Diabetic medicine : a journal of the British Diabetic Association最新文献

{"title":"Social support and diabetes self-care among African American adults with type 2 diabetes: A systematic review.","authors":"Richard Marfo, Dennis Miezah, Musah Abubakari, Ellen Assuah, Sandra Duoduwaa Lartey, Dorothy Wilson, Ernest Asamoah, Evans F Kyei, Rockson Ansong, Michelle Boakye","doi":"10.1111/dme.70414","DOIUrl":"https://doi.org/10.1111/dme.70414","url":null,"abstract":"<p><strong>Aims: </strong>Type 2 diabetes (T2D) disproportionately affects African American adults in the United States, who experience higher complication rates and poorer outcomes. Social support is a key determinant of diabetes self-care, yet evidence in this population remains fragmented. This review aimed to synthesize evidence on the types, soucres and impact of social support on diabetes self-care behaviours among African American adults with T2D.</p><p><strong>Methods: </strong>A systematic review was conducted following PRISMA guidelines and registered with PROSPERO (CRD420261284391). Four databases (PubMed, CINAHL, APA PsycINFO and Web of Science) were searched for studies published between January 2015 and December 2025. Eligible studies included African American adults (≥18 years) with T2D and examined at least one component of social support. Data extraction and quality appraisal using the Mixed Methods Appraisal Tool were performed by multiple reviewers. A convergent narrative synthesis approach was used to integrate qualitative, quantitative and mixed-methods findings due to substantial methodological heterogeneity.</p><p><strong>Results: </strong>Eleven studies (four quantitative, six qualitative and one mixed methods) were included. Social support types included emotional, informational, instrumental, appraisal, spiritual and companionship support, delivered through family, peers, healthcare providers, community health workers and faith-based organizations. Overall, social support was associated with improved adherence to diet, physical activity, medication use and glucose monitoring. Peer-led and culturally tailored interventions were associated with enhanced engagement through shared identity, trust and accountability. Conversely, negative or controlling support was associated with poorer adherence and greater diabetes-related distress.</p><p><strong>Conclusions: </strong>Social support is a multifaceted and culturally embedded determinant of diabetes self-care among African American adults with T2D. Findings suggest that culturally relevant, autonomy-supportive and community-based interventions may strengthen self-management behaviours and help address persistent diabetes disparities.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70414"},"PeriodicalIF":3.4,"publicationDate":"2026-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148665581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 4-week community-implemented diabetes prevention program is associated with improved metabolic outcomes at 12 months after participation.","authors":"J E Bourne, K Cranston, T Dineen, M MacPherson, S Locke, A Santos, N Grieve, A Colyer, K Falkenhain, A N Yildirim, M E Jung","doi":"10.1111/dme.70387","DOIUrl":"10.1111/dme.70387","url":null,"abstract":"<p><strong>Aims: </strong>Small Steps for Big Changes (SSBC) is a 4-week, evidence-based diabetes prevention program delivered by non-medical personnel in community settings. This study explored changes in type 2 diabetes risk factors and health behaviours over 12 months following SSBC program completion.</p><p><strong>Methods: </strong>A single-arm pragmatic trial with repeated measures was conducted in three urban locations in Canada and was delivered virtually during COVID-19. Participants were adults at risk of developing type 2 diabetes (HbA1c 39-46 mmol/mol[5.7-6.4%]). SSBC consists of 6 one-hour sessions involving behavioural counselling and exercise. The primary outcome was HbA1c at 12-month post-program. Secondary outcomes included weight, waist circumference, functional exercise capacity, diet and physical activity behaviour at 12-month post-program.</p><p><strong>Results: </strong>Three hundred and eighty-nine individuals at risk of developing type 2 diabetes were enrolled (mean age = 58.8(8.7) years, 61% White, 68% women), with a 93% session attendance rate. Of 389 enrolled, 172 completed 12-month assessments, of whom 117 had HbA1c at baseline and the 12-month follow-up. At 12 months, participants had significant reductions in HbA1c (-1.91 mmol/mol; -0.19% [95% CI: -2.57, -1.36 mmol/mol; -0.25, -0.13%]), weight (-3.03 [-4.15, -1.93] kg), waist circumference (-4.07 [-5.27, -2.91] cm) and improved distance walked on the six-minute walk test (37.55 [28.58, 46.75] m). Favourable changes in diet and physical activity were also sustained at 12-month post-program.