Primary care diabetes最新文献

Aims: This study aimed to examine the association of the level of nurse and general practitioner (GP) interprofessional care on all-cause and cause-specific mortality in patients aged 60 years or more with T2D.

Methods: This cohort study was conducted between January 2002 and December 2018 in the public primary health care of Vantaa, Finland. An index was created to measure the level of interprofessional care. Mortality was measured with standardized mortality ratio (SMR). Analyzed causes of death included cardiovascular diseases, dementia, digestive system diseases, cancer and respiratory diseases.

Results: 11 020 patients were followed for 71 598 person years. Mean follow-up time was 7.3 years. The group with slightly nurse-centred care had the lowest mortality (SMR 0.92, 95 % CI 0.87 - 0.97) and the group with the most GP-centred care had the highest mortality (SMR 2.69: 95 % CI 2.27 - 3.19). Cardiovascular diseases were the leading cause of death in all groups followed by cancer and dementia varying in rank.

Conclusions: Slightly nurse-centred interprofessional care might reduce mortality in patients with T2D. Common causes of death in general population were prevalent in patients with T2D.

Aims: This study aimed to translate the Type 2 Diabetes Distress Assessment System (T2-DDAS) into Traditional Chinese (C-T2-DDAS) and evaluate its psychometric properties among individuals with type 2 diabetes in Hong Kong. T2-DDAS is a comprehensive tool designed to assess diabetes-related core emotional distress and the sources contributing to the distress.

Methods: A two-phase approach was employed. Phase 1 involved translation and cultural adaptation through forward and backward translation, expert panel review, and pilot testing. Phase 2 comprised a cross-sectional validation study with 292 participants recruited from a public hospital outpatient clinic. Psychometric evaluation included assessments of reliability (internal consistency and test-retest), content validity, structural validity via confirmatory factor analysis, and convergent validity through correlations with the Chinese Diabetes Distress Scale.

Results: The C-T2-DDAS demonstrated good internal consistency (0.95 for CORE scale; 0.76-0.88 for seven SOURCE scales) and moderate test-retest reliability (ICC = 0.63). Content validity indices were high (S-CVI = 1.00 for CORE; 0.96 for seven SOURCE scales). Confirmatory factor analysis supported the original eight-factor structure, indicating a strong model fit (RMSEA = 0.045; SRMR = 0.041; CFI/NNFI = 1.00). Convergent validity was confirmed through strong correlations with the Chinese Diabetes Distress Scale (CORE scale: r = 0.78, p < 0.001).

Conclusions: The C-T2-DDAS is a reliable and culturally appropriate tool for assessing diabetes-related distress in Chinese adults with type 2 diabetes. Its multidimensional structure facilitates targeted psychosocial interventions, supporting routine screening and improved diabetes management in both clinical and research contexts. Future research should explore its longitudinal responsiveness and applicability across broader Chinese-speaking populations.

Aim: To determine the psychometric properties of the Turkish version of the Diabetes Self-Stigma Scale (DSSS) MATERIALS AND METHODS: We recruited adults with type 2 diabetes (T2D) using a multicenter convenience sampling method. We examined the test-retest reliability, internal consistency, and convergent validity. Confirmatory factor analysis (CFA) was used to assess the fit of the 2-factor model for the DSSS.

Results: Data were obtained from 160 participants, 60.0 % of whom were male, with a mean age of 60.31 ± 10.71 years. The DSSS showed excellent internal consistency and strong test-retest reliability. (Cronbach's α=0.93; ICC=0.82) The scale revealed a two-factor structure explaining 60.77 % of the total variance. The factor loadings ranged from 0.44 to 0.95. The two-factor model fit was supported by the data. A significant and positive relationship was found between the scales for convergent validity.

Conclusion: The scale is a valid and reliable tool for assessing diabetes stigma in Turkish individuals with T2DM. The scale may also be a valid assessment tool in the Turkish sociocultural context of Turkey. Testing it in different cultures will increase its international validity and reliability.

