The science of diabetes self-management and care最新文献

{"title":"Cultural Beliefs and Practices in Self-Management of Diabetes Among Pnar Women in Meghalaya, India.","authors":"Alacrity Muksor, Daksha Parmar","doi":"10.1177/26350106231208155","DOIUrl":"10.1177/26350106231208155","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to explore the cultural beliefs and practices of the Pnar tribe in terms of their self-management of diabetes.</p><p><strong>Methods: </strong>A qualitative study design using an ethnographic approach was adopted to understand the experiences of the Pnar women with type 2 diabetes. Around 60 women living with diabetes across 20 villages in the Thadlaskein rural block were interviewed in the Pnar language. Thematic analysis was employed to identify the pattern related to beliefs and cultural practices in the self-management of diabetes across the data set.</p><p><strong>Results: </strong>Misconceptions related to diet, such as all vegetables grown underground need to be avoided and bitter herbs and vegetables are good for blood glucose control, were reported. Participants used home remedies and complementary and alternative medicine to bring down their blood glucose levels. Participants believe that diabetes is an episodic or short-term illness and can be cured through herbal medicine. Participants reported that consuming <i>atta</i> or round flat bread made of wheat flour instead of rice caused \"acidity.\"</p><p><strong>Conclusions: </strong>Misconceptions are barriers to disease management, which are often shaped in people's minds by culture. Therefore, health care service providers must know what people think about diabetes and its management. Accordingly, information related to diabetes should be disseminated to the masses for effective management of diabetes.</p>","PeriodicalId":75187,"journal":{"name":"The science of diabetes self-management and care","volume":" ","pages":"462-476"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72016421","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":"Validation and Psychometric Evaluation of Diabetes Literacy, Numeracy, and Knowledge Tools in the Arabic Context.","authors":"Sanah Hasan, Hamzah Alzubaidi, Catarina Samorinha, Ahmed Al Radhaideh","doi":"10.1177/26350106231207349","DOIUrl":"10.1177/26350106231207349","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to validate the Literacy Assessment for Diabetes (LAD), the Diabetes Numeracy Test (DNT), and the Simplified Diabetes Knowledge Test (DKT) in the Arabic language and context.</p><p><strong>Methods: </strong>Three hundred eighty four, ≥18-year-old patients with type 1, type 2, or gestational diabetes mellitus were recruited from 3 endocrinology clinics in the United Arab Emirates. Exploratory factor analysis using principal component was performed. Achieved scores were compared using Pearson bivariate correlation.</p><p><strong>Results: </strong>All 60 LAD items loaded on 1 factor accounting for 66.7% of the variance, with internal consistency α = .991. Average score = 68.7%. Nineteen out of 26 items were retained on the DNT and grouped into 4 factors, prescription reading and directions, proper dose coverage, nutrition, and insulin, with good internal consistency (α = .721). Average score = 73.2%. All 20 DKT items loaded on 3 factors accounting for 41.2% of the variance, causes and consequences of the high blood sugar level, prevention of the disease, and misconceptions about diabetes self-management, with good internal consistency (α = .799). Average score = 71.9%. A moderate and significant correlation between the DKT and DNT (<i>r</i> = .56, <i>P</i> < .001) was observed.</p><p><strong>Conclusions: </strong>Three tools to assess diabetes literacy, numeracy, and knowledge were psychometrically tested to establish their validity and reliability in the Arabic language and context. The tools could be used to assess patient skills and competence in navigating the health care system and managing their diabetes.</p>","PeriodicalId":75187,"journal":{"name":"The science of diabetes self-management and care","volume":" ","pages":"449-461"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415851","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":"Barriers and Facilitators to Uptake of Continuous Glucose Monitoring for Management of Type 2 Diabetes Mellitus in Youth.","authors":"Vaishnavi Peyyety, Margaret F Zupa, Brianna Hewitt, Adriana Rodriguez Gonzalez, Iswariya Mani, Temiloluwa Prioleau, Jessica McCurley, Yu Kuei Lin, Mary Ellen Vajravelu","doi":"10.1177/26350106231205030","DOIUrl":"10.1177/26350106231205030","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to identify factors impacting the acceptability of continuous glucose monitoring (CGM) in adolescents and young adults (AYAs) with type 2 diabetes mellitus (T2DM).