Diabetic Medicine最新文献

{"title":"Exploring healthcare professionals' attitudes to screening for disordered eating in type 1 diabetes","authors":"Katie Fitzgerald,&nbsp;Christina Jones,&nbsp;Helen Partridge,&nbsp;Lindsey Rouse,&nbsp;Rose-Marie Satherley","doi":"10.1111/dme.70003","DOIUrl":"10.1111/dme.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Eating disorders and disordered eating behaviours are prevalent among adults with type 1 diabetes, making early identification essential for improving health outcomes. Although screening tools exist to detect disordered eating in type 1 diabetes (T1DE), their application in clinical practice remains limited. This study investigates healthcare professionals' perspectives and attitudes towards screening for disordered eating in adult diabetes services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>This qualitative study employed semi-structured interviews with 13 healthcare professionals from adult diabetes services. Purposive sampling was used to ensure a broad range of healthcare professional viewpoints. The interviews centred on their perceptions of screening for disordered eating in type 1 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Reflexive thematic analysis was used to identify four themes: (1) Uncertainty and Inevitabiltiy of T1DE: ‘A bit of a black hole’, (2) Asking about T1DE: ‘My fear is…am I overstepping the line’, (3) Patient-provider relationships: ‘A backward step’, and (4) Lack of support for T1DE: ‘Where do you go?’. While healthcare professionals recognised the link between diabetes management and disordered eating, they lacked confidence in screening for these challenges due to limited time and the scarcity of specialist disordered eating resources for type 1 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights the challenges healthcare professionals face in screening for disordered eating in type 1 diabetes. By highlighting the need for enhanced training and clear clinical guidelines, this research suggests pathways to improve healthcare professional confidence in addressing these critical conversations with patients, ultimately supporting better health outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413781","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":"Guidelines for the management of diabetes-related ketoacidosis (DKA) have been poorly adopted and implemented, resulting in a lack of improvement in outcomes","authors":"Angelica Sharma,&nbsp;Lakshmi Rengarajan,&nbsp;Parth Narendran,&nbsp;Ketan Dhatariya,&nbsp;Punith Kempegowda,&nbsp;DEKODE Working Group","doi":"10.1111/dme.70010","DOIUrl":"10.1111/dme.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The Joint British Diabetes Society-Inpatient (JBDS-IP) group recommends reducing fixed rate intravenous insulin infusion (FRIII) from 0.1 to 0.05 units/kg/h when blood glucose falls &lt;14 mmol/L to reduce the risk of complications associated with acute management of diabetes-related ketoacidosis. However, whether this change results in real-world improvements is not known.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective review of DKA admissions between October 2021 and March 2023 across five hospitals in the United Kingdom. We collated data on demographics, biochemical profiles, management interventions, complications, and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 753 DKA admissions. There was a slow uptake of reduced-rate FRIII, reaching 49.7% over 18 months. In DKA episodes where FRIII rate reduction guidelines were adopted, there was a significant lag (median [IQR] hours) between starting 10% Dextrose and FRIII rate reduction when blood glucose became &lt;14 mmol/L (0.5 (0.1–1.8) vs. 3.2 (0.7–6.5), <i>p</i> = 0.00001). There was no significant reduction in hypoglycaemia (16.5% vs. 13.8%, <i>p</i> = 0.344) in episodes that adopted FRIII reduction. There were no significant differences in the frequency of hypokalaemia, hyperkalaemia, DKA duration, and length of stay between episodes with FRIII rate reduction versus those without FRIII.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study demonstrates suboptimal adoption of guidelines. Therefore, it was perhaps unsurprising that no favourable effect on the rate of complications or outcomes in DKA episodes with reduced-rate FRIII was demonstrated. In DKA episodes where FRIII rate reduction was adopted, there was a significant delay in adjusting the FRIII when glucose levels were &lt;14 mmol/L. Understanding the barriers and facilitators is vital in creating resources to safely implement guidelines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390276","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":"Dietary interventions for the management of type 2 diabetes mellitus in childhood and adolescence: A systematic review","authors":"Alisha Bhanot,&nbsp;Katherine Hawton,&nbsp;Rachel Perry,&nbsp;Felix Miller-Molloy,&nbsp;Francesca Blest,&nbsp;Shelley Easter,&nbsp;Julian Hamilton-Shield,&nbsp;Toby Candler","doi":"10.1111/dme.70005","DOIUrl":"10.1111/dme.70005","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Despite the alarming increasing incidence of type 2 diabetes mellitus (T2DM) in children and young People (CYP), and its associated morbidities and poor long-term prognosis, there remains uncertainty in its management. Dietary interventions have been shown to be effective in adults with T2DM, but little is known about their effectiveness in CYP. The aim of this systematic review is to provide up-to-date evidence regarding dietary interventions for T2DM in childhood and adolescence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Five databases Embase, MEDLINE, CENTRAL, Web of Science and CINAHL were searched from January 2000 to May 2023 for all studies involving dietary interventions in CYP under 19 years with T2DM. The primary outcome was glycaemic control as measured by HbA1c.