Frontiers in clinical diabetes and healthcare最新文献

{"title":"Incidence and predictors of mortality in children with diabetic ketoacidosis in the comprehensive specialized referral hospitals of West Amhara Region, Northwest Ethiopia: a retrospective follow-up study.","authors":"Rahel Asres Shimelash,&nbsp;Getaneh Mulualem Belay,&nbsp;Worknesh Aknaw,&nbsp;Aster Tadesse Shibabaw,&nbsp;Aderajew Agmas Adebabay,&nbsp;Gezahagn Demsu Gedefaw,&nbsp;Tadele Derbew Kassie,&nbsp;Alemu Birara Zemariam","doi":"10.3389/fcdhc.2023.1204133","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1204133","url":null,"abstract":"<p><strong>Background: </strong>Diabetic ketoacidosis is one of the major life-threatening conditions associated with acute metabolic complications. It remains a major public health problem in developing countries such as Ethiopia.</p><p><strong>Objective: </strong>To assess the incidence and prediction of mortality in children with diabetic ketoacidosis in West Amhara Region Comprehensive Specialized Referral Hospitals, Northwest Ethiopia, in 2022.</p><p><strong>Methods: </strong>An institution-based retrospective follow-up study was conducted among 423 study participants with a confirmed diagnosis of diabetic ketoacidosis from 01/01/2017 to 31/12/2021. Data were entered, coded, cleaned, and checked using Epi-Data version 4.6 and exported to Stata version 14 for data analysis.</p><p><strong>Results: </strong>A total of 401 child records were included in the final analysis and were followed for 3781 days during the study period. The overall mortality of children with diabetic ketoacidosis was 10.6 per 1000 person-days observed (95% CI: 7.8-14.4) during the entire follow-up period. Hypoglycemia (AHR=4.6; 95% CI: 2.13-10.1), rural residence (AHR=2.9; 95% CI=1.01-8.11), age younger than five (AHR=4.4; 95% CI=1.4-13.7) or between five and 10 (AHR=3.1; 95% CI=1.1-8.8), and female gender (AHR=2.6; 95% CI=1.1-5.8) were significant predictors of mortality.</p><p><strong>Conclusions: </strong>The incidence rate of mortality in children with diabetic ketoacidosis was relatively high. Age, rural residence, female gender, and hypoglycemia were significantly predictive of mortality. Community education or mass campaigns about the signs and symptoms of diabetic ketoacidosis may reduce the mortality rate in children.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10655418","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":"Prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients attended at Jugol General Hospital in eastern Ethiopia: A cross-sectional study.","authors":"Shambel Nigussie,&nbsp;Fekade Demeke","doi":"10.3389/fcdhc.2023.1061628","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1061628","url":null,"abstract":"<p><strong>Background: </strong>Most clinical practice guidelines support the use of statins in patients with type 2 diabetes mellitus to lower the risk of cardiovascular disease. However, nothing is known about the prescribing patterns of statins at Jugol General Hospital in eastern Ethiopia.</p><p><strong>Objective: </strong>This study aimed to assess the prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients attended at Jugol General Hospital in eastern Ethiopia.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted among 423 patients with type 2 diabetes mellitus who received follow-up care from 1 June 2017 to 1 June 2022. The study participants were enrolled consecutively using a convenience sampling technique. The data were extracted from patients' medical records using a data abstraction checklist. The extracted data were entered into EpiData, version 3.1, and exported to Statistical Package for the Social Sciences (SPSS), version 22, for analysis. Associations were considered to be statistically significant at a <i>p</i>-value < 0.05 and presented as adjusted odds ratios and 95% confidence intervals.</p><p><strong>Result: </strong>The medical records of 423 patients were reviewed. The review revealed that medical records were complete for 410 of these patients, and these records were included in the analysis. The majority of the study participants were female (72.2%) and between the age of 40 and 65 years (61.2%). All of the study participants were eligible for statin prescription; however, statins were prescribed for only 257 (62.7%) study participants. Of the statins prescribed, moderate-dose-intensity statins were prescribed for 40 (15.6%) participants who were at high risk of cardiovascular disease. Atorvastatin was the most commonly (93.3%) prescribed statin. The presence of hypertension, coronary artery disease, and cerebrovascular events was significantly associated with statin prescribing.</p><p><strong>Conclusion: </strong>The magnitude of prescribing statins for patients with type 2 diabetes mellitus was low in comparison with the clinical practice guidelines recommendation. This finding is alarming and is a call for action to improve the execution of clinical practice guidelines for the benefit of this high-risk population.