Diabetic Medicine最新文献

{"title":"Correspondence between the Diabetes Eating Problems Survey–Revised and eating disorder diagnosis: Examining the current cut-off for clinically significant eating disorder symptoms","authors":"Ashley A. Moskovich,&nbsp;Caitrin Murphy,&nbsp;Samantha Schram,&nbsp;Francesca Scheiber,&nbsp;Rhonda M. Merwin","doi":"10.1111/dme.70022","DOIUrl":"10.1111/dme.70022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Eating disorders (EDs) are associated with severe health complications and early death in individuals with type 1 diabetes, making the accurate detection of EDs crucial so that treatment can be initiated. The Diabetes Eating Problems Survey–Revised (DEPS-R) is commonly used to identify individuals with type 1 diabetes with a probable ED, with scores ≥20 recommended as a clinical cut-off. However, the correspondence between a score ≥20 and an ED diagnosis has yet to be examined. This study examines the accuracy, sensitivity, and specificity of the DEPS-R ≥20 for detecting EDs in a sample of adults with type 1 diabetes participating in a study of eating and weight concerns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults with type 1 diabetes (<i>N</i> = 83) completed the DEPS-R and a structured diagnostic ED interview (Eating Disorder Examination [EDE]). Each participant's EDE and DEPS-R scores were dichotomized (EDE: 1 = ED diagnosis, 0 = otherwise; DEPS-R: 1 = DEPS-R ≥20, 0 = otherwise) and DEPS-R ≥20 accuracy, sensitivity, and specificity for identifying EDs were calculated. A logistic regression was used to determine whether there was a significant association between the dichotomized EDE and DEPS-R scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A DEPS-R ≥20 accurately detected the presence or absence of an ED in 81.8% of the cases, with a sensitivity of 76.7% and a specificity of 88.2%. The logistic regression exhibited a significant association between the EDE and DEPS-R binary variables (coefficient estimate = 3.2, 95% CI [2.0, 4.6]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While the majority of individuals with an ED were identified using DEPS-R ≥20, a subset failed to be detected. Clinicians should keep this in mind when using the DEPS-R and may consider additional screening methods.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623947","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":"LncRNA CASC2 mediates SOCS6 mRNA stabilization via U2AF2 recruitment to modulate macrophage polarisation in diabetic retinopathy.","authors":"Fan Xiao, Feipeng Wu, Peipei Zhong, Tian Hu, Rong Luo","doi":"10.1111/dme.70014","DOIUrl":"https://doi.org/10.1111/dme.70014","url":null,"abstract":"<p><strong>Background: </strong>Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes and a leading cause of vision loss among diabetic individuals. Retinal pigment epithelium (RPE) cells play a crucial role in the pathophysiology of DR by releasing cytokines and exosomal cargo, such as long non-coding RNAs (lncRNAs), that modulate local immune responses, maintain retinal immune homeostasis and influence macrophage polarisation. Recent studies suggest that lncRNA cancer susceptibility candidate 2 (CASC2) may be involved in the regulation of DR progression. However, the regulatory mechanisms linking CASC2 with RPE cells and its role in macrophage polarisation remain insufficiently understood.</p><p><strong>Methods: </strong>Various types of cells, including human retinal pigment epithelial cells (ARPE-19), THP-1 monocytes and additional retinal cell lines, were cultured under normal glucose and high glucose conditions. ARPE-19 cells were exposed to oxidative stress, inflammatory stimulation, or hypoxic conditions. Plasma and aqueous humour samples were collected from DR patients and diabetic controls. Exosomes were extracted from AREP-19 cells and characterised. Various gene and protein expression analyses were performed using techniques including quantitative reverse transcription polymerase chain reaction, Western blot, immunofluorescence, flow cytometry, enzyme-linked immunosorbent assay, and histological staining. Cell proliferation and migration were assessed using Cell Counting Kit-8 assays and Transwell migration assays, respectively. The interactions among CASC2, suppressor of cytokine signalling 6 (SOCS6), and U2 small nuclear RNA auxiliary factor 2 (U2AF2) were explored using RNA immunoprecipitation and dual-luciferase reporter assays. An in vivo diabetic rat model was established.