Diabetic Medicine最新文献

{"title":"Detecting clinical cases of binge eating in diabetes care: Introducing the Diabetes Eating Problem Survey-10 (DEPS-10) for type 1 and type 2 diabetes","authors":"Laura Yvonne Klinker,&nbsp;Andreas Schmitt,&nbsp;Dominic Ehrmann,&nbsp;Bernhard Kulzer,&nbsp;Norbert Hermanns","doi":"10.1111/dme.70060","DOIUrl":"10.1111/dme.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Binge eating disorders (BED) are underdiagnosed in diabetes care, despite being the most common eating problem for diabetes patients. While diabetes-specific screening for disordered eating behaviour is recommended, the only diabetes-specific instrument available, Diabetes Eating Problem Survey-Revised (DEPS-R), focuses on type 1 diabetes and rapid-acting insulin, limiting its use across diabetes types and treatment regimens. This study aimed to develop a non-insulin version of the DEPS-R and evaluate its screening performance for BED in people with type 1 and type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The DEPS-R was reduced to 10 non-insulin-specific items (DEPS-10). As part of the ongoing pro-mental study, 679 people with type 1 or type 2 diabetes completed the baseline survey and took part in diagnostic interviews to assess BED. The screening performance of the DEPS-10 was tested via receiver operating characteristic (ROC) curve analysis and compared with DEPS-R and food-related items of the Problem Areas In Diabetes (PAID).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p><i>N</i> = 24 participants (total = 3.5%; type 1 = 2.9%, type 2 = 4.3%) were diagnosed with a current BED. The DEPS-10 performed well in screening for BED (area under the curve [AUC] = 0.92, <i>p</i> &lt; 0.001) comparable with the DEPS-R (AUC = 0.92, <i>p</i> &lt; 0.001) and exceeded the performance of food-related PAID items (AUC = 0.82, <i>p</i> &lt; 0.001). A cut-off score of ≥15 showed optimal sensitivity and specificity in BED screening. People who met the cut-off had significantly higher BMI and HbA1c and more diabetes distress, depressive and anxiety symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DEPS-10 is a reliable screening instrument for BED. Its associations with glycaemic and mental health outcomes reflect its good construct validity comparable to DEPS-R.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 8","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183111","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":"Testing methods used to predict disease progression in children with early-stage type 1 diabetes: A systematic review and meta-analysis","authors":"Rabbi Swaby,&nbsp;Kruthika Narayan,&nbsp;Claire Scudder,&nbsp;Julia Townson,&nbsp;Richard A. Oram,&nbsp;Kirstine J. Bell,&nbsp;Maria E. Craig,&nbsp;Colin Dayan,&nbsp;Paul Aveyard,&nbsp;Rachel E. J. Besser","doi":"10.1111/dme.70077","DOIUrl":"10.1111/dme.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Current guidance on how best to monitor children and young people (CYP) with early-stage type 1 diabetes is evidenced mainly by expert consensus. This systematic review and meta-analysis aims to evaluate the current evidence for tests used to predict disease progression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were sourced from PubMed, Cochrane Central, Ovid Embase and Scopus. The association (hazard ratio [HR]) between test positivity and progression to stage 3 type 1 diabetes in CYP aged ≤18 years with ≥2 islet autoantibodies was examined. Data were pooled using random effects models, and the Hartung–Knapp–Sidik–Jonkman (HKSJ) method was used to adjust confidence intervals to account for greater uncertainty. The risk of bias was evaluated using the QUADAS-2 tool (CRD42023393960).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In this study, 12,923 studies were identified and 285 underwent full-text review. Thirty-four studies (<i>n</i> = 6866 CYP, median age 11.8 years [IQR, 6.6–13.8]) were included. Overall, 2080 (30%) CYP progressed to stage 3 type 1 diabetes over a median follow-up of 5 years (IQR 2–5). The pooled HR for tests that predicted progression were: 1.40 (95% CI 1.07–1.84) for fasting glucose (OGTT), 3.19 (1.75–5.82) for 2-h glucose (OGTT), 6.43 (1.21–34.18) for the M120 above the median value, 3.12 (2.19–4.43) per 1-unit increase in Index 60 and 1.40 (1.17–1.68) per 1.1 mmol/mol increase in HbA1c (C-statistics 0.7–0.8). Evidence for other tests, including CGM, was uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The OGTT, its related tests (M120, Index60) and HbA1c predict progression to stage 3 in CYP with early-stage type 1 diabetes. Other tests, including CGM, need more evidence to support their use as predictive tests in this context.