Search

Type 2 diabetes mellitus (T2DM) management and glycemic control in underserved non-Hispanic Black adults presents with multifaceted challenges: balancing the optimal complexity of antihyperglycemic medications prescribed, limited medication access due to socioeconomic status, medication nonadherence, and high prevalence of cardiometabolic comorbidities. This single-center, cross-sectional, retrospective chart analysis evaluated the association of Medication Regimen Complexity (MRC) with cardiometabolic outcomes (glycemic, atherogenic cholesterol, and blood pressure control) among non-Hispanic Black adults with type 2 diabetes. Utilizing 470 independent patient electronic health records, MRC and other covariates were examined to determine their associations with cardiometabolic outcomes. Chi-square tests of independence and multiple logistic regression were performed to identify associations between MRC and cardiometabolic outcomes. Our findings indicate significant negative and positive associations between MRC and glycemic control and atherogenic cholesterol control, respectively. However, there were no associations between MRC and blood pressure control. As diabetes MRC was shown to be associated with poor glycemic control and improved atherogenic cholesterol control, there is a critical need to standardize interdisciplinary diabetes care to include pharmacists and to develop more insurance policy interventions that increase access to newer, efficacious diabetes medications for historically marginalized populations.

Introduction: The primary objective of this study is to report the results of an online questionnaire and the in-person discussion sessions of physicians specializing in diabetes care in which their opinions about current diabetes management was obtained. Methods: The Diabetes Innovation Summit 2023 drew attendance from a diverse group of specialized physicians from multiple countries. A comprehensive literature review was conducted to examine the technologies and medical needs associated with diabetes management. Using the results of the review, a questionnaire was developed by three experts from the steering committee to solicit feedback from specialized physicians. The online survey was made accessible between 10th December 2022 and 10th January 2023. Following the online survey, six structured in-person discussion sessions were conducted with specialized physicians from the Middle East, Central-Eastern Europe, and North Africa regions. Results: The study revealed that about 59% of survey requests were answered, with many participants being pediatric endocrinologists from North Africa. Around 60% of diabetes patients followed Multiple Daily Injections (MDI) according to specialized physicians. Among MDI users, 62% employed Blood Glucose Monitors (BGM), 31% used intermittent-scanning Continuous Glucose Monitors (isCGM), and 23% used CGM. In North Africa, nearly 90% of patients used MDI due to financial constraints. While physicians focused on both Time in Range (TIR) and HbA1c for MDI-treated patients, satisfaction with TIR achieved was expressed by 31%, while 74·1% believed Real-Time CGM (rtCGM) was effective. Concerns arose about potentially misleading HbA1c results and the relatively low patient achievement of target TIR despite CGM usage. The Smart MDI System was seen favorably compared to other applications. The system's affordability was a significant barrier, particularly in the Middle East and Africa. Conclusion: The present study highlights that physicians are generally supportive of utilizing new technology. The questionnaires and the open discussion revealed the expectation that the Smart MDI technology provides better control, primarily by identifying missed boluses, while expressing concerns on the use of the technology by teenagers and children, who might forget the device and be reluctant to use in public, and by the older population, who might be challenged by the technology. [ABSTRACT FROM AUTHOR]

Background: Several GLP-1 receptor agonists (GLP-1 RAs) are used to treat type 2 diabetes (T2DM). Their cardio- and renal-protective effects and their association with substantial weight loss have been evident and progressively expanded their role in the American Diabetes Association (ADA) guidelines, which are endorsed by the European Association for the Study of Diabetes (EASD). The increased demand led to a global shortage. Methods: We utilized a repeated cross-sectional design, drawing data from national prescribing databases, to analyze six GLP-1 RAs: Dulaglutide, Exenatide, Liraglutide, Lixisenatide, Semaglutide, and Tirzepatide. AutoRegressive Integrated Moving Average (ARIMA) models with exogenous variables were applied to assess the trends over time and in different regions. Results: The prescription rates significantly differ between regions. Wales shows the highest prescribing rate for most GLP-1 RAs. The ARIMA models indicated a significant increase in their prescribing rates after the release of the 2022 ADA guidelines (e.g., Dulaglutide: Post-ADA effect of 15.22, 95% CI: [12.97, 17.47]). Following the GLP-1 RA shortages in July 2023, the prescribing rates, particularly for Semaglutide, increased (Shortage effect: 74.36, 95% CI: [71.92, 76.80]). Model diagnostics, including the Akaike Information Criterion (AIC) and Durbin–Watson statistics, confirmed the robustness of these trends. Conclusions: Informed decisions should be made by considering the prescribing trends before and after important events such as the issuing of new guidelines or safety alerts. [ABSTRACT FROM AUTHOR]

Introduction: HbA1c, or glycated hemoglobin, is crucial for diagnosing and monitoring diabetes, reflecting average blood glucose levels over 2-3 months. However, its accuracy can be affected by conditions like iron deficiency anemia (IDA), which alters red blood cell lifespan and potentially skews HbA1c readings. This study aims to explore the effect of IDA on HbA1c levels in type 2 diabetes mellitus (T2DM) patients. Aim: This study aims to explore the effect of IDA on HbA1c levels in type 2 diabetes mellitus (T2DM) patients. Methods: This comparative cross-sectional study was conducted from January to April 2024 at SMS Multispecialty Hospital, Ahmedabad. The study included 176 T2DM patients, divided into those with and without IDA. Data were collected through structured questionnaires and clinical examinations, including blood tests for HbA1c and various hematological parameters. Statistical analyses were performed using SPSS version 21. Results: The IDA group exhibited significantly lower HbA1c levels (6.17 ± 1.58%) compared to the non-IDA group (7.75 ± 1.82%) with p < 0.05. Hematological parameters such as RBC, Hgb, HCT, MCV, MCH, and MCHC were also significantly lower in the IDA group. No significant correlation was found between HbA1c and RBC parameters in IDA patients. The distribution of anemia severity in IDA patients was 29.55% mild, 45.45% moderate, and 25.00% severe. Discussion: The findings indicate that HbA1c levels are significantly lower in T2DM patients with IDA, potentially leading to underestimation of glycemic control. This aligns with some previous studies but contradicts others. The lack of significant correlation between HbA1c and RBC parameters suggests that HbA1c may not reliably reflect glycemic control in the presence of IDA. Healthcare providers should consider treating IDA before relying on HbA1c for diabetes management. Further research is needed to confirm these findings and explore alternative monitoring methods. [ABSTRACT FROM AUTHOR]

Objective: Although diabetes is one of the leading causes of death among Korean Americans, the levels and predictors of diabetes knowledge in this group have not been sufficiently reported. This study aimed to (1) describe the level of diabetes knowledge of Korean immigrant women in the U.S. and (2) examine whether there is an interaction effect between social support and education on diabetes knowledge. Design: This study conducted a cross-sectional survey design. The sample included 227 Korean immigrant women living in the southeast region of the U.S. The fourteen items of the Diabetes Knowledge Test were used to assess the diabetes knowledge level of Korean American women. A multiple linear regression analysis was conducted to examine the interaction effect between social support and education on diabetes knowledge. Results: Only 6% of the participants presented a good diabetes knowledge level, 12.5% had a poor level, and the majority (81.5%) had a moderate level. We found a significant interaction effect between social support and education on diabetes knowledge. The highest diabetes knowledge was observed when individuals with a lower education level had higher social support. Conclusion: Future health practices and policies may focus on increasing knowledge among Korean American women with lower education levels and lower social support. Implementing peer-led initiatives can enhance diabetes knowledge and encourage better self-care practices within the community. [ABSTRACT FROM AUTHOR]