</p><p><strong>Results: </strong>lncRNA CASC2 expression levels were significantly lower in plasma and aqueous humour from DR patients compared to those from diabetic patients without retinopathy. Overexpression of CASC2 significantly attenuated DR and inflammatory damage both in vitro and in vivo. We demonstrated that exosomal CASC2 from ARPE-19 cells mediated macrophage polarisation by inhibiting M1 polarisation and promoting M2 polarisation. Our findings suggest that CASC2 regulates this polarisation through the stabilisation of SOCS6 mRNA via U2AF2.</p><p><strong>Conclusion: </strong>CASC2 derived from RPE cells was transported to macrophages, inducing M2 polarisation by stabilising SOCS6 mRNA through the recruitment of U2AF2. This research may provide a foundation for developing novel therapeutic strategies for DR.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e70014"},"PeriodicalIF":3.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596442","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":"Shortcut to the needle in the haystack? Screening for maturity onset diabetes of the young in a population of women with gestational diabetes","authors":"Sine Knorr,&nbsp;Laura L. Knudsen,&nbsp;Anne L. Madsen,&nbsp;Lene R. Madsen,&nbsp;Lene Mortensen,&nbsp;Henrik H. Thomsen,&nbsp;Lars Peter Sørensen,&nbsp;Per G. Ovesen,&nbsp;Jens Fuglsang,&nbsp;Ulla Kampmann","doi":"10.1111/dme.70021","DOIUrl":"10.1111/dme.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Pregnant women are occasionally misdiagnosed with gestational diabetes (GDM) when they may have glucokinase monogenic diabetes (GCK-MODY). Differentiating between GCK-MODY and GDM is critical due to the distinct treatment strategies required during and after pregnancy. Since pregnancy often elicits the first glucose tolerance test, it provides a unique opportunity to identify individuals with GCK-MODY. However, testing all pregnant women with GDM for GCK-MODY is expensive, and the use of clinical criteria is warranted. An Irish study suggested using a combined criteria of a pre-pregnancy body mass index (BMI) &lt;25 kg/m² and fasting glucose ≥5.5 mmol/L to differentiate GCK-MODY from GDM. Therefore, we aimed to identify women with GCK-MODY during pregnancy using these combined criteria in a Danish population of women with GDM. Additionally, we aimed to screen for other MODY subtypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We recruited women from the Central Denmark Region diagnosed with GDM between April 2019 and December 2022. Women meeting the criteria of pre-pregnancy BMI &lt;25 kg/m² and fasting glucose ≥5.5 mmol/L were offered screening for MODY (17 known genetic variants) using Illumina's Next Generation Sequencing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1270 women with GDM, 46 met the MODY screening criteria. Of these, 41 were offered MODY screening, 34 participated and 1 woman was identified with MODY (MODY 8–CEL variant).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The current Danish GDM screening guidelines do not apply with recommending the use of pre-pregnancy BMI &lt;25 kg/m² and fasting glucose ≥5.5 mmol/L as criteria for identifying women with GCK-MODY among women with GDM in the Danish population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572449","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":"CODIFI2: Randomised controlled trial to compare clinical and cost-effectiveness of swabs versus tissue sampling to inform management of infected diabetic foot ulcers","authors":"E. Andrea Nelson,&nbsp;Sarah T. Brown,&nbsp;Colin C. Everett,&nbsp;Angela Oates,&nbsp;Michael Backhouse,&nbsp;Howard Collier,&nbsp;Joanna Dennett,&nbsp;Rachael Gilberts,&nbsp;Ben Lipsky,&nbsp;Michelle M. Lister,&nbsp;Jane E. Nixon,&nbsp;David Russell,&nbsp;Tim Sloan,&nbsp;Fran Game","doi":"10.1111/dme.70009","DOIUrl":"10.1111/dme.