Frontiers in clinical diabetes and healthcare最新文献

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.

Background: Diabetic nephropathy (DN) is one of the most frequent microvascular consequences of diabetes, accounting for a significant portion of morbidity and mortality in diabetic patients in Africa. This study aims to report on the prevalence of nephropathy among patients with diabetes mellitus patients in Africa and the risk factors.

Methods: This systematic review was reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, and the protocol was pre-registered in PROSPERO with the registration number CRD42024587467. The search was conducted across databases such as PubMed, Google Scholar, CINAHL and Scopus to retrieve studies published between January 2000 and August 2024. All statistical analyses were conducted using R software (version 4.4.2). The pooled prevalence of nephropathy in patients with diabetes was calculated with a 95% confidence interval (CI).

Results: Thirty-four (34) articles met the inclusion criteria. Only 28 studies were incorporated into the meta-analysis to determine the pooled prevalence of nephropathy among diabetes patients. The findings indicated a pooled prevalence of 21% (95%, CI: 16-28) of nephropathy among diabetes patients. Among type 1 and type 2 diabetes patients, the pooled prevalence of nephropathy is 46% (95%, CI: 18-77, I² = 98%) and 20% (95% CI: 14-27, I² = 98%), respectively. Weighted prevalence of 47%, 31%, 33% and 11% were reported in North Africa, Central Africa, South Africa and West Africa respectively. The result also showed that diabetes patients with hypertension are more than three times at risk of developing nephropathy compared to those without hypertension OR:3.46 (95% CI: 2.61-4.59).

Conclusion: The current study showed the prevalence of nephropathy with a significant association with hypertension among diabetic mellitus patients. Higher prevalence in North Africa is likely due to Western cultural impacts on dietary consumption.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024587467.

Background: Prediabetes is highly prevalent and significantly increases the risk of type 2 diabetes. While access to proven interventions like the Diabetes Prevention Program (DPP) has historically been limited, digital DPPs (dDPPs) present a promising and scalable option. With the recent growth of dDPP offerings and potential variability across platforms, access to accurate and clear information is crucial for individuals seeking diabetes prevention options. This review provides an overview of the dDPP landscape and characterizes the "direct-to-consumer" information available-or lacking-for patients choosing a dDPP.

Methods: We identified dDPPs through the CDC Diabetes Prevention Recognition Program (DPRP) Registry. Data were extracted from three sources available to consumers: the CDC DPRP Registry, the CDC "Find a Lifestyle Program" Website, and program-specific websites. Extracted data included CDC recognition status, intended audience, available languages, program features (e.g., artificial intelligence, integration with smart devices), website availability and functionality, demonstrations of credibility (e.g., ADA endorsement), clinical performance metrics (e.g., average weight loss), and user experience factors (e.g., satisfaction). Descriptive statistics were used to summarize extracted data.

Results: A total of 97 dDPPs were included in the review, with most in the early stages of CDC recognition. Only 35% of dDPPs listed in the CDC registry had functional websites, though additional websites were identified through manual searches. Program-specific features included AI-driven health recommendations, device integration (e.g., digital scales and activity trackers), nutrition tracking tools, and telehealth platforms. Nearly half of the dDPPs reported clinical performance metrics such as weight loss and A1C outcomes. User experience details were often presented through patient testimonials and satisfaction scores. Notably, many programs required users to provide personal information to access additional information.

Conclusion: We found that available dDPPs vary significantly in their features, designs, and structures, reflecting a diverse and evolving landscape of diabetes prevention options. Concurrently, many dDPPs lack accessible information due to missing or incomplete websites. Centralized sources of information provided by the CDC are also insufficient, with discrepancies and gaps that hinder transparency and consumer decision-making. Addressing these issues through enhanced program visibility and improved centralized databases will be critical to optimizing the reach and impact of dDPPs.

Introduction: Many people with type 1 diabetes struggle to manage their glucose levels and experience stress related to the behavioral demands of the disease. The aim of this study is to investigate whether treatment with a diabetes-educated psychologist can improve glucose levels and decrease diabetes distress.

