Diabetic Medicine最新文献

{"title":"Acceptability of LISTEN for adults with diabetes distress: A qualitative study using the theoretical framework of acceptability to explore a brief problem-solving therapy intervention guided by diabetes health professionals","authors":"Chelsea Chum,&nbsp;Aliaska McKeon,&nbsp;Laura Jenkins,&nbsp;Roslyn Le Gautier,&nbsp;Sarah Manallack,&nbsp;Jennifer Halliday,&nbsp;Shikha Gray,&nbsp;Virginia Hagger,&nbsp;Kim Henshaw,&nbsp;Timothy C. Skinner,&nbsp;Christel Hendrieckx,&nbsp;Jane Speight,&nbsp;Edith E. Holloway","doi":"10.1111/dme.70128","DOIUrl":"10.1111/dme.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To explore the acceptability to adults with diabetes of LISTEN (Low Intensity Mental Health Support via a Telehealth Enabled Network), a brief problem-solving intervention to reduce diabetes distress, facilitated by diabetes health professionals, and identify areas for refinement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semi-structured interviews were conducted with 24 adults with type 1 or type 2 diabetes experiencing diabetes distress (Problem Areas in Diabetes [PAID-20] score ≥ 25, or ≥2 on three or more items) who had participated in LISTEN. Data were analysed using deductive thematic analysis, applying the theoretical framework of acceptability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants reported that LISTEN was valuable, supporting them with the emotional side of their diabetes and equipping them with skills to address challenges experienced in managing their diabetes. They valued the diabetes-specific knowledge the health professional brought to the sessions. Key factors associated with their satisfaction with LISTEN were their positive rapport with the health professional and accountability. Telehealth delivery was acceptable due to its convenience and anonymity. They reported that participating in LISTEN required minimal effort. Most would be willing to pay a small fee to take part, though they believe that all people with diabetes should have equitable access to LISTEN. Minor areas for refinement include flexible delivery and clearly articulating the structured, stepwise nature of the programme in pre-program information.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings indicate that LISTEN, delivered by diabetes health professionals via telehealth, is acceptable to this sample of Australian adults experiencing elevated diabetes distress and provides evidence-based strategies to strengthen engagement, delivery and implementation of LISTEN.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of self-management interventions on Type 2 diabetes among young adults (18–45 years): A systematic review and meta-analysis","authors":"Sonia Khavere,&nbsp;Michelle Hadjiconstantinou,&nbsp;Joanne Miksza,&nbsp;Jenny Hagan,&nbsp;Shukrat Salisu-Olatunji,&nbsp;Sara Naderpour,&nbsp;Sarah Nalir Hassen,&nbsp;Zahra Karimi,&nbsp;Clare L. Gillies","doi":"10.1111/dme.70127","DOIUrl":"10.1111/dme.70127","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Self-management interventions effectively improve health outcomes in adults with Type 2 diabetes. Young adults living with Type 2 diabetes are at a higher risk of diabetes-related complications, hospitalisation and reduced quality of life. While self-management is key in diabetes care, its effectiveness in young adults with Type 2 diabetes remains unclear. This review assessed self-management interventions' impact on health outcomes in young adults (18–45 years) with Type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Five electronic databases were searched from inception to May 2024. Trials evaluating self-management interventions versus usual care in young adults were included. Outcomes of interest were clinical, self-care behaviour and psychological health. Meta-analysis used a random effects model; study quality was assessed using the Cochrane risk of bias tool (RoB2) and the JBI checklist for quasi-experimental studies. The review followed PRISMA guidelines and was registered on PROSPERO (CRD42024522979).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten studies were included, nine in the meta-analysis, which reported no significant differences between the intervention and control groups in HbA1c, body mass index, weight, waist circumference, blood pressure, lipids, depression or self-efficacy outcomes. Nevertheless, these findings are imprecise due to few studies, missing data and small sample sizes. Commonly used behaviour change techniques were goals and planning, shaping knowledge and feedback/monitoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Existing self-management interventions did not improve clinical and psychological outcomes among young adults (18–45 years) living with Type 2 diabetes. More effective strategies are needed for this priority population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of diabetes mellitus healthcare and metabolic control during transition from paediatric to adult care: A systematic review and meta-analysis","authors":"Giovanna Donvito,&nbsp;Carlo Maltecca,&nbsp;Sabine E. Hofer,&nbsp;Dagmar Meraner,&nbsp;Uwe Siebert,&nbsp;Marjan Arvandi","doi":"10.1111/dme.70125","DOIUrl":"10.1111/dme.70125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Emerging adults with chronic diseases like diabetes often experience a decline in health during the process of transition from paediatric to adult healthcare. This study assesses the impact of transition on healthcare quality of people with diabetes, focusing on glycated haemoglobin (HbA_1c).