Diabetic Medicine最新文献

{"title":"Protocol for a feasibility and acceptability study for UK general population paediatric type 1 diabetes screening-the EarLy Surveillance for Autoimmune diabetes (ELSA) study.","authors":"Lauren M Quinn, Renuka P Dias, Sheila M Greenfield, Alex G Richter, Joanna Garstang, David Shukla, Animesh Acharjee, Georgios Gkoutos, Richard Oram, Sian Faustini, Olga Boiko, Ian Litchfield, Felicity Boardman, Fatima Zakia, Christine Burt, Clair Connop, Amanda Lepley, Christine Gardner, Colin Dayan, Tim Barrett, Parth Narendran","doi":"10.1111/dme.15490","DOIUrl":"https://doi.org/10.1111/dme.15490","url":null,"abstract":"<p><strong>Aim: </strong>The EarLy Surveillance for Autoimmune (ELSA) study aims to explore the feasibility and acceptability of UK paediatric general population screening for type 1 diabetes.</p><p><strong>Methods: </strong>We aim to screen 20,000 children aged 3-13 years for islet-specific autoantibodies through dried blood spot sample collection at home, hospital or community settings. Children with two or more autoantibodies are offered metabolic staging via oral glucose challenge testing. Feasibility assessments will compare recruitment modalities and uptake according to demographic factors (age, gender, ethnicity, level of deprivation and family history of diabetes) to determine optimal approaches for general population screening. The study is powered to identify 60 children (0.3%) with type 1 diabetes (stage 1-3). Parents are invited to qualitative interviews following ELSA completion (child screened negative or positive, single autoantibody or multiple, stage 1-3) to share their screening experience, strengths of the programme and any areas for improvement (acceptability assessments). Parents who decline screening or withdraw from participation are invited to interview to explore any concerns. Finally, we will interview professional stakeholders delivering the ELSA study to explore barriers and facilitators to implementation.</p><p><strong>Conclusion: </strong>Early detection of type 1 diabetes allows insulin treatment to be started sooner, avoids diagnosis as an emergency, gives families time to prepare and the opportunity to benefit from future prevention trials and treatments. ELSA will provide essential feasibility and acceptability assessments for UK general population screening to inform a future national screening programme for paediatric type 1 diabetes.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e15490"},"PeriodicalIF":3.2,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767208","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":"Understanding inequities in access to diabetes technologies in children and young people with type 1 diabetes: Qualitative study of healthcare professionals' perspectives and views","authors":"Rachel Dlugatch,&nbsp;David Rankin,&nbsp;Mark Evans,&nbsp;Nick Oliver,&nbsp;Sze May Ng,&nbsp;Julia Lawton","doi":"10.1111/dme.15486","DOIUrl":"10.1111/dme.15486","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We explored healthcare professionals' perceptions and understandings of the factors and considerations underlying inequities in technology access in children and young people (CYP) with type 1 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We interviewed (<i>n</i> = 29) healthcare professionals working in paediatric diabetes in England recruited from (<i>n</i> = 15) purposively selected sites. We analysed data thematically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Interviewees highlighted multiple, often overlapping barriers to accessing technology faced by CYP with type 1 diabetes from deprived and/or ethnic minority backgrounds. They described the impacts of deprivation on technology uptake, together with the complex social, ethnic and cultural factors that could also reinforce disparities in technology access. Interviewees further highlighted staffing shortfalls as a significant barrier to supporting CYP to use technology, especially those from under-represented groups who they perceived as requiring more staff time to be trained to use technology. While interviewees suggested that unconscious bias has become less prominent, they reported being less likely to recommend technology (especially pumps) to CYP/caregivers who they feared would not use it safely and effectively (e.g. those with low literacy levels). Interviewees also highlighted geographical variability in the technology commissioning process (a ‘postcode lottery’).