Materials and methods: Individuals with HbA1c >62 mmol/mol (7.8%) were randomized to either psychological treatment or control group. The study duration for each participant was 52 weeks. Patients who received treatment met with a diabetes-educated psychologist a minimum of seven times. In total 6 outpatient diabetes units and 10 psychologists participated. Cognitive behavioral therapy was primarily the treatment of choice. Both groups met with a diabetes nurse and/or physician at the start of the study and at 3, 6, and 12 months. HbA1c, blood pressure, and weight were measured at scheduled visits. Diabetes distress, quality of life, hypoglycemia confidence, and treatment satisfaction were evaluated using questionnaires. The primary endpoint is the difference in HbA1c from baseline to week 52. Secondary endpoints are changes in diabetes distress and quality of life from baseline to week 52, as well as treatment satisfaction at 52 weeks.

Discussion: This study seeks to improve knowledge about how to support patients who struggle to manage their diabetes. If the results of this study show that psychological treatment has an effect on HbA1c or on diabetes distress, it could indicate that psychologists should become more involved in diabetes care teams. Clinical trial registration: ClinicalTrials.gov ID NCT03753997.

Background: The health and economic impacts of type 2 diabetes mellitus (T2DM) remain substantial, notably in developing countries.

Objectives: To provide an in-depth assessment of the T2DM situation in Algeria to understand its multifaceted burden and identify priority areas of intervention.

Methods: A systematic literature search was conducted on all published articles about T2DM in Algeria over the past 30 years, including original research, reviews, and case series. The extracted data were thoroughly analyzed and synthesized by a committee of diabetes experts.

Results: Algerian epidemiological data point towards a constant rise of T2DM prevalence, roughly from 8.9% in 2003 to 14.4% in 2016-2017. The mean onset is around 41 years with women experiencing a greater burden at younger age. Low socioeconomic status, limited education, and lack of health insurance exacerbate T2DM risk and health inequities. Lifestyle and metabolic risk factors are prevalent. Despite advancements in glycemic control, prescribing practices lack standardization, with suboptimal use of antidiabetic drugs and absence of novel drugs in the market. Health and economic burdens are dominated by complications, highlighting inadequate primary and tertiary prevention strategies.

Conclusion: Notwithstanding the increasing burden of T2DM in Algeria, the healthcare strategies and therapeutic outcomes remain suboptimal. This underscores the necessity for a comprehensive strategy including enhanced prevention, access to novel treatments, standardized practices, along with a patient-centered approach.

Background: Diabetic ketoacidosis (DKA) is one of the most common life-threatening acute metabolic complications of diabetes, typically associated with disability, mortality, and significant health costs for all societies. In Ethiopia, available studies on in-hospital mortality rates of people living with DKA have shown high variability. Therefore, this systematic review and meta-analysis aims to summarize and provide quantitative estimates of the prevalence of in-hospital mortality among adult people living with DKA treated in Ethiopian hospitals.

Methodology: A systematic literature search was conducted using MEDLINE, Embase, Google Scholar, Web of Science, and Africa-specific databases. Data were extracted in a structured format prepared using Microsoft Excel. The extracted data were exported to R software Version 4.3.0 for analysis. The I² test was used to check the heterogeneity between primary studies with a corresponding 95% confidence interval (CI). Based on the test result, a random-effects meta-analysis model was used to estimate Der Simonian and Laird's pooled effect on in-hospital mortality.

Result: The review included a total of 5 primary studies. The pooled prevalence of in-hospital mortality among people living with DKA who received treatment in Ethiopia hospitals was found to be 7% (95% CI: 1-12). Most of the included studies reported that nonadherence to insulin treatment followed by infection was the most common triggering factor for the development of DKA.

Conclusion: The prevalence of in-hospital mortality among people living with DKA was found to be 7%. This figure is unacceptably high compared to other published reports. Nonadherence to insulin treatment or antidiabetic medication and infection were identified as precipitating factors for developing DKA. Therefore, measures must be taken to improve medication adherence and decrease in-hospital mortality by providing ongoing health education on medication usage, effective in-hospital management of hyperglycemia, and increased access to high-quality care.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023432594.

