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Pedersen KF, Molsted S, Mogensen PR, Østerskov A, Karagkounis G, Kristensen PL. Characteristics of exercise patterns in people with type 1 diabetes-insights from the Hedia diabetes assistant mobile app. Diabet Med 2024; 41:e15410. [PMID: 39004936 DOI: 10.1111/dme.15410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Affiliation(s)
| | - Stig Molsted
- Department of Clinical Research, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne Østerskov
- Department of Medical and Clinical Affairs, Hedia ApS, Copenhagen, Denmark
| | - Gkikas Karagkounis
- Department of Medical and Clinical Affairs, Hedia ApS, Copenhagen, Denmark
| | - Peter Lommer Kristensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology and Nephrology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
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2
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Zhuang P, Wang F, Yao J, Liu X, Li Y, Ao Y, Ye H, Wan X, Zhang Y, Jiao J. Unhealthy plant-based diet is associated with a higher cardiovascular disease risk in patients with prediabetes and diabetes: a large-scale population-based study. BMC Med 2024; 22:485. [PMID: 39443972 DOI: 10.1186/s12916-024-03683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 10/03/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND The role of plant-based dietary patterns in preventing cardiovascular disease (CVD) among individuals with prediabetes and diabetes remains unclear. We aimed to evaluate the associations of plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) with cardiovascular disease (CVD) risk and explore potential contributing factors among people with prediabetes and diabetes. METHODS A total of 17,926 participants with prediabetes and 7798 with diabetes were enrolled from the UK Biobank between 2006 and 2010 and followed until the end of 2020. We calculated the PDI, hPDI, and uPDI based on 18 major food groups including plant-based foods and animal-based foods and applied Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD risk related to PDI, hPDI, and uPDI. Decomposition analysis was performed to assess the role of dietary components, and mediation analysis was performed to assess the potential mediating role of serum biomarkers underlying these associations. RESULTS A total of 2324 CVD events were documented among individuals with prediabetes, while 1461 events occurred among patients with diabetes. An inverse association was found between hPDI and CVD risk among individuals with prediabetes (HR T3 vs. T1 = 0.88, 95% CI = 0.79-0.98, Ptrend = 0.025) but not those with diabetes. A positive association was found between uPDI and CVD risk among individuals with prediabetes (HR T3 vs. T1 = 1.17, 95% CI = 1.05-1.30, Ptrend = 0.005) and those with diabetes (HR T3 vs. T1 = 1.14, 95% CI = 1.00-1.29, Ptrend = 0.043). High-sugar-sweetened beverages (SSB) intake accounted for 35% of the hPDI-CVD association and 15% of the uPDI-CVD association among individuals with prediabetes, whereas low intake of whole grain accounted for 36% of the association among patients with diabetes. Elevated cystatin C levels explained the largest proportion of the association between uPDI and CVD risk among individuals with prediabetes (15%, 95% CI = 7-30%) and diabetes (44%, 95% CI = 9-86%). CONCLUSIONS Adherence to an unhealthy plant-based diet is associated with a higher CVD risk in people with prediabetes or diabetes, which may be partially attributed to low consumption of whole grains, high intake of SSB, and high blood cystatin C levels.
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Affiliation(s)
- Pan Zhuang
- Department of Endocrinology, The Second Affiliated Hospital, School of Public Health, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fenglei Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jianxin Yao
- Department of Food Science and Nutrition, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaohui Liu
- Department of Endocrinology, The Second Affiliated Hospital, School of Public Health, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Yin Li
- Department of Endocrinology, The Second Affiliated Hospital, School of Public Health, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Yang Ao
- Department of Endocrinology, The Second Affiliated Hospital, School of Public Health, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Hao Ye
- Department of Endocrinology, The Second Affiliated Hospital, School of Public Health, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Xuzhi Wan
- Department of Endocrinology, The Second Affiliated Hospital, School of Public Health, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Yu Zhang
- Department of Food Science and Nutrition, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jingjing Jiao
- Department of Endocrinology, The Second Affiliated Hospital, School of Public Health, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
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3
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Pastusiak KM, Kręgielska-Narożna M, Mróz M, Seraszek-Jaros A, Błażejewska W, Bogdański P. Does Online Social Support Affect the Eating Behaviors of Polish Women with Insulin Resistance? Nutrients 2024; 16:3509. [PMID: 39458504 DOI: 10.3390/nu16203509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/08/2024] [Accepted: 10/11/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND Insulin resistance, a key factor in developing type 2 diabetes mellitus, is linked to various health conditions. The basis of its treatment is lifestyle modification. However, adherence to nutritional and other medical recommendations can be challenging for chronic disease patients due to many factors, including demographics, social context, gender, age, and the patient's baseline health condition. This study aims to evaluate the impact of online support group members on the diet quality of women with insulin resistance. METHODS This study was conducted as an online survey consisting of KomPAN (validated food frequency questionnaire) augmented with questions regarding using professional counseling and membership in support groups. The study covered 1565 women with insulin resistance, 1011 of whom were associated with the online support group. RESULTS The mean pHDI (pro-health diet index) was 5.18 ± 2.69 in the support groups and 4.86 ± 2.69 in the control group (p = 0.0319. There were no significant differences in the nHDI (non-health diet index). We found that the pHDI is associated with financial situations, the household's situation, occupation education level, and medical or dietitian care, whereas occupation, medical, and dietitian care affect the nHDI. Membership in support groups is related to a higher pHDI and state of self-assessment of nutritional knowledge. CONCLUSIONS Our study indicates a relationship between participation in online support groups and dietary behaviors and the subjective assessment of nutrition knowledge. Future research should focus on elucidating the mechanisms behind these influences and exploring how these communities can be optimized for broader public health initiatives.
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Affiliation(s)
- Katarzyna Magdalena Pastusiak
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Matylda Kręgielska-Narożna
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Michalina Mróz
- Faculty of Medical Sciences, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Agnieszka Seraszek-Jaros
- Department of Bioinformatics and Computational Biology, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Wiktoria Błażejewska
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Paweł Bogdański
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-355 Poznan, Poland
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Choi S, Choi J. Exploring Food Preferences as a Pre-Step for Developing Diabetes-Friendly Options in Adults with Diabetes and Prediabetes. Foods 2024; 13:3276. [PMID: 39456338 DOI: 10.3390/foods13203276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 10/10/2024] [Accepted: 10/11/2024] [Indexed: 10/28/2024] Open
Abstract
Given the low compliance with healthy eating among patients with diabetes, personalized dietary plans incorporating their food preferences are urgently needed. However, few studies have explored the food preferences of adults with diabetes or prediabetes (AdDMP). We aimed to examine taste and food preferences among AdDMP, comparing them by sex, age, and weight status. A total of 415 AdDMP completed the survey via Amazon Mechanical Turk in 2023 (53% women, 47% men; 20-70 years old). Food/taste preferences were measured using Likert-type scales for six taste-cluster food groups, as well as basic tastes/spicy flavor. Open-ended questions assessed comfort, favorite, and least favorite foods, which were then categorized into five groups. Independent t-tests, analysis of variance, and Tukey-HSD were performed to compare outcomes across the groups. Men, the 41-70-year-old group, and the obese group regarded warm food as a comfort food more than in other comparable groups, while women and the 20-30-year-old group tend to prefer fruits and vegetables. Additionally, men expressed a significantly higher preference for salty-/umami-/fat-tasting foods compared to women. These findings underscore the need to align dietary expectations with reality for AdDMP. Future research should focus on strategies to accommodate their preferences within a healthy eating framework.
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Affiliation(s)
- Sungeun Choi
- Department of Family, Nutrition, and Exercise Sciences, Queens College, The City University of New York, Flushing, NY 11367, USA
| | - Jihee Choi
- Department of Family, Nutrition, and Exercise Sciences, Queens College, The City University of New York, Flushing, NY 11367, USA
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Rezaeiahari M, Acharya M, Henske J, Owsley K, Bodenhamer J. Utilization of Diabetes Self-Management Education and Support Among Medicare Beneficiaries Newly Diagnosed With Diabetes in Arkansas, 12 Months Postdiagnosis (2015-2018). Sci Diabetes Self Manag Care 2024:26350106241285827. [PMID: 39399979 DOI: 10.1177/26350106241285827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
PURPOSE The purpose of the study was to determine the rate of diabetes self-management education and support (DSMES) utilization among Medicare fee-for-service (FFS) and Medicare Advantage (MA) populations with type 2 diabetes in Arkansas. METHODS The Arkansas All-Payer Claims Database was used to identify Medicare FFS and MA beneficiaries diagnosed with type 2 diabetes from 2015 to 2018. Claims from 2013 to 2020 were analyzed to determine newly diagnosed individuals from 2015 to 2018. The criteria included 1 outpatient diabetes claim in the index year and at least 1 inpatient or outpatient claim in the 2 years following the initial claim. A total of 15 648 Medicare FFS individuals and 7520 MA individuals with newly diagnosed type 2 diabetes were identified. The use of DSMES 1 year following the diagnosis dates for both Medicare FFS and MA populations was assessed. Descriptive statistics and multiple logistic regression analyses were conducted to understand the factors associated with DSMES utilization. RESULTS DSMES utilization consistently remained lower in the MA population compared to Medicare FFS (2.3% vs 4.9%). The adjusted analysis indicated that factors such as older age, living in a rural area, belonging to a racial group other than White, and MA enrollment were associated with a lower likelihood of receiving DSMES. CONCLUSIONS DSMES utilization in Arkansas, where the prevalence of diabetes is higher than the national average, is notably low. There is a need for coordinated efforts at various levels to enhance access to DSMES.
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Affiliation(s)
- Mandana Rezaeiahari
- Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mahip Acharya
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Joseph Henske
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kelsey Owsley
- Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Cangelosi G, Mancin S, Pantanetti P, Sguanci M, Morales Palomares S, De Luca A, Biondini F, Tartaglia F, Ferrara G, Petrelli F. Impact of the COVID-19 Pandemic on Lifestyle Behavior and Clinical Care Pathway Management in Type 2 Diabetes: A Retrospective Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1624. [PMID: 39459411 DOI: 10.3390/medicina60101624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 09/23/2024] [Accepted: 10/02/2024] [Indexed: 10/28/2024]
Abstract
Background and Objectives: In Italy, as in the rest of the world, government restrictions aimed at containing the spread of COVID-19 primarily imposed limitations on social relationships and personal behavior. This situation significantly affected the management of chronic illnesses, including type 2 diabetes (T2D). The objective was to evaluate the perceptions of patients with T2D regarding the quality of care received during the COVID-19 pandemic and the impact on dietary and physical activity behaviors. Materials and Methods: We conducted a retrospective cross-sectional survey. Data were collected from June to July 2023 using the convenience sampling of patients with T2D, and the Patient Assessment of Chronic Illness Care (PACIC) and Medi-Lite questionnaires were administered. Results: During the research period, out of the 130 subjects who met all enrollment criteria, 103 patients were included in this study (79.23%). The results of the administered questionnaires were heterogeneous. The average scores from the PACIC Questionnaire for each question displayed significant variability, indicating a range of experiences in the quality of care. In the Medi-Lite survey, fruit, cereals, and olive oil showed the highest adherence levels, with mean scores ranging from 2.58 (SD ± 1.18) for fruit to 1.89 (SD ± 0.34) for olive oil and 1.97 (SD ± 0.17) for cereals. Patients who reported increased food intake during the lockdown attributed it to having more time to prepare meals. Physical activity levels remained unchanged for 48 patients, decreased for 45 patients, and only 9 patients managed to exercise more during the COVID-19 restrictions. Conclusions: Healthcare systems must prioritize comprehensive care plans for T2D that address not only physical health, but also emotional and social well-being. Post-pandemic, promoting healthier lifestyles and empowering patients to manage their condition is crucial. A multidisciplinary and multidimensional approach could support the care of vulnerable individuals, such as patients with T2D, especially during crises like pandemics or other dramatic events.
