Canadian Journal of Diabetes最新文献

{"title":"Impaired Cardiovagal Activity as a Link Between Hyperglycemia and Arterial Stiffness in Adults With Type 2 Diabetes Mellitus Among an Eastern Indian Population: A Cross-sectional Study","authors":"Nibedita Priyadarsini MD ,&nbsp;Devineni Likhitha MBBS ,&nbsp;Madumathy Ramachandran MD ,&nbsp;Kishore Kumar Behera MD, DM","doi":"10.1016/j.jcjd.2023.12.003","DOIUrl":"10.1016/j.jcjd.2023.12.003","url":null,"abstract":"<div><h3>Objectives</h3><p>Cardiac autonomic neuropathy<span><span> (CAN) is one of the most common yet overlooked complications of type 2 diabetes mellitus (T2DM). Individuals with T2DM with CAN have a 5-fold higher rate of cardiovascular morbidity and mortality. The presence of CAN in T2DM could potentially lead to arterial stiffness. However, only sparse data are available suggesting any association between </span>autonomic dysfunction and arterial stiffness in T2DM.</span></p></div><div><h3>Methods</h3><p><span>We recruited 80 people with T2DM and 74 healthy controls for our study. Heart rate variability (HRV) testing was performed to assess autonomic function. Assessment of arterial stiffness was done by measuring the brachial </span>pulse wave velocity (baPWV) and augmentation index (AI).</p></div><div><h3>Results</h3><p>The time-domain parameters were significantly decreased (p&lt;0.001) and frequency-domain parameters, such as total power and high-frequency band expressed as a normalized unit, were found to be significantly reduced in people with T2DM (p&lt;0.001). Both baPWV and AI were significantly higher in people with T2DM compared with healthy controls (p&lt;0.001). We observed a moderate correlation between standard deviation of normal to normal interval (SDNN) and baPWV (r=−0.437, p=0.002) and AI (r=−0.403, p=0.002). A multiple linear regression model showed an association between SDNN and arterial stiffness parameters, such as baPWV and AI, which were statistically significant (p&lt;0.05) in a fully adjusted model that included the conventional risk factors for atherosclerosis.</p></div><div><h3>Conclusions</h3><p>Impaired cardiovagal activity is an independent risk factor for the development of arterial stiffness. Incorporation of HRV testing into the diabetes management protocol would have potential benefits for identifying individuals at high risk of developing cardiovascular events. Hence, preventive measures can be taken as early as possible to improve patient outcomes.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139017377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online Educational Resources for Youth Living With Type 1 Diabetes Transitioning to Adult Care: An Environmental Scan of Canadian Content","authors":"Asmaa Housni BSc ,&nbsp;Rosemarie Cianci BSc ,&nbsp;Rayzel Shulman PhD ,&nbsp;Meranda Nakhla PhD ,&nbsp;Joseph A. Cafazzo PhD ,&nbsp;Sarah D. Corathers PhD ,&nbsp;Joyce P. Yi-Frazier PhD ,&nbsp;Jessica C. Kichler PhD ,&nbsp;Anne-Sophie Brazeau RD, PhD","doi":"10.1016/j.jcjd.2023.12.008","DOIUrl":"10.1016/j.jcjd.2023.12.008","url":null,"abstract":"<div><h3>Objectives</h3><p>There are many educational resources for adolescents and young adults living with type 1 diabetes<span>; however, it is unknown whether they address the breadth of topics related to transition to adult care. Our aim in this study was to collect educational resources relevant to Canadian youth and assess their quality and comprehensiveness in addressing the knowledge necessary for youth to prepare for interdependent management of their diabetes.</span></p></div><div><h3>Methods</h3><p>We conducted an environmental scan, a systematic assessment and analysis, of online education resources in English and French relevant to Canadian youth living with type 1 diabetes. Resources were screened using an open education resource evaluation grid and relevant resources were mapped to the Readiness for Emerging Adults with Diabetes Diagnosed in Youth, a validated diabetes transition readiness assessment tool.