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> BAims/Hypothesis</h3>\u0000 \u0000 <p>CODIFI2 compared wound swabbing and tissue sampling in people with infected diabetic foot ulcers (DFU) to determine the effects on clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multicentre, Phase III, prospective, non-blind, 2-arm parallel group, randomised controlled trial comparing time to ulcer healing (primary outcome), proportions healed, antimicrobial regimen, ulcer area reduction, hospitalisation duration, and time to death for swab compared to tissue sampling. Allocation was via a central and independent randomisation system, with minimisation by DFU site, number, type, size, location, and duration.</p>\u0000 \u0000 <p>Follow-up was 52–104 weeks, with healing confirmed by a blinded assessor. Samplesize target was 730 participants for 90% power to detect a 12.5% difference in healing at 52 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between May 2019 and May 2022, 149 participants were recruited (75 Swab, 74 Tissue) from 21 UK sites. The 52-week cumulative incidence of confirmed healing as the first event was 45.3% (33.5%–56.4%) and 44.6% (33.0–55.6%) for swab vs. tissue. The hazard ratio (HR) for healing for tissue vs. swab was 1.01 (95% CI 0.65–1.55). The median (IQR) days in hospital was 17 (12–39) for swab and 16 (10–32) for tissue. Seventeen swab and 7 tissue participants died during follow-up, and 18.7% and 24.3% of participants in the swab and tissue groups, respectively, had an amputation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions/Interpretation</h3>\u0000 \u0000 <p>This trial was underpowered to determine whether swab or tissue sampling impacted the rate of healing or time to healing. Clinical prescribing and patient outcomes differed slightly between groups; hence, the clinical benefit of tissue sampling is not established.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572436","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":"Marked improvement in HbA1c following introduction of biosimilar insulin to treatment regimen of children and youth with type 1 diabetes in Mali: A randomised controlled trial","authors":"Stéphane Besançon,&nbsp;Aveni Haynes,&nbsp;Amagara Domon Togo,&nbsp;Jessica Lynn Sandy,&nbsp;Jayanthi Maniam,&nbsp;Asa Traoré Sidibe,&nbsp;Sylla Djéneba,&nbsp;Carine de Beaufort,&nbsp;Montserrat Castellsague Perolini,&nbsp;Giacomo Gastaldi,&nbsp;David Beran,&nbsp;Cecile Eigenmann,&nbsp;Graham David Ogle","doi":"10.1111/dme.70007","DOIUrl":"10.1111/dme.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Evidence on outcomes of treating type 1 diabetes (T1D) with long-acting basal insulins in low-resourced settings is lacking. This study aimed to evaluate the impact of switching children and youth with T1D in the low-income country of Mali from human insulin via syringe to long-acting biosimilar insulin glargine delivered by reusable pens combined with short-acting insulin via syringe.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A two-group parallel design randomised trial was conducted enrolling 260 youth aged &lt;25 years, diagnosed with T1D for ≥12 months without prior use of analogue insulin. Youth were randomised 1:1 to either continue receiving current therapy or switch to analogue insulin. The primary outcome was HbA1c, collected at baseline and 3-monthly for 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Primary outcome data were available for 130 (100%) youth in the intervention group and 128 (98.5%) in the control group. Over the 12-month study period, mean HbA1c decreased from 103 to 65 mmol/mol (11.6%–8.1%) (<i>p</i> &lt; 0.001) in the intervention group and from 101 to 93 mmol/mol (11.4% to 10.7%) in the control group (<i>p</i> &lt; 0.01), an absolute difference of 30 mmol/mol (95% CI: −37, −24) (<i>p</i> &lt; 0.001). The proportion of participants with HbA1c ≥130 mmol/mol (≥14%) decreased from 38.5% to 0% in the intervention group, versus 40.6% to 21.9% in the control group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Switching to a basal-bolus insulin regimen including biosimilar glargine resulted in marked improvements in HbA1c and diabetic ketoacidosis episodes. With relevant training, resources, and support, use of long-acting analogue insulin for treating T1D in Mali was feasible and acceptable to participants and healthcare