Primary care diabetes最新文献

Aims: This retrospective cohort study aimed to investigate the impact of pay-for-performance programs (P4P) on hospitalization rates in individuals with type 1 diabetes mellitus (T1D).

Methods: Using propensity score matching, we recruited 625 pairs of individuals with T1D with and without P4P care from the National Health Insurance Research Database of Taiwan between January 1, 2006, and December 31, 2018. The study used a multivariable Cox regression model to compare the risks of hospitalization for various reasons in individuals with T1D with and without P4P care.

Results: Individuals with T1D receiving pay-for-performance (P4P) care demonstrated a significantly lower risk of all-cause hospitalization (adjusted hazard ratio [aHR] 0.63, 95 % confidence interval [CI] 0.54-0.73). This reduction was particularly notable for hospitalizations related to glucose management or metabolic disorders, infectious diseases, pneumonia, circulatory and respiratory system diseases, and mental health, compared with those not receiving P4P care. However, no significant differences were observed in hospitalization risks for hyperglycemic crisis, severe hypoglycemia, or injury between individuals with and without P4P care.

Conclusions: This nationwide cohort study found that P4P participation was associated with a lower risk of hospitalization in individuals with type 1 diabetes.

Aims: Low-income adults face barriers to diabetes prevention and self-management, especially healthy eating. This study assessed factors associated with diet quality in low-income adults with prediabetes or type 2 diabetes (T2D), particularly modifiable factors that could be targeted in diabetes self-management education and support (DSMES).

Methods: This secondary analysis of a cohort of low-income health center patients in Boston, Massachusetts determined the association between diet quality and sociodemographic (e.g., race/ethnicity, social support) and behavioral (e.g., depression) factors in adults with prediabetes or T2D. Primary outcome was Healthy Eating Index-2020 (HEI; range 0-100, higher=healthier). Random forests, interpreted using Shapley Additive Explanation values, were fit to determine relative importance of factors in predicting HEI.

Results: Of 278 participants, 42 % had prediabetes and 58 % had T2D. Median age (IQR) was 52 (43, 57); 58 % were Hispanic. Top factors associated with higher HEI were older age, female gender, and Hispanic ethnicity; other important factors were non-smoking, greater dietary variety, less time sitting, higher sleep quality, lower stress, more social support, and fewer depression symptoms.

Conclusion: Modifiable factors for low diet quality, such as dietary variety, social support, and stress, could be emphasized in diabetes prevention and DSMES programs tailored for low-income populations.

Aim: The purpose of this study is to evaluate the applicability and efficacy of the Synchronized Diabetes Monitoring System (SDMs), which consists of a smart cap attached to insulin pens with recording, alarm, alert, and reminder functions, and software that operates via Bluetooth, in patients with type 2 diabetes on insulin treatment.

Methods: The system consists of a smart mobile apparatus mounted on an insulin pen and automatically recording the dose and time of the administered insulin, an application developed for mobile phones that can read blood glucose results from the glucometer, and a website.

Results: The system has been tested in a 6-month pilot cohort of SDMs group (n = 23, 44 % female, age: 50.1 ± 13 years, duration: 12.2 ± 9.2 years) in a transparent, controlled, and single-center pilot trial, showing promising results. The results were compared to the control group (n = 23, age: 54 ± 9.3 years, 52 % female, duration: 13.8 ± 7.4 years). In the third month, we found that they had better glycemic control, as indicated by a decrease in fasting blood glucose (from 147 to 114 mg/dL, p = 0.024) and HbA1c levels (from 8.5 % to 7.2 %, p = 0.003). Additionally, improvements were achieved in physical function, role limitation, and physical and mental health domains of SF-36 survey in patients using the system.

Conclusion: The preliminary results from this pilot study suggest that the synchronized diabetes monitoring system have the potential to improve glycemic control and increase health satisfaction in insulin-treated patients with type 2 diabetes.

Background: A new feeding strategy called time-restricted eating (TRE) is being developed with the goal to remedy obesity and type 2 diabetes by aligning food consumption with the body's endogenous circadian rhythms. These rhythms regulate metabolic function on a daily 24-hour basis by exerting a significant impact on energy balance, lipid metabolism, and glucose homeostasis.

Methods: These databases were searched in an exhaustive manner: Scopus, Web of Science, Google Scholar, PubMed, Saudi Digital Library, and the Cochrane Library; the search was widened until January 2025. Essential search terms were: dieting on time constraint, metabolic health, the circadian rhythm, obesity, and diabetes.

Results: To optimize metabolic health, TRE takes advantage of circadian rhythms by restricting daily calorie consumption to a specified time window. TRE has been shown in clinical trials to enhance weight loss, insulin sensitivity, and glucose metabolism. Clinical evidence indicates that TRE can alter the disease trajectory of obese patients as well as patients with type 2 diabetes. The psychological and behavioral determinants of compliance with this intervention are also addressed in this review.

Conclusion: For the control of metabolic disease, TRE holds promise. For more insight into the therapeutic benefit of TRE, future studies should investigate its possible combination with individualized nutritional regimens and its long-term impact on metabolic and psychological health.

Background: Frailty is increasingly recognized as a condition that negatively affects self-management in individuals with type 2 diabetes. Limited evidence exists regarding its impact on diabetic foot self-care and self-efficacy, particularly in middle-aged populations.

Objectives: This study aimed to examine the effect of frailty on foot care behaviors and self-efficacy among middle-aged and older adults with type 2 diabetes.

Methods: A descriptive, cross-sectional study was conducted with 75 middle-aged (40-64 years) and 75 older (≥65 years) adults diagnosed with type 2 diabetes. Data were collected using the FRAIL Scale, the Foot Care Behavior Scale, and the Diabetic Foot Care Self-Efficacy Scale. Group comparisons were performed using independent t-tests, and regression analyses were used to evaluate the predictive role of frailty.

Results: Frailty prevalence was 22.7 % in middle-aged adults and 42.7 % in older adults. Regression analyses showed that frailty was a strong predictor of both self-efficacy and foot care behaviors. Each one-point increase in frailty score was associated with a ∼12-point decrease in self-efficacy (β=-0.876; p < 0.001) and an ∼8-point decrease in foot care behaviors (β=-0.905; p < 0.001). The explanatory power of frailty was greater in middle-aged adults compared to older adults.

Conclusion: Frailty significantly impairs foot care behaviors and self-efficacy in adults with type 2 diabetes. Routine frailty screening, even from middle age, may support the early identification of individuals at risk for diabetic foot complications and inform preventive wound care strategies.

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.