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that without targeted interventions, technology inequities may continue to persist amongst CYP from the most and least deprived areas and from white and ethnic minority groups in the United Kingdom. Additionally, our findings suggest that closing the technology gap will require large-scale governmental and health policies aimed at fostering socioeconomic, ethnic and cultural equality alongside targeted measures to improve technology accessibility.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15486","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750300","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 lived experience of women with gestational diabetes: A cross-sectional Irish national survey.","authors":"Pauline Dunne, Louise O'Mahony, Linda Culliney, Molly Byrne, Andrew W Murphy, Sharleen O'Reilly","doi":"10.1111/dme.15489","DOIUrl":"https://doi.org/10.1111/dme.15489","url":null,"abstract":"<p><strong>Aim: </strong>Gestational diabetes (GDM) poses risks of short- and long-term complications for mother and infant, emphasising the importance of antenatal and postpartum education and support. We aimed to understand the experiences and views of women with GDM in the Republic of Ireland.</p><p><strong>Methods: </strong>Women with current or previous GDM were invited to complete an online cross-sectional survey (April-June 2022). Recruitment utilised social media, local media and personal networks. The survey addressed demographics, GDM knowledge and experiences, breastfeeding and weight management during pregnancy and post-pregnancy GDM support needs. Descriptive statistics were conducted, and between-group comparisons were undertaken using the chi-square test. Content analysis was applied to free text data.</p><p><strong>Results: </strong>Amongst 231 respondents, most were aged 35-39 (42%); 70% experienced a single GDM pregnancy. Only 6% correctly identified their increased level of risk for developing type 2 diabetes. Under half (44.5%) of respondents reported sufficient time with health professionals to address GDM-related questions. Just over half (54.3%) reported attending for diabetes screening at 6-12 weeks postpartum. The majority (66%) expressed a desire for postpartum information, particularly on healthy eating and physical activity. Having a more recent GDM experience was associated with a stronger preference for weaning (p ≤ 0.001) and weight management information (p = 0.025). Qualitative analysis identified inconsistencies in healthcare messaging, significant concerns about a GDM diagnosis' impact on the pregnancy experience, and financial costs of diagnosis.</p><p><strong>Conclusions: </strong>The findings underscore women's desire for appropriate information and support during and after pregnancy with GDM. Future interventions should address these needs to effectively promote chronic disease prevention after GDM.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e15489"},"PeriodicalIF":3.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750229","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":"Parental perspectives following the implementation of advanced hybrid closed-loop therapy in children and adolescents with type 1 diabetes and elevated glycaemia","authors":"Sin-ting Tiffany Lai,&nbsp;Sara E. Styles,&nbsp;Alisa Boucsein,&nbsp;Yongwen Zhou,&nbsp;Venus Michaels,&nbsp;Craig Jefferies,&nbsp;Esko Wilshire,&nbsp;Martin I. De Bock,&nbsp;Benjamin J. Wheeler","doi":"10.1111/dme.15448","DOIUrl":"10.1111/dme.15448","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To identify from a parental perspective facilitators and barriers of effective implementation of advanced hybrid closed-loop (AHCL) therapy in children and adolescents with type 1 diabetes (T1D) with elevated glycaemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semi-structured interviews were conducted with parents of participants while in a post-trial extension phase of the CO-PILOT randomized controlled trial. The Capability, Opportunity, Motivation, Behaviour Model and Theoretical Domain Framework informed the interviews and framework analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eleven parents of 9 children and adolescents were interviewed. The median age of their children and adolescents was 14.2 years (IQR 13.3–14.7) with median HbA1c 78 mmol/mol (IQR 75–86) (9.3% IQR 9–10) before starting AHCL. Facilitators of implementing AHCL therapy included the following: (1) knowledge acquired