Primary care diabetes最新文献

{"title":"Cognitive impairment is associated with poor diabetic foot ulcer outcomes.","authors":"Christopher Girgis, Stephanie Behme, Crystal Holmes, Sari Priesand, Evan L Reynolds, Jihyun Park, Pearl G Lee, Brian M Schmidt","doi":"10.1016/j.pcd.2025.07.008","DOIUrl":"https://doi.org/10.1016/j.pcd.2025.07.008","url":null,"abstract":"<p><strong>Background: </strong>Up to one-third of individuals with diabetes develop diabetic foot ulcers (DFU), and cognitive impairment affects up to 34 % of this population. This study evaluates the impact of cognitive impairment on ulcer outcomes.</p><p><strong>Methods: </strong>This six-year retrospective study analyzed ICD-9/10 codes from a large tertiary health system. Eligible patients had DFU and at least six months of follow-up. Exclusions were made for those without an ulcer and not seen by a podiatrist. For the cohort without cognitive impairment, patients were excluded if they screened positive for cognitive impairment or dementia in the five years prior to diagnosis. Clinical outcomes were assessed using the Wound, Ischemic, Foot Infection classification, focusing on healing rates, time to healing, amputation events, and hospital admissions. Logistic regression determined associations between cognitive impairment and DFU outcomes.</p><p><strong>Results: </strong>Of 631 charts reviewed, 123 patients were included: 56 with cognitive impairment (mean age 71.9) and 67 without (mean age 58). Healing rates at six months were lower for those with cognitive impairment (39 % vs. 72 %, p < 0.001). They had higher rates of major amputations (17.8 % vs. 5.9 %, odds ratio 4.5, p < 0.05) and foot-related admissions (p = 0.01).</p><p><strong>Conclusions: </strong>Individuals with DFU and cognitive impairment were at higher risk of major amputation, foot-related admissions, and nonhealing, underscoring the need for targeted interventions.</p>","PeriodicalId":94177,"journal":{"name":"Primary care diabetes","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755529","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":"Response to comment on \"Comment on characteristics of metabolic inflammatory syndrome among inpatients with type 2 diabetes: A cross-sectional study in China\".","authors":"Mengjuan Xue, Bin Lu","doi":"10.1016/j.pcd.2025.07.006","DOIUrl":"https://doi.org/10.1016/j.pcd.2025.07.006","url":null,"abstract":"<p><p>This manuscript addresses several comments raised by Dr. Liao on metabolic inflammatory syndrome (MIS) in type 2 diabetes inpatients. It explains the limitations including selection bias in the study population, lack of exploration of molecular mechanisms, and discrepancies in dyslipidemia findings.</p>","PeriodicalId":94177,"journal":{"name":"Primary care diabetes","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755530","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 iron biomarkers in predicting type 2 Diabetes: An international, multi-cohort Study.","authors":"Farnaz Khatami, Pien Rawee, Vlada Hanchar, Martin H de Borst, Stephan J L Bakker, Milton Severo, Henrique Barros, Michele F Eisenga, Taulant Muka, Pedro Marques-Vidal","doi":"10.1016/j.pcd.2025.07.004","DOIUrl":"https://doi.org/10.1016/j.pcd.2025.07.004","url":null,"abstract":"<p><strong>Aims: </strong>We investigated whether adding iron biomarkers into existing type 2 diabetes risk models improves risk prediction.</p><p><strong>Methods: </strong>Data from three population-based cohorts were used; CoLaus|PsyCoLaus in Switzerland (5250 participants, 54.9 % females, mean age± standard deviation 51.8 ± 10.5 years, median follow-up of 14.5 years; PREVEND in the Netherlands (4784 participants, 51.8 % females, 52.2 ± 11.5 years, follow-up 7.3 years); and EPIPorto in Portugal (806 participants, 40 % females, 62 ± 13 years, follow-up 7.8 years). The effect of adding iron, ferritin, and transferrin in seven type 2 diabetes risk models was examined.</p><p><strong>Results: </strong>486 participants (9.3 %) in the CoLaus|PsyCoLaus, 170 (3.6 %) in PREVEND, and 22 (3.4 %) in EPIPorto developed diabetes. There was a substantial association between type 2 diabetes and all risk scores. In the CoLaus|PsyCoLaus and PREVEND, ferritin levels were positively and independently associated with the incidence of diabetes and considerably enhanced its prediction. Transferrin levels were positively and independently associated with the incidence of diabetes across all risk scores in all cohorts and improved its prediction in PREVEND, EpiPorto, and certain risk models in CoLaus|PsyCoLaus. There was found to be no association between iron levels and type 2 diabetes.</p><p><strong>Conclusions: </strong>Adding ferritin or transferrin slightly improved most diabetes risk prediction models.