</p><p><strong>Conclusions: </strong>SSBC participation was associated with improvements in key diabetes risk factors at 12-month post-program. These findings suggest that brief, community-based, lay-led programs may have potential for supporting diabetes prevention.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70387"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274502","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":"Towards equitable implementation of AI-assisted screening for diabetic retinopathy: Perspectives on digital literacy, trust and system readiness in developing countries.","authors":"Bela Janare Putra, Rohmiati","doi":"10.1111/dme.70325","DOIUrl":"10.1111/dme.70325","url":null,"abstract":"","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70325"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978493","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":"Application of construction and validation of logistic regression model in risk prediction of non-proliferative diabetic retinopathy in type 2 diabetes mellitus.","authors":"Jiaoyan Zhang, Xiaodong Cao, Xin Yu, Minfeng Jiang, Tianhua Xie, Yangningzhi Wang, Zhengyuan Tang","doi":"10.1111/dme.70374","DOIUrl":"10.1111/dme.70374","url":null,"abstract":"<p><strong>Aims: </strong>Diabetic retinopathy (DR) is a leading cause of vision impairment in type 2 diabetes mellitus (T2DM), with non-proliferative DR (NPDR) representing its most prevalent form. Early identification of high-risk individuals remains challenging due to the complexity and poor interpretability of existing machine learning models. This study aims to develop a clinically interpretable Logistic regression model for NPDR risk prediction using routinely available clinical indicators.</p><p><strong>Methods: </strong>A retrospective cohort of 421 T2DM patients from a single centre was divided into training (n = 295) and validation (n = 126) sets. Demographic, glycemic (fasting glucose, HbA1c), renal (UACR) and ophthalmologic (macular oedema) data were collected. Univariate and multivariate Logistic regression with stepwise selection identified independent predictors. Model performance was evaluated using area under the ROC curve (AUC), sensitivity, specificity and Hosmer-Lemeshow goodness-of-fit. Internal validation was performed via bootstrapping (1000 replicates), and external validation used an independent cohort.</p><p><strong>Results: </strong>Four independent predictors were identified: macular oedema (OR = 3.247), fasting glucose (OR = 2.194), HbA1c (OR = 2.799) and UACR (OR = 1.153). The model demonstrated excellent discrimination in the training set (AUC = 0.949, sensitivity = 86.4%, specificity = 95.5%) and good calibration (H-L test, p = 0.358). Bootstrap validation confirmed stability of HbA1c and UACR. External validation yielded an AUC of 0.918, with a positive predictive value of 91.1% and maintained calibration (p = 0.282).</p><p><strong>Conclusions: </strong>The constructed Logistic regression model accurately predicts NPDR risk using four readily available clinical variables, offering high discriminative power, interpretability and clinical utility for stratifying high-risk T2DM patients in primary care settings.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70374"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059347","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":"Response to letter: 'Towards equitable implementation of AI-assisted screening for diabetic retinopathy: Perspectives on digital literacy, trust and system readiness in developing countries'.","authors":"Umar A R Chaudhry, Lakshmi Chandrasekaran, Alicja R Rudnicka","doi":"10.1111/dme.70345","DOIUrl":"10.1111/dme.70345","url":null,"abstract":"","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70345"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978458","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 burden and health-related quality of life in young adults with type 1 diabetes.","authors":"Anka Van Gastel, Matthijs Graner-Baars, Anne M Stiggelbout, Viet-Thi Tran, Erik J Giltay, Sean F Dinneen, Jessica Mesman, Joris Swaak, Henk-Jan Aanstoot, Victor M Montori, Eelco J P De Koning, Marleen Kunneman","doi":"10.1111/dme.70376","DOIUrl":"10.1111/dme.70376","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to assess the treatment burden and health-related quality of life (HRQoL) in young adults with type 1 diabetes (T1D).