher educational level were factors associated with better knowledge of DR. Therefore, health professionals should target newly diagnosed, relatively younger patients and less educated DM patients when providing diabetes self-management education related to DR.

Introduction: Adherence to diabetes self-care management is a lifestyle modification for people with diabetes.

Objective: To assess adherence to diabetic self-care management and associated factors among type 2 diabetic patients in North Shewa Zone public hospitals, Ethiopia, 2023.

Methods: The study employed a concurrent mixed-methods approach among 600 type 2 diabetic patients in North Shewa Zone public hospitals in Amhara, Ethiopia. The study was conducted from May 5 to May 20, 2023. The quantitative data were collected by using a semi-structured interview-administered questionnaire and chart review. Logistic regression was employed, and a p-value < 0.05 was considered statistically significant. Qualitative data were collected by in-depth interviews, and audio recordings were first transcribed verbatim and then translated to the English language by the first author and analyzed manually using a thematic approach.

Result: Out of the total 600 type 2 diabetic patients, 262 (43.7%) with 95% CI: 40-47.8% of the study participants had good adherence to diabetes self-care practices. The multivariable analysis indicated that type 2 diabetic patients who lived in urban areas [AOR: 5.4, 95% CI: (1.05-8.7)] were 5.4 times more likely to have good diabetic self-care practice than those rural residents. Those who had a high school level of education [AOR: 2.9, 95% CI: (1.3-6.6)] were 2.9 times more likely to have good self-care practice, and those with college and above [AOR: 5, 95% CI (2-12):] were five times more likely to have good self-care practice. Regarding occupation, unemployed people were 66% less likely to have good self-care practices than employed people. Those who had no availability of healthcare services [AOR: 0.19, 95% CI: (0.09-0.37)] were less likely by 81% to have good self-care practice than those who had availability of healthcare services. These are significantly associated with diabetic self-care practice. The qualitative component clarified six themes: lack of education and awareness, financial affordability, accessibility, lack of family support, and having diabetic-related complications were identified as barriers.

Conclusion: This study indicated that adherence of patients with type 2 diabetes to the recommended self-care practices was considerably poor. Different factors included the respondents who had a high school level or higher level of education and those who lived in urban areas. This was supported by the results from the qualitative part and thus the endorsement to strengthen diabetes health education to patients and their families. So, diabetic patients require an integrated approach through treatment as well as health education, which will increase the health and well-being of the patient.