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176388","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":"Beyond vision: The emotional toll of advanced diabetic retinopathy","authors":"Hellena Hailu Habte-Asres,&nbsp;Clara Nartey,&nbsp;Sarah Afuwape","doi":"10.1111/dme.70081","DOIUrl":"10.1111/dme.70081","url":null,"abstract":"<p>Diabetes distress refers to the emotional and psychological burden of managing diabetes, including the pressures of daily self-care and fear of complications. This burden may be heightened in individuals with advanced diabetic retinopathy (DR), where visual impairment, loss of independence and health-related anxiety exacerbate distress. Although 30%–46% of people with diabetes experience distress,<span>^1-3</span> its prevalence in those with advanced DR, particularly those not undergoing surgery, remains underexamined.<span>⁴</span> Given the increased risk of vision loss and its impact on quality of life,<span>^{3, 5}</span> this study aims to assess the prevalence of diabetes distress in this group and identify associated clinical and psychosocial factors.</p><p>This cross-sectional study included individuals with diabetes referred to the nurse-led diabetes service at Moorfields Eye Hospital between January 2023 and January 2024. Participants with ocular complications who consented and could complete the Diabetes Distress Scale (DDS-17) were eligible, while those with cognitive impairments were excluded. We obtained approval from the hospital's Institutional Review Board (MEH-1277) and the study adheres to the Declaration of Helsinki.</p><p>Diabetes distress was assessed using the 17-item DDS-17, which looks at four areas: emotional burden, regimen-related distress, physician-related distress and interpersonal distress.<span>⁶</span> A mean score of 3 or more indicated severe distress. Sociodemographic and clinical information was gathered from electronic records.</p><p>Descriptive statistics summarised participant characteristics, χ² tests compared distress across groups and logistic regression examined links with clinical and sociodemographic factors, adjusting for age and sex. Analyses were carried out using Stata version 17.</p><p>The study included 59 participants, with a mean age of 61.7 (±11.7) years. The sample was predominantly male (61%) and 52.5% were from a non-white background. Nearly half (45.7%) of the participants lived in the most deprived areas. A majority had a raised body mass index (68.8%) and were hypertensive, with a mean systolic blood pressure of 137.4 mmHg. Most participants had varying levels of DR, with common grades including R1M1 and R3AM1 in the right eye and R2M1 and R3AM1 in the left. Seven participants had ocular complications, including cataracts, glaucoma and macular atrophy.</p><p>The mean total DDS score was 41.6 ± 20.1, with 32.2% of participants scoring ≥3, indicating diabetes distress. Emotional burden was the most common distress (35.5%), followed by physician-related distress (37.3%) and regimen-related distress (25.4%).</p><p>Unadjusted and adjusted analyses showed no significant association between diabetes distress and age, sex, BMI, blood pressure, HbA1c, ethnicity or deprivation (Table 1).</p><p>This study explored the link between diabetes di","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153214","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":"Perception of factors influencing preventive behaviours for the recurrence of gestational diabetes in women with a history of gestational diabetes during subsequent pregnancies: A qualitative study","authors":"Leyang Liu,&nbsp;Hua Liu,&nbsp;Weiwei Liu","doi":"10.1111/dme.70072","DOIUrl":"10.1111/dme.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To explore the perspectives of pregnant women with a history of gestational diabetes mellitus (GDM) on factors influencing preventive behaviours for GDM recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative descriptive study was conducted through semi-structured interviews with 30 pregnant women with a history of GDM. Interviews were recorded and transcribed verbatim and analysed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study identified four major themes and 19 sub-themes related to the prevention behaviors of GDM recurrence. These themes are as follows: Knowledge and Belief Levels include previous successful management experience, knowledge of recurrence prevention, awareness of the importance of GDM recurrence prevention, self-efficacy, outcome expectancy, and risk perception. Self-Regulation Skills and Abilities encompass goal setting, goal reconstruction, planning, self-monitoring, self-reflection, self-evaluation, positive emotion adjustment, and self-control. Social Environment involves social influence and social support. Accessibility of Personal Conditions includes physical health status, concurrent priorities, and physical environment accessibility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The study findings highlight that the level of knowledge on GDM recurrence prevention, self-regulation ability, social support and accessibility of individual conditions are important influencing factors for