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10076854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9641669","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":"Editorial: Diabetes and depression.","authors":"G R Sridhar,&nbsp;G Lakshmi","doi":"10.3389/fcdhc.2023.1221640","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1221640","url":null,"abstract":"COPYRIGHT © 2023 Sridhar and Lakshmi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. TYPE Editorial PUBLISHED 23 June 2023 DOI 10.3389/fcdhc.2023.1221640","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9816305","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":"Leveraging a genetically-informative study design to explore depression as a risk factor for type 2 diabetes: Rationale and participant characteristics of the Mood and Immune Regulation in Twins Study.","authors":"Briana Mezuk,&nbsp;Kristen Kelly,&nbsp;Erica Bennion,&nbsp;Jeannie B Concha","doi":"10.3389/fcdhc.2023.1026402","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1026402","url":null,"abstract":"<p><strong>Background: </strong>Comorbidity between depression and type 2 diabetes is thought to arise from the joint effects of psychological, behavioral, and biological processes. Studies of monozygotic twins may provide a unique opportunity for clarifying how these processes inter-relate. This paper describes the rationale, characteristics, and initial findings of a longitudinal co-twin study aimed at examining the biopsychosocial mechanisms linking depression and risk of diabetes in mid-life.</p><p><strong>Methods: </strong>Participants in the Mood and Immune Regulation in Twins (MIRT) Study were recruited from the Mid-Atlantic Twin Registry. MIRT consisted of 94 individuals who do not have diabetes at baseline, representing 43 twin pairs (41 monozygotic and 2 dizygotic), one set of monozygotic triplets, and 5 individuals whose co-twin did not participate. A broad set of variables were assessed including <i>psychological factors</i> (e.g., lifetime history major depression (MD)); <i>social factors</i> (e.g., stress perceptions and experiences); and <i>biological factors</i>, including indicators of metabolic risk (e.g., BMI, blood pressure (BP), HbA1c) and immune functioning (e.g., pro- and anti-inflammatory cytokines), as well as collection of RNA. Participants were re-assessed 6-month later. Intra-class correlation coefficients (ICC) and descriptive comparisons were used to explore variation in these psychological, social, and biological factors across time and within pairs.</p><p><strong>Results: </strong>Mean age was 53 years, 68% were female, and 77% identified as white. One-third had a history of MD, and 18 sibling sets were discordant for MD. MD was associated with higher systolic (139.1 vs 132.2 mmHg, p=0.05) and diastolic BP (87.2 vs. 80.8 mmHg, p=0.002) and IL-6 (1.47 vs. 0.93 pg/mL, p=0.001). MD was not associated with BMI, HbA1c, or other immune markers. While the biological characteristics of the co-twins were significantly correlated, all within-person ICCs were higher than the within-pair correlations (e.g., HbA1c within-person ICC=0.88 vs. within-pair ICC=0.49; IL-6 within-person ICC=0.64 vs. within-pair=0.54). Among the pairs discordant for MD, depression was not substantially associated with metabolic or immune markers, but was positively associated with stress.</p><p><strong>Conclusions: </strong>Twin studies have the potential to clarify the biopsychosocial processes linking depression and diabetes, and recently completed processing of RNA samples from MIRT permits future exploration of gene expression as a potential mechanism.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9296162","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 oral microbiota and gestational diabetes mellitus.","authors":"Jôice Dias Corrêa,&nbsp;Giovanna Araújo Faria,&nbsp;Leticia Ladeia Fernandes","doi":"10.3389/fcdhc.2023.1120920","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1120920","url":null,"abstract":"<p><p>Gestational diabetes mellitus (GDM) is one of the most frequent endocrine conditions during pregnancy. GDM is linked to adverse pregnancy outcomes and has implications for maternal health. Studies have demonstrated the link between pathogenic periodontal bacteria, glycemic control, and the risk of diabetes. The objective of the current study is to perform a mini-review of the available literature on the potential changes in the oral microbiota of women with GDM. The review was conducted by two independent reviewers (LLF and JDC). Indexed electronic databases (PubMed/Medline, Cochrane Library, Web of Science, and Scopus) were searched, including articles published in English and Portuguese. A manual search was also performed to identify related articles. The oral microbial community of pregnant women with GDM is unique from that of healthy pregnant women. The majority of the alterations found in the oral microbiota of women with GDM point to a pro-inflammatory environment with high levels of bacteria associated with periodontitis (<i>Prevotella, Treponema</i>, anaerobic bacteria) and a depletion of bacteria associated with periodontal health maintenance (Firmicutes, <i>Streptococcus, Leptotrichia).