Diabetic Medicine最新文献

{"title":"The relationship of plasma glucose, stress hyperglycaemia and glycated haemoglobin with intermediate-term mortality after acute myocardial infarction in patients with and without diabetes","authors":"Annalisa Montebello,&nbsp;Martina Agius,&nbsp;Martina Grech,&nbsp;Nicoletta Maniscalco,&nbsp;Ivana Kenkovski,&nbsp;Stephen Fava","doi":"10.1111/dme.70008","DOIUrl":"10.1111/dme.70008","url":null,"abstract":"<div>\u0000 <section>\u0000 <h3> Aims</h3>\u0000 <p>Admission hyperglycaemia is an adverse prognostic indicator in the setting of acute myocardial infarction. It is unclear if this is because of previously undiagnosed diabetes, due to admission plasma glucose being a marker of a greater stress hormone response and therefore a more severe event, or due to a detrimental effect of high blood glucose on the myocardium.</p>\u0000 </section>\u0000 <section>\u0000 <h3> Methods</h3>\u0000 <p>We performed retrospective analysis of a cohort of 430 participants admitted with a diagnosis of acute myocardial infarction. We investigated the relation of admission plasma glucose, glycated haemoglobin, stress hyperglycaemia ratio and a novel parameter; the stress hyperglycaemia index, to mortality by Cox regression analyses. The stress hyperglycaemia index is the difference between the admission glucose and glucose estimated from HbA_1c.</p>\u0000 </section>\u0000 <section>\u0000 <h3> Results</h3>\u0000 <p>We included 430 participants who were followed for a median of 2.5 years. The stress hyperglycaemia index was associated with increased mortality in patients with diabetes in both univariate and multivariate analyses. Admission glucose was associated with mortality in subjects with diabetes in univariate analysis and after adjustment of age and sex, but not after adjusting for eGFR. There was no significant association between admission glucose and mortality in subjects without diabetes. HbA_1c was not associated with mortality in either patient group in both univariate and multivariate analyses.</p>\u0000 </section>\u0000 <section>\u0000 <h3> Conclusion</h3>\u0000 <p>Our results suggest a possible detrimental effect of hyperglycaemia in the setting of an acute myocardial infarction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364065","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":"Consistency of the personalized glycated haemoglobin (pHbA1c) methodology over time in people with type 1 diabetes (T1D) using continuous glucose monitoring","authors":"Adrian H. Heald,&nbsp;Mike Stedman,&nbsp;Angela Paisley,&nbsp;Edward Jude,&nbsp;Hellena Habte-Asres,&nbsp;J. Martin Gibson,&nbsp;Angus Forbes,&nbsp;Martin Whyte","doi":"10.1111/dme.15520","DOIUrl":"10.1111/dme.15520","url":null,"abstract":"&lt;p&gt;Since the discovery of the association between glycated haemoglobin (HbA1c) and glucose control in 1968,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; HbA1c has been adopted globally and continues to be the primary marker for overall glycaemic control due to its convenience, wide availability and evidence base for association with diabetes complications.&lt;span&gt;&lt;sup&gt;2-4&lt;/sup&gt;&lt;/span&gt; This measure is dependent on assay performance, blood glucose levels, the glycation process itself and the lifespan of red blood cells (RBCs).&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; With the widespread adoption of continuous glucose monitoring (CGM), it is becoming clear that glucose metrics and HbA1c may be discordant.&lt;/p&gt;&lt;p&gt;Recent studies have looked at the agreement between CGM-derived glucose management index (GMI) and HbA1c in diabetes and non-diabetes populations and have provided insights regarding appropriate clinical interpretations, highlighting where more data are needed.&lt;span&gt;&lt;sup&gt;6-8&lt;/sup&gt;&lt;/span&gt; The difference between GMI and laboratory HbA1c (labHbA1c) can be clinically significant and may have implications for clinical risk.&lt;span&gt;&lt;sup&gt;9, 10&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In a group of individuals with type 1 diabetes (T1D), we recently reported that individuals in the highest tertile of reading-to-reading glucose change showed the greatest change in estimated glomerular filtration rate (eGFR) and that those with a higher proportion of glucose readings &gt;18 mmol/L also showed a fall in eGFR while experiencing higher rates of sight-threatening retinopathy, as did people with higher mean glucose.&lt;/p&gt;&lt;p&gt;The size of the mismatch can be significant between GMI and labHBA1c for any individual, perhaps more than has been appreciated when the association between average glucose and HbA1c was first established by the A1C-Derived Average Glucose (ADAG) study and adopted in the American Diabetes Association Standards of Care, as well as other international guidelines.