Aims: Type 2 diabetes (T2D) is a growing global health concern, with its prevalence rising rapidly in Iran. Dysregulation of lipid metabolism has been implicated in the development of T2D, yet potential differences between men and women remain underexplored. Lipid markers, including triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and the TG/HDL-C ratio, may serve as early predictors of metabolic dysfunction. This study investigates the sex-specific associations between lipid profiles and T2D within the Shiraz University Employees Cohort.

Methods: Data from 7100 participants of the Shiraz University Employees Cohort, with type 2 diabetes at baseline, were analyzed. Demographic, anthropometric, and biochemical data, including lipid profiles (TG, HDL-C, TC, LDL-C) and derived ratios (TG/HDL-C, TC/HDL-C), were collected. Sex-specific logistic regression and ROC analyses were used to evaluate the association between lipid indices and type 2 diabetes and to determine optimal cut-off points RESULTS: The study included 3035 men and 4047 women. Higher TG and TG/HDL-C ratios were observed in person with diabetes, with 1-SD increases in TG/HDL-C raising diabetes odds (men: OR=1.28, 95 % CI 1.12-1.45; women: OR=1.35, 95 % CI 1.19-1.52), while HDL-C was protective (men: OR=0.80, 95 % CI 0.66-0.98; women: OR=0.81, 95 % CI 0.67-0.97). TG/HDL-C cut-offs of 3.72 (men) and 2.73 (women) showed the best predictive performance.

Conclusion: TG and TG/HDL-C ratios are simple, accessible, and independent predictors of type 2 diabetes, especially in women, and can help identify high-risk individuals for targeted preventive interventions in clinical settings.

Background: Type 2 Diabetes Mellitus (T2DM) requires a multifaceted management approach involving lifestyle modifications, education, and pharmacological treatments. Medication adherence is critical for achieving glycaemic control; however, up to 45 % of patients fail to meet HbA1c targets. The Morisky Medication Adherence Scale (MMAS) is a validated tool widely used in clinical practice to assess self-reported medication adherence, offering valuable insights into patient behaviours affecting treatment outcomes.

Aim: This systematic review evaluates medication adherence in adults with T2DM using the MMAS and to identify modifiable factors influencing non-adherence. The COM-B model was used to structure the analysis by mapping barriers and enablers to the Capability, Opportunity, and Motivation components that underpin medication-taking Behaviour.

Method: A systematic review was conducted following the PRISMA framework. MEDLINE, EMBASE, EMCARE, and Ovid Nursing databases were searched for cross-sectional studies published between January 2013 and December 2024 that utilised the MMAS scale to assess adherence in adults with T2DM receiving oral or injectable anti-glycaemic therapies. A narrative synthesis was conducted using the COM-B model to identify key barriers and enablers influencing adherence.

Results: Of 9990 records screened, 30 studies from 17 countries, involving 8405 participants, met the inclusion criteria. Overall, 40.9 % of participants demonstrated high adherence, while 42.6 % had low adherence. Key barriers included poor diabetes knowledge, depression, polypharmacy, side effects, inadequate patient-provider communication, and lack of continuity in care. Enablers encompassed patient education, family support, effective patient-provider communication, and structured diabetes education programmes.

Conclusions: The MMAS remains a reliable tool for assessing self-reported medication adherence in T2DM. However, adherence levels remain suboptimal. Addressing modifiable factors, such as depression, enhancing diabetes education, and improving healthcare communication, may improve adherence, glycaemic control, and overall T2DM management outcomes.

Registration: Registered with PROSPERO (CRD42022359969).

Aims: Diabetic foot ulcers (DFU) are a major cause of morbidity and mortality, but data on incidence and predictors in newly diagnosed, uncomplicated type 2 diabetes mellitus (T2DM) are limited. Aim of this longitudinal study was to quantify the incidence of first-ever DFU in newly diagnosed, complication-free T2DM and to identify predictors.

