Diabetic Medicine最新文献

{"title":"Parent sleep quality and fear of nighttime hypoglycaemia","authors":"MaryJane S. Campbell,&nbsp;Alexandra Monzon,&nbsp;Ryan J. McDonough,&nbsp;Susana R. Patton","doi":"10.1111/dme.70110","DOIUrl":"10.1111/dme.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Parents of children with type 1 diabetes (T1D) frequently endorse fear of hypoglycaemia (FH) overnight when blood glucose (BG) values may be variable. We aimed to understand how fear of <i>nighttime</i> hypoglycaemia (FoNH) was associated with BG data, parent-reported sleep quality and the role of diabetes technology in these associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One hundred and thirty-six parents (<i>M</i> age = 43.00[6.44] years, 89% female) completed surveys. Continuous glucose monitoring data were obtained from 116 youth (<i>M</i> age = 12.97[2.58] years, 47.8% female) to examine blood glucose values during the day and overnight.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Frequency of hypoglycaemic events overnight was not associated with parent sleep quality nor with parent FoNH, but glucose variability overnight was associated with poorer sleep quality and higher FoNH. Higher parent-reported FoNH was associated with lower sleep quality. Findings were mixed regarding the role of diabetes technology and FoNH and sleep quality. FoNH explained 26% of the variance in the association between glucose variability and parent sleep quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>FoNH is a challenge for parents of youth with T1D. Targeted behavioural intervention to reduce FoNH and improve sleep may be beneficial. Future research should include objective measures of parent sleep and specific diabetes technology use overnight to disentangle mixed findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive value of cumulative plantar tissue stress on future plantar foot ulceration in people with diabetes—A 12-month prospective observational study","authors":"Chantal M. Hulshof,&nbsp;Jaap J. van Netten,&nbsp;Tessa E. Busch-Westbroek,&nbsp;Louise W. E. Sabelis,&nbsp;Edgar J. G. Peters,&nbsp;Mirjam Pijnappels,&nbsp;Sicco A. Bus","doi":"10.1111/dme.70099","DOIUrl":"10.1111/dme.70099","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Plantar foot ulcers are a burdensome complication of diabetes caused by abnormal foot biomechanics. Predicting foot ulcers aids in their prevention, but the value of peak pressure—the most used biomechanical parameter—is only moderate. We aimed to improve prediction based on the more comprehensive load measure cumulative plantar tissue stress (CPTS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We prospectively observed 60 participants with diabetes at high foot ulcer risk for 12 months. At baseline, we assessed demographic and clinical characteristics—including plantar pre-ulcers (i.e., abundant callus, haemorrhage, blister, fissure)—and measured barefoot and in-shoe plantar pressures during walking and standing. Daily-life weight-bearing activity and adherence to prescribed footwear were assessed over 7 days after baseline. The primary outcome was plantar foot ulceration during the 12-month follow-up. CPTS was calculated (in GPa^.s/day) from the above foot-loading factors and analysed for predicting foot ulcers and its association with pre-ulcers, using multivariate regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-two participants (37%) developed a plantar forefoot ulcer. CPTS was not a significant predictor (odds ratio (OR) = 0.90 (95% confidence interval (CI): 0.50–1.59)) but pre-ulcers at baseline (OR = 9.97, 95%CI: 1.41–70.65) and walking speed (in m/s) (OR = 0.01, 95%CI: 0.00–0.32) were. CPTS was significantly associated with pre-ulcers (OR = 2.38, 95%CI: 1.02–5.54).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CPTS did not predict plantar foot ulceration in our high-risk participants, but our findings support the mechanical pathway of plantar foot ulceration through pre-ulcer development and indicate lower walking speed as an important predictor. Assessing walking speed and early identifying and treating pre-ulcers will help predict and prevent plantar foot ulcers in high-risk people with diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763062","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":"Satisfaction with continuous glucose monitoring and diabetes care among hospitalised patients with type 2 diabetes managed by inpatient diabetes teams","authors":"Mikkel Thor Olsen,&nbsp;Malene Elbæk Vikner,&nbsp;Signe Hjejle Jensen,&nbsp;Louise Mathorne Rasmussen,&nbsp;Carina Kirstine Klarskov,&nbsp;Birgitte Lindegaard,&nbsp;Jonas Askø Andersen,&nbsp;Hans Gottlieb,&nbsp;Suzanne Lunding,&nbsp;Kirsten Nørgaard,&nbsp;Ulrik Pedersen-Bjergaard,&nbsp;Katrine