</p>","PeriodicalId":94177,"journal":{"name":"Primary care diabetes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700756","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":"Achieving meaningful reduction of HgbA1c in pediatric type 1 diabetes requires an individualized approach.","authors":"Andrew Kanouse, Joanna S Fishbein, Parissa Salemi","doi":"10.1016/j.pcd.2025.07.005","DOIUrl":"https://doi.org/10.1016/j.pcd.2025.07.005","url":null,"abstract":"<p><strong>Objective: </strong>Individuals with diabetes often have difficulty attaining a goal hemoglobin A1c < 7.0 %. Diabetes care is multifactorial, including medications, education, and lifestyle intervention. Individuals with a hemoglobin A1c (HgbA1c) > 10 % are especially at risk for complications. The aim of this study was to evaluate the association of technological interventions [continuous glucose monitors (CGM) and/or continuous subcutaneous insulin infusion devices (CSII, i.e. insulin pumps)] and frequency of clinic visits with improvement of HgbA1c values in children with type 1 diabetes (T1D) who have a HgbA1c > 10 %.</p><p><strong>Research design and methods: </strong>A chart review was performed for patients with T1D who had a HgbA1c > 10 % and a diagnosis of T1D for greater than 1 year between 2018 and 2019 analyzing demographic data, treatment modality, and frequency of visits to determine if a clinically meaningful HgbA1c reduction (>0.5 %) was achieved.</p><p><strong>Results: </strong>One hundred and forty-seven children were evaluated. Altogether, 9 children (53 %) with CGM only, 18 (64 %) with CSII only, and 14 (78 %) with combination use achieved a clinically significant reduction as compared to 50 (60 %) with no technology. When evaluating number of visits, 41 children (61 %) with 1-2 visits, 40 (60 %) with 3, 19 (70 %) with 4, and 5 (50 %) with 5-6 achieved reduction.</p><p><strong>Conclusions: </strong>These results show that while either use of technology or increased clinic visits may improve the ability to achieve meaningful HgbA1c reductions, this may not be true for all patients. While some patients may need numerous clinic visits, others may be able to make dramatic changes with only two visits. Similarly, while some may benefit from CGM use alone, others may improve their HgbA1c with a CSII or no technology. Given the intricacies of diabetes care, this data supports that patients would likely benefit from a tailored treatment plan catered to their individual needs to best optimize their HgbA1c.</p>","PeriodicalId":94177,"journal":{"name":"Primary care diabetes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692793","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":"Corrigendum to \"Continuity of care across sectors in patients with type 2 diabetes: A nationwide register study in Denmark\" [Prim. Care Diabetes 19 (2025) 261-269].","authors":"Anne Sofie Baymler Lundberg, Claus Høgstrup Vestergaard, Annelli Sandbæk, Anders Prior","doi":"10.1016/j.pcd.2025.07.003","DOIUrl":"https://doi.org/10.1016/j.pcd.2025.07.003","url":null,"abstract":"","PeriodicalId":94177,"journal":{"name":"Primary care diabetes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651675","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 Influence of Local Service Configuration on All-Cause Mortality: An Age- and Sex-Standardised Analysis.","authors":"Mike Stedman, Mark Davies, Adam Robinson, John Warner-Levy, Martin Whyte, Martin Gibson, Ritwika Mallik, Adrian Heald","doi":"10.1016/j.pcd.2025.06.003","DOIUrl":"https://doi.org/10.1016/j.pcd.2025.06.003","url":null,"abstract":"<p><strong>Aims: </strong>Public Health England mortality data shows that most deaths are associated with underlying longer-term health issues and could potentially be mitigated by more effective preventive and planned healthcare. General practitioner practices (GPPs) are the provider and gatekeeper to most NHS healthcare services and there are no direct publications of deaths at GPP level Our aim here was to determine how estimated mortality rate at GPP level may associate with the effectiveness of local services in delivering healthcare outcomes.</p><p><strong>Methods: </strong>We used Office of National Statistics (ONS) data for January 2018-January 2020 (inclusive). From this an estimated Age Standardised Mortality Rate (SMR) for that Layer Super Output Areas (LSOA) was calculated. A linear link between local LSOA SMR and IMD was established so that the SMR_D could be calculated which assumes the practice was at median deprivation. Risk Factors that were then included into the Analysis these included: demographic, medical conditions, local use of preventive Medication (prescriptions) and impact of local area health services, including diabetes. Stepwise (removing factors with p value > 0.05) multifactorial linear regression was applied to derive the impact of these factors on the SMR_D RESULTS: The analysis covered 5792 GPP where all the data was available, and where more than 2000 patients were on the practice list. There were 22 factors taken into consideration for the model, of which 17 remained significant. If all practices achieved at least the median level there might be as many as 30,000 (7 %) fewer deaths/year. IMD even after adjustment within the LSOA SMR continued to have a strong effect. The association of Cancer QOF registration rates was associated with a lower mortality rate. A higher rate of diabetes case identification did not associate with reduced mortality rate, rather with higher mortality rate. Practice size was not a factor. Practices with higher percentage of older patients had relative lower mortality rates as did those with higher rates of antihypertensive prescribing.