Canadian journal of diabetes最新文献

Objectives: To explore adolescents' experiences of T2D, particularly concerning (1) diagnosis and management and (2) emotional wellbeing.

Methods: Participants, recruited from an Australian tertiary paediatric hospital, participated in a focus group or semi-structured interview. Data were analysed using inductive thematic analysis.

Results: Eight adolescents (seven females and one male) (mean±SD age 16.2±2.3 years, median [IQR] diabetes duration 1.7 [0.8-2.5] years, HbA1c 7.5 [6.2-8.4]%, and body mass index (Z-score) 1.97 [0.70-2.29]) participated. Most participants (n = 6) were from a linguistically diverse background. Their diabetes management varied from lifestyle measures alone to medication/s. Thematic analysis generated three themes relating to diagnosis and management: (1) 'Dietary modification as the biggest encumbrance in managing T2D', (2) 'Medications pose a significant challenge to managing T2D', and (3) 'The value of reminders in managing T2D varies in adolescents. Furthermore, four themes were generated concerning emotional wellbeing: (1) 'Diverse feelings are experienced at the time of diagnosis', (2) 'Diabetes has varying impacts on the daily lives of adolescents with T2D', (3) 'Young people fear stigma and judgement', and (4) 'Having a good support network matters'.

Conclusions: Adolescents with T2D experience difficulties with dietary modification and medication management. Adolescents' feelings at diagnosis and the impact of T2D on a young person's life vary. They fear judgment and stigma, and a diverse support network is paramount in supporting their T2D management and emotional wellbeing. The findings can assist health professionals in supporting adolescents with T2D.

The South Asian population is rapidly growing in the Greater Toronto Area with a growth rate of 10.6% versus the national average of 5.2%. Diabetes disproportionately affects South Asians, 8.1 times higher compared to Caucasians with increased risk of macrovascular and microvascular complications. There are several risk factors that have been identified including 24 single nucleotide polymorphisms, higher insulin resistance, low mean skeletal mass with higher visceral fat, and socioeconomic and family stressors. As the largest visible minority in Canada, these factors alongside a lack of accessible primary care have led to vital gaps in diabetes care and management, a holistic approach with culturally inclusive team-based strategies is proposed to improve health outcomes for South Asians living in Canada.

Background: Children and youth with type 1 diabetes (T1D) must have support to manage their condition at school. In 2017, Ontario students and their parents were surveyed to assess the level of school support and the extent to which that support met perceived needs. In 2018 a provincial policy was established, providing high level guidance regarding children with T1D in school. We redistributed our survey in 2023 to determine whether support for children with T1D has improved and where gaps remain.

Methods: An online survey was circulated to patients and families through the 35 Pediatric Diabetes Education Centres (PDEPs) in the Ontario Pediatric Diabetes Network (PDN) in 2017 and 2023. Survey responses were collected via REDCap software. Results were analyzed using descriptive statistics and Pearsons Chi Squared Test. A Mann-Whitney U Test was used to compare satisfaction with school support.

Results: 1060 responses were received in 2017 and 437 responses in 2023. Between the two timepoints, respondents reported increased use of individual care plans, continuous glucose monitoring and improved management of hypoglycemia at school. There was no improvement in support for blood sugar monitoring or insulin administration. Overall, there was no increase in satisfaction with school support. Importantly, 37% of caregivers stopped work related to diabetes care at school.

Conclusions: School support for children with T1D has improved in specific domains. However gaps remain, and many families remain adversely affected by lack of support in school. Our findings suggest a need for ongoing advocacy to address care gaps.

Purpose: To determine the contemporary annual incidence rates of hospitalization for diabetes-related foot complication (DFC) and lower-extremity amputation in Canada.

Methods: The study timeframe was April 2011 to March 2022. The population was persons at least 20 years old in all of Canada except Québec. From the Canadian Institute for Health Information's Discharge Abstract Database of acute care hospitalizations, a person's (i) first DFC, (ii) first diabetes-related major amputation, and (iii) first diabetes-related major or minor amputation were identified. Using population data from Statistics Canada, age- and sex-adjusted annual rates were calculated for each of these events. Regression models for temporal trends in these rates were fitted for the full population and by province or territory.

Results: Over the 11-year study period, there were 20,886 first major amputations, 41,643 first major or minor amputations, and 48,526 first DFC. The average incidence rates across years for major amputation, major or minor amputation, and DFC were 8.8, 17.5, and 20.3 per 100,000 population respectively. The major amputation rate decreased over time (-0.06 per year [95% CI -0.11 to -0.01]), but there was no change over time for other events. A declining rate of major amputation was only observed in Ontario, Manitoba, and Saskatchewan, but not in other provinces or territories.