from training, (2) establishing routines and action plans, (3) remote glucose monitoring, (4) achievement of glycaemic goals through automation, (5) children/adolescents' capability to use AHCL independently, (6) improved outcomes incentivized continued AHCL, (7) optimism about sustained improvements and (8) social support from healthcare providers, school staff, peers and parents. Barriers to AHCL implementation included the following: (1) challenges with device usability, (2) need for technical support, (3) forgotten knowledge and skills, (4) non-adherence to best practices, (5) negative social influences, (6) physical and psychosocial burden and (7) negative emotions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study provides comprehensive insights into parental perspectives of influences on implementing AHCL therapy in children and adolescents with elevated glycaemia. As parents remain key partners in diabetes care, these findings inform successful implementation of AHCL and development of future diabetes technology.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15448","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715662","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":"Designing a regional clinical service for people with early-onset type 2 diabetes in England","authors":"Jonathan Goldney,&nbsp;Victoria Alabraba,&nbsp;Priscilla Sarkar,&nbsp;Harriet Morgan,&nbsp;Malak Hamza,&nbsp;Michael Skarlatos,&nbsp;Tommy Slater,&nbsp;Jack A. Sargeant,&nbsp;Rhys O'Callaghan,&nbsp;Michelle Hadjiconstantinou,&nbsp;Julia Burdon,&nbsp;Azhar Farooqi,&nbsp;Samuel Seidu,&nbsp;Claire Meek,&nbsp;Melanie J. Davies","doi":"10.1111/dme.15479","DOIUrl":"10.1111/dme.15479","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To design a regional clinical service for people with early-onset type 2 diabetes (EOT2D) in Leicester, Leicestershire and Rutland (England).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A literature search was undertaken to identify important considerations. A working group of key stakeholders was formed to design a triage system and service pathway. Electronic medical records (EMRs) were searched (15th November 2023) to assess feasibility of the pathway and adapt accordingly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A literature search identified important considerations: High risk of complications; large proportion from minority ethnic and socioeconomically deprived backgrounds; significant psychological burden; stigma and other social challenges; and misclassification and miscoding. Novel clinical risk criteria were developed, implementable in EMRs, to match intervention-intensity to clinical need. Specialist clinics were planned, one for people at the highest-clinical risk, another for women with adverse perinatal risk factors. A healthcare professional training package was developed to increase awareness of the unmet clinical needs of people with EOT2D and to upskill in provision of holistic care. Subsequent EMR searches supported the need for our service. Due to the large numbers with HbA1c ≥86mmol/mol (10.0%; n=299; 10.8% of total), these people were prioritised for clinic access. We opted for specialist nurse/educator support to practices with clustering of patients and to financially incentivise referrals from primary care into services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We showcase a service specifically for people with EOT2D based on the literature, a broad range of stakeholder involvement and utilising a locally-sourced data-driven approach. We further discuss areas for development and recommendations based on the challenges we encountered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15479","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715661","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":"Managing diabetic chronic kidney disease in pregnancy: Current clinical practice and uncertainties","authors":"Anita Banerjee,&nbsp;Anna Brackenridge","doi":"10.1111/dme.15460","DOIUrl":"10.1111/dme.15460","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pre-gestational diabetes occurs in approximately 1% of pregnancies in the UK and increases the risk of adverse maternal and fetal outcomes. More women with type 2 than type 1 diabetes are now becoming pregnant and tend to have higher rates of obesity and other multi-morbidities. Chronic kidney disease (CKD) affects approximately 5%–10% of pregnant women with type 1 diabetes and about 2%–3% with type 2 