Canadian Journal of Diabetes最新文献_第4页

Impaired Cardiovagal Activity as a Link Between Hyperglycemia and Arterial Stiffness in Adults With Type 2 Diabetes Mellitus Among an Eastern Indian Population: A Cross-sectional Study 心迷走神经活动受损是印度东部人群中 2 型糖尿病患者高血糖与动脉僵化之间的联系：一项横断面研究。

IF 2.5 4区医学 Q2 Medicine

Canadian Journal of Diabetes

Pub Date : 2024-04-01 DOI: 10.1016/j.jcjd.2023.12.003

Nibedita Priyadarsini MD , Devineni Likhitha MBBS , Madumathy Ramachandran MD , Kishore Kumar Behera MD, DM

Objectives

Cardiac autonomic neuropathy (CAN) is one of the most common yet overlooked complications of type 2 diabetes mellitus (T2DM). Individuals with T2DM with CAN have a 5-fold higher rate of cardiovascular morbidity and mortality. The presence of CAN in T2DM could potentially lead to arterial stiffness. However, only sparse data are available suggesting any association between autonomic dysfunction and arterial stiffness in T2DM.

Methods

We recruited 80 people with T2DM and 74 healthy controls for our study. Heart rate variability (HRV) testing was performed to assess autonomic function. Assessment of arterial stiffness was done by measuring the brachial pulse wave velocity (baPWV) and augmentation index (AI).

Results

The time-domain parameters were significantly decreased (p<0.001) and frequency-domain parameters, such as total power and high-frequency band expressed as a normalized unit, were found to be significantly reduced in people with T2DM (p<0.001). Both baPWV and AI were significantly higher in people with T2DM compared with healthy controls (p<0.001). We observed a moderate correlation between standard deviation of normal to normal interval (SDNN) and baPWV (r=−0.437, p=0.002) and AI (r=−0.403, p=0.002). A multiple linear regression model showed an association between SDNN and arterial stiffness parameters, such as baPWV and AI, which were statistically significant (p<0.05) in a fully adjusted model that included the conventional risk factors for atherosclerosis.

Conclusions

Impaired cardiovagal activity is an independent risk factor for the development of arterial stiffness. Incorporation of HRV testing into the diabetes management protocol would have potential benefits for identifying individuals at high risk of developing cardiovascular events. Hence, preventive measures can be taken as early as possible to improve patient outcomes.

目的心脏自主神经病变（CAN）是 2 型糖尿病（T2DM）最常见但却最容易被忽视的并发症之一。患有 T2DM 并伴有自律神经病变的患者，其心血管疾病的发病率和死亡率要高出 5 倍。T2DM 中的 CAN 有可能导致动脉僵化。我们招募了 80 名 T2DM 患者和 74 名健康对照者进行研究。进行心率变异性（HRV）测试以评估自律神经功能。结果发现 T2DM 患者的时域参数显著降低（p<0.001），频域参数，如以归一化单位表示的总功率和高频段，也显著降低（p<0.001）。与健康对照组相比，T2DM 患者的 baPWV 和 AI 均明显升高（p<0.001）。我们观察到正常至正常间期的标准偏差（SDNN）与 baPWV（r=-0.437，p=0.002）和 AI（r=-0.403，p=0.002）之间存在中度相关性。多元线性回归模型显示，SDNN 与动脉僵化参数（如 baPWV 和 AI）之间存在关联，在包含动脉粥样硬化传统危险因素的完全调整模型中，SDNN 与动脉僵化参数之间的关联具有统计学意义（p<0.05）。将心率变异测试纳入糖尿病管理方案，对识别心血管事件高危人群有潜在益处。因此，可以尽早采取预防措施，改善患者的预后。

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引用次数: 0

Online Educational Resources for Youth Living With Type 1 Diabetes Transitioning to Adult Care: An Environmental Scan of Canadian Content 为过渡到成人护理的 1 型糖尿病青少年提供在线教育资源：对加拿大内容的环境扫描。

IF 2.5 4区医学 Q2 Medicine

Canadian Journal of Diabetes

Pub Date : 2024-04-01 DOI: 10.1016/j.jcjd.2023.12.008

Asmaa Housni BSc , Rosemarie Cianci BSc , Rayzel Shulman PhD , Meranda Nakhla PhD , Joseph A. Cafazzo PhD , Sarah D. Corathers PhD , Joyce P. Yi-Frazier PhD , Jessica C. Kichler PhD , Anne-Sophie Brazeau RD, PhD

Objectives

There are many educational resources for adolescents and young adults living with type 1 diabetes; however, it is unknown whether they address the breadth of topics related to transition to adult care. Our aim in this study was to collect educational resources relevant to Canadian youth and assess their quality and comprehensiveness in addressing the knowledge necessary for youth to prepare for interdependent management of their diabetes.