women with a history of GDM to prevent GDM recurrence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136504","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":"A UK healthcare professional survey on the islet autoantibody status of children and young people with pre-stage 3 type 1 diabetes, on behalf of the British Society for Paediatric Endocrinology and Diabetes","authors":"Rabbi Swaby,&nbsp;Tabitha Randell,&nbsp;Jane Bowen-Morris,&nbsp;Colin Dayan,&nbsp;Daniela Elleri,&nbsp;Clare Hambling,&nbsp;Rebecca Martin,&nbsp;Sarinda Millar,&nbsp;Pooja Sachdev,&nbsp;Ambika Shetty,&nbsp;Julia Townson,&nbsp;Rachel E. J. Besser","doi":"10.1111/dme.70069","DOIUrl":"10.1111/dme.70069","url":null,"abstract":"&lt;p&gt;Screening research programmes around the world are identifying children and young people (CYP) with early-stage type 1 diabetes (T1D), defined by the presence of ≥2 islet autoantibodies (IAb), before the onset of clinical disease (pre-stage 3 T1D).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; It has been recognised that monitoring IAb-positive individuals is key to observing the clinical benefits, which include a reduction in diabetic ketoacidosis and the need for hospitalisation at clinical onset, and identifying CYP eligible for immune intervention.&lt;span&gt;&lt;sup&gt;2-5&lt;/sup&gt;&lt;/span&gt; Recent international consensus guidance has provided recommendations for the monitoring of affected individuals in clinical care.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Several screening research programmes exist in the United Kingdom, offering testing to first-degree relatives and the general population.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Anecdotal reports suggest that CYP may also be identified through clinical care (personal communication &lt;i&gt;R Besser&lt;/i&gt;). We therefore sought to identify the numbers of children with pre-stage 3 T1D being managed by paediatricians and how they were identified. In addition, since dropout from screening and follow-up can be as high as 50%,&lt;span&gt;&lt;sup&gt;2, 8, 9&lt;/sup&gt;&lt;/span&gt; we sought to gather information on the number of CYP with ≥1 IAb who are not on insulin, and their management, from research screening platforms as well as those who had been identified in clinical care.&lt;/p&gt;&lt;p&gt;We distributed an electronic survey via all 188 UK paediatric diabetes units (PDUs) between March 2024 and July 2024. Data were collected on the type of centre (district general hospital or tertiary hospital), reason for IAb testing, IAb status (single or multiple), management strategies and attitudes to sibling testing.&lt;/p&gt;&lt;p&gt;The survey was completed by 124/188 (66%) of PDUs contacted: 111/172 (65%) from England and Wales, 9/11 (82%) from Scotland and 4/5 (80%) from Northern Ireland. Of those PDUs who responded to the survey, 106/124 (85%) were district general hospitals and 18/124 (15%) were tertiary centres. This is similar to PDUs that did not respond (55/64 (86%) district general hospitals, and 9/64 (14%) tertiary centres). Twenty-eight per cent of units (35/124) reported managing 145 CYP with ≥1 IAb: 41/145 (28.3%) with a single IAb, 102/145 (70.3%) with ≥2 IAb and 2/145 (1.4%) with unknown IAb status. Of the PDUs who reported managing IAb-positive individuals, 24/35 (69%) were district general hospitals, with a median of 1 IAb-positive child per PDU (IQR, 1–2) and 11/35 (31%) were tertiary centres, with a median of 5 IAb-positive individuals per PDU (IQR, 2–12). Of these 35 PDUs with IAb-positive individuals, 49% reported that CYP were identified from a clinical care setting (44% from secondary care and 5% from primary care), and 51% from a research screening programme.&lt;/p&gt;&lt;p&gt;The reasons units reported for IAb testing included screening as part of a research programme (39%), clinical symptoms su","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 8","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130018","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":"Exploring the social experiences, stigma and discrimination, faced by women with gestational diabetes: A collaborative qualitative study and item-pool development","authors":"E. Holmes-Truscott,&nbsp;E. Litterbach,&nbsp;C. Arampatzi,&nbsp;C. Calyx,&nbsp;J. E. Cherry,&nbsp;V. Gilbert-Morresi,&nbsp;A. Williams,&nbsp;M. Fuller-Tyszkiewicz,&nbsp;H. Teede,&nbsp;J. Speight","doi":"10.1111/dme.70073","DOIUrl":"10.1111/dme.