Bagge Hansen,&nbsp;Peter Lommer Kristensen","doi":"10.1111/dme.70114","DOIUrl":"10.1111/dme.70114","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Continuous glucose monitoring (CGM) is increasingly recognised as a valuable tool in the hospital setting, with evidence supporting its accuracy and potential for improving glycaemic and clinical outcomes. However, patient perspectives on the use of CGM in the hospital setting remain underexplored. This study investigates patient satisfaction with CGM during hospitalisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This analysis included 166 hospitalised non-intensive care unit (non-ICU) patients with type 2 diabetes from the DIAbetes TEam and Cgm (DIATEC) trial. Participants were randomised to either point-of-care (POC) glucose testing (<i>n</i> = 82) or CGM (<i>n</i> = 84) for glucose monitoring during their hospital stay and were managed by inpatient diabetes teams. At discharge, patients completed a survey developed for this specific study, assessing their satisfaction with the diabetes management, with a focus on glucose monitoring methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall satisfaction with the diabetes treatment during hospitalisation was similar in both groups, with 77% of patients in each group reporting being satisfied or very satisfied (<i>p</i> = 0.188). Regarding glucose assessment, 75% in the CGM group preferred CGM over POC glucose testing (<i>p</i> &lt; 0.001). In the CGM group, 95% felt comfortable with CGM being the primary method for glucose management (<i>p</i> &lt; 0.001). Approximately 5% reported discomfort from wearing the CGM, mainly due to itching from the sensor. Most patients (95%) in both groups were comfortable with their diabetes management being handled by inpatient diabetes teams (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Satisfaction with CGM among non-ICU patients with type 2 diabetes managed by inpatient diabetes teams was high, highlighting CGM's potential to enhance patient care in the hospital setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes distress and sleep impairment in type 2 diabetes: A population-based cross-sectional study—The HUNT Study, Norway","authors":"Hilde K. R. Riise,&nbsp;Anne Haugstvedt,&nbsp;Jannicke Igland,&nbsp;Ane Wilhelmsen-Langeland,&nbsp;Eirik Søfteland,&nbsp;Monica Hermann,&nbsp;Sofia Carlsson,&nbsp;Timothy C. Skinner,&nbsp;Bjørn Olav Åsvold,&nbsp;Marjolein M. Iversen","doi":"10.1111/dme.70106","DOIUrl":"10.1111/dme.70106","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To examine associations between sleep impairments and diabetes distress in men and women with type 2 diabetes (T2D) by using cross-sectional data from the Trøndelag Health Study (HUNT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This population-based cross-sectional study consists of individuals ≥20 years with T2D participating in the HUNT4 survey (2017–2019; <i>n</i> = 1954). Sleep impairments (snoring, sleep apnoea, troubles falling asleep, wake up during the night, early wakening, difficulties coping during the daytime due to sleep problems and restless legs) were measured by the sleeping HUNT-Questionnaire, along with a separate question on the number of hours of sleep at night. Diabetes distress was measured using the Problem Areas in Diabetes (PAID-5) questionnaire. Diabetes distress prevalence, grouped by sleep impairment, was estimated with 95% confidence intervals. Multivariable linear regression models with distress as outcome and adjusted for demographic, clinical and mental health factors were used to examine associations with sleep.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, sleep impairment was associated with increased diabetes distress. Regression coefficients B (95% CI) for higher distress score were 0.6 (95% CI 0.2, 0.9) for ≤7 h of sleep, 0.6 (95% CI 0.1–1.1) for snoring, 1.4 (95% CI 0.8–2.2) for troubles falling asleep, 1.1 (95% CI 0.6–1.6) for waking up during the night, 1.2 (95% CI 0.7–1.8) for early wakening, 2.6 (95% CI 1.7–3.6) for troubles coping during daytime due to sleep problems and 0.8 (95% CI 0.2–1.3) for restless legs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Multiple components of sleep impairment were significantly associated with high diabetes distress in individuals with T2D.