Background: Approaches to prevent and manage diabetes at a community population level are hindered because current strategies are not aligned with the structure and function of a community system. We describe a community-driven process based on local data and rapid prototyping as an alternative approach to create diabetes prevention and care management solutions appropriate for each community. We report on the process and provide baseline data for a 3-year case study initiative to improve diabetes outcomes in two rural Nebraska communities. Methods: We developed an iterative design process based on the assumption that decentralized decision-making using local data feedback and monitoring will lead to the innovation of local sustainable solutions. Coalitions act as community innovation hubs and meet monthly to work through a facilitated design process. Six core diabetes measures will be tracked over the course of the project using the electronic health record from community clinics as a proxy for the entire community. Results: Baseline data indicate two-thirds of the population in both communities are at risk for prediabetes based on age and body mass index. However, only a fraction (35% and 12%) of those at risk have been screened. This information led both coalitions to focus on improving screening rates in their communities. Discussion: In order to move a complex system towards an optimal state (e.g., improved diabetes outcomes), stakeholders must have access to continuous feedback of accurate, pertinent information in order to make informed decisions. Conventional approaches of implementing evidence-based interventions do not facilitate this process. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the relationship between sociodemographic and clinical characteristics, as well as the utilization of diabetes technologies, with diabetes management in individuals with type 1 diabetes (T1D). Materials and Methods: Our study included 134 cases diagnosed with T1D who were followed for at least 1 year with T1D. Results: Of the cases, 67.2% were using insulin pens as their insulin regimen, while 37.8% were using insulin pumps. The rate of continuous glucose monitoring (CGM) usage was 29.9%. The rate of CGM usage was 5% in families with low income levels. Glycosylated hemoglobin A1c (HbA1c) level of children with working mothers was found to be higher compared to those with non-working mothers (median 9.2% vs. 8%; P = .009). Cases with 3 or more siblings had higher HbA1c levels compared to those with 2 or fewer siblings (median 8.7% vs. 8.1%; P = .044).The median HbA1c was 8.7% in cases using insulin pens and checking fingerstick blood glucose (SMBG); 8.3% in cases using insulin pumps and SMBG; 7.6% in cases using insulin pens with CGM, and 7.5% in cases using insulin pumps with CGM (P = .003). Conclusion: The utilization of insulin pumps with CGM in T1D cases exhibited lower HbA1c levels. Similarly, even the usage of insulin pens with CGM demonstrated improved diabetes management. Maternal employment and having a higher number of siblings may negatively affect diabetes management due to increased caregiver burden. We believe that personalized healthcare delivery tailored to the individual needs of T1D patients based on family and clinical characteristics could have positive effects on diabetes management. [ABSTRACT FROM AUTHOR]

This review aimed to assess the effectiveness of interventions for type 2 diabetes (T2D) management in New Zealand on clinical outcomes, and explore the factors impacting their feasibility and acceptability. Scoping review. Three databases (PubMed, Web of Science and Scopus) were searched between January 2000 and July 2023. Reference lists of included studies were hand searched to identify additional articles. The search yielded 550 publications, of which 11 were included in the final review. Most interventions (n = 10) focussed on education and seven were delivered by health professionals. Supporting factors for interventions included clinical/peer support (n = 8) and whānau (family) involvement (n = 6). Hindering factors included non-adherence (n = 4) and high drop-out (n = 4). Most studies reported modest improvement in HbA1c and weight at six months, but minimal change in HbA1c, weight, lipids, renal profile, and blood pressure by two years. Future interventions should involve culturally appropriate approaches to improve engagement and acceptability while addressing lifestyle and medication adherence for T2D management. T2D interventions not widely disseminated via academic channels need to be further identified. [ABSTRACT FROM AUTHOR]

Low-carbohydrate-diets (LCDs) are gaining popularity in individuals with type 1 diabetes (T1D). However, the impact of such diets on glycemia and cardiovascular risk factors is debated. This study aims to evaluate associations between low-carbohydrate intakes using LCD score with glycemia and cardiovascular risk factors (lipid profile) in adults with T1D or LADA in Québec, Canada. This is a cross-sectional study using data collected in the BETTER registry (02/2019 and 04/2021) including self-reported 24-h dietary recalls to calculate LCD scores, waist circumference, level-2 and level-3 hypoglycemic episodes and measured biochemical data (HbA1c, LDL-cholesterol and non-HDL-cholesterol). Participants were divided into quartiles (Q) based on LCD scores. Two hundred eighty-five adults (aged 48.2 ± 15.0 years; T1D duration 25.9 ± 16.2 years) were included. Categorical variables underwent Chi-squared/Fisher's Exact tests, while continuous variables underwent ANOVA tests. Mean carbohydrate intake ranged from 31.2 ± 6.9% (Q1) to 56.5 ± 6.8% (Q4) of total daily energy. Compared to Q4, more people in Q1 reported HbA1c ≤ 7% [≤53.0 mmol/mol] (Q1: 53.4% vs. Q4: 29.4%; P = 0.011). The same results were found in the models adjusted for age, sex and T1D duration. A greater proportion of participants in Q1 never experienced level-3 hypoglycemia compared to Q3 (Q1: 60.0% vs. Q3: 31.0%; P = 0.004). There were no differences across quartiles for frequency of level-2 hypoglycemia events and lipid profile (LDL-cholesterol and non-HDL-cholesterol). Low-carbohydrate intakes are associated with higher probabilities of reaching HbA1c target and of never having experienced level-3 hypoglycemia. No associations with level-2 hypoglycemia frequency, nor cardiovascular risk factors were observed. • Low-carb intakes are associated with higher probabilities of reaching HbA1c target. • Patients with lowest carb intakes were less likely to report history of severe hypoglycemia. • Low-carb intakes were not associated with adverse cardiovascular risk factors. • Cross-sectional study of baseline data extracted from the BETTER registry in Québec. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM) is a prevalent chronic metabolic disorder characterized by insulin resistance and progressive beta cell dysfunction, presenting substantial global health and economic challenges. This review explores recent advancements in diabetes management, emphasizing novel pharmacological therapies and their physiological mechanisms. We highlight the transformative impact of Sodium-Glucose Cotransporter 2 inhibitor (SGLT2i) and Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA), which target specific physiological pathways to enhance glucose regulation and metabolic health. A key focus of this review is tirzepatide, a dual agonist of the glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptors. Tirzepatide illustrates how integrating innovative mechanisms with established physiological pathways can significantly improve glycemic control and support weight management. Additionally, we explore emerging treatments such as glimins and glucokinase activators (GKAs), which offer novel strategies for enhancing insulin secretion and reducing glucose production. We also address future perspectives in diabetes management, including the potential of retatrutide as a triple receptor agonist and evolving guidelines advocating for a comprehensive, multifactorial approach to care. This approach integrates pharmacological advancements with essential lifestyle modifications—such as dietary changes, physical activity, and smoking cessation—to optimize patient outcomes. By focusing on the physiological mechanisms of these new therapies, this review underscores their role in enhancing T2DM management and highlights the importance of personalized care plans to address the complexities of the disease. This holistic perspective aims to improve patient quality of life and long-term health outcomes. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) significantly impacts global health due to its complications and the economic burden it places on healthcare systems. The rise of novel once-weekly diabetes medications with different mechanisms of action necessitates an evaluation of their relative efficacy and safety. Objectives: This study compares the efficacy and tolerability of once-weekly insulin analogs (icodec and BIF) with once-weekly GLP-1/GIP agonists (semaglutide, exenatide, tirzepatide, dulaglutide) in managing type 2 diabetes mellitus (T2DM). Methods: We conducted a network meta-analysis (NMA) using data from randomized controlled trials (RCTs) that compared these treatments with a baseline of daily basal insulin. Primary outcomes included changes in HbA1c, body weight, and tolerability. Results: The analysis integrated data from 25 RCTs, involving 18,257 patients. Tirzepatide significantly outperformed other treatments in reducing HbA1c and promoting weight loss. Weekly insulins, compared to GLP-1/GIP agonists, showed a more tolerable profile and were beneficial for certain patient demographics emphasizing weight stability. Conclusion: Our findings suggest that while once-weekly GLP-1/GIP agonists provide superior glycemic control and weight management, weekly insulins offer viable options for patients prioritizing fewer side effects and weight stability. This comprehensive comparison aids in refining personalized treatment strategies for T2DM management. [ABSTRACT FROM AUTHOR]

