Diabetology

13 pages, 1718 KiB

Open AccessArticle

Surrogate Indexes of Insulin Resistance Are Affected by Sex and Gender and by the Combination of Smoking and Oral Contraceptives

by Giancarlo Tonolo, Andrea Montella, Mariangela V. Puci, Giovanni Sotgiu, Narcisa Muresu, Sara Cherchi, Mario Palermo, Giuseppe Seghieri, Flavia Franconi and Ilaria Campesi

Diabetology 2024, 5(7), 677-689; https://doi.org/10.3390/diabetology5070050 - 5 Dec 2024

Abstract

Background: Surrogate indexes of insulin resistance (IR) are less expensive than the euglycemic glucose clamp. The simultaneous impact of sex and gender, smoking, and combined oral contraceptives (COC) on IR surrogate indexes was studied in a cohort of healthy young men and women [...] Read more.

Background: Surrogate indexes of insulin resistance (IR) are less expensive than the euglycemic glucose clamp. The simultaneous impact of sex and gender, smoking, and combined oral contraceptives (COC) on IR surrogate indexes was studied in a cohort of healthy young men and women (stratified in COC-free women and COC users). Methods: Glycemia, insulin, C-peptide, TG, and HDL were measured in serum samples and used to calculate IGR, HOMA-IR-IR, QUICKI, FIRI, METS-IR, TG, and MCAi. Results: Men had higher BMI, glycemia, TG, METS-IR, TyG, and lower HDL than COC-free women and they had lower IGR and higher METS-IR and MCAi than COC users. TG, HDL, and TyG were lower and MCAi is higher in COC-free women than in COC users. In non-smokers, men had higher BMI and METS-IR and lower HDL than both cohorts of women. COC-free women showed a lower TyG index than men and COC women and lower TG, HDL, and IGR. MCAi was higher in COC-free women than in COC users. Smoking reduced sex and gender differences: HDL was lower in men than COC users and IGR was lower in men than COC-free women. Intra-sex differences were reported only in COC-free women: smokers had higher insulin, C-peptide, TG, and IGR and lower MCAi than non-smokers. Cluster analysis evidenced a significant separation between the sexes and smokers and non-smokers. Conclusions: Smoking leads to changes in the phenotype of both men and women, as well as COC in women; they should be considered independent variables in clinical studies given, representing a fundamental cornerstone in the personalization of prevention and care. Full article

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10 pages, 202 KiB

Open AccessArticle

Empowering Through Group Exercise: Beat It Trainers’ Views on Successful Implementation of a Diabetes Management Program Online and In-Person

by Morwenna Kirwan, Christine L. Chiu, Connie Henson, Thomas Laing, Jonathon Fermanis, Leah Scott, Jordan Janszen and Kylie Gwynne

Diabetology 2024, 5(7), 667-676; https://doi.org/10.3390/diabetology5070049 - 2 Dec 2024

Abstract

Background: The Beat It program is a clinician-led, community-based group exercise intervention for adults with Type 2 Diabetes Mellitus (T2DM). While previous studies have demonstrated its effectiveness in improving physical and mental health outcomes, this study explores the perspectives of Beat It Trainers [...] Read more.

Background: The Beat It program is a clinician-led, community-based group exercise intervention for adults with Type 2 Diabetes Mellitus (T2DM). While previous studies have demonstrated its effectiveness in improving physical and mental health outcomes, this study explores the perspectives of Beat It Trainers to identify key factors contributing to the program’s success and areas for improvement. Methods: Semi-structured interviews were conducted with 11 Accredited Exercise Physiologists who had delivered both in-person and online versions of the program. Interviews were thematically analyzed using inductive approaches. Results: Eight main themes emerged: customization to individual needs, capability building, outcome improvement, affordability, accessibility, sustainability, and a holistic approach delivered in a group setting. Challenges identified included managing group dynamics, maintaining participant commitment in a fully subsidized program, and providing nutrition advice within the trainers’ scope of practice. The program’s adaptability to both in-person and online delivery modes was highlighted as enhancing its accessibility and resilience. Conclusions: This study provides valuable insights into the factors contributing to the success of the Beat It program from the implementers’ perspective. The findings suggest that investing in comprehensive training for facilitators, particularly in group dynamics management, could benefit similar programs. While the program’s fully subsidized structure reduces financial barriers to entry, innovative strategies to enhance participant engagement and perceived value should be explored. The success of the online delivery mode indicates that hybrid models offering both in-person and virtual options could increase accessibility in future supervised, community-based exercise programs for T2DM management. Full article

