Diabetic Medicine最新文献

{"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,&nbsp;Michael Lockhart,&nbsp;Aonghus O'Loughlin,&nbsp;David Gallagher,&nbsp;Stephen R. Kearns,&nbsp;Sean F. Dinneen,&nbsp;Diane Bergin","doi":"10.1111/dme.15517","DOIUrl":"10.1111/dme.15517","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Following clinical and radiological (X-ray and MRI) assessment, 50% (<i>n</i> = 7) were diagnosed with active CNO. Of those with a confirmed diagnosis, ≥3 sonographic features suggestive of active CNO were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Ultrasound combined with clinical presentation and medical history may support decision making around the diagnosis of CNO at the bedside.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15517","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":"OA","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,&nbsp;Bruce Guthrie,&nbsp;Julia Lawton","doi":"10.1111/dme.15515","DOIUrl":"10.1111/dme.15515","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We explored primary care professionals' perceptions and understandings of T2D remission and their views about supporting remission within routine clinical care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semi-structured interviews were conducted with 14 GPs and nine nurses working in Scottish general practices. Data were analysed thematically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15515","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertensive disorders of pregnancy and gestational diabetes mellitus and predicted risk of maternal cardiovascular disease 10–14 years after delivery: A prospective cohort","authors":"Kartik K. Venkatesh,&nbsp;William A. Grobman,&nbsp;Jiqiang Wu,&nbsp;Nilay S. Shah,&nbsp;Michael Pencina,&nbsp;Maged M. Costantine,&nbsp;Mark B. Landon,&nbsp;Patrick Catalano,&nbsp;William L. Lowe,&nbsp;Denise M. Scholtens,&nbsp;Sadiya S. Khan","doi":"10.1111/dme.15516","DOIUrl":"10.1111/dme.15516","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Studies evaluating the relationship between adverse pregnancy outcomes (APOs), namely hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), with the estimated risk of atherosclerotic cardiovascular disease (ASCVD) remains limited and could inform patient-centred decision-making in the postpartum period. We examined whether HDP or GDM were associated with a higher 10- and 30-year predicted risk of ASCVD measured 10–14 years after delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A secondary analysis from the international prospective Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (2013–2016) cohort. The exposures were HDP or GDM (untreated according to the International Association of the Diabetes and Pregnancy Study Groups criteria). Outcomes were 10- and 30-year predicted risk of ASCVD (composite of fatal and non-fatal coronary heart disease and stroke) as quantified by the validated Framingham Risk Score as a continuous measure, and secondarily, at thresholds used for clinical decision-making of ≥7.5% for 10-year predicted risk and ≥20% for 30-year predicted risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 4432 individuals at a median age of 30.5 years and a median gestational age of 27.9 weeks at pregnancy enrollment, 10.7% developed HDP and 13.7% developed GDM. At 10–14 years after delivery, individuals with HDP had a higher 10-year predicted risk of ASCVD (least squares mean: 2.9% vs. 2.2%; adj. <i>β</i>: 0.59; 95% CI: 0.41–0.77) and a higher 30-year predicted risk of ASCVD (7.7% vs. 6.1%; adj. <i>β</i>: 1.27; 95% CI: 0.81–1.72) compared with those without HDP. Similarly, individuals with GDM had a higher predicted risk of ASCVD (10-year: 3.2% vs. 2.1%; adj. <i>β</i>: 0.51; 95% CI: 0.34–0.67 and 30-year: 8.8% vs. 5.8%; adj. <i>β</i>: 1.56; 95% CI: 1.11–2.01) compared with those without GDM. These results were similar when predicted ASCVD risk was assessed at thresholds of ≥7.5% at 10 years and ≥20% at 30 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Individuals who experienced HDP or GDM had a higher predicted 10- and 30-year risk of ASCVD measured 10–14 years after delivery compared with individuals who did not experience these APOs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15516","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001890","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":"Differential effect of nonpharmacological interventions according to prediabetes phenotype: Systematic