Frontiers in clinical diabetes and healthcare最新文献

{"title":"\"I want to be there for my children\": fatherhood, diabetes and temporality among Peruvian men.","authors":"M Amalia Pesantes,&nbsp;Isabella Ferrazza,&nbsp;J Jaime Miranda","doi":"10.3389/fcdhc.2023.1207028","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1207028","url":null,"abstract":"<p><strong>Introduction: </strong>Living with a chronic condition is a challenging experience, as it can disrupt your capacity to function and fulfill social roles such as being a father. Fatherhood constitutes an important component of masculinity that has not received significant attention in studies aimed at understanding the role of gender norms in health-related behaviors. Fatherhood refers to the set of social expectations placed on men to provide, protect, and care for those considered his children. Our paper aims to show the importance of understanding men's perspectives around fatherhood and its relevance for staying healthy.</p><p><strong>Methods: </strong>In-depth semi-structured interviews with men living with Type 2 diabetes in Peru to explore their experiences with diabetes management.</p><p><strong>Results: </strong>Eighteen Peruvian men, diagnosed with Type 2 diabetes for at least one year and with ages between 27 and 59 years old were interviewed. They had an average of three children each and were all insured under the national insurance plan aimed at low-income groups in Peru. Their accounts described their concern of not being able to fulfill their roles as fathers as a result of their condition. They mentioned the importance of being physically and emotionally present in the lives of their children, taking care of them, and being an example. These concerns varied depending on the age of their children: those with younger children were more preoccupied with ensuring they stayed healthy. Temporality provides a relevant analytical approach to understand the interplay of fatherhood and motivation for diabetes management.</p><p><strong>Discussion: </strong>Our study advances the research around the intersection between health and gender norms and argues that a more nuanced understanding of the construction of masculinity and the relevance of fatherhood in the lives of men could be useful to design and identify better health promotion strategies tailored to men with diabetes.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"4 ","pages":"1207028"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10603236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415732","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":"Vascular deficits contributing to skeletal fragility in type 1 diabetes.","authors":"Adina E Draghici, Bita Zahedi, J Andrew Taylor, Mary L Bouxsein, Elaine W Yu","doi":"10.3389/fcdhc.2023.1272804","DOIUrl":"10.3389/fcdhc.2023.1272804","url":null,"abstract":"<p><p>Over 1 million Americans are currently living with T1D and improvements in diabetes management have increased the number of adults with T1D living into later decades of life. This growing population of older adults with diabetes is more susceptible to aging comorbidities, including both vascular disease and osteoporosis. Indeed, adults with T1D have a 2- to 3- fold higher risk of any fracture and up to 7-fold higher risk of hip fracture compared to those without diabetes. Recently, diabetes-related vascular deficits have emerged as potential risks factors for impaired bone blood flow and poor bone health and it has been hypothesized that there is a direct pathophysiologic link between vascular disease and skeletal outcomes in T1D. Indeed, microvascular disease (MVD), one of the most serious consequences of diabetes, has been linked to worse bone microarchitecture in older adults with T1D compared to their counterparts without MVD. The association between the presence of microvascular complications and compromised bone microarchitecture indicates the potential direct deleterious effect of vascular compromise, leading to abnormal skeletal blood flow, altered bone remodeling, and deficits in bone structure. In addition, vascular diabetic complications are characterized by increased vascular calcification, decreased arterial distensibility, and vascular remodeling with increased arterial stiffness and thickness of the vessel walls. These extensive alterations in vascular structure lead to impaired myogenic control and reduced nitric-oxide mediated vasodilation, compromising regulation of blood flow across almost all vascular beds and significantly restricting skeletal muscle blood flow seen in those with T1D. Vascular deficits in T1D may very well extend to bone, compromising skeletal blood flow control, and resulting in reduced blood flow to bone, thus negatively impacting bone health. Indeed, several animal and <i>ex vivo</i> human studies report that diabetes induces microvascular damage within bone are strongly correlated with diabetes disease severity and duration. In this review article, we will discuss the contribution of diabetes-induced vascular deficits to bone density, bone microarchitecture, and bone blood flow regulation, and review the potential contribution of vascular disease to skeletal fragility in T1D.