</p><p><strong>Methods: </strong>In this single-center study, semistructured interviews were conducted with AYAs with T2DM and their parents to determine attitudes about CGM, including barriers and facilitators. Interviews were audio-recorded, transcribed, and evaluated using thematic analysis.</p><p><strong>Results: </strong>Twenty AYAs and 10 parents participated (n = 30 total). AYAs were mean age 16.5 years (SD 2.2, range = 13.7-20.1) and had median diabetes duration of 1.3 years. Most were female (65%) and from minoritized background (40% non-Hispanic Black, 10% Hispanic, 5% Asian). Seven (35%) used CGM. The primary facilitator elicited was convenience over glucose meter use. Important barriers included the impact of physically wearing the device and drawing unwanted attention, desire for AYA privacy, and inadequate education about the device.</p><p><strong>Conclusions: </strong>In this diverse sample of AYAs with T2DM and their parents, CGM was generally regarded as convenient, although concerns about worsening stigma and conflict with parents were prevalent. These findings can guide the development of patient-centered approaches to CGM for AYAs with T2DM, a critical step toward reducing inequities in diabetes technology uptake.</p>","PeriodicalId":75187,"journal":{"name":"The science of diabetes self-management and care","volume":" ","pages":"426-437"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10895543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71489833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Promotore</i>-Led Versus Registered Nurse-Led Diabetes Self-Management Education in Mexican Americans: A Randomized Clinical Trial.","authors":"Alex Kopelowicz,&nbsp;Soma Wali,&nbsp;Rhonda Polzin,&nbsp;Maria Elena Ruiz,&nbsp;Karabi Nandy","doi":"10.1177/26350106231192353","DOIUrl":"https://doi.org/10.1177/26350106231192353","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to compare the benefits of a diabetes self-management program led by registered nurses (RNs) versus community health workers (<i>promotores</i>) for Spanish-speaking Mexican Americans with type 2 diabetes (T2DM).</p><p><strong>Methods: </strong>Three hundred thirty Spanish-speaking Mexican American adults with T2DM were randomly assigned to \"Tomando Control de Su Diabetes\" delivered for six 2.5-hour sessions either by <i>promotores</i> or RNs. The primary outcome measure was the Summary of Diabetes Self-Care Activities (SDSCA). Evaluations were made at baseline, 6 weeks, and at 3, 6, and 12 months. Mixed-effects regression models were fit to test if participants had differential changes in the SDSCA total score by group over time, controlling for demographic and clinical factors.</p><p><strong>Results: </strong>SDSCA scores were significantly higher at all time points compared to baseline and not statistically different between the 2 groups. Only years of education correlated with improvement in diabetes self-management behaviors. No moderating variables predicted improvement between groups.</p><p><strong>Conclusions: </strong>Spanish-speaking Mexican American adults with T2DM who participated in a diabetes educational program with <i>promotores</i> or RNs demonstrated similar improvements. <i>Promotores</i> may increase the accessibility of effective diabetes self-management training for this difficult-to-reach population.</p>","PeriodicalId":75187,"journal":{"name":"The science of diabetes self-management and care","volume":"49 5","pages":"374-383"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41223096","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":"Comparisons of Psycho-Behavioral Factors, Body Composition, and Clinical Outcomes in Adults With Type 2 Diabetes by Perceived Hypoglycemia.","authors":"EunSeok Cha,&nbsp;Kyong Hye Joung,&nbsp;Yun-A Shin,&nbsp;Nak-Hoon Son,&nbsp;Hyun Jin Kim,&nbsp;Melissa Spezia Faulkner","doi":"10.1177/26350106231192362","DOIUrl":"https://doi.org/10.1177/26350106231192362","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to examine the associations between perceived hypoglycemia and psycho-behavioral and clinical factors in persons with type 2 diabetes (T2D).