&lt;span&gt;&lt;sup&gt;11, 12&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;A new glycaemic measure, personalised HbA1c (pHbA1c),&lt;span&gt;&lt;sup&gt;13&lt;/sup&gt;&lt;/span&gt; was developed from first principles to calculate a value equivalent to the laboratory-measured HbA1c from the average measured by CGM that may address the inaccuracies of HbA1c as a measure of glycaemia by accounting for interindividual variability in RBC glycation and lifespan. This is essential not only for monitoring in diabetes but also for decisions about potential treatment changes. There are also implications for the way that HbA1c is applied in screening for type 2 diabetes (T2D).&lt;span&gt;&lt;sup&gt;14, 15&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;We here report findings from a study in individuals with T1D in which we analysed the relation between pHbA1c and labHbA1c at different time points, using FreeStyle Libre© data collected up to 18 months, and how this relationship may be modulated by individual characteristics.&lt;/p&gt;&lt;p&gt;CGM values were downloaded from the LibreView record for people with T1D in order to estimate pHbA1c. Their contemporaneous labHb","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15520","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the COVID-19 pandemic on diabetic retinopathy and referral levels in the English National Health Service Diabetic Eye Screening Programme","authors":"P. H. Scanlon,&nbsp;C. F. E. Norridge,&nbsp;D. Prentis,&nbsp;N. Holman,&nbsp;P. Rankin,&nbsp;J. Valabhji","doi":"10.1111/dme.15518","DOIUrl":"10.1111/dme.15518","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim was to determine the effect of the COVID-19 pandemic on diabetic retinopathy and referral rates in the English National Health Service (NHS) Diabetic Eye Screening Programme (DESP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Non-patient identifiable data are submitted centrally from the 57 regional centres in the NHS DESP on a quarterly basis and analysed using STATA, comparing 01/04/2019–31/03/2020 and 01/04/2021–31/03/2022. Patient characteristics were analysed from National Diabetes Audit (NDA) data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 2,274,635 grades from the 57 centres in 2019–2020 and 2,199,623 grades in 2021–2022. The proportion of eyes with referable DR increased from 3.1% in 2019–2020 to 3.2% in the 2021–2022 NHS year (<i>p</i> &lt; 0.01) with a small increase in the level of non-referable DR from 24.6% to 24.8% (<i>p</i> &lt; 0.01). The median proportion of ungradable eyes in 2019–2020 was 2.6% (IQR: 2.3% to 3.3%) increasing to 3.1% (IQR: 2.5% to 3.7%) in 2021–2022. NDA data demonstrated that the proportions with type 1 diabetes receiving eye screening were higher in the latter year (8.3% vs. 7.3%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The COVID-19 pandemic was associated with small increases in referable retinopathy rates from 3.1% to 3.2%, non-referable DR from 24·6% to 24.8% and an increase in the ungradable image rate from 2.6% to 3.1%, the latter increase possibly being caused by untreated cataract during the pandemic. Risk stratification of invitations in the recovery period was believed to have contributed to keeping the referable rates low and supports a similar approach in extension of the screening interval for low-risk groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15518","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122411","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":"Healthcare professional views of a diabetes review postal box: A qualitative study.","authors":"Jack Colley, Sian Holt, Lucy Smith, Glenn Simpson, Hajira Dambha-Miller, Hermione Price","doi":"10.1111/dme.70001","DOIUrl":"https://doi.org/10.1111/dme.70001","url":null,"abstract":"<p><strong>Background: </strong>Non-attendance at diabetes appointments is common, ^1-4 and associated with higher HbA1c levels, reduced medication taking, and increased complications. ^1-45 Barriers to attendance are multifactorial including both logistical and psychosocial factors. ^6-11 A proposed solution is the implementation of a postal diabetes annual review box enabling self-collection of blood and urine samples, and measurement of blood pressure and weight.</p><p><strong>Aim: </strong>To explore the views of Healthcare Professionals (HCPs) who are involved in the organisation or delivery of diabetes care regarding the acceptability and implementation of a postal box as part of the diabetes annual review.</p><p><strong>Method: </strong>We conducted a qualitative study recruiting HCPs into semi-structured interviews and focus groups. Collected data were analysed using an inductive approach and following the principles of reflexive thematic analysis¹².</p><p><strong>Results: </strong>Twenty-one HCPs participated in the study. HCPs felt that a postal box could overcome many individual and service factors contributing to non-attendance. They felt the box could encourage self-management behaviours and could be used as a tool for communication. HCPs recognised that the postal box could free up time in appointments to focus on holistic care delivery without further stretching limited resources. HCPs were concerned about the possible additional administrative burden a postal box might create, and the public perception of an intervention which could reduce face-to-face care.