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"4 ","pages":"1272804"},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10587602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49694746","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 holistic approach to preventing type 2 diabetes in Asian women with a history of gestational diabetes mellitus: a feasibility study and pilot randomized controlled trial.","authors":"Seaw Jia Liew,&nbsp;Chun Siong Soon,&nbsp;Yu Chung Chooi,&nbsp;Mya Thway Tint,&nbsp;Johan Gunnar Eriksson","doi":"10.3389/fcdhc.2023.1251411","DOIUrl":"10.3389/fcdhc.2023.1251411","url":null,"abstract":"<p><strong>Background: </strong>Gestational Diabetes Mellitus (GDM) exposes women to future risk of Type 2 Diabetes. Previous studies focused on diet and physical activity, less emphasis was given to tackle intertwined risk factors such as sleep and stress. Knowledge remains scarce in multi-ethnic Asian communities. This study explored the: (1) feasibility of a holistic digital intervention on improving diet, physical activity (PA), sleep and stress of Asian women with a history of GDM, and (2) preliminary efficacy of the holistic intervention on women's physical and mental well-being via a pilot randomized controlled trial.</p><p><strong>Methods: </strong>Female volunteers with a history of GDM but without pre-existing diabetes were recruited from multi-ethnic Singaporean community. Each eligible woman was given a self-monitoring opportunity using Oura Ring that provided daily feedback on step counts, PA, sleep and bedtime heart rate. Intervention group additionally received personalized recommendations aimed to reinforce healthy behaviors holistically (diet, PA, sleep and stress). Dietary intake was evaluated by a research dietitian, while step counts, PA, sleep and bedtime heart rate were evaluated by health coaches based on Oura Ring data. Perceived physical and mental health and well-being were self-reported. Clinical outcomes included glycemic status determined by HbA_1c and OGTT tests, body mass index, blood pressures and lipid profile.</p><p><strong>Results: </strong>Of 196 women from the community, 72 women completed diabetes screening, 61 women were eligible and 56 women completed the study. The 56 completers had mean age of 35.8 ± 3.7 years, predominantly Chinese, majority had their first GDM diagnosed at least 2 years ago and had two GDM-affected pregnancies. After intervention period, more women in the Intervention group achieved at least 8,000 steps/day and had at least 6 hours of sleep per night. Noticeable reduction of added sugar in their food and beverages were observed after the dietary intervention. Changes in body weight and mental well-being were observed but group differences were not statistically significant.</p><p><strong>Conclusions: </strong>The holistic approach appeared feasible for personalizing lifestyle recommendations to promote physical and mental well-being among women with a history of GDM. Larger studies with sufficient assessment timepoints and follow-up duration are warranted to improve the evaluation of intervention effects on clinical outcomes.</p><p><strong>Clinical trial registration number: </strong>https://clinicaltrials.gov/show/NCT05512871, NCT05512871.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"4 ","pages":"1251411"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10569025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41241783","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 SGLT2i in attenuating residual cardiovascular risk through blood pressure-lowering: mechanistic insights and perspectives.","authors":"Joaquim Barreto, Alessandra M Campos-Staffico, Wilson Nadruz, Thiago Quinaglia, Andrei C Sposito","doi":"10.3389/fcdhc.2023.1243530","DOIUrl":"10.3389/fcdhc.2023.1243530","url":null,"abstract":"<p><p>Sodium glucose cotransporter 2 inhibitors (SGLT2) have been increasingly pursued as a promising target for addressing residual cardiovascular risk. Prior trials demonstrated that SGLT2i not only promotes glucose-lowering, but also improves endothelial dysfunction, adiposity, fluid overload, and insulin sensitivity thus contributing to hemodynamic changes implicated in its cardiorenal benefits. The mechanisms in the effect of SGLT2i on blood pressure and their potential role in preventing cardiovascular events are hereby revised.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"4 ","pages":"1243530"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10562622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41222100","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":"Placental pathology in perinatal asphyxia: a case-control study.","authors":"Silvia Alongi,&nbsp;Laura Lambicchi,&nbsp;Francesca Moltrasio,&nbsp;Valentina Alice Botto,&nbsp;Davide Paolo Bernasconi,&nbsp;Maria Serena Cuttin,&nbsp;Giuseppe Paterlini,&nbsp;Silvia Malguzzi,&nbsp;Anna Locatelli","doi":"10.3389/fcdhc.2023.1186362","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1186362","url":null,"abstract":"<p><strong>Introduction: </strong>Placentas of term infants with birth asphyxia are reported to have more lesion such as maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM) and chorioamnionitis with fetal response (FIR) than those of term infants without birth asphyxia. We compared the placental pathology of asphyxiated newborns, including those who developed hypoxic-ischemic encephalopathy (HIE), with non-asphyxiated controls.