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review and meta-analysis of the difference in HbA_1c before and after transition following the PRISMA guidelines. A comprehensive search across four databases for studies of diabetes type 1 and 2 published between 2018 and 2024 was conducted. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty studies were included in the systematic review, fifteen to the meta-analysis. Eleven studies considered a structured or semi-structured transition programme: three reported a reduction in HbA_1c (improved glycaemic control) and eight no significant difference. Nine studies considered no transition programme: four showed a worsening of glycaemic control and five no significant difference. Overall, the meta-analysis showed a worsening of glycaemic control post-transition with mean difference (MD) −1.75 mmol/mol (−0.16%) [95% confidence interval (CI) –5.24–1.75 mmol/mol (−0.48%–0.16%)], with considerable heterogeneity, where negative values indicate higher HbA_1c post-transition. Subgroup analysis for transition programmes and usual care showed, respectively, significant improvement and worsening of glycaemic control with MD of 3.28 mmol/mol (0.30%) [95% CI 0.44–6.12 mmol/mol (0.04%–0.56%)] and −6.99 mmol/mol (−0.64%) [95% CI −11.79 to −2.19 mmol/mol (−1.08% to −0.20%)].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings suggest that the transition to adult care may negatively affect glycaemic control in emerging adults with diabetes, whereas structured transition programmes can neutralize this effect and prevent consequences. Further investigations are needed to develop evidence-based guidelines for optimizing transition interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of glycaemia-related risk factors with dementia and cognitive decline in individuals with type 2 diabetes: A systematic review and meta-analysis","authors":"Mahtab Tabesh,&nbsp;Julian W. Sacre,&nbsp;Kanika Mehta,&nbsp;Lei Chen,&nbsp;Seyedeh Forough Sajjadi,&nbsp;Dianna J. Magliano,&nbsp;Jonathan E. Shaw","doi":"10.1111/dme.70123","DOIUrl":"10.1111/dme.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To quantify prospective associations of glycaemia-related factors with cognitive decline and all-cause dementia and its subtypes in people with type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched Embase and MEDLINE (January 2000–October 2024) for studies in people with diabetes reporting longitudinal associations of a relevant exposure (i.e. hypoglycaemia, HbA1c, HbA1c variability or diabetes duration) with any of these outcomes: cognitive decline, all-cause dementia, Alzheimer's disease (AD) or vascular dementia (VaD). Data were meta-analysed using a random-effects model followed by meta-regression if appropriate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty studies representing 7,076,724 individuals with diabetes were included. Hypoglycaemia was significantly associated with 49% and 31% higher risks of all-cause dementia and AD, respectively. The pooled effect size did not significantly vary according to age, sex, diabetes duration, smoking, follow-up length, comorbid hypertension, kidney disease, dyslipidaemia or stroke (all <i>p</i> &gt; 0.05). A positive association existed between hypoglycaemia frequency and all-cause dementia, with maximum hazard ratios (HRs) of 2.36–2.60 in the highest exposure group. HbA1c showed a positive risk gradient for all-cause dementia, with maximum significant HRs of 1.40–3.88 for the highest category, while only three studies were available for meta-analysis, with a pooled HR (95% CI) of 1.18 (0.97, 1.45). HbA1c variability and diabetes duration were each significantly associated with a higher risk of dementia. Limited evidence supported a relationship between glycaemia-related factors and cognitive decline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Having a history of hypoglycaemia, longer diabetes duration, and higher HbA1c levels and variability were related to higher dementia risk in people with type 2 diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How do hypoglycaemias affect the everyday life of people with diabetes and are they able to treat them adequately?","authors":"Nicolle Müller,&nbsp;Christiane Kellner,&nbsp;Sebastian Schmidt,&nbsp;Nadine Kuniß,&nbsp;Gunter Wolf,&nbsp;Christof Kloos","doi":"10.1111/dme.70121","DOIUrl":"10.1111/dme.