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The impact of structured self-monitoring of blood glucose on clinical, behavioral, and psychosocial outcomes among adults with non-insulin-treated type 2 diabetes: a systematic review and meta-analysis. 有组织的血糖自我监测对非胰岛素治疗的2型糖尿病患者的临床、行为和社会心理结局的影响:一项系统回顾和荟萃分析
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1177030
Elizabeth Holmes-Truscott, Shaira Baptista, Mathew Ling, Eileen Collins, EIif I Ekinci, John Furler, Virginia Hagger, Jo-Anne Manski-Nankervis, Caroline Wells, Jane Speight

Background: Self-monitoring of blood glucose (SMBG) is considered of little clinical benefit for adults with non-insulin-treated type 2 diabetes, but no comprehensive review of a structured approach to SMBG has been published to date.

Purpose: To conduct a systematic review and meta-analysis of the impact of sSMBG on HbA1c, treatment modifications, behavioral and psychosocial outcomes, and; examine the moderating effects of sSMBG protocol characteristics on HbA1c.

Data sources: Four databases searched (November 2020; updated: February 2022).

Study selection: Inclusion criteria: non-randomized and randomized controlled trials (RCTs) and prospective observational studies; reporting effect of sSMBG on stated outcomes; among adults (≥18 years) with non-insulin-treated type 2 diabetes. Studies excluded if involving children or people with insulin-treated or other forms of diabetes.

Data extraction and analysis: Outcome data extracted, and risk of bias/quality assessed independently by two researchers. Meta-analysis was conducted for RCTs, and moderators explored (HbA1c only).

Data synthesis: From 2,078 abstracts, k=23 studies were included (N=5,372). Risk of bias was evident and study quality was low. Outcomes assessed included: HbA1c (k=23), treatment modification (k=16), psychosocial/behavioral outcomes (k=12). Meta-analysis revealed a significant mean difference favoring sSMBG in HbA1c (-0·29%, 95% CI: -0·46 to -0·11, k=13) and diabetes self-efficacy (0.17%, 95% CI: 0.01 to 0.33, k=2). Meta-analysis revealed no significant moderating effects by protocol characteristics.

Limitations: Findings limited by heterogeneity in study designs, intervention characteristics, and psychosocial assessments.

Conclusion: A small positive effect of sSMBG on HbA1c and diabetes self-efficacy was observed. Narrative synthesis of sSMBG intervention characteristics may guide future implementation.

Prospero registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020208857, identifier CRD42020208857.

背景:自我血糖监测(SMBG)被认为对非胰岛素治疗的成人2型糖尿病患者没有什么临床益处,但迄今为止尚未发表关于SMBG结构化方法的全面综述。目的:对sSMBG对HbA1c、治疗修改、行为和社会心理结局的影响进行系统回顾和荟萃分析;检查sSMBG协议特征对HbA1c的调节作用。数据来源:检索到4个数据库(2020年11月;更新日期:2022年2月)。研究选择:纳入标准:非随机对照试验和随机对照试验(rct)以及前瞻性观察性研究;报告sSMBG对既定结果的影响;非胰岛素治疗的2型糖尿病成人(≥18岁)。研究排除了儿童或胰岛素治疗或其他形式的糖尿病患者。数据提取和分析:结果数据提取,偏倚风险/质量由两名研究人员独立评估。对随机对照试验进行了荟萃分析,并探讨了调节因子(仅HbA1c)。数据综合:从2078篇摘要中,纳入了k=23项研究(N= 5372)。偏倚风险明显,研究质量较低。评估的结果包括:糖化血红蛋白(k=23),治疗改变(k=16),社会心理/行为结果(k=12)。荟萃分析显示,sSMBG在HbA1c (- 0.29%, 95% CI: - 0.46至- 0.11,k=13)和糖尿病自我效能(0.17%,95% CI: 0.01至0.33,k=2)方面的平均差异显著。meta分析显示,协议特征没有显著的调节作用。局限性:研究设计、干预特征和社会心理评估的异质性限制了研究结果。结论:sSMBG对HbA1c和糖尿病自我效能感有较小的正向作用。对sSMBG干预特征的叙述性综合可以指导未来的实施。普洛斯彼罗注册:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020208857,标识符CRD42020208857。
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引用次数: 0
A pragmatic lifestyle intervention for overweight and obese women with gestational diabetes mellitus (PAIGE2): A parallel arm, multicenter randomized controlled trial study protocol. 一种实用的生活方式干预超重和肥胖妇女合并妊娠糖尿病(PAIGE2):一项平行组、多中心随机对照试验研究方案。
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1118509
Emma McAuley, Olwen Fleck, Laura Cassidy, Bridie J Kemp, Gina Cupples, Bronagh Kelly, Rachel M Creighton, Una Graham, Helen Wallace, Chris C Patterson, David R McCance

