Diabetes Spectrum最新文献

{"title":"Limitations of Continuous Glucose Monitoring in the Pediatric Total Pancreatectomy With Islet Autotransplantation Population: Comparing Patient Experiences of the Dexcom and FreeStyle Libre Systems.","authors":"Bhavapriya Mani, Lindsey Hornung, Chelsie Fellman, Maisam Abu El-Haija, Siobhan Tellez, Deborah Elder","doi":"10.2337/ds24-0073","DOIUrl":"10.2337/ds24-0073","url":null,"abstract":"<p><strong>Objective: </strong>Continuous glucose monitoring (CGM) systems reduce self-monitoring burden compared with glucose meter use but have limitations when used after total pancreatectomy with islet autotransplantation (TPIAT). An example is false elevation of sensor readings after hydroxyurea (HU) administration, a medication often used after TPIAT. This study compared user experiences of CGM not affected by HU with CGM affected by HU in pediatric patients post-TPIAT.</p><p><strong>Research design and methods: </strong>This was a retrospective study of 20 TPIAT patients. Caregivers were informed of known limitations and chose the CGM system for postoperative use. Ten chose a Dexcom, and 10 chose a FreeStyle Libre CGM system. Demographic data and caregiver-reported CGM concerns were collected up to 16 weeks after discharge.</p><p><strong>Results: </strong>Half of Dexcom users reported false hypoglycemia alerts that resolved with repositioning, recalibration, or sensor change. False hyperglycemia was an anticipated outcome and therefore not reported as concerning. Eight FreeStyle Libre users reported false hypoglycemia and frequent alarms that persisted despite sensor changes, which limited device supply. These concerns could not be independently resolved, contributed to caregiver distress, and interrupted sleep. More FreeStyle Libre patients switched to Dexcom than Dexcom patients who switched to a FreeStyle Libre system (70 vs. 10%, <i>P</i> = 0.02) by a median of 2.9 weeks after discharge.</p><p><strong>Conclusion: </strong>Caregivers reported frequent false alarms on both systems. The frequency of false hypoglycemia with FreeStyle Libre was an unexpected limitation with an unclear cause. The inability to calibrate the FreeStyle Libre likely contributed to frequent sensor changes and supply depletion. The ability to recalibrate the Dexcom system may provide an advantage, but not for people taking HU. Knowledge of CGM limitations post-TPIAT can help individuals make informed decisions.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"300-306"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Performance Improvement Using Team Resources and Continuous Glucose Monitoring in Patients With Poorly Controlled Type 2 Diabetes.","authors":"Andrew Behnke, Kara S Lucas, Christopher G Parkin, Varsha Reddy, Michele Orlowski, Ailene Edwards","doi":"10.2337/ds24-0085","DOIUrl":"10.2337/ds24-0085","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to assess the impact of an interdisciplinary diabetes care team approach using continuous glucose monitoring (CGM) on glycemic outcomes in a population of adults with type 2 diabetes with suboptimal glycemic control.</p><p><strong>Research design and methods: </strong>This 6-month, longitudinal observational study was conducted at the outpatient endocrinology clinic of Carilion Clinic in Roanoke, VA. The intervention included use of CGM and weekly interactions either virtually or by telephone by one of the team members. The primary outcomes were changes in A1C, average glucose, and glycemic time in range (TIR; 70-180 mg/dL) over the 6-month observation period. Changes in diabetes medications were also assessed.</p><p><strong>Results: </strong>Twenty-one adults with type 2 diabetes and a baseline A1C >9% were included in the analysis. At 6 months, A1C levels decreased from 11.3 to 7.6%, average glucose decreased from 212.8 to 159.5 mg/dL, and TIR increased from 44.5 to 67.7%.</p><p><strong>Conclusion: </strong>These results suggest that an interdisciplinary team approach in combination with CGM and frequent interaction is effective in improving glycemic outcomes in a high-risk population. Studies of longer duration are needed to further elucidate the efficacy of this intervention.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"353-358"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Effectiveness of Tirzepatide in Solid-Organ Transplant Recipients.","authors":"Helen Sweiss, Ryan Flores, Samantha Windler, Reed Hall, Suverta Bhayana, Rupal Patel, Christina Long","doi":"10.2337/ds24-0071","DOIUrl":"10.2337/ds24-0071","url":null,"abstract":"","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"368-371"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Effects of the Integrated Perinatal Diabetes Education and Management Program.","authors":"Loral Patchen, Asli McCullers, Serenity Budd, Melanie Browning, Shrey Mathur, Kristopher Wu, Rebecca Dills, Stacee Silagi, Jennifer Welch, Victoria Greenberg","doi":"10.2337/ds24-0076","DOIUrl":"10.2337/ds24-0076","url":null,"abstract":"<p><strong>Objective: </strong>The Integrated Perinatal Diabetes Education and Management Program (IP-DEMP) was launched to improve outcomes of pregnant and postpartum individuals with diabetes at a large, urban academic hospital system. The purpose of this study was to evaluate treatment outcomes achieved by program participants.