</p><p><strong>Methods: </strong>Online survey on experienced treatment burden (Treatment Burden Questionnaire, TBQ, 0-150, higher scores indicate higher burden) and HRQoL (Type 1 Diabetes and Life questionnaire for ages 18-25 and 26-45, T1DAL, 0-100, higher scores indicate better HRQoL) among Dutch young adults with T1D (aged 18-30).</p><p><strong>Results: </strong>In total, 294 young adults with T1D completed the survey. Mean TBQ score was 59.5 (SD = 24.9). Regular medical care reminding participants of their health problems scored highest. Mean T1DAL scores were 55.9 (SD = 12.9) for ages 18-25, and 62.1 (SD = 13.2) for ages 26-30. Lowest scores were in the subcategory 'Emotional experiences and daily activities' (18-25: median = 41.7, IQR = 24.9; 26-30: median = 47.8, IQR = 22.5). TBQ was strongly negatively correlated with T1DAL (r = -0.69, 95% CI [-0.74, -0.62], p < 0.001). Characteristics associated with higher treatment burden and lower HRQoL included female gender, lower time in range and dissatisfaction with diabetes management approach.</p><p><strong>Conclusion: </strong>Young adults with T1D report considerable treatment burden and moderate HRQoL, suggesting a high impact of diabetes care on their lives. Treatment burden is particularly affected by regular medical care activities, whereas diabetes affects the daily functioning and emotional experiences domains of HRQoL. Further research is needed to understand how young adults make care fit and to improve care for these patients, resulting in minimally disruptive care plans. While cautiously interpreted, this may be especially relevant for women and those with adverse clinical outcomes.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70376"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148153130","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":"Type 1 diabetes stigma: A UK survey of adults living with type 1 diabetes.","authors":"Harriet Housby, Akaal Kaur, Ian Godsland, Thomas Wylie, Nick Oliver, Katrina Scior, Vicky McKechnie","doi":"10.1111/dme.70365","DOIUrl":"10.1111/dme.70365","url":null,"abstract":"<p><strong>Aims: </strong>Type 1 diabetes stigma (T1D-stigma) refers to negative social judgement towards people living with type 1 diabetes (T1D) and is linked to poorer psychological well-being and suboptimal diabetes self management. This observational study aimed to explore sociodemographic, diabetes health and well-being factors linked to high stigma scores to inform future, targeted intervention studies.</p><p><strong>Methods: </strong>UK-based adults (aged ≥18 years) with T1D completed an online survey comprising sociodemographic and diabetes health questions, wellbeing measures for anxiety (Generalised Anxiety Disorder Scale: GAD-7), diabetes impact (Impact of Diabetes Profile: DIDP) and depression (Patient Health Questionnaire: PHQ-9) and the Type 1 Diabetes Stigma Assessment Scale (DSAS-1). Potential relationships between sociodemographic, diabetes health and well-being factors and DSAS-1 score were identified by univariate regression and the independence of significant (p < 0.05) relationships was explored in multivariable regression.</p><p><strong>Results: </strong>Of 438 participants, 96% endorsed one or more items on the DSAS-1. In multivariable regression, age (β = -0.136, p = 0.006), sex (β = 0.114, p = 0.006), BMI (β = 0.112, p = 0.023), insulin pump use (β = 0.108, p = 0.015), DIDP score (β = 0.211, p = <0.001), GAD-7 score (β = 0.192, p = 0.002) and PHQ-9 score (β = 0.195, p = 0.002) predicted DSAS-1 score. Ethnicity did not predict DSAS-1 score, nor did age at diagnosis or number of severe hypoglycaemia episodes.</p><p><strong>Conclusion: </strong>Most participants reported at least one instance of T1D-stigma. High DSAS-1 scores in the United Kingdom were predicted by younger age, being a woman, higher BMI, insulin pump use, higher diabetes impact and anxiety and depression scores. Future studies should further explore the impact of T1D-stigma within these groups to tailor appropriate interventions.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70365"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978508","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":"HbA1c improvement in pregnant women with type 1 diabetes using the CamAPS FX automated insulin delivery (AID) system: Clinical and economic outcomes.","authors":"Maria-Eleni Syleouni, Tara T M Lee, Federica Carrieri, Eleanor M Scott, Aesha Khan Mirón, Helen R Murphy","doi":"10.1111/dme.70394","DOIUrl":"10.1111/dme.70394","url":null,"abstract":"<p><strong>Aims: </strong>The Automated Insulin Delivery among Pregnant women with Type 1 diabetes (AiDAPT) trial demonstrated that using the CamAPS FX automated insulin delivery (AID) was associated with improved glycaemic outcomes. This study aimed to assess the clinical and economic impact of improving third-trimester HbA1c.