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 8352 search results, five papers met inclusion criteria. No randomised controlled trials were identified. Two interventional studies (<i>n</i> = 28) found very low energy diets (VLED) were associated with reduced HbA1c (16 mmol/mol (3.6%) reduction after 8 weeks), decreased requirement for pharmacotherapy and weight loss. However, benefits to HbA1c were not sustained over 2 years. From the observational studies, the most frequent self-reported dietary strategies were limiting sweets and increasing fruit/vegetable intake, but efficacy was limited. Limiting fat intake was associated with improved HbA1c in women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There is limited evidence and a lack of robust clinical trials to support the effectiveness of dietary interventions for CYP-onset T2DM. With evidence of benefit in adulthood and encouraging initial results in the young, it is imperative that fully powered randomised trials with longer follow-up are undertaken to determine efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381825","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":"Screening for disordered eating in adolescents with Type 1 diabetes: A comparison of Diabetes Eating Problem Survey Revised (DEPS-R) and Youth Eating Disorder Examination Questionnaire (YEDE-Q) with item-level analysis","authors":"Caroline B. Abild,&nbsp;Loa Clausen,&nbsp;Line Wisting,&nbsp;Jens Meldgaard Bruun,&nbsp;Kurt Kristensen,&nbsp;Rene Klinkby Støving,&nbsp;Esben Thyssen Vestergaard","doi":"10.1111/dme.15521","DOIUrl":"10.1111/dme.15521","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>People with type 1 diabetes (T1D) face an increased risk of disordered eating (DE) and eating disorders (ED), associated with glucose levels outside target range and an increased risk of complications. The aim of this study was to investigate the type and severity of DE and assess the item accuracy of the Diabetes Eating Problem Survey Revised (DEPS-R) compared to the Youth Eating Disorder Examination Questionnaire (YEDE-Q) in the screening of DE among adolescents with T1D.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional online survey including DEPS-R, YEDE-Q and medical records. Item to total analysis with correlations, and group comparisons were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 131 adolescents between 11 and 19 (mean age 15.3 ± 2.2) years completed both DEPS-R and YEDE-Q, identifying 21.4% and 22.9% with DE, respectively. Significantly more females (&gt;30%) than males (≈5%) were identified in both measures. More than 50% reported insulin restriction in DEPS-R vs. 1.5% in YEDE-Q. YEDE-Q yielded 32% with weight controlling behaviours, however, half of these were unidentified by DEPS-R. Item-total analysis of DEPS-R showed that item 10 had small correlations to both total score and clinical variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study confirms the clinical relevance of DEPS-R, including associations between DE and female sex, older age, and glucose levels outside target range, however, it may not accurately capture distinct ED risk behaviours, such as excessive exercise or shape and weight related insulin restriction. The item-total analysis shows that the relevance of item 10 should be further investigated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15521","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381829","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":"Heat shock-pretreated bone marrow mesenchymal stem cells accelerate wound healing in a diabetic foot ulcer rat model","authors":"Xi Lin,&nbsp;Qi Lin","doi":"10.1111/dme.15507","DOIUrl":"10.1111/dme.15507","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diabetic foot ulcers (DFUs) are the severe chronic complications of diabetes, amputation is required when ulcers cause severe loss of tissue or evoke a life-threatening infection. Mesenchymal stem cells (MSCs) have shown a good effect in helping DFU healing, though the efficiency needs to be improved. This study aimed to investigate the effects of heat shock pretreatment on the improvement of the therapeutic effects of MSCs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Primary rat bone marrow MSCs (BMSCs) were isolated and stimulated with heat shock pretreatment and then tested on a DFU rat model. Alkaline phosphatase, Alizarin Red S, and Oil Red O were stained to check the osteogenic differentiation ability of heat shock-pretreated BMSCs. The effect of heat shock pretreatment on the inflammatory response of macrophages was studied with the lipopolysaccharides stimulation model on a mouse macrophage cell line RAW264.7. The impact of heat shock-pretreated BMSCs on dermal fibroblasts was also checked. Last, heat shock-pretreated BMSCs were tested on a DFU rat model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Heat shock-pretreated BMSCs were characterized by the expression of CD105 and CD44. Heat shock pre-stimulation did not affect cell viability when cultured up to 96 h. Heat shock pre-stimulated BMSCs inhibited the inflammatory response by reducing the pro-inflammatory cytokine production (IL-1β, IL-6, and TNF-α) and enhancing the anti-inflammatory cytokine production (IL-10) (at least all <i>p</i> &lt; 0.01), as well as increasing the ratio of M2 polarization macrophages to M1 polarization in vitro (<i>p</i> &lt; 0.001). Heat shock pre-stimulated BMSCs enhanced the growth and migration of dermal fibroblasts in vitro (<i>p</i> &lt; 0.001). Heat shock-BMSCs promoted the M2 polarization level of macrophages in wound tissues in a DFU rat model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Heat shock pretreatment could enhance the therapeutic effect of BMSCs on wound healing in a DFU rat model.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 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,&nbsp;Sian Holt,&nbsp;Lucy Smith,&nbsp;Glenn Simpson,&nbsp;Hajira Dambha-Miller,&nbsp;Hermione Price","doi":"10.1111/dme.70001","DOIUrl":"10.1111/dme.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 6","pages":""},"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}