</p><p><strong>Methods: </strong>We conducted a retrospective case-control study of placentas from neonates with a gestational age ≥ 35 weeks, a birthweight ≥ 1,800 g, and no malformations. Cases were asphyxiated newborns (defined as those with an umbilical artery pH ≤ 7.0 or base excess ≤ -12 mMol, 10-minute Apgar score ≤ 5, or the need for resuscitation lasting >10 min) from a previous cohort, with (<i>n</i>=32) and without (<i>n</i>=173) diagnosis of HIE. Controls were non-asphyxiated newborns from low-risk l (<i>n</i>= 50) or high-risk (<i>n</i>= 68) pregnancies. Placentas were analyzed according to the Amsterdam Placental Workshop Group Consensus Statement 2014.</p><p><strong>Results: </strong>Cases had a higher prevalence of nulliparity, BMI>25, thick meconium, abnormal fetal heart monitoring, and acute intrapartum events than controls (<i>p</i><0.001). MVM and FVM were more frequent among non-asphyxiated than asphyxiated newborns (<i>p</i><0.001). There was no significant difference in inflammatory lesions or abnormal umbilical insertion site. Histologic meconium-associated changes (MAC) were observed in asphyxiated newborns only (<i>p</i>= 0.039).</p><p><strong>Discussion: </strong>Our results confirm the role of antepartum and intrapartum risk factors in neonatal asphyxia and HIE. No association between neonatal asphyxia and placental lesions was found, except for in the case of MAC. The association between clinical and placental data is crucial to understanding and possibly preventing perinatal asphyxia in subsequent pregnancies.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"4 ","pages":"1186362"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10545088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175469","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":"Metabolic syndrome and its associated factors among type 2 diabetic patients in Mizan-Tepi University Teaching Hospital, Southwest Ethiopia Region.","authors":"Abel Shita,&nbsp;Habtamu Teshome,&nbsp;Mulugeta Ayalew,&nbsp;Wudu Yesuf,&nbsp;Dawit Getachew","doi":"10.3389/fcdhc.2023.1234674","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1234674","url":null,"abstract":"<p><strong>Background: </strong>Patients with diabetes mellitus (DM) are prone to modifiable and non-modifiable complications, which can be grouped under metabolic syndrome (MetS). Evaluating MetS in patients with diabetes is critical for the prevention of cardiovascular disease among patients with DM. In Ethiopia, more specifically in the southwest of Ethiopia, these kinds of information are lacking. Thus, this study estimated the prevalence of metabolic syndrome among type 2 diabetic patients and its associated factors.</p><p><strong>Methods: </strong>A health facility-based cross-sectional study was done from May 1 to 30, 2021. The data were collected using structured questionnaires, laboratory investigations, and anthropometric measurements. MetS was diagnosed using the modified International Diabetic Federation guidelines (IDF) and the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. The data was entered into Epidata and analyzed using SPSS software. Bivariable and multiple variable logistic regression was done to identify the factors associated with MetS. In multiple-variable logistic regression analysis, variables that have a p-value ≤ 0.05 were declared to have statistical significance.</p><p><strong>Result: </strong>The majority (31.4%) of study participants were within the age group of 41-50 years and the mean ± SD of age is 51.75 ± 11.66, and 54.9% of them were men. In this study, the prevalence of MetS was 31.4% and 41.2% using the IDF and NCEP-ATP III criteria, respectively. Being a woman (AOR = 11.33, 95% CI; 3.73, 34.34; p < 0.001), having a lower level of education (AOR=7.10, 95% CI; 1.88, 26.70; p <0.004), and performing high physical activities (AOR=0.08, 95%CI; 0.01, 0.40; p <0.002) were significantly associated with MetS.</p><p><strong>Conclusion: </strong>According to this study, the magnitude of Metabolic Syndrome in Mizan-Teppi University Teaching Hospital was 31.4% and 41.2% using IDF and NCEP-ATP III criteria, respectively. Being a woman and having a lower level of education increased the odds of MetS among patients with DM while performing high physical activities decreased the odds of MetS among patients with DM. Therefore, to prevent metabolic syndrome among type 2 DM patients in the study area, it is crucial to focus on women and individuals who have not had access to adequate education. One way to do this is by prioritizing interventions that involve physical activity.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"4 ","pages":"1234674"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10542573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41160671","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":"Investigating the value of glucodensity analysis of continuous glucose monitoring data in type 1 diabetes: an exploratory analysis.","authors":"Elvis Han Cui,&nbsp;Allison B Goldfine,&nbsp;Michelle Quinlan,&nbsp;David A James,&nbsp;Oleksandr Sverdlov","doi":"10.3389/fcdhc.2023.1244613","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1244613","url":null,"abstract":"<p><strong>Introduction: </strong>Continuous glucose monitoring (CGM) devices capture longitudinal data on interstitial glucose levels and are increasingly used to show the dynamics of diabetes metabolism. Given the complexity of CGM data, it is crucial to extract important patterns hidden in these data through efficient visualization and statistical analysis techniques.