diabetes. Diabetic chronic kidney disease (DCKD) increases the risk of preeclampsia, preterm birth, Caesarean section, small for gestational age (SGA) infant and infant admission to neonatal intensive care unit (NICU), and risks are higher compared to those with diabetes without CKD and those with CKD from other causes. Definitions of CKD in pregnancy are not standardised, and studies are generally small, observational, heterogenous, mainly include women with type 1 diabetes and often predate modern diabetes management such as continuous glucose monitoring and insulin pumps. Therefore, there is a lack of robust data to guide practice and clinical guidelines offer conflicting advice, without precise detail.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We present our approach to caring for women with diabetes and CKD in pregnancy based on available guidelines and clinical experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusion</h3>\u0000 \u0000 <p>Our practice is to aim for intensive targets for blood pressure and glycaemic control pre and during pregnancy, lower than suggested in many guidelines. The importance of multidisciplinary team work and patient centred care is emphasised. Using standardised prospective data collection to better understand the prevalence and outcomes of diabetes and CKD in contemporary pregnancy populations, is recommended to drive future improvements in care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 2","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681087","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":"Explanatory variables of objectively measured physical activity, sedentary behaviour and sleep in adults with type 1 diabetes: A systematic review","authors":"Lotte Bogaert,&nbsp;Eveline Dirinck,&nbsp;Patrick Calders,&nbsp;Simon Helleputte,&nbsp;Bruno Lapauw,&nbsp;Joke Marlier,&nbsp;Vera Verbestel,&nbsp;Marieke De Craemer","doi":"10.1111/dme.15473","DOIUrl":"10.1111/dme.15473","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This systematic review aimed to summarize knowledge on explanatory variables of PA, SB and sleep in adults with T1D to support the development of healthy lifestyle interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of four databases (PubMed, Web of Science, Scopus and Embase) was performed. Only objective measurements of PA, SB and sleep were included and all explanatory variables were classified according to the socio-ecological model (i.e. intrapersonal, interpersonal, environmental and policy level). Risk of bias (ROB) (Joanna Briggs Institute appraisal checklists) and level of evidence (Evidence-Based Guideline Development) were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-one studies were included (66.7% low ROB). Most explanatory variables were situated at the intrapersonal level. A favourable body composition was associated with more time spent in total PA and moderate-to-vigorous PA (MVPA). Men with T1D spent more time in MVPA than women and a younger age was associated with increased MVPA. Barriers to PA were indeterminately associated with MVPA and HbA1c showed an indeterminate association with sleep. Explanatory variables of SB and light PA were not studied in at least two independent studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review underscores the focus on the individual level to identify explanatory variables of movement behaviours in adults with T1D, despite the necessity for a socio-ecological approach to develop effective interventions. More evidence on psychological, interpersonal and environmental variables is needed as these are modifiable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686410","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 impact of the dose adjustment for normal eating (DAFNE) structured education programme on health outcomes and healthcare costs for people with type 1 diabetes in Ireland","authors":"Shikha Sharma,&nbsp;Paddy Gillespie,&nbsp;Anna Hobbins,&nbsp;Sean F. Dinneen","doi":"10.1111/dme.15483","DOIUrl":"10.1111/dme.15483","url":null,"abstract":"&lt;p&gt;The dose adjustment for normal eating (DAFNE) structured education programme has been shown to be clinically and cost-effective in enhancing self-management and improving health outcomes for people with type 1 diabetes.&lt;span&gt;&lt;sup&gt;1-4&lt;/sup&gt;&lt;/span&gt; Like many jurisdictions worldwide, the National Clinical Guideline for type 1 diabetes mellitus in Ireland, which was first published in 2018 and recently updated in 2024, calls for the provision of the DAFNE programme as a core element of clinical practice.