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11 pages, 629 KiB

Open AccessArticle

Evaluating Hospital Revisit Risk in Patients Discharged from the Emergency Department with Blood Glucose of 300 mg/dL (16.7 mmol/L) or Greater

by Ryan M. Richstein, Caitlyn Gordon, Martin Gozar, Lori Ohanesian, Joanna Fishbein, Dana E. Gottlieb, Robert A. Silverman and Rifka C. Schulman-Rosenbaum

Diabetology 2024, 5(7), 656-666; https://doi.org/10.3390/diabetology5070048 - 29 Nov 2024

Abstract

Background: In the emergency department (ED), hyperglycemia may be overlooked due to non-diabetes mellitus (DM) primary diagnoses. We compared the risk of all-cause hospital revisits within 30 days after ED discharge in DM patients with normal blood glucose (BG), moderate hyperglycemia, and severe [...] Read more.

Background: In the emergency department (ED), hyperglycemia may be overlooked due to non-diabetes mellitus (DM) primary diagnoses. We compared the risk of all-cause hospital revisits within 30 days after ED discharge in DM patients with normal blood glucose (BG), moderate hyperglycemia, and severe hyperglycemia. Methods: This was a retrospective cohort study of patients 18 years and older discharged from a tertiary care ED between 1 January and 31 March 2018. The severe hyperglycemia group had BG levels of 300 mg/dL (16.7 mmol/L) or greater. The moderate hyperglycemia group had a history of DM, all BG levels less than 300 mg/dL (16.7 mmol/L), and at least one BG level of 180 mg/dL (10 mmol/L) or greater. The normal BG group had a history of DM and BG less than 180 mg/dL (10 mmol/L). Results: Of 302 patients who met criteria, 118 had severe hyperglycemia, 67 had moderate hyperglycemia, and 117 had normal BG. No significant difference between the severe hyperglycemia, moderate hyperglycemia, and normal BG groups was found in 30-day all-cause hospital revisits (19.5% vs. 10.4% vs. 15.4%, respectively, p = 0.25). Patients with a past medical history (PMH) of atherosclerotic cardiovascular disease (ASCVD) or any ED visit in the year preceding the index visit each had an increased risk of a hospital revisit within 30 days (p = 0.025) after covariate adjustment; the adjusted risk of a 30-day hospital revisit among those with a PMH of ASCVD was 2.68 times greater than the risk among those without a history of ASCVD (95% CI: 1.59 to 4.53), and the adjusted RR of a 30-day revisit among those who had an ED visit in the prior year was 1.92 times greater than those without an ED visit in the prior year (95% CI: 1.10 to 3.35). Conclusions: The results suggest no significant association between hyperglycemia in the ED and 30-day hospital revisits. In any patient with DM with a history of ASCVD or any ED visit in the previous year, there may be an increased risk of revisits. Full article

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16 pages, 854 KiB

Open AccessArticle

Impact of Personal Health Records on Diabetes Management: A Propensity Score Matching Study

by Yuriko Ono, Hiroshi Okada, Noriyuki Kitagawa, Saori Majima, Takuro Okamura, Takafumi Senmaru, Emi Ushigome, Naoko Nakanishi, Masahide Hamaguchi and Michiaki Fukui

Diabetology 2024, 5(7), 640-655; https://doi.org/10.3390/diabetology5070047 - 27 Nov 2024

Abstract

Background: Effective self-management is crucial in diabetes care. This study investigates the impact of Personal Health Records (PHR) on diabetes management and person self-management behaviors. Methods: Retrospective cohort study was conducted involving individuals with diabetes using insulin and prescribed FreeStyle Libre^®. [...] Read more.

