Diabetes Spectrum最新文献

{"title":"Connected Insulin Pens and Pen Caps: Expanding Diabetes Technology Access and Adoption.","authors":"Janice MacLeod","doi":"10.2337/dsi25-0001","DOIUrl":"10.2337/dsi25-0001","url":null,"abstract":"<p><p>With the availability of connected insulin pens and pen caps, the most used insulin delivery method around the world has entered the digital age and enabled data-informed care for a broader population. Data from these devices are revealing gaps in care for people on multiple daily injection insulin therapy. Incorporating connected insulin pens and pen caps can significantly improve diabetes management for the people who use them by supporting precision insulin injection management. Health care providers are encouraged to embrace these capabilities and develop person-centric practice protocols for their use. Doing so will expand access to and adoption of diabetes technology for all individuals on insulin therapy, regardless of how they choose to administer their insulin.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"239-248"},"PeriodicalIF":0.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875728","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 Demographic Features on Glycemic Management With Tubeless Automated Insulin Delivery Systems in Youth With Type 1 Diabetes.","authors":"Melinda Li, Noah Feldman, Joshua Ray Tanzer, Elise Tremblay, Kate Millington","doi":"10.2337/ds24-0080","DOIUrl":"10.2337/ds24-0080","url":null,"abstract":"<p><strong>Objective: </strong>Automated insulin delivery (AID) systems have been shown to improve glycemic time in range (TIR) and A1C; however, there are limited data on their use among historically marginalized groups, technology-naive individuals, and young children. This study evaluated whether certain patient features affect the influence of tubeless AID on glycemic metrics in youth with type 1 diabetes.</p><p><strong>Research design and methods: </strong>This was a retrospective chart review involving patients 2-26 years of age with type 1 diabetes who were prescribed a tubeless AID system between January 2021 and May 2023. Demographic and diabetes treatment data were abstracted from the electronic medical record system. Cluster analysis methodology was used to identify clinically relevant patient groups based on demographics and medical history. Generalized mixed-effects modeling was used to compare TIR and A1C between groups.</p><p><strong>Results: </strong>Through review of cluster-identified patient characteristics, 133 participants were assigned to one of four groups. Group 1 (<i>n</i> = 42) was predominantly White and privately insured, group 2 (<i>n</i> = 26) had public insurance or was uninsured and was largely non-White, group 3 (<i>n</i> = 44) had the lowest prior pump usage, and group 4 (<i>n</i> = 21) had the youngest median age at diagnosis and at pump initiation. All groups had an increase in TIR and a decrease in A1C after pump initiation, and there was no difference in the improvement between groups (TIR from 46-47 to 60%, <i>P</i> <0.001 for all groups, and A1C from 8.41-8.44 to 7.45-7.49%, <i>P</i> <0.05 for all groups).</p><p><strong>Conclusion: </strong>Improvements in glycemic management were consistent across groups, despite intragroup differences historically associated with barriers to diabetes management. These findings suggest the importance and potential impact of offering tubeless AID in mitigating care disparities and support its implementation for all youth with type 1 diabetes.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 4","pages":"423-430"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12620742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551364","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":"\"I Just Wish That It Would Be Easier\": Caregivers' Perspectives on Barriers and Proposed Solutions to Diabetes Technology Use for Non-Hispanic Black and Hispanic Youth With Type 1 Diabetes.","authors":"Charlotte W Chen, Alexa J Durante, Margaret G Maynard, Jennifer K Raymond, Marina Reznik, Lori M Laffel, Shivani Agarwal","doi":"10.2337/ds24-0061","DOIUrl":"10.2337/ds24-0061","url":null,"abstract":"<p><strong>Objective: </strong>We sought to examine barriers to diabetes technology use in underserved non-Hispanic Black and Hispanic youth with type 1 diabetes from the caregivers' perspectives and to co-create solutions to overcome barriers.</p><p><strong>Research design and methods: </strong>Using user-centered design methodology, we held virtual workshops with caregivers to identify barriers and solutions associated with diabetes technology use. Three independent coders analyzed workshop recordings using an inductive coding approach.</p><p><strong>Results: </strong>Twenty-three caregivers of non-Hispanic Black and Hispanic youth with type 1 diabetes participated. The majority of participants were mothers (<i>n</i> = 21), were publicly insured (<i>n</i> = 18), and had social needs (<i>n</i> = 13). We uncovered novel barriers to diabetes technology use, including <i>1</i>) health-related social needs specific to diabetes technology use, <i>2</i>) insufficient diabetes technology support at school, <i>3</i>) disjointed care integration, and <i>4</i>) the need for personalized diabetes device education. Proposed solutions included resources for social needs, more technology education for schools, enhanced care coordination, and a nonmedical person to deliver tailored device education.</p><p><strong>Conclusion: </strong>This study revealed new approaches to support caregivers of non-Hispanic Black and Hispanic youth with type 1 diabetes with persistent barriers to device use. Integrating interventions that align with caregivers' needs will facilitate the adoption and sustained use of diabetes technology by non-Hispanic Black and Hispanic youth with type 1 diabetes.