professionals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540527","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":"Cardiovascular disease risk prediction and profiling among Asian Indians with young-onset type 1 and type 2 diabetes.","authors":"Sengottuvelu Aswath Krishna, Ulagamathesan Venkatesan, Anandakumar Amutha, Saravanan Jebarani, Gunasekaran Sengottuvelu, Ranjit Unnikrishnan, Viswanathan Mohan, Ranjit Mohan Anjana","doi":"10.1111/dme.70020","DOIUrl":"https://doi.org/10.1111/dme.70020","url":null,"abstract":"<p><strong>Aims: </strong>This study aims to describe the profile of Asian Indians with young-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) who have 'low cardiovascular disease (CVD) risk' and 'high CVD risk' based on QRESEARCH risk estimator version 3(QRISK3) and Framingham Risk Score (FRS). It also aims to assess the predictive ability of these risk calculators to estimate CVD risk in this population.</p><p><strong>Methods: </strong>Retrospective data of 18,837 individuals with T1D or T2D with an age of onset of between 10 to 30 years were retrieved from Diabetes Electronic Medical Records. QRISK3 algorithm and FRS were used to estimate the 10-year risk of CVD. After excluding individuals with preexisting CVD (n = 175), the QRISK3 score was calculated for 5371, and FRS for 7444 individuals with young-onset T1D and T2D. CVD risk was categorized as high if the QRISK3 and FRS scores ≥10.0% and low, if <10.0%.</p><p><strong>Results: </strong>Among individuals with T1D,17.3% had high QRISK3 scores and 19.0% had high FRS scores. Among individuals with T2D, 31.9% had high QRISK3 scores and 37.2% had high FRS scores. Individuals with T2D had a higher risk than those with T1D by both risk scores (p < 0.001). The frequency of high-risk scores increased with age and was higher among men. The receiver operating characteristic-area under the curve (ROC-AUC) showed that both scores (QRISK3-0.788; FRS-0.746; p = 0.241) predicted 10-year cardiovascular disease risk well.</p><p><strong>Conclusion: </strong>Both QRISK and FRS were good predictors of CVD in this population. Individuals with young-onset diabetes have a high propensity to develop cardiovascular disease within 10 years, with T2D having a higher risk than T1D. Regular risk monitoring, lifestyle modifications and medical interventions are essential among individuals with young-onset T2D and T1D.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e70020"},"PeriodicalIF":3.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522915","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":"Development and validation of a diabetes/nutrition knowledge questionnaire in type 1 and type 2 diabetes.","authors":"Giulia Hofer, Lorena Sabbatini, Carolina Fellinghauer, Ruth Hirschmann, Roger Lehmann, Claudia Cavelti-Weder","doi":"10.1111/dme.70018","DOIUrl":"https://doi.org/10.1111/dme.70018","url":null,"abstract":"<p><strong>Aims: </strong>Effective diabetes management requires adherence to medication regimens and nutritional guidelines, underscoring the importance of health literacy. Our study aimed to develop and validate diabetes and nutrition knowledge questionnaires and correlate diabetes-specific health literacy with glucose metrics in people with type 1 and type 2 diabetes.</p><p><strong>Methods: </strong>In a cross-sectional study at a Swiss tertiary centre, questionnaires were developed to assess diabetes and nutrition knowledge in 289 participants with type 1 diabetes on insulin pumps or basal-bolus insulin and 222 participants with type 2 diabetes with or without insulin. Questionnaire validation involved content and construct validity established by a multidisciplinary team, and measurement properties were evaluated using the Rasch model. Multiple linear regression was performed to analyse the relationship between scores and glucose metrics.</p><p><strong>Results: </strong>The questionnaire demonstrated strong content and construct validity, with minor item misfits identified. In type 1 diabetes participants, higher nutrition knowledge scores (≥9/10) were significantly associated with reduced HbA1c levels (-5 mmol/mol or -0.47%, p < 0.05) and increased TIR (+9.2%, p < 0.05). No significant associations were observed in type 2 diabetes after adjusting for confounders, such as gender, BMI and diabetes duration.