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Notably, however, this recommendation emerged in the absence of Irish-specific data on clinical and cost-effectiveness and instead was informed by and dependent upon the generalisability of the well-established international evidence base.&lt;span&gt;&lt;sup&gt;1-4&lt;/sup&gt;&lt;/span&gt; While this is a justifiable assumption, the evidence base supporting the clinical recommendation to implement DAFNE in the Irish context is worthy of further interrogation. To this end, we undertook an opportunistic, secondary analysis of historical data collected via a cluster randomised controlled trial (RCT) of people with type 1 diabetes in Ireland.&lt;span&gt;&lt;sup&gt;6-8&lt;/sup&gt;&lt;/span&gt; Notwithstanding the RCT study design, we do not provide definitive, causal evidence given sample size and data limitations. Instead, our results may be interpreted as independent associations between DAFNE completion and health outcomes and healthcare costs. Taken together, our findings that DAFNE was associated with lower distress and better quality of life at no additional healthcare cost are supportive of its inclusion in the Irish clinical guideline.&lt;/p&gt;&lt;p&gt;Data from the cluster RCT were previously used to evaluate the clinical and cost-effectiveness of group follow-up versus individual follow-up for people with type 1 diabetes who completed the DAFNE programme.&lt;span&gt;&lt;sup&gt;7, 8&lt;/sup&gt;&lt;/span&gt; Notably, the RCT also recruited a third arm of participants who did not complete DAFNE. The study authors initially planned to include this non-DAFNE arm as a third comparator in the RCT. However, the study failed to recruit a sufficient number of participants in the non-DAFNE arm to justify its inclusion. The study recruited participants from nine hospital centres between October 2006 and February 2009. Inclusion and exclusion criteria are reported elsewhere.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; In total, 437 individuals were collectively recruited by the centres randomised to deliver DAFNE, while 57 individuals were recruited by the centres randomised to the non-DAFNE arm. Nonetheless, baseline and follow-up data were collected for all 494 recruited participants: DAFNE and non-DAFNE. At baseline, the mean age was 41 years [standard deviation (SD): 12] in the DAFNE arm and 42 years (SD: 14) in the non-DAFNE arm. The proportion of females was 54% for DAFNE and 44% for non-DAFNE. The mean duration of diabetes was 16 years (SD: 11) for DAFNE and 17 years (SD: 12) for non-DAFNE. Mean HbA1c was 8.31% or 67 mmol/m","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681089","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":"Severe hypoglycaemia and diabetic ketoacidosis in adults presenting to a hospital emergency department: Adverse prognostic markers for survival in type 2 diabetes and the role of SGLT2 inhibitors","authors":"Soon H. Song,&nbsp;Brian M. Frier","doi":"10.1111/dme.15466","DOIUrl":"10.1111/dme.15466","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To determine the prognosis associated with severe hypoglycaemia (SH) and diabetic ketoacidosis (DKA) in adults presenting to a hospital emergency department (ED).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Medical records of adults with type 1 (T1D) and type 2 (T2D) diabetes who attended the ED with SH and DKA between 1 January 2019 and 30 June 2023, were reviewed for comorbidities, long-term survival, mortality and causes of death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 429 episodes of DKA occurred in 293 people and 643 episodes of SH in 515 people. DKA predominated in T1D (77.6%) and SH in T2D (54.3%). In T2D, 32.3% of DKA events were associated with sodium-glucose cotransporter-2 inhibitor (SGLT2-i) medication. In both SH and DKA, patients with T2D were older and had more comorbidities than T1D, particularly cardiorenal disease, heart failure, cognitive impairment and cancer (all <i>p</i> &lt; 0.005). Compared with T1D, mortality was higher in T2D after SH (48.4% vs. 19.9%, <i>p</i> &lt; 0.005) and after DKA (30.8% vs. 13.4%, <i>p</i> = 0.001) with shorter median times to fatal outcome (SH: 134 vs. 511 days; DKA: 43 vs. 266 days, both <i>p</i> &lt; 0.005). Long-term survival was lower (<i>p</i> &lt; 0.005) and mortality risk was higher in T2D after index presentation with SH (HR 3.43 [95% CI: 2.43–4.84], <i>p</i> &lt; 0.005) and DKA (HR 3.00 [95% CI: 1.77–5.10], <i>p</i> &lt; 0.005). Irrespective of diabetes type, most causes of death in SH and DKA were non-cardiovascular.