</p></div><div><h3>Results</h3><p>From 44 different sources, 1,245 resources were identified and, of these, 760 were retained for analysis. The majority were webpages (50.1%) and downloadable PDFs (42.4%), and 12.1% were interactive. Most resources covered Diabetes Knowledge (46.0%), Health Behaviour (23.8%), Insulin and Insulin Pump Management (11.8% and 8.6%, respectively), and Health-care System Navigation (9.7%). Topic areas with the fewest resources were disability accommodations (n=5), sexual health/function (n=4), and locating trustworthy diabetes resources (n=3).</p></div><div><h3>Conclusions</h3><p>There are many resources available for those living with type 1 diabetes preparing to transition to adult care, with the majority pertaining to diabetes knowledge and the least for navigation of the health system. Few resources were available on the topics of substance use, sexual health, and reproductive health. An interactive presentation of these resources, as well as a central repository to house these resources, would improve access for youth and diabetes care providers during transition preparation.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139096330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining the Associations Between Glucocorticoid Use During Hematologic Chemotherapy Treatment and New-onset Diabetes and Hyperglycemia and Mortality: A Population-based Cohort Study","authors":"Sarah Moore-Vasram PhD, NP ,&nbsp;Monakshi Sawhney PhD, NP ,&nbsp;Robyn L. Houlden MD ,&nbsp;Patti A. Groome PhD ,&nbsp;Catherine Goldie PhD, RN ,&nbsp;Wenbin Li MSc ,&nbsp;Annette E. Hay MD ,&nbsp;Joan Tranmer PhD, RN","doi":"10.1016/j.jcjd.2024.01.001","DOIUrl":"10.1016/j.jcjd.2024.01.001","url":null,"abstract":"<div><h3>Objectives</h3><p>The aim of this study was to determine the associations between glucocorticoid administration during chemotherapy for hematologic malignancy and hyperglycemia, new-onset diabetes, and mortality in Ontario, Canada. Hospitalization and emergency room utilization during the chemotherapy treatment period were also described.</p></div><div><h3>Methods</h3><p>We conducted a retrospective cohort study using health administrative data from ICES, Ontario, to assess risk of new-onset diabetes, new-onset hyperglycemia, and hyperglycemia for individuals with leukemia, non-Hodgkin lymphoma (NHL), and Hodgkin lymphoma (HL) receiving glucocorticoids during chemotherapy between 2006 and 2016. Using multivariable regression models, we determined the associations between glucocorticoid exposure and our outcomes of interest, controlling for age, sex, marginalization, and comorbidities.</p></div><div><h3>Results</h3><p>Our cohort included 19,530 individuals; 71.1% (n=13,893) received a glucocorticoid. The highest proportion of hyperglycemia occurred with leukemia (25.4%, n=1,301). Of the 15,580 individuals with no history of diabetes, those with leukemia had the highest rate of new-onset diabetes (7.1%, n=279) and new-onset hyperglycemia (18.1%, n=641), and glucocorticoid exposure increased the risk of new-onset diabetes (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.01 to 1.64, p=0.04) and new-onset hyperglycemia (HR 1.28, 95% CI 1.09 to 1.5, p=0.003). Hyperglycemia during chemotherapy increased the risk of all-cause mortality for the combined (HR 1.18, 95% CI 1.09 to 1.27, p&lt;0.0001) and NHL (HR 1.16, 95% CI 1.04 to 1.28, p=0.007) cohorts.</p></div><div><h3>Conclusions</h3><p>Hyperglycemia is common during hematologic chemotherapy treatment and is associated with a modest increased risk of all-cause mortality. Routine screening, monitoring, and management of hyperglycemia should be an integral part of treatment plans for leukemia, NHL, or HL, with or without glucocorticoid administration.