Canadian Journal of Diabetes最新文献

Calling All Clinicians: A Brief 5-Step Model for Exploring Diabetes Distress in Routine Diabetes Care 召集所有临床医生：在常规就诊中探索糖尿病困扰的简明五步模式

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Canadian Journal of Diabetes

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjd.2024.03.005

引用次数: 0

A Tailored Intervention for Improving Diabetes Self-care Among Adults With Visual Impairment: A Pilot Study 改善视力障碍者糖尿病自我护理的定制干预：试点研究

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Canadian Journal of Diabetes

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjd.2024.05.002

Objectives

Our aim in this study was to develop and evaluate a tailored intervention for improving diabetes self-care among people with visual impairment (TID-VI) in South Korea.

Methods

The TID-VI program was designed around the barriers, resources, and perceptual factors to promote diabetes self-care in those with visual impairment (VI). A single-arm pilot study was conducted to evaluate the feasibility and preliminary effects of the intervention. Diabetes self-efficacy, self-care behaviours, depression, health-related quality of life, and clinical outcomes (fasting blood glucose, glycated hemoglobin [A1C], lipids, and blood pressure) were measured before and up to 2 months after the 12-week intervention.

Results

All 14 participants completed TID-VI. Diabetes self-efficacy, diabetes self-care behaviours, depression, and health-related quality of life showed improvement from baseline that was sustained at 2 months. Although high- and low-density lipoprotein also improved, there were no differences in blood glucose, A1C, total cholesterol, or blood pressure at 2 months.

Conclusions

A theory-driven, tailored intervention specific to the needs of adults with VI can produce substantial improvements in patient-reported quality of life and health status outcomes, although the benefits are yet to be confirmed in a controlled study.

方法 TID-VI 计划是围绕促进视力障碍（VI）患者糖尿病自我护理的障碍、资源和感知因素而设计的。为评估该干预措施的可行性和初步效果，我们开展了一项单臂试点研究。在为期 12 周的干预前和干预后 2 个月内，对糖尿病自我效能、自我护理行为、抑郁、与健康相关的生活质量和临床结果（空腹血糖、糖化血红蛋白 [A1C]、血脂和血压）进行了测量。与基线相比，糖尿病自我效能、糖尿病自我护理行为、抑郁以及与健康相关的生活质量均有所改善，且在两个月后仍能保持。尽管高密度和低密度脂蛋白也有所改善，但在 2 个月时，血糖、A1C、总胆固醇或血压均无差异。结论针对成人 VI 患者的需求进行理论驱动的定制干预，可显著改善患者报告的生活质量和健康状况，但其益处仍有待对照研究证实。

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引用次数: 0

Association of Sodium-Glucose Cotransporter-2 Inhibitors vs Dipeptidyl Peptidase-4 Inhibitors With Pneumonia, COVID-19, and Other Adverse Respiratory Events in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis SGLT2I 与 DPP4I 与 2 型糖尿病患者肺炎、COVID-19 和呼吸系统不良事件的关系：系统回顾与元分析》。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Canadian Journal of Diabetes

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjd.2024.04.009

Objective

Our aim in this study was to systematically assess the association of sodium-glucose cotransporter-2 inhibitors (SGLT2i) vs dipeptidyl peptidase-4 inhibitors (DPP4i) with pneumonia, COVID-19, and adverse respiratory events in patients with type 2 diabetes mellitus (DM).

Methods

PubMed, Embase, and Cochrane Library databases were retrieved to include studies on DM patients receiving SGLT2i (exposure group) or DPP4i (control group). Stata version 15.0 statistical software was used for the meta-analysis.

Results

Ten studies were included, all 10 of which were used for the qualitative review and 7 for the meta-analysis. According to the meta-analysis, patients receiving SGLT2i had a lower incidence of pneumonia (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.51 to 0.74) and pneumonia risk (OR 0.63, 95% CI 0.60 to 0.68, p=0.000) compared with those receiving DPP4i. The same situation was seen for mortality for pneumonia (OR 0.49, 95% CI 0.39 to 0.60) and pneumonia mortality risk (OR 0.47, 95% CI 0.42 to 0.51). There was lower mortality due to COVID-19 (OR 0.31, 95% CI 0.28 to 0.34) and a lower hospitalization rate (OR 0.61, 95% CI 0.56 to 0.68, p=0.000) and incidence of mechanical ventilation (OR 0.69, 95% CI 0.58 to 0.83, p=0.000) due to COVID-19 in patients with type 2 DM receiving SGLT2i. Qualitative analysis results show that SGLT2i were associated with a lower incidence of COVID-19, lower risk of obstructive airway disease events, and lower hospitalization rate of health-care–associated pneumonia than DPP4i.