Methods

We conducted an environmental scan, a systematic assessment and analysis, of online education resources in English and French relevant to Canadian youth living with type 1 diabetes. Resources were screened using an open education resource evaluation grid and relevant resources were mapped to the Readiness for Emerging Adults with Diabetes Diagnosed in Youth, a validated diabetes transition readiness assessment tool.

Results

From 44 different sources, 1,245 resources were identified and, of these, 760 were retained for analysis. The majority were webpages (50.1%) and downloadable PDFs (42.4%), and 12.1% were interactive. Most resources covered Diabetes Knowledge (46.0%), Health Behaviour (23.8%), Insulin and Insulin Pump Management (11.8% and 8.6%, respectively), and Health-care System Navigation (9.7%). Topic areas with the fewest resources were disability accommodations (n=5), sexual health/function (n=4), and locating trustworthy diabetes resources (n=3).

Conclusions

There are many resources available for those living with type 1 diabetes preparing to transition to adult care, with the majority pertaining to diabetes knowledge and the least for navigation of the health system. Few resources were available on the topics of substance use, sexual health, and reproductive health. An interactive presentation of these resources, as well as a central repository to house these resources, would improve access for youth and diabetes care providers during transition preparation.

背景为患有 1 型糖尿病的青少年和年轻成人提供了许多教育资源；但是，这些资源是否涉及到与向成人护理过渡相关的广泛主题尚不得而知。我们的目标是收集与加拿大青少年相关的教育资源，并评估这些资源的质量和全面性，以了解青少年为糖尿病的相互依存管理做好准备所需的知识。方法我们对与加拿大 1 型糖尿病青少年患者相关的英语和法语在线教育资源进行了环境扫描、系统评估和分析。我们使用开放式教育资源评估网格对资源进行了筛选，并将相关资源映射到 "青年期诊断出糖尿病的新成人准备情况"（Readiness for Emerging Adults with Diabetes Diagnosed in Youth，READDY）这一经过验证的糖尿病过渡准备情况评估工具。其中大部分是网页（50.1%）和可下载的 PDF 文件（42.4%），12.1% 是互动式的。大多数资源涉及糖尿病知识（46.0%）、健康行为（23.8%）、胰岛素和胰岛素泵管理（分别为 11.8% 和 8.6%）以及医疗系统导航（9.7%）。结论对于准备过渡到成人护理的 1 型糖尿病患者来说，有很多可用的资源，其中大部分与糖尿病知识有关，最少与健康系统导航有关。有关药物使用、性健康和生殖健康的资源很少。对这些资源进行交互式展示，并建立一个中央资源库来存放这些资源，将有助于青少年和糖尿病医疗服务提供者在过渡准备期间更好地获取这些资源。

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引用次数: 0

Determining the Associations Between Glucocorticoid Use During Hematologic Chemotherapy Treatment and New-onset Diabetes and Hyperglycemia and Mortality: A Population-based Cohort Study 确定血液化疗期间使用糖皮质激素与新发糖尿病、高血糖和死亡率之间的关系：一项基于人群的队列研究

IF 2.5 4区医学 Q2 Medicine

Canadian Journal of Diabetes

Pub Date : 2024-04-01 DOI: 10.1016/j.jcjd.2024.01.001

Sarah Moore-Vasram PhD, NP , Monakshi Sawhney PhD, NP , Robyn L. Houlden MD , Patti A. Groome PhD , Catherine Goldie PhD, RN , Wenbin Li MSc , Annette E. Hay MD , Joan Tranmer PhD, RN

Objectives

The aim of this study was to determine the associations between glucocorticoid administration during chemotherapy for hematologic malignancy and hyperglycemia, new-onset diabetes, and mortality in Ontario, Canada. Hospitalization and emergency room utilization during the chemotherapy treatment period were also described.

Methods

We conducted a retrospective cohort study using health administrative data from ICES, Ontario, to assess risk of new-onset diabetes, new-onset hyperglycemia, and hyperglycemia for individuals with leukemia, non-Hodgkin lymphoma (NHL), and Hodgkin lymphoma (HL) receiving glucocorticoids during chemotherapy between 2006 and 2016. Using multivariable regression models, we determined the associations between glucocorticoid exposure and our outcomes of interest, controlling for age, sex, marginalization, and comorbidities.