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S149926712400011X/pdfft?md5=b83bba3b08312537806edf0166492e08&pid=1-s2.0-S149926712400011X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139409499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of Beverages With Non-nutritive Sweeteners Among Indigenous Adults Living in Manitoba and Implications for Type 2 Diabetes","authors":"Natalie D. Riediger PhD ,&nbsp;Mya Ruby Kidson BSc ,&nbsp;Kelsey Mann MSc ,&nbsp;Larry Wood ,&nbsp;Byron Beardy ,&nbsp;Michael Champagne ,&nbsp;Riel Dubois ,&nbsp;Krista Beck BSc, RD ,&nbsp;Maria Kisselgoff MSc ,&nbsp;Mary Jane Harper ,&nbsp;Anne Waugh MSc ,&nbsp;Andrea Bombak PhD ,&nbsp;Chantal Perchotte BSc ,&nbsp;Céleste Theriault BBA","doi":"10.1016/j.jcjd.2023.12.006","DOIUrl":"10.1016/j.jcjd.2023.12.006","url":null,"abstract":"<div><h3>Objectives</h3><p>The purpose of this study was to explore the perspectives of Indigenous adults on consuming beverages with non-nutritive sweeteners.</p></div><div><h3>Methods</h3><p>In this work, we used a community-based, participatory design in partnership with National Indigenous Diabetes Association, Four Arrows Regional Health Authority, and Fearless R2W. We conducted 74 qualitative interviews with Indigenous adults living in Manitoba, including Island Lake First Nations (n=39), Flin Flon (n=15), and the North End neighbourhood of Winnipeg (n=20). Data were indexed in NVivo, and transcripts were analyzed thematically.</p></div><div><h3>Results</h3><p>Participants exclusively discussed beverages with non-nutritive sweeteners (BNNSs) as an alternative to regular pop or sugary drinks, which were widely available, accessible, and consumed. Why or how BNNSs were viewed as an alternative comprised 3 subthemes: an alternative for health reasons; divergent taste preferences; and an alternative with mysterious but negative health effects. Participants who reported regular consumption of BNNSs largely described consuming them to manage type 2 diabetes. Fewer participants discussed BNNS as a means of weight management or as a preventive health behaviour. Participants who did not report regular BNNS consumption described not liking the taste of BNNSs. Finally, many participants described negative health impacts of consuming BNNSs, and specifically aspartame, although few articulated what those negative impacts were.</p></div><div><h3>Conclusions</h3><p>Divergent perspectives among Indigenous adults regarding the health implications of consuming BNNSs may reflect ongoing scholarly debates. These findings have implications for the prevention and dietary management of type 2 diabetes in Indigenous communities.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1499267123007256/pdfft?md5=1ac56273f67d3e956e848dede379a7cb&pid=1-s2.0-S1499267123007256-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139053396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Prediction Scores for Type 2 Diabetes Microvascular and Cardiovascular Complications Derived and Validated With Real-world Data From 2 Provinces: The DIabeteS COmplications (DISCO) Risk Scores","authors":"Baiju R. Shah MD, PhD ,&nbsp;Peter C. Austin PhD ,&nbsp;Noah M. Ivers MD, PhD ,&nbsp;Alan Katz MD ,&nbsp;Alexander Singer MB, BCh, BAO ,&nbsp;Monica Sirski PhD ,&nbsp;Deva Thiruchelvam MSc ,&nbsp;Karen Tu MD, MSc","doi":"10.1016/j.jcjd.2023.12.009","DOIUrl":"10.1016/j.jcjd.2023.12.009","url":null,"abstract":"<div><h3>Objectives</h3><p>Existing tools to predict the risk of complications among people with type 2 diabetes poorly discriminate high- from low-risk patients. Our aim in this study was to develop risk prediction scores for major type 2 diabetes complications using real-world clinical care data, and to externally validate these risk scores in a different jurisdiction.</p></div><div><h3>Methods</h3><p>Using health-care administrative data and electronic medical records data, risk scores were derived using data from 25,088 people with type 2 diabetes from the Canadian province of Ontario, followed between 2002 and 2017. Scores were developed for major clinically important microvascular events (treatment for retinopathy, foot ulcer, incident end-stage renal disease), cardiovascular disease events (acute myocardial infarction, heart failure, stroke, amputation), and mortality (cardiovascular, noncardiovascular, all-cause). They were then externally validated using the independent data of 11,416 people with type 2 diabetes from the province of Manitoba.