Background: The global epidemic of type 2 diabetes (T2D) and obesity has been translated into pregnancy, with approximately 18% of women being diagnosed worldwide with Gestational Diabetes Mellitus (GDM). Whilst preventive strategies have proven effective in the non-pregnant context, attrition rates are high and there is an urgent need to develop a customized, pragmatic lifestyle intervention for women both during and after pregnancy. Diet and exercise modification, behavioral support, and Commercial Weight Management Organizations have been strongly recommended to aid postpartum weight reduction for mothers with previous GDM, subsequently reducing their risk of developing obesity and T2D. This study, informed by a previous pilot study, aims to determine the effectiveness of a pragmatic pregnancy and postpartum lifestyle modification program for overweight women with previous GDM (PAIGE2) to reduce body weight at 12 months postpartum.

Methods/design: This paper summarizes the protocol for the PAIGE2 study, which has been developed based on results from a pilot study (PAIGE). A six center, two parallel arm, 12-month, randomized controlled trial will be conducted across Northern Ireland and the Republic of Ireland (3 centers each), involving 340 women with GDM and body mass index ≥25 kg/m2 recruited during pregnancy. The lifestyle intervention involves a one-hour virtual educational program (to take place at 32-36 weeks gestation). Postpartum, the intervention will include monthly phone calls, weekly motivational text messages, weekly step counts, and referral for three months to a Commercial Weight Management Organization (Slimming World). The control arm will receive usual care as offered by the local maternity hospital. The primary outcome is weight loss at 12 months postpartum. Study visits for anthropometric and clinical measurements, fasting blood samples, questionnaires pertaining to health, wellbeing and physical activity will take place at 6 weeks, 6- and 12-months postpartum. Focus groups will be conducted with intervention mothers' post-intervention to determine the acceptability of the study design including utility of a Commercial Weight Management Organization, feasibility of remote patient contact, family involvement and patient satisfaction.

Discussion: The PAIGE2 study will address the gaps in previously conducted research and, if positive, has the potential to have major public health implications for the prevention of future GDM and subsequent T2D.

Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT04579016?term=NCT04579016&draw=2&rank=1, identifier NCT04579016.