Abstract This retrospective observational study, building on prior research that demonstrated the efficacy of the Digital Twin (DT) Precision Treatment Program over shorter follow-up periods​​, aimed to examine glycemic control and reduced anti-diabetic medication use after one-year in a DT commercial program. T2D patients enrolled had adequate hepatic and renal function and no recent cardiovascular events. DT intervention powered by artificial intelligence utilizes precision nutrition, activity, sleep, and deep breathing exercises. Outcome measures included HbA1c change, medication reduction, anthropometrics, insulin markers, and continuous glucose monitoring (CGM) metrics. Of 1985 enrollees, 132 (6.6%) were lost to follow-up, leaving 1853 participants who completed one-year. At one-year, participants exhibited significant reductions in HbA1c [mean change: -1.8% (SD 1.7%), p

Background Diabetes has a high incidence rate and many complications, which was an urgent public health problem, but the prevention and management is still not ideal. Objective To observe the effect of Three Division management on metabolic indicators and self-management levels of diabetes patients with different courses of disease. Methods One hundred and 81 type 2 diabetes patients from April 2021 to April 2022 were managed by the mode of Three Division management and followed up for more than 6 months in Shenzhen Hospital Guangzhou University of Chinese Medicine (Futian). The patients were grouped according to the course of disease (Group A: course of disease5-10 years; Group D: course of disease>10 years) ; In outpatient, the three-division team composed of traditional Chinese medicine practitioners, endocrinologists and caregivers carries out comprehensive treatment such as physique identification, complication screening, medicine, food, exercises and emotion intervention; When patients are at home, the caregivers carry out intelligent management through intelligent Glucose meter equipment and mobile phone APP. We collected changes in blood glucose and body weight indicators in patients with different disease courses after six months of management. Additionally, we used a questionnaire to gather common issues in patient self-management and fill out the Summary of Diabetes Self-Care Activities Measure-6 (SDSCA-6) . Results Through the management of the Three Division management, Group A patients showed significant improvement in reducing fasting blood glucose and postprandial 2-hour blood glucose after the intervention (P

Context The global prevalence of type 2 diabetes mellitus (T2DM) has increased significantly in recent decades. Despite numerous studies and systematic reviews, there is a gap in comprehensive and up-to-date evaluations in this rapidly evolving field.Objective This review provides a comprehensive and current overview of the efficacy of Traditional Chinese Medicine (TCM) in treating T2DM.Methods A systematic review was conducted using PubMed, Web of Science, Wanfang Data, CNKI, and Medline databases, with a search timeframe extending up to November 2023. The search strategy involved a combination of subject terms and free words in English, including ‘Diabetes,’ ‘Traditional Chinese Medicine,’ ‘TCM,’ ‘Hypoglycemic Effect,’ ‘Clinical Trial,’ and ‘Randomized Controlled Trial.’ The studies were rigorously screened by two investigators, with a third investigator reviewing and approving the final selection based on inclusion and exclusion criteria.Results A total of 108 relevant papers were systematically reviewed. The findings suggest that TCMs not only demonstrate clinical efficacy comparable to existing Western medications in managing hypoglycemia but also offer fewer adverse effects and a multitarget therapeutic approach. Five main biological mechanisms through which TCM treats diabetes were identified: improving glucose transport and utilization, improving glycogen metabolism, promoting GLP-1 release, protecting pancreatic islets from damage, and improving intestinal flora.Conclusions TCM has demonstrated significant protective effects against diabetes and presents a viable option for the prevention and treatment of T2DM. These findings support the further exploration and integration of TCM into broader diabetes management strategies.

Self-monitoring of blood glucose has been considered to be a cornerstone of adequate diabetes management for decades. The structured self-monitoring leads to better compensation of carbohydrate metabolism disorders, decreased risk of hypoglycemia, and quality of life improvement in patients with DM. The technologies, as well as the glucose meter convenience and accuracy have improved considerably since the moment these were introduced several decades ago. Modern glucose meters are small and easy to use; these require small amounts of capillary blood and provide measurement results within seconds. Furthermore, glucose meters are more and more often equipped with such features, as connectivity with other devices and/or electronic diaries and instruments for diabetes management. Despite the fact that the measurement accuracy can be close to or equal to the quality level ensured by laboratory biochemical analyzers, some glucose meters continue to fall short of the internationally accepted accuracy standards, such as ISO-15197, the standard of the International Organization for Standardization. Numerous reports from the number of countries, such as Russia, China, India, and Brazil, that are based on the routine practice data suggest that in addition to the problems with the glucose meter accuracy, there are other obstacles to overcome to optimize the use of blood glucose monitoring systems. Nevertheless, the adequate use of blood glucose self-monitoring data is very important for treatment of patients with type 2 diabetes mellitus.

Abstract Introduction Type 2 diabetes is a major public health issue in Mexico due to its high prevalence and its projection for the coming years for this disease. Findings on multidisciplinary care related to chronic diseases have proven effective, based on measurement of patient-centered outcomes, The Center of Comprehensive Care for Patients with Diabetes (CAIPaDi) is a multidisciplinary program focused on reducing diabetes complications. This case study aims to illustrate the results of implementing health outcomes measurements and demonstrate the beneficial effects of establishing a comprehensive model of care through a patient-centered approach. Methods A descriptive analysis of the comprehensive care indicators of patients with type 2 diabetes treated in the CAIPaDi program between 2013 and 2023 was conducted. The results were structured according to the standard set of outcomes for diabetes proposed by the International Consortium for Health Outcomes Measurements (ICHOM). Results The baseline and prospective registration of consultations was completed for five years, complying with 25 of the 26 indicators of the ICHOM set. In diabetes control, 56.5% of patients had A1c ≤ 7%, 87.9% had BP ≤ 130/80 mmHg, 60.9% had LDL-cholesterol

The global burden of controlling and managing diabetes mellitus (DM) is a significant challenge. Despite the advancements in conventional DM therapy, there remain hurdles to overcome, such as enhancing medication adherence and improving patient prognosis. Digital therapeutics (DTx), an innovative digital application, has been proposed to augment the traditional disease management workflow, particularly in managing chronic diseases like DM. Several studies have explored DTx, yielding promising results. However, certain concerns about this innovation persist. In this review, we aim to encapsulate the potential of DTx and its applications in DM management, thereby providing a comprehensive overview of this technique for public health policymakers.

Introduction: The increasing prevalence of diabetes necessitates sustainable care and preventative strategies for patients. Plant-based diets have emerged as a promising intervention for the management of type 2 diabetes mellitus. However, the sustainability of such diets remains a subject of debate. Aim: To investigate the impact of plant-based diets on treating type 2 diabetes mellitus and assess their sustainability. Materials and Methods: Systematic searches were performed using the PubMed, Scopus, and Web of Science databases for studies published between 2013 and 2023 following Preferred Reporting Items for Systemic Reviews and Meta Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The Medical Subject Headings (MeSH) terms used in the search were “type-2 diabetes,” “diabetes mellitus,” “plant-based diets,” “vegan diet,” and “vegetarian diets.” The search yielded 227 studies, of which eight were included based on inclusion criteria. Covidence software was used to analyse the selected studies, focusing on the long-term effects of plant-based diets on diabetes. Results: The studies included in the review followed 12 weeks of intervention with plant-based diets, examining Glycated Haemoglobin (HbA1c) levels, insulin sensitivity, lipid profile, weight changes, and Body Mass Index (BMI). The observations included a significant reduction of approximately 0.4% in HbA1c levels and approximately 1.04 kg/m2 in BMI, along with a significant weight loss of approximately 2-6 kg. While there was no significant reduction observed in the lipid profile. Conclusion: Plant-based diets with a 12-week consumption period show positive cardiometabolic profiles due to antioxidants, fiber, vitamins, and minerals. However, long-term studies are needed to ensure sustainability.