Results

Our cohort included 19,530 individuals; 71.1% (n=13,893) received a glucocorticoid. The highest proportion of hyperglycemia occurred with leukemia (25.4%, n=1,301). Of the 15,580 individuals with no history of diabetes, those with leukemia had the highest rate of new-onset diabetes (7.1%, n=279) and new-onset hyperglycemia (18.1%, n=641), and glucocorticoid exposure increased the risk of new-onset diabetes (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.01 to 1.64, p=0.04) and new-onset hyperglycemia (HR 1.28, 95% CI 1.09 to 1.5, p=0.003). Hyperglycemia during chemotherapy increased the risk of all-cause mortality for the combined (HR 1.18, 95% CI 1.09 to 1.27, p<0.0001) and NHL (HR 1.16, 95% CI 1.04 to 1.28, p=0.007) cohorts.

Conclusions

Hyperglycemia is common during hematologic chemotherapy treatment and is associated with a modest increased risk of all-cause mortality. Routine screening, monitoring, and management of hyperglycemia should be an integral part of treatment plans for leukemia, NHL, or HL, with or without glucocorticoid administration.

本研究旨在确定加拿大安大略省血液恶性肿瘤化疗期间使用糖皮质激素与高血糖、新发糖尿病和死亡率之间的关系。方法我们利用安大略省ICES的健康管理数据进行了一项回顾性队列研究，调查了2006年至2016年期间化疗期间接受糖皮质激素治疗的白血病、非霍奇金淋巴瘤（NHL）和霍奇金淋巴瘤（HL）患者新发糖尿病、新发高血糖和高血糖的风险。通过多变量回归模型，我们确定了糖皮质激素暴露与相关结果之间的关系，并对年龄、性别、边缘化和合并症进行了控制。结果我们的队列包括 19,530 人；71.1%（n=13,893）的患者接受了糖皮质激素治疗。白血病患者发生高血糖的比例最高（25.4%，n=1,301）。在15580名无糖尿病史的患者中，白血病患者新发糖尿病（7.1%，n=279）和新发高血糖（18.1%，n=641）的比例最高，糖皮质激素暴露增加了新发糖尿病（HR 1.29；95% CI 1.01-1.64；P=0.04）和新发高血糖（HR 1.28；95% CI 1.09-1.5；P=0.003）的风险。化疗期间的高血糖会增加合并组（HR 1.18；95% CI 1.09-1.27；P=0.0001）和 NHL 组（HR 1.16；95% CI 1.04-1.28；P=0.007）的全因死亡风险。无论是否使用糖皮质激素，高血糖症的常规筛查、监测和管理都应成为白血病、NHL或HL治疗计划的组成部分。

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引用次数: 0

Perceptions of Beverages With Non-nutritive Sweeteners Among Indigenous Adults Living in Manitoba and Implications for Type 2 Diabetes 马尼托巴省土著成年人对非营养性甜味剂饮料的看法及其对 2 型糖尿病的影响

IF 2.5 4区医学 Q2 Medicine

Canadian Journal of Diabetes

Pub Date : 2024-04-01 DOI: 10.1016/j.jcjd.2023.12.006

Natalie D. Riediger PhD , Mya Ruby Kidson BSc , Kelsey Mann MSc , Larry Wood , Byron Beardy , Michael Champagne , Riel Dubois , Krista Beck BSc, RD , Maria Kisselgoff MSc , Mary Jane Harper , Anne Waugh MSc , Andrea Bombak PhD , Chantal Perchotte BSc , Céleste Theriault BBA

Objectives

The purpose of this study was to explore the perspectives of Indigenous adults on consuming beverages with non-nutritive sweeteners.

Methods

In this work, we used a community-based, participatory design in partnership with National Indigenous Diabetes Association, Four Arrows Regional Health Authority, and Fearless R2W. We conducted 74 qualitative interviews with Indigenous adults living in Manitoba, including Island Lake First Nations (n=39), Flin Flon (n=15), and the North End neighbourhood of Winnipeg (n=20). Data were indexed in NVivo, and transcripts were analyzed thematically.