Conclusion

In patients with type 2 DM, SGLT2i are associated with a lower risk of pneumonia, COVID-19, and mortality than DPP4i.

目的本研究旨在系统评估钠-葡萄糖共转运体-2抑制剂（SGLT2i）与二肽基肽酶-4抑制剂（DPP4i）与2型糖尿病（DM）患者肺炎、COVID-19和呼吸系统不良事件的关系。方法检索PubMed、Embase和Cochrane图书馆数据库，纳入接受SGLT2i（暴露组）或DPP4i（对照组）治疗的DM患者的相关研究。结果共纳入 10 项研究，其中 10 项用于定性综述，7 项用于荟萃分析。根据荟萃分析结果，与接受 DPP4i 治疗的患者相比，接受 SGLT2i 治疗的患者肺炎发生率（几率比 [OR] 0.62，95% 置信区间 [CI] 0.51 至 0.74）和肺炎风险（OR 0.63，95% CI 0.60 至 0.68，P=0.000）较低。肺炎死亡率（OR 0.49，95% CI 0.39 至 0.60）和肺炎死亡风险（OR 0.47，95% CI 0.42 至 0.51）也是如此。在接受SGLT2i治疗的2型DM患者中，COVID-19导致的死亡率较低（OR 0.31，95% CI 0.28至0.34），COVID-19导致的住院率（OR 0.61，95% CI 0.56至0.68，P=0.000）和机械通气发生率（OR 0.69，95% CI 0.58至0.83，P=0.000）较低。定性分析结果显示，与DPP4i相比，SGLT2i与较低的COVID-19发生率、较低的阻塞性气道疾病事件风险和较低的医源性肺炎住院率相关。

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引用次数: 0

Experiences of Motivational Interviewing in Virtual Health-care Visits for Adults With Type 2 Diabetes Mellitus: A Qualitative Analysis 2 型糖尿病成人患者在虚拟医疗保健访问中的动机访谈体验：定性分析。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Canadian Journal of Diabetes

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjd.2024.04.008

Objectives

The purpose of this qualitative study is to identify barriers minimizing the effectiveness of motivational interviewing during virtual clinic encounters for individuals with type 2 diabetes based on the capability, opportunity, motivation, and behaviour (COM-B) model.

Methods

One-on-one semistructured interviews were conducted from March to June 2023, with 17 adults with type 2 diabetes (64.7% female; median age 69 years [range 47 to 83 years]) followed at St. Michael’s Hospital (Toronto, Canada). Themes from transcribed interviews were identified through descriptive analysis using a grounded theory approach.

Results

The following main themes were identified: 1) face-to-face appointments strengthen provider–patient rapport and collaboration; 2) virtual encounters reduce patient accountability and hinder health-seeking behaviour; and 3) individuals with physical disabilities and/or low technological proficiency experience decreased provider accessibility. Protective factors that can mitigate these negative impacts include establishing rapport during in-person appointments before transitioning to virtual appointments and incorporating a video component during virtual encounters.

Conclusions

Several barriers of virtual appointments currently limit the effectiveness of motivational interviewing for individuals with type 2 diabetes and make it difficult to provide person-centred care, especially by phone. However, there are protective factors that help to maintain healthy lifestyle behaviours, even after transitioning to virtual settings, and are areas for optimization moving forward.

本定性研究的目的是根据能力、机会、动机和行为（COM-B）模型，找出在虚拟诊所中对 2 型糖尿病患者进行动机访谈时最大程度降低其有效性的障碍。方法于 2023 年 3 月至 6 月在圣迈克尔医院（加拿大多伦多）对 17 名 2 型糖尿病成人患者（64.7% 为女性；中位年龄 69 岁 [47 至 83 岁]）进行了一对一的半结构式访谈。通过使用基础理论方法进行描述性分析，确定了转录访谈中的主题：1）面对面的预约加强了医疗服务提供者与患者之间的融洽关系和合作；2）虚拟会面降低了患者的责任感，阻碍了患者寻求健康的行为；3）身体残疾和/或技术水平较低的人对医疗服务提供者的可及性降低。可以减轻这些负面影响的保护性因素包括：在过渡到虚拟会诊之前，先在面对面会诊中建立融洽关系，并在虚拟会诊中加入视频元素。结论目前，虚拟会诊的一些障碍限制了动机访谈对 2 型糖尿病患者的有效性，并使其难以提供以人为本的护理，尤其是通过电话。不过，有些保护性因素有助于保持健康的生活方式行为，即使在过渡到虚拟环境后也是如此，这也是今后需要优化的领域。