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Affiliation(s)
- Giovanni Cangelosi
- Unit of Diabetology, Asur Marche-Area Vasta 4 Fermo, 63900 Fermo, FM, Italy
| | - Stefano Mancin
- IRCCS Humanitas Research Hospital, 20089 Rozzano, ML, Italy
| | - Paola Pantanetti
- Unit of Diabetology, Asur Marche-Area Vasta 4 Fermo, 63900 Fermo, FM, Italy
| | - Marco Sguanci
- A.O. Polyclinic San Martino Hospital, Largo R. Benzi 10, 16132 Genova, GE, Italy
| | - Sara Morales Palomares
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, CS, Italy
| | - Alessia De Luca
- School of Biosciences and Veterinary Medicine, University of Camerino, 62032 Camerino, MC, Italy
| | | | - Francesco Tartaglia
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, ML, Italy
| | - Gaetano Ferrara
- Nephrology and Dialysis Unit, Ramazzini Hospital, 41012 Carpi, MO, Italy
| | - Fabio Petrelli
- School of Pharmacy, Polo Medicina Sperimentale e Sanità Pubblica "Stefania Scuri", 62032 Camerino, MC, Italy
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7
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Parsons KA, Ekong GJ, Charbonneau MS, Hopkins KE, Capoccia KL. Effect of Pharmacist-Led Interventions on Diabetes Distress Among People With Type 2 Diabetes. Sci Diabetes Self Manag Care 2024; 50:418-427. [PMID: 39133126 DOI: 10.1177/26350106241268413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
PURPOSE The purpose of this study was to determine the effectiveness of pharmacist-led interventions on diabetes distress and glucose management among people with type 2 diabetes (T2DM) in a community care clinic. METHODS Adults with T2DM were recruited during routine visits at the pharmacist-run clinic. Participants completed a baseline A1C, demographic survey, Diabetes Distress Scale (DDS), and Patient Health Questionnaire-2 (PHQ-2). Depending on DDS subscale-specific responses, participants qualified for pharmacist-led educational interventions based on the ADCES7 Self-Care Behaviors™. After 6 months, participants completed another A1C, satisfaction survey, DDS, and PHQ-2. Data analysis included descriptive statistics and paired t tests. RESULTS Among 53 participants at baseline, diabetes distress was present in 77.4%; emotional burden was most common in 64.2%, followed by regimen distress in 45.3%, interpersonal distress in 34.0%, and physician distress in 20.8%. After the intervention, significant reductions occurred in mean overall DDS score (2.0 to 1.7), emotional burden (2.4 to 1.8), regimen distress (2.3 to 1.7), A1C (7.0% to 6.5%; 53.0 to 47.5 mmol/mol), and PHQ-2 score (1.6 to 1.0). Participants were highly satisfied with the service, their knowledge, and self-management skills following completion of the study. CONCLUSIONS Diabetes distress was present in most participants despite glucose management that was largely achieving treatment goals. Pharmacist-led educational interventions significantly reduced overall DDS score, emotional burden, regimen distress, A1C, and PHQ-2 score. The results of this study suggest that people with T2DM should receive routine screening for diabetes distress and that pharmacists can positively affect diabetes management and emotional well-being through tailored education.
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Affiliation(s)
- Katelyn A Parsons
- Western New England University College of Pharmacy and Health Sciences, Springfield, Massachusetts
| | - Gladys J Ekong
- Western New England University College of Pharmacy and Health Sciences, Springfield, Massachusetts
| | - Maria S Charbonneau
- Western New England University College of Pharmacy and Health Sciences, Springfield, Massachusetts
| | | | - Kam L Capoccia
- Western New England University College of Pharmacy and Health Sciences, Springfield, Massachusetts
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8
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Avogaro A. Diabetes and obesity: the role of stress in the development of cancer. Endocrine 2024; 86:48-57. [PMID: 38831236 PMCID: PMC11445296 DOI: 10.1007/s12020-024-03886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024]
Abstract
Diabesity is a condition where an individual has both diabetes and obesity, which can lead to severe complications including cardiovascular disease, a leading cause of mortality. Recently, cancer has become a leading cause of excess hospitalizations, and both diabetes and obesity are associated with a higher risk of developing several types of cancer. In this review, we propose that chronic stress significantly increases this association. Managing diabetes and obesity is challenging as they both cause significant distress. The relationship between stress and cancer is interconnected, with anxiety and depression being common in cancer patients. Cancer diagnosis and treatment can cause lasting changes in the body's neuroendocrine system, with stress causing an excessive release of catecholamines and prostaglandins in patients undergoing cancer surgery, which promotes the spread of cancer to other parts of the body. Furthermore, stress could significantly increase the risk of cancer in patients with diabetes, obesity, or both.
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Affiliation(s)
- Angelo Avogaro
- Department of Medicine.(DIMED), Unit of Metabolic Disease, University of Padova University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
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de Wit DF, Fuhri Snethlage CM, Rampanelli E, Maasen K, Walpot N, van Raalte DH, Nieuwdorp M, Soeters MR, Hanssen NMJ. Higher fibre and lower carbohydrate intake are associated with favourable CGM metrics in a cross-sectional cohort of 470 individuals with type 1 diabetes. Diabetologia 2024; 67:2199-2209. [PMID: 38967668 PMCID: PMC11446970 DOI: 10.1007/s00125-024-06213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/26/2024] [Indexed: 07/06/2024]
Abstract
AIMS/HYPOTHESIS The aim of this work was to investigate the association between macronutrient intakes and continuous glucose monitoring (CGM) metrics in individuals with type 1 diabetes. METHODS In 470 individuals with type 1 diabetes of the GUTDM1 cohort (65% female, median age 40 [IQR 28-53] years, median diabetes duration 15 [IQR 6-29] years), we used logistic regression to establish associations between macronutrient intakes and the CGM metrics time in range (TIR, time spent between 3.9-10.0 mmol/l blood glucose, optimally set at ≥70%) and time below range (TBR, <3.9 mmol/l blood glucose, optimally set at <4%). ORs were expressed per 1 SD intake of nutrient and were adjusted for other macronutrient intakes, age, sex, socioeconomic status, BMI, duration of type 1 diabetes, pump use, insulin dose and alcohol intake. RESULTS The median (IQR) TIR was 67 (51-80)% and TBR was 2 (1-4)%; the mean ± SD energy intake was 6879±2001 kJ, fat intake 75±31 g, carbohydrate intake 162±63 g, fibre intake 20±9 g and protein intake 70±24 g. A higher fibre intake and a lower carbohydrate intake were associated with higher odds of having a TIR≥70% (OR [95% CI] 1.64 [1.22, 2.24] and 0.67 [0.51, 0.87], respectively), whereas solely a higher carbohydrate intake was associated with TBR<4% (OR 1.34 [95% CI 1.02, 1.78]). CONCLUSIONS/INTERPRETATION A higher fibre intake is independently associated with a higher TIR. A higher carbohydrate intake is associated with less time spent in hypoglycaemia, a lower TIR and a higher time above range. These findings warrant confirmatory (interventional) investigations and may impact current nutritional guidelines for type 1 diabetes.
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Affiliation(s)
- Douwe F de Wit
- Department of (Experimental) Vascular and Internal Medicine, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Coco M Fuhri Snethlage
- Department of (Experimental) Vascular and Internal Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Elena Rampanelli
- Department of (Experimental) Vascular and Internal Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Kim Maasen
- Department of (Experimental) Vascular and Internal Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Noortje Walpot
- Department of (Experimental) Vascular and Internal Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Daniël H van Raalte
- Department of Endocrinology and Metabolism, Amsterdam UMC, Amsterdam, the Netherlands
- Diabeter Centrum Amsterdam, Amsterdam, the Netherlands
| | - Max Nieuwdorp
- Department of (Experimental) Vascular and Internal Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- Diabeter Centrum Amsterdam, Amsterdam, the Netherlands
| | - Maarten R Soeters
- Department of Endocrinology and Metabolism, Amsterdam UMC, Amsterdam, the Netherlands
| | - Nordin M J Hanssen
- Department of (Experimental) Vascular and Internal Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- Diabeter Centrum Amsterdam, Amsterdam, the Netherlands
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Messina R, Lenzi J, Rosa S, Fantini MP, Di Bartolo P. Clinical Health Psychology Perspectives in Diabetes Care: A Retrospective Cohort Study Examining the Role of Depression in Adherence to Visits and Examinations in Type 2 Diabetes Management. Healthcare (Basel) 2024; 12:1942. [PMID: 39408121 PMCID: PMC11475538 DOI: 10.3390/healthcare12191942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 09/23/2024] [Accepted: 09/26/2024] [Indexed: 10/20/2024] Open
Abstract
BACKGROUND Depression in type 2 diabetes mellitus (T2DM) impacts glycemic control and complications. This study examines the influence of depression on compliance with recommended annual diabetes assessments in patients within the Local Healthcare Authority of Romagna. From a clinical health psychology perspective, understanding how depression influences patients' engagement in managing their conditions is crucial. This insight can help improve healthcare services by ensuring they address mental health needs and thereby enhance treatment effectiveness and overall patient outcomes. METHODS This retrospective cohort study included residents of Romagna with incident T2DM from 2015 to 2017, followed from 1 January 2018 to 31 December 2022. Depression was identified via hospital discharge records or antidepressant prescriptions. Adherence to diabetes care guidelines was measured using the Guideline Composite Indicator (GCI). RESULTS The study included 13,285 patients, with a mean age of 61.1 years. Prevalence of post-diabetes depression increased from 3.0% in 2018 to 8.9% in 2022. Initial analyses showed higher GCI rates among patients with depression. However, propensity-score adjustment revealed that by 2021-2022, patients with pre-diabetes depression had 5% lower compliance rates (p-value ≤ 0.05). Older adults with depression had reduced adherence, while younger adults with post-diabetes depression had higher adherence rates. CONCLUSIONS Depression significantly affects adherence to diabetes care guidelines in T2DM patients, particularly among older adults. Integrated care models addressing both diabetes and depression are crucial for improving health outcomes.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Paolo Di Bartolo
- Diabetes Unit, Local Healthcare Authority of Romagna, 48100 Ravenna, Italy
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Beretta MV, Flores CAO, Colameo GF, Echabe LW, Busnello FM. Low-Carbohydrate Dietary Interventions for Metabolic Control in Individuals With Type 2 Diabetes Mellitus: An Overview of Systematic Reviews. Nutr Rev 2024:nuae123. [PMID: 39298713 DOI: 10.1093/nutrit/nuae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024] Open
Abstract
CONTEXT Dietary interventions providing different amounts of carbohydrates have been proposed as a means of achieving glycemic control and weight loss in type 2 diabetes mellitus (T2DM); however, the supporting evidence is heterogeneous, making this recommendation difficult to apply in nutritional clinical practice. OBJECTIVE The aim was to assess the quality of evidence from meta-analyses on low-carbohydrate (LC) dietary interventions for glycemic control, weight loss, and lipid profile in individuals with T2DM. DATA SOURCES The MEDLINE, Web of Science, and Scopus databases were searched until September 2023. DATA EXTRACTION A systematic review was conducted. Systematic reviews with meta-analysis of randomized clinical trials designed to assess glycated hemoglobin (HbA1c) reductions in individuals with T2DM were eligible. The AMSTAR-2 critical appraisal tool was used to evaluate the methodological aspects of all included studies. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to assess the certainty of the evidence. DATA ANALYSIS The LC interventions were associated with a reduction in HbA1c (%) of -0.42 (-1.45 to -0.09; high certainty of evidence) without considering follow-up time; at up to 3 months of follow-up of -0.28 (-0.13 to -0.43); at up to 6 months of follow-up of -0.40 (-0.61 to -0.09); at 6 to 12 months of follow-up of -0.32 (-0.49 to 0.11); and at >12 months of follow-up time of -0.31 (-0.14 to -0.65) compared with control diets. CONCLUSION LC diets can help reduce HbA1c in individuals with T2DM in the short term (up to 3 months). However, dietary recommendations must always be individualized, as the studies reviewed herein analyzed different populations and used different definitions of what constitutes an LC diet. SYSTEMATIC REVIEW REGISTRATION PROSPERO no. CRD42023404197.