</p><p><strong>Conclusions: </strong>We developed and validated a questionnaire encompassing diabetes and nutrition knowledge, tailored to diabetes type and treatment strategy. Psychometric analysis demonstrated robust measurement properties for assessing health literacy across diverse diabetes populations. Better nutrition knowledge was significantly linked to improved glycaemic control in type 1 diabetes, reflected by lower HbA1c and increased TIR.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e70018"},"PeriodicalIF":3.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522917","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":"Ecological momentary assessment in adolescents with type 1 diabetes: A mixed-methods feasibility study","authors":"Paul T. Enlow,&nbsp;Stephanie Madden,&nbsp;Courtney Thomas,&nbsp;Amy Milkes,&nbsp;Tim Wysocki,&nbsp;Melissa A. Alderfer","doi":"10.1111/dme.70015","DOIUrl":"10.1111/dme.70015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Diabetes self-management is dynamic and subject to the influence of contextual variables. Ecological momentary assessment (EMA) facilitates the examination of temporal processes and the influence of contextual variables but is underutilised in paediatric type 1 diabetes research. This study examined the feasibility of using text-message-based EMA and how patient and contextual factors predict adherence to EMA procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adolescents (12–18 years old) with type 1 diabetes (<i>n</i> = 66) watched an EMA training video, completed a 5-question EMA quiz, and then participated in a 3-month EMA study. Mixed-effects models and paired t-tests examined predictors (i.e. HbA1c, participant age, EMA quiz score, study time-point, time of day, day of week) of response rate and latency. Eighteen participants, purposively sampled based on response rates, were interviewed, and thematic analysis was used to summarize themes related to their EMA experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Average response rate was 70% and average response latency was 77.83 min. Response rates were higher on weekdays. Response latency was longer for morning and weekday prompts. In mixed-effects models, response rates decreased over time and were lower for youth with higher HbA1c. Better quiz scores predicted higher response rates and shorter response latency. Qualitative data revealed themes highlighting (1) methodological considerations for research using EMA and (2) how EMA positively affected participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Text-message-based EMA is a feasible method for capturing near-real-time patient experiences related to diabetes management. Combined with diabetes technology, EMA has significant potential for improving our understanding of the behavioural aspects of diabetes self-management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522991","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":"Cost-effectiveness of swab versus tissue sampling for infected diabetic foot ulcers from the CODIFI2 randomised controlled trial","authors":"Chris Bojke,&nbsp;Henrietta Konwea,&nbsp;E. Andrea Nelson,&nbsp;Sarah T. Brown,&nbsp;Colin C. Everett,&nbsp;Angela Oates,&nbsp;Michael Backhouse,&nbsp;Howard Collier,&nbsp;Joanna Dennett,&nbsp;Rachael Gilberts,&nbsp;Benjamin A. Lipsky,&nbsp;Michelle M. Lister,&nbsp;Jane E. Nixon,&nbsp;David Russell,&nbsp;Tim Sloan,&nbsp;Fran Game,&nbsp;the CODIFI2 Investigators","doi":"10.1111/dme.15492","DOIUrl":"10.1111/dme.15492","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To compare the cost-effectiveness of wound swabbing versus tissue sampling for infected diabetic foot ulcers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multi-centre, Phase III, prospective, unblinded, two-arm parallel group, randomised controlled trial compared clinical (reported elsewhere) and economic outcomes of swab versus tissue sampling over a 52–104 week period.</p>\u0000 \u0000 <p>Resource use was logged using case record forms and patient questionnaire at weeks 4, 12, 26, 39, 52 and 104, costed using laboratory and published sources from the UK NHS perspective, at 2021/2022 price-year. EQ-5D-3L questionnaires issued at these time points were used to derive quality-adjusted life-years (QALYs).