</p><p><strong>Conclusion: </strong>Healthcare professionals seem receptive to the idea of a postal diabetes annual review box and feel it has the potential to offer people with diabetes an improved quality of care.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e70001"},"PeriodicalIF":3.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074329","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":"Large group onboarding of Omnipod 5 automated insulin delivery system—Experience from a UK secondary care diabetes service","authors":"A. Chapman,&nbsp;S. McGriskin,&nbsp;L. Findlow,&nbsp;A. Urwin,&nbsp;S. Ohol,&nbsp;S. Thomas,&nbsp;R. Obsiye,&nbsp;J. Schofield,&nbsp;H. Thabit","doi":"10.1111/dme.70000","DOIUrl":"10.1111/dme.70000","url":null,"abstract":"&lt;p&gt;In December 2023, the National Institute for Health and Care Excellence (NICE) published technology appraisal guidance (TA943) recommending hybrid closed-loop (HCL) systems as an option for managing blood glucose levels for adults living with Type 1 diabetes (T1D).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; NICE agreed to an NHS England request to extend the normal period of compliance to 5 years to allow specialist services time to develop education and training to support wider access. Diabetes services across England and Wales have been considering how to build the clinical capacity required to deliver equitable access to HCL systems in a safe and timely manner, while meeting the expectations of people living with the condition.&lt;/p&gt;&lt;p&gt;Our diabetes service is based at a large inner city hospital and supports over 2000 people living with T1D. We have a dedicated multidisciplinary team (MDT) consisting of diabetologists, insulin pump-trained diabetes specialist nurses (DSN), and specialist dieticians. The MDT, supported by a clinical psychologist, meets weekly virtually to discuss cases of significant clinical complexity, or where HCL is being considered. At the time of writing, 1145 of our cohort are benefitting from insulin pump therapy, with 989 established on HCL systems.&lt;/p&gt;&lt;p&gt;Here, we share our experience onboarding 56 people with T1D onto the Omnipod 5 automated insulin delivery (AID) system at a 1-day group event&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; (see Table 1 for baseline characteristics). To our knowledge, this is the largest 1-day HCL onboarding event to date in the UK. The proposal for this collaborative effort between the clinical and administrative teams and industry was presented to the hospital's outpatient services leadership team for approval, including financial planning. Based on our significant experience with diabetes technology, the proposal was deemed feasible and an opportunity to enhance productivity.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The clinical and administrative teams held joint operational meetings prior to the event. This included participant identification, contact and invitation, ordering and shipment of devices, and consumables to each participant. Invited participants were existing users of Omnipod pumps (Eros or Dash) and had chosen to use Omnipod 5 with the Libre 2 Plus continuous glucose monitoring (CGM) device. A standardised letter was sent to the participant's GP for prescription of Libre 2 Plus CGM prior to the event. Written instructions were sent to each participant, providing guidance and instructions on how to prepare ahead of the onboarding event, including setting up individual Glooko and Omnipod 5 personal web accounts. This was supported by verbal communications with the DSN team where needed. Ahead of the event all participants were re-contacted by telephone and e-mail to confirm the location and timings, and ensure the pre-onboarding tasks had been completed.&lt;/p&gt;&lt;p&gt;The onboarding event was performed in a conference roo","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064473","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":"Clinical outcomes of a real-world prospective study using Dexcom ONE continuous glucose monitoring in people with diabetes treated with two or more insulin injections per day","authors":"Jackie Elliott,&nbsp;Chloe Husband,&nbsp;Heydar Khadem,&nbsp;Hoda Nemat,&nbsp;Lucy Cardno,&nbsp;Laura Currin,&nbsp;Susan Hudson","doi":"10.1111/dme.15519","DOIUrl":"10.1111/dme.15519","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study assessed real-world glycaemic outcomes associated with the use of Dexcom ONE in adults with suboptimally controlled diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this single-site prospective study, adults with type 1 (T1D) or type 2 diabetes (T2D) taking two or more insulin injections per day initiated Dexcom ONE CGM use and