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Affiliation(s)
- Mileni Vanti Beretta
- Graduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS 90050-170, Brazil
| | - Cíntia Aparecida Oliveira Flores
- Graduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS 90050-170, Brazil
| | - Gabriella Fontes Colameo
- Graduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS 90050-170, Brazil
| | - Luana Weissheimer Echabe
- Undergraduate Course in Nutrition, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS 90050-170, Brazil
| | - Fernanda Michielin Busnello
- Department of Nutrition and Graduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS 90050-170, Brazil
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12
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Makrilakis K, Papachristoforou E. Common mistakes concerning diabetes management in daily clinical practice. Prim Care Diabetes 2024:S1751-9918(24)00190-6. [PMID: 39299897 DOI: 10.1016/j.pcd.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 08/12/2024] [Accepted: 09/12/2024] [Indexed: 09/22/2024]
Abstract
Diabetes mellitus is a chronic metabolic disease, potentially leading to dire complications. Although there are numerous pharmaceutical treatments available, management of the disease is frequently not optimal. Managing diabetes in daily clinical practice can be challenging, and several common mistakes may occur. Healthcare providers must be aware of these errors to provide adequate patient care. In this review, some frequent mistakes in diabetes management are analyzed, focusing on factors such as medication management, blood glucose level monitoring, inadequate addressing of complications and comorbidities, lifestyle choices, patient education, and overall health counselling.
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Affiliation(s)
- Konstantinos Makrilakis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece.
| | - Eleftheria Papachristoforou
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece
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13
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Cepeda-Marte JL, Moore A, Ruiz-Matuk CB, Salado-Díaz DD, Socias-Pappaterra P, Ho-Sang VWY, Mella-Bonilla I. Culturally adapted mobile application for optimizing metabolic control in type 1 diabetes: a pilot study. Rev Panam Salud Publica 2024; 48:e86. [PMID: 39286660 PMCID: PMC11404233 DOI: 10.26633/rpsp.2024.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/26/2024] [Indexed: 09/19/2024] Open
Abstract
Objective To evaluate whether use of a culturally adapted mobile application (app) for adolescents with type 1 diabetes is associated with improved metabolic control. Methods The Dominican Republic's National Institute of Diabetes, Endocrinology, and Nutrition and the Learning to Live clinic recruited 23 pediatric participants for the study. Blood tests were performed before and after use of the app for a period of 3 months. Based on the user profile, participants were encouraged to use the app's bolus insulin calculator after each meal. The app included a list of regionally and culturally specific foods, color-coded to indicate a high glycemic index (GI) as red; medium GI as yellow; and low GI as green. The color-coding was designed to assist participants in making healthier eating choices. Results There were statistically significant improvements in lipid profile. Mean high-density lipoprotein values rose to acceptable levels, while low-density lipoproteins and triglyceride levels fell to the recommended values. The overall quality of life increased, although glycated hemoglobin levels showed no statistically significant changes. Conclusion The findings of this study suggest that using this culturally tailored app can help young patients with type 1 diabetes to improve metabolic health.
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Affiliation(s)
- Jenny L Cepeda-Marte
- Universidad Iberoamericana Research Hub Santo Domingo Dominican Republic Universidad Iberoamericana, Research Hub, Santo Domingo, Dominican Republic
| | - Arelis Moore
- Language Department Clemson University ClemsonSouth Carolina United States of America Language Department, Clemson University, Clemson, South Carolina, United States of America
| | - Carlos B Ruiz-Matuk
- Universidad Iberoamericana Research Hub Santo Domingo Dominican Republic Universidad Iberoamericana, Research Hub, Santo Domingo, Dominican Republic
| | - Daniela D Salado-Díaz
- Universidad Iberoamericana Research Hub Santo Domingo Dominican Republic Universidad Iberoamericana, Research Hub, Santo Domingo, Dominican Republic
| | - Pablo Socias-Pappaterra
- Universidad Iberoamericana Research Hub Santo Domingo Dominican Republic Universidad Iberoamericana, Research Hub, Santo Domingo, Dominican Republic
| | - Vivian W Y Ho-Sang
- Universidad Iberoamericana Research Hub Santo Domingo Dominican Republic Universidad Iberoamericana, Research Hub, Santo Domingo, Dominican Republic
| | - Isabella Mella-Bonilla
- Universidad Iberoamericana Research Hub Santo Domingo Dominican Republic Universidad Iberoamericana, Research Hub, Santo Domingo, Dominican Republic
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14
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Koirala S, Sunnaa M, Bernier T, Oktay AA. The Role of Obesity as a Cardiac Disease Risk Factor in Patients with Type 2 Diabetes. Curr Cardiol Rep 2024:10.1007/s11886-024-02129-z. [PMID: 39235729 DOI: 10.1007/s11886-024-02129-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is the leading cause of death globally and is closely associated with obesity and type 2 diabetes mellitus (T2DM). This review examines the interplay between obesity, T2DM, and CVD, highlighting the increasing prevalence and economic burden of these conditions. RECENT FINDINGS Pharmacologic therapies, particularly glucagon-like peptide-1 receptor agonists, show promise in substantial weight loss and subsequent reduction of adverse cardiovascular events in obese individuals with and without diabetes. Obesity significantly contributes to the development of insulin resistance and T2DM, further escalating CVD risk. The common co-occurrence of these three conditions may involve several other pathophysiological mechanisms, such as chronic inflammation, increased visceral adiposity, and endothelial dysfunction. Until recently, lifestyle modifications and bariatric surgery had been the primary methods for weight loss and mitigating obesity-associated cardiovascular risk. Newer pharmacological options have led to a paradigm shift in our approach to obesity management as they provide substantial benefits in weight loss, glycemic control, and cardiovascular risk reduction.
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Affiliation(s)
- Sushant Koirala
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Michael Sunnaa
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Thomas Bernier
- Division of Cardiology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Ahmet Afsin Oktay
- Division of Cardiology, Rush University Medical Center, Chicago, IL, 60612, USA.
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15
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Kosmalski M, Frankowski R, Leszczyńska J, Różycka-Kosmalska M, Pietras T, Majak I. The Evaluation of Selected Trace Elements in Blood, Serum and Blood Cells of Type 2 Diabetes Patients with and without Renal Disorder. Nutrients 2024; 16:2989. [PMID: 39275304 PMCID: PMC11397730 DOI: 10.3390/nu16172989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 08/31/2024] [Accepted: 09/01/2024] [Indexed: 09/16/2024] Open
Abstract
BACKGROUND An appropriate diet is the basis for the treatment of type 2 diabetes (T2DM). However, there are no strict recommendations regarding the content of micronutrients and their modifications in the presence of chronic kidney disease (CKD). Therefore, we decided to investigate whether T2DM patients, including those with CKD, have different levels of chromium, nickel, cobalt, magnesium, and zinc in various blood elements compared to healthy individuals. METHODS We divided our subjects into three groups: the control group (individuals without T2DM and proper renal function), those with T2DM and proper renal function, and those with T2DM and GFR < 60 mL/min/1.73 m2. RESULTS We observed higher levels of chromium in all materials examined in patients with T2DM and impaired renal function. Both study groups found higher levels of nickel in samples of whole blood and red blood cells. Patients with T2DM and proper renal function had higher levels of serum manganese. Both study groups had lower levels of serum zinc. We observed higher levels of chromium in all materials examined in patients with T2DM and impaired renal function. Both study groups found higher levels of nickel in samples of whole blood and red blood cells. Patients with T2DM and proper renal function had higher levels of serum manganese. Both study groups had lower levels of serum zinc. CONCLUSIONS In order to ensure effective care for patients with T2DM, it is necessary to improve the standard diet, including the content of micronutrients and their modification in patients with concomitant CKD.
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Affiliation(s)
- Marcin Kosmalski
- Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Rafał Frankowski
- Students' Research Club, Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Joanna Leszczyńska
- Institute of Natural Products and Cosmetics, Department of Biotechnology and Food Sciences, Lodz University of Technology, 90-537 Lodz, Poland
| | | | - Tadeusz Pietras
- Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland
- The Second Department of Psychiatry, Institute of Psychiatry and Neurology in Warsaw, 02-957 Warsaw, Poland
| | - Iwona Majak
- Institute of Food Technology and Analysis, Department of Biotechnology and Food Sciences, Lodz University of Technology, 90-924 Lodz, Poland
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16
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Bombaci B, Torre A, Longo A, Pecoraro M, Papa M, Sorrenti L, La Rocca M, Lombardo F, Salzano G. Psychological and Clinical Challenges in the Management of Type 1 Diabetes during Adolescence: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1085. [PMID: 39334618 PMCID: PMC11430186 DOI: 10.3390/children11091085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/22/2024] [Accepted: 09/03/2024] [Indexed: 09/30/2024]
Abstract
Adolescence, a critical period of physical and psychological development, presents unique challenges in type 1 diabetes (T1D) management due to endocrinological changes, reduced therapeutic adherence, and elevated susceptibility to psychological issues such as depression, anxiety, and eating disorders. This narrative review explores the impact of psychological and behavioral factors on glycemic control in adolescents with T1D. We examine the prevalence and influence of mental health disorders, lifestyle factors, harmful behaviors, and social dynamics on diabetes management and glycemic outcomes. Strategies for improving metabolic control are also reviewed, including cognitive behavioral therapy, technological devices, and educational interventions. The importance of tailored psychological support, family involvement, and targeted interventions to improve adherence to treatment and glycemic control in adolescents with T1D should be emphasized.