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes body project eating disorder prevention program—Descriptive content analysis of participant and facilitator feedback in a multinational randomized controlled trial","authors":"Severina Haugvik,&nbsp;Shiraz Harel,&nbsp;Heather Shaw,&nbsp;Maartje de Wit,&nbsp;Elena Toschi,&nbsp;Mareille H. C. L. Hennekes,&nbsp;Torild Skrivarhaug,&nbsp;Knut Dahl-Jørgensen,&nbsp;Eric Stice,&nbsp;Line Wisting","doi":"10.1111/dme.70108","DOIUrl":"10.1111/dme.70108","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To examine and describe feedback after participation in a novel eating disorder prevention program for young women with type 1 diabetes (<i>Diabetes Body Project)</i> in a multinational randomised controlled trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Written feedback from participants (<i>N</i> = 109) and facilitators (<i>N</i> = 19) at four sites (Europe and US) was analysed using descriptive, manifest content analysis. Open-ended questions included motivation for participation, most/less valuable aspects of the program and suggestions for improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>“Community” was the most important motivator and most valued aspect, reported by one-third of participants. When asked about less valued aspects of the program, participants and facilitators most frequently reported “none/not sure/everything was valuable” and “nothing” respectively. Suggestions to improve the program common for participants and facilitators were “more creative exercises”, specific for participants after “none” was “limit homework/obligations” and specific for facilitators was “more flexibility to move away from the script”. The three most frequently perceived barriers for participation reported by participants and facilitators were “requiring personal vulnerability”, “time and energy constraints” and the “group setting”.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Participants and facilitators expressed overall high satisfaction with the program, specifically the value of T1D community. Additionally, they suggested incorporating more creative exercises. Future research should aim at widespread implementation and addressing barriers to participation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719353","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":"A new approach to identifying safety measures across transfers of care for people who use insulin for Type 2 diabetes","authors":"Catherine Leon,&nbsp;Clare Crowley,&nbsp;Helen Hogan,&nbsp;Yogini H. Jani","doi":"10.1111/dme.70101","DOIUrl":"10.1111/dme.70101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>When people who use insulin for Type 2 diabetes have a hospital admission and discharge, they are at risk of harm from incorrect, delayed, or missed insulin doses. Leading indicators can highlight potential areas of risk, providing opportunities to improve safety. Modelling the complex transfer of care pathway can provide insight into where leading indicators could be targeted to support improved outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multiple qualitative methods were used, and a framework approach was applied to identify activities (termed functions) involved in managing insulin during the transfer of care, and how factors involving people, equipment and environments (local, organisational and external) impacted these. The Functional Resilience Analysis Method was used to map the transfer of care pathway, and key areas of variability were identified. These areas of variability and two example functions were validated and discussed with key/representative stakeholders in an online seminar.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 59 functions were mapped, and 21 were identified as key functions for potential new measures. These 21 functions were validated at a seminar, and two example functions, empowering people with diabetes who use insulin to manage their diabetes and arranging self-administration of insulin in hospital, were discussed in detail. A selection of potential measures was identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Many potential areas for new leading indicators were identified, and examples of potential measures were described. A coproduction approach is required to expand, define and validate these. Such measures provide an opportunity for proactively improving insulin safety during care transfers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693004","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":"Understanding women's sex hormone physiology—A priority in diabetes care","authors":"Céline Isabelle Laesser,&nbsp;Bettina Weber,&nbsp;David Studer,&nbsp;Reem Jalal Alshareef,&nbsp;Lia Bally","doi":"10.1111/dme.70109","DOIUrl":"10.1111/dme.70109","url":null,"abstract":"&lt;p&gt;Women experience profound, dynamic changes in sex hormone exposure throughout their lifespan that directly influence diabetes pathophysiology and management. In the pre-pubertal period, sex hormone levels remain consistently low, but with the onset of puberty, women begin experiencing the remarkable fluctuations characteristic of reproductive biology. The menstrual cycle alone produces 5- to 50-fold