attended follow-up data collection visits after 3 and 6 months. During the study, participants received usual diabetes care. Primary outcome was a change in HbA1c at 6 months. Additional outcomes included change in participant-reported outcomes and CGM-derived time in glucose range 3.9–10 mmol/L (TIR), time above range &gt;10 mmol/L (TAR), and time below range &lt;3.9 mmol/L (TBR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 110 adults enrolled [T1D (<i>n</i> = 34): mean age 36.6 years, 55.9% female; T2D (<i>n</i> = 76): mean age 54.9 years, 38.2% female]. Mean HbA1c significantly decreased from 90 mmol/mol (10.3%) to 79 mmol/mol (9.4%) at 6 months (∆-12 mmol/mol, <i>p</i> &lt; 0.001) in T1D users and from 86 mmol/mol (10.1%) to 67 mmol/mol (8.3%) in T2D users (∆-18 mmol/mol, <i>p</i> &lt; 0.001). Perception of health and diabetes distress improved at 6 months for both groups. T1D users had modest improvement in TBR. T2D users exhibited a clinically meaningful increase in TIR (∆ + 9.0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Real-world Dexcom ONE use was associated with clinically significant reductions in mean HbA1c after 6 months, along with meaningful improvements in participant-reported outcomes. CGM-derived outcomes also improved, with the possibility of there being greater improvement than could be captured in this study. These findings support expanding access to this real-time CGM system.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15519","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058380","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":"Sonographic features of active Charcot neuro-osteoarthropathy: A case series.","authors":"Jennifer A Pallin, Michael Lockhart, Aonghus O'Loughlin, David Gallagher, Stephen R Kearns, Sean F Dinneen, Diane Bergin","doi":"10.1111/dme.15517","DOIUrl":"https://doi.org/10.1111/dme.15517","url":null,"abstract":"<p><strong>Aims: </strong>To describe the sonographic features of active Charcot neuro-osteoarthropathy (CNO) and assess the potential role of ultrasound in identifying those with active CNO.</p><p><strong>Methods: </strong>Using a prospective case-series study design we assessed the sonographic features of 14 patients with a diagnosis of diabetes presenting with clinical signs and symptoms suspicious for active CNO. Patients had standard weight-bearing plain X-Ray and, where possible, MRI to evaluate the presence of active CNO. Ultrasound was performed bilaterally to assess for subcutaneous oedema, intra-articular and peri-articular colour flow. The spectral waveform morphology, peak systolic velocity and resistive index of the dorsalis pedis arteries of both feet were also documented.</p><p><strong>Results: </strong>Following clinical and radiological (X-ray and MRI) assessment, 50% (n = 7) were diagnosed with active CNO. Of those with a confirmed diagnosis, ≥3 sonographic features suggestive of active CNO were observed.</p><p><strong>Conclusions: </strong>Ultrasound combined with clinical presentation and medical history may support decision making around the diagnosis of CNO at the bedside.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e15517"},"PeriodicalIF":3.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037544","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":"Exploring low-dose glucagon for exercise-induced hypoglycaemia in type 1 diabetes: A randomised controlled trial","authors":"Sissel Banner Lundemose,&nbsp;Christian Laugesen,&nbsp;Ajenthen Gayathri Ranjan,&nbsp;Kirsten Nørgaard","doi":"10.1111/dme.15512","DOIUrl":"10.1111/dme.15512","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study was designed to compare the effectiveness of a single subcutaneous (s.c.) glucagon dose versus the same total dose split into a dose before and after and placebo (PBO) in preventing exercise-induced hypoglycaemia in adults with type 1 diabetes (T1D).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-two adults with T1D participated in a randomised, single-blinded, three-arm crossover study. Participants underwent a 60-min bout of moderate-intensity cycle ergometry (~50% HRmax) in fasted state, followed by 2 h of rest. Plasma glucose (PG) concentrations were monitored at 5- and 15-minute intervals. Participants were randomly assigned to receive two separate injections before (<i>t</i> = 0 min) and just after (<i>t</i> = 60 min) exercise: (i) 150 μg s.c. glucagon (G150) before and PBO after; (ii) 75 μg s.c. glucagon (G75*2) before and after; or (iii) PBO before and after. Insulin pump users reduced their basal insulin rate by 50% during cycling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The occurrence of hypoglycaemia did not significantly differ between arms (G150: 7, G75*2: 5 and PBO: 6 events, <i>p</i> = 0.078). Mean PG levels throughout the trial were lower in the PBO arm compared to both glucagon arms (G150: 8.6 ± 2.9, G75*2: 8.9 ± 3.4 and PBO: 7.3 ± 2.6 mmol/L, <i>p</i> = 0.015). Time spent with PG in target range (3.9–10.0 mmol/L) was higher in the PBO arm versus both glucagon arms (G150: 63.9 ± 38.9%, G75*2: 60.0 ± 34.1% and PBO: 82.7 ± 29.6%, <i>p</i> = 0.005), driven by less time above range (G150: 32.9 ± 41.3%, G75*2: 35.9 ± 36.4% and PBO: 13.2 ± 30.2%, <i>p</i> = 0.007).