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Affiliation(s)
- Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Arianna Torre
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Alessandro Longo
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Maria Pecoraro
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Mattia Papa
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Lacrima Sorrenti
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Mariarosaria La Rocca
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
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17
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Vincent JB. Is chromium(III) supplementation beneficial for dietary rodent models of prediabetes? J Trace Elem Med Biol 2024; 85:127482. [PMID: 38861777 DOI: 10.1016/j.jtemb.2024.127482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/13/2024]
Abstract
Chromium as the trivalent ion is believed to pharmaceutically active, increasing insulin sensitivity in high doses in genetic rodent models of diabetes. However, contradictory results have been obtained chemical rodent models of diabetes. The current review analyses the effects of dietary Cr supplementation of rodent models of prediabetes, where the condition is administered using a high-fat or high-sugar diet. Rat model studies display a range of quality, with studies utilizing basal diets of known Cr content suggesting Cr beneficially affects insulin sensitivity. Mouse model studies display too much heterogeneity in results for any firm conclusions to be drawn. Comparison of these results with those of clinical trials suggest that the effective dose of Cr may be proportionally lower for rodents than humans, if one exists for humans.
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Affiliation(s)
- John B Vincent
- Department of Chemistry and Biochemistry, The University of Alabama, Tuscaloosa, AL 35487-0336, USA.
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18
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Premadasa SS, Masingboon K, Samartkit N. Diabetes self-management and its influencing factors among adults with type 2 diabetes mellitus in rural Sri Lanka: A cross-sectional study. BELITUNG NURSING JOURNAL 2024; 10:448-455. [PMID: 39211462 PMCID: PMC11350352 DOI: 10.33546/bnj.3441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/21/2024] [Accepted: 07/17/2024] [Indexed: 09/04/2024] Open
Abstract
Background Diabetes Self-Management (DSM) is pivotal in managing diabetes. However, poor engagement in DSM has been observed in rural Sri Lankan settings. Thus, identifying factors influencing DSM is crucial for nurses and other healthcare professionals. Objectives This study aimed to describe DSM among adults with Type 2 Diabetes Mellitus (T2DM) in rural Sri Lanka and to examine whether perceived stress, health literacy, self-efficacy, and family support can predict DSM among adults with T2DM in rural Sri Lanka. Methods This correlational predictive study used a simple random sampling technique to recruit 160 adults with T2DM from an outpatient clinic at a secondary care hospital in a rural area of Sri Lanka. Data were collected from March to April 2024 using socio-demographic and standardized questionnaires to examine predictive factors of DSM, including perceived stress, health literacy, self-efficacy, and family support. Data analysis was conducted using descriptive statistics and standard multiple linear regression analysis. Results Approximately half of the participants had uncontrolled T2DM (Fasting Plasma Glucose (FPG) >126) and sub-optimal DSM. The analysis revealed that all variables could explain 39.3% of the variance in DSM among rural Sri Lankan adults with T2DM. However, DSM was significantly predicted by self-efficacy (β = 0.530, p = 0.001), harmful family involvement (β = -0.169, p = 0.038), and health literacy (β = -0.162, p = 0.020). Conclusion The findings emphasized the need for further development of interventions to increase self-efficacy and reduce harmful family involvement to enhance DSM among adults with T2DM. Nurses and other healthcare providers should target family members' engagement to improve self-efficacy among this population.
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Affiliation(s)
- Samantha Sandamali Premadasa
- Master of Nursing Science Program Adult Nursing (International Program), Faculty of Nursing, Burapha University, Chon Buri, Thailand
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19
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West JL, Ballard RA, May JP. Considerations to Better Meet the Needs of People Living With Diabetes While in Prison or Detention. Diabetes Spectr 2024; 37:241-246. [PMID: 39157782 PMCID: PMC11327161 DOI: 10.2337/dsi24-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Diabetes care within prison walls offers challenges and opportunities for both health care providers and individuals living with diabetes. To meet the challenges, providers and patients work together to manage diabetes within the limitations imposed by imprisonment. Upon release, patients face new challenges, as they transition from incarceration into the community.
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20
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Baretić M, de Bruijn D. Health beyond biology: the extended health hypothesis and technology. Monash Bioeth Rev 2024:10.1007/s40592-024-00206-1. [PMID: 39143390 DOI: 10.1007/s40592-024-00206-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/16/2024]
Abstract
There are ethical dilemmas faced by clinicians when responding to using unregistered medical devices, such as innovative internet technologies for managing type 1 diabetes mellitus. This chronic disease significantly impacts patients' health, requiring intensive daily activities like blood glucose monitoring, insulin injections, and specific dietary recommendations. Recent technological advances, including continuous glucose monitors and insulin pumps, have been shown to improve glycemic control. Di-it Yourself Artificial Pancreas Systems are emerging open-source automated delivery methods initiated by the diabetes community, although they are not clinically evaluated and present a liability challenge for healthcare providers. To use them or not? Should parents and healthcare providers use such technology that helps, but is not proven?Having all of that in mind, we argue that the World Health Organization's (WHO) definition of health is outdated, advocating for the "Extended Health Hypothesis". This hypothesis claims that health extends beyond traditional biological boundaries to include essential functional structures like diabetes-related technology, making technology a part of a patient's health. This view aligns with the "Extended Mind Hypothesis," suggesting that health should include elements beyond organic material if they are vital to a patient's functions.In the commentary, we highlight that both naturalist and normative conceptions of health support the extended health hypothesis, emphasizing that human health is not confined to organic material. This perspective raises critical questions about whether devices like insulin pumps and continuous glucose monitors are integral to a patient's health and whether their malfunction constitutes a form of disease. Devices are considered integral to health, there is no ethical dilemma in using unregistered medical devices for managing type 1 diabetes. Finally, we call for reevaluating the definitions of health and patients, particularly for children with type 1 diabetes using advanced technologies. It asserts that the optimal use of such devices represents a new form of health, creating a health-device symbiosis that should be evaluated with the child's best interests in mind.
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Affiliation(s)
- Maja Baretić
- University Hospital Centre Zagreb, Internal clinic, Department of endocrinology and diabetes, Zagreb, Croatia.
- Faculty of Philosophy, Auburn University, Auburn, Alabama, USA.
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21
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Venkatesh S, Leal DO, Valdez A, Butler PI, Keenan OE, Montemayor-Gonzalez E. Cooking Well with Diabetes: A Healthy Cooking School for Diabetes Prevention and Management. Nutrients 2024; 16:2543. [PMID: 39125422 PMCID: PMC11313969 DOI: 10.3390/nu16152543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
One in ten Americans suffers from type 2 diabetes, which, if not managed well, can result in severe complications, disability, and premature death. Diabetes education classes can play a pivotal role in providing practical education on diabetes and self-care behaviors, with a particular emphasis on dietary management, which is often regarded as the most demanding diabetes self-care behavior. The Texas A&M AgriLife Extension Service developed Cooking Well with Diabetes (CWWD), a four-week interactive diabetes education series, with each week consisting of a lecture on healthy eating coupled with cooking lessons featuring diabetes-friendly recipes. The current study aimed to examine the effectiveness of CWWD in improving the frequency of healthy food preparation and consumption of program participants. Secondary data from 2017 to 2023 was analyzed involving 1574 adults from 59 predominantly rural Texas counties. Data from self-reported pre and post evaluations showed improvements in healthy food preparation and consumption behaviors. The curriculum enabled Extension Educators to introduce healthful dietary behaviors to a diverse group of clients. The curriculum can be adapted by Extension Educators in other states reaching a broader audience. The findings will inform future research aimed at planning and implementing successful diabetes education programs.
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Affiliation(s)
- Sumathi Venkatesh
- Department of Nutrition, Texas A&M AgriLife Extension Service, College Station, TX 77840, USA
| | - David O. Leal
- Healthy South Texas, Texas A&M AgriLife Extension Service, College Station, TX 77845, USA
| | - Amy Valdez
- Healthy South Texas, Texas A&M AgriLife Extension Service, College Station, TX 77845, USA
| | - Paula I. Butler
- Family and Community Health, Texas A&M AgriLife Extension Service, Dallas, TX 75252, USA
| | - Odessa E. Keenan
- Department of Nutrition, Texas A&M AgriLife Extension Service, College Station, TX 77840, USA
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Walker RJ, Williams JS, Linde S, Egede LE. Social Risk and Clinical Outcomes Among Adults With Type 2 Diabetes. JAMA Netw Open 2024; 7:e2425996. [PMID: 39207760 PMCID: PMC11362860 DOI: 10.1001/jamanetworkopen.2024.25996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/28/2024] [Indexed: 09/04/2024] Open
Abstract
Importance No clear process exists for categorizing social risks in a way that informs effective social risk screening and intervention development. Objective To investigate social risk profiles and associations of those profiles with clinical outcomes in adults with diabetes using latent profile analysis. Design, Setting, and Participants For this cross-sectional study, a latent profile analysis was conducted using data for adults with type 2 diabetes collected at 2 primary care clinics in the Southeastern US from 2013 to 2014. Data were analyzed from November to December 2023. Main Outcomes and Measures Participants completed validated questionnaires for 26 social risk factors within 5 domains of social determinants of health: socioeconomic, neighborhood, education, food, and social and community context. In addition, participants completed questions that assessed psychological risk and behavioral risk. A 3-step latent profile analysis was used to identify different subgroups within the sample. Profiles were then regressed on outcomes of hemoglobin A1c (HbA1c), blood pressure, and quality of life. Results A total of 615 participants (mean [SD] age, 61.3 [10.9] years; 379 men [61.6%]) were included. Five latent class profiles were identified. The lowest risk group had significantly higher mental health-related quality of life compared with a group with higher neighborhood risk (β, 1.11; 95% CI, 0.67 to 1.55). The second group had low economic risk but high neighborhood risk and served as the reference group. The third group had high economic and neighborhood risk and had significantly higher blood pressure (β, 8.08; 95% CI, 2.16 to 14.01) compared with the reference. The fourth group had high psychological and behavioral risks but low socioeconomic and neighborhood risks. This group had significantly higher HbA1c (β, 0.47; 95% CI, 0.01 to 0.92) and lower mental health-related quality of life (β, -1.83; 95% CI, -2.41 to -1.24) compared with the reference. The highest risk group indicated high risk in all domains, had significantly higher HbA1c (β, 1.07; 95% CI, 0.50 to 1.63), and had lower mental health-related quality of life (β, -2.15; 95% CI, -2.87 to -1.42) compared with the reference. Conclusions and Relevance These findings suggest that social risk profiles can be identified according to social, psychological, and behavioral risk domains and the health outcome of concern among adults with diabetes. Future work should consider the use of social risk profiles in intervention development and testing.
