Diabetes care最新文献

Objective: This study aimed to evaluate the diabetic eye disease screening continuum at two academic centers and identify its barriers.

Research design and methods: We analyzed health records from the University of California, San Francisco, and University of California, Irvine, to identify primary care patients needing diabetic eye screening. We tracked referrals, screenings, diagnoses, and treatments to evaluate predictors and the impact of an automated referral system. We analyzed physician notes using GPT-4o to determine reasons for missed screenings.

Results: Of 8,240 unscreened patients with type 2 diabetes mellitus (T2DM), 43% received a referral, and only 16% completed screening within 1 year. Demographic, provider, and socioeconomic factors predicted adherence, with referrals being the strongest predictor. An automated referral system could improve screening rates to 22-34%. Clinician notes cited comorbidities, scheduling challenges, logistical issues, coronavirus disease 2019, and personal circumstances as barriers.

Conclusions: Many patients with T2DM remain unscreened after primary care visits. Although an automated referral system may partially improve adherence, additional tailored strategies are needed.

Objective: To identify prevalence, risk factors, and visual outcomes associated with occurrence and duration of lapses in proliferative diabetic retinopathy (PDR) care.

Research design and methods: This was a retrospective national cohort study (2008-2023) of adults with PDR and ≥6 months of follow-up who were participating in the Sight Outcomes Research Collaborative. We used multivariable regressions to assess factors associated with lapse occurrence and duration, and compared post-lapse visual acuity by lapse duration.

Results: Among 15,211 individuals, 71.8% experienced a lapse in care; 14.2% of the lapses lasted >24 months. Lapses were more common among non-Hispanic Black, younger, and individuals with disability, and less common in those with poor vision or prior PDR treatment. Older age and PDR treatment predicted shorter lapses, and residence in distressed areas predicted longer lapses. Visual acuity worsened after lapses, with greater declines after longer lapses.

Conclusions: Prolonged lapses in PDR care are common, disproportionately affect vulnerable groups, and are associated with persistent vision loss.

Objective: In the Evaluate Renal Function With Semaglutide Once Weekly (FLOW) trial, semaglutide reduced the risk of major kidney and cardiovascular (CV) outcomes and all-cause mortality in people with type 2 diabetes (T2D) and chronic kidney disease (CKD). This prespecified analysis assessed the effects of semaglutide on kidney, CV, and mortality outcomes by baseline mineralocorticoid receptor antagonist (MRA) use.

Research design and methods: Participants were randomized to once-weekly subcutaneous semaglutide 1.0 mg or placebo. The primary kidney outcome was a composite of time to first persistent ≥50% eGFR reduction from baseline, kidney failure, or death from kidney/CV causes. Baseline MRA was predominantly spironolactone; finerenone was only available after recruitment ended.

Results: Effects were analyzed by baseline MRA use (n = 257 [136 in the semaglutide group and 121 in the placebo group]) and nonuse (n = 3,276 [1,631 in the semaglutide group and 1,645 in the placebo group]). Semaglutide reduced the risk of the primary kidney outcome by 49% (59 events; hazard ratio [HR] 0.51 [95% CI 0.30, 0.86]) and 21% (682 events; HR 0.79 [95% CI 0.68, 0.92]; P-interaction = 0.12) versus placebo in MRA and non-MRA subgroups, respectively. There was no heterogeneity, favoring the effects of semaglutide on major adverse CV events (MACE) and all-cause mortality in both MRA subgroups (P-interaction > 0.7). Albuminuria at 104 weeks was reduced from baseline with semaglutide by 15% (95% CI -41, 31) in MRA users and 33% (26, 39) in nonusers versus placebo (P-interaction = 0.22). Estimated glomerular filtration rate decline was similarly reduced with semaglutide (P-interaction = 0.71). The safety profile of semaglutide was comparable between subgroups.

Conclusions: In participants with T2D and CKD, consistent benefits of semaglutide on major kidney outcomes, MACE, and all-cause mortality were observed regardless of baseline MRA use.