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To investigate whether people with type 1 and type 2 diabetes respond adequately to hypoglycaemia symptoms after participating in a treatment and teaching programme. Additionally, it explored how hypoglycaemia impacts patients' everyday life and the differences between individuals with and without impaired awareness of hypoglycaemia (IAH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study included 340 adult participant with type 1 (<i>n</i> = 156) or type 2 diabetes (<i>n</i> = 184) undergoing insulin therapy at the University Hospital Jena. Participants completed validated questionnaires and participated in structured interviews about hypoglycaemia. Awareness of hypoglycaemia was measured using the Gold Score, and diabetes distress with the PAID Scale (PAID Score 0–100, the higher the score the higher the distress).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>23.8% of the participants treated hypoglycaemia adequately (type 1 diabetes 27.6% vs. type 2 diabetes 24.7%; <i>p</i> = 0.606). Significantly more people without IAH-treated hypoglycaemia adequately in type 2 (27.9% vs. 10.3%; <i>p</i> = 0.047) but not in type 1 diabetes (28.6% vs. 23.1%; <i>p</i> = 0.568). Hypoglycaemia altered daily routines for 26.2% of participants, particularly those with type 1 diabetes (type 1 diabetes 37.3% vs. type 2 diabetes 20.1%; <i>p</i> = 0.001). People with type 1 and type 2 diabetes reporting changes in daily routines had higher diabetes distress scores (PAID: 22.3 ± 16.0 vs. 13.8 ± 13.5; <i>p</i> &lt; 0.001). Fear of hypoglycaemia was associated with higher HbA_1c values due to people accepting elevated blood glucose levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite education programmes, the majority of participants do not treat hypoglycaemia adequately. Hypoglycaemic events significantly impact daily life and are associated with increased diabetes-related distress, especially in those with IAH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Diabetes Attitudes Wishes and Needs (DAWN)-SMI study: A cross sectional comparison of the psychosocial impact of diabetes in adults with and without severe mental illness","authors":"Richard I. G. Holt,&nbsp;Heather Peyrot-Stuckey,&nbsp;Dankmar Böhning,&nbsp;Jo Taylor,&nbsp;Najma Siddiqi","doi":"10.1111/dme.70126","DOIUrl":"10.1111/dme.70126","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>People with severe mental illness (SMI) are 2–3 times more likely to have diabetes than the general population. Little is known about the impact of living with diabetes for people with SMI. This study investigates psychosocial problems and diabetes self management for people with SMI and diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We compared cross sectional survey data collected from 258 adults with diabetes and SMI in England with 500 adults with diabetes from the UK sample of the second Diabetes Attitudes, Wishes and Needs study (DAWN2). Effect size (ES) tests were used to quantify differences between the two samples adjusted for diabetes type, age, gender, treatment, treatment duration, diabetes complications and co-morbidities to achieve comparability of the two samples.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to the DAWN2-UK sample, people with diabetes and SMI reported poorer quality of life (WHOQOL ES −0.3 (CI −0.5, −0.1), <i>p</i> &lt; 0.001), mental well-being (ES −13.4 (CI −17.3, −9.5), <i>p</i> &lt; 0.001) and increased diabetes distress (PAID5 ES 1.6 (CI 0.9,2.3), <i>p</i> &lt; 0.001). While people with diabetes and SMI reported a negative impact from diabetes, their SMI had a greater impact on their lives than diabetes (mental illness impact profile 2.6 ± 1.1 vs. diabetes impact profile 3.4 ± 1.0, <i>p</i> &lt; 0.001). People with SMI reported being less engaged in self management than the DAWN2-UK population (SDSCA-6; ES −0.4 (CI −0.7, −0.1), <i>p</i> = 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The psychosocial impact of diabetes is greater for people with SMI. To reduce inequalities in diabetes outcomes, people with SMI and diabetes require tailored support for diabetes management that considers the additional challenges associated with living with a severe mental illness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70126","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fully closed-loop control with ultra-rapid versus standard insulin lispro: A randomised crossover study simulating missed meal boluses","authors":"Hood Thabit,&nbsp;Jonathan Lim,&nbsp;Malgorzata E. Willinska,&nbsp;Catherine Fullwood,&nbsp;Roman Hovorka,&nbsp;Lalantha Leelarathna","doi":"10.1111/dme.70122","DOIUrl":"10.1111/dme.70122","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Ultra-rapid insulin lispro (URIL) is associated with faster insulin absorption