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore experiences of stigma related to gestational diabetes (GDM) among Australian women and collaboratively develop a comprehensive item pool to assess experienced and internalised GDM-specific stigma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A GDM Lived Experience Advisory Group (G-LEAG; <i>n</i> = 4) informed all aspects of a two-phase qualitative research process. Phase 1 included semi-structured online interviews with 20 women with current or recent GDM. Reflexive thematic analysis identified drivers and facilitators, markers, manifestations, impacts and protective mechanisms of GDM stigma. Findings informed the development of an item pool, debriefed and refined with a subset of 10 participants in Phase 2 interviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All participants perceived, experienced, anticipated and/or internalised GDM-specific stigma. They perceived GDM-specific stigma to be driven by stereotypes and blame, and facilitated by societal norms regarding motherhood and pregnancy, media messaging, as well as inflexible and inconsistent healthcare policies. They reported social, emotional and self care impacts, as well as perceived loss of autonomy in clinical care. They proposed potential protective mechanisms, including social and healthcare support, self-belief and self-compassion, and community awareness. In cognitive debriefing interviews, women reported that the draft items comprehensively covered their experiences of GDM-specific stigma and offered suggestions for refinement, resulting in a 74-item pool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings provide rich insights into the experiences and impacts of stigma among women with GDM in Australia and resulted in a co-designed GDM-specific stigma item pool. The item pool is ready for psychometric assessment and item reduction, which will enable future quantification of the occurrence, impacts and mechanisms of GDM-specific stigma.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 8","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130019","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":"Pregnancy outcomes in women with young-onset type 2 diabetes: the impact of age of diabetes diagnosis and duration of diabetes","authors":"Xi May Zhen,&nbsp;Glynis Ross,&nbsp;Amanda Gauld,&nbsp;Alberto Nettel-Aguirre,&nbsp;Stephanie Noonan,&nbsp;Maria Constantino,&nbsp;Arianne Sweeting,&nbsp;Anna-Jane Harding,&nbsp;Adam Mackie,&nbsp;Hend Chatila,&nbsp;Margaret McGill,&nbsp;Timothy Middleton,&nbsp;Ted Wu,&nbsp;Stephen Twigg,&nbsp;Jencia Wong","doi":"10.1111/dme.70049","DOIUrl":"10.1111/dme.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Young-onset type 2 diabetes mellitus (YT2DM) is an aggressive phenotype, with some claiming that diagnosis at &lt;40 years of age represents a distinct higher risk group. Others have suggested restricting YT2DM to those diagnosed at &lt;30 years of age. In this context, we examined whether pregnancy outcomes differ between women diagnosed with YT2DM at &lt;30 years of age (T2D30) versus those diagnosed at 30 to &lt;40 years of age (T2D40).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective analysis (2010–2019) compared pregnancy outcomes in women with pre-gestational T2D30 versus T2D40. Co-primary outcomes included preterm delivery, large for gestational age (LGA) infants, and pre-eclampsia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to T2D40 (<i>N</i> = 69), T2D30 (<i>N</i> = 66) were significantly younger, had a longer duration of diabetes, and had higher rates of smoking (<i>p</i> &lt;0.05 for all). In both groups, obesity affected ≥60% of women and similar rates of preterm delivery and LGA infants were seen. Women with T2D30 had at least a twofold increase in the adjusted odds of excess gestational weight gain (GWG). Rates of proteinuria and pre-eclampsia were increased in T2D30, although significance was lost following adjustment for factors such as glycaemia. Younger age of YT2DM diagnosis and longer duration of YT2DM (as continuous variables), but not maternal age, were independently associated with higher mean pregnancy HbA1c and excess GWG (<i>p</i> &lt;0.05 for both).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An earlier age of YT2DM diagnosis and/or longer duration of YT2DM were associated with excess GWG and a higher mean-pregnancy HbA1c. Rates of pre-eclampsia and proteinuria were increased in T2D30, likely mediated at least in part by factors such as glycaemia. Our findings suggest that the age of YT2DM diagnosis and/or duration of YT2DM, not just maternal age, should be considered when assessing pregnancy risks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 8","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121984","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":"Management of hyperglycaemia in people with Type 1 diabetes on dialysis: What are the options? A case report and review of the literature","authors":"Thinn Thinn Yu,&nbsp;Dorcas Mukuba,&nbsp;Mahalia Casabar,&nbsp;Conor Byrne,&nbsp;Amy Shlomowitz,&nbsp;Peter Jacob,&nbsp;Bobby Huda,&nbsp;M. Magdi Yaqoob,&nbsp;Tahseen A. Chowdhury","doi":"10.1111/dme.70075","DOIUrl":"10.1111/dme.70075","url":null,"abstract":"<p>Type 1 diabetes remains an important cause of end-stage kidney disease. In this report, we describe the use of automated insulin delivery technology to assist a person living with Type 1 diabetes to manage their glucose pre-, peri- and post-renal transplantation. In addition, we review the potential options available for managing such patients, including closed-loop technology, pancreatic and islet cell transplantation.