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SH and DKA events requiring hospital treatment herald a poor prognosis with greater mortality in T2D adults with multimorbidity. A significant number of DKA episodes in T2D occurred in people receiving SGLT2-i medication.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675447","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":"Age and outcomes in people with type 2 diabetes admitted to hospital with COVID-19: A cohort study","authors":"M. Ni'Man,&nbsp;Y. Ruan,&nbsp;J. Davies,&nbsp;S. Harris,&nbsp;D. Nagi,&nbsp;P. Narendran,&nbsp;B. C. T. Field,&nbsp;I. Idris,&nbsp;D. Patel,&nbsp;R. Rea,&nbsp;R. E. J. Ryder,&nbsp;S. H. Wild,&nbsp;K. A. Várnai,&nbsp;E. G. Wilmot,&nbsp;K. Khunti","doi":"10.1111/dme.15481","DOIUrl":"10.1111/dme.15481","url":null,"abstract":"&lt;p&gt;Type 2 diabetes has been associated with an increased risk of COVID-19 severity and mortality.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The incidence of young onset (aged &lt;50 years) T2D (YOT2D) has increased in many countries over the past 30 years, particularly in ethnic minority groups.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Accumulating evidence confirms that individuals with YOT2D have greater risks of developing micro- and macrovascular complication.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The reasons for poorer outcomes in YOT2D are not known but associated risk factors include female sex, obesity, low birthweight, family history of T2D and non-white ethnicity.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In view of the high-risk phenotype, YOT2D may have worse outcomes following COVID-19.&lt;/p&gt;&lt;p&gt;The aim of this study was, therefore, to assess outcomes, by age on admission to hospital, in two cohorts with T2D: young (&lt;50 years) and older (≥50 years).&lt;/p&gt;&lt;p&gt;Data for this retrospective cohort study were collected through a nationwide audit between March and December 2020, conducted by the Association of British Clinical Diabetologists (ABCD), of COVID-19-related admissions in people with diabetes. Full details of data collection have been published previously.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Whilst there is variance in the definition of YOT2D between studies,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; we opted to define the age range of the younger people with type 2 diabetes as &lt;50 years, opposed to the typical &lt;40 years definition for YOT2D. This enabled us to study a larger cohort, whilst still referencing this &lt;40 years cohort.&lt;/p&gt;&lt;p&gt;Continuous data variables were summarised as mean (standard deviation) or median [interquartile range] for normally and non-normally distributed data, respectively. We compared the characteristics of patients using t-tests or chi-squared tests for continuous or categorical data. All statistical analysis was performed using R, version 3.3. &lt;i&gt;p&lt;/i&gt; &lt; 0.05 was considered statistically significant.&lt;/p&gt;&lt;p&gt;Data from 279 YOT2D were compared to data from 3476 individuals aged ≥50 years with Type 2 diabetes on admission (see Table 1). Despite the mean age of 43.3 years in the YOT2D cohort, there was a high prevalence of microvascular (21%) and macrovascular disease (12%) and hypertension (48%). On admission to hospital, the YOT2D had higher median [IQR] blood glucose levels (10.6[7.4,15.3] mmol/l, &lt;i&gt;p&lt;/i&gt; &lt; 0.01) compared to the population with T2D that was older (≥50 years) on admission (9.0[6.7,13.0] mmol/L, &lt;i&gt;p&lt;/i&gt; &lt; 0.01) and higher mean (SD) BMI (33.7 (9.5) kg/m&lt;sup&gt;2&lt;/sup&gt; vs. 29.1(7.2) kg/m&lt;sup&gt;2&lt;/sup&gt;, &lt;i&gt;p&lt;/i&gt; &lt; 0.01). Larger proportions of YOT2D were on metformin (59% vs. 49%, &lt;i&gt;p&lt;/i&gt; &lt; 0.01), SGLT2 inhibitors (9% vs. 6%, &lt;i&gt;p&lt;/i&gt; &lt; 0.01), GLP-1 receptor agonists (6% vs. 3%, &lt;i&gt;p&lt;/i&gt; &lt; 0.01) and they had higher HbA1c levels (67 (8.3%) versus 61 (7.7%) mmol/mol, &lt;i&gt;p&lt;/i&gt; &lt; 0.01). Similar proportions of both groups were treated with insulin (38% vs","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15481","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675434","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}