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.

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: Prediabetes represents an intermediate stage in the dysglycemia continuum, associated with increased cardiometabolic risk but also substantial opportunity for prevention. The aim of this review was to summarize and critically evaluate the available evidence on the effects of semaglutide and tirzepatide in individuals with prediabetes, focusing on diabetes prevention and cardiovascular (CV) outcomes.

Methods: A narrative synthesis of data from randomized controlled trials, meta-analyses, and real-world studies assessing semaglutide and tirzepatide in people with prediabetes.

Results: Across the STEP 1, STEP 5, and SELECT trials, semaglutide 2.4 mg significantly increased regression to normoglycemia (up to 84 %) and reduced the risk of progression to diabetes compared with placebo. In the SURMOUNT-1 trial, tirzepatide reduced the incidence of diabetes by nearly 90 % (Hazard Ratio: 0.07; p < 0.001), an effect largely mediated by substantial weight loss. Regarding CV outcomes, the SELECT trial, of which 66.4 % of participants had prediabetes, demonstrated a significant reduction in the primary composite endpoint of CV death, nonfatal myocardial infarction, or nonfatal stroke with semaglutide versus placebo (hazard ratio 0.80; 95 % CI: 0.72-0.90). A prespecified analysis showed that CV risk reduction was independent of baseline HbA1c, supporting CV benefit in people with prediabetes. The ongoing SURMOUNT-MMO trial will further clarify the CV effects of tirzepatide in individuals with obesity without diabetes.

Conclusion: Semaglutide and tirzepatide markedly increase regression to normoglycemia and reduce progression to diabetes in people with obesity and prediabetes. Semaglutide has also demonstrated CV benefit in SELECT, including among participants with prediabetes. Ongoing outcome data, particularly from SURMOUNT-MMO, will further define the cardioprotective potential of GLP-1-based medicines across the dysglycemia spectrum.

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.

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: Type 2 diabetes mellitus (T2DM) is a growing public‑health challenge in Greece, yet validated tools to assess care quality in primary settings are lacking. We aimed to develop a context‑specific set of consensus‑based quality indicators (QIs) for T2DM in Greek primary care, with an eye toward broader applicability in comparable European and low‑ and middle‑income country (LMIC) systems.

Methods: A two-phase study was conducted: (1) a focused bibliographic search (Medline/PubMed and Scopus; January 2019-August 2020) to identify existing T2DM QI sets suitable for primary care; and (2) a three-round modified Delphi survey with 10 stakeholders (general practitioners, diabetologist, dietician, health policy expert, patients) to evaluate indicator importance and feasibility and reach consensus. Candidate indicators were contextually adapted for European relevance prior to Delphi rating.

Results: The bibliographic search identified 16 records; only one study met eligibility criteria and provided 43 candidate QIs. The Delphi process yielded 39 QIs across nine domains: access (2), monitoring (13), health counseling (3), treatment and prevention (2), patient safety (3), records (1), health status (11), patient satisfaction (2), and self-management (2).

Conclusions: We present the first context-adapted, consensus-based T2DM QI set for Greek primary care, covering clinical, organizational, and patient-reported aspects of care. This framework lays the groundwork for wider implementation, electronic health record integration, and international benchmarking.

Background: Prediabetes, marked by elevated blood glucose levels below the type 2 diabetes mellitus (T2DM) threshold, is a growing public health concern due to its rising prevalence and risk of progression to diabetes and cardiovascular issues. Structured weight loss programs in primary care show promise for improving glycemic control, yet their impact on HbA1c remains underexplored. This systematic review evaluates their effectiveness in reducing HbA1c in adults with prediabetes.

Methods: Following the 2020 PRISMA and SWiM guidelines, we searched six databases (PubMed, EMBASE, Cochrane CENTRAL, Scopus, CINAHL, Web of Science) up to July 10, 2025, for studies on structured weight loss programs in primary care. Eligible studies involved adults (≥18 years) with prediabetes, using RCTs, cohort studies, or pilot interventions with HbA1c as the primary outcome. Data were extracted, and risk of bias was assessed using Cochrane RoB 2.0 and ROBINS-I tools. A narrative synthesis was performed due to study heterogeneity.

Results: Seven studies (n = 43-2227) showed HbA1c reductions of 0.03 %-0.83 %, with high-intensity (e.g., frequent behavioral sessions) and digital interventions (e.g., low-carbohydrate apps) yielding the largest effects. Weight loss (up to 7.2 kg), BMI, and lipid profiles also improved. Adherence and intervention intensity were key factors, though inconsistent reporting limited comparisons.

Conclusion: Structured weight loss programs in primary care are consistently associated with modest-to-moderate HbA1c reductions, with high-intensity and digital interventions showing the greatest promise. However, study heterogeneity and inconsistent adherence reporting limit definitive conclusions. Future research should prioritize standardized reporting, long-term outcomes, and diverse populations to enhance generalizability.