背景:2型糖尿病(T2D)和肥胖的全球流行已转化为妊娠,全世界约18%的妇女被诊断患有妊娠糖尿病(GDM)。虽然预防策略已被证明在未怀孕的情况下是有效的,但损耗率很高,迫切需要为怀孕期间和怀孕后的妇女制定一种定制的、实用的生活方式干预措施。饮食和运动调整、行为支持和商业体重管理组织被强烈推荐用于帮助患有既往GDM的母亲产后减肥,从而降低其发生肥胖和糖尿病的风险。本研究在之前的一项试点研究的基础上,旨在确定一项实用的孕期和产后生活方式改变计划对患有既往GDM (PAIGE2)的超重妇女在产后12个月减轻体重的有效性。方法/设计:本文总结了PAIGE2研究的方案,该研究是根据一项试点研究(PAIGE)的结果制定的。在北爱尔兰和爱尔兰共和国(各3个中心)开展一项6个中心、2个平行臂、12个月的随机对照试验,纳入340名妊娠期GDM、体重指数≥25 kg/m2的女性。生活方式干预包括一个一小时的虚拟教育项目(在妊娠32-36周进行)。产后,干预将包括每月打电话,每周发激励短信,每周计算步数,并向商业体重管理组织(Slimming World)推荐三个月。对照组将接受当地妇产医院提供的常规护理。主要结果是产后12个月体重减轻。将在产后6周、6个月和12个月进行人体测量和临床测量的研究访问、空腹血液样本、有关健康、福祉和体育活动的问卷调查。焦点小组将与干预后的母亲一起进行,以确定研究设计的可接受性,包括商业体重管理组织的效用、远程患者联系的可行性、家庭参与和患者满意度。讨论:PAIGE2研究将弥补先前开展的研究的空白,如果结果是积极的,则有可能对预防未来的GDM和随后的T2D产生重大的公共卫生影响。临床试验注册:https://clinicaltrials.gov/ct2/show/NCT04579016?term=NCT04579016&draw=2&rank=1,标识符NCT04579016。
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引用次数: 0
Corrigendum: Automatic inference of hypoglycemia causes in type 1 diabetes: a feasibility study. 更正:1型糖尿病低血糖原因的自动推断:一项可行性研究。
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1227105
Aleksandr Zaitcev, Mohammad R Eissa, Zheng Hui, Tim Good, Jackie Elliott, Mohammed Benaissa

[This corrects the article DOI: 10.3389/fcdhc.2023.1095859.].

[这更正了文章DOI: 10.3389/fcdhc.2023.1095859.]。
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引用次数: 0
Association of the use of psychotropic drugs with hospitalization, cardiovascular events, and mortality in patients with type 2 diabetes: a propensity score-matched cohort study. 精神药物使用与2型糖尿病患者住院、心血管事件和死亡率的关系:一项倾向评分匹配的队列研究
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1181998
Hidetaka Hamasaki, Hidekatsu Yanai

Background: Use of psychotropic drugs (PD) may be associated with impairment of physical function. However, few studies have assessed the impact of PD on health outcomes in patients with type 2 diabetes. This study aimed to examine the associations between psychotropic drug use and handgrip strength (HGS) and between the use of PD and hospitalization in patients with type 2 diabetes.

Methods: From April 2013 to December 2015, we conducted a retrospective cohort study in patients with type 2 diabetes at the National Center for Global Health and Medicine Kohnodai Hospital. Patients aged 20 years and over who can measure HGS were included. All participants received nutritional guidance regarding diet therapy for type 2 diabetes at baseline. Nonpsychotropic drug users were matched one-to-one with the PD users using propensity score matching method with respect to their baseline covariates. The differences in HGS and the number of patients who had hospitalizations during the study period were examined. By Cox proportional hazard regression analysis, the association between the use of PD and repeated hospitalizations was estimated.

Results: A total of 1,282 patients were enrolled and followed up for 2.36 ± 0.73 years. In the propensity score matching cohort, HGS was significantly lower (p = 0.006) in PD users than non-PD users. PD users had more hospitalizations than non-PD users. Cox proportional hazard regression analysis confirmed the association of repeated hospitalizations with the use of PD (hazard ratio = 2.138; 95% confidence interval, 1.144-3.995, p = 0.017)). In addition, HGS was significantly and inversely correlated with the number of hospitalizations (r = -0.143, p = 0.013).

Conclusions: The use of PD could increase the risk of repeated hospitalizations. Skeletal muscle may play a role in reducing the risk of hospitalization in patients who are treated with PD.