Background: Effective self-management is crucial in diabetes care. This study investigates the impact of Personal Health Records (PHR) on diabetes management and person self-management behaviors. Methods: Retrospective cohort study was conducted involving individuals with diabetes using insulin and prescribed FreeStyle Libre^®. Participants were categorized into PHR users and non-users. Key metrics such as HbA1c, Time in Range (TIR), Time above Range (TAR), and body weight were analyzed. Results: Among 212 intermittently scanned continuous glucose monitoring (isCGM) users, 25 individuals used PHR. Comparing 21 individuals using a PHR with 42 matched controls, the TIR significantly increased (ΔTIR 17.2% vs. 1.90%, p = 0.020), and HbA1c levels showed a greater decrease (ΔHbA1c −0.83% vs. −0.22%, p = 0.023). A significant reduction was also observed in TAR among PHR users (ΔTAR −17.6% vs. −1.63%, p = 0.017). There were no significant changes in body weight (ΔBW −0.51 kg vs. −1.60 kg, p = 0.578). Conclusions: PHR systems demonstrate potential in improving diabetes management by enhancing self-management practices and glycemic control. Although the sample size of PHR users was relatively low, PHR should be more widely used. The study underscores the need for further research on PHR’s long-term impact and its applicability in diverse diabetic populations. Full article

(This article belongs to the Special Issue Feature Papers in Diabetology 2024)

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11 pages, 488 KiB

Open AccessArticle

Assessing the Feasibility of Handheld Cameras to Increase Access to Teleretinal Diabetic Retinopathy Screenings in Safety Net Clinics in Los Angeles

by Gabrielle Green, Roxana Flores, Elvia Figueroa, Tony Kuo and Lauren P. Daskivich

Diabetology 2024, 5(6), 629-639; https://doi.org/10.3390/diabetology5060046 - 20 Nov 2024

Abstract

Background: Handheld cameras may increase access to teleretinal diabetic retinopathy screenings (TDRS), as they are more economical and nimbler than traditional desktop cameras. However, their use in safety net clinical settings is less understood. Methods: The Los Angeles County Department of Public Health [...] Read more.

Background: Handheld cameras may increase access to teleretinal diabetic retinopathy screenings (TDRS), as they are more economical and nimbler than traditional desktop cameras. However, their use in safety net clinical settings is less understood. Methods: The Los Angeles County Department of Public Health collaborated with the Los Angeles County Department of Health Services (DHS) to pilot the use of handheld cameras in DHS’s TDRS program. This study assessed screening metrics and interviewed TDRS coordinators and photographers about their experiences using these cameras. Results: Handheld cameras were harder to operate and performed less optimally on key screening metrics (e.g., image quality) compared to desktop cameras. However, this challenge appeared to be linked to the selected model rather than to all handheld cameras. The adoption of handheld cameras in DHS was aided by their integration into an existing agency infrastructure that already supported the use of desktop cameras; these operational supports included an established workflow, a data platform, and experienced photographers. Conclusions: The use of handheld cameras for TDRS is a promising practice for assuring equitable access to screenings. Handheld cameras are portable, smaller in size, and lower in cost than desktop cameras. Future projects should invest in and assess the performance of higher-quality models of these cameras, especially their use in safety net clinical settings. Full article

(This article belongs to the Special Issue Feature Papers in Diabetology 2024)

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8 pages, 612 KiB

Open AccessArticle

Impact of an Ambulatory Clinical Pharmacy Population Health Initiative on HbA1c Reduction and Value-Based Measures: A Retrospective, Single-Center Cohort Study

by Savannah Nelson, Tasha A. Butler, Amanda Martinez, Jessica Bianco, Delilah Blanco and Nicholas W. Carris

Diabetology 2024, 5(6), 621-628; https://doi.org/10.3390/diabetology5060045 - 18 Nov 2024

Abstract

Background: Studies of pharmacists’ clinical programs have demonstrated improvements in controlling chronic diseases. However, significantly less data are available regarding pharmacist impact in a value-based Patient-Centered Medical Home (PCMH). The present study assessed a population health initiative to incorporate pharmacists for the [...] Read more.