</i> More well-designed studies differentiating between pregnant women with good oral health and those with periodontitis are needed to ascertain which differences are due to GDM or periodontitis.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9589756","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":"Non-alcoholic fatty liver disease in diabetes mellitus patients on chronic hemodialysis - A case series addressing cardiovascular and mortality risks.","authors":"Roxana Adriana Stoica,&nbsp;Laura Carina Tribus,&nbsp;Raluca Ioana Marin,&nbsp;Tara David,&nbsp;Carmen Monica Preda,&nbsp;Ioana Cristina Bica,&nbsp;Cristian Serafinceanu","doi":"10.3389/fcdhc.2023.1113666","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1113666","url":null,"abstract":"<p><p>Non-alcoholic fatty liver disease (NAFLD) has an important role in the pathogenesis of cardiovascular diseases in the population with diabetes and it is highly prevalent in end-stage renal disease (ESRD) patients. This case series describes NAFLD associated factors and survival in type 2 diabetes patients (T2DM) who have ESRD treated with hemodialysis. NAFLD prevalence in patients with T2DM and ESRD is 69.2%. A high number of patients (15 out of 18) have obesity evaluated by calculating body mass index (BMI) and bioimpedance measurements. Patients with NAFLD have higher cardiovascular mortality risk, 13 of 18 patients were already diagnosed with coronary heart disease, 6 of 18 had cerebrovascular disease, and 6 of 18 had peripheral artery disease. Fourteen patients were treated with insulin, two patients with sitagliptin (renal adjusted dose of 25mg/day) and two patients with medical nutrition therapy, with an HbA1c ranging from 4.4 to 9.0%. After one-year follow-up 7 of 18 patients died, the causes having roughly equal proportions: myocardial infarction, SARS-CoV2 infection, and pulmonary edema. In conclusion, our population of type 2 diabetic patients with ESRD in hemodialysis had a prevalence of ultrasound-diagnosed NAFLD of 69.2%. Also, this population had a high death rate at one-year follow-up, cardiovascular causes being among the most common.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9589757","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":"Associations of aortic stiffness and intra-aortic flow parameters with epicardial adipose tissue in patients with type-2 diabetes.","authors":"Khaoula Bouazizi,&nbsp;Mohamed Zarai,&nbsp;Abdallah Noufaily,&nbsp;Mikaël Prigent,&nbsp;Thomas Dietenbeck,&nbsp;Emilie Bollache,&nbsp;Toan Nguyen,&nbsp;Valéria Della Valle,&nbsp;Eléonore Blondiaux,&nbsp;Karine Clément,&nbsp;Judith Aron-Wisnewsky,&nbsp;Fabrizio Andreelli,&nbsp;Alban Redheuil,&nbsp;Nadjia Kachenoura","doi":"10.3389/fcdhc.2023.1106342","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1106342","url":null,"abstract":"<p><strong>Background: </strong>It has been shown that increased aortic stiffness is related to type-2 diabetes (T2D) which is considered as a risk factor for cardiovascular disease. Among other risk factors is epicardial adipose tissue (EAT) which is increased in T2D and is a relevant biomarker of metabolic severity and adverse outcome.</p><p><strong>Purpose: </strong>To assess aortic flow parameters in T2D patients as compared to healthy individuals and to evaluate their associations with EAT accumulation as an index of cardiometabolic severity in T2D patients.</p><p><strong>Materials and methods: </strong>Thirty-six T2D patients as well as 29 healthy controls matched by age and sex were included in this study. Participants had cardiac and aortic MRI exams at 1.5 T. Imaging sequences included cine SSFP for left ventricle (LV) function and EAT assessment and aortic cine and phase-contrast imaging for strain and flow parameters quantification.</p><p><strong>Results: </strong>In this study, we found LV phenotype to be characterized by concentric remodeling with decreased stroke volume index despite global LV mass within a normal range. EAT was increased in T2D patients compared to controls (p<0.0001). Moreover, EAT, a biomarker of metabolic severity, was negatively correlated to ascending aortic (AA) distensibility (p=0.048) and positively to the normalized backward flow volume (p=0.001). These relationships remained significant after further adjustment for age, sex and central mean blood pressure. In a multivariate model, presence/absence of T2D and AA normalized backward flow (BF) to forward flow (FF) volumes ratio are both significant and independent correlates of EAT.