</p><p><strong>Methods: </strong>In this paper, we adopted the concept of glucodensity, and using a subset of data from an ongoing clinical trial in pediatric individuals and young adults with new-onset type 1 diabetes, we performed a cluster analysis of glucodensities. We assessed the differences among the identified clusters using analysis of variance (ANOVA) with respect to residual pancreatic beta-cell function and some standard CGM-derived parameters such as time in range, time above range, and time below range.</p><p><strong>Results: </strong>Distinct CGM data patterns were identified using cluster analysis based on glucodensities. Statistically significant differences were shown among the clusters with respect to baseline levels of pancreatic beta-cell function surrogate (C-peptide) and with respect to time in range and time above range.</p><p><strong>Discussion: </strong>Our findings provide supportive evidence for the value of glucodensity in the analysis of CGM data. Some challenges in the modeling of CGM data include unbalanced data structure, missing observations, and many known and unknown confounders, which speaks to the importance of--and provides opportunities for--taking an approach integrating clinical, statistical, and data science expertise in the analysis of these data.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"4 ","pages":"1244613"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10518413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41142001","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":"Data-driven digital health technologies in the remote clinical care of diabetic foot ulcers: a scoping review.","authors":"Joel Lazarus, Iulia Cioroianu, Beate Ehrhardt, David Gurevich, Lisa Kreusser, Benjamin Metcalfe, Prasad Nishtala, Ezio Preatoni, Tamsin H Sharp","doi":"10.3389/fcdhc.2023.1212182","DOIUrl":"10.3389/fcdhc.2023.1212182","url":null,"abstract":"<p><strong>Background: </strong>The availability and effectiveness of Digital Health Technologies (DHTs) to support clinicians, empower patients, and generate economic savings for national healthcare systems are growing rapidly. Of particular promise is the capacity of DHTs to autonomously facilitate remote monitoring and treatment. Diabetic Foot Ulcers (DFUs) are characterised by high rates of infection, amputation, mortality, and healthcare costs. With clinical outcomes contingent on activities that can be readily monitored, DFUs present a promising focus for the application of remote DHTs.</p><p><strong>Objective: </strong>This scoping review has been conducted as a first step toward ascertaining fthe data-related challenges and opportunities for the development of more comprehensive, integrated, and individualised sense/act DHTs. We review the latest developments in the application of DHTs to the remote care of DFUs. We cover the types of DHTs in development and their features, technological readiness, and scope of clinical testing.</p><p><strong>Eligibility criteria: </strong>Only peer-reviewed original experimental and observational studies, case series and qualitative studies were included in literature searches. All reviews and manuscripts presenting pre-trial prototype technologies were excluded.</p><p><strong>Methods: </strong>An initial search of three databases (Web of Science, MEDLINE, and Scopus) generated 1,925 English-language papers for screening. 388 papers were assessed as eligible for full-text screening by the review team. 81 manuscripts were found to meet the eligibility criteria.</p><p><strong>Results: </strong>Only 19% of studies incorporated multiple DHTs. We categorised 56% of studies as 'Treatment-Manual', i.e. studies involving technologies aimed at treatment requiring manual data generation, and 26% as 'Prevention-Autonomous', i.e. studies of technologies generating data autonomously through wearable sensors aimed at ulcer prevention through patient behavioural change. Only 10% of studies involved more ambitious 'Treatment-Autonomous' interventions. We found that studies generally reported high levels of patient adherence and satisfaction.</p><p><strong>Conclusions: </strong>Our findings point to a major potential role for DHTs in remote personalised medical management of DFUs. However, larger studies are required to assess their impact. Here, we see opportunities for developing much larger, more comprehensive, and integrated monitoring and decision support systems with the potential to address the disease in a more complete context by capturing and integrating data from multiple sources from subjective and objective measurements.