variations in oestradiol and progesterone,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; while hormonal contraceptives, except for local intrauterine devices, alter these patterns. Pregnancy elevates oestradiol 100- to 200-fold and progesterone 15-fold,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; with assisted reproduction achieving even higher levels. The menopausal transition then precipitates a sharp decline in oestradiol exposure to levels that actually fall below those of age-matched men. While menopausal hormone therapy can restore sex hormone concentrations approximating premenopausal follicular phase levels, the achieved exposure shows substantial variability depending on formulation specifics, dosage and administration route.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Additionally, body weight changes represent another important modifier of oestrogen exposure, with weight loss consistently associated with decreased oestrogen levels.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Beyond their reproduction functions, female sex hormones, particularly oestradiol, interact extensively with glucose and energy metabolism pathways.&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt; Oestradiol enhances insulin sensitivity, increases insulin secretion, improves β-cell viability, delays gastric emptying and promotes favourable adipose tissue distribution—all collectively promoting glucose homeostasis. These metabolic advantages are further amplified by oestradiol's critical role in modulating energy expenditure and promoting satiety.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; While many mechanistic insights originate from preclinical models, human evidence from studies of the impact of menopause and anti-oestrogenic cancer therapies on diabetes incidence, and investigations on the glycaemic effect of oestradiol replacement (including menopausal hormone therapy) generally corroborate the glycaemic benefits of oestradiol.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; In contrast to oestradiol's beneficial effects, progesterone demonstrates a less well-characterized and predominantly unfavourable metabolic profile, with its characteristic mid-luteal phase surge consistently linked to decreased insulin sensitivity.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; Similarly, both androgenic progestins (frequently utilized in hormonal contraceptives) and states of hyperandrogenism, as clinically seen in polycystic ovary syndrome (PCOS), have been associated with impaired insulin sensitivity.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;While sex hormones demonstrably influence diabetes risk and manifestations, this relationship is fundamentally bidirectional, as impaired glucose homeostasis substantially affects the hypothala","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661733","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":"“It is a constant battle”: A qualitative study of the lived experience of individuals with diabetic foot ulcer and post-healing challenges in primary care","authors":"Xiaoli Zhu,&nbsp;Eng Sing Lee,&nbsp;Phoebe X. H. Lim,&nbsp;Frederick H. F. Chan,&nbsp;Yee Chui Chen,&nbsp;Konstadina Griva","doi":"10.1111/dme.70096","DOIUrl":"10.1111/dme.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore the lived experiences of primary care patients with active diabetic foot ulcer (DFU) and post-healing in remission (PHIR) to inform tailored interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative interview study was conducted with primary care patients with DFU and PHIR in Singapore. In-depth interviews were held with 27 participants (15 with active DFU and 12 with PHIR) from April to July 2022. Transcripts were analysed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The lived experiences of individuals with DFU across its stages (active DFU and PHIR) were encapsulated in the notion of ‘<i>a cyclical lifelong illness threat alongside a vicious foot cycle</i>’, reflected in three key themes. The first theme, <i>Making Sense of DFU</i>, captured participants' varied perceptions of their condition—from misattributing in DFU management to seeing it as a constant battle, an unavoidable terminal disease (active DFU) or a wake-up call (PHIR). The second theme, <i>Emotional Consequences</i>, highlighted the significant psychological burden experienced by participants, encompassing emotional exhaustion leading to self care burnout, as well as chronic anxiety and persistent fear of recurrence. The third theme, <i>Behavioural Challenges,</i> illustrated the complexities of self management, with participants describing their efforts as a constant struggle to maintain self care routines, often marked by ambivalence towards long-term adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlights the persistent psychosocial and behavioural challenges faced by individuals with DFU and PHIR, underscoring the need for autonomy-supportive and empowerment-focused interventions to reshape perceptions of DFU, alleviate emotional distress and enhance adherence to self care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THR1VE!: Randomized controlled trial to reduce diabetes distress in adolescents with type 1 diabetes","authors":"Sarah S. Jaser,&nbsp;Karishma Datye,&nbsp;James C. Slaughter,&nbsp;Lauren LeStourgeon,&nbsp;Randi Streisand","doi":"10.1111/dme.70107","DOIUrl":"10.1111/dme.