Results

Participants exclusively discussed beverages with non-nutritive sweeteners (BNNSs) as an alternative to regular pop or sugary drinks, which were widely available, accessible, and consumed. Why or how BNNSs were viewed as an alternative comprised 3 subthemes: an alternative for health reasons; divergent taste preferences; and an alternative with mysterious but negative health effects. Participants who reported regular consumption of BNNSs largely described consuming them to manage type 2 diabetes. Fewer participants discussed BNNS as a means of weight management or as a preventive health behaviour. Participants who did not report regular BNNS consumption described not liking the taste of BNNSs. Finally, many participants described negative health impacts of consuming BNNSs, and specifically aspartame, although few articulated what those negative impacts were.

Conclusions

Divergent perspectives among Indigenous adults regarding the health implications of consuming BNNSs may reflect ongoing scholarly debates. These findings have implications for the prevention and dietary management of type 2 diabetes in Indigenous communities.

本研究旨在探讨土著成年人对饮用无营养甜味剂饮料的看法。本研究采用了社区参与式设计，与全国土著糖尿病协会、四箭地区卫生局和无畏 R2W 合作。我们对居住在马尼托巴省的土著成年人进行了 74 次定性访谈，包括岛湖原住民（39 人）、弗林弗隆（15 人）和温尼伯北端社区（20 人）。结果参与者专门讨论了无营养甜味剂（BNNS）饮料，将其作为普通汽水或含糖饮料的替代品，因为这些饮料可以广泛获得、饮用。为什么或如何将 BNNS 视为一种替代品包括 3 个子主题：出于健康原因的替代品、不同的口味偏好以及神秘但对健康有负面影响的替代品。报告经常食用 BNNS 的参与者大多描述食用 BNNS 是为了控制 2 型糖尿病。较少参与者将 BNNS 作为控制体重的一种手段或预防性健康行为。没有报告定期食用 BNNS 的参与者表示不喜欢 BNNS 的味道。最后，许多参与者描述了食用 BNNS（特别是阿斯巴甜）对健康造成的负面影响，但很少有人明确指出这些负面影响是什么。这些发现对原住民社区 2 型糖尿病的预防和饮食管理具有重要意义。

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引用次数: 0

Risk Prediction Scores for Type 2 Diabetes Microvascular and Cardiovascular Complications Derived and Validated With Real-world Data From 2 Provinces: The DIabeteS COmplications (DISCO) Risk Scores 2 型糖尿病微血管和心血管并发症风险预测评分，利用两个省份的实际数据得出并验证 DIabeteS COmplications (DISCO) 风险评分

IF 2.5 4区医学 Q2 Medicine

Canadian Journal of Diabetes

Pub Date : 2024-04-01 DOI: 10.1016/j.jcjd.2023.12.009

Baiju R. Shah MD, PhD , Peter C. Austin PhD , Noah M. Ivers MD, PhD , Alan Katz MD , Alexander Singer MB, BCh, BAO , Monica Sirski PhD , Deva Thiruchelvam MSc , Karen Tu MD, MSc

Objectives

Existing tools to predict the risk of complications among people with type 2 diabetes poorly discriminate high- from low-risk patients. Our aim in this study was to develop risk prediction scores for major type 2 diabetes complications using real-world clinical care data, and to externally validate these risk scores in a different jurisdiction.

Methods

Using health-care administrative data and electronic medical records data, risk scores were derived using data from 25,088 people with type 2 diabetes from the Canadian province of Ontario, followed between 2002 and 2017. Scores were developed for major clinically important microvascular events (treatment for retinopathy, foot ulcer, incident end-stage renal disease), cardiovascular disease events (acute myocardial infarction, heart failure, stroke, amputation), and mortality (cardiovascular, noncardiovascular, all-cause). They were then externally validated using the independent data of 11,416 people with type 2 diabetes from the province of Manitoba.

Results

The 10 derived risk scores had moderate to excellent discrimination in the independent validation cohort, ranging from 0.705 to 0.977. Their calibration to predict 5-year risk was excellent across most levels of predicted risk, albeit with some displaying underestimation at the highest levels of predicted risk.

Conclusions

The DIabeteS COmplications (DISCO) risk scores for major type 2 diabetes complications were derived and externally validated using contemporary real-world clinical data. As a result, they may be more accurate than other risk prediction scores derived using randomized trial data. The use of more accurate risk scores in clinical practice will help improve personalization of clinical care for patients with type 2 diabetes.