and earlier offset than standard insulin lispro (IL). This study evaluated whether URIL improves glucose control in a fully closed-loop setting over an 8-h period compared to IL under conditions simulating a missed meal bolus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this open-label, randomised crossover trial, 18 adults with type 1 diabetes using insulin pump therapy [12 females, age 39.1 (14.2) yrs., HbA1c 57.9 (8.7) mmol/mol] completed two 8-h inpatient sessions (09:00 to 17:00 h). Glucose levels were managed using the CamAPS FX closed-loop system with either URIL or IL, in random order. Participants received a standardised meal at 11:00 h without a meal bolus. The primary endpoint was the percentage of time in range (TIR; 3.9–10 mmol/L) based on sensor glucose.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data related to the 8-h study period from 17 participants were analysed. TIR was numerically higher but not statistically significant with URIL than IL [49.3 (15.6) vs. 39.9 (18.9)%; <i>p</i> = 0.072], with lower time spent in Level 1 (&gt;10 mM) [50.7 (15.6) vs. 59.5 (19.1)%; <i>p</i> = 0.098] and Level 2 hyperglycaemia (&gt;13.9) [18.7 (17.1) vs. 27.9 (19.8)%; <i>p</i> = 0.136]. Similar trends were observed in the 4-h post-meal period. Time in hypoglycaemia was low and comparable between both periods (<i>p</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>URIL in a fully closed-loop setting showed a clinically meaningful trend towards improved TIR and reduced hyperglycaemia compared to IL. Further advancements in faster-acting insulins are needed to alleviate the burden of pre-meal bolusing and enhance fully closed-loop performance in the future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous glucose monitoring remote monitoring does not meet the needs of all adult users: A qualitative study of adults with type 1 diabetes who do not use remote monitoring","authors":"Anjana Rathan,&nbsp;Alisa Boucsein,&nbsp;Hamish Crocket,&nbsp;Benjamin J. Wheeler","doi":"10.1111/dme.70120","DOIUrl":"10.1111/dme.70120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Continuous glucose monitoring (CGM) is increasingly popular in the management of type 1 diabetes (T1D). These devices have a remote monitoring function that allows for a third-party individual to monitor the user's glucose levels. While remote monitoring in CGM devices is widely used in T1D management, especially in paediatric populations, there are some individuals with T1D that do not utilise this function. This study aimed to explore the reasons behind some adults not using the remote following function on their real-time CGM (rtCGM) devices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults with T1D who had been using rtCGM without the remote monitoring function were invited to participate in a semi-structured interview. Interviews explored the participants' experiences using CGM and their reasons on why remote monitoring was not for them. Interviews were analysed thematically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Interviews were conducted with fifteen people with T1D. Mean age was 27.3 years ± 9.34 SD. Thematic analysis identified three remote monitoring themes: (1) anxiety/concern regarding sharing data; (2) independence with diabetes management; and (3) desire for more customised sharing. There was a universal appeal of the efficacy, ease and practicality of glucose management with CGM devices among participants, particularly when compared to their past experiences with finger-prick testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Remote monitoring can be a valuable complement to CGM, but it may not appeal to all individuals with T1D, particularly some adults. These findings offer insights for healthcare teams and provide feedback to help CGM manufacturers develop a more customised remote monitoring experience. Some users clearly wish to prioritise privacy and autonomy while still gaining a safety net in critical situations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of switching from intermittently scanned to real-time continuous glucose monitoring on glycaemic outcomes in adults with type 1 diabetes: A real-world, Canadian retrospective study","authors":"Lisa Chu,&nbsp;Alexander Abitbol","doi":"10.1111/dme.70119","DOIUrl":"10.1111/dme.70119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study investigated the real-world clinical outcomes of switching from intermittently scanned continuous glucose monitoring (isCGM) to real-time CGM (rtCGM) in adults with type 1 diabetes (T1D) from a large Canadian speciality care population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study examined data from January 1, 2018, through July 31, 2023, in the Canadian LMC Diabetes Registry. The analysis measured 6–12-month change in HbA1c in adults with T1D who switched from isCGM to rtCGM and compared changes to a propensity score-matched isCGM cohort. Changes