</p><p><strong>Research design and methods: </strong>This retrospective cohort study compared diabetes treatment received by participants in the IP-DEMP with diabetes treatment in a historical comparison group at the same health care facility just before implementation of the IP-DEMP. Logistic regression was used to model the association of participation in the intervention with treatment, adjusting for covariates.</p><p><strong>Results: </strong>A total of 355 people were included in the analysis. Descriptive characteristics were similar between the intervention and comparison groups. Among participants with gestational diabetes mellitus (GDM), participation in the intervention group significantly increases the likelihood of receiving insulin, the gold-standard therapy during pregnancy. No significant differences in therapy received were observed among participants with different racial and ethnic identities.</p><p><strong>Conclusion: </strong>People with GDM who participated in the IP-DEMP were more likely to receive insulin therapy. Treatment received was not different for participants from historically marginalized groups.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"321-326"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Actionability of Genetic Variants in Diabetes: Core Aspects and Applied Examples.","authors":"Sarah Yvonnet, Pauline Kromann Reim, Anne Cathrine Baun Thuesen","doi":"10.2337/ds24-0081","DOIUrl":"10.2337/ds24-0081","url":null,"abstract":"<p><p>Diabetes is a complex and highly heterogeneous disease, and its traditional division into broad diagnostic categories such as type 1 diabetes and type 2 diabetes fails to capture its underlying pathology, which can lead to diagnostic misclassification and suboptimal treatment. Growing evidence of the genetic components of diabetes combined with advancements in and availability of genomic technologies have created high expectations for precision medicine in the field of diabetes, which have yet to be met. Successfully implementing genomic precision medicine in the clinical setting requires bridging the translational gap between research and practice. At the core of this effort lies the concept of actionability, which lacks a clear, cross-disciplinary definition and robust and broadly accepted criteria to assess when and in which contexts a genetic variant is actionable. This work is a collaborative effort between philosophy of medicine and biomedical science disciplines that seeks to provide a framework to assess the actionability of genetic variants in the treatment and management of diabetes. Building on the scientific, medical, and philosophical literature and using an example case study, the authors describe core aspects of actionability and evaluate the tensions between research and practice, diagnosis and discovery, and clinical actionability and relevance.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"343-352"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of School Versus Summer on Sleep and Glycemic Outcomes in School-Aged Children With Type 1 Diabetes.","authors":"Nikita M Patel, Casey Sakamoto, Angela J Karami, Erin C Cobry","doi":"10.2337/ds24-0063","DOIUrl":"10.2337/ds24-0063","url":null,"abstract":"<p><strong>Objective: </strong>Sleep is critically important to children's well-being, and inadequate sleep duration significantly increases the risk for poor health outcomes. Insufficient sleep is a common finding in the pediatric population, specifically among individuals with type 1 diabetes. The aim of this study is to determine whether there are differences in sleep and glycemic outcomes between the summer and the school year among school-aged children with type 1 diabetes.</p><p><strong>Research design and methods: </strong>School-aged children with type 1 diabetes enrolled in a hybrid closed-loop (HCL) automated insulin delivery (AID) and sleep study wore actigraphy watches and completed sleep diaries and surveys to assess their sleep quality and duration. Glycemic outcomes and sleep data were analyzed to determine variability between the summer and school year.