Abstract Background BMI variability has been associated with increased cardiovascular disease risk in individuals with type 2 diabetes, however comparison between clinical studies and real-world observational evidence has been lacking. Furthermore, it is not known whether BMI variability has an effect independent of HbA1c variability. Methods We investigated the association between BMI variability and 3P-MACE risk in the Harmony Outcomes trial (n = 9198), and further analysed placebo arms of REWIND (n = 4440) and EMPA-REG OUTCOME (n = 2333) trials, followed by real-world data from the Tayside Bioresource (n = 6980) using Cox regression modelling. BMI variability was determined using average successive variability (ASV), with first major adverse cardiovascular event of non-fatal stroke, non-fatal myocardial infarction, and cardiovascular death (3P-MACE) as the primary outcome. Results After adjusting for cardiovascular risk factors, a + 1 SD increase in BMI variability was associated with increased 3P-MACE risk in Harmony Outcomes (HR 1.12, 95% CI 1.08–1.17, P

The rising incidence of type 2 diabetes underscores the need for technological innovations aimed at enhancing diabetes management by aiding individuals in monitoring their dietary intake. This has resulted in the development of technologies capable of tracking the timing and content of an individual's meals. However, the ability to use non-invasive wearables to estimate or classify the carbohydrate content of the food an individual has just consumed remains a relatively unexplored area. This study investigates carbohydrate content classification using postprandial heart rate responses from non-invasive wearables. We designed and developed timeStampr, an iOS application for collecting timestamps essential for data labeling and establishing ground truth. We then conducted a pilot study in controlled, yet naturalistic settings. Data were collected from 23 participants using an Empatica E4 device worn on the upper arm, while each participant consumed either low-carbohydrate or carbohydrate-rich foods. Due to sensor irregularities with dark skin tones and non-compliance with the study's health criteria, we excluded data from three participants. Finally, we configured and trained a Light Gradient Boosting Machine (LGBM) model for carbohydrate content classification. Our classifiers demonstrated robust performance, with the carbohydrate content classification model consistently achieving at least 84% in accuracy, precision, recall, and AUCROC within a 60 s window. The results of this study demonstrate the potential of postprandial heart rate responses from non-invasive wearables in carbohydrate content classification. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes is a major public health issue in Mexico due to its high prevalence and its projection for the coming years for this disease. Findings on multidisciplinary care related to chronic diseases have proven effective, based on measurement of patient-centered outcomes, The Center of Comprehensive Care for Patients with Diabetes (CAIPaDi) is a multidisciplinary program focused on reducing diabetes complications. This case study aims to illustrate the results of implementing health outcomes measurements and demonstrate the beneficial effects of establishing a comprehensive model of care through a patient-centered approach. Methods: A descriptive analysis of the comprehensive care indicators of patients with type 2 diabetes treated in the CAIPaDi program between 2013 and 2023 was conducted. The results were structured according to the standard set of outcomes for diabetes proposed by the International Consortium for Health Outcomes Measurements (ICHOM). Results: The baseline and prospective registration of consultations was completed for five years, complying with 25 of the 26 indicators of the ICHOM set. In diabetes control, 56.5% of patients had A1c ≤ 7%, 87.9% had BP ≤ 130/80 mmHg, 60.9% had LDL-cholesterol < 100 mg/dl, and obesity rates decreased from 42.19% to 30.6% during annual consultations. Fewer years of diagnosis before the first visit is key to overall improvement in program adherence (P = 0.02). In acute events, a hyperglycemic crisis occurred in only two cases and severe hypoglycemia episodes in 8 patients. For chronic complications, no lower limb amputations occurred. Cardiovascular outcomes occurred in < 1%. Periodontal disease was analyzed, and periodontitis decreased from 82.9% to 78.7%. Mortality reports were low, with COVID-19 being the main cause of death. Patient-reported outcomes demonstrated reductions in anxiety, depression, and diabetes distress during follow-up. Conclusion: Registering quality-of-care indicators is feasible in a comprehensive care program. It allows improving the medical, mental health, and lifestyle outcomes of patients with type 2 diabetes and provides relevant data for planning health programs. A quick diagnosis before program adherence is crucial for overall improvement in patients. [ABSTRACT FROM AUTHOR]

Diabetes is one of the most common life-threatening diseases in the world. The accurate amount, and on-time injection will directly affect the patient's health. The current standard of care for insulin-dependent diabetes management is paper based, so the patients provided with self-management support through health coaches which consumes time and effort. Smart insulin box as proposed meets the needs of the market by integrating electronic technology and IoT network functionality. The interactive box comprises a particular device with embedded sensors in each compartment. Two Infrared and one DHT11 sensors are used. IR sensors are used for detecting the absence or availability of the insulin pen inside the box. While, DHT11 sensor is used for measuring the internal temperature and humidity of the package. The interactive box not only transmits patient status messages to the cloud but also receives a reminder message to patient mobile phone presented by LCD screen. The system manages the insulin injection process and provides a remote monitoring system for doctors using two individual applications. Doctor application provides remote monitoring and controlling for insulin amount and injection time while patient application used to notify patients about injection time, status, and insulin stock status. The system is laboratory tested and evaluated by the authors. The low cost at 84 USD shows promising results. It has a potential impact on patient health outcomes as a smart, low cost, and interactive management system for the insulin injection process which can be integrated with the existing healthcare systems. [ABSTRACT FROM AUTHOR]

Background: BMI variability has been associated with increased cardiovascular disease risk in individuals with type 2 diabetes, however comparison between clinical studies and real-world observational evidence has been lacking. Furthermore, it is not known whether BMI variability has an effect independent of HbA1c variability. Methods: We investigated the association between BMI variability and 3P-MACE risk in the Harmony Outcomes trial (n = 9198), and further analysed placebo arms of REWIND (n = 4440) and EMPA-REG OUTCOME (n = 2333) trials, followed by real-world data from the Tayside Bioresource (n = 6980) using Cox regression modelling. BMI variability was determined using average successive variability (ASV), with first major adverse cardiovascular event of non-fatal stroke, non-fatal myocardial infarction, and cardiovascular death (3P-MACE) as the primary outcome. Results: After adjusting for cardiovascular risk factors, a + 1 SD increase in BMI variability was associated with increased 3P-MACE risk in Harmony Outcomes (HR 1.12, 95% CI 1.08–1.17, P < 0.001). The most variable quartile of participants experienced an 87% higher risk of 3P-MACE (P < 0.001) relative to the least variable. Similar associations were found in REWIND and Tayside Bioresource. Further analyses in the EMPA-REG OUTCOME trial did not replicate this association. BMI variability's impact on 3P-MACE risk was independent of HbA1c variability. Conclusions: In individuals with type 2 diabetes, increased BMI variability was found to be an independent risk factor for 3P-MACE across cardiovascular outcome trials and real-world datasets. Future research should attempt to establish a causal relationship between BMI variability and cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

Smart shoes have ushered in a new era of personalised health monitoring and assistive technologies. Smart shoes leverage technologies such as Bluetooth for data collection and wireless transmission, and incorporate features such as GPS tracking, obstacle detection, and fitness tracking. As the 2010s unfolded, the smart shoe landscape diversified and advanced rapidly, driven by sensor technology enhancements and smartphones' ubiquity. Shoes have begun incorporating accelerometers, gyroscopes, and pressure sensors, significantly improving the accuracy of data collection and enabling functionalities such as gait analysis. The healthcare sector has recognised the potential of smart shoes, leading to innovations such as shoes designed to monitor diabetic foot ulcers, track rehabilitation progress, and detect falls among older people, thus expanding their application beyond fitness into medical monitoring. This article provides an overview of the current state of smart shoe technology, highlighting the integration of advanced sensors for health monitoring, energy harvesting, assistive features for the visually impaired, and deep learning for data analysis. This study discusses the potential of smart footwear in medical applications, particularly for patients with diabetes, and the ongoing research in this field. Current footwear challenges are also discussed, including complex construction, poor fit, comfort, and high cost. [ABSTRACT FROM AUTHOR]