review and meta-analysis of randomized clinical trials","authors":"J. Pierre Zila-Velasque,&nbsp;Rodrigo M. Carrillo-Larco,&nbsp;Antonio Bernabe-Ortiz","doi":"10.1111/dme.15511","DOIUrl":"10.1111/dme.15511","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Impaired glucose intolerance (IGT) and impaired fasting glucose (IFG) are totally different. Lifestyle modification is effective in moving from prediabetes to normoglycaemia. There is a lack of information showing the effect of lifestyle modification according to each prediabetes and assessing its effect on the degree of reversibility to normoglycaemia and on cardiometabolic markers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We searched for randomized controlled trials (RCT) that enrolled individuals with IGT or IFG. Meta-analysis was performed to compare the proportion of subjects progressing to type 2 diabetes mellitus (T2DM); proportion reversing to normoglycaemia and mean differences in glucose level and cardiometabolic parameters. Thirty-six RCTs were included. The proportion of subjects progressing from impaired glycaemia to T2DM was higher among those with IGT (16.3% vs. 10.9%), whereas reversion to normoglycaemia was higher in subjects with IFG (27.2% vs. 24.8%). The effect of lifestyle modification on glucose level was significant on those with IFG (mean difference [MD] = −1.56 mg/dL, 95% CI: −2.71, −0.40), but not on those with IGT of (MD = 1.47 mg/dL, 95% CI: −1.33, 4.28).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Diverse lifestyle modification interventions improved glucose levels in people with IFG, but not in those with IGT. Our findings imply that different non-pharmacological interventions are warranted for IGT and IFG.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001881","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 trauma-informed approach to type 1 diabetes mellitus in adults","authors":"Hadassah Buechner,&nbsp;Shreena Unadkat,&nbsp;Joanne Skeldon,&nbsp;Gregory C. Jones","doi":"10.1111/dme.15510","DOIUrl":"10.1111/dme.15510","url":null,"abstract":"<p>Suggested mechanisms for an association between early life adversity and worse glycaemic control.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15510","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The missing piece: The clinical translation of precision diabetes medicine requires precision mental health care: A call to action from the international PsychoSocial Aspects of Diabetes (PSAD) Study Group","authors":"François Pouwer,&nbsp;Katharine Barnard-Kelly,&nbsp;Bryan Richard Cleal,&nbsp;Debbie Cooke,&nbsp;Mary de Groot,&nbsp;Sonya Deschênes,&nbsp;Dominic Ehrmann,&nbsp;Anthony Fernandez,&nbsp;Lisbeth Frostholm,&nbsp;David Hopkins,&nbsp;Norbert Hermanns,&nbsp;Richard I. G. Holt,&nbsp;Marjolein Memelink Iversen,&nbsp;Thomas Kubiak,&nbsp;Christina Maar Andersen,&nbsp;Briana Mezuk,&nbsp;Giesje Nefs,&nbsp;Susanne S. Pedersen,&nbsp;Miranda Schram,&nbsp;Frank Snoek,&nbsp;Uffe Søholm,&nbsp;Timothy C. Skinner,&nbsp;Søren Skovlund,&nbsp;Marietta Stadler,&nbsp;Ragnhild B. Strandberg,&nbsp;Sarah Bro Trasmundi,&nbsp;Michael Vallis,&nbsp;Kirsty Winkley,&nbsp;Per Winterdijk,&nbsp;Maartje de Wit,&nbsp;Natalie Zaremba,&nbsp;Jane Speight,&nbsp;the international PsychoSocial Aspects of Diabetes (PSAD) Study Group","doi":"10.1111/dme.15514","DOIUrl":"10.1111/dme.15514","url":null,"abstract":"&lt;p&gt;Diabetes is an increasingly common, long-term condition, requiring 24/7 self-care and constituting one of the greatest health challenges of our time. As with all ‘wicked problems’, a one-size-fits-all approach to care is doomed to fail.&lt;/p&gt;&lt;p&gt;In 2020, we welcomed the first international consensus report on precision diabetes medicine, which included a section on patient-centred mental health and quality of life outcomes.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This included the recommendation that, &lt;i&gt;‘in the setting of precision diabetes medicine, providers should assess symptoms of diabetes distress, depression, anxiety, disordered eating and cognitive capacities using appropriate standardized and validated tools at the initial visit, at periodic intervals and when there is a change in disease, treatment or life circumstance (..), information that, when combined with other data, are likely to improve the precision of clinical decision making’&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In 2023, the Precision Medicine in Diabetes Initiative (PMDI) published the second international consensus report, on gaps and opportunities for the clinical translation of precision diabetes medicine.