Methods: A total of 937 newly diagnosed, uncomplicated T2DM patients were enrolled between July 2013 and February 2019 and followed prospectively for 62.7 ± 21.5 months. The primary outcome was the first incident DFU.

Results: During follow-up, 48 patients (5.1 %) developed DFU (incidence 0.99/100 person-years). Multivariable Cox regression identified four independent predictors of incident DFU: baseline TcPO₂≤ 46 mmHg (Hazard Ratio -HR-=5.09, 95 %Confidence Interval -95 %CI-:2.68-9.65, p < 0.001), incident retinopathy (HR=6.11, 95 %CI=3.39-11.00, p < 0.001), incident polyneuropathy (HR=7.05, 95 %CI:3.94-12.62, p < 0.001), and incident micro-/macroalbuminuria (HR=2.67, 95 %CI:1.47-4.85, p < 0.001). Sexual dysfunction was more frequent in DFU patients (47.9 % vs. 31.3 %, p = 0.016) but was not an independent predictor.

Conclusions: In newly diagnosed, uncomplicated T2DM, reduced tissue oxygenation and early microvascular complications strongly predict DFU. TcPO₂ measurement at diagnosis may help identify high-risk patients who could benefit from targeted foot surveillance and preventive interventions. However, our findings cannot be applied to all T2DM patients due to the specific characteristics of our study population.

Aims: Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) improve glycemic control and reduce cardiovascular (CV) mortality. However, evidence regarding their real-world utilization in people living with HIV (PLWH) receiving primary care remains limited.

Methods: The present study evaluates the real-world diabetes management, prescription patterns and outcomes in PLWH with type 2 diabetes (T2D) compared to HIV-negative controls in primary care, using retrospective and prospective data from multiple outpatient healthcare facilities from urban outpatient clinics in Germany.

Results: No significant difference was found for treatment with either SGLT-2i or GLP-1 RA (PLWH [30.0 %] vs. controls [28.3 %], p = 0.86) or the combined therapy (p = 0.34). Among participants with established CV disease, only a third received an SGLT-2i and/or a GLP-1 RA (p = 0.63). Regarding quality of life, PLWH had more difficulties with self-care (p = 0.038) and there was a trend towards a greater burden of anxiety and depression (p = 0.051).

Conclusions: PLWH and T2D in primary care received similar evidence-based therapies as controls, however, prescription rates in participants with CV disease were relatively low. Future studies with a larger sample size and longitudinal follow-up are needed to confirm the present findings.

Aims: To expand existing evidence on the effectiveness of peer support on health outcomes in people with type 2 diabetes. Differentiate between offline, online, and hybrid forms of peer support to advance nursing practice in chronic disease management.

Methods: A systematic search of five databases was executed, covering the period from their inception up to July 18, 2025. The risk of bias in the included RCTs was assessed using the Cochrane Risk of Bias tool 2.0 (RoB 2.0). A meta-analysis was performed on the included studies utilizing Stata 17.0. A narrative synthesis was conducted when the meta-analysis was deemed infeasible.

Results: Meta-analysis showed that offline peer support significantly improved body-mass index [SMD= -0.59, 95 %CI= (-1.12,-0.05), p = 0.033, I²= 88.1 %] and fasting blood glucose [SMD= -0.45, 95 %CI= (-0.79,-0.12), p = 0.008, I²= 40.2 %], whereas hybrid support significantly reduced glycated haemoglobin [SMD= -0.19, 95 %CI= (-0.35,-0.04), p = 0.016, I²= 48.0 %]. Online peer support showed no significant effect. No statistically significant improvement in self-efficacy was observed. Additionally, the presence of substantial heterogeneity warrants cautious interpretation of all conclusions.

Conclusions: Peer support interventions help patients with type 2 diabetes regulate glycated hemoglobin, body mass index, and fasting glucose levels, strengthen disease control, and improve clinical outcomes.