Introduction: The increasing prevalence of diabetes necessitates sustainable care and preventative strategies for patients. Plantbased diets have emerged as a promising intervention for the management of type 2 diabetes mellitus. However, the sustainability of such diets remains a subject of debate. Aim: To investigate the impact of plant-based diets on treating type 2 diabetes mellitus and assess their sustainability. Materials and Methods: Systematic searches were performed using the PubMed, Scopus, and Web of Science databases for studies published between 2013 and 2023 following Preferred Reporting Items for Systemic Reviews and Meta Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The Medical Subject Headings (MeSH) terms used in the search were “type-2 diabetes,” “diabetes mellitus,” “plant-based diets,” “vegan diet,” and “vegetarian diets.” The search yielded 227 studies, of which eight were included based on inclusion criteria. Covidence software was used to analyse the selected studies, focusing on the long-term effects of plant-based diets on diabetes. Results: The studies included in the review followed 12 weeks of intervention with plant-based diets, examining Glycated Haemoglobin (HbA1c) levels, insulin sensitivity, lipid profile, weight changes, and Body Mass Index (BMI). The observations included a significant reduction of approximately 0.4% in HbA1c levels and approximately 1.04 kg/m² in BMI, along with a significant weight loss of approximately 2-6 kg. While there was no significant reduction observed in the lipid profile. Conclusion: Plant-based diets with a 12-week consumption period show positive cardiometabolic profiles due to antioxidants, fiber, vitamins, and minerals. However, long-term studies are needed to ensure sustainability. [ABSTRACT FROM AUTHOR]

Objective: There has been a trend toward hospital systems and insurers acquiring privately owned physician practices and subsequently converting them into vertically integrated practices. The purpose of this study is to observe whether this change in ownership of a medical practice influences adherence to clinical guidelines for the management of type 1 and type 2 diabetes. Methods: This is an observational study using pooled cross-sectional data (2014-2016 and 2018-2019) from the National Ambulatory Medical Care Survey, a nationally representative probability sample of US office-based physician visits. A total of 7499 chronic routine follow ups and preventative care visits to non-integrated (solo and group physician practices) and integrated practices were analyzed to see whether guideline concordant care was provided. Measures included 7 services that are recommended annually for individuals with type 1 and type 2 diabetes (HbA1c, lipid panel, serum creatinine, depression screening, influenza immunization, foot examination, and BMI). Results: Compared to non-integrated physician practices, vertically integrated practices had higher rates of hemoglobin A1C testing (odds ratio 1.58 [95% CI 1.07-2.33], P <.05), serum creatine testing (odds ratio 1.53 [95% CI 1.02-2.29], P <.05), foot examinations (odds ratio 2.03 [95% CI 0.98-4.22], P =.058), and BMI measuring (odds ratio 1.54 [95% CI 0.99-2.39], P =.054). There was no significant difference in lipid panel testing, depression screenings, or influenza immunizations. Conclusions: Our results show that integrated medical practices have a higher adherence to diabetes practice guidelines than non-integrated practices. However, rates of services provided regardless of ownership were low. [ABSTRACT FROM AUTHOR]

Advanced glycation end-products (AGEs) are complex compounds closely associated with several chronic diseases, especially diabetes mellitus (DM). Current methods for detecting AGEs are not suitable for screening large populations, or for long-term monitoring. This paper introduces a portable autofluorescence detection system that measures the concentration of AGEs in the skin based on the fluorescence characteristics of AGEs in biological tissues. The system employs a 395 nm laser LED to excite the fluorescence of AGEs, and uses a photodetector to capture the fluorescence intensity. A model correlating fluorescence intensity with AGEs concentration facilitates the detection of AGEs levels. To account for the variation in optical properties of different individuals' skin, the system includes a 520 nm light source for calibration. The system features a compact design, measuring only 60 mm × 50 mm × 20 mm, and is equipped with a miniature STM32 module for control and a battery for extended operation, making it easy for subjects to wear. To validate the system's effectiveness, it was tested on 14 volunteers to examine the correlation between AGEs and glycated hemoglobin, revealing a correlation coefficient of 0.49. Additionally, long-term monitoring of AGEs' fluorescence and blood sugar levels showed a correlation trend exceeding 0.95, indicating that AGEs reflect changes in blood sugar levels to some extent. Further, by constructing a multivariate predictive model, the study also found that AGEs levels are correlated with age, BMI, gender, and a physical activity index, providing new insights for predicting AGEs content and blood sugar levels. This research supports the early diagnosis and treatment of chronic diseases such as diabetes, and offers a potentially useful tool for future clinical applications. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: The aim of this study was to compare cardiovascular risk management among people with type 2 diabetes according to severe mental illness (SMI) status. Methods: We used linked electronic data to perform a retrospective cohort study of adults diagnosed with type 2 diabetes in Scotland between 2004 and 2020, ascertaining their history of SMI from hospital admission records. We compared total cholesterol, systolic BP and HbA1c target level achievement 1 year after diabetes diagnosis, and receipt of a statin prescription at diagnosis and 1 year thereafter, by SMI status using logistic regression, adjusting for sociodemographic factors and clinical history. Results: We included 291,644 individuals with type 2 diabetes, of whom 1.0% had schizophrenia, 0.5% had bipolar disorder and 3.3% had major depression. People with SMI were less likely to achieve cholesterol targets, although this difference did not reach statistical significance for all disorders. However, people with SMI were more likely to achieve systolic BP targets compared to those without SMI, with effect estimates being largest for schizophrenia (men: adjusted OR 1.72; 95% CI 1.49, 1.98; women: OR 1.64; 95% CI 1.38, 1.96). HbA1c target achievement differed by SMI disorder and sex. Among people without previous CVD, statin prescribing was similar or better in those with vs those without SMI at diabetes diagnosis and 1 year later. In people with prior CVD, SMI was associated with lower odds of statin prescribing at diabetes diagnosis (schizophrenia: OR 0.54; 95% CI 0.43, 0.68, bipolar disorder: OR 0.75; 95% CI 0.56, 1.01, major depression: OR 0.92; 95% CI 0.83, 1.01), with this difference generally persisting 1 year later. Conclusions/interpretation: We found disparities in cholesterol target achievement and statin prescribing by SMI status. This reinforces the importance of clinical review of statin prescribing for secondary prevention of CVD, particularly among people with SMI. [ABSTRACT FROM AUTHOR]

Background: Diabetes Mellitus is a chronic, progressive disease with serious complications, and its prevalence is rising, especially in India. This study evaluates the clinical characteristics, prehospital care, and proximity to healthcare facilities among patients presenting with diabetic emergencies at a tertiary care hospital. Methodology: A cross-sectional study was conducted with 70 diabetic emergency patients (hyperglycemia, hypoglycemia, and DKA). Data were collected using a semi-structured questionnaire assessing clinical characteristics, prehospital care, and health-seeking behavior. Geospatial analysis measured the distance from patients' residences to the hospital. Results: Among the 70 participants, 36 (51.4%) were over 60 years old, and 55 (78.6%) were male. The most common symptoms were polyuria (85.7%) and excessive thirst (57.1%). Hyperglycemia was diagnosed in 68 (97.1%) cases, with 46 (65.7%) showing high random blood sugar levels (>200 mg/dl). Severe symptoms led 55 (78.6%) to seek emergency care, with 17 (24.3%) requiring ambulance services. Geospatial analysis revealed that 50% of patients lived 1-50 km from the hospital. Conclusion: The study emphasizes the need for improved access to diabetes care near patients' homes to prevent emergencies, highlighting the importance of decentralizing services to improve health outcomes.

Microneedle (MN) patches are composed of micron-sized needles organised in arrays and attached to the backing of a patch. The most common type is the transdermal patch, designed to uniformly penetrate the stratum corneum to reach the dermis of the skin. Recent advances in 3D printing technology have allowed the development of reproducible, efficient methods to create microneedles on a large scale, which had previously been a factor in the limited clinical uptake. In comparison to conventional drug delivery methods, MN patches have been shown to significantly reduce pain and scar generation while maintaining effective and reliable delivery of vaccines, immunotherapies, and slow-release drug therapies. The MN design has also been investigated as an alternative to conventional tissue biopsy, with positive results. Synchronous delivery of medications while monitoring biomarkers in dermal interstitial fluid (ISF) is also a promising clinical development with wide-reaching benefits. MNs are diverse in design and material composition, and with developments in fabrication technology, transdermal drug delivery has been applied to many clinical fields, including chronic illnesses such as arthritis or diabetes, cancer, immunotherapies, epidemic disease prevention and ocular treatments. While the majority of MN patch applications are still in the pre-clinical testing phase in animal models, further translation of this technology to the clinic could aid in medication and vaccine compliance, improve treatment access in rural and remote communities, improve targeted therapy applications and provide financial cost savings to the public health sector. This review evaluates the designs and applications of current transdermal MN patches for drug delivery, biomarker monitoring and diagnostic biopsies compared to conventional needle-based methods.