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引用次数: 0

Basal Insulin Initiation in Adults With Type 2 Diabetes Mellitus: A Retrospective Cohort Study Using Administrative Health Data in Alberta, Canada 成人 2 型糖尿病患者开始使用基础胰岛素的情况：一项利用加拿大艾伯塔省行政健康数据进行的回顾性队列研究。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Canadian Journal of Diabetes

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjd.2024.04.011

Objectives

Pharmacologic treatment of type 2 diabetes mellitus (T2DM) follows a stepwise approach. Typically, metformin monotherapy is first-line treatment, followed by other noninsulin antihyperglycemic agents (NIAHAs) or progression to insulin if glycated hemoglobin (A1C) targets are not achieved. We aimed to describe real-world patterns of basal insulin initiation in people with T2DM and A1C not at target despite treatment with at least 2 NIAHAs.

Methods

A retrospective cohort study was conducted using administrative health data from Alberta, Canada, among adults with T2DM, indexed on the first test with 7.0% < A1C < 9.5% (April 1, 2011, to March 31, 2019), with at least 2 previous NIAHAs but no insulin. Kaplan–Meier (KM) methodology was used to analyze time to basal insulin initiation, with stratification by index A1C. Annual patient status was categorized into 5 groups: basal insulin initiation, death, NIAHA intensification, no change in therapy (subgroups of A1C <7.1% and A1C ≥7.1% [clinical inertia]), or discontinuance.

Results

The cohort included 14,083 individuals. The KM cumulative probability of initiating basal insulin was 7.7% (95% confidence interval [CI] 7.3% to 8.2%) at 1 year, increasing to 43.1% (95% CI 42.1% to 44.1%) at 8 years of follow-up. Higher A1C levels were associated with greater proportions of basal insulin initiation. By year 8, proportions with NIAHA intensification and clinical inertia were 12.1% and 19.3%, respectively, relative to year 7.

Conclusions

Despite current clinical practice guidelines recommending achieving A1C targets within 6 months, less than half of the individuals with T2DM and clear indications for basal insulin initiated treatment within 8 years. Efforts to reduce delays in basal insulin initiation are needed.

背景：2 型糖尿病（T2DM）的药物治疗采用循序渐进的方法。通常情况下，二甲双胍单药治疗是一线治疗，随后使用其他非胰岛素类降糖药物（NIAHAs），或在血红蛋白A1c（A1C）未达标的情况下转为胰岛素治疗。我们旨在描述真实世界中 T2DM 患者开始使用基础胰岛素的模式，这些患者在使用≥2 种 NIAHAs 治疗后 A1C 仍未达到目标：利用加拿大阿尔伯塔省的行政健康数据，对首次检测指标为 7.0% 的 T2DM 成人患者进行了一项回顾性队列研究：队列包括 14,083 人。随访 1 年时，开始使用基础胰岛素的 KM 累积概率为 7.7%（95% CI：7.3-8.2%），随访 8 年时增加到 43.1%（95% CI：42.1-44.1%）。A1C 水平越高，开始使用基础胰岛素的比例越高。到第8年，NIAHA强化和临床惰性的比例分别为12.1%和19.3%：结论：尽管目前的临床实践指南建议在 6 个月内达到 A1C 目标，但只有不到一半的 T2DM 患者有明确的基础胰岛素适应症，并在 8 年内开始了基础胰岛素治疗。需要努力减少基础胰岛素治疗的延迟。

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引用次数: 0

The Impact of Gender on Physical Activity Preferences and Barriers in Adults With Type 1 Diabetes: A Qualitative Study 性别对 1 型糖尿病成人体育锻炼偏好和障碍的影响：定性研究

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Canadian Journal of Diabetes

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjd.2024.05.003

Objectives

Current exercise recommendations for people with type 1 diabetes (T1D) are based on research involving primarily young, fit male participants. Recent studies have shown possible differences between male and female blood glucose response to exercise, but little is known about whether these differences are sex-related (due to physiological differences between male and female participants) or gender-related (behavioural differences between men and women).