</p><p><strong>Methods: </strong>Adults with T2D were recruited from outpatient clinics in a university hospital in Korea. Sociodemographics, psycho-behavioral and clinical factors, and body composition were assessed. The participants were divided into 2 groups reporting perceived hypoglycemia or not in the previous month based on an item of the Control Problem Scale. Group differences were compared at α = .05 using SPSS (version 26.0).</p><p><strong>Results: </strong>Of 177 participants, approximately one-third (n = 67) perceived hypoglycemia. The hypoglycemia group reported poor health-related quality of life, frequent blood monitoring and foot care, and sleep difficulties. However, no differences between groups were identified for diet, exercise, or glycosylated hemoglobin. The hypoglycemia group had a lower body mass index and a trend toward a lower skeletal muscle mass and fat free mass.</p><p><strong>Conclusions: </strong>Perceived hypoglycemia was associated with psycho-behavioral factors and body composition. Importantly, some persons on oral antidiabetic medications that do not cause hypoglycemia still perceived hypoglycemia. Further investigation is warranted to examine the efficacy of strategies to minimize hypoglycemia and inappropriate fear of hypoglycemia. In addition, clinicians should be aware of the potential risk of hypoglycemia in persons with lower muscle mass.</p>","PeriodicalId":75187,"journal":{"name":"The science of diabetes self-management and care","volume":"49 5","pages":"351-361"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41223097","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":"COVID-19 Impact Predicts Diabetes Distress Among Individuals With Type 2 Diabetes.","authors":"Leigh Anne Koonmen,&nbsp;Terry A Lennie,&nbsp;Laura B Hieronymus,&nbsp;Mary Kay Rayens,&nbsp;Melinda Ickes,&nbsp;Jennifer L Miller,&nbsp;Gia Mudd-Martin","doi":"10.1177/26350106231196300","DOIUrl":"https://doi.org/10.1177/26350106231196300","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to determine whether COVID-19 impact and Diabetes Self-Management Education and Support (DSMES) service attendance predicted diabetes distress among individuals with type 2 diabetes during the pandemic.</p><p><strong>Methods: </strong>Eighty-six adults with type 2 diabetes who either attended (n = 29) or did not previously attend (n = 57) DSMES services completed a cross-sectional survey. Participants' mean age was 57 ± 12.3 years, 50% were female, and 71.3% were diagnosed with diabetes >5 years. The Coronavirus Impact Scale was used to measure impact of the pandemic on daily life. The Diabetes Distress Scale was used to measure distress overall and within 4 subscales (emotional burden, interpersonal distress, physician-related distress, regimen distress). Separate multiple linear regressions were conducted for each outcome, controlling for age, sex, marital status, financial status, and time since diabetes diagnosis.</p><p><strong>Results: </strong>Higher COVID-19 impact predicted higher diabetes-related distress for all subscales and overall. Only the subscale for interpersonal distress was predicted by DSMES attendance, which decreased with DSMES attendance.</p><p><strong>Conclusion: </strong>This study identifies a link between the effects of the COVID-19 pandemic and diabetes distress. The findings highlight the negative impact of the pandemic on diabetes distress and the importance of DSMES services for diabetes-related distress. Interventions are needed to reduce psychological distress among this population during public health crises.</p>","PeriodicalId":75187,"journal":{"name":"The science of diabetes self-management and care","volume":"49 5","pages":"392-400"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41223098","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":"Cross-Cultural Adaptation and Validation of the Revised Brief Diabetes Knowledge Test (DKT2) in Individuals With Type 2 Diabetes Mellitus and Their Caregivers.","authors":"Irene Baroni,&nbsp;Rosario Caruso,&nbsp;Cristina Arrigoni,&nbsp;Diletta Fabrizi,&nbsp;Floriana Pinto,&nbsp;Michela Luciani,&nbsp;Davide Ausili","doi":"10.1177/26350106231192354","DOIUrl":"https://doi.org/10.1177/26350106231192354","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to develop an Italian version of the Revised Brief Diabetes Knowledge Test (DKT2), providing a cultural and linguistic validation supported by psychometrics and hypotheses testing.