</p></div><div><h3>Results</h3><p>The 10 derived risk scores had moderate to excellent discrimination in the independent validation cohort, ranging from 0.705 to 0.977. Their calibration to predict 5-year risk was excellent across most levels of predicted risk, albeit with some displaying underestimation at the highest levels of predicted risk.</p></div><div><h3>Conclusions</h3><p>The DIabeteS COmplications (DISCO) risk scores for major type 2 diabetes complications were derived and externally validated using contemporary real-world clinical data. As a result, they may be more accurate than other risk prediction scores derived using randomized trial data. The use of more accurate risk scores in clinical practice will help improve personalization of clinical care for patients with type 2 diabetes.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1499267123007281/pdfft?md5=053a69f7565503c99812eb9afc1a90dd&pid=1-s2.0-S1499267123007281-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139065132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cross-sectional Study on the Impact of Educational Status on Physical Activity Level in Danish and English Adults With Type 1 Diabetes","authors":"Sarah Elton Sander MSc, RN ,&nbsp;Rakel Fuglsang Johansen PhD, MD ,&nbsp;Sharon Caunt PhD ,&nbsp;Esben Søndergaard MD, PhD ,&nbsp;Monica Gylling Rolver MS ,&nbsp;Anni Sandbæk MBA ,&nbsp;Simon Heller DM, FRCP ,&nbsp;Peter Lommer Kristensen PhD, MD ,&nbsp;Stig Molsted PhD","doi":"10.1016/j.jcjd.2024.01.002","DOIUrl":"10.1016/j.jcjd.2024.01.002","url":null,"abstract":"<div><h3>Objectives</h3><p>Physical activity is associated with improved health in people with type 1 diabetes<span>. However, physical activity level may be associated with socioeconomic status. The primary aim of this study was to investigate the association between education level and physical activity level among people with type 1 diabetes.</span></p></div><div><h3>Methods</h3><p>In this cross-sectional study, data on physical activity level (high or low) was measured using the Saltin–Grimby Physical Activity Level Scale, and education level (low, medium, or high) was self-reported.</p></div><div><h3>Results</h3><p>Respondents were recruited from outpatient clinics (Steno Diabetes Centre Aarhus, Denmark; Nordsjællands Hospital, Denmark; or Sheffield Diabetes and Endocrine Centre, United Kingdom), by health-care personnel from September 2019 to July 2021. A total of 324 people with type 1 diabetes were included (54% male, median age 50 years [interquartile range 30–60 years]). Education level was low in 10%, medium in 33%, and high in 57%. A logistic regression analysis, adjusted for age, sex, cohabitation status and nationality, found that a medium vs. high education level was associated with lower odds of a high physical activity level (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.32–0.94, p=0.029), while no association was found for low vs. high education level with high physical activity level (OR 0.56, 95% CI 0.25–1.29, p=0.173).</p></div><div><h3>Conclusions</h3><p>Medium education level compared with a high education level was associated with a lower level of physical activity in people with type 1 diabetes. Health-care professionals are advised to be attentive of physical activity levels among people with type 1 diabetes.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139464071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Body: Using Photovoice to Explore Social Determinants of Diabetes With South Asian Adolescents in the Peel Region of Ontario, Canada","authors":"Ananya Tina Banerjee PhD ,&nbsp;Shudipta Islam MPH ,&nbsp;Amina Khan MPH ,&nbsp;Nousin Hussain MPH ,&nbsp;Evelyn Ascencio MPH ,&nbsp;Nuzha Hafleen MPH","doi":"10.1016/j.jcjd.2023.11.002","DOIUrl":"10.1016/j.jcjd.2023.11.002","url":null,"abstract":"<div><h3>Objectives</h3><p>The higher prevalence of diabetes in the South Asian (SA) population living in Canada spans across generations and is often associated with individual risk factors while undermining the social determinants of health (SDOH). There is a scarcity of studies on the perspectives of SA adolescents with a family history of type 2 diabetes mellitus (T2DM). Learning directly from these adolescents can fill a major gap by providing insight on how the SDOH contribute to disproportionate rates of T2DM in SA immigrant communities.