Children with type 1 diabetes (T1D) frequently have nocturnal hypoglycemia, daytime physical activity being the most important risk factor. The risk for late post-exercise hypoglycemia depends on various factors and is difficult to anticipate. The availability of continuous glucose monitoring (CGM) enabled the development of various machine learning approaches for nocturnal hypoglycemia prediction for different prediction horizons. Studies focusing on nocturnal hypoglycemia prediction in children are scarce, and none, to the best knowledge of the authors, investigate the effect of previous physical activity. The primary objective of this work was to assess the risk of hypoglycemia throughout the night (prediction horizon 9 h) associated with physical activity in children with T1D using data from a structured setting. Continuous glucose and physiological data from a sports day camp for children with T1D were input for logistic regression, random forest, and deep neural network models. Results were evaluated using the F2 score, adding more weight to misclassifications as false negatives. Data of 13 children (4 female, mean age 11.3 years) were analyzed. Nocturnal hypoglycemia occurred in 18 of a total included 66 nights. Random forest using only glucose data achieved a sensitivity of 71.1% and a specificity of 75.8% for nocturnal hypoglycemia prediction. Predicting the risk of nocturnal hypoglycemia for the upcoming night at bedtime is clinically highly relevant, as it allows appropriate actions to be taken—to lighten the burden for children with T1D and their families.

Introduction: Developing countries like India are facing an increased threat from both non communicable and communicable diseases. The prevalence of Type 2 Diabetes Mellitus (DM) among non communicable diseases has been rapidly increasing in India. The complications of diabetes, including both acute and chronic effects, impact the physical, mental, and social well being of patients. The effectiveness of diabetes management solely depends on the self-care practices adopted by individuals and their family members. Aim: To evaluate the patterns of self-care practices among diabetic patients and the factors associated with them. Materials and Methods: A community-based cross-sectional study was carried out among 206 diabetic patients in and around the rural field practice area of ACS Medical College and Hospital in Thiruvallur district, Chennai, Tamil Nadu, India, from June 2022 to November 2022. Type 2 DM patients aged ≥18 years were included in the study. The participants were interviewed about their diabetic status and various parameters of self-care practices, using the Summary of Diabetes Self-care Activities (SDSCA) score. The Chi-square test was applied to assess the relationship between self-care practices and factors such as age and gender. Results: The mean age of the participants was 47±10 years. The present study observed that the overall prevalence of poor self-care practices was low, with 92 participants (44.7%) exhibiting poor practices and 114 participants (55.3%) demonstrating good self-care practices. In the current study, the association between self-care activities and education level, as well as the clinical profile of the patients, was statistically significant. A negative linear correlation was found between self-care practice scores and blood glucose levels. Conclusion: Self-care behaviours among diabetes patients were found to be good in more than half of the study population. These behaviours were significantly associated with age, education level, and complications of diabetes. The results emphasise the complex nature of self-care behaviours among individuals with DM and highlight the necessity for customised therapies that target individual challenges and foster supportive environments.

IntroductionThe primary objective of this study is to report the results of an online questionnaire and the in-person discussion sessions of physicians specializing in diabetes care in which their opinions about current diabetes management was obtained.MethodsThe Diabetes Innovation Summit 2023 drew attendance from a diverse group of specialized physicians from multiple countries. A comprehensive literature review was conducted to examine the technologies and medical needs associated with diabetes management. Using the results of the review, a questionnaire was developed by three experts from the steering committee to solicit feedback from specialized physicians. The online survey was made accessible between 10th December 2022 and 10th January 2023. Following the online survey, six structured in-person discussion sessions were conducted with specialized physicians from the Middle East, Central-Eastern Europe, and North Africa regions.ResultsThe study revealed that about 59% of survey requests were answered, with many participants being pediatric endocrinologists from North Africa. Around 60% of diabetes patients followed Multiple Daily Injections (MDI) according to specialized physicians. Among MDI users, 62% employed Blood Glucose Monitors (BGM), 31% used intermittent-scanning Continuous Glucose Monitors (isCGM), and 23% used CGM. In North Africa, nearly 90% of patients used MDI due to financial constraints. While physicians focused on both Time in Range (TIR) and HbA1c for MDI-treated patients, satisfaction with TIR achieved was expressed by 31%, while 74·1% believed Real-Time CGM (rtCGM) was effective. Concerns arose about potentially misleading HbA1c results and the relatively low patient achievement of target TIR despite CGM usage. The Smart MDI System was seen favorably compared to other applications. The system’s affordability was a significant barrier, particularly in the Middle East and Africa.ConclusionThe present study highlights that physicians are generally supportive of utilizing new technology. The questionnaires and the open discussion revealed the expectation that the Smart MDI technology provides better control, primarily by identifying missed boluses, while expressing concerns on the use of the technology by teenagers and children, who might forget the device and be reluctant to use in public, and by the older population, who might be challenged by the technology.

Background: Diabetes management has not been optimally implemented by patients, considering the high incidence of diabetes complications. Therefore, family empowerment is important for diabetes management. Objective: This study aims to determine factors related to diabetes management, inhibiting, and supporting factors for diabetes management to develop a family-based educational model in diabetes management through expert testing. Methods: This research used Mixed Methods design with an Explanatory Sequential Design approach. A cross-sectional approach to 207 people with DM selection using a multistage sampling technique. Data was collected by questionnaire, in-depth interview, and Delphi study. Data analysis using chi-square and logistic regression. The development of family empowerment model is based on the theory Ladder of Empowerment, Social Cohesion, and Family Support. Results: Research results showed that good knowledge of patients, good family empowerment, and absence of DM risk factors are related to diabetes management. Model development and expert testing (Delphi Study) of the model find that a family-based diabetes management module is needed. Conclusion: A good family-based diabetes management module includes aspects of Self-Instructional, Self-Contained, Stand Alone, Adaptive, and User-Friendly aspects. This module is expected to improve diabetes management for patients and their families so that diabetes complications can be prevented and the patient's quality of life increases.

Background: Type 2 Diabetes Mellitus (T2DM) is a global health concern, with cardiac autonomic neuropathy (CAN) being a significant complication that exacerbates cardiovascular risks. Aerobic and resistance exercises are recognized for their benefits in managing T2DM, but the optimal integration of these modalities, especially for patients with T2DM, requires further exploration. Objective: To investigate the effects of the sequence of aerobic and resistance training in a concurrent training regimen on heart rate variability (HRV), glycemic control, body composition, lipid profile, and cardiorespiratory fitness (CRF) in patients with T2DM. Methods: In this randomized controlled trial, 45 T2DM patients with CAN were allocated to three groups: a control group, an aerobic then resistance training (ART) group, and a resistance then aerobic training (RAT) group. Measurements were taken at baseline and after a 13-week intervention, assessing HRV, glycemic control, body composition, lipid profile, and CRF. Results: Both ART and RAT groups showed significant improvements in HRV, glycemic control, body composition, lipid profile, and CRF compared to the control group. Notably, there were no significant differences between ART and RAT groups in these outcomes, suggesting that the sequence of aerobic and resistance exercises in concurrent training does not significantly affect the health benefits attained. Conclusion: Concurrent aerobic and resistance training, irrespective of the sequence, effectively improves HRV, glycemic control, body composition, lipid profile, and CRF in T2DM patients with CAN. This study supports the inclusion of concurrent training in exercise prescriptions for managing T2DM and its complications.

Nowadays, Diabetes Mellitus is one of the significant health challenges that affects many people across the world. Early detection of Diabetes Mellitus will help in preventing complications, i.e., kidney disease, nerve damage, eye damage, etc. Over the past few years, several Machine Learning and Deep Learning techniques have been applied for the early detection of Diabetes Mellitus. The paper provides reviews on various Machine Learning and Deep Learning techniques applied for early detection of Diabetes mellitus. The review criteria mainly focus on five topics: the diabetes dataset, methods used, performance metrics, limitations of the work, and the overall status of diabetic research. The objective of this paper is to provide a comprehensive review of Diabetes Mellitus prediction techniques applying Machine Learning and Deep Learning that will be helpful sources for researchers in the healthcare field.