Purpose: To assess long-term ophthalmic and clinical blood test changes in patients with different severities of diabetic retinopathy (DR).

Methods: We performed a longitudinal case-control study of 130 patients with diabetes mellitus (DM) and 67 controls, including visual acuities from 2,201 eye clinic visits and 44,833 blood tests. We also analyzed optic disc and macular structure and vasculature using optical coherence tomography (OCT) and angiography (OCTA).

Results: Ninety-one percent of eyes in diabetic patients had stable visual acuity (better than 20/40) over 7 years. Cluster analysis revealed most prominent blood test changes in the DM included elevated glucose and hemoglobin A1c and evidence of nephropathy. Optic disc OCTA was most correlated with OCT in the superior and inferior quadrants. Notably, peripapillary and macular OCTA measurements revealed evidence of microvascular drop out even in those with DR grade 0.

Conclusions: Majority of patients with DM monitored by physicians maintained good visual acuity over years. Ophthalmic imaging revealed evidence of early vascular changes even in patients without evidence of DR on clinical exam and color fundus imaging. In addition to ophthalmic functional and structural assessments, clinical blood tests for renal function are also important early biomarkers of end organ damage in DM.

Introduction: Blood glucose monitoring meters (BGM) have not become redundant yet. The accuracy and precision of "GLUCOCARD S onyx," a new BGM with Bluetooth function, has been evaluated and proven to exceed the actual ISO 15197:2013/EN ISO 15197:2015 guidelines besides offering features for better patient safety and telemedicine.

Methods: 100 finger-prick whole blood samples from subjects with diabetes and 32 without diabetes were collected and measured with GLUCOCARD S onyx. Plasma blood glucose levels were measured using YSI2300 STAT PLUS as reference analyzer for comparison. The evaluation followed ISO 15197:2013, section 6.3 accuracy criteria. Furthermore, the MARD factor was calculated for the overall clinical important range (with n=132 samples).

Results: The performance of GLUCOCARD S onyx was evaluated according to ISO 15197:2013, revealing that 99.7% (598/600) of the results fell within ±15% or ±0.8 mmol/L (± 15 mg/dL) of difference over the total clinically relevant glucose range compared to the YSI2300 STAT PLUS. 100% (600/600) of the measurement results over the total range fell within Clark Error Grid Zone A. An overall mean absolute relative difference (MARD) factor of 4.15% was obtained; 5.05% for glucose <5.6 mmol/L (<100 mg/dL), and 3.65% for glucose ≥5.6 mmol/L (≥100 mg/dL).

Discussion: GLUCOCARD S onyx shows clinically satisfactory accuracy and reliability, even exceeding the ISO 15197:2013 criteria, for hypoglycemic cases with glucose critically low as <3.9 mmol/L (<70 mg/dL) and hyperglycemic cases with glucose ≥10.0 mmol/L (≥180 mg/dL). Healthcare organizations as well as manufacturers are aiming to offer new BGM systems that go beyond the ISO criteria and offer systems that can be consulted instead or besides CGM (Continuous Glucose Monitoring) in case of e.g. severe hypo- and/or hyperglycemic episodes. A MARD factor of 4.15% revealed an excellent system accuracy over the total clinically relevant glucose range. With additional user-friendly features, this BGM can be seen as a useful tool for efficient diabetes therapy, especially in the event of severe blood glucose fluctuations.

Gestational diabetes mellitus (GDM) is regarded by many as maternal maladaptation to physiological insulin resistance during the second half of pregnancy. However, recent evidence indicates that alterations in carbohydrate metabolism can already be detected in early pregnancy. This observation, the increasing prevalence of GDM, and the significant short and long-term implications for the mother and offspring call for reevaluation of the conceptual paradigm of GDM as a syndrome. This review will present evidence for the syndromic nature of GDM and the controversies regarding screening, diagnosis, management, and treatment.