Diabetes Spectrum最新文献

{"title":"Using Second-Generation Anti-Obesity Medications.","authors":"Sarah H Schmitz, Louis J Aronne","doi":"10.2337/dsi24-0002","DOIUrl":"10.2337/dsi24-0002","url":null,"abstract":"<p><p>Second-generation anti-obesity medications are more effective than their first-generation predecessors, resulting in an average weight loss of 15% when combined with lifestyle modifications. This article examines the efficacy and therapeutic implications of the three currently approved second-generation medications: setmelanotide for individuals with monogenic forms of obesity, semaglutide 2.4 mg, and tirzepatide. Particular emphasis is placed on the concurrent treatment of obesity and type 2 diabetes with semaglutide 2.4 mg and tirzepatide.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"37 4","pages":"303-312"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802616","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 Guideline-Directed Approach to Obesity Treatment.","authors":"Ariana M Chao, Alexandra Paul, Josef V Hodgkins, Thomas A Wadden","doi":"10.2337/dsi24-0001","DOIUrl":"10.2337/dsi24-0001","url":null,"abstract":"<p><p>This article summarizes and compares 18 sets of guidelines for adult obesity treatment, highlighting key recommendations for patient evaluation, lifestyle intervention, anti-obesity medications (AOMs), and metabolic and bariatric surgery. Guidelines are consistent in many regards, although there is divergence regarding preferred AOMs. Metabolic and bariatric surgery is still recognized as the most durable form of obesity treatment, and newer guidelines suggest these procedures at lower BMI thresholds for people with uncontrolled type 2 diabetes. Overall, guidelines for obesity treatment show a high degree of agreement, although updates are needed to incorporate new treatment innovations.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"37 4","pages":"281-295"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802669","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 of a Novel Continuous Glucose Monitoring-Informed Insulin Bolus Calculator Mobile Application for People With Type 1 or Type 2 Diabetes.","authors":"Mansur Shomali, Colleen Kelly, Abhimanyu Kumbara, Anand Iyer, Jean Park, Grazia Aleppo","doi":"10.2337/ds24-0032","DOIUrl":"10.2337/ds24-0032","url":null,"abstract":"<p><strong>Background: </strong>Managing bolus insulin dosing can be a significant burden for people with diabetes, many of whom have limited numeracy skills. Insulin bolus calculators (IBCs) may improve glycemia as well as treatment satisfaction.</p><p><strong>Objective: </strong>The purpose of this study was to demonstrate the safety of a novel, continuous glucose monitoring (CGM)-informed IBC mobile device app that applies trend arrow adjustments to bolus insulin dose recommendations.</p><p><strong>Research design and methods: </strong>This clinical trial was an open-label, industry-sponsored single-arm study conducted at two sites. Fifty-four participants with type 1 or type 2 diabetes were enrolled and used the IBC app on their mobile device for 30 days. Study participants were adults who were already using CGM and dosing bolus insulin. The analysis examined both noninferiority and superiority of time in range (TIR) during the study period compared with baseline. Other important end points included hypoglycemia, glucose variability, nocturnal and diurnal TIR, and diabetes distress. The per-protocol (PP) group was defined as participants who used the IBC >30 times during the study.</p><p><strong>Results: </strong>Mean TIR improved by 3.8% (95% CI 0.7-6.9%) from 69.2 to 73.0% (<i>P</i> = 0.017) in the PP group. This TIR corresponds to a mean of 0.9 more hours per day spent in range, and the improvement was driven by those with type 2 diabetes. There was no increase in measures of hypoglycemia or diabetes distress. Exploratory analysis revealed a reduction in measures of glucose variability. In addition, individuals with type 1 diabetes had greater improvements in diurnal TIR than in nocturnal TIR.</p><p><strong>Conclusion: </strong>A CGM-informed IBC app that applies trend arrow adjustments to bolus insulin dose recommendations improved TIR without increasing hypoglycemia or diabetes distress in individuals with type 1 or type 2 diabetes.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 2","pages":"153-160"},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095217","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":"Diabetes On Track: Redesigning Diabetes Management in Rural Primary Care.","authors":"Kristin L Pullyblank, Leslie A Eiland, Stephen M Mohring, Stephanie Nygaard, Sarah S Keegan, Christopher S Wichman, Cyrus Desouza","doi":"10.2337/ds24-0043","DOIUrl":"10.2337/ds24-0043","url":null,"abstract":"<p><strong>Objective: </strong>Diabetes remains an intractable public health problem, particularly in rural communities. The Diabetes On Track initiative returns control of designing and implementing strategies to improve diabetes care delivery systems to the local clinics and community partners. This article reports on protocol development and the first 18 months of the Diabetes On Track project within the health care setting.