Methods

To better understand gender-based behavioural differences surrounding physical activity (PA), we asked men and women (n=10 each) with T1D to participate in semistructured interviews. Topics discussed included motivation and barriers to exercise, diabetes management strategies, and PA preferences (type, frequency, duration of exercise, etc). Interview transcripts were coded by 2 analysts before being grouped into themes.

Results

Six themes were identified impacting participants’ PA experience: motivation, fear of hypoglycemia, time lost to T1D management, medical support for PA, the role of technology in PA accessibility, and desire for more community. Gender differences were found in motivations, medical support, and desire for more community. Women were more motivated by directional weight dissatisfaction, and men were more motivated to stay in shape. Men felt less supported by their health-care providers than women. Women more often preferred to exercise in groups, and sought more community surrounding T1D and PA.

Conclusion

Although men and women with T1D experience similar barriers around PA, there are differences in motivation, desire for community, and perceived support from medical providers.

导言：目前针对 1 型糖尿病患者（PWT1D）的运动建议主要基于年轻、体格健壮的男性参与者的研究。最近的研究表明，男性和女性对运动的血糖反应可能存在差异，但对于这些差异是与性别有关（由于男性和女性参与者的生理差异），还是与性别有关（男性和女性的行为差异），却知之甚少：为了更好地了解围绕体育锻炼（PA）的基于性别的行为差异，我们邀请患有 T1D 的男性和女性（各 10 人）参加半结构化访谈。讨论的主题包括锻炼的动机和障碍、糖尿病管理策略以及体育锻炼的偏好（锻炼的类型、频率、持续时间等）。访谈记录由两名分析师进行编码，然后按主题分组：结果：确定了影响参与者运动疗法体验的六个主题：结果：共确定了影响参与者体育锻炼体验的六个主题：动机、对低血糖的恐惧、因治疗 T1D 而损失的时间、对体育锻炼的医疗支持、科技在体育锻炼中的作用以及对更多社区的渴望。在动机、医疗支持和对更多社区的渴望方面发现了性别差异。女性更多的动机是对体重不满意，而男性更多的动机是保持身材。与女性相比，男性较少得到医疗服务提供者的支持。女性更倾向于在团体中锻炼，并围绕 T1D 和 PA 寻求更多的社区支持：结论：尽管患有 T1D 的男性和女性在进行体育锻炼时会遇到类似的障碍，但他们的动机、对社区的渴望以及对医疗服务提供者支持的感知却各不相同。

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引用次数: 0

Estimating the Rates of Undiagnosed Prediabetes and Diabetes Among People Experiencing Homelessness 估算无家可归者中未确诊的糖尿病前期和糖尿病发病率。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Canadian Journal of Diabetes

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjd.2024.03.008

Objectives

The rising prevalence of type 2 diabetes in Canada poses a significant health challenge. Despite the convenience of screening for diabetes with glycated hemoglobin (A1C) concentration, people experiencing homelessness (PEH) often face barriers to accessing diabetes screening, potentially leading to underdiagnosis. In this study, we aim to assess the prevalence of undiagnosed diabetes among PEH in Calgary, Alberta, and contribute insights for planning health-care services and public health initiatives.

Methods

Four screening clinics were held, and participants were recruited through posters and word of mouth. Participants underwent point-of-care A1C testing using the Siemens DCA Vantage point-of-care analyzer. Descriptive statistics were used to identify the proportions of prediabetes and diabetes, whereas CANRISK survey scores were used to identify the pre-test probability of diabetes.

Results

The mean age of participants (n=102) was 47.6 years, and the self-reported causes of homelessness among the participants were diverse, including housing and financial issues (n=53), interpersonal and family issues (n=35), and health- or corrections-related factors (n=27). The average A1C was 5.60% (standard deviation 0.57%), with 5 values in the diabetes range and 12 in the prediabetes range, for a total of 17 participants found to have previously undiagnosed dysglycemia.

Conclusions

The high rate of undiagnosed prediabetes and diabetes among PEH reflects at least what is already seen in the general population in Canada. More resources are required to reduce the barriers to screening for diabetes among this population.