目标现有预测 2 型糖尿病患者并发症风险的工具对高风险和低风险患者的区分度较低。本研究的目的是利用真实世界的临床护理数据开发 2 型糖尿病主要并发症的风险预测评分，并在不同的司法管辖区对这些风险评分进行外部验证。方法利用医疗保健管理数据和电子病历数据，通过对加拿大安大略省 25,088 名 2 型糖尿病患者在 2002 年至 2017 年期间的随访数据得出风险评分。针对临床上重要的微血管事件（视网膜病变治疗、足部溃疡、终末期肾病）、心血管疾病事件（急性心肌梗死、心力衰竭、中风、截肢）和死亡率（心血管疾病、非心血管疾病、全因）制定了评分。然后，利用马尼托巴省 11,416 名 2 型糖尿病患者的独立数据对这些风险评分进行了外部验证。结果在独立验证队列中，10 个衍生风险评分具有中度到极佳的区分度，从 0.705 到 0.977 不等。在大多数预测风险水平上，它们预测 5 年风险的校准效果都很好，尽管在预测风险最高的水平上，有些评分显示被低估了。结论 DIabeteS COmplications（DISCO）2 型糖尿病主要并发症风险评分是利用当代真实世界的临床数据得出并经过外部验证的。因此，与其他使用随机试验数据得出的风险预测评分相比，它们可能更加准确。在临床实践中使用更准确的风险评分将有助于改善对 2 型糖尿病患者的个性化临床护理。

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引用次数: 0

A Cross-sectional Study on the Impact of Educational Status on Physical Activity Level in Danish and English Adults With Type 1 Diabetes 关于教育状况对丹麦和英国成年 1 型糖尿病患者体育锻炼水平影响的横断面研究

IF 2.5 4区医学 Q2 Medicine

Canadian Journal of Diabetes

Pub Date : 2024-04-01 DOI: 10.1016/j.jcjd.2024.01.002

Sarah Elton Sander MSc, RN , Rakel Fuglsang Johansen PhD, MD , Sharon Caunt PhD , Esben Søndergaard MD, PhD , Monica Gylling Rolver MS , Anni Sandbæk MBA , Simon Heller DM, FRCP , Peter Lommer Kristensen PhD, MD , Stig Molsted PhD

Objectives

Physical activity is associated with improved health in people with type 1 diabetes. However, physical activity level may be associated with socioeconomic status. The primary aim of this study was to investigate the association between education level and physical activity level among people with type 1 diabetes.

Methods

In this cross-sectional study, data on physical activity level (high or low) was measured using the Saltin–Grimby Physical Activity Level Scale, and education level (low, medium, or high) was self-reported.

Results

Respondents were recruited from outpatient clinics (Steno Diabetes Centre Aarhus, Denmark; Nordsjællands Hospital, Denmark; or Sheffield Diabetes and Endocrine Centre, United Kingdom), by health-care personnel from September 2019 to July 2021. A total of 324 people with type 1 diabetes were included (54% male, median age 50 years [interquartile range 30–60 years]). Education level was low in 10%, medium in 33%, and high in 57%. A logistic regression analysis, adjusted for age, sex, cohabitation status and nationality, found that a medium vs. high education level was associated with lower odds of a high physical activity level (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.32–0.94, p=0.029), while no association was found for low vs. high education level with high physical activity level (OR 0.56, 95% CI 0.25–1.29, p=0.173).

Conclusions

Medium education level compared with a high education level was associated with a lower level of physical activity in people with type 1 diabetes. Health-care professionals are advised to be attentive of physical activity levels among people with type 1 diabetes.

目的体力活动与改善 1 型糖尿病（T1D）患者的健康状况有关。然而，体力活动水平可能与社会经济地位有关。研究的主要目的是调查 T1D 患者的教育水平与体力活动水平之间的关系。方法在这项横断面研究中，体力活动水平（高或低）的数据使用 Saltin-Grimby 体力活动水平量表进行测量，教育水平（低、中或高）则由受访者自我报告。结果2019年9月至2021年7月期间，医护人员从门诊诊所（丹麦奥胡斯斯泰诺糖尿病中心、丹麦Nordsjællands医院或英国谢菲尔德糖尿病与内分泌中心）招募受访者。共纳入 324 名 T1D 患者（54% 为男性，中位年龄为 50 岁（IQR 30-60））。受教育程度低的占 10%，中等的占 33%，高的占 57%。经年龄、性别、同居状况和国籍调整后进行的逻辑回归分析发现，中等教育水平与高教育水平相比，高体力活动水平的几率较低，OR 为 0.55 [95% CI 0.32;0.94]，P=0.029，而低教育水平与高教育水平相比，高体力活动水平与低教育水平没有关联（OR 为 0.56 [0.25; 1.29]，P=0.173）。建议医疗保健专业人员关注T1D患者的体育锻炼水平：P-2016-48.s赞助商彼得-洛默-克里斯滕森