Background: Studies of pharmacists’ clinical programs have demonstrated improvements in controlling chronic diseases. However, significantly less data are available regarding pharmacist impact in a value-based Patient-Centered Medical Home (PCMH). The present study assessed a population health initiative to incorporate pharmacists for the management of type 2 diabetes (T2D), hypertension, and hyperlipidemia in a PCMH. Methods: This was a single-center retrospective cohort study of patients with T2D and baseline glycated hemoglobin (HbA1c) greater than 9%. Patients were excluded if they received care from an endocrinology provider or were lost to follow-up during the observation window of 1 January 2023 through 31 July 2023. Patients were analyzed in two cohorts: (1) patients who received any outpatient care from a clinical pharmacist (pharmacist cohort) and (2) patients who did not receive any outpatient care from a clinical pharmacist (usual care cohort). The primary outcome was the proportion of patients achieving an HbA1c of less than 8%. Secondary outcomes included blood pressure control and receipt of guideline-directed statin therapy. Results: Ninety-one patients were identified, twenty-nine in the pharmacist cohort and sixty-two in the usual care cohort. The overall population was older (mean age ~66 years), 59% female, and racially diverse (<50% Caucasian). HbA1c less than 8% was achieved in 34% of patients in the pharmacist cohort and 29% of patients in the usual care cohort (p = 0.001). A blood pressure goal of less than 140/90 mmHg was achieved more frequently in the pharmacist cohort (90% vs. 61%, p = 0.006), but guideline-directed statin therapy was similar between groups (90% vs. 79%, p = 0.215). Conclusions: Pharmacists can play an integral role within a PCMH to improve value-based measures for HbA1c and blood pressure control. Further research is needed to assess the impact of pharmacist care on statin use and economic outcomes. Full article

(This article belongs to the Special Issue Risk of Type 2 Diabetes Mellitus: Cardiorenometabolic Syndrome and Its Components)

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13 pages, 245 KiB

Open AccessArticle

The Dynamics of Diabetes Disclosure in the Workplace

by Niki Markou and Doxa Papakonstantinou

Diabetology 2024, 5(6), 608-620; https://doi.org/10.3390/diabetology5060044 - 8 Nov 2024

Abstract

Background/Objectives: Individuals with diabetes often experience discrimination and barriers at work and are confronted with the challenge of deciding whether to disclose their health status in their workplace. This study explores the disclosure of diabetes in the workplace. The research was based [...] Read more.

Background/Objectives: Individuals with diabetes often experience discrimination and barriers at work and are confronted with the challenge of deciding whether to disclose their health status in their workplace. This study explores the disclosure of diabetes in the workplace. The research was based on a previously developed questionnaire. Methods: Two hundred and five persons with diabetes who were employed in Greece participated in the research. Results: The majority of the participants chose to disclose. Demographic characteristics influenced their disclosure decision, with the diabetes type and the employment sector showing a more significant impact. The majority of the participants showed a strong preference for early disclosure. Conclusions: The main reasons for disclosure were the belief that there was no reason to conceal it and the need to know in an emergency. In contrast, the main reasons for concealment were the fear of being fired or not being hired, the belief that disclosure was unnecessary, and concerns about being treated differently. The present research brings to light the reality of employed people with diabetes in Greece. Future research could focus on a deeper understanding of the disclosure issues of people with diabetes and other non-visible disabilities. Full article

8 pages, 589 KiB

Open AccessCase Report

Diabetic Ketoacidosis as a Debut and Immune-Mediated Complication Caused by Pembrolizumab: Case Report

by Julian Andrés Pacichana, Luis Miguel Osorio, Katherine Restrepo, Andres Felipe García, Giovanna Rivas and Yamil Liscano

Diabetology 2024, 5(6), 600-607; https://doi.org/10.3390/diabetology5060043 - 6 Nov 2024

Abstract

Background/Objectives: Diabetic ketoacidosis (DKA) is an acute and potentially life-threatening complication characterized by the accumulation of ketone bodies in the blood, primarily occurring in patients with type 1 diabetes and occasionally in those with type 2 diabetes under certain conditions. DKA presents [...] Read more.

Background/Objectives: Diabetic ketoacidosis (DKA) is an acute and potentially life-threatening complication characterized by the accumulation of ketone bodies in the blood, primarily occurring in patients with type 1 diabetes and occasionally in those with type 2 diabetes under certain conditions. DKA presents with symptoms such as polyuria, polydipsia, polyphagia, and, in severe cases, mental status changes. Identifying the triggering factor is crucial to prevent complications and effectively manage this medical emergency. Methods: This report describes the case of a 58-year-old male patient with stage IIIb nodular melanoma, diagnosed in November 2022. Results: After receiving five cycles of pembrolizumab, the patient developed de novo DKA, presenting with blurred vision, asthenia, adynamia, polyuria, and polydipsia. He was admitted to the emergency department with a blood glucose level of 764 mg/dL, confirming hyperglycemia and metabolic acidosis. He was transferred to the intensive care unit for fluid resuscitation and insulin infusion. After adequate clinical evolution and meeting the criteria for DKA resolution, possible autoimmune endocrinopathies secondary to immunotherapy were considered. Due to this complication, the oncological treatment was changed. Finally, the patient was discharged with the need to continue insulin therapy and oral hypoglycemic agents, along with thyroid hormone supplementation. Conclusions: The novelty of this case lies in the presentation of DKA as an immune-mediated complication induced by pembrolizumab, highlighting the importance of closely monitoring patients receiving immune checkpoint inhibitors to detect and manage emerging autoimmune endocrinopathies. It is essential to adjust oncological treatment according to the patient’s response and promptly manage autoimmune endocrinopathies to improve clinical outcomes and the patient’s quality of life. Full article