</p></div><div><h3>Methods</h3><p>In this study, we used Photovoice, which is a community-based participatory research (CBPR) method that involves the use of photography to visually capture the challenges of diabetes prevention from the perspective of those with lived experiences. A group of 15 SA youth were recruited from an adolescent diabetes education program in the Peel Region of Ontario. The youth discussed their images and accompanied written narratives during focus groups.</p></div><div><h3>Results</h3><p>Four themes emerged from the thematic analysis of the photographs and participant narratives that influence the manifestation of T2DM in SA communities: 1) immigration and resettlement stressors; 2) food insecurity; 3) unhealthy school environments; and 4) academic pressures.</p></div><div><h3>Conclusions</h3><p>Findings suggest the need to address T2DM as a response to unjust conditions and environments rather than as an epidemic entrenched in genetic predisposition, culture, and poor lifestyle choices.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89721031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Resilience in Arabic-speaking Adult Refugees With Type 2 Diabetes: A Grounded Theory Study During the COVID-19 Pandemic","authors":"Hanin Omar RN, MN ,&nbsp;David Busolo PhD ,&nbsp;Jason Hickey PhD ,&nbsp;Neeru Gupta PhD","doi":"10.1016/j.jcjd.2023.10.403","DOIUrl":"10.1016/j.jcjd.2023.10.403","url":null,"abstract":"<div><h3>Objectives</h3><p>This qualitative study aimed to describe the lived experiences of Arabic-speaking refugees in managing their type 2 diabetes mellitus (T2DM) while resettling during the COVID-19 pandemic, and to generate a grounded theory of how resilience is used to facilitate living well while facing multiple health stressors.</p></div><div><h3>Methods</h3><p>A grounded theory approach was used to conceptualize the dynamic process of resilience in living well with diabetes. Five recently resettled adult refugees with T2DM (2 women and 3 men) participated in unstructured individual interviews in Arabic in New Brunswick, Canada, during the pandemic’s second wave (October 2020 to March 2021). Interview data were transcribed and analyzed thematically using open, axial, and core category coding followed by member checking.</p></div><div><h3>Results</h3><p>Participants identified self-reliance as the core driver for decision-making, actions, and interpretations in health management while experiencing unplanned instability. The process was found to be facilitated by 4 distinct constructs: knowledge seeking, positive outlook, self-care, and creativity.</p></div><div><h3>Conclusions</h3><p>The substantive model derived from this study supports a strengths-based approach to clinical assessment and care of refugees with T2DM, notably during disrupted access to primary and preventive services due to forced resettlement and pandemic mitigation measures. More research is needed to increase understanding of how self-reliance can be optimized in resilience-promoting interventions to facilitate diabetes management among populations in posttraumatic circumstances.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1499267123006901/pdfft?md5=624f16769a060d04a6b05f3dcc05ad9a&pid=1-s2.0-S1499267123006901-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Need to Prioritize Education and Resources to Support Exercise in Type 1 Diabetes: Results of an Australian Survey of Adults With Type 1 Diabetes and Health Providers","authors":"Tessa Glyn MBChB ,&nbsp;Spiros Fourlanos MBBS, FRACP, PhD ,&nbsp;Barbora Paldus MBBS, FRACP ,&nbsp;Steve Flint MD ,&nbsp;Emma Armstrong BSc, MPH ,&nbsp;Robert Charles Andrews MBChB, PhD, FRCP ,&nbsp;Parth Narendran MBBS, PhD, FRCP ,&nbsp;John Wentworth MBBS, PhD, FRACP","doi":"10.1016/j.jcjd.2023.11.003","DOIUrl":"10.1016/j.jcjd.2023.11.003","url":null,"abstract":"<div><h3>Objectives</h3><p>Regular exercise is recommended for people with type 1 diabetes (PWD) to improve their health, but many do not meet recommended exercise targets. Educational resources supporting PWD to exercise exist, but their value is unclear. To determine the need for improved exercise resources in Australia, we surveyed adult PWD and health providers (HPs) about their confidence in managing type 1 diabetes (T1D) around exercise, barriers to exercise, and the adequacy of current resources.