背景:精神药物(PD)的使用可能与身体功能损害有关。然而,很少有研究评估PD对2型糖尿病患者健康结局的影响。本研究旨在探讨精神药物使用与2型糖尿病患者握力(HGS)之间的关系,以及PD使用与住院之间的关系。方法:2013年4月至2015年12月,我们在Kohnodai医院的国家全球卫生与医学中心对2型糖尿病患者进行了回顾性队列研究。包括年龄在20岁及以上且能测量HGS的患者。所有参与者在基线时接受关于2型糖尿病饮食治疗的营养指导。非精神药物使用者与PD使用者使用倾向评分匹配方法对其基线协变量进行一对一匹配。在研究期间,HGS的差异和住院患者的数量被检查。通过Cox比例风险回归分析,估计PD使用与重复住院之间的关系。结果:共纳入1282例患者,随访时间为2.36±0.73年。在倾向评分匹配队列中,PD患者的HGS显著低于非PD患者(p = 0.006)。PD使用者比非PD使用者住院率更高。Cox比例风险回归分析证实重复住院与PD使用相关(风险比= 2.138;95%置信区间为1.144 ~ 3.995,p = 0.017)。此外,HGS与住院次数呈显著负相关(r = -0.143, p = 0.013)。结论:使用PD可增加重复住院的风险。骨骼肌可能在降低PD患者住院风险方面发挥作用。
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引用次数: 0
Smile with diabetes: reflections on illness perception and diabetes management behaviors of adolescents in private health care in South Africa. 与糖尿病微笑:对南非私立医疗机构青少年疾病认知和糖尿病管理行为的反思
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1097441
Elmari Deacon

Background: The association between illness perception and diabetes management has been well established in adults but is not clearly understood for adolescents. This article reflects on qualitative findings on illness perception from the perspective of adolescents, and suggests future research to operationalize findings.

Methods: Qualitative document analysis was conducted on four research projects forming part of the Smile with Diabetes project, which aims to investigate psychosocial variables in diabetes management, including illness perception, within the adolescent and youth populations. Thematic analysis was used to derive four themes from the qualitative and review studies examined in the document analysis.

Results: The voices of the adolescents were evident as four prominent themes: 1) living with diabetes leads to a sense of being different; 2) integration of diabetes into identity is critical, but difficult to achieve; 3) fear of potential negative consequences motivates adherence to treatment; 4) diabetes management is difficult, but possible.

Conclusion: The findings not only confirmed the importance of illness perception in the management of diabetes by adolescents, but also indicate that illness perceptions should be investigated from a developmental perspective, specifically taking identity development into consideration in this group. Adolescents should be made aware of how their thinking about diabetes and its management affects their experience of living with diabetes and its future management. This study further contributes to the literature by focusing on the patient's voice in understanding living with a chronic condition, and reassures that positive outcomes are possible when living with a chronic condition such as diabetes.

背景:疾病感知与糖尿病管理之间的关系在成人中已经得到了很好的确立,但在青少年中还不清楚。本文从青少年的角度对疾病知觉的定性研究结果进行了反思,并对未来的研究提出了操作性建议。方法:对构成“微笑与糖尿病”项目一部分的四个研究项目进行定性文献分析,该项目旨在调查青少年和青年人群中糖尿病管理的社会心理变量,包括疾病认知。专题分析用于从文件分析中审查的定性和审查研究中得出四个主题。结果:青少年的声音明显,有四个突出的主题:1)糖尿病患者的不同感;2)将糖尿病纳入身份认同至关重要,但很难实现;3)对潜在负面后果的恐惧促使坚持治疗;糖尿病管理是困难的,但也是可能的。结论:研究结果不仅证实了疾病感知在青少年糖尿病管理中的重要性,而且表明应从发展的角度研究疾病感知,特别是考虑该群体的身份发展。应该让青少年意识到他们对糖尿病及其管理的看法如何影响他们的糖尿病生活经历和未来的管理。本研究通过关注患者在理解慢性疾病生活中的声音,进一步为文献做出了贡献,并保证了患有慢性疾病(如糖尿病)时可能出现的积极结果。
{"title":"Smile with diabetes: reflections on illness perception and diabetes management behaviors of adolescents in private health care in South Africa.","authors":"Elmari Deacon","doi":"10.3389/fcdhc.2023.1097441","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1097441","url":null,"abstract":"<p><strong>Background: </strong>The association between illness perception and diabetes management has been well established in adults but is not clearly understood for adolescents. This article reflects on qualitative findings on illness perception from the perspective of adolescents, and suggests future research to operationalize findings.</p><p><strong>Methods: </strong>Qualitative document analysis was conducted on four research projects forming part of the <i>Smile with Diabetes</i> project, which aims to investigate psychosocial variables in diabetes management, including illness perception, within the adolescent and youth populations. Thematic analysis was used to derive four themes from the qualitative and review studies examined in the document analysis.</p><p><strong>Results: </strong>The voices of the adolescents were evident as four prominent themes: 1) living with diabetes leads to a sense of being different; 2) integration of diabetes into identity is critical, but difficult to achieve; 3) fear of potential negative consequences motivates adherence to treatment; 4) diabetes management is difficult, but possible.</p><p><strong>Conclusion: </strong>The findings not only confirmed the importance of illness perception in the management of diabetes by adolescents, but also indicate that illness perceptions should be investigated from a developmental perspective, specifically taking identity development into consideration in this group. Adolescents should be made aware of how their thinking about diabetes and its management affects their experience of living with diabetes and its future management. This study further contributes to the literature by focusing on the patient's voice in understanding living with a chronic condition, and reassures that positive outcomes are possible when living with a chronic condition such as diabetes.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"4 ","pages":"1097441"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10175576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9846861","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: 1
Developing digital mental health tools for youth with diabetes: an agenda for future research. 为青少年糖尿病患者开发数字心理健康工具:未来研究议程。
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1227332
Katie M Babbott, Anna Serlachius