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Affiliation(s)
- Rebekah J. Walker
- Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Joni S. Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Sebastian Linde
- Department of Health Policy & Management, Texas A&M School of Public Health, College Station
| | - Leonard E. Egede
- Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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Yi-Frazier JP, Hilliard ME, O’Donnell MB, Zhou C, Ellisor BM, Garcia Perez S, Duran B, Rojas Y, Malik FS, DeSalvo DJ, Pihoker C, Bradford MC, Scott S, Devaraj S, Rosenberg AR. Promoting Resilience in Stress Management for Adolescents With Type 1 Diabetes: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2428287. [PMID: 39158914 PMCID: PMC11333977 DOI: 10.1001/jamanetworkopen.2024.28287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/21/2024] [Indexed: 08/20/2024] Open
Abstract
Importance Type 1 diabetes (T1D) requires demanding self-management health behaviors, and adolescents with T1D are at risk for poor psychosocial and medical outcomes. Developing resilience skills may help adolescents with T1D and elevated distress navigate common stressors and achieve positive outcomes. Objective To test the efficacy of the Promoting Resilience in Stress Management (PRISM) intervention on levels of hemoglobin A1c (HbA1c), diabetes distress, self-management behaviors, resilience, and quality of life among adolescents. Design, Setting, and Participants This phase 3, parallel, 1:1 randomized clinical trial that followed up 172 participants for 12 months was conducted from January 1, 2020, to November 30, 2022, at each of 2 children's hospitals, in Seattle, Washington, and Houston, Texas. Participants were ages 13 to 18 years with T1D for at least 12 months and elevated diabetes distress. Intervention PRISM, a manualized, skills-based, individual intervention program that teaches stress management, goal setting, reframing, and meaning-making, facilitated by a coach and accompanied by a digital app, was delivered in three 30- to 60-minute sessions approximately 2 weeks apart. Main Outcomes and Measures The 2 primary outcomes, diabetes distress and HbA1c levels, and 3 secondary outcomes, resilience, quality of life, and engagement in self-management behaviors, were assessed at baseline and 6 and 12 months after baseline. Linear mixed-effects regression models were used to evaluate associations between PRISM or usual care (UC) and these outcomes at both time points for the intention-to-treat population. Results Among 172 adolescents (mean [SD] age, 15.7 [1.6] years), 96 were female (56%), and their baseline mean (SD) HbA1c level was 8.7% (2.0%). No differences were evident between PRISM and UC recipients in HbA1c levels (β, -0.21 [95% CI, -0.65 to 0.22]; P = .33) or diabetes distress (β, -2.71 [95% CI, -6.31 to 0.90]; P = .14) or any participant-reported outcome (eg, β, 2.25 [95% CI, -0.30 to 4.80]; P = .08 for self-management behaviors) at 6 months. At 12 months, there was no statistically significant difference between arms in HbA1c levels (β, -0.26 [95% CI, -0.72 to 0.19]; P = .25); however, PRISM recipients reported significantly greater amelioration of diabetes distress (β, -4.59 [95% CI, -8.25 to -0.94]; P = .01) and improvement in self-management behaviors (β, 3.4 [95% CI, 0.9 to 5.9]; P = .01) compared with UC recipients. Conclusions and Relevance The findings in this randomized clinical trial of psychosocial and behavioral improvements associated with PRISM at 12 months illustrate the value of a strengths-based intervention. Integrating resilience skills-building with traditional diabetes care may be a promising approach for improving outcomes among adolescents with T1D and elevated diabetes distress. Trial Registration ClinicalTrials.gov number: NCT03847194.
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Affiliation(s)
- Joyce P. Yi-Frazier
- Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington
- Department of Psychosocial Oncology & Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Marisa E. Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Maeve B. O’Donnell
- Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington
- Cambia Palliative Care Center of Excellence, University of Washington School of Medicine, Seattle
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Britney M. Ellisor
- Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Samantha Garcia Perez
- Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Brenda Duran
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Yuliana Rojas
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Faisal S. Malik
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
- Division of Diabetes/Endocrinology, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Daniel J. DeSalvo
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Catherine Pihoker
- Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington
- Division of Diabetes/Endocrinology, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Miranda C. Bradford
- Core for Biostatistics, Epidemiology and Analytics for Research (BEAR), Seattle Children’s Research Institute, Seattle, Washington
| | - Samantha Scott
- Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington
- Department of Psychology, University of Denver, Denver, Colorado
| | - Sridevi Devaraj
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Abby R. Rosenberg
- Department of Psychosocial Oncology & Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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24
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Lecomte J, de Beeck IO, Mamouris P, Mathieu C, Goderis G. Knowledge and prescribing behaviour of Flemish general practitioners regarding novel glucose-lowering medications: Online cross-sectional survey. Prim Care Diabetes 2024; 18:441-447. [PMID: 38862313 DOI: 10.1016/j.pcd.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/25/2024] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
AIMS To determine the knowledge and prescribing behaviour regarding new type 2 diabetes medication in general practice. Physicians in Belgium are bound by the prescription criteria which do not always correspond to the international guidelines. DESIGN & METHOD A mixed methods study with an online questionnaire was conducted in Flanders to collect data on demographic characteristics, theoretical knowledge, and prescribing behaviour, using ten theoretical questions and six clinical cases, based on the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) guidelines and the Belgian reimbursement criteria. RESULTS 201 GPs and GPs in training were included in this study with a median age of 30 years and 68 % female participants. On the knowledge questionnaire, the mean test result was 7.15/15 (= 48 %) with a median of 8. Further analysis showed that 90 % of the respondents correctly recommended a sodium-glucose cotransporter 2 (sglt2) inhibitor when the clinical case showed a comorbidity of heart failure, whereas only 42 % suggested correctly a glucagon-like peptide 1 (GLP-1) agonist if presence of cardiovascular disease. Subgroup analysis showed no statistically significant demographic differences in obtained test results. Regarding prescription behaviour, 23 % of the respondents would prescribe medication that did not match the reimbursement criteria in at least one of the 6 proposed clinical cases. CONCLUSION This study highlights the need for enhanced knowledge and updated prescribing practices among Flemish GPs and Trainee GPs to effectively manage patients with T2DM.
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Affiliation(s)
- Julie Lecomte
- Academic Center for General Practice, Department of Public Health and Primary Care, Kapucijnenvoer 7 blok h - box 7001, Leuven 3000, Belgium
| | - Isabelle Op de Beeck
- Academic Center for General Practice, Department of Public Health and Primary Care, Kapucijnenvoer 7 blok h - box 7001, Leuven 3000, Belgium
| | - Pavlos Mamouris
- Academic Center for General Practice, Department of Public Health and Primary Care, Kapucijnenvoer 7 blok h - box 7001, Leuven 3000, Belgium
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, UZ Herestraat 49 - box 902, Leuven 3000, Belgium
| | - Geert Goderis
- Academic Center for General Practice, Department of Public Health and Primary Care, Kapucijnenvoer 7 blok h - box 7001, Leuven 3000, Belgium.
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25
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Parikh RV, Nau CL, Tan TC, Tucher E, Vallejo JD, Jimenez JJ, Horiuchi KM, Allen AR, Stehr P, Alexeeff SE, Han B, Lo JC, Mozaffarian D, Go AS, Grant RW. Rationale and design of the KP ENRICH trial: A food is medicine intervention in low-income high-risk adults with diabetes within Kaiser Permanente. Contemp Clin Trials 2024; 143:107601. [PMID: 38851480 DOI: 10.1016/j.cct.2024.107601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/11/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Food insecurity is associated with poor glycemic control and increased risk for diabetes-related complications. The clinical benefit of addressing these challenges through a medically supportive grocery prescription (GRx) program in patients with type 2 diabetes mellitus (T2D) remains unclear. We report the aims and design of a randomized clinical trial to evaluate the effectiveness of a 6-month GRx intervention on hemoglobin A1c (HbA1c) levels among low-income adults with T2D. METHODS The Kaiser Permanente Evaluating Nutritional Interventions in Food-Insecure High-Risk Adults (KP ENRICH) Study is a pragmatic randomized trial enrolling 1100 participants within Kaiser Permanente Northern California and Southern California, two integrated health care delivery systems serving >9 million members. Medicaid-insured adults with T2D and baseline HbA1c ≥7.5% will be randomized at a 1:1 ratio to either GRx, delivered as $100 per month for select items from among a curated list of healthful food groups in an online grocery ordering and home-delivery platform along with biweekly digital nutrition educational materials, or control, consisting of free membership and deliveries from the online grocery platform but without curated food groups or purchasing dollars. The primary outcome is 6-month change in HbA1c. Secondary outcomes include 12-month change in HbA1c, and 6- and 12-month change in medical resource utilization, food security, nutrition security, dietary habits, diabetes-related quality of life, and dietary self-efficacy. CONCLUSIONS The results of this large randomized clinical trial of GRx will help inform future policy and health system-based initiatives to improve food and nutrition security, disease management, and health equity among patients with T2D.
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Affiliation(s)
- Rishi V Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Claudia L Nau
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emma Tucher
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jessica D Vallejo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jennifer J Jimenez
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Kate M Horiuchi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Amanda R Allen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Peter Stehr
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Bing Han
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Joan C Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Dariush Mozaffarian
- Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, USA
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26
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Ehrmann D, Hermanns N, Schmitt A, Klinker L, Haak T, Kulzer B. Perceived glucose levels matter more than CGM-based data in predicting diabetes distress in type 1 or type 2 diabetes: a precision mental health approach using n-of-1 analyses. Diabetologia 2024:10.1007/s00125-024-06239-9. [PMID: 39078490 DOI: 10.1007/s00125-024-06239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/13/2024] [Indexed: 07/31/2024]
Abstract
AIMS/HYPOTHESIS Diabetes distress is one of the most frequent mental health issues identified in people with type 1 and type 2 diabetes. Little is known about the role of glucose control as a potential contributor to diabetes distress and whether the subjective perception of glucose control or the objective glycaemic parameters are more important for the experience. With the emergence of continuous glucose monitoring (CGM), this is a relevant question as glucose values are now visible in real-time. We employed a precision monitoring approach to analyse the independent associations of perceived and measured glucose control with diabetes distress on a daily basis. By using n-of-1 analyses, we aimed to identify individual contributors to diabetes distress per person and analyse the associations of these individual contributors with mental health at a 3 month follow-up. METHODS In this prospective, observational study, perceived (hypoglycaemia/hyperglycaemia/glucose variability burden) and measured glucose control (time in hypoglycaemia and hyperglycaemia, CV) were assessed daily for 17 days using an ecological momentary assessment (EMA) approach with a special EMA app and CGM, respectively. Mixed-effect regression analysis was performed, with daily diabetes distress as the dependent variable and daily perceived and CGM-measured metrics of glucose control as random factors. Individual regression coefficients of daily distress with perceived and CGM-measured metrics were correlated with levels of psychosocial well-being at a 3 month follow-up. RESULTS Data from 379 participants were analysed (50.9% type 1 diabetes; 49.6% female). Perceived glucose variability (t=14.360; p<0.0001) and perceived hyperglycaemia (t=13.637; p<0.0001) were the strongest predictors of daily diabetes distress, while CGM-based glucose variability was not significantly associated (t=1.070; p=0.285). There was great heterogeneity between individuals in the associations of perceived and measured glucose parameters with diabetes distress. Individuals with a stronger association between perceived glucose control and daily distress had more depressive symptoms (β=0.32), diabetes distress (β=0.39) and hypoglycaemia fear (β=0.34) at follow-up (all p<0.001). Individuals with a stronger association between CGM-measured glucose control and daily distress had higher levels of psychosocial well-being at follow-up (depressive symptoms: β=-0.31; diabetes distress: β=-0.33; hypoglycaemia fear: β=-0.27; all p<0.001) but also higher HbA1c (β=0.12; p<0.05). CONCLUSIONS/INTERPRETATION Overall, subjective perceptions of glucose seem to be more influential on diabetes distress than objective CGM parameters of glycaemic control. N-of-1 analyses showed that CGM-measured and perceived glucose control had differential associations with diabetes distress and psychosocial well-being 3 months later. The results highlight the need to understand the individual drivers of diabetes distress to develop personalised interventions within a precision mental health approach.