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16 pages, 2209 KiB

Open AccessArticle

Exploration of Foundational Models for Blood Glucose Forecasting in Type-1 Diabetes Pediatric Patients

by Simone Rancati, Pietro Bosoni, Riccardo Schiaffini, Annalisa Deodati, Paolo Alberto Mongini, Lucia Sacchi, Chiara Toffanin and Riccardo Bellazzi

Diabetology 2024, 5(6), 584-599; https://doi.org/10.3390/diabetology5060042 - 4 Nov 2024

Abstract

Aims: The accurate prediction of blood glucose (BG) levels is critical for managing Type-1 Diabetes (T1D) in pediatric patients, where variability due to factors like physical activity and developmental changes presents significant challenges. Methods: This work explores the application of foundational models, particularly [...] Read more.

Aims: The accurate prediction of blood glucose (BG) levels is critical for managing Type-1 Diabetes (T1D) in pediatric patients, where variability due to factors like physical activity and developmental changes presents significant challenges. Methods: This work explores the application of foundational models, particularly the encoder–decoder model TimeGPT, for BG forecasting in T1D pediatric patients. Methods: The performance of TimeGPT is compared against state-of-the-art models, including ARIMAX and LSTM, and multilayer perceptron (MLP) architectures such as TiDE and TSMixer. The models were evaluated using continuous glucose monitoring (CGM) data and exogenous variables, such as insulin intake. Results: TimeGPT outperforms or achieves comparable accuracy to the state of the art and MLP models in short-term predictions (15 and 30 min), with most predictions falling within the clinically safe zones of the Clarke Error Grid. Conclusions: The findings suggest that foundational models like TimeGPT offer promising generalization capabilities for medical applications and can serve as valuable tools to enhance diabetes management in pediatric T1D patients. Full article

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18 pages, 793 KiB

Open AccessArticle

Exploring the Feasibility of Opportunistic Diabetic Retinopathy Screening with Handheld Fundus Cameras in Primary Care: Insights from Doctors and Nurses

by Sílvia Rêgo, Matilde Monteiro-Soares, Marco Dutra-Medeiros, Cláudia Camila Dias and Francisco Nunes

Diabetology 2024, 5(6), 566-583; https://doi.org/10.3390/diabetology5060041 - 30 Oct 2024

Abstract

Aims: This study aims to assess the perspective of doctors and nurses regarding the clinical settings and barriers to implementing opportunistic diabetic retinopathy screening with handheld fundus cameras. Design: This study was a cross-sectional, online questionnaire study. Methods: An online survey was distributed [...] Read more.

Aims: This study aims to assess the perspective of doctors and nurses regarding the clinical settings and barriers to implementing opportunistic diabetic retinopathy screening with handheld fundus cameras. Design: This study was a cross-sectional, online questionnaire study. Methods: An online survey was distributed to doctors and nurses working in Portuguese primary care units and hospitals between October and November 2021. The survey assessed current fundus observation practices, potential contexts, and barriers to using handheld fundus cameras. Results: We received 299 eligible responses. About 87% of respondents (n = 255) believe in the clinical utility of handheld fundus cameras to increase patients’ access to diabetes-related retinopathy screening, and 74% (n = 218) attribute utility to identify other eye or systemic diseases. More than a third of participants (37%, n = 111) envisioned using such devices multiple times per week. The main potential barriers identified included limited time (n = 90), equipment cost (n = 48), or the lack of skills in retinal image acquisition (n = 47). Most respondents (94%, n = 275) expected a follow-up recommendation to accompany the telemedicine diagnosis. Conclusions: Doctors and nurses support the use of handheld fundus cameras. However, to optimize their implementation, some strategies should be considered, including training, telemedicine-based diagnosis, and support for follow-up through accessible, user-friendly, and efficient information systems. Full article