Youth living with diabetes face a concurrent challenge: managing a chronic health condition and managing the psychosocial and developmental changes that are characteristic of adolescence and young adulthood. Despite these unique challenges, psychological support is often difficult for youth with diabetes to access due to a lack of trained mental health professionals and other resource constraints. Digital wellbeing tools offer the potential to improve access to psychological support for this population. However, very few digital wellbeing tools exist for youth with diabetes. Of those that do exist, very few are evidence-based therapies, undermining their contribution to the field. Given the increasing global prevalence of diabetes in young people, the support necessitated by the challenges experienced by this population is not always accessible in a face-to-face setting and cannot be effectively scaled to meet demand. To support the health and wellbeing of youth with diabetes, there is a clear need to develop digital interventions that are widely accessible to users, but, more saliently, grounded in empirical evidence that supports their efficacy. Thus, the purpose of this paper is to offer an agenda for future research, including insights into which psychological techniques and behavioral change theories may be a good conceptual fit for digital mental health interventions, and how these tools may be best developed and utilized by the individuals that need them. Scalable, evidence-based wellbeing tools for this population are urgently required to improve psychological outcomes, and potentially, improve the equity of service access.

患有糖尿病的青年同时面临着一项挑战:既要控制慢性健康状况,又要控制青春期和青年期特有的社会心理和发育变化。尽管存在这些独特的挑战,但由于缺乏训练有素的精神卫生专业人员和其他资源限制,患有糖尿病的青年往往难以获得心理支持。数字健康工具有可能改善这一人群获得心理支持的机会。然而,针对青少年糖尿病患者的数字健康工具很少。在那些确实存在的疗法中,很少有基于证据的疗法,这削弱了它们对该领域的贡献。鉴于全球年轻人糖尿病患病率不断上升,这一人群所面临的挑战所需要的支持并不总是能够在面对面的环境中获得,也不能有效地扩大规模以满足需求。为了支持青少年糖尿病患者的健康和福祉,显然需要制定数字干预措施,这些干预措施要便于用户广泛获取,但更重要的是,要以支持其有效性的经验证据为基础。因此,本文的目的是为未来的研究提供一个议程,包括洞察哪些心理技术和行为改变理论可能是数字心理健康干预的一个很好的概念,以及这些工具如何被需要它们的个人最好地开发和利用。迫切需要为这一人群提供可扩展的、基于证据的健康工具,以改善心理结果,并有可能改善服务获取的公平性。
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引用次数: 0
The clinical implications of fasting serum insulin levels in patients with insulin-treated type 2 diabetes: a cross-sectional survey. 胰岛素治疗的2型糖尿病患者空腹血清胰岛素水平的临床意义:一项横断面调查。
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1172208
Lingli Zhou, Yingying Luo, Yan Wang, Yao Cheng, Rui Zhang, Simin Zhang, Siqian Gong, Xueyao Han, Linong Ji

Objective: This study aimed to investigate the clinical implications of fasting serum insulin (FINS) levels in subjects with type 2 diabetes who were receiving insulin therapy.