目标加拿大 2 型糖尿病患病率的上升对健康构成了重大挑战。尽管利用糖化血红蛋白（A1C）浓度筛查糖尿病很方便，但无家可归者（PEH）在接受糖尿病筛查时往往面临障碍，可能导致诊断不足。在这项研究中，我们旨在评估阿尔伯塔省卡尔加里市无家可归者中未确诊糖尿病的患病率，并为规划医疗保健服务和公共卫生措施提供见解。参与者使用西门子 DCA Vantage 床旁分析仪进行床旁 A1C 检测。结果参与者（102 人）的平均年龄为 47.6 岁，自述无家可归的原因多种多样，包括住房和经济问题（53 人）、人际和家庭问题（35 人）以及健康或矫正相关因素（27 人）。平均 A1C 值为 5.60%（标准偏差为 0.57%），其中 5 个值在糖尿病范围内，12 个值在糖尿病前期范围内，共有 17 名参与者以前未被诊断出血糖异常。需要更多的资源来减少这一人群中糖尿病筛查的障碍。

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引用次数: 0

An Aerobic Cooldown After Morning, Fasted Resistance Exercise Has Limited Impact on Post-exercise Hyperglycemia in Adults With Type 1 Diabetes: A Randomized Crossover Study 清晨空腹阻力运动后的有氧冷却对 1 型糖尿病成人运动后高血糖的影响有限：随机交叉研究。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Canadian Journal of Diabetes

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjd.2024.05.001

Objectives

Expert guidelines recommend an aerobic cooldown to lower blood glucose for the management of post-exercise hyperglycemia. This strategy has never been empirically tested. Our aim in this study was to compare the glycemic effects of performing an aerobic cooldown vs not performing a cooldown after a fasted resistance exercise session. We hypothesized that the cooldown would lower blood glucose in the 30 minutes after exercise and would result in less time in hyperglycemia in the 6 hours after exercise.

Methods

Participants completed 2 identical resistance exercise sessions. One was followed by a low-intensity (30% of peak oxygen consumption) 10-minute cycle ergometer cooldown, and the other was followed by 10 minutes of sitting. We compared the changes in capillary glucose concentration during these sessions and continuous glucose monitoring (CGM) outcomes over 24 hours post-exercise.

Results

Sixteen participants completed the trial. Capillary glucose was similar between conditions at the start of exercise (p=0.07). Capillary glucose concentration decreased by 0.6±1.0 mmol/L during the 10-minute cooldown, but it increased by 0.7±1.3 mmol/L during the same time in the no-cooldown condition. The resulting difference in glucose trajectory led to a significant interaction (p=0.02), with no effect from treatment (p=0.7). Capillary glucose values at the end of recovery were similar between conditions (p>0.05). There were no significant differences in CGM outcomes.

Conclusions

An aerobic cooldown reduces glucose concentration in the post-exercise period, but the small and brief nature of this reduction makes this strategy unlikely to be an effective treatment for hyperglycemia occurring after fasted exercise.

目的：专家指南建议采用有氧冷却来降低血糖，以控制运动后高血糖。这一策略从未经过实证测试。我们的目的是比较空腹阻力运动后进行有氧冷却与不进行有氧冷却对血糖的影响。我们假设，有氧冷却会降低运动后 30 分钟内的血糖，并减少运动后 6 小时内的高血糖时间：方法：参与者完成两节相同的阻力运动。方法：参与者完成了两次相同的阻力运动，其中一次运动后进行了 10 分钟的低强度（30% VO2 峰值）循环测力计冷却，另一次运动后进行了 10 分钟的静坐。我们比较了运动过程中毛细血管葡萄糖浓度的变化以及运动后 24 小时内连续血糖监测（CGM）的结果：结果：16 名参与者完成了试验。运动开始时，不同条件下的毛细血管葡萄糖浓度相似（P=0.07）。在 10 分钟的冷却过程中，毛细血管葡萄糖浓度下降了 0.6 ± 1.0 毫摩尔/升，但在无冷却条件下，毛细血管葡萄糖浓度在同一时间内上升了 0.7 ± 1.3 毫摩尔/升。由此产生的血糖轨迹差异导致了显著的交互作用（p=0.02），而治疗没有影响（p=0.7）。恢复结束时的毛细血管葡萄糖值在不同条件下相似（p>0.05）。CGM结果无明显差异：结论：有氧冷却可降低运动后的血糖浓度，但由于降低幅度较小且持续时间较短，因此这一策略不太可能有效治疗空腹运动后出现的高血糖。