</p><p><strong>Conclusions: </strong>We here describe associations that suggest that there are underlying themes to understanding the drivers to mortality in England. Our model can be applied to local practices to highlight those that have the largest gap. The association of general practice percentage identification of diabetes cases with increased practice mortality rate likely relates to the reality of type 2 diabetes being associated with many other conditions that can shorten life. The association of higher rates of prescription of antihypertensive agents in individuals over 65 years old with lower practice mortality, highlights the importance of effective identification and effective treatment of hypertension in this group.</p>","PeriodicalId":94177,"journal":{"name":"Primary care diabetes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651676","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":"Evaluating the mySugr diabetes app: A randomised controlled trial exploring changes in HbA1c and psychological outcomes in adults with type 1 diabetes.","authors":"Ashley Anjali Singh, Katie M Babbott, Simon Young, Zhenqiang Wu, Anna Serlachius","doi":"10.1016/j.pcd.2025.07.002","DOIUrl":"https://doi.org/10.1016/j.pcd.2025.07.002","url":null,"abstract":"<p><strong>Aim: </strong>The present study sought to explore if engagement with a commercially available diabetes app, mySugr, could facilitate improvement in glycaemic outcomes, diabetes self-care behaviours and psychological wellbeing compared to standard care among adults with type 1 diabetes (T1D).</p><p><strong>Methods: </strong>Participants were randomised to the intervention (n = 31) or control group (n = 32) and assessed at 12 weeks after baseline. Changes to blood glucose levels (HbA1c) was the primary outcome of interest in the present study. Secondary outcomes included diabetes self-care behaviours, diabetes self-efficacy, diabetes distress, psychological well-being and general stress. These outcomes were quantitatively assessed via self-report questionnaires. Qualitative accounts of user engagement with the app were also explored.</p><p><strong>Results: </strong>Fifty-five participants completed the 12-week follow-up questionnaires. The intervention group demonstrated a lower HbA1c than the control group at 12-weeks, however this change was not statistically significant (adjusted mean difference 4.20 mmol/mol, 95 % CI [-0.39,8.79], p = 0.072). Additionally, no significant changes across time or between-group differences were observed for secondary outcomes at 12 weeks. However, close to 80 % of participants in the intervention group reported using the app daily for 12 weeks, suggesting good user engagement. Further, users scored the app on average favourably on the uMARS scale (objective quality M=3.93, SD=0.55, subjective quality M=3.31, SD=0.99, perceived impact M=3.15, SD=1.25).</p><p><strong>Conclusion: </strong>Results suggest that mySugr is an engaging diabetes app. Preliminary findings suggest that the mySugr app may assist users in improving glycaemic levels over 12 weeks, but the trends found in the present study did not reach statistical significance. Thus, the study needs to be replicated in a larger sample size with a longer follow-up period to more robustly ascertain the effects of mySugr on glycaemic outcomes and diabetes self-management.</p>","PeriodicalId":94177,"journal":{"name":"Primary care diabetes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602700","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":"Managing type 1 diabetes at work - A qualitative meta-synthesis.","authors":"Emma Victoria Shiel, Steve Hemingway, Rajeeb Kumar Sah, Kim Burton","doi":"10.1016/j.pcd.2025.06.009","DOIUrl":"https://doi.org/10.1016/j.pcd.2025.06.009","url":null,"abstract":"<p><strong>Aims: </strong>To interpret the available qualitative research findings on people's experiences of managing type 1 diabetes at work.</p><p><strong>Methods: </strong>A qualitative meta-synthesis was conducted using constant comparative methods, reciprocal analysis, and a line of argument synthesis, which were expressed narratively.</p><p><strong>Results: </strong>The study included thirteen articles, revealing a complex relationship between type 1 diabetes and work. People with type one diabetes want minimal interference in their daily routines while balancing health and work responsibilities. The concept of 'containment' emerged as a key strategy, where self-management is integrated alongside work demands. However, this approach may inadvertently lead to psychosocial conflicts and detrimental health outcomes.</p><p><strong>Conclusions: </strong>The findings highlight the importance of creating supportive and empowering workplaces to reduce the tensions between type one diabetes and work. Enabling people with type one diabetes to self-manage effectively while maintaining autonomy requires support that both fosters self-management and avoids isolation. This sort of supportive and empowering work environment for workers with type one diabetes could contribute to facilitating [re]entry and retention in the workforce. This synthesis adds to contemporary knowledge, particularly in qualitative areas, yet further study is needed to identify specific actions that can create more accommodating workplaces for people with type one diabetes.