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引用次数: 0

Beyond the Body: Using Photovoice to Explore Social Determinants of Diabetes With South Asian Adolescents in the Peel Region of Ontario, Canada Beyond the Body:使用Photovoice来探索加拿大安大略省皮尔地区南亚青少年糖尿病的社会决定因素。

IF 2.5 4区医学 Q2 Medicine

Canadian Journal of Diabetes

Pub Date : 2024-03-01 DOI: 10.1016/j.jcjd.2023.11.002

Ananya Tina Banerjee PhD , Shudipta Islam MPH , Amina Khan MPH , Nousin Hussain MPH , Evelyn Ascencio MPH , Nuzha Hafleen MPH

Objectives

The higher prevalence of diabetes in the South Asian (SA) population living in Canada spans across generations and is often associated with individual risk factors while undermining the social determinants of health (SDOH). There is a scarcity of studies on the perspectives of SA adolescents with a family history of type 2 diabetes mellitus (T2DM). Learning directly from these adolescents can fill a major gap by providing insight on how the SDOH contribute to disproportionate rates of T2DM in SA immigrant communities.

Methods

In this study, we used Photovoice, which is a community-based participatory research (CBPR) method that involves the use of photography to visually capture the challenges of diabetes prevention from the perspective of those with lived experiences. A group of 15 SA youth were recruited from an adolescent diabetes education program in the Peel Region of Ontario. The youth discussed their images and accompanied written narratives during focus groups.

Results

Four themes emerged from the thematic analysis of the photographs and participant narratives that influence the manifestation of T2DM in SA communities: 1) immigration and resettlement stressors; 2) food insecurity; 3) unhealthy school environments; and 4) academic pressures.

Conclusions

Findings suggest the need to address T2DM as a response to unjust conditions and environments rather than as an epidemic entrenched in genetic predisposition, culture, and poor lifestyle choices.

生活在加拿大的南亚(SA)人口中糖尿病的高患病率跨越了几代人，并且通常与个人风险因素有关，同时破坏了健康的社会决定因素(SDOH)。有2型糖尿病(T2DM)家族史的SA青少年的研究很少。直接从青少年那里学习可以填补一个重要的空白，通过深入了解SDOH如何导致SA移民社区中不成比例的2型糖尿病发病率。本研究使用Photovoice，这是一种基于社区的参与式研究(CBPR)方法，涉及使用摄影从有生活经历的人的角度直观地捕捉糖尿病预防的挑战。一组15名来自安大略省皮尔地区青少年糖尿病教育项目的SA青年被招募。在焦点小组中，年轻人讨论他们的图像，并附上书面叙述。从对影响南苏丹社区2型糖尿病表现的照片和参与者叙述的专题分析中得出了四个主题:(一)移民和重新安置的压力因素，(二)粮食不安全，(三)不健康的学校环境，以及(四)学业压力。研究结果表明，需要将2型糖尿病视为对不公平条件和环境的反应，而不是将其视为根深蒂固的遗传易感性、文化和不良生活方式选择的流行病。

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引用次数: 0

Health Resilience in Arabic-speaking Adult Refugees With Type 2 Diabetes: A Grounded Theory Study During the COVID-19 Pandemic 阿拉伯2型糖尿病成年难民的健康恢复力：新冠肺炎大流行期间的一项有根据的理论研究。

IF 2.5 4区医学 Q2 Medicine

Canadian Journal of Diabetes

Pub Date : 2024-03-01 DOI: 10.1016/j.jcjd.2023.10.403

Hanin Omar RN, MN , David Busolo PhD , Jason Hickey PhD , Neeru Gupta PhD

Objectives

This qualitative study aimed to describe the lived experiences of Arabic-speaking refugees in managing their type 2 diabetes mellitus (T2DM) while resettling during the COVID-19 pandemic, and to generate a grounded theory of how resilience is used to facilitate living well while facing multiple health stressors.

Methods

A grounded theory approach was used to conceptualize the dynamic process of resilience in living well with diabetes. Five recently resettled adult refugees with T2DM (2 women and 3 men) participated in unstructured individual interviews in Arabic in New Brunswick, Canada, during the pandemic’s second wave (October 2020 to March 2021). Interview data were transcribed and analyzed thematically using open, axial, and core category coding followed by member checking.