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Affiliation(s)
- Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany.
| | - Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany.
- Diabetes Clinic, Diabetes Centre Mergentheim (DZM), Bad Mergentheim, Germany.
| | - Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Diabetes Clinic, Diabetes Centre Mergentheim (DZM), Bad Mergentheim, Germany
| | - Laura Klinker
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Diabetes Clinic, Diabetes Centre Mergentheim (DZM), Bad Mergentheim, Germany
| | - Thomas Haak
- Diabetes Clinic, Diabetes Centre Mergentheim (DZM), Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Diabetes Clinic, Diabetes Centre Mergentheim (DZM), Bad Mergentheim, Germany
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27
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Ni MH, Yang YS, Huang JY, Lo SC, Huang CN, Kornelius E. The association of depression and sleep disorders in patients with type 1 diabetes in Taiwan. Medicine (Baltimore) 2024; 103:e38969. [PMID: 39029051 PMCID: PMC11398819 DOI: 10.1097/md.0000000000038969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
The association between depression and sleep disorders in patients with type 1 diabetes mellitus (T1DM) in Taiwan is underexplored. We used a nationwide population-based dataset to evaluate the association of T1DM with these conditions in Taiwan from 2001 to 2019. Patients with T1DM were identified as cases, and 2 control groups were used for comparison: patients with type 2 diabetes mellitus (T2DM) and nondiabetic patients. Age, sex, date of diagnosis, and multiple comorbidities were included and matched using propensity score matching between cases and controls. The primary outcome of this study was to identify new occurrences of the first diagnosis of depression or sleep disorders. After matching, this study included 27,029 T1DM cases, 54,058 T2DM controls, and 108,116 nondiabetic controls. Patients with T1DM exhibited a 1.55-fold higher risk of developing depression (hazard ratio [HR] 1.55, 95% confidence intervals [CI] 1.48-1.61) and a 1.41-fold higher risk of experiencing sleep disorders (HR 1.41, 95% CI 1.37-1.46) compared to nondiabetic controls. Similarly, patients with T2DM displayed elevated risks of both depression (HR 1.39, 95% CI 1.34-1.43) and sleep disorders (HR 1.40, 95% CI 1.37-1.44) relative to non-diabetic controls. When comparing the T1DM and T2DM groups, T1DM patients demonstrated a slightly higher risk of depression (HR 1.11, 95% CI 1.07-1.16) but no significant difference in the risk of sleep disorders compared to T2DM patients. These results were consistent regardless of different ages or sexes. This study demonstrates a significant association between diabetes mellitus and the risk of depression and sleep disorders in a large cohort of Taiwanese patients.
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Affiliation(s)
- Meng-Han Ni
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Sun Yang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shih-Chang Lo
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chien-Ning Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Edy Kornelius
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan
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28
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Shin A. FODMAPs in IBS: Revisiting Restriction. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00589-5. [PMID: 38960275 DOI: 10.1016/j.cgh.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024]
Affiliation(s)
- Andrea Shin
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California.
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29
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Jinnouchi H, Yoshida A, Taniguchi M, Yamauchi E, Kurosawa D, Yachiku K, Minoura I, Kadowaki T, Yamauchi T, Aihara M, Kubota N, Sekimizu K. Efficacy of Self-Review of Lifestyle Behaviors with Once-Weekly Glycated Albumin Measurement in People with Type 2 Diabetes: A Randomized Pilot Study. Diabetes Ther 2024; 15:1561-1575. [PMID: 38753121 PMCID: PMC11211309 DOI: 10.1007/s13300-024-01599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Lifestyle management, including appropriate modifications of nutrition, exercise, and medication behaviors, is essential for optimal glycemic control. The absence of appropriate monitoring methods to validate the lifestyle change may hinder the modification and continuation of behaviors. In this study, we evaluated whether once-weekly glycated albumin (GA) measurement received via a smartphone application could improve glycemia management in patients with type 2 diabetes mellitus by supporting self-review and modification of lifestyle behaviors. METHODS This open-label, randomized controlled, single-center study in Japan with an 8-week intervention period was conducted in individuals with type 2 diabetes mellitus and HbA1c levels between 7.0 and 9.0% (53‒75 mmol/mol). The intervention was once-weekly home monitoring of GA with a daily self-review of lifestyle behaviors using a smartphone application, in addition to conventional treatment. RESULTS A total of 98 participants (72.0% males; age 63.2 ± 11.4 years; HbA1c 7.39 ± 0.39% [57.3 ± 4.3 mmol/mol]) were randomly assigned to the intervention or control group. Significant decreases of the GA and HbA1c levels from the baseline to the last observation day were observed in the intervention group (- 1.71 ± 1.37% [- 39.1 ± 31.3 mmol/mol] and - 0.32 ± 0.32% [- 3.5 ± 3.5 mmol/mol], respectively). Significant decreases of the body weight, waist circumference, and caloric expenditure (p < 0.0001 and p = 0.0003, p = 0.0346, respectively), but not of the caloric intake (p = 0.678), were also observed in the intervention group as compared with the control group. CONCLUSIONS Self-review of lifestyle behaviors in combination with once-weekly GA home testing received via a smartphone application might potentially benefit glycemic management in people with type 2 diabetes mellitus. TRIAL REGISTRATION jRCTs042220048.
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Affiliation(s)
| | - Akira Yoshida
- Jinnouchi Hospital Diabetes Care Center, Kumamoto, Japan
| | | | | | - Daisuke Kurosawa
- Provigate, Inc., R/m 302, University of Tokyo Entrepreneur Plaza, 7-3-1, Hongo Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenji Yachiku
- Provigate, Inc., R/m 302, University of Tokyo Entrepreneur Plaza, 7-3-1, Hongo Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Itsushi Minoura
- Provigate, Inc., R/m 302, University of Tokyo Entrepreneur Plaza, 7-3-1, Hongo Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Toranomon Hospital, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masakazu Aihara
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoto Kubota
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Metabolic Medicine, Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | - Koshin Sekimizu
- Provigate, Inc., R/m 302, University of Tokyo Entrepreneur Plaza, 7-3-1, Hongo Bunkyo-ku, Tokyo, 113-0033, Japan.
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30
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Gal AM, Arhire LI, Gherasim A, Graur M, Nita O, Dumitrascu O, Soimaru RM, Popa AD, Mihalache L. Association between Diet Quality and Eating Behavior in Type 2 Diabetes Adults: A Cross-Sectional Study. Nutrients 2024; 16:2047. [PMID: 38999795 PMCID: PMC11243329 DOI: 10.3390/nu16132047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) has become a global epidemic. To effectively control T2DM, individuals must adhere to a high-quality diet that encompasses not only healthy dietary patterns but also promotes positive eating behaviors. We conducted a cross-sectional study on 314 patients with T2DM, and we evaluated the diet quality and also examined the associations between eating behavior, diet quality, and anthropometric and clinical factors in T2DM patients. We used the Diet Quality Index-International and Dutch Eating Behavior Questionnaire to assess dietary characteristics. We found that women had a significantly higher diet quality than men (61.40 vs. 58.68, p = 0.002) but were also more prone to emotional eating (2.00 vs. 1.53, p < 0.001) and restrained eating (2.39 vs. 2.05, p = 0.002). Restrained eating correlated with duration of diabetes (r = -0.169, p = 0.003), body mass index (r = 0.182, p = 0.001), and external eating with glycated hemoglobin (r = 0.114, p = 0.044). Patients with emotional eating had a higher vitamin C adequacy score (β = 0.117, p = 0.045). External eating was positively associated with grain adequacy (β = 0.208, p < 0.001) and negatively associated with empty-calorie food moderation score (β = -0.125, p = 0.032). For restrained eating, we found associations with vitamin C adequacy (β = -0.138, p = 0.017) and fruit adequacy (β = 0.125, p = 0.033). In conclusion, the results of this study provide valuable insight into dietary behavior and emphasize the importance of promoting healthy eating habits for T2DM patients.
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Affiliation(s)
- Ana Maria Gal
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania;
| | - Lidia Iuliana Arhire
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
| | - Andreea Gherasim
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
| | - Mariana Graur
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania;
| | - Otilia Nita
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
| | - Oana Dumitrascu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
| | - Raluca Meda Soimaru
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania;
| | - Alina Delia Popa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
| | - Laura Mihalache
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
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Grech J, Norman I, Azzopardi C, Grixti M, Sammut R. Assessing the feasibility and acceptability of a diabetes-specific nurse-led multicomponent smoking cessation intervention in diabetes education: study protocol for an open-label pragmatic randomised controlled trial. BMJ Open 2024; 14:e083235. [PMID: 38904126 PMCID: PMC11191808 DOI: 10.1136/bmjopen-2023-083235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Smoking cessation is an essential, but often overlooked aspect of diabetes management. Despite the need for tailored smoking cessation support for individuals with diabetes, evidence of effective interventions for this cohort is limited. Additionally, individuals with diabetes do not easily adopt such interventions, resulting in low uptake and abstinence rates. This protocol describes a study that aims to assess the feasibility and acceptability of a unique smoking cessation intervention, based on the best evidence, theory and the needs of individuals with diabetes, among patients and service providers, the diabetes nurse educators. METHODS AND ANALYSIS This is an open-label pragmatic randomised controlled trial. Between 80 and 100 individuals with type 1 or type 2 diabetes who smoke will be recruited from the diabetes outpatients at the main acute public hospital in Malta, starting in August 2023. Participants will be randomly assigned (1:1 ratio) to the intervention or control arm for 12 weeks. The experimental intervention will consist of three to four smoking cessation behavioural support sessions based on the 5As (Ask, Advise, Assess, Assist and Arrange) algorithm, and a 6-week supply of nicotine replacement therapy. The control intervention will consist of an active referral to the Maltese National Health Service's one-to-one smoking cessation support service, which is based on motivational interviewing. The primary feasibility and acceptability outcomes include the recruitment and participation rates, resources used, problems identified by the nurses, the nurses' perceived challenges and facilitators to implementation and the nurses' and patients' acceptability of the study intervention. Data analyses will be descriptive, with quantitative feasibility and acceptability outcomes reported with 95% confidence intervals. ETHICS AND DISSEMINATION Ethical clearance was obtained from the Faculty of Health Sciences Research Ethics Committee, University of Malta. The study results will be disseminated through conference presentations and a publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05920096.