Methods: A total of 1,553 subjects with type 2 diabetes [774 subjects who had never received insulin treatment (N-INS) and 779 subjects who were receiving insulin therapy (constant insulin treatment, C-INS)] admitted to the Department of Endocrinology and Metabolism of Peking University People's Hospital were enrolled in this study. Their FINS levels were measured and those with hyperinsulinemia were identified. The underlying mechanisms of hyperinsulinemia were revealed by measuring insulin antibodies (IAs) and analyzing changes in FINS levels before and after polyethylene glycol (PEG) precipitation. In addition, the clinical characteristics of patients with different types of hyperinsulinemia were compared.

Results: Higher FINS levels and a higher incidence (43.8%, 341/779) of hyperinsulinemia (FINS > 15μIU/mL) were observed in subjects with C-INS than in subjects with N-INS. Among subjects with C-INS and hyperinsulinemia, 66.9% (228/341) were IAs positive, and the incidence of IAs was found to be positively associated with FINS level. By performing PEG precipitation, we found that all subjects without IAs (i.e., those with real hyperinsulinemia) and 31.1% of subjects (71/228) with IAs (i.e., those with both real and IAs-related hyperinsulinemia) still had hyperinsulinemia after PEG precipitation, whereas FINS levels in the other 68.9% of subjects (157/228) with IAs were normal (IAs-related hyperinsulinemia) after PEG precipitation. Comparisons between the groups showed that subjects with real hyperinsulinemia showed more obvious insulin resistance characteristics, including higher lipid levels, BMIs, and homoeostasis model assessment2-estimated insulin resistance (HOMA2-IR) index, and were more likely to have hypertension, obesity, and metabolic syndromes (p < 0.05). However, the risk of hypoglycemia and glucose variability increased significantly in subjects with IAs compared with those without IAs. A cutoff of FINS to serum C-peptide ratio (≥ 9.3μIU/ng) could be used to screen IAs in clinical practice with 83.3% sensitivity and 70% specificity.

Conclusions: It is necessary to measure FINS in subjects with C-INS to distinguish between types of hyperinsulinemia, which should help to tailor treatment regimens.

目的:本研究旨在探讨接受胰岛素治疗的2型糖尿病患者空腹血清胰岛素(FINS)水平的临床意义。方法:选取北京大学人民医院内分泌与代谢科收治的1553例2型糖尿病患者[774例未接受胰岛素治疗(N-INS), 779例接受胰岛素治疗(持续胰岛素治疗(C-INS))]。测量他们的FINS水平,并确定高胰岛素血症。通过测量胰岛素抗体(IAs)和分析聚乙二醇(PEG)沉淀前后FINS水平的变化,揭示了高胰岛素血症的潜在机制。并比较不同类型高胰岛素血症患者的临床特点。结果:C-INS组FINS水平较高,高胰岛素血症发生率(FINS > 15μIU/mL)高于N-INS组(43.8%,341/779)。在C-INS合并高胰岛素血症的受试者中,66.9%(228/341)的IAs呈阳性,IAs的发生率与FINS水平呈正相关。通过进行PEG沉淀,我们发现所有没有IAs的受试者(即真正的高胰岛素血症患者)和31.1%的IAs患者(即同时患有真实的和IAs相关的高胰岛素血症患者)在PEG沉淀后仍然存在高胰岛素血症,而其他68.9%的IAs患者(157/228)在PEG沉淀后FINS水平正常(IAs相关的高胰岛素血症)。组间比较显示,真正的高胰岛素血症患者表现出更明显的胰岛素抵抗特征,包括更高的脂质水平、bmi和稳态模型评估2-估计胰岛素抵抗(HOMA2-IR)指数,并且更容易出现高血压、肥胖和代谢综合征(p)。结论:有必要测量C-INS患者的FINS,以区分高胰岛素血症的类型,有助于制定治疗方案。
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引用次数: 0
Incidence and predictors of mortality in children with diabetic ketoacidosis in the comprehensive specialized referral hospitals of West Amhara Region, Northwest Ethiopia: a retrospective follow-up study. 埃塞俄比亚西北部西阿姆哈拉地区综合性专科转诊医院糖尿病酮症酸中毒儿童的发病率和死亡率预测因素:一项回顾性随访研究
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1204133
Rahel Asres Shimelash, Getaneh Mulualem Belay, Worknesh Aknaw, Aster Tadesse Shibabaw, Aderajew Agmas Adebabay, Gezahagn Demsu Gedefaw, Tadele Derbew Kassie, Alemu Birara Zemariam