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Low-dose native glucagon did not offer any advantages in preventing exercise-induced hypoglycaemia in individuals with T1D, regardless of glucagon dosing variations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022557","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 visits in paediatric versus adult clinics for young adults (YA) with T1D: Pre-pandemic and pandemic care","authors":"Amit Shapira,&nbsp;Liane J. Tinsley,&nbsp;Elena Toschi,&nbsp;Lori M. Laffel","doi":"10.1111/dme.15509","DOIUrl":"10.1111/dme.15509","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Young adults (YA) with type 1 diabetes mellitus (T1D) are at high risk of worsening glycated haemoglobin (HbA1c) with fewer follow-up visits. We examined the association of demographic and diabetes characteristics with care utilization, including in-person and telehealth visits, pre- (1 April 2019 to 15 March 2020) and during the COVID-19 pandemic (30 March 2020 to 15 March 2021) for YA (ages: 18–30) with T1D, comparing those seen in paediatric versus adult diabetes clinics at a single diabetes centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were obtained from the electronic health record for YA with a pre-pandemic HbA1c. We performed descriptive statistics to describe the sample and paired <i>t</i>-tests to compare visits before and during the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data from 1762 YA (54% male; age 24.0 ± 3.6 (M ± SD) years; HbA1c 66 ± 18 mmol/mol (8.2 ± 1.6%) revealed that in the full sample, mean pre-pandemic visit frequency was 3.5 ± 3.4 and mean pandemic visit frequency was 3.1 ± 4.1 (<i>p</i> &lt; 0.0001). Furthermore, the pandemic visit frequency declined in the adult clinic regardless of sex, pump therapy, CGM use, and pre-pandemic HbA1c, whereas in the paediatric clinic, visit frequency was only reduced for those with HbA1c &lt;53 mmol/mol (&lt;7%) but was otherwise maintained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this diabetes centre, the paediatric clinic maintained diabetes care delivery during the pandemic (30 March 2020 to 15 March 2021) to YA with glycaemic control above target, suggesting that preservation of remote care delivery should be considered in this high-risk group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001879","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":"Does remission of type 2 diabetes matter? A qualitative study of healthcare professionals' perspectives and views about supporting remission in primary care.","authors":"Mireille Captieux, Bruce Guthrie, Julia Lawton","doi":"10.1111/dme.15515","DOIUrl":"https://doi.org/10.1111/dme.15515","url":null,"abstract":"<p><strong>Background: </strong>Trials conducted in highly selected populations have shown that type 2 diabetes (T2D) remission is possible, but the feasibility and acceptability of supporting remission in routine clinical practice remain uncertain.</p><p><strong>Aim: </strong>We explored primary care professionals' perceptions and understandings of T2D remission and their views about supporting remission within routine clinical care.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 14 GPs and nine nurses working in Scottish general practices. Data were analysed thematically.</p><p><strong>Results: </strong>Most participants considered remission to be a motivational tool but were unsure that it actually altered clinical management, due to patients still requiring follow-up and their expectations that remission is often temporary because of the constant effort required to sustain remission in an obesogenic environment. These perceptions, together with participants' concerns about loss to follow-up of patients who were likely to relapse and/or were still at high cardiovascular risk, appeared to underpin a reluctance to code remission in medical records. Most participants did not consider remission support to be a clinical priority. Moreover, they described being sensitive to the pitfalls of only encouraging some patients to pursue remission, because if resources were directed towards apparently more motivated, affluent individuals, there was a risk that this could widen health inequalities.</p><p><strong>Conclusion: </strong>For integration of remission support into mainstream T2D care to be successful, primary care professionals may need to be persuaded that remission matters more than encouraging well-managed T2D. They would also benefit from clear guidance on follow-up and optimal support for people in remission.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e15515"},"PeriodicalIF":3.2,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001888","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}