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Affiliation(s)
- Joseph Grech
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Ian Norman
- King's College London Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, London, London, UK
| | | | - Moira Grixti
- Diabetes Education Unit, Mater Dei Hospital, Msida, Malta
| | - Roberta Sammut
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
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Hsu CY, Yeh CY, Yen TY, Chen CC, Chen JF, Chu CH, Huang CN, Lin CL, Lin SY, Liu FH, Ou HY, Wang CY. The expert consensus on care and education for patients with diabetic kidney disease in Taiwan. Prim Care Diabetes 2024; 18:284-290. [PMID: 38423826 DOI: 10.1016/j.pcd.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
Increasing prevalence of type 2 DM (T2DM) and diabetic kidney disease (DKD) has posed a great impact in Taiwan. However, guidelines focusing on multidisciplinary patient care and patient education remain scarce. By literature review and expert discussion, we propose a consensus on care and education for patients with DKD, including general principles, specifics for different stages of chronic kidney disease (CKD), and special populations. (i.e. young ages, patients with atherosclerotic cardiovascular disease or heart failure, patients after acute kidney injury, and kidney transplant recipients). Generally, we suggest performing multidisciplinary patient care and education in alignment with the government-led Diabetes Shared Care Network to improve the patients' outcomes for all patients with DKD. Also, close monitoring of renal function with early intervention, control of comorbidities in early stages of CKD, and nutrition adjustment in advanced CKD should be emphasized.
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Affiliation(s)
- Chih-Yao Hsu
- Endocrinology and Metabolism Division, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | | | - Tsung-Yi Yen
- Family Medicine Department, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Ching-Chu Chen
- Endocrinology and Metabolism Division, China Medical University Hospital, Taichung, Taiwan
| | - Jung-Fu Chen
- Endocrinology and Metabolism Division, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| | - Chih-Hsun Chu
- Endocrinology and Metabolism Division, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chien-Ning Huang
- Endocrinology and Metabolism Division, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ching-Ling Lin
- Endocrinology and Metabolism Division, Cathay General Hospital, Taipei, Taiwan
| | - Shih-Yi Lin
- Endocrinology and Metabolism Division, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Feng-Hsuan Liu
- Endocrinology and Metabolism Division, Chang Gung Memorial Hospital, Taipei Branch, Taipei, Taiwan
| | - Horng-Yih Ou
- Endocrinology and Metabolism Division, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Chih-Yuan Wang
- Endocrinology and Metabolism Division, National Taiwan University Hospital, Taipei, Taiwan.
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Crawford AL, Laiteerapong N. Type 2 Diabetes. Ann Intern Med 2024; 177:ITC81-ITC96. [PMID: 38857502 DOI: 10.7326/aitc202406180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
Type 2 diabetes (T2D) is a prevalent disease that increases risk for vascular, renal, and neurologic complications. Prevention and treatment of T2D and its complications are paramount. Many advancements in T2D care have emerged over the past 5 years, including increased understanding of the importance of early intensive glycemic control, mental health, social determinants of health, healthy eating patterns, continuous glucose monitoring, and the benefits of some drugs for preventing cardiorenal disease. This review summarizes the evidence supporting T2D prevention and treatment, focusing on aspects that are commonly in the purview of primary care physicians.
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Seckiner S, Bas M, Simsir IY, Ozgur S, Akcay Y, Aslan CG, Kucukerdonmez O, Cetinkalp S. Effects of Dietary Carbohydrate Concentration and Glycemic Index on Blood Glucose Variability and Free Fatty Acids in Individuals with Type 1 Diabetes. Nutrients 2024; 16:1383. [PMID: 38732629 PMCID: PMC11085728 DOI: 10.3390/nu16091383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024] Open
Abstract
Monitoring glycemic control status is the cornerstone of diabetes management. This study aimed to reveal whether moderate-carbohydrate (CHO) diets increase the risk of free fatty acid (FFA) levels, and it presents the short-term effects of four different diet models on blood sugar, glycemic variability (GV), and FFA levels. This crossover study included 17 patients with type 1 diabetes mellitus to identify the effects of four diets with different CHO contents and glycemic index (GI) on GV and plasma FFA levels. Diet 1 (D1) contained 40% CHO with a low GI, diet 2 (D2) contained 40% CHO with a high GI, diet 3 (D3) contained 60% CHO with a low GI, and diet 4 (D4) contained 60% CHO with a high GI. Interventions were performed with sensor monitoring in four-day periods and completed in four weeks. No statistical difference was observed among the groups in terms of blood glucose area under the curve (p = 0.78), mean blood glucose levels (p = 0.28), GV (p = 0.59), and time in range (p = 0.567). FFA and total triglyceride levels were higher in the D1 group (p < 0.014 and p = 0.002, respectively). Different diets may increase the risk of cardiovascular diseases by affecting GI, FFA, and blood glucose levels.
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Affiliation(s)
- Selda Seckiner
- Department of Nutrition and Dietetics, Faculty of Health Sciences, İstanbul Beykent University, Istanbul 34520, Turkey
- Institute of Health Sciences, Acibadem Mehmet Ali Aydınlar University, Istanbul 34450, Turkey
| | - Murat Bas
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Acibadem Mehmet Ali Aydınlar University, Istanbul 34450, Turkey;
| | - Ilgin Yildirim Simsir
- Division of Endocrinology and Metabolism Disorders, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir 35100, Turkey; (I.Y.S.); (S.C.)
| | - Su Ozgur
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Ege University, Izmir 35100, Turkey;
| | - Yasemin Akcay
- Department of Medical Biochemistry, Faculty of Medicine, Ege University, Izmir 35100, Turkey;
| | - Cigdem Gozde Aslan
- Department of Medical Biochemistry, Faculty of Medicine, Biruni University, Istanbul 34010, Turkey;
| | - Ozge Kucukerdonmez
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ege University, Izmir 35100, Turkey;
| | - Sevki Cetinkalp
- Division of Endocrinology and Metabolism Disorders, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir 35100, Turkey; (I.Y.S.); (S.C.)
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Murillo S, Brugnara L, Ríos S, Ribas V, Servitja JM, Novials A. People with type 1 diabetes exhibit lower exercise capacity compared to a control population with similar physical activity levels. Diabetes Res Clin Pract 2024; 211:111655. [PMID: 38574895 DOI: 10.1016/j.diabres.2024.111655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/23/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
AIMS We aimed to assess physical activity (PA) levels, adherence to PA guidelines, and fitness capacity in individuals with type 1 diabetes (T1D) and control population. METHODS This cross-sectional study included 232 T1D and 248 controls. PA levels (IPAQ-SF questionnaire), adherence to guidelines (>150 min/week of moderate-to-vigorous PA), fitness capacity (VO2max, maximal incremental test on a cycle ergometer and 1RM test) were assessed, along with other clinical variables. RESULTS Total PA levels (T1D 2202 ± 1839 vs. controls 2357 ± 2189 METs/min/week), adherence (T1D 53.1 % vs controls 53.2 %), and sedentariness (T1D 27.3 % vs. controls 25.1 %) were similar between groups. However, participants with T1D exhibited significantly lower levels of VO2max (29.1 ± 10.5 vs. 32.5 ± 11.5 mlO2/kg/min, p < 0.001), work capacity (2.73 ± 1.03 vs. 3 ± 10 W/kg of body weight, p = 0.004) and strength capacity (2.29 ± 0.53 vs. 2.41 ± 0.79 kg/kg body weight in 1RM, p = 0.01) than controls, after adjusting for sex and age. CONCLUSIONS Individuals with T1D exhibit lower fitness capacity compared to a control population, regardless of age and sex, even when presenting similar levels of total physical activity and adherence to guidelines.
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Affiliation(s)
- Serafín Murillo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Endocrinology, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - Laura Brugnara
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Santiago Ríos
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.
| | - Vicent Ribas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Joan-Marc Servitja
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Anna Novials
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
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Lorber DL, ElSayed NA, Bannuru RR, Shah V, Puisis M, Crandall J, Fech-Baughman S, Wakeen B, Dantone JJ, Hunter-Buskey R, Moritsugu K, Wang E, Desimone M, Weinstock R, Fischer A, Sherman J, Eber G, Shefelman W. Diabetes Management in Detention Facilities: A Statement of the American Diabetes Association. Diabetes Care 2024; 47:544-555. [PMID: 38527114 DOI: 10.2337/dci24-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 03/27/2024]
Abstract
This statement provides guidance for diabetes care in detention facilities. It focuses on areas where the processes for delivery of care to people with diabetes in detention facilities may differ from those in the community, and key points are made at the end of each section. Areas of emphasis, which inform multiple aspects discussed in this statement, include 1) timely identification or diagnosis of diabetes treatment needs and continuity of care (at reception/intake, during transfers, and upon discharge), 2) nutrition and physical activity, 3) timely access to diabetes management tools (insulin, blood glucose monitoring, tracking data, current diabetes management technologies, etc.), and 4) treatment of the whole person with diabetes (self-management education, mental health support, monitoring and addressing long-term complications, specialty care, etc.).