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 8","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112122","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":"Continuous glucose monitoring during intravenous insulin infusion treatment: Assessing accuracy to enable future clinical utility","authors":"Ray Wang,&nbsp;Mervyn Kyi,&nbsp;Brintha Krishnamoorthi,&nbsp;Ailie Connell,&nbsp;Cherie Chiang,&nbsp;Debra Renouf,&nbsp;Rahul Barmanray,&nbsp;Spiros Fourlanos","doi":"10.1111/dme.70076","DOIUrl":"10.1111/dme.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Continuous glucose monitoring (CGM) during intravenous insulin infusions (IVII) could reduce blood glucose (BG) testing burden in hospital, however CGM accuracy concerns exist. We aimed to assess CGM accuracy during IVII.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multi-centre observational study included adults with type 1 diabetes (T1D) who required IVII treatment during hospital admission whilst wearing their own CGM devices (Abbott FreeStyle Libre 2, Medtronic Guardian 3, Dexcom G6). IVII dose adjustments were performed based upon standard of care BG measures. Accuracy was assessed according to mean absolute relative difference (MARD) and Consensus error grid (CEG) analysis, using time-matched (±5 minutes) pairs of CGM glucose and reference BG (point-of-care [POC], blood gas [GAS]) obtained during IVII.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 736 time-matched glucose pairs were obtained from 56 hospital admissions (52% with diabetic ketoacidosis; 32% requiring intensive care). Median IVII duration was 16 hours (IQR 7.2–28). Overall MARD was 12.5% (11.9% for CGM-POC pairs; 14.1% for CGM-GAS pairs). In CEG analysis, 99.0% of glucose pairs were within zones A/B. Based on local hospital IVII dose titration protocols for non-intensive care wards, if CGM measures had been used instead of POC, dose adjustments would have been the same in 77% of instances.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This real-world study of adults with T1D demonstrated high concordance of CGM measures with BG during IVII. The accuracy of CGM during IVII might enable its greater clinical utility when treating inpatients receiving IVII. More inpatient studies are required to validate the use of CGM during IVII.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113262","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":"Predictors of impaired awareness of hypoglycaemia and severe hypoglycaemia in adults with type 1 diabetes","authors":"Nicola N. Zammitt,&nbsp;Shareen Forbes,&nbsp;Berit Inkster,&nbsp;Mark W. J. Strachan,&nbsp;Rohana J. Wright,&nbsp;Anna R. Dover,&nbsp;Roland H. Stimson,&nbsp;Fraser W. Gibb","doi":"10.1111/dme.70074","DOIUrl":"10.1111/dme.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to assess the prevalence of impaired awareness of hypoglycaemia (IAH) and severe hypoglycaemia (SH) in adults with type 1 diabetes and identify risk factors for both conditions in a contemporary cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional survey was conducted on 782 adults with type 1 diabetes. Participants completed a questionnaire including validated hypoglycaemia awareness and mental health tools. Continuous glucose monitoring (CGM) data were collected in 402 participants. SH was identified based on self-reported episodes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>89% were CGM users and 27% were using continuous subcutaneous insulin infusion (CSII). 5.3% of participants reported a recent episode of SH and 21% had IAH based on the Gold score. Elevated Gold Score was independently associated with socioeconomic deprivation (OR 1.9, <i>p</i> = 0.002), female sex (OR 1.8, <i>p</i> = 0.002) and positive depression screen (OR 2.1, <i>p</i> = 0.007). Hypoglycaemia detection threshold &lt;3.0 mM was independently associated with older age (OR 1.03 per year, <i>p</i> &lt; 0.001) and positive depression screen (OR 2.7, <i>p</i> &lt; 0.001). Greater glucose variability (OR 1.14 per % CV glucose, <i>p</i> &lt; 0.001), positive anxiety screen (OR 3.0, <i>p</i> = 0.031) and detection threshold &lt;3.0 mM (OR 6.7, <i>p</i> &lt; 0.001) were all independently associated with SH risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The prevalence of SH is lower in the modern era of type 1 diabetes management and may reflect greater use of CGM and CSII. Mental health symptoms and socioeconomic deprivation are key associations with IAH and SH. Risk models incorporating clinical, psychological and CGM data may more effectively predict SH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096776","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}