</p><p><strong>Methods: </strong>This multimethods study was divided into 4 phases: (a) cultural-linguistic validation, with a translation and back-translation process; (b) confirmatory factor analysis (CFA) considering the original scale's structure (knowledge and insulin-specific knowledge); (c) criterion validity via hypotheses testing; and (d) cross-group measurement invariance. The internal consistency reliability was assessed by the Kuder-Richardson Formula 20 (KR-20) of the overall scale.</p><p><strong>Results: </strong>A total of 251 patients and 251 caregivers were enrolled. The CFA showed good goodness of fit for both patients and caregivers. The tested hypotheses supported criterion validity in both groups. Reliability was adequate: All KR-20 values in both groups and domains were higher than 0.60. The mean percentage of knowledge score on DKT2 was lower for patients than caregivers.</p><p><strong>Conclusion: </strong>The DKT2 is a valid and reliable scale to assess overall knowledge of diabetes, considering its role in promoting appropriate self-care behaviors in patients with type 2 diabetes mellitus. The Italian version of DKT2 demonstrated reliability and validity, and it can be used by researchers and diabetes care and education specialists to assess a patient's or population's overall knowledge of diabetes.</p>","PeriodicalId":75187,"journal":{"name":"The science of diabetes self-management and care","volume":"49 5","pages":"362-373"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41223099","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":"The Role of Perceived Sleep Quality in Cardiovascular Health Factors and Behaviors Among Young Adults With Type 1 Diabetes.","authors":"Stephanie Griggs, Johnathan Huynh, Jorden Rieke, Quiana Howard","doi":"10.1177/26350106231192352","DOIUrl":"10.1177/26350106231192352","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to determine the associations between perceived sleep quality and individual cardiovascular health (CVH) factors (A1C and body mass index [BMI]) and CVH behaviors (physical activity and dietary diabetes self-management) in young adults ages 18 to 25 years with type 1 diabetes (T1D).</p><p><strong>Methods: </strong>Associations among perceived sleep quality and CVH factors and behaviors were examined using multivariable linear regression in 69 participants ages 18 to 25 years (mean age 21.4 ± 2.0, mean T1D duration 9.7 ± 5.6 years).</p><p><strong>Results: </strong>Lower perceived sleep quality was associated with multiple lower CVH factors and behaviors (higher A1C and BMI, lower physical activity, poorer diet) even after adjusting for covariates (age, T1D duration, sex assigned at birth).</p><p><strong>Conclusion: </strong>Experimental studies are needed to better understand the impact of modifying sleep habits on both short- and long-term CVH in adults with T1D.</p>","PeriodicalId":75187,"journal":{"name":"The science of diabetes self-management and care","volume":"49 5","pages":"384-391"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10551801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10648461","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":"Comparing American Indian/Alaska Native Adolescent Daughters' and Their Mothers' Awareness, Knowledge, Attitudes, and Behaviors Regarding Risk for Gestational Diabetes: Implications for Mother-Daughter Communication on Reproductive Health.","authors":"Denise Charron-Prochownik, Kelly R Moore, Sarah Stotz, Aletha Akers, Sandra Beirne, Angela G Brega, Laura Chalmers, Andrea Fischl, Heather Garrow, Kelly Gonzales, Kristen J Nadeau, Nancy O'Banion, Jeff Powell, Ellen Seely, Blair Powell, Hiba Abujaradeh, Susan M Sereika","doi":"10.1177/26350106231178837","DOIUrl":"10.1177/26350106231178837","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to describe, compare, and examine associations at baseline of reproductive health awareness, knowledge, health beliefs, communication and behaviors related to gestational diabetes (GDM) and GDM risk reduction in a vulnerable population of both American Indian/Alaska Native (AIAN) adolescent girls and their mothers.</p><p><strong>Methods: </strong>Descriptive/comparative/correlational analyses examined multitribal baseline data on 149 mother-daughter (M-D) dyads (N = 298; daughter age = 12-24 years) enrolled in a longitudinal study to adapt and evaluate a culturally relevant diabetes preconception counseling (PC) program (Stopping-GDM). The associations between GDM risk reduction awareness, knowledge, health beliefs, and behaviors (eg, daughters' eating, physical activity, reproductive-health [RH] choices/planning, M-D communication, daughters' discussions on PC) were examined. Data collected online from 5 national sites.