</p><p><strong>Methods: </strong>Using the AiDAPT data, a health economics model was built to estimate clinical outcomes and healthcare resource utilisation associated with third-trimester HbA1c categories (<42 mmol/mol, 42-53 mmol/mol, ≥53 mmol/mol). AiDAPT HbA1c distribution and associated clinical outcomes (obstetric: pre-eclampsia, delivery method; neonatal: length of stay in normal/critical/intensive care) were used to estimate perinatal complications. UK-specific healthcare costs were extracted from the NHS National Schedule and other published sources. Total costs to the UK healthcare system were estimated using an incremental 3.3 mmol/mol (0.3%) HbA1c reduction observed with CamAPS FX AID over Standard Care in AIDAPT.</p><p><strong>Results: </strong>In the model, HbA1c improvement with CamAPS FX AID was associated with projected reductions in pre-eclampsia risk (-13%), high dependency neonatal care days (-16%), neonatal intensive care unit days (-12%) and clinic visits. The model projected cost reduction for the NHS healthcare system of £6,696,636 under conservative modelling assumptions, being cost saving at 96.8% of the simulations. The projected incremental cost difference per woman treated with CamAPS FX AID was -£1016, mainly derived from a modelled shift in the distribution of neonatal care, with reduced length of stay in high dependency neonatal intensive care.</p><p><strong>Conclusion: </strong>CamAPS FX AID improves third-trimester HbA1c with projected cost reductions for the UK healthcare system.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70394"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298599","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":"Fear of hypoglycaemia and parent sleep disturbance in families of young children with type 1 diabetes.","authors":"Susana R Patton, Alexandra D Monzon, Jacob Redel, Holly O'Donnell, Kimberly A Driscoll","doi":"10.1111/dme.70441","DOIUrl":"10.1111/dme.70441","url":null,"abstract":"<p><strong>Background: </strong>Parents of young children with type 1 diabetes (T1D) commonly report fear of hypoglycaemia (FH), which may prompt night-time vigilance and disrupt sleep. We examined whether FH relates to parent-reported sleep disturbance using baseline (pretreatment) data from a multisite randomized clinical trial. We also evaluated whether these associations remain after accounting for other parent concerns and child demographic and device covariates.</p><p><strong>Methods: </strong>Parents of children ages 2-7 years (N = 180) completed questionnaires assessing FH (HFS-PYC), sleep disturbance (PROMIS-S), diabetes distress (PAID-PR), anxiety (PROMIS-A) and depressive symptoms (CESD-R). We collected demographic and clinical data and obtained 14-day continuous glucose monitoring (CGM) downloads from young children when available. We used Pearson correlations, partial correlations and multiple regression models to test FH-sleep associations.</p><p><strong>Results: </strong>Parents reported slightly elevated sleep disturbance (M = 57.9 ± 8.1). Higher FH total, worry and hypoglycaemia avoidance behaviour scores showed positive associations with sleep disturbance in unadjusted models (all p < 0.05). After adjusting for anxiety, diabetes distress and elevated depressive symptoms, FH total and worry scores continued to predict sleep disturbance, whereas hypoglycaemia avoidance behaviours did not. In regression analyses, FH total, diabetes distress and elevated depressive symptoms each uniquely predicted sleep disturbance; anxiety and child clinical/device characteristics did not. In the CGM subset, parent sleep disturbance did not relate to children's glycaemic metrics.</p><p><strong>Conclusions: </strong>FH, particularly worry-driven FH, independently contributes to parent sleep disturbance in families of very young children with T1D. Screening for FH and offering interventions targeting FH worry may help improve parent sleep.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70441"},"PeriodicalIF":3.4,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633571","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":"Potential future directions for research into hypoglycaemia awareness and mental health: The role of substance use, sedative exposure and sleep.","authors":"Chun-Ting Ma, Lien-Chung Wei","doi":"10.1111/dme.70446","DOIUrl":"https://doi.org/10.1111/dme.70446","url":null,"abstract":"","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70446"},"PeriodicalIF":3.4,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148650279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}