</p><p><strong>Conclusion: </strong>In our study, aortic stiffness as depicted by an increased backward flow volume and decreased distensibility seems to be related to EAT volume in T2D patients. This observation should be confirmed in the future on a larger population while considering additional biomarkers specific to inflammation and using a longitudinal prospective study design.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10250660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9619022","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":"GLP-1 receptor agonists as promising disease-modifying agents in WFS1 spectrum disorder.","authors":"Eleonora Panfili,&nbsp;Giulio Frontino,&nbsp;Maria Teresa Pallotta","doi":"10.3389/fcdhc.2023.1171091","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1171091","url":null,"abstract":"<p><p>WFS1 spectrum disorder (WFS1-SD) is a rare monogenic neurodegenerative disorder whose cardinal symptoms are childhood-onset diabetes mellitus, optic atrophy, deafness, diabetes insipidus, and neurological signs ranging from mild to severe. The prognosis is poor as most patients die prematurely with severe neurological disabilities such as bulbar dysfunction and organic brain syndrome. Mutation of the <i>WFS1</i> gene is recognized as the prime mover of the disease and responsible for a dysregulated ER stress signaling, which leads to neuron and pancreatic β-cell death. There is no currently cure and no treatment that definitively arrests the progression of the disease. GLP-1 receptor agonists appear to be an efficient way to reduce elevated ER stress <i>in vitro</i> and <i>in vivo</i>, and increasing findings suggest they could be effective in delaying the progression of WFS1-SD. Here, we summarize the characteristics of GLP-1 receptor agonists and preclinical and clinical data obtained by testing them in WFS1-SD as a feasible strategy for managing this disease.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10275359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9663706","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":"Editorial: Highlights in diabetes self-management 2021/22.","authors":"Roberta Lamptey,&nbsp;Emma Berry,&nbsp;Norbert Hermanns,&nbsp;Frank Snoek","doi":"10.3389/fcdhc.2023.1116879","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1116879","url":null,"abstract":"COPYRIGHT © 2023 Lamptey, Berry, Hermanns and Snoek. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. TYPE Editorial PUBLISHED 13 January 2023 DOI 10.3389/fcdhc.2023.1116879","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9203869","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 vicious cycle: employment challenges associated with diabetes foot ulcers in an economically marginalized Southwest US sample.","authors":"Kelly N B Palmer,&nbsp;Rebecca M Crocker,&nbsp;David G Marrero,&nbsp;Tze-Woei Tan","doi":"10.3389/fcdhc.2023.1027578","DOIUrl":"https://doi.org/10.3389/fcdhc.2023.1027578","url":null,"abstract":"<p><strong>Aim: </strong>To describe patients' reported employment challenges associated with diabetic foot ulcers (DFUs).</p><p><strong>Methods: </strong>Fifteen patients from under-resourced communities in Southern Arizona, with a history of DFUs and/or amputations, were recruited from a tertiary referral center from June 2020 to February 2021. Participants consented to an audio-recorded semi-structured phone interview. Interviews were transcribed and thematically analyzed using the Dedoose data analysis platform.</p><p><strong>Results: </strong>Participants shared a common theme around the cyclic challenges of DFU prevention/management and employment. Those employed in manual labor-intensive jobs or jobs requiring them to be on their feet for long durations of time believed working conditions contributed to the development of their DFUs. Patients reported work incapacity due to declines in mobility and the need to offload for DFU management. Many expressed frustration and emotional distress related to these challenges noting that DFUs resulted in lower remuneration as medical expenses increased. Consequently, loss of income and/or medical insurance often hindered participants' ability to manage DFUs and subsequent complications.</p><p><strong>Conclusion: </strong>These data illuminate the vicious cycle of DFU and employment challenges that must be addressed through patient-centered prevention strategies. Healthcare providers should consider a person's contextual factors such as employment type to tailor treatment approaches. Employers should establish inclusive policies that support patients with DFUs returning to work through flexible working hours and adapted work tasks as needed. Policymakers can also mitigate employment challenges by implementing social programs that provide resources for employees who are unable to return to work in their former capacity.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10140327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9393389","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}