</p><p><strong>Results: </strong>Many M-D lacked awareness/knowledge of GDM and risk reduction. Both M-D were unaware of the girl's risk for GDM. Mothers' knowledge and beliefs on GDM prevention/RH were significantly higher than daughters. Younger daughters had greater self-efficacy healthy living. Overall sample reported low to moderate scores for both M-D communication and daughters' GDM and RH risk-reduction behaviors.</p><p><strong>Conclusions: </strong>Knowledge, communication, and behaviors to prevent GDM were low in AIAN M-D, especially daughters. More than daughters, mothers perceive greater risk of GDM for daughters. Early culturally responsive dyadic PC programs could help decrease risk of developing GDM. Implications for M-D communication is compelling.</p>","PeriodicalId":75187,"journal":{"name":"The science of diabetes self-management and care","volume":"49 4","pages":"267-280"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9904239","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":"Impact of Research: Achieving Health Equity for Adults With Diabetes.","authors":"Gretchen A Piatt","doi":"10.1177/26350106231169691","DOIUrl":"https://doi.org/10.1177/26350106231169691","url":null,"abstract":"Since 1977, Diabetes Research and Training Centers (DRTCs) and, more recently, Centers for Diabetes Translational Research (CDTRs) played a foundational role in the nation’s efforts to translate advances in diabetes research into improved outcomes for people with diabetes. With many certified diabetes education specialists playing critical roles in the DRTCs and CDTRs over the years, the impact of diabetes translational research on the Association of Diabetes Care & Education Specialists (ADCES) is significant. It enhanced professional development of ADCES members, led to the development of new and innovative management and treatment options, enabled certified diabetes education specialists to provide personalized management approaches, and supported certified diabetes education specialists working to the extent of their licensures. Over the years, diabetes translational research evolved from health-system-centric patient education, team care, and model care delivery to regional, national, and international approaches that target patients, certified diabetes care and education specialists, providers, practices, health systems, and communities. Indeed, researchers from the University of Michigan CDTR made significant contributions to the science and practice of using nontraditional, complex study designs to evaluate and improve diabetes prevention, management, and self-management support programs; the development and implementation of the empowerment approach to diabetes education; new measurements to assess knowledge, provider attitudes, and patient empowerment; establishment of the cost-effectiveness of diabetes selfmanagement education and support and other novel programs; and the design and evaluation of innovative intervention strategies, tools, and platforms to improve individual and population health. To address the progression of diabetes translational science, in 2020, the CDTRs refocused their programs to provide specialized expertise and resources to raise awareness of, interest in, and successful execution of rigorous translational diabetes research focused on improving health equity for people with and at risk for developing diabetes. Although landmark trials established the scientific basis for diabetes prevention and management and significant progress was made in decreasing the gaps between optimal care and the care delivered in everyday clinical practice, the public health impact of these efforts remains unrealized. The continued disproportionate disease burden that faces health care systems, nationwide and globally, is largely attributable to several factors, including systemic differences in health that are avoidable, unjust, and related to social and economic disadvantage. Glaring disparities persist by race/ethnicity, education, income, and geography in prevalence, morbidity, and mortality from diabetes and other cardiometabolic conditions.1,2 There are steep inverse gradients in diabetes prevalence, complications, and mortali","PeriodicalId":75187,"journal":{"name":"The science of diabetes self-management and care","volume":"49 4","pages":"317-318"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9920009","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}