Results

Participants identified self-reliance as the core driver for decision-making, actions, and interpretations in health management while experiencing unplanned instability. The process was found to be facilitated by 4 distinct constructs: knowledge seeking, positive outlook, self-care, and creativity.

Conclusions

The substantive model derived from this study supports a strengths-based approach to clinical assessment and care of refugees with T2DM, notably during disrupted access to primary and preventive services due to forced resettlement and pandemic mitigation measures. More research is needed to increase understanding of how self-reliance can be optimized in resilience-promoting interventions to facilitate diabetes management among populations in posttraumatic circumstances.

目的：这项定性研究旨在描述阿拉伯难民在新冠肺炎大流行期间重新定居期间管理2型糖尿病（T2DM）的生活经历，并提出一个有根据的理论，说明如何在面临多重健康压力的情况下，利用复原力促进良好生活。方法：采用扎根理论方法对糖尿病患者恢复力的动态过程进行概念化。在第二波疫情期间（2020年10月至2021年3月），五名最近重新安置的T2DM成年难民（两名女性和三名男性）在加拿大新不伦瑞克参加了用阿拉伯语进行的非结构化个人采访。访谈数据采用开放、轴向和核心类别编码进行转录和主题分析，然后进行成员检查。结果：参与者认为，在经历计划外的不稳定时，自力更生是健康管理决策、行动和解释的核心驱动力。研究发现，这一过程由四个不同的结构推动：求知、积极乐观、自我照顾和创造力。结论：这项研究得出的实质性模型支持对患有2型糖尿病的难民进行基于优势的临床评估和护理，特别是在由于强制重新安置和疫情缓解措施而无法获得初级和预防服务的情况下。需要进行更多的研究，以更好地了解如何在促进恢复力的干预措施中优化自力更生，从而促进创伤后人群的糖尿病管理。

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引用次数: 0

The Need to Prioritize Education and Resources to Support Exercise in Type 1 Diabetes: Results of an Australian Survey of Adults With Type 1 Diabetes and Health Providers 需要优先考虑教育和资源，以支持1型糖尿病患者的运动:澳大利亚对1型糖尿病成年人和健康提供者的调查结果。

IF 2.5 4区医学 Q2 Medicine

Canadian Journal of Diabetes

Pub Date : 2024-03-01 DOI: 10.1016/j.jcjd.2023.11.003

Tessa Glyn MBChB , Spiros Fourlanos MBBS, FRACP, PhD , Barbora Paldus MBBS, FRACP , Steve Flint MD , Emma Armstrong BSc, MPH , Robert Charles Andrews MBChB, PhD, FRCP , Parth Narendran MBBS, PhD, FRCP , John Wentworth MBBS, PhD, FRACP

Objectives

Regular exercise is recommended for people with type 1 diabetes (PWD) to improve their health, but many do not meet recommended exercise targets. Educational resources supporting PWD to exercise exist, but their value is unclear. To determine the need for improved exercise resources in Australia, we surveyed adult PWD and health providers (HPs) about their confidence in managing type 1 diabetes (T1D) around exercise, barriers to exercise, and the adequacy of current resources.

Methods

Australian adult PWD and HPs completed surveys to rate the importance of exercise in T1D management, confidence in managing T1D around exercise, barriers to giving and receiving education, resources used, and what form new resources should take.

Results

Responses were received from 128 PWD and 122 HPs. Both groups considered exercise to be important for diabetes management. PWD cited time constraints (57%) and concern about dysglycemia (43%) as barriers to exercise, and many lacked confidence in managing T1D around exercise. HPs were more confident, but experienced barriers to providing advice, and PWD did not tend to rely on this advice. Instead, 72% of PWD found continuous glucose monitoring most helpful. Both groups desired better resources to support exercise in T1D, with PWD preferring to obtain information through a structured education program and HPs through eLearning.

Conclusions

Australian HPs and PWD appreciate the importance of exercise in T1D management and express a clear desire for improved educational resources. Our findings provide a basis for developing a comprehensive package of resources for both adult PWD and HPs, to support exercise in PWD.