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"4 ","pages":"1212182"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10505804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41177613","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 narrative review of exercise participation among adults with prediabetes or type 2 diabetes: barriers and solutions.","authors":"Samantha C Thielen, Jane E B Reusch, Judith G Regensteiner","doi":"10.3389/fcdhc.2023.1218692","DOIUrl":"10.3389/fcdhc.2023.1218692","url":null,"abstract":"<p><p>Type 2 diabetes (T2D) has been rising in prevalence over the past few decades in the US and worldwide. T2D contributes to significant morbidity and premature mortality, primarily due to cardiovascular disease (CVD). Exercise is a major cornerstone of therapy for T2D as a result of its positive effects on glycemic control, blood pressure, weight loss and cardiovascular risk as well as other measures of health. However, studies show that a majority of people with T2D do not exercise regularly. The reasons given as to why exercise goals are not met are varied and include physiological, psychological, social, cultural and environmental barriers to exercise. One potential cause of inactivity in people with T2D is impaired cardiorespiratory fitness, even in the absence of clinically evident complications. The exercise impairment, although present in both sexes, is greater in women than men with T2D. Women with T2D also experience greater perceived exertion with exercise than their counterparts without diabetes. These physiological barriers are in addition to constructed societal barriers including cultural expectations of bearing the burden of childrearing for women and in some cultures, having limited access to exercise because of additional cultural expectations. People at risk for and with diabetes more commonly experience unfavorable social determinants of health (SDOH) than people without diabetes, represented by neighborhood deprivation. Neighborhood deprivation measures lack of resources in an area influencing socioeconomic status including many SDOH such as income, housing conditions, living environment, education and employment. Higher indices of neighborhood deprivation have been associated with increased risk of all-cause, cardiovascular and cancer related mortality. Unfavorable SDOH is also associated with obesity and lower levels of physical activity. Ideally regular physical activity should be incorporated into all communities as part of a productive and healthy lifestyle. One potential solution to improve access to physical activity is designing and building environments with increased walkability, greenspace and safe recreational areas. Other potential solutions include the use of continuous glucose monitors as real-time feedback tools aimed to increase motivation for physical activity, counseling aimed at improving self-efficacy towards exercise and even acquiring a dog to increase walking time. In this narrative review, we aim to examine some traditional and novel barriers to exercise, as well as present evidence on novel interventions or solutions to overcome barriers to increase exercise and physical activity in all people with prediabetes and T2D.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"4 ","pages":"1218692"},"PeriodicalIF":0.0,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10499496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10263035","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":"Does hand stiffness reflect internal organ fibrosis in diabetes mellitus?","authors":"Sanat Phatak, Jennifer L Ingram, Pranay Goel, Satyajit Rath, Chittaranjan Yajnik","doi":"10.3389/fcdhc.2023.1198782","DOIUrl":"10.3389/fcdhc.2023.1198782","url":null,"abstract":"<p><p>Fibrosis leads to irreversible stiffening of tissue and loss of function, and is a common pathway leading to morbidity and mortality in chronic disease. Diabetes mellitus (both type 1 and type 2 diabetes) are associated with significant fibrosis in internal organs, chiefly the kidney and heart, but also lung, liver and adipose tissue. Diabetes is also associated with the diabetic cheirarthropathies, a collection of clinical manifestations affecting the hand that include limited joint mobility (LJM), flexor tenosynovitis, Duypuytren disease and carpal tunnel syndrome. Histo-morphologically these are profibrotic conditions affecting various soft tissue components in the hand. We hypothesize that these hand manifestations reflect a systemic profibrotic state, and are potential clinical biomarkers of current or future internal organ fibrosis. Epidemiologically, there is evidence that fibrosis in one organ associates with fibrosis with another; the putative exposures that lead to fibrosis in diabetes (advanced glycation end product deposition, microvascular disease and hypoxia, persistent innate inflammation) are 'systemic'; a common genetic susceptibility to fibrosis has also been hinted at. These data suggest that a subset of the diabetic population is susceptible to multi-organ fibrosis. The hand is an attractive biomarker to clinically detect this susceptibility, owing to its accessibility to physical examination and exposure to repeated mechanical stresses. Testing the hypothesis has a few pre-requisites: being able to measure hand fibrosis in the hand, using clinical scores or imaging based scores, which will facilitate looking for associations with internal organ fibrosis using validated methodologies for each. Longitudinal studies would be essential in delineating fibrosis trajectories in those with hand manifestations. Since therapies reversing fibrosis are few, the onus lies on identification of a susceptible subset for preventative measures. If systematically validated, clinical hand examination could provide a low-cost, universally accessible and easily reproducible screening step in selecting patients for clinical trials for fibrosis in diabetes.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"4 ","pages":"1198782"},"PeriodicalIF":0.0,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10363986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9875211","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}