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Affiliation(s)
- Daniel L Lorber
- Lang Center for Research and Education at New York Hospital Queens, Queens, NY
| | - Nuha A ElSayed
- American Diabetes Association, Arlington, VA
- Harvard Medical School, Boston, MA
| | | | - Viral Shah
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | | | | | | | - Jo Jo Dantone
- Nutrition Education Resources, Inc., Frances Place, LA
| | - Robin Hunter-Buskey
- Immigration Health Service Corps, U.S. Department of Homeland Security, Washington, DC
| | | | - Emily Wang
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT
| | | | | | | | | | - Gabe Eber
- Center for Public Health & Human Rights, Johns Hopkins School of Public Health, Rockville, MD
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Kärberg K, Forbes A, Lember M. Unlocking the Dietary Puzzle: How Macronutrient Intake Shapes the Relationship between Visfatin and Atherosclerosis in Type 2 Diabetes. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:438. [PMID: 38541164 PMCID: PMC10972461 DOI: 10.3390/medicina60030438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
Background and Objectives. Optimal nutrition for type 2 diabetes (T2DM) aims to improve glycemic control by promoting weight loss and reducing adipose tissue, consequently improving cardiovascular health. Dietary alterations can influence adipose tissue metabolism and potentially impact adipocytokines like visfatin, thereby affecting atherosclerosis development. This study aimed to investigate dietary habits and adherence to recommendations among individuals with T2DM and to examine how dietary adherence influences the association between visfatin and subclinical atherosclerosis. Materials and Methods: This cross-sectional multicenter study involved 216 adults (30-70 years) with T2DM, assessing dietary habits, adherence to recommendations (carbohydrates, fats, protein, fiber, saturated fatty acid, polyunsaturated and monounsaturated fatty acid (PUFA and MUFA) and salt), and the association between visfatin and subclinical atherosclerosis. Participants completed 24 h dietary recalls; dietary misreporting was assessed using the Goldberg cut-off method. Carotid intima-media thickness (IMT) and plaque occurrence were evaluated with ultrasound, while visfatin levels were measured using Luminex's xMAP technology. Results: Three of the eight recommendations were followed in 31% of subjects, two in 26%, and four in 20%, with the highest adherence to MUFA and protein intake. Significant correlations between IMT and visfatin were observed in individuals with specific dietary patterns. The association between IMT and visfatin persisted when PUFA and MUFA intake aligned with recommendations. PUFA intake ≤ 10% and MUFA ≤ 20% of total energy significantly correlated with carotid artery IMT (p = 0.010 and p = 0.006, respectively). Visfatin's associations with IMT remained significant (p = 0.006) after adjusting for common risk factors, medication use, and dietary nonadherence. No association was observed with carotid artery plaque. Conclusions: Dietary compliance was limited, as only 31% adhered even to three of eight recommendations. A common dietary pattern characterized by low carbohydrate and fiber but high fat, total fat, saturated fat, and salt intake was identified. This pattern amplifies the statistical association between visfatin and subclinical atherosclerosis.
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Affiliation(s)
- Kati Kärberg
- Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 50406 Tartu, Estonia; (A.F.); (M.L.)
- Internal Medicine Clinic, Tartu University Hospital, L. Puusepa 8, 50406 Tartu, Estonia
| | - Alastair Forbes
- Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 50406 Tartu, Estonia; (A.F.); (M.L.)
- Internal Medicine Clinic, Tartu University Hospital, L. Puusepa 8, 50406 Tartu, Estonia
| | - Margus Lember
- Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 50406 Tartu, Estonia; (A.F.); (M.L.)
- Internal Medicine Clinic, Tartu University Hospital, L. Puusepa 8, 50406 Tartu, Estonia
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Khosrovaneh K, Hisamatsu R, Reiss J, Rau J, Oshman L, Diez HL, Lee JM, Aikens JE, Richardson C, Griauzde DH. Nutrition counsellors' recommended eating patterns for individuals with type 2 diabetes in the USA. BMJ Nutr Prev Health 2024; 7:119-127. [PMID: 38966120 PMCID: PMC11221297 DOI: 10.1136/bmjnph-2023-000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/13/2024] [Indexed: 07/06/2024] Open
Abstract
Introduction Multiple eating patterns can promote glycaemic control and weight loss among patients with type 2 diabetes mellitus (T2D). Clinical practice guidelines for T2D management encourage health professionals to guide patients' selection of a patient-centred eating pattern. This study aims to characterise beliefs about and recommendations for and against practice guideline-concordant eating patterns among registered dietitians (RDs) and other healthcare professionals who provide nutrition counselling to patients with T2D. Methods This was a cross-sectional online survey. We invited 82 RDs affiliated with an academic health system in the midwestern USA to participate. We also invited health professionals who provide nutrition counselling to patients with T2D and are affiliated with 264 primary care practices within the Michigan Collaborative for Type 2 Diabetes. Participants were asked to select the eating pattern(s) that they commonly recommend or avoid for patients with T2D and why. Results Survey respondents (n=81) most commonly recommend low-carbohydrate (77.8%); Mediterranean-style (52.8%) and energy-modified/calorie-restricted (36.1%) eating patterns. Survey respondents most commonly recommend avoiding very low-carbohydrate (51.0%) and very low-calorie (49.0%) eating patterns. Respondents who did not recommend very low-carbohydrate were most concerned about the eating pattern being too restrictive (93.0%). Conclusions Survey respondents recommend a range of guideline-adherent eating patterns to patients with T2D but tend to recommend against very low-carbohydrate and very low-calorie eating patterns. Additional strategies are needed to increase patient-centred use of these evidence-based options in clinical practice settings.
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Affiliation(s)
| | | | - Jacob Reiss
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Lauren Oshman
- University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| | - Heidi L Diez
- University of Michigan, Ann Arbor, Michigan, USA
| | - Joyce M Lee
- University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| | | | - Caroline Richardson
- University of Michigan, Ann Arbor, Michigan, USA
- Brown University, Providence, Rhode Island, USA
| | - Dina H Griauzde
- University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
- Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Nemlekar PM, Hannah KL, Green CR, Norman GJ. Association Between Adherence, A1C Improvement, and Type of Continuous Glucose Monitoring System in People with Type 1 Diabetes or Type 2 Diabetes Treated with Intensive Insulin Therapy. Diabetes Ther 2024; 15:639-648. [PMID: 38289464 PMCID: PMC10942933 DOI: 10.1007/s13300-023-01529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/22/2023] [Indexed: 03/16/2024] Open
Abstract
INTRODUCTION Use of continuous glucose monitoring (CGM) systems by people with diabetes is associated with improved glycemic outcomes, including lower glycated hemoglobin (A1C). Less is known about adherence to CGM systems, whether glycemic outcomes are impacted by levels of adherence, or whether adherence rates differ between types of CGM systems-intermittently scanned CGM (isCGM) or real-time CGM (rtCGM). METHODS A retrospective analysis of de-identified US administrative health claims and linked laboratory data was conducted using the Merative™ MarketScan® Research Database. The cohort included CGM-naïve people with type 1 diabetes (T1D) or type 2 diabetes treated with intensive insulin therapy (T2D-IIT) who initiated rtCGM or isCGM between August 1, 2019 and March 31, 2021 (defined as the index date). Adherence was calculated over a 12-month period using the proportion of days covered (PDC) with PDC ≥ 0.8 defined as adherent. A1C values were obtained within 6 months of the index date. RESULTS A total of 7669 individuals were identified. Subgroups included T1D using isCGM (n = 1578), T1D using rtCGM (n = 1244), T2D-IIT using isCGM (n = 3567), and T2D-IIT using rtCGM (n = 1280). After 12 months, PDC was 0.71 (0.30)-0.72 (0.31) (mean(SD)) for T1D and T2D-IIT rtCGM users and 0.55 (0.34)-0.56 (0.34) for T1D and T2D-IIT isCGM users. The proportion of adherent users (PDC ≥ 0.8) was 56.8-59.7% for rtCGM users and 36.3-37.6% for isCGM users. Overall, regardless of diabetes type, the odds of adherence were over two times higher for rtCGM users compared to isCGM users. For those with available A1C information (T1D n = 213; T2D-IIT n = 346), independent of CGM type, adherence to CGM was associated with a greater reduction in A1C and more people reaching A1C targets of < 7.0% or < 8.0%. CONCLUSION For people with T1D or T2D-IIT, higher adherence to CGM is associated with greater reductions in A1C, and higher adherence rates were observed with rtCGM systems than with isCGM systems.
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Affiliation(s)
| | - Katia L Hannah
- Dexcom, Inc., 6340 Sequence Dr., San Diego, CA, 92121, USA
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Renda S, Freeman J. You may delay, but time will not. Beta cells lost are never found again: a case for timely initiation of basal insulin in type 2 diabetes. Postgrad Med 2024; 136:150-161. [PMID: 38465574 DOI: 10.1080/00325481.2024.2328511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
Since its first use just over a century ago, insulin treatment has evolved dramatically, such that the molecules are physiologic in nature, and treatment can now closely resemble the natural hormone response over 24 hours. Newer, longer-acting basal insulin analogs have provided insulin therapies with improved characteristics and, therefore, ease of use, and can readily be incorporated as part of routine treatment for type 2 diabetes (T2D), but evidence suggests that insulin remains underused in people with T2D. We review the barriers to initiation of basal insulin and the education needed to address these barriers, and we provide practical pointers, supported by evidence, for primary care physicians and advanced practice providers to facilitate timely initiation of basal insulin in the people with T2D who will benefit from such treatment.
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Affiliation(s)
- Susan Renda
- Johns Hopkins Comprehensive Diabetes Center, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Jeffrey Freeman
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
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Erbakan AN, Arslan Bahadir M, Gonen O, Kaya FN. Mindful Eating and Current Glycemic Control in Patients With Type 2 Diabetes. Cureus 2024; 16:e57198. [PMID: 38681461 PMCID: PMC11056196 DOI: 10.7759/cureus.57198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 05/01/2024] Open
Abstract
Objective Lifestyle adjustments are essential in the management of type 2 diabetes mellitus (T2DM). Mindful eating involves being more attentive to and aware of meals. This study aimed to investigate the relationship between mindful eating and glycemic control, as well as body mass index (BMI), in people with T2DM. Materials and methods This cross-sectional study included 448 participants who had been diagnosed with T2DM for at least six months. The participants were categorized into three groups based on their HbA1c levels. The Turkish adaptation of the Mindful Eating Questionnaire (MEQ-30) was employed to assess levels of mindful eating behavior. Obesity was defined as a BMI ≥ 30. Anthropometric measurements, laboratory tests, and questionnaire responses were also collected. Results Participants with well-controlled diabetes (HbA1c ≤7%) demonstrated significantly higher scores on the MEQ-30 and its various subgroups in comparison to those with poorly controlled diabetes (HbA1c >9%). The suboptimal glycemic control groups exhibited noticeable variations in mindful eating behaviors. Moreover, participants with lower BMIs displayed stronger inclinations toward mindful eating. Weak negative correlations were observed between BMI and specific MEQ-30 subgroups. Notably, subgroups such as emotional eating, eating control, eating discipline, and interference demonstrated weak negative correlations with the HbA1c levels. Conclusion Higher levels of mindful eating were associated with lower levels of HbA1c and BMI, indicating that incorporating mindful eating practices may present promising advantages for individuals diagnosed with type 2 diabetes, specifically in terms of glycemic control and weight management.
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Affiliation(s)
- Ayşe Naciye Erbakan
- Department of Internal Medicine, Göztepe Prof. Dr. Süleyman Yalçın Şehir Hastanesi, Medeniyet University, Istanbul, TUR
| | - Muzeyyen Arslan Bahadir
- Department of Internal Medicine, Göztepe Prof. Dr. Suleyman Yalcin City Hospital, Medeniyet University, Istanbul, TUR
| | - Ozlem Gonen
- Department of Internal Medicine, Göztepe Prof. Dr. Suleyman Yalcin City Hospital, Medeniyet University, Istanbul, TUR
| | - Fatos Nimet Kaya
- Department of Internal Medicine, Göztepe Prof. Dr. Suleyman Yalcin City Hospital, Medeniyet University, Istanbul, TUR
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