</p><p><strong>Results: </strong>On average, children (6-17 years of age) with type 1 diabetes using an HCL AID system slept more during the school year than in the summer, although this difference did not achieve statistical significance (442.2 vs. 483.3 minutes, <i>P</i> = 0.053). There was also no statistically significant difference in glycemic control between summer and the school year.</p><p><strong>Conclusion: </strong>School-aged children with type 1 diabetes using a hybrid closed-loop AID system did not experience statistically significant differences in sleep or glycemic outcomes between summer and the school year. Use of a hybrid closed-loop AID system may play a role in eliminating variations in sleep and glycemic outcomes between summer and the school year. Sleep is a crucial factor in the management of type 1 diabetes, and further research is needed to identify interventions to improve sleep among school-aged children.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"294-299"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Diabetes Distress and Self-Efficacy as Mediators of Barriers to Diabetes Self-Management in Young Adults With Type 1 Diabetes: A Cross-Sectional Study.","authors":"Ngozi D Nnoli, John Sideris, Pey-Jiuan Lee, Steven Fox, Jennifer K Raymond, Elizabeth A Pyatak","doi":"10.2337/ds24-0087","DOIUrl":"10.2337/ds24-0087","url":null,"abstract":"<p><strong>Objective: </strong>This study examined how structural and contextual barriers, including social needs and gender, influence diabetes self-management (DSM) through psychosocial pathways, particularly diabetes distress (DD) and self-efficacy (SE). Although these barriers are well documented, their interactions with psychosocial factors remain underexplored.</p><p><strong>Research design and methods: </strong>We analyzed cross-sectional baseline data from the REAL-T (Resilient, Empowered, Active Living-Telehealth) study (<i>n</i> = 198). Using hierarchical regression, we assessed factors influencing DSM. Structural predictors included unmet social needs and limited insulin access; contextual predictors included gender and ethnicity. Hypothesized mediators were the scores on the Diabetes Distress Scale, the Diabetes Empowerment Scale, and the Audit of Diabetes Dependent Quality of Life. After identifying significant predictors and potential mediators through hierarchical multivariate regression analysis, separate path models were tested for each hypothesized mediator.</p><p><strong>Results: </strong>Unmet social needs, as well as female and nonconforming genders, were found likely to increase DSM challenges. All selected predictors became nonsignificant when accounting for all psychosocial variables. DD mediated all tested relationships, and SE partially mediated the relationship between unmet social needs and DSM.</p><p><strong>Conclusion: </strong>The proposed model suggests the need for targeted interventions addressing psychosocial pathways, particularly DD and SE, to mitigate the downstream effects of structural barriers to DSM. Inclusive gender-specific care models and systemic reforms to reduce social inequities are crucial for improving DSM outcomes and overall well-being.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"335-342"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-Analytic Insights Into Mindfulness Approaches for Depression and Diabetes Comorbidity Care.","authors":"Kenni Wojujutari Ajele, Erhabor Sunday Idemudia","doi":"10.2337/ds24-0048","DOIUrl":"10.2337/ds24-0048","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the effectiveness of mindfulness-based interventions (MBIs) in managing comorbid depression and diabetes by assessing their efficacy in reducing depressive symptoms and improving glycemic control, while addressing inconsistencies in existing research.</p><p><strong>Research design and methods: </strong>A systematic review and meta-analysis were conducted of 17 randomized controlled trials published between 2013 and 2024 and involving 1,336 participants with diabetes and depressive symptoms. Effect sizes were calculated using Hedges' <i>g</i> and random-effects models, with heterogeneity assessed using <i>I</i> ² statistics.</p><p><strong>Results: </strong>MBIs significantly reduced depressive symptoms (standardized mean difference [SMD] -0.88, 95% CI -1.34 to -0.42) with high heterogeneity (<i>I</i> ² = 90%) and improved A1C levels (SMD -0.23, 95% CI -0.38 to -0.08). Among intervention types, mindfulness-based stress reduction (SMD -1.02, 95% CI -1.57 to -0.48) and mindfulness-based cognitive therapy (SMD -0.92, 95% CI -1.45 to -0.39) showed strong effects. Effects varied by region, with Asian studies showing greater benefits (SMD -1.44) compared with North American studies (SMD -0.61).