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; This report focused on results ‘&lt;i&gt;from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2)&lt;/i&gt;’, to inform the translation of precision medicine research into practice.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Regrettably, the second consensus omits any such recommendation or discussion of mental health issues. Furthermore, among the ‘key sources of heterogeneity in diabetes’, only ‘behaviour’ was included, while among the ‘pillars of precision medicine’, only ‘lifestyle interventions’ were included.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The first consensus called for ‘&lt;i&gt;a rigorous review elucidating effective precision medicine strategies, areas of promise and notable gaps across …[diabetes]… to inform an evidence-based road map to optimize the integration of precision medicine into the global response to the diabetes crisis’&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Of the 15 new systematic reviews conducted to inform the second consensus report, none includes the psychosocial aspects of diabetes.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Yet, there is a robust evidence base demonstrating the crucial role of psychosocial factors for people living with, or at risk of, diabetes; and this evidence has only strengthened since the first consensus. For example, a recent umbrella review of 25 systematic reviews of longitudinal studies concluded that common mental disorders, such as depression, anxiety disorders, sleep disorders and schizophrenia, are associated with increased risks for developing type 2 diabetes.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Various psychotropic medications can increase weight, and people living with mental disorders often face additional challenges, such as","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15514","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964252","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":"Evaluating the impact of severe hypoglycaemia definition wording on severe hypoglycaemia history assessment","authors":"Yu Kuei Lin,&nbsp;Wen Ye,&nbsp;Emily Hepworth,&nbsp;Lynn Ang,&nbsp;Stephanie A. Amiel,&nbsp;Simon J. Fisher","doi":"10.1111/dme.15513","DOIUrl":"10.1111/dme.15513","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Several wordings of the definition of severe hypoglycaemia (SH) exist. This study aims to evaluate how different SH definition wordings affect SH history assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cross-sectional study, surveys were emailed to registrants of the T1D Exchange, a U.S. national type 1 diabetes patient registry. Participants' demographic information was collected. Six-month SH history was evaluated with questionnaires including SH definition wordings from either (1) professional societies, (2) a diabetes community website, or (3) a hypoglycaemia research questionnaire. Analyses included the McNemar test, pairwise Wilcoxon signed-rank test, logistic regression analysis, Kappa statistics, and Spearman correlation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1580 valid responses were obtained from participants (52% female; mean ± SD age: 46 ± 15 years; 95% White; mean ± SD diabetes duration: 25 ± 16 years). Questionnaires with four different SH definition wordings yielded significant variations in the prevalence of SH (i.e., having developed at least one episode of SH) and the number of SH episodes: the ADA/ENDO 2013 definition wording yielded the highest results on both metrics, whereas HypoA-Q and ADA 2023 yielded the lowest. Among participants reporting at least one SH episode, the number of episodes identified with the different SH definition wordings was poorly correlated (R_s: 0.09–0.37; <i>p</i> &lt; 0.001). Race, education level, and household income were associated with higher odds of discrepancies in SH history (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This U.S. national survey with individuals living with type 1 diabetes demonstrated significant discrepancies in SH history when assessed with different SH definition wordings. Race and socioeconomic status were associated with these discrepancies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15513","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964201","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}