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate the effects of a positive psychology intervention to treat diabetes distress (DD) and improve glycaemic outcomes among adolescents with type 1 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adolescents ages 13–17 with elevated DD and their caregivers from 2 sites (<i>n</i> = 198 dyads) were randomized to receive enhanced usual care (Diabetes Education) or a Diabetes Education + Positive Affect intervention, delivered via automated text messages. Psychosocial and glycaemic data were collected at baseline, 3 months, 6 months and 12 months. The primary outcomes were changes in diabetes distress (DD) and HbA1c over 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adolescents demonstrated high levels of engagement in the trial; overall response to text messages was 91%, and retention was 90% over 12 months. Adolescents in both groups reported reductions in DD from baseline to 12 months (effect size <i>d</i> = 0.40), and they were significantly more likely to move from clinically relevant levels into the normal range of DD than to report increased DD (OR = 2.2, <i>p</i> = 0.002). Adolescents' HbA1c was stable over 12 months. We did not observe significant differences in outcomes between groups. Improvement in DD was associated with decreased HbA1c over time (β = 1.89, <i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was no significant intervention effect on DD or HbA1c. Adolescents in both the Diabetes Education and Diabetes Education + Positive Affect arms reported reduced DD over 12 months. Future studies are needed to determine how to employ the least burdensome, engaging intervention for distressed adolescents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652031","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 2 diabetes risk communication following a diagnosis of gestational diabetes mellitus: A qualitative study","authors":"Molly Caba,&nbsp;Alison Northern,&nbsp;Amar Virdee,&nbsp;Kamlesh Khunti,&nbsp;Melanie Jane Davies,&nbsp;Michelle Hadjiconstantinou","doi":"10.1111/dme.70105","DOIUrl":"10.1111/dme.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Gestational diabetes mellitus (GDM) increases women's risk of developing type 2 diabetes (T2DM) tenfold. Understanding of T2DM risk in women with GDM is variable and can impact health behaviours. To better understand how T2DM risk is communicated by healthcare professionals, we explored women's experiences of T2DM risk communication and support following a diagnosis of GDM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative study was conducted utilising semi-structured interviews. Participants were 10 women previously diagnosed with GDM. Transcripts were analysed following reflexive thematic analysis guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three themes and four sub-themes were created to describe women's experiences of, and responses to, T2DM risk communication and support following a diagnosis of GDM. Minimal T2DM risk communication during GDM and postnatally was a common experience, and as a result, women forgot about their increased risk and felt forgotten by the health service. The lack of correspondence and support further fostered a dearth of knowledge and misunderstandings regarding what T2DM is, how it affects a person's body, and the necessity of preventative actions, all of which could impact women's management of their risk. Several strategies were suggested by women to remedy the currently absent communication and support. This included group education sessions, tangible and digital support resources, providing individualised information, and continuous and harmonious T2DM risk communication from healthcare professionals and health services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Current deficiencies for communicating T2DM risk and providing avenues of support following a diagnosis of GDM leaves many women feeling under-supported. Improvements to current care are recommended to ameliorate this.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645183","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}