</p><p><strong>Conclusion: </strong>MBIs are effective in reducing depressive symptoms and improving glycemic control in individuals with comorbid diabetes and depression. These findings highlight the importance of culturally adapted approaches and call for further research to refine MBI applications in diabetes care.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"307-320"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot Study: Improving Glycemic Control Among Children and Adolescents With Obesity and Prediabetes With Real-Time Feedback Via Continuous Glucose Monitoring.","authors":"Zachary Z Mayer, Timothy P Foster, Xiaofei Chi, Michael A Tan, Matthew J Gurka, Angelina V Bernier","doi":"10.2337/ds24-0051","DOIUrl":"10.2337/ds24-0051","url":null,"abstract":"<p><strong>Objective: </strong>To assess the feasibility and efficacy of a novel use of continuous glucose monitoring (CGM) in prediabetes to promote behavioral change and improve glycemia.</p><p><strong>Research design and methods: </strong>We conducted a single-arm prospective study in a pediatric obesity clinic to evaluate the feasibility and acceptability of wearing a CGM sensor in children aged 10-17 years with obesity (BMI ≥95th percentile for age) and prediabetes. Feasibility was determined through participant recruitment. We analyzed differences in A1C, glucose variability, BMI, and dietary intake at 12 weeks.</p><p><strong>Results: </strong>Of 22 participants recruited, 14 completed the study. Over 12 weeks, the mean BMI percentage of the 95th percentile decreased from 153.4 to 150.1% (<i>P</i> = 0.006), daily estimated carbohydrate consumption decreased by 41.4% (<i>P</i> = 0.009), and A1C decreased by 0.2% (<i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>CGM in an adolescent population with prediabetes and obesity may be a helpful adjunct to therapy to improve A1C, support dietary changes, reduce the rate of weight gain, and attenuate diabetes risk.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"279-284"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregestational Diabetes Intervention Pilot Study With Diabetes Self-Management Education and Support and Cellular-Enabled Glucose Meter.","authors":"Kathy Fincher, Casey Fiocchi, Jessica Odom, Michelle Stancil, Hannah White, Megan Schellinger","doi":"10.2337/ds24-0052","DOIUrl":"10.2337/ds24-0052","url":null,"abstract":"<p><strong>Objective: </strong>Uncontrolled diabetes in pregnancy is associated with maternal and fetal complications. Individuals with pregestational diabetes require frequent glucose monitoring and insulin adjustments to meet glycemic targets. The purpose of the study was to provide improved management of diabetes during pregnancy and up to 6 weeks postpartum, improve patient understanding of diabetes and diabetes self-management, and develop a multidisciplinary obstetrics workflow model for women with diabetes that is both replicable and self-sustaining.</p><p><strong>Research design and methods: </strong>Fifty participants who were pregnant, diagnosed with type 1 or type 2 diabetes, and ≥18 years of age comprised two groups: a historical group who received traditional diabetes education and an intervention group who received traditional diabetes education enhanced with a cellular-enabled glucose meter, both alongside their prenatal medical appointments. In the intervention group, glucose levels were monitored daily via a cloud-based portal in addition to traditional weekly review, and outreach was initiated when glucose levels met thresholds. Diabetes medications were adjusted as needed in both groups. Practice, clinical, and glycemic data were extracted from the electronic medical record and cloud portal.</p><p><strong>Results: </strong>Neonatal hypoglycemia was reduced (<i>P</i> = 0.047) and more participants used continuous glucose monitoring (<i>P</i> = 0.01) in the intervention group. Communication by text and telephone occurred more frequently in the intervention group (<i>P</i> = 0.007 and <i>P</i> = 0.011, respectively). The intervention group also received more diabetes education (4.44 vs. 2.89 hours, <i>P</i> = 0.030). Differences in other clinical, practice, or glycemic outcomes did not differ significantly.</p><p><strong>Conclusion: </strong>Enhanced care with a cellular-enabled glucose meter facilitated remote patient monitoring with accurate glucose data. The intervention group received more hours of diabetes education and more text and telephone contact. Review of glucose data via the cloud-based portal increased the identification of hypoglycemic and hyperglycemic events, informing delivery decisions. Delivery was earlier for the intervention group, yet rates of neonatal hypoglycemia were reduced.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"285-293"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}