Conclusion: The national rate of major amputation related to diabetes has decreased, but the burden of DFC requiring hospitalization has not. These contemporary data support the need to strengthen foot screening and limb preservation efforts for people living with diabetes across Canada.

Background: Diabetic foot ulcer (DFU), a complication of diabetes, is associated with an increased risk of major amputation and mortality. However, the underlying pathogenesis of DFU remains unclear. The goal of this study was to investigate the role and underlying mechanism of MAF bZIP transcription factor G (MAFG) in DFU wound healing.

Methods: HUVECs were subjected to high glucose (HG) treatment. RT-qPCR and western blot were used to determine the expression of MAFG and autophagy/ferroptosis-related markers. Cell proliferation was tested using CCK-8 assay. Wound healing and tube formation assays were used to assess cell migration and angiogenesis, respectively. ELISA and DCFH-DA staining were employed to measure intracellular oxidative stress and iron content. LC3B expression was detected by immunofluorescent staining. Luciferase reporter assay investigated MAFG-mediated transcriptional regulation of ATG7/BECN1.

Results: Increased MAFG level were observed in DFU patients and HG-exposed HUVECs. The suppression of MAFG resulted in improved proliferation and angiogenesis in HG-induced HUVECs. MAFG knockdown effectively mitigated HG-induced oxidative stress and ferroptosis. Notably, the beneficial effect of MAFG silence on HG-induced HUVECs was diminished after 3-methyladenine (3-MA) administration (a specific autophagy inhibitor). Biologically, MAFG acted as a transcriptional repressor in HUVECs by directly targeting the promoters of autophagy-related genes ATG7 and BECN1. The depletion of ATG7 or BECN1 reversed the protective effects of MAFG knockdown on HG-stimulated angiogenesis and ferroptosis inhibition in HUVECs.

Conclusion: Taken together, MAFG knockdown inhibited ferroptosis and promoted angiogenesis to impair DFU wound healing via modulating ATG7/BECN1-mediated autophagy, providing a novel therapeutic target for DFU treatment.

Objectives: Diabetes self-management often occurs in social contexts, around others without diabetes. International consensus identifies the pervasive presence of social stigma toward those with diabetes, negatively impacting health, well-being, and social and professional lives. In this study we aimed to identify the social experiences of Canadian adults living with type 1 diabetes (T1D) or type 2 diabetes (T2D).

Methods: An online survey was completed by 1,799 adults with diabetes (T1D: n=786; T2D: n=1,013). The survey assessed diabetes stigma, emotional well-being, diabetes distress, quality of life, and health-care experiences. Analyses involved descriptives of stigma experiences and associations with other measures.

Results: Experiencing blame and judgment for having diabetes was common. For T1D, 73% of respondents reported people making unfair assumptions about their capabilities, and 69% reported being judged for what they eat. For T2D, 41% reported being stigmatized as having a "lifestyle disease," and 31% reported being judged for their food choices. Being treated differently due to diabetes was common: 54% with T1D reported being rejected, and 22% with T2D reported being treated as sick. Many respondents with T1D were concerned about managing diabetes in public (44.2%) and many with T2D were embarrassed about having diabetes (27.4%). Greater stigmatization was associated with lower general emotional well-being, greater diabetes distress, and greater negative impact on quality of life.

Conclusions: Adults with T1D or T2D commonly experience stigmatization, negatively impacting well-being and quality of life. These data support changing the conversation about diabetes in way that will lead to greater respect, empathy, and support for all people living with diabetes in Canada.

Diabetes care in Canada is compromised by the lack of resources to adequately address the mental health challenges associated with both type 1 and type 2 diabetes. To address this gap Breakthrough T1D (formerly JDRF) Canada and Diabetes Canada developed a bilingual training program, and associated directory listing successful graduates, to educate and empower existing mental health providers to better provide services to those living with diabetes. This study reports on the development and initial outcomes of this virtual training program. Training involved 6 self-learning modules and a 3-hour interactive session to consolidate knowledge. Over a 24-month period, 796 mental health providers (68.5% English-speaking, 31.5% French-speaking) enrolled in the training program. Over half of enrollees (56.3%) have completed the program to date (N=448) and 37% of completers (N = 166) were approved for the Directory. The professions enrolled, spanning the country, included social workers (42.1%), psychologists (33.7%), psychotherapists (10.8%), counsellors (7.0%), mental health nurses (5.5%), and psychiatrists (0.6%). Satisfaction with the program was very high and training was considered very practical. The program is available at no cost on an ongoing basis, and follow-up research will evaluate the feasibility, acceptability, and potential health-related impact of training mental health providers in working with people with diabetes.