Legumes provide a major portion of protein and calories in the diet of many people around the world. Among different legumes, chickpeas have higher bioavailability and protein. Legumes are the second most important source of human food after the cereal family. Among them, chickpea with 15 to 25% of protein rich in essential amino acids such as arginine, leucine, isoleucine, lysine, valine, threonine, meotine and cysteine, phenylalanine and tyrosine, this plant causes fertility due to nitrogen fixation. The content chickpea is not only a source of protein, but also a source of dietary fiber, resistant starch, polyunsaturated fatty acids, vitamins and minerals, especially folate, calcium, magnesium and potassium. Regarding chickpea milk, plant milk consumers have accepted chickpea extract well. Due to the effective compounds, it is necessary to study the process of human health. In this research, the evaluation of published articles was used and the extracts of these studies were used to compile this article. Reading this article inspires the reader with a favorable view about planting peas in the field and their properties in the body. It is recommended that according to the properties of chickpeas, food industry researchers, plant breeding researchers and other related experts should provide more extensive research works to identify its useful aspects for the healthy and organic production of this valuable plant. Finally, it should be seriously included in the household basket to have a healthy human body.

Abstract Background Coronary inflammation plays crucial role in type 2 diabetes mellitus (T2DM) induced cardiovascular complications. Both glucose-lowering drug interventions (GLDIS) and glycemic control (GC) status potentially correlate coronary inflammation, as indicated by changes in pericoronary adipose tissue (PCAT) attenuation, and thus influence cardiovascular risk. This study evaluated the impact of GLDIS and GC status on PCAT attenuation in T2DM patients. Methods This retrospective study collected clinical data and coronary computed tomography angiography (CCTA) images of 1,342 patients, including 547 T2DM patients and 795 non-T2DM patients in two tertiary hospitals. T2DM patients were subgroup based on two criteria: (1) GC status: well: HbA1c 9%; (2) GLDIS and non-GLDIS. PCAT attenuations of the left anterior descending artery (LAD-PCAT), left circumflex artery (LCX-PCAT), and right coronary artery (RCA-PCAT) were measured. Propensity matching (PSM) was used to cross compare PCAT attenuation of non-T2DM and all subgroups of T2DM patients. Linear regressions were conducted to evaluate the impact of GC status and GLDIS on PCAT attenuation in T2DM patients. Results Significant differences were observed in RCA-PCAT and LCX-PCAT between poor GC-T2DM and non-T2DM patients (LCX: − 68.75 ± 7.59 HU vs. – 71.93 ± 7.25 HU, p = 0.008; RCA: − 74.37 ± 8.44 HU vs. − 77.2 ± 7.42 HU, p = 0.026). Higher PCAT attenuation was observed in LAD-PCAT, LCX-PCAT, and RCA-PCAT in non-GLDIS T2DM patients compared with GLDIS T2DM patients (LAD: − 78.11 ± 8.01 HU vs. − 75.04 ± 8.26 HU, p = 0.022; LCX: − 71.10 ± 8.13 HU vs. − 68.31 ± 7.90 HU, p = 0.037; RCA: − 78.17 ± 8.64 HU vs. − 73.35 ± 9.32 HU, p = 0.001). In the linear regression, other than sex and duration of diabetes, both metformin and acarbose were found to be significantly associated with lower LAD-PCAT (metformin: β coefficient = − 2.476, p=0.021; acarbose: β coefficient = − 1.841, p = 0.031). Conclusion Inadequate diabetes management, including poor GC and lack of GLDIS, may be associated with increased coronary artery inflammation in T2DM patients, as indicated by PCAT attenuation on CCTA, leading to increased cardiovascular risk. This finding could help healthcare providers identify T2DM patients with increased cardiovascular risk, develop improved cardiovascular management programs, and reduce subsequent cardiovascular related mortality.

This study used a randomized online survey design to examine the potential influence of ageism on physical activity (PA) prescription for hypothetical patients with prediabetes of different chronological ages. Participants included 356 kinesiology students who were randomly assigned to one of four conditions. Each condition presented a clinical case study of a hypothetical patient with prediabetes referred to the participant as a qualified exercise professional for a PA intervention. Case studies were identical except for the reported patient's chronological age. Participants provided recommendations for PA support, frequency, duration, and intensity. Significant main effects were observed for PA duration, F(3, 352) = 8.62; p <.001, and intensity, F(3, 352) = 16.20; p <.001. The older patient was prescribed significantly lower PA duration and intensity compared to younger patients and no-age control. This study provides evidence for the presence and independent influence of ageism against older patients in PA prescription for prediabetes management. [ABSTRACT FROM AUTHOR]

1,5-Anhydroglucitol (1,5-AG) is sensitive to short-term glucose fluctuations and postprandial hyperglycemia, which has great potential in the clinical application of diabetes as a nontraditional blood glucose monitoring indicator. A large number of studies have found that 1,5-AG can be used to screen for diabetes, manage diabetes, and predict the perils of diabetes complications (diabetic nephropathy, diabetic cardiovascular disease, diabetic retinopathy, diabetic pregnancy complications, diabetic peripheral neuropathy, etc.). Additionally, 1,5-AG and β cells are also associated with each other. As a noninvasive blood glucose monitoring indicator, salivary 1,5-AG has much more benefit for clinical application; however, it cannot be ignored that its detection methods are not perfect. Thus, a considerable stack of research is still needed to establish an accurate and simple enzyme assay for the detection of salivary 1,5-AG. More clinical studies will also be required in the future to confirm the normal reference range of 1,5-AG and its role in diabetes complications to further enhance the blood glucose monitoring system for diabetes. [ABSTRACT FROM AUTHOR]

Purpose: To examine factors of influence in diabetes management and their association with self-reported health outcomes in patients with type 2 diabetes treated at Federally Qualified Health Centers (FQHCs). Methods: This cross-sectional study examined data from the 2014 Health Center Patient Survey (HCPS). Predictor variables were categorized across three levels of the National Institute on Minority Health and Health Disparities research framework. Outcome variables retrieved from HCPS included self-reports of blood glucose levels, and diabetes-related emergency department (ED)/hospital visits during past year. Results: A total of 936 patients with diabetes were included. Most (65%) participants received a diabetes self-management plan. During the previous year, 72% received > = 2 A1C checks, 52% reported high blood glucose levels, and 12% visited an ED/hospital. Multivariable results showed that insulin use and receiving a self-management plan were associated with high blood glucose levels and ED/hospital visits. Community factors of being unable to get medications and receiving a specialist foot exam were respectively associated with high blood glucose levels and ED/hospital visits. Conclusion: Different factors were associated with health outcomes in patients with diabetes treated at FQHCs. Identifying these factors can help with targeted screening and follow-up and assessing potential interventions to improve health outcomes. [ABSTRACT FROM AUTHOR]

Aims: Both parent and adolescent involvement in type 1 diabetes management are critical during adolescence. The current study sought to understand the factors associated with parent and adolescent satisfaction with their own and one another's involvement in diabetes management. Methods: Cross‐sectional baseline data from 157 parent‐adolescent dyads enrolled in an RCT were used. Adolescent ages ranged from 12 to 19 (Mage = 14.7, SD = 1.89) and were balanced by gender (50.3% male). Paired t‐tests examined concordance between parent and adolescent satisfaction, bivariate correlations identified correlates, and regressions examined unique associations. Results: Roughly, 43% of adolescents and 29% of parents were very satisfied with adolescent involvement in diabetes management, whereas 71% of adolescents and 26.1% of parents were very satisfied with parent involvement. Indicators of better glycaemic health (via higher percent time‐in‐range and lower HbA1c and percent time in hyperglycaemia) and psychosocial functioning (less diabetes distress and depression) were correlated with higher satisfaction. Parent satisfaction with adolescent involvement was higher among older adolescents (R = 0.198, p = 0.013). Non‐Hispanic white youth were more satisfied with their own involvement than youth of colour (t(149) = −2.783, p = 0.003). Both percent time‐in‐range and one's own diabetes distress uniquely related to parent and adolescent satisfaction with adolescent involvement. Conversely, parent satisfaction with their own involvement was only uniquely associated with parent diabetes distress. Conclusion: Both adolescent and parents' satisfaction with adolescents' involvement in self‐management are indicators of both glycaemic control and psychosocial well‐being, whereas parents' self‐evaluations are more closely tied to diabetes‐specific distress. [ABSTRACT FROM AUTHOR]