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 4","pages":"431-440"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12620741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551408","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":"Parent Engagement in School Health Decisions for Type 1 Diabetes: Barriers to and Facilitators of Collaboration and Implications for Intervention Design.","authors":"Elissa Naame, Martha Pangburn, Jacquelin Rankine, Ingrid Libman, Christine A March","doi":"10.2337/ds25-0004","DOIUrl":"10.2337/ds25-0004","url":null,"abstract":"<p><strong>Objective: </strong>Parent engagement is a frequently cited barrier to school health interventions. Little is known about what influences parent involvement in school health decisions for children with chronic conditions such as type 1 diabetes. We aimed to explore parent perspectives on the factors they believe affect their engagement in school-based type 1 diabetes management to identify potential targets for intervention design and implementation.</p><p><strong>Research design and methods: </strong>We conducted semi-structured interviews with 27 parents of 28 school-aged children (6-15 years of age) with type 1 diabetes from a large academic center. Interview guide questions explored parents' experiences, communication, and relationships with school staff; the impact of diabetes technology; and perceptions of direct communication between schools and health systems. Interviews transcripts were analyzed using a consensus coding approach with thematic analysis to align with the social-ecological model.</p><p><strong>Results: </strong>Parents identified four categories of factors that affected their engagement in school health decisions: <i>1</i>) child-specific factors, such as proximity to diagnosis, self-management skills, and the use of technology; <i>2</i>) family-specific factors, including personal motivations for their child's experience in school and external stressors and demands that may compete with their motivations; <i>3</i>) interpersonal relationships, including parents' trust or mistrust in school health staff and the perceived role of school health staff within the medical team; and <i>4</i>) school district factors, including health staffing and policies for device use.</p><p><strong>Conclusion: </strong>Parental engagement in school-based diabetes care is complex and multifaceted. Using well-timed interventions that address parent priorities, foster trust, enhance communication, and engage technology may mitigate barriers.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"359-367"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875793","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":"Management of Hypoglycemia Using Continuous Glucose Monitoring During Tirzepatide Initiation or Uptitration When Used in Addition to Other Glucose-Lowering Agents.","authors":"Kelsey Mews, Drew Momchilovich","doi":"10.2337/ds24-0074","DOIUrl":"10.2337/ds24-0074","url":null,"abstract":"","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 4","pages":"525-528"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12620735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551385","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":"Adherence to Type 1 Diabetes Care Visits After Transfer From Pediatric to Adult Care: A Prospective Cohort Study.","authors":"Simon Lafontaine, Elise Mok, Jennifer Frei, Kaberi Dasgupta, Elham Rahme, Marc Dorais, Lorraine Bell, Meranda Nakhla","doi":"10.2337/ds24-0090","DOIUrl":"10.2337/ds24-0090","url":null,"abstract":"<p><strong>Objective: </strong>The objectives of this study were to describe health care utilization by adolescents and young adults with type 1 diabetes after transfer from pediatric to adult care and to determine predictors of nonadherence to diabetes care visits after this transition.</p><p><strong>Research design and methods: </strong>This was a prospective cohort study following adolescents with type 1 diabetes for 18 months after their last pediatric visit from 2017 to 2021. We assessed health care utilization using Quebec health administrative data. The primary exposure was delay in establishing adult diabetes care, defined as a delay of >6 months between the last pediatric and the first adult diabetes care visit. Secondary exposures were self-reported self-efficacy, transition readiness, and diabetes distress before transferring to adult care. The primary outcome was nonadherence, defined as having gap(s) of >6 months between adult diabetes care visits. Secondary outcomes were one or more diabetes-related emergency department (ED) visit and one or more diabetes-related hospitalization. We used multivariable logistic regression to identify predictors of nonadherence to diabetes care visits after transition to adult care.</p><p><strong>Results: </strong>Fifteen of 74 participants (20%) had delays in establishing adult diabetes care. Twenty participants (27%) were nonadherent to adult diabetes care visits. Six participants (8.1%) had one or more ED visit, and one participant (1.4%) was hospitalized after transferring to adult care. Delay in establishing adult care was associated with subsequent nonadherence to adult diabetes care visits (adjusted odds ratio 29.9, 95% CI 5.3-169.9).</p><p><strong>Conclusion: </strong>Health care utilization after transfer to adult care is suboptimal in young adults with type 1 diabetes. Delayed transfer of care puts young adults at risk of disengaging from adult diabetes care.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"327-334"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875725","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":"A Case Report on the Metabolic Effects of a Very-Low-Carbohydrate Ketogenic Diet in a Patient With <i>HNF1A</i>-Related Maturity-Onset Diabetes of the Young.","authors":"Anum Sheikh, Sadia Nasir, Catherine Flanagan, Latika Sibal","doi":"10.2337/ds24-0083","DOIUrl":"10.2337/ds24-0083","url":null,"abstract":"","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"372-376"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875722","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":"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}