</p>","PeriodicalId":94177,"journal":{"name":"Primary care diabetes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593292","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":"Performance of the finnish diabetes risk score in screening for undiagnosed type 2 diabetes among adults without prior diagnosis: A Kharameh Cohort Study, Iran.","authors":"Andishe Hamedi, Mozhgan Seif, Mohammad Hossein Sharifi, Abbas Rezaianzadeh, Jafar Hassanzadeh","doi":"10.1016/j.pcd.2025.07.001","DOIUrl":"https://doi.org/10.1016/j.pcd.2025.07.001","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the effectiveness of the Finnish Diabetes Risk Score (FINDRISC) as a potentially valuable tool for diabetes screening and prevention.</p><p><strong>Methods: </strong>This study utilized data from the Kharameh Cohort Study, which included 10,663 participants. Of these, 1600 individuals with known diabetes were excluded. Participants were assessed using the FINDRISC questionnaire and a fasting blood glucose test to determine their glucose metabolism status. Receiver Operating Characteristic curves evaluated the effectiveness of FINDRISC in identifying Undiagnosed Diabetes Mellitus (UDM).</p><p><strong>Results: </strong>The prevalence of individuals with UDM was 2.2 %. The FINDRISC score was 14.18 ± 4.46 for those with UDM, compared to 9.51 ± 4.69 for those without. Women had a mean FINDRISC score of 10.99 ± 4.42, significantly higher than the mean score of 8.07 ± 4.60 for men. The overall AUC-ROC curve for diagnosing UDM was 0.767 (95 % CI: 0.735-0.800). For men, it was 0.809 (95 % CI: 0.764-0.853), while for women, it was 0.737 (95 % CI: 0.689-0.785).</p><p><strong>Conclusions: </strong>The FINDRISC score demonstrates good accuracy in identifying individuals with UDM, making it a valuable and simple screening tool, especially in resource-limited settings. Significant gender differences were observed in the risk scores between women and men. Therefore, we recommend that screening tools be adapted to account for these gender differences, with particular attention to individuals with a family history of diabetes to improve early detection and prevention strategies.</p>","PeriodicalId":94177,"journal":{"name":"Primary care diabetes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602701","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":"Clinical characteristics and mortality in novel subgroups of adult-onset diabetes in an Australian population-based cohort of men.","authors":"Jacob W Harland, Zoe Shih-Jung Liu, Kimberly Cukier, Spiros Fourlanos, Courtney Swinton, Briana Spolding, Mark A Kotowicz, Julie A Pasco, Kara L Holloway-Kew","doi":"10.1016/j.pcd.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.pcd.2025.06.007","url":null,"abstract":"<p><strong>Aims: </strong>To determine the prevalence of the novel diabetes subgroups in a population-based study, and investigate clinical characteristics and mortality in these subgroups compared to participants without diabetes.</p><p><strong>Methods: </strong>Men from the Geelong Osteoporosis study (n = 895) were categorised according to diabetes status. Men with diabetes (n = 105) were categorised into the severe auto-immune diabetes (SAID) subgroup based on islet antibody seropositivity. The remaining men were then classified into the other subgroups using k-means clustering. ANOVA and chi-squared tests were used to determine differences in demographics, lifestyle factors and comorbidities between the novel diabetes subgroups and normoglycaemia (n = 790). Cox proportional hazard models were used to compare mortality over a median of 11.8 years (IQR 9.7-11.3). A p-value< 0.05 was considered significant, models were adjusted for age, physical activity, and systolic blood pressure.</p><p><strong>Results: </strong>Compared to men with normoglycaemia, mean blood pressure and cardiovascular comorbidities were higher in the mild obesity-related diabetes (MOD), mild age-related diabetes (MARD), and severe insulin-resistant diabetes (SIRD) subgroups. The MARD subgroup was associated with higher mortality in unadjusted models (HR 5.5, 95 %CI 3.6-8.4); although this was attenuated after adjustment. In unadjusted models, mortality was not different in the SIRD subgroup, however, after adjustment this subgroup had higher mortality (HR 2.0; 95 %CI 1.0-3.9).</p><p><strong>Conclusions: </strong>These data may influence choice of antihyperglycaemic medication and management of cardiovascular risk factors in men with type 2 diabetes particularly in the SIRD subgroup which is associated with cardiovascular-related comorbidities, and mortality.</p>","PeriodicalId":94177,"journal":{"name":"Primary care diabetes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568290","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}