</p><p><strong>Research design and methods: </strong>Using a rapid-cycling quality improvement approach, the research team partnered with two rural clinics. Clinics completed a strengths and needs assessment before being offered a menu of possible strategies to implement. Clinics worked with the research team to implement, refine, and adapt these initial interventions and develop further strategies based on local data that were continually collected and shared. Six core indicators were established as primary outcome measures. Process measures were established based on the strategies chosen.</p><p><strong>Results: </strong>Both clinics decided to create a registered nurse health coach position to provide diabetes education to individuals with or at risk for developing diabetes. Both clinics also chose to implement a physician dashboard highlighting diabetes-related indicators so clinicians could track panel improvement over time. Other interventions included using a prediabetes outreach list and taking advantage of professional development opportunities, including a diabetes-focused Project ECHO (Extension for Community Healthcare Outcomes) series.</p><p><strong>Conclusion: </strong>Improving diabetes care in rural communities is a challenge, and novel solutions are needed, with a focus on sustainability. The Diabetes On Track initiative is showing promising results, allowing primary care clinics to use community knowledge and data to redesign effective diabetes care delivery systems.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 2","pages":"145-152"},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095147","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 Prescribing Patterns Before and After Short-Term, Pharmacist-Led Type 2 Diabetes Service in an Endocrinology Clinic.","authors":"Rita Parsiani, Francine Mendoza, Leah Wilson, Farahnaz Joarder, Roula Zahr, Andrew Ahmann, Siting Chen, Haemin Lee","doi":"10.2337/ds24-0046","DOIUrl":"10.2337/ds24-0046","url":null,"abstract":"","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 2","pages":"194-200"},"PeriodicalIF":0.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095201","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":"LGBTQ+ Supportive and Inclusive Care Practices: Survey Data From the T1D Exchange Quality Improvement Collaborative.","authors":"Jaquelin Flores Garcia, Shideh Majidi, Ann Mungmode, Mark W Reid, Carla Demeterco-Berggen, Nicole Rioles, Margarita Ochoa-Maya, David M Maahs, Ryan J McDonough, Osagie Ebekozien, Jennifer K Raymond","doi":"10.2337/ds24-0025","DOIUrl":"10.2337/ds24-0025","url":null,"abstract":"<p><strong>Objective: </strong>Living with type 1 diabetes is challenging, but more barriers exist when one also identifies as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, or other gender-expansive identities). Acknowledging the importance of identifying this population and providing personalized care, the Health Resources and Services Administration mandated institutions to document sexual orientation and gender identity (SOGI) data. To understand the current state of SOGI documentation in the T1D Exchange Quality Improvement Collaborative, a survey assessing LGBTQ+ supportive and inclusive care practices was given to affiliated sites.</p><p><strong>Research design and methods: </strong>Thirty-three pediatric and 21 adult care centers were surveyed via Qualtrics. The survey included questions about their electronic health record documentation of patient-identified gender, pronouns, sexual orientation, and sex assigned at birth (SAAB). Care centers also reported on the legality of gender-affirming care in their municipalities, as well as their willingness to change SAAB after patients meet requirements. Fisher exact tests were used to evaluate response frequencies.</p><p><strong>Results: </strong>All 33 of the pediatric centers and 81% (17 of 21) of the adult centers responded to the survey. Sixty-four percent of pediatric centers had established strategies to support SOGI documentation, whereas only 50% of adult centers had implemented strategies. Some adult centers could not confirm whether they documented SOGI. Differences were seen between the pediatric and adult endocrinology centers in their documentation of gender identity (<i>P</i> = 0.04) and pronouns (<i>P</i> = 0.02).</p><p><strong>Conclusion: </strong>Although most endocrinology centers documented gender identity and pronouns, fewer documented sexual orientation. Further work is needed to improve SOGI documentation and assess its impact on LGBTQ+ patients with diabetes.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 2","pages":"124-132"},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095204","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":"Life Lessons and Diabetes Research.","authors":"Paula M Trief","doi":"10.2337/ds24-0065","DOIUrl":"10.2337/ds24-0065","url":null,"abstract":"<p><p>This article was adapted from the address Dr. Trief delivered as the recipient of the American Diabetes Association's Richard R. Rubin Award for 2024. This award recognizes a behavioral researcher who has made outstanding, innovative contributions to the study and understanding of the behavioral aspects of diabetes in diverse populations. Dr. Trief delivered the address in June 2024 at the Association's 84th Scientific Sessions.