in number of hypoglycaemic events, CGM metrics, body weight, and total daily dose (TDD) of insulin were also evaluated at 6–12-month follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The full T1D rtCGM switch cohort comprised of 136 adults (mean: age 43 years, diabetes duration 20.9 years, baseline HbA1c 67 mmol/mol [8.2%]). For the full cohort, HbA1c was significantly lower at follow-up compared to baseline (∆-7 mmol/mol [∆-0.6%], <i>p</i> &lt; 0.001). The propensity score-matched subset (<i>n</i> = 84) of these participants had a greater HbA1c reduction compared to the matched isCGM cohort (<i>n</i> = 84; adjusted mean difference, 5 mmol/mol [0.5%]; <i>p</i> = 0.002). The matched rtCGM switch subset had significantly higher time in range 3.9–10.0 mmol/L and lower time above range &gt;10.0 mmol/L, time below range &lt;3.9 mmol/L, and mean glucose compared to the isCGM cohort. There were no significant differences in hypoglycaemic events, body weight, and insulin TDD between the matched cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This real-world analysis of adults with T1D showed that switching from isCGM to rtCGM use led to significant improvements in HbA1c and CGM metrics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type 1 diabetes technology gap between high-income and developing countries: Continuous glucose monitoring access remains a challenge in Brazil","authors":"Ana Victoria Santos Castro,&nbsp;Karina O. Caneca,&nbsp;Paula M. Garcia,&nbsp;Veridiana Tischer,&nbsp;Luciana C. Theodoro,&nbsp;Isabella S Leão,&nbsp;Letícia B. Cunha,&nbsp;Julia B. Vieira,&nbsp;Ludmila N.R. Campos,&nbsp;Jorge L. Luescher,&nbsp;Joana R. Dantas,&nbsp;Lenita Zajdenverg,&nbsp;Melanie Rodacki","doi":"10.1111/dme.70116","DOIUrl":"10.1111/dme.70116","url":null,"abstract":"&lt;p&gt;We read with great interest the article by Dlugatch et al., recently published in &lt;i&gt;Diabetic Medicine&lt;/i&gt;, which addresses inequalities in the access and use of diabetes technology among children and young people with type 1 diabetes (T1D) in the UK.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Their findings resonate strongly with the reality faced in low- and middle-income countries, particularly Brazil, where barriers to diabetes technology are even more pronounced.&lt;/p&gt;&lt;p&gt;Insulin pumps and continuous glucose monitoring (CGM) systems are expensive and are not currently provided by Brazil's public healthcare system (SUS), nor do private insurance routinely cover them. This creates socioeconomic inequities in diabetes care. While wealthier individuals with T1D can access and benefit from advanced technologies, those reliant on public healthcare are deprived of these tools, resulting in disparities in glycaemic control, complication risk and overall quality of care.&lt;/p&gt;&lt;p&gt;Even intermittent CGM (isCGM), the least costly CGM option, remains out of reach for most patients. In addition, long-acting insulin analogues are not universally provided, and many patients are still treated with neutral protamine hagedorn (NPH) insulin in combination with rapid-acting analogues. The absence of CGM impairs the ability to make informed insulin adjustments and to obtain key glycaemic control metrics, such as time in range (TIR), time above range (TAR) and time below range (TBR), which are increasingly recognized as important predictors of outcomes in T1D.&lt;/p&gt;&lt;p&gt;To evaluate the glycaemic patterns in patients without routine CGM access, we conducted an observational study involving 92 individuals (45 children and 47 adults) with T1D at a public diabetes clinic in Brazil. None of the participants had regular access to CGM; they relied exclusively on four to five daily capillary glucose measurements in a public healthcare clinic in Brazil. Their mean age, diabetes duration and HbA1c were 18.95 ± 10.06 years, 11.15 ± 8.48 years and 61 mmol/mol (7.7% ± 1.2%), respectively. Of these, 81.5% used long-acting insulin analogues, while 18.5% were using NPH insulin with rapid-acting analogues. After 14 days of isCGM, the mean TIR was 50.9% ± 15.1%, TAR 31.7% ± 19.1% and TBR 16.2% ± 11.4%. All metrics were outside the recommended targets. Notably, among individuals with HbA1c &lt; 53 mmol/mol (7%), mean TBR was 21.13% ± 14.1%, with TIR and TAR at 51.9% ± 16.1% and 26.9% ± 18.1%, respectively.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In a separate case, a 24-year-old woman with T1D using NPH and rapid-acting insulin analogues, an HbA1c of 57 mmol/mol (7.4%) and satisfactory capillary glucose records, underwent a 15-day real-time CGM analysis with no recommended interventions based on CGM data. The report showed a TIR of 55%, TAR of 30% and TBR of 15%, including 10% of readings &lt;3.9 mmol/L (&lt;70 mg/dL) and 5% &lt; 3.0 mmol/L (&lt;54 mg/dL), with significant episodes of asymptomatic nocturnal hypoglyc","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}