</p></div><div><h3>Methods</h3><p>Australian adult PWD and HPs completed surveys to rate the importance of exercise in T1D management, confidence in managing T1D around exercise, barriers to giving and receiving education, resources used, and what form new resources should take.</p></div><div><h3>Results</h3><p>Responses were received from 128 PWD and 122 HPs. Both groups considered exercise to be important for diabetes management. PWD cited time constraints (57%) and concern about dysglycemia (43%) as barriers to exercise, and many lacked confidence in managing T1D around exercise. HPs were more confident, but experienced barriers to providing advice, and PWD did not tend to rely on this advice. Instead, 72% of PWD found continuous glucose monitoring most helpful. Both groups desired better resources to support exercise in T1D, with PWD preferring to obtain information through a structured education program and HPs through eLearning.</p></div><div><h3>Conclusions</h3><p>Australian HPs and PWD appreciate the importance of exercise in T1D management and express a clear desire for improved educational resources. Our findings provide a basis for developing a comprehensive package of resources for both adult PWD and HPs, to support exercise in PWD.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138471395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alterations in the Menstrual Cycle as a Peculiar Sign of Type 1 Diabetes Mellitus: A Meta-analytic Approach","authors":"Carla Greco MD ,&nbsp;Marta Cacciani MD ,&nbsp;Rossella Corleto MD ,&nbsp;Manuela Simoni MD, PhD ,&nbsp;Giorgia Spaggiari MD ,&nbsp;Daniele Santi MD, PhD","doi":"10.1016/j.jcjd.2023.07.009","DOIUrl":"10.1016/j.jcjd.2023.07.009","url":null,"abstract":"<div><h3>Background</h3><p>Menstrual irregularities<span><span> are present in &gt;30% of women with type 1 diabetes mellitus<span> (T1DM). These abnormalities will likely lead to reduced fertility and </span></span>earlier menopause<span>. T1DM management has changed over time, with even more emphasis on stringent levels of glycemic management. Thus, we investigated whether therapeutic T1DM changes have an influence on the proportion of menstrual disorders in women with T1DM.</span></span></p></div><div><h3>Methods</h3><p>A meta-analysis was performed that included clinical trials in which menstrual abnormalities in women with T1DM were studied. The literature was checked for studies in which women with T1DM were compared with healthy, age-matched controls. Case–control, cohort, and cross-sectional studies were included. The primary endpoint was rate of menstrual dysfunction.</p></div><div><h3>Results</h3><p><span>Menstrual dysfunction was higher in women with T1DM compared with controls (odds ratio 2.08, 95% confidence interval [CI] 1.43 to 3.03, p&lt;0.001), even when sensitivity analysis was performed, considering only studies published after 2000. The age at menarche was higher for women with T1DM compared with controls (mean difference 0.53, 95% CI 0.32 to 0.74 years, p&lt;0.001). The proportion of menstrual abnormalities in T1DM was inversely related to diabetes duration, but was unrelated to both </span>body mass index<span> and glycated hemoglobin.</span></p></div><div><h3>Conclusions</h3><p>The meta-analytic approach used confirmed the correlation between T1DM and menstrual irregularities. T1DM menstrual dysfunction seemed unrelated to change in therapeutic management across years, as well as to glycemic management and body weight. The underlying pathogenetic mechanisms are not fully understood.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10029644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}