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 1","pages":"108-114"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433851","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":"Lessons Learned: Diabetes Education for One and for All.","authors":"Patti Urbanski","doi":"10.2337/ds24-0067","DOIUrl":"10.2337/ds24-0067","url":null,"abstract":"<p><p>This article is adapted from a speech Ms. Urbanski delivered in June 2024 as President, Health Care & Education, of the American Diabetes Association. She delivered her address at the Association's 84th Scientific Sessions.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 1","pages":"101-107"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433734","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":"Evaluation of a Standardized Obstetrics Insulin Drip Protocol and Order Set.","authors":"Margaret Davis, Kristina Naseman, Noelle Leung, Aric Schadler","doi":"10.2337/ds24-0011","DOIUrl":"10.2337/ds24-0011","url":null,"abstract":"<p><strong>Objective: </strong>The prevalence of pregnancies affected by diabetes is increasing, with the Centers for Disease Control and Prevention reporting that 1-2% of pregnant women have type 1 or type 2 diabetes and up to 10% of pregnancies are affected by gestational diabetes as of 2018. Maternal glycemic management is directly related to fetal and neonatal outcomes, and aberrant maternal hyperglycemia has known negative outcomes. Although most of glycemic management centers on outpatient treatment, evidence exists to support the use of intravenous insulin drips during inpatient admissions. This study aimed to evaluate an intravenous insulin protocol specific to the obstetric (OB) population.</p><p><strong>Research design and methods: </strong>This was a single-center retrospective pre-/post- cohort study of OB patients with diabetes admitted to an academic medical center. Groups were differentiated based on admission date and protocol implementation with a 6-month washout period. Included patients received an intravenous insulin drip around either antenatal corticosteroid administration or during labor and delivery. Those who were within 7 days of receiving a diabetic ketoacidosis diagnosis or who were admitted to an intensive care unit were excluded.</p><p><strong>Results: </strong>Fifty-nine patients received 69 distinct insulin drip orders. Twelve drips were included in the group admitted before initiation of the insulin drip protocol (pre-group) and 57 in the group admitted after the protocol went into effect (post-group). Time spent within the goal glucose range while on an insulin drip in the pre-group was 1.63% compared with 39.30% in the post-group (<i>P</i> <0.001). Glucose levels <70 mg/dL was 0.00% in the pre-group compared with 3.23% in the post-group (<i>P</i> = 0.045). There were no differences in severe hypoglycemia (glucose <50 mg/dL), hyperglycemia (glucose >110 mg/dL), or neonatal outcomes.</p><p><strong>Conclusion: </strong>Implementation of a nursing-driven, obstetrics-specific intravenous insulin drip protocol significantly improved maternal glycemic management within a goal glucose range of 70-110 mg/dL during antenatal corticosteroid administration and labor and delivery.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 1","pages":"68-74"},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434254","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":"Comparison of the Efficacy of Type 2 Diabetes Group Training Courses With and Without the Integration of mHealth Support in a Controlled Trial Setting: Results of a Comparative Pilot Study.","authors":"Melanie Roth, Johanna Bodenhofer, Magdalena Fischill-Neudeck, Caroline Roth, Michael Domhardt, Gerlinde Emsenhuber, Babette Grabner, Gertie J Oostingh, Anja Schuster","doi":"10.2337/ds24-0012","DOIUrl":"10.2337/ds24-0012","url":null,"abstract":"<p><strong>Objective: </strong>This study assessed the effects on type 2 diabetes self-management education provided in group courses with or without a supporting smartphone application (the DM2CUA app).</p><p><strong>Research design and methods: </strong>This open-label, cluster-randomized, controlled, multicenter pilot study involved three Austrian diabetes educational group courses. People with type 2 diabetes in the control group received a regular educational group course, whereas those in the intervention group received the same course plus the use of the DM2CUA app. The app prompted participants to carry out educational tasks that were discussed in the course. After the last lesson, the app provided participants with relevant messages for another 4 weeks. The primary outcome measure was the Diabetes Self-Management Questionnaire score assessed at four time points. Secondary outcome measures included scores on the Diabetes Distress Scale and the Health Education Impact Questionnaire and A1C levels.</p><p><strong>Results: </strong>Participants in the intervention group already had a higher level of diabetes self-management at the start, but the median score showed further improvement during the entire study period.</p><p><strong>Conclusion: </strong>Findings from this pilot study suggest that the DM2CUA app may have a positive impact on diabetes self-management.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 1","pages":"58-67"},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434250","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}