Canadian journal of diabetes最新文献

Objectives: Our aim in this study was to explore adolescents' experiences of type 2 diabetes (T2D), particularly those concerning 1) diagnosis and management and 2) emotional well-being.

Methods: Participants, recruited from an Australian tertiary pediatric hospital, took part in a focus group or semistructured interview. Data were analyzed using inductive thematic analysis.

Results: Eight adolescents participated in the study (7 female youths and 1 male youth; mean ± standard deviation age: 16.2±2.3 years; median [interquartile range] diabetes duration: 1.7 [0.8 to 2.5] years; glycated hemoglobin: 7.5% [6.2% to 8.4%]; and body mass index z score: 1.97 [0.70 to 2.29]). Most participants (n=6) were from linguistically diverse backgrounds. Their diabetes management varied from lifestyle measures alone to medication(s). The thematic analysis generated 3 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, 4 themes were generated concerning emotional well-being: 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 judgement and stigma, and a diverse support network is paramount in supporting their T2D management and emotional well-being. The findings can assist health professionals in supporting adolescents with T2D.

Objective: Our aim in this study was to identify the contemporary annual incidence rates of hospitalization for diabetes-related foot complication (DFC) and lower extremity amputation in Canada.

Methods: The time frame of this study was April 2011 to March 2022. The population included people at least 20 years of age throughout Canada, except for Québec. From the Canadian Institute for Health Information Discharge Abstract Database of acute care hospitalizations, a person's 1) first DFC, 2) first diabetes-related major amputation, and 3) 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 DFCs. 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% confidence interval -0.11 to -0.01]), but there was no change over time for other events. A declining rate for major amputations was observed in Ontario, Manitoba, and Saskatchewan, but not in the other provinces or territories.

Conclusions: The national rate of major amputation related to diabetes has decreased, but the burden of DFCs 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.

Objectives: Gestational diabetes mellitus (GDM) increases future risks of type 2 diabetes and cardiovascular disease. Despite Diabetes Canada guidelines recommending postpartum glucose testing after GDM, uptake remains low. Canadian population-based studies are needed to examine system-level factors affecting uptake.

Methods: We used linked Alberta Health data sets, including births from 2017 to 2018, to identify prenatal care provider specialty (general practitioner [GP], obstetrician [OB], or midwife [RM]), postpartum glucose tests, and cohort demographics. Outcomes were 1) gold standard testing, which is oral glucose tolerance testing (OGTT) within 6 weeks to 6 months postpartum; and 2) any glucose test within 6 weeks to 1 year. We used adjusted logistic regression modelling to estimate the association between test incidence and provider specialty.

Results: From 105,691 births, we identified a cohort of 9,884 with GDM. Uptake of postpartum glucose testing was low: 22.2% (95% confidence interval [CI] 21.4% to 23.1%) received gold standard testing and 53.9% (95% CI 52.9% to 54.9%) received any glucose test. When compared with the OB group, GP patients were less likely to receive both glucose test outcomes (odds ratio [OR]_GS=0.86, 95% CI 0.77 to 0.95; OR_Any=0.88, 95% CI 0.81 to 0.96). Patients of RMs were also less likely to receive both glucose test outcomes (OR_GS=0.67, 95% CI 0.46 to 0.96; OR_Any=0.88, 95% CI 0.67 to 1.15).

Conclusions: We report low postpartum glucose testing overall and found no clinically meaningful differences across provider specialties. The higher incidence of any glucose testing suggests that providers may be prioritizing alternative tests over the OGTT protocol for GDM patients.

the article by Dolatabadi et al. offers timely insights into the use of virtual care in managing gestational diabetes mellitus (GDM), but several critical limitations temper the strength and applicability of its conclusions. This Letter to the Editor outlines concerns regarding the study's retrospective design, its omission of patient-reported and adherence-related outcomes, and its limited generalizability. Drawing on recent literature, including evaluations aligned with the Quadruple Aim and meta-analyses of digital interventions, we argue for more robust and patient-centered methodologies in future research. Virtual care in GDM holds promise, but its real-world effectiveness must be assessed through rigorous, equitable, and multidimensional frameworks.