Diabetic Medicine最新文献

{"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, Karina O. Caneca, Paula M. Garcia, Veridiana Tischer, Luciana C. Theodoro, Isabella S Leão, Letícia B. Cunha, Julia B. Vieira, Ludmila N.R. Campos, Jorge L. Luescher, Joana R. Dantas, Lenita Zajdenverg, Melanie Rodacki","doi":"10.1111/dme.70116","DOIUrl":"10.1111/dme.70116","url":null,"abstract":"<p>We read with great interest the article by Dlugatch et al., recently published in <i>Diabetic Medicine</i>, which addresses inequalities in the access and use of diabetes technology among children and young people with type 1 diabetes (T1D) in the UK.<span><sup>1</sup></span> 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.</p><p>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.</p><p>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.</p><p>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 < 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.<span><sup>2</sup></span></p><p>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 <3.9 mmol/L (<70 mg/dL) and 5% < 3.0 mmol/L (<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}

{"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":"Illustrating stories of stigma from the perspective of people living with diabetes while experiencing homelessness: An arts-based community participatory research project","authors":"Saania Tariq,&nbsp;Tucker Reed,&nbsp;Jeremy Auger,&nbsp;Brian Bowdridge,&nbsp;Matt Larsen,&nbsp;Justin Lawson,&nbsp;Anna Whaley,&nbsp;Eshleen K. Grewal,&nbsp;Nathan G. Johnson,&nbsp;Scott Westby,&nbsp;David J. T. Campbell","doi":"10.1111/dme.70113","DOIUrl":"10.1111/dme.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Our objective was to explore the stigma experienced by people with lived experiences of both diabetes and homelessness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This community-based participatory research (CBPR) project was underpinned by a partnership between academic researchers and those with lived experience (co-researchers). We used two arts-based research methods, Forum Theatre and Participatory Filmmaking, and collected field notes, interviews with co-researchers, and the narrative scripts from the play and film. Interpretative analysis was used to generate broader themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified three themes describing the experience of diabetes stigma while experiencing homelessness, including: (i) limited knowledge of diabetes in the broader community, (ii) the lack of privacy in the shelter environment, and (iii) substance use stereotypes associated with homelessness. Experiences of diabetes and homelessness stigma consisted of instances characterised by judgement, unfair treatment, and skepticism imparted by others. The experience of diabetes stigma was heightened in the context of homelessness, creating situations exacerbated by the judgement and blame passed onto those with diabetes in the shelter.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Diabetes stigma has a profound mental and emotional impact on individuals experiencing homelessness, often impacting their ability to manage their condition. Future research is needed to explore these intersections in different contexts and develop comprehensive strategies that may mitigate stigma and improve the well-being of individuals with diabetes experiencing homelessness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 11","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746856","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":"The impact of socio-economic deprivation on the long-term survival of people with diabetes and acute myocardial infarction: A nationwide cohort study","authors":"Nicholas Weight,&nbsp;Andrew Cole,&nbsp;Muhammad Rashid,&nbsp;Kamlesh Khunti,&nbsp;Shivani Misra,&nbsp;Evangelos Kontopantelis,&nbsp;Thomas A. Shepherd,&nbsp;Martin K. Rutter,&nbsp;Mamas A. Mamas","doi":"10.1111/dme.70111","DOIUrl":"10.1111/dme.70111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>People from areas of socio-economic deprivation have poorer outcomes following acute myocardial infarction (AMI). How deprivation influences the survival of people with diabetes mellitus (DM) post-AMI is not well described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Myocardial Ischaemia National Audit Project (MINAP) registry, with Office for National Statistics (ONS) mortality recording, 729,722 patients from England and Wales between 2005 and 2019 were included, 152,867 with DM and followed up to 31 July 2021. Patients were stratified into quintiles using the Index of Multiple Deprivation (IMD) score (Q1—most-deprived, Q5—least deprived), Cox regression models were fitted and adjusted mortality risk estimates were compared by IMD quintile and DM status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-day mortality risk between Q1 (most deprived) and Q5 (least deprived) was similar for patients with DM, but in patients without DM, risk was higher in the most deprived group (aHR: 1.05 (1.01–1.09), <i>p</i> &lt; 0.001). Risk of 1-year (aHR: 1.05 (1.01–1.10), <i>p</i> &lt; 0.001), 5-year (aHR: 1.14 (1.11–1.17), <i>p</i> &lt; 0.001) and overall mortality (aHR: 1.14 (1.12–1.17), <i>p</i> &lt; 0.001) was higher in Q1 compared to Q5 for patients with DM, but this increase was smaller than in patients without DM at 1 year (aHR: 1.12 (1.09–1.14), <i>p</i> &lt; 0.001), 5 years (aHR: 1.18 (1.16–1.20), <i>p</i> &lt; 0.001) and overall (aHR: 1.22 (1.20–1.23), <i>p</i> &lt; 0.001). Adjusted 1-year mortality was higher in patients with DM than those without DM regardless of IMD quintile (e.g. DM vs. non-DM: Q1: 18.8% vs. 16.1%, Q5: 17.8% vs. 14.6%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with DM from socio-economically deprived regions have a higher risk of mortality at 1 year, 5 years and overall, compared to least deprived patients with DM following AMI. However, the inequality gap was larger in the non-diabetic population, suggesting that current approaches to management in people with DM may mitigate some of the effect of deprivation on outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 11","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736617","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 usability and feasibility of a self-compassion chatbot (COMPASS) for youth living with type 1 diabetes","authors":"Anna L. Boggiss,&nbsp;Katie Babbott,&nbsp;Ānna Milford,&nbsp;Sian Ellett,&nbsp;Nathan Consedine,&nbsp;Susan Reid,&nbsp;Nic Cao,&nbsp;Alana Cavadino,&nbsp;Sarah Hopkins,&nbsp;Craig Jefferies,&nbsp;Martin de Bock,&nbsp;Anna Serlachius","doi":"10.1111/dme.70115","DOIUrl":"10.1111/dme.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Although it is well established that youth with type 1 Diabetes (T1D) experience high rates of distress, current clinical care is often under-resourced and unable to provide sufficient or timely psychological support. The current study was designed to evaluate the safety, usability and feasibility of ‘COMPASS,’ a self-compassion chatbot intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty adolescents (aged 12–16 years) living with T1D participated in a 12-week, single-group feasibility study using a mixed methods approach. Usability was assessed via qualitative feedback and interviews, feasibility through app analytics and recruitment data, and safety by utilisation of distress risk management protocols. Psychosocial measures (including diabetes distress, strengths and resilience, self-efficacy, self-compassion, self-care behaviours and emotional well-being) were collected at baseline, 6- and 12-week follow-ups, alongside HbA1c at baseline and 12 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 40 participants recruited, 32 (80%) completed the study. On average, participants completed 95% of modules started. Follow-up assessments showed promising reductions in diabetes distress, and improvements in resilience, self-efficacy, self-compassion and emotional well-being. Qualitative analysis highlighted strengths in engagement and relevance of information covered. Areas for improvement included increasing decision-making support to help alleviate the felt burden of diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The COMPASS chatbot was demonstrated to be safe, feasible and acceptable to adolescents living with T1D. Future research aims to conduct a hybrid type 1 effectiveness-implementation trial that will leverage updates in artificial intelligence to increase the flexibility and tailoring of responding.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 11","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736618","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":"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}