Purpose: A remote platform for diabetes care (Roche Diabetes® Care Platform, RDCP) has been developed that allows combined face-to-face consultations and remote patient monitoring (RPM). Methods: A dedicated flowchart is proposed as a clinical approach to help healthcare professionals in the appropriate interpretation of structured self-monitoring blood glucose data, as visualized on the RDCP during the visits, and in the optimal management of patients using the integrated RDCP-RPM tools. Results: The platform organizes patterns in different blocks: (i) hypoglycemia; (ii) hyperglycemia; (iii) blood glucose variability; (iv) treatment adherence, which identifies a possible individual pattern according to glycemic control challenges, potential causal factors, and behavioral type patterns. The flowchart proposed for use of the RDCP-RPM is self-explanatory and entails 3 steps: (1) evaluation of quality and quantity of self-monitoring blood glucose data; (2) pattern analysis; (3) personalized suggestions and therapy changes. Conclusion: The main aim of the remote treatment flowchart proposed is to support healthcare professionals in the identification of hypoglycemic and hyperglycemic patterns using the RDCP regardless of the HbA1c value and ongoing treatment, which however, become crucial in combination with pattern analysis in the therapeutical choice. [ABSTRACT FROM AUTHOR]

Diabetes management requires constant monitoring and individualized adjustments. This study proposes a novel approach that leverages digital twins and personal health knowledge graphs (PHKGs) to revolutionize diabetes care. Our key contribution lies in developing a real-time, patient-centric digital twin framework built on PHKGs. This framework integrates data from diverse sources, adhering to HL7 standards and enabling seamless information access and exchange while ensuring high levels of accuracy in data representation and health insights. PHKGs offer a flexible and efficient format that supports various applications. As new knowledge about the patient becomes available, the PHKG can be easily extended to incorporate it, enhancing the precision and accuracy of the care provided. This dynamic approach fosters continuous improvement and facilitates the development of new applications. As a proof of concept, we have demonstrated the versatility of our digital twins by applying it to different use cases in diabetes management. These include predicting glucose levels, optimizing insulin dosage, providing personalized lifestyle recommendations, and visualizing health data. By enabling real-time, patient-specific care, this research paves the way for more precise and personalized healthcare interventions, potentially improving long-term diabetes management outcomes. [ABSTRACT FROM AUTHOR]

Background: Glycated hemoglobin (HbA1c) control is a crucial goal in the management of type 2 diabetes mellitus (T2DM), requiring lifelong commitment and family support. This study aimed to assess the effectiveness of family-based diabetes management intervention on HbA1c among adults with T2DM. Methods: From inception up to 2022, a comprehensive literature search was conducted across PubMed, ProQuest, Scopus, CORE, and the Cochrane Library. The quality of studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Effect sizes were calculated using standard deviations (SD), while the degree of heterogeneity was evaluated using the Higgins I2 test. Subgroup analyses were performed to explore factors contributing to sources of heterogeneity among trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed, and the protocol was registered with PROSPERO CRD42022384034. Results: A total of 18 randomized controlled trials (RCTs) involving 2815 participants indicated that family-based diabetes management intervention had a statistically significant impact on improving HbA1c (Mean Difference [MD] = −.47; 95% Confidence Interval [CI]: −.64 to −.30, p <.001) with a moderate level of heterogeneity (I2 = 59%). Subgroup analysis indicated that family-based diabetes management intervention among adults with T2DM in developing regions was more effective in improving HbA1c levels compared to developed countries. Conclusion: Family-based diabetes management interventions improved HbA1c. Further research is required to develop diabetes management strategies with a family focus that clearly defines the family's involvement. [ABSTRACT FROM AUTHOR]

Background: Coronary inflammation plays crucial role in type 2 diabetes mellitus (T2DM) induced cardiovascular complications. Both glucose-lowering drug interventions (GLDIS) and glycemic control (GC) status potentially correlate coronary inflammation, as indicated by changes in pericoronary adipose tissue (PCAT) attenuation, and thus influence cardiovascular risk. This study evaluated the impact of GLDIS and GC status on PCAT attenuation in T2DM patients. Methods: This retrospective study collected clinical data and coronary computed tomography angiography (CCTA) images of 1,342 patients, including 547 T2DM patients and 795 non-T2DM patients in two tertiary hospitals. T2DM patients were subgroup based on two criteria: (1) GC status: well: HbA1c < 7%, moderate: 7 ≤ HbA1c ≤ 9%, and poor: HbA1c > 9%; (2) GLDIS and non-GLDIS. PCAT attenuations of the left anterior descending artery (LAD-PCAT), left circumflex artery (LCX-PCAT), and right coronary artery (RCA-PCAT) were measured. Propensity matching (PSM) was used to cross compare PCAT attenuation of non-T2DM and all subgroups of T2DM patients. Linear regressions were conducted to evaluate the impact of GC status and GLDIS on PCAT attenuation in T2DM patients. Results: Significant differences were observed in RCA-PCAT and LCX-PCAT between poor GC-T2DM and non-T2DM patients (LCX: − 68.75 ± 7.59 HU vs. – 71.93 ± 7.25 HU, p = 0.008; RCA: − 74.37 ± 8.44 HU vs. − 77.2 ± 7.42 HU, p = 0.026). Higher PCAT attenuation was observed in LAD-PCAT, LCX-PCAT, and RCA-PCAT in non-GLDIS T2DM patients compared with GLDIS T2DM patients (LAD: − 78.11 ± 8.01 HU vs. − 75.04 ± 8.26 HU, p = 0.022; LCX: − 71.10 ± 8.13 HU vs. − 68.31 ± 7.90 HU, p = 0.037; RCA: − 78.17 ± 8.64 HU vs. − 73.35 ± 9.32 HU, p = 0.001). In the linear regression, other than sex and duration of diabetes, both metformin and acarbose were found to be significantly associated with lower LAD-PCAT (metformin: β coefficient = − 2.476, p=0.021; acarbose: β coefficient = − 1.841, p = 0.031). Conclusion: Inadequate diabetes management, including poor GC and lack of GLDIS, may be associated with increased coronary artery inflammation in T2DM patients, as indicated by PCAT attenuation on CCTA, leading to increased cardiovascular risk. This finding could help healthcare providers identify T2DM patients with increased cardiovascular risk, develop improved cardiovascular management programs, and reduce subsequent cardiovascular related mortality. [ABSTRACT FROM AUTHOR]

Diabetes is a prevalent chronic condition that significantly impacts older adults worldwide. Effective management of diabetes relies on consistent adherence to prescribed antihyperglycemic medications. However, medication non-adherence remains a challenging issue, resulting in suboptimal glycemic control and increased complications. This study aims to explore behavioral patterns and barriers related to medication use among older adults with diabetes. In-depth interviews were conducted with 18 older adults diagnosed with type 2 diabetes, who had been actively taking glycemic control medication for at least ten years. The data collection took place in four communities in Bangkok, selected for their accessibility and the presence of individuals using diabetes medications. Through thorough content analysis, various themes related to medication adherence patterns and barriers emerged. The findings of the study revealed poor behavioral patterns, including dosage adjustment, drug discontinuation, and improper medication storage. Key factors hindering medication adherence were physical limitations, such as forgetfulness resulting from Cognitive Decline, visual impairments, and mobility limitations. Additionally, the study identified the physician-patient interaction and a lack of purpose in life as major obstacles to medication adherence. To address these challenges, the study emphasized the importance of providing accessible medication information to aid individuals with visual impairments. Furthermore, practical support, like medication organizers and reminders, effectively improved adherence, helping individuals overcome physical limitations. [ABSTRACT FROM AUTHOR]