Background: Diabetic ketoacidosis is one of the major life-threatening conditions associated with acute metabolic complications. It remains a major public health problem in developing countries such as Ethiopia.

Objective: To assess the incidence and prediction of mortality in children with diabetic ketoacidosis in West Amhara Region Comprehensive Specialized Referral Hospitals, Northwest Ethiopia, in 2022.

Methods: An institution-based retrospective follow-up study was conducted among 423 study participants with a confirmed diagnosis of diabetic ketoacidosis from 01/01/2017 to 31/12/2021. Data were entered, coded, cleaned, and checked using Epi-Data version 4.6 and exported to Stata version 14 for data analysis.

Results: A total of 401 child records were included in the final analysis and were followed for 3781 days during the study period. The overall mortality of children with diabetic ketoacidosis was 10.6 per 1000 person-days observed (95% CI: 7.8-14.4) during the entire follow-up period. Hypoglycemia (AHR=4.6; 95% CI: 2.13-10.1), rural residence (AHR=2.9; 95% CI=1.01-8.11), age younger than five (AHR=4.4; 95% CI=1.4-13.7) or between five and 10 (AHR=3.1; 95% CI=1.1-8.8), and female gender (AHR=2.6; 95% CI=1.1-5.8) were significant predictors of mortality.

Conclusions: The incidence rate of mortality in children with diabetic ketoacidosis was relatively high. Age, rural residence, female gender, and hypoglycemia were significantly predictive of mortality. Community education or mass campaigns about the signs and symptoms of diabetic ketoacidosis may reduce the mortality rate in children.

背景:糖尿病酮症酸中毒是与急性代谢并发症相关的主要危及生命的疾病之一。它仍然是埃塞俄比亚等发展中国家的一个主要公共卫生问题。目的:了解2022年埃塞俄比亚西北部西阿姆哈拉地区综合专科转诊医院糖尿病酮症酸中毒患儿的发病率及死亡率预测。方法:对2017年1月1日至2021年12月31日确诊为糖尿病酮症酸中毒的423名研究参与者进行了基于机构的回顾性随访研究。使用Epi-Data 4.6版本输入、编码、清理和检查数据,并导出到Stata 14版本进行数据分析。结果:最终分析共纳入401例儿童病历,研究期间随访3781天。在整个随访期间,糖尿病酮症酸中毒儿童的总死亡率为10.6 / 1000人天(95% CI: 7.8-14.4)。气道高反应性低血糖(= 4.6;95% CI: 2.13-10.1),农村居民(AHR=2.9;95% CI=1.01-8.11),年龄小于5岁(AHR=4.4;95% CI=1.4-13.7)或在5 - 10之间(AHR=3.1;95% CI=1.1-8.8),女性(AHR=2.6;95% CI=1.1-5.8)是死亡率的重要预测因子。结论:糖尿病酮症酸中毒患儿死亡率较高。年龄、农村居住地、女性性别和低血糖对死亡率有显著预测作用。关于糖尿病酮症酸中毒症状和体征的社区教育或群众运动可降低儿童死亡率。
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引用次数: 0
Prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients attended at Jugol General Hospital in eastern Ethiopia: A cross-sectional study. 埃塞俄比亚东部Jugol总医院2型糖尿病患者他汀类药物的处方模式及相关因素:一项横断面研究。
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1061628
Shambel Nigussie, Fekade Demeke

Background: Most clinical practice guidelines support the use of statins in patients with type 2 diabetes mellitus to lower the risk of cardiovascular disease. However, nothing is known about the prescribing patterns of statins at Jugol General Hospital in eastern Ethiopia.