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引用次数: 0

The Canadian Hypoglycemia During Hospitalization Score Is Externally Valid in the Australian Diabetes IN-hospital: Glucose & Outcomes (DINGO) Cohort 加拿大住院期间低血糖（HyDHo）评分在澳大利亚 DINGO 成年糖尿病患者队列中具有外部有效性。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Canadian Journal of Diabetes

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjd.2024.04.010

Objectives

The Hypoglycemia During Hospitalization (HyDHo) score predicts hypoglycemia in a population of Canadian inpatients by assigning various weightings to 5 key clinical criteria known at the time of admission, in particular age, recent presentation to an emergency department, insulin use, use of oral hypoglycemic agents, and chronic kidney disease. Our aim in this study was to externally validate the HyDHo score by applying this risk calculator to an Australian population of inpatients with diabetes.

Methods

This study was a retrospective data analysis of a subset of the Diabetes IN-hospital: Glucose & Outcomes (DINGO) cohort. The HyDHo score was applied based on clinical information known at the time of admission to stratify risk of inpatient hypoglycemia.

Results

The HyDHo score was applied to 1,015 patients, generating a receiver-operating characteristic c-statistic of 0.607. A threshold of ≥9, as per the original study, generated a sensitivity of 83% and a specificity of 20%. A threshold of ≥10, to better suit this Australian population, generated a sensitivity of 90% and a specificity of 34%. The HyDHo score has been externally valid in a geographically different population; in fact, it outperformed the original study after accounting for local hypoglycemia rates.

Conclusions

Our findings support the external validity of the HyDHo score in a geographically different population. Application of this simple and accessible tool can serve as an adjunct to predict an inpatient’s risk of hypoglycemia and guide more appropriate glucose monitoring and diabetes management.

目的住院期间低血糖（HyDHo）评分通过对入院时已知的 5 项关键临床标准（尤其是年龄、最近到急诊科就诊的情况、胰岛素使用情况、口服降糖药的使用情况和慢性肾病）进行不同权重的分配，预测加拿大住院患者的低血糖情况。本研究的目的是通过将该风险计算器应用于澳大利亚的住院糖尿病患者，从外部验证 HyDHo 评分：Glucose & Outcomes (DINGO) 队列的子集进行的回顾性数据分析。根据入院时已知的临床信息应用 HyDHo 评分对住院患者低血糖风险进行分层。结果对 1,015 名患者应用 HyDHo 评分，得出的接收者操作特征 c 统计量为 0.607。根据原始研究，阈值≥9 的灵敏度为 83%，特异性为 20%。阈值≥10更适合澳大利亚人群，灵敏度为90%，特异性为34%。在不同地域的人群中，HyDHo 评分具有外部有效性；事实上，在考虑当地低血糖发生率后，HyDHo 评分的结果优于最初的研究结果。应用这一简单易行的工具可作为预测住院病人低血糖风险的辅助工具，并指导更适当的血糖监测和糖尿病管理。

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引用次数: 0

Glycemic Management Among Adults With Type 1 Diabetes During Passover: A Pre–Post Single-center Study 逾越节期间 1 型糖尿病成人患者的血糖控制：一项前后期单中心研究。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Canadian Journal of Diabetes

Pub Date : 2024-07-01 DOI: 10.1016/j.jcjd.2024.03.003

Objectives

No data are available regarding glycemic management of individuals with type 1 diabetes (T1D) during Passover. Our aim in this study was to assess the effect of Passover on diabetes management and glycemic management in adults with T1D with nutritional changes during Passover (observant) compared with those who did not change their dietary habits during Passover (nonobservant).

Methods

We conducted an observational pre–post study of adults with T1D, followed in a diabetes clinic in Israel. Data were downloaded from insulin pumps and continuous glucose monitoring for 37 days: 2 weeks before Passover, 9 days of Passover, and 2 weeks thereafter. Differences in percentage of time spent above target (>10.0 to >13.9 mmol/L), at target (3.9 to 10.0 mmol/L), and below target (<3.9 to <3.0 mmol/L) were compared using paired t tests or paired signed rank tests.