</p>\u0000 \u0000 <p>To account for imbalances such as age, a regression-based approach was used to estimate survival, expected costs and QALYs between the sampling arms. Available case analysis (ACA) and multiple imputation methods were applied for self reported missing data, and ACA for researcher-collected data (survival, hospitalisations and antibiotic use). Probabilistic sensitivity analysis was used to assess the uncertainty of economic results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We recruited 149 participants (75 swab, 74 tissue) from 21 UK sites, between 07 May 2019 and 28 April 2022 (last follow-up 28 April 2023). Planned sample size was 730 participants, for 90% power to detect 12.5% difference in healing at 52 weeks, but the trial stopped early due to low recruitment.</p>\u0000 \u0000 <p>Expected QALYs in the swab-sampling arm were greater than in the tissue-sampling arm at weeks 26, 52 and 104.</p>\u0000 \u0000 <p>The cost of tissue sampling was greater than of swabbing when including antibiotics and hospitalisation. Swab sampling participants had higher QALYs and lower costs across weeks 26–52, reducing slightly by week 104.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Because of higher costs, lower QALYs and lack of evidence of benefit, potentially due to the trial being underpowered, tissue sampling was dominated by wound swabbing in the cost-effectiveness analysis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15492","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514762","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":"Electrocardiograpic responses during spontaneous hypoglycaemia in people with type 1 diabetes and impaired awareness of hypoglycaemia.","authors":"Peter Novodvorsky, Alan Bernjak, Ellen Downs, Amelia Smith, Muhammad Fahad Arshad, Andrei I Oprescu, Richard M Jacques, Justin Lee, Simon R Heller, Ahmed Iqbal","doi":"10.1111/dme.70019","DOIUrl":"https://doi.org/10.1111/dme.70019","url":null,"abstract":"<p><strong>Aims: </strong>Hypoglycaemia causes abnormal cardiac repolarisation, which has been related to sympathoadrenal activation. We examined whether individuals with type 1 diabetes (T1D) and impaired awareness of hypoglycaemia (IAH) were protected against proarrhythmogenic alterations on their electrocardiogram during clinical episodes of hypoglycaemia.</p><p><strong>Methods: </strong>Adults with T1D and IAH underwent 96 h of simultaneous ambulatory electrocardiogram and blinded continuous interstitial glucose (IG) monitoring. Measures of cardiac repolarisation and heart rate variability (HRV) were compared during hypoglycaemia versus time and person-matched euglycaemia. We compared these data to a historical control group of individuals with T1D and no IAH.</p><p><strong>Results: </strong>Fourteen individuals (10/14 female) with a mean (SD) age of 39 (10) years and T1D duration of 24 (9) years were examined. Fourteen daytime and 12 nocturnal hypoglycaemic episodes were analysed. During daytime hypoglycaemia versus euglycaemia, the mean (SD) QT_c interval was prolonged to 443 (38) versus 422 (27) ms, p = 0.027; the Tpeak-to-Tend interval was prolonged to 93 (18) versus 77 (9) ms, p = 0.002; and the T wave area symmetry decreased to 1.19 (0.37) versus 1.39 (0.23), p = 0.014. High-frequency power decreased during daytime hypoglycaemia versus euglycaemia to 1.66 (0.41) versus 1.92 (0.52), p = 0.038. At daytime, the Tpeak-to-Tend interval decreased significantly more (hypoglycaemia vs. euglycaemia) in the IAH group in comparison to the decrease observed in the historical control group of T1D individuals without IAH (p for interaction 0.005). Cardiac arrhythmias were infrequent and of no clinical significance.</p><p><strong>Conclusions: </strong>Hypoglycaemia can still lead to proarrhythmogenic electrocardiographic changes in individuals with T1D and IAH. We observed diurnal, inter- and intraindividual variability in responses to hypoglycaemia.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e70019"},"PeriodicalIF":3.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522993","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}