Objective: This study aimed to assess the prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients attended at Jugol General Hospital in eastern Ethiopia.

Methods: A retrospective cross-sectional study was conducted among 423 patients with type 2 diabetes mellitus who received follow-up care from 1 June 2017 to 1 June 2022. The study participants were enrolled consecutively using a convenience sampling technique. The data were extracted from patients' medical records using a data abstraction checklist. The extracted data were entered into EpiData, version 3.1, and exported to Statistical Package for the Social Sciences (SPSS), version 22, for analysis. Associations were considered to be statistically significant at a p-value < 0.05 and presented as adjusted odds ratios and 95% confidence intervals.

Result: The medical records of 423 patients were reviewed. The review revealed that medical records were complete for 410 of these patients, and these records were included in the analysis. The majority of the study participants were female (72.2%) and between the age of 40 and 65 years (61.2%). All of the study participants were eligible for statin prescription; however, statins were prescribed for only 257 (62.7%) study participants. Of the statins prescribed, moderate-dose-intensity statins were prescribed for 40 (15.6%) participants who were at high risk of cardiovascular disease. Atorvastatin was the most commonly (93.3%) prescribed statin. The presence of hypertension, coronary artery disease, and cerebrovascular events was significantly associated with statin prescribing.

Conclusion: The magnitude of prescribing statins for patients with type 2 diabetes mellitus was low in comparison with the clinical practice guidelines recommendation. This finding is alarming and is a call for action to improve the execution of clinical practice guidelines for the benefit of this high-risk population.

背景:大多数临床实践指南支持在2型糖尿病患者中使用他汀类药物以降低心血管疾病的风险。然而,对埃塞俄比亚东部Jugol总医院的他汀类药物的处方模式一无所知。目的:本研究旨在评估埃塞俄比亚东部Jugol总医院就诊的2型糖尿病患者他汀类药物的处方模式及其相关因素。方法:对2017年6月1日至2022年6月1日接受随访治疗的423例2型糖尿病患者进行回顾性横断面研究。研究参与者采用方便抽样技术连续登记。使用数据抽象检查表从患者的医疗记录中提取数据。提取的数据输入EpiData 3.1版本,导出到SPSS (Statistical Package for The Social Sciences) 22版本进行分析。在p值< 0.05时认为相关性具有统计学意义,并以调整后的优势比和95%置信区间表示。结果:回顾了423例患者的病历。审查显示,其中410名患者的医疗记录是完整的,这些记录被纳入分析。大多数研究参与者为女性(72.2%),年龄在40至65岁之间(61.2%)。所有的研究参与者都有资格服用他汀类药物;然而,只有257名(62.7%)研究参与者开了他汀类药物。在他汀类药物的处方中,40名(15.6%)心血管疾病高危患者服用了中等剂量的他汀类药物。阿托伐他汀是最常见的他汀类药物(93.3%)。高血压、冠状动脉疾病和脑血管事件的存在与他汀类药物处方显著相关。结论:与临床实践指南推荐相比,2型糖尿病患者的他汀类药物处方量较低。这一发现令人震惊,并呼吁采取行动,改善临床实践指南的执行,以造福这一高危人群。
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引用次数: 0
Editorial: Diabetes and depression. 社论:糖尿病和抑郁症。
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1221640
G R Sridhar, G Lakshmi
COPYRIGHT © 2023 Sridhar and Lakshmi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. TYPE Editorial PUBLISHED 23 June 2023 DOI 10.3389/fcdhc.2023.1221640
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引用次数: 0
期刊
Frontiers in clinical diabetes and healthcare
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