Results

The study cohort included 43 individuals with T1D (23 observant, 20 nonobservant). The average blood glucose was significantly higher during Passover compared with the period before Passover---in nonobservant patients 8.2±1.5 mmol/L and 7.9±1.3 mmol/L (p=0.043), respectively, and in observant patients 8.7±1.6 mmol/L and 8.4±1.6 mmol/L (p=0.048), respectively. Time above range 10 to 13.9 mmol/L was increased in observant individuals during Passover, as compared with the period before Passover, at 24.9±16.2% and 20.6±12.4% (p=0.04), respectively. The dose of bolus insulin had increased significantly in observant individuals: 27.4±13.9 units during Passover, as compared with 24.2±11.2 units before Passover (p=0.02).

Conclusions

Passover alters glycemic management and insulin needs in Jewish adults with T1D. It is advisable to make specific adjustments to maintain the recommended glycemic management.

背景：目前还没有关于 1 型糖尿病（T1D）患者在逾越节期间血糖控制情况的数据：与逾越节期间未改变饮食习惯的患者（未遵守逾越节）相比，评估逾越节对在逾越节期间改变营养的成年 T1D 患者的糖尿病管理和血糖控制的影响：方法：对以色列一家糖尿病诊所随访的 T1D 成年患者进行前后期观察研究。从胰岛素泵和 CGM 上下载了 37 天的数据：逾越节前 2 周、逾越节期间 9 天和逾越节后 2 周。超过目标值（>10.0 毫摩尔/升和>13.9 毫摩尔/升）、达到目标值（3.9-10.0 毫摩尔/升）和低于目标值的时间百分比差异（结果：研究队列包括 43 名患者（23 名观察者，20 名非观察者）。与逾越节前相比，逾越节期间的平均血糖明显升高--非观察期患者分别为 8.2±1.5 mmol/l 和 7.9±1.3 mmol/l（P=0.043），观察期患者分别为 8.7±1.6 mmol/l 和 8.4±1.6 mmol/l（P=0.048）。与逾越节前相比，逾越节期间观察患者血糖高于范围（TAR）10-13.9 毫摩尔/升的时间分别增加了（24.9±16.2%）和（20.6±12.4%）（P=0.04）。逾越节期间，观察患者的胰岛素注射剂量明显增加，为 27.4±13.9 单位，而逾越节前为 24.2±11.2 单位（P=0.02）：逾越节改变了 T1D 犹太患者的血糖控制和胰岛素需求。结论：逾越节会改变患有 T1D 的犹太患者的血糖控制和胰岛素需求。

{"title":"Glycemic Management Among Adults With Type 1 Diabetes During Passover: A Pre–Post Single-center Study","authors":"","doi":"10.1016/j.jcjd.2024.03.003","DOIUrl":"10.1016/j.jcjd.2024.03.003","url":null,"abstract":"<div><h3>Objectives</h3><p>No data are available regarding glycemic management of individuals with type 1 diabetes (T1D) during Passover. Our aim in this study was to assess the effect of Passover on diabetes management and glycemic management in adults with T1D with nutritional changes during Passover (observant) compared with those who did not change their dietary habits during Passover (nonobservant).</p></div><div><h3>Methods</h3><p>We conducted an observational pre–post study of adults with T1D, followed in a diabetes clinic in Israel. Data were downloaded from insulin pumps and continuous glucose monitoring for 37 days: 2 weeks before Passover, 9 days of Passover, and 2 weeks thereafter. Differences in percentage of time spent above target (>10.0 to >13.9 mmol/L), at target (3.9 to 10.0 mmol/L), and below target (<3.9 to <3.0 mmol/L) were compared using paired t tests or paired signed rank tests.</p></div><div><h3>Results</h3><p>The study cohort included 43 individuals with T1D (23 observant, 20 nonobservant). The average blood glucose was significantly higher during Passover compared with the period before Passover---in nonobservant patients 8.2±1.5 mmol/L and 7.9±1.3 mmol/L (p=0.043), respectively, and in observant patients 8.7±1.6 mmol/L and 8.4±1.6 mmol/L (p=0.048), respectively. Time above range 10 to 13.9 mmol/L was increased in observant individuals during Passover, as compared with the period before Passover, at 24.9±16.2% and 20.6±12.4% (p=0.04), respectively. The dose of bolus insulin had increased significantly in observant individuals: 27.4±13.9 units during Passover, as compared with 24.2±11.2 units before Passover (p=0.02).</p></div><div><h3>Conclusions</h3><p>Passover alters glycemic management and insulin needs in Jewish adults with T1D. It is advisable to make specific adjustments to maintain the recommended glycemic management.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140178178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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