背景:建议1型糖尿病(PWD)患者定期锻炼以改善他们的健康，但许多人没有达到推荐的锻炼目标。支持残疾人运动的教育资源是存在的，但其价值尚不清楚。为了确定澳大利亚对改善运动资源的需求，我们调查了成年PWD和健康提供者(hp)，了解他们在运动、运动障碍和当前资源充足性方面管理T1D的信心。方法:澳大利亚成年PWD和HPs完成调查，评估运动在T1D管理中的重要性，围绕运动管理T1D的信心，给予和接受教育的障碍，使用的资源以及应该采取何种形式的新资源。结果:收到128名PWD和122名hp的回复。两组人都认为运动对糖尿病的控制很重要。PWD认为时间限制(57%)和对血糖异常的担忧(43%)是运动的障碍，许多人对在运动中管理T1D缺乏信心。hp更有信心，但在提供建议方面遇到了障碍，而PWD不倾向于依赖这种建议。相反，72%的PWD患者认为持续血糖监测最有帮助。两组都希望有更好的资源来支持T1D的锻炼，PWD倾向于通过结构化的教育计划获得信息，hp倾向于通过电子学习获得信息。结论:澳大利亚HPs和PWD认识到锻炼在T1D管理中的重要性，并明确表达了改善教育资源的愿望。我们的研究结果为开发成人PWD和HPs的综合资源包提供了基础，以支持PWD锻炼。

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引用次数: 0

Alterations in the Menstrual Cycle as a Peculiar Sign of Type 1 Diabetes Mellitus: A Meta-analytic Approach 月经周期改变是 1 型糖尿病的特殊征兆：元分析方法

IF 2.5 4区医学 Q2 Medicine

Canadian Journal of Diabetes

Pub Date : 2024-03-01 DOI: 10.1016/j.jcjd.2023.07.009

Carla Greco MD , Marta Cacciani MD , Rossella Corleto MD , Manuela Simoni MD, PhD , Giorgia Spaggiari MD , Daniele Santi MD, PhD

Background

Menstrual irregularities are present in >30% of women with type 1 diabetes mellitus (T1DM). These abnormalities will likely lead to reduced fertility and earlier menopause. T1DM management has changed over time, with even more emphasis on stringent levels of glycemic management. Thus, we investigated whether therapeutic T1DM changes have an influence on the proportion of menstrual disorders in women with T1DM.

Methods

A meta-analysis was performed that included clinical trials in which menstrual abnormalities in women with T1DM were studied. The literature was checked for studies in which women with T1DM were compared with healthy, age-matched controls. Case–control, cohort, and cross-sectional studies were included. The primary endpoint was rate of menstrual dysfunction.

Results

Menstrual dysfunction was higher in women with T1DM compared with controls (odds ratio 2.08, 95% confidence interval [CI] 1.43 to 3.03, p<0.001), even when sensitivity analysis was performed, considering only studies published after 2000. The age at menarche was higher for women with T1DM compared with controls (mean difference 0.53, 95% CI 0.32 to 0.74 years, p<0.001). The proportion of menstrual abnormalities in T1DM was inversely related to diabetes duration, but was unrelated to both body mass index and glycated hemoglobin.

Conclusions

The meta-analytic approach used confirmed the correlation between T1DM and menstrual irregularities. T1DM menstrual dysfunction seemed unrelated to change in therapeutic management across years, as well as to glycemic management and body weight. The underlying pathogenetic mechanisms are not fully understood.

背景30%的 1 型糖尿病（T1DM）女性患者会出现月经不调。这些异常可能会导致生育能力下降和更年期提前。随着时间的推移，T1DM 的治疗方法也发生了变化，更加强调严格的血糖管理水平。因此，我们研究了 T1DM 的治疗变化是否会影响 T1DM 女性患者中月经紊乱的比例。我们还查阅了相关文献，以了解是否有将 T1DM 女性患者与健康、年龄匹配的对照组进行比较的研究。研究包括病例对照、队列和横断面研究。结果与对照组相比，T1DM女性患者的月经功能障碍发生率更高（几率比2.08，95%置信区间[CI] 1.43至3.03，p<0.001），即使进行了敏感性分析，仅考虑2000年以后发表的研究也是如此。与对照组相比，T1DM女性的初潮年龄更高（平均差异为0.53岁，95% CI为0.32岁至0.74岁，p<0.001）。T1DM患者中月经异常的比例与糖尿病持续时间成反比，但与体重指数和糖化血红蛋白无关。T1DM月经功能障碍似乎与不同年份的治疗管理变化以及血糖管理和体重无关。其潜在的发病机制尚不完全清楚。

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引用次数: 0