(This article belongs to the Special Issue Feature Papers in Diabetology 2024)

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12 pages, 958 KiB

Open AccessArticle

Evaluation of Insulin Secretion and Continuous Glucose Monitoring in Patients with Cystic Fibrosis After Initiation of Transmembrane Conductance Regulator Modulator: A 52-Week Prospective Study

by Ane Bayona, Edurne Lecumberri Pascual, Saioa Vicente, Luis Maíz, Ana Morales, Adelaida Lamas, Cristina Sánchez Rodríguez, Rosa Yelmo, María Martín-Frías, Victoria Martínez Vaello, Enrique Blitz Castro and Lía Nattero-Chávez

Diabetology 2024, 5(6), 554-565; https://doi.org/10.3390/diabetology5060040 - 24 Oct 2024

Abstract

Introduction: Limited studies have explored the impact of cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulators on glucose tolerance and insulin secretion in patients with CF, yielding varied results. This study aims to assess alterations in glucose metabolism and insulin secretion over 24 [...] Read more.

Introduction: Limited studies have explored the impact of cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulators on glucose tolerance and insulin secretion in patients with CF, yielding varied results. This study aims to assess alterations in glucose metabolism and insulin secretion over 24 and 52 weeks following CFTR modulator initiation in a cohort of pediatric and adult patients with CF. Materials and Methods: A prospective longitudinal study conducting oral glucose tolerance test (OGTT) with C-peptide and insulin levels. The insulin secretion rate at 60 min (ISR60) and the insulinogenic index (IGI) were calculated during the first 60 and 30 min of the OGTT, respectively. Glucose metabolism status was categorized as normal (NGT), indeterminate (INDET), impaired glucose tolerance (IGT), or cystic fibrosis-related diabetes (CFRD). Additionally, continuous glucose monitoring (CGM) was performed for 14 days at each visit. We employed a repeated-measures general linear model to assess changes in insulin secretion and CGM metrics, with glucose tolerance status as the between-subjects factor and visit (baseline, 24 and 52 weeks) as the within-subjects factor. Results: The study comprised 25 patients (11 adults and 14 pediatrics). At baseline, 2 patients (8%) had NGT, 8 (32%) had INDET, 10 (40%) had IGT, and 5 (20%) had CFRD. Overall, there were no significant changes in insulin and C-peptide area under the curve (AUC), IGI and DI after 52 weeks. However, we observed an increase in ISR60 among NGT patients (mean change: 1.766; 95% CI: 1.414; 2.118, p < 0.001). Consistently, average glucose exhibited a significant decrease in NGT patients between 24 and 52 weeks (mean change: −5.645; 95% CI: −4.233; −10.866, p = 0.028). Conclusions: Treatment with CFTR modulators potentially enhances insulin secretion in patients with CF NGT. Early initiation of treatment, as evaluated through long-term prospective trials, is essential to further investigate whether decreased glucose control is preventable or reversible. Full article

(This article belongs to the Special Issue Feature Papers in Diabetology 2024)

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17 pages, 255 KiB

Open AccessArticle

The Impact of Lifestyle Changes on the Prevalence of Prediabetes and Diabetes in Urban and Rural Indonesia: Results from the 2013 and 2018 Indonesian Basic Health Research (RISKESDAS) Survey

by Iche A. Liberty, Farid Kurniawan, Calysta N. Wijaya, Pradana Soewondo and Dicky L. Tahapary

Diabetology 2024, 5(6), 537-553; https://doi.org/10.3390/diabetology5060039 - 23 Oct 2024

Abstract

(1) Background: Prediabetes represents reversible glycemic abnormalities between normal glucose regulation and diabetes. Indonesia has a high burden of non-communicable diseases, such as diabetes. This study aims to evaluate the impact of lifestyle changes on prediabetes and diabetes in rural and urban populations. [...] Read more.

(1) Background: Prediabetes represents reversible glycemic abnormalities between normal glucose regulation and diabetes. Indonesia has a high burden of non-communicable diseases, such as diabetes. This study aims to evaluate the impact of lifestyle changes on prediabetes and diabetes in rural and urban populations. (2) Methods: This is a repeated cross-sectional study, and data were obtained from Basic Health Research (RISKESDAS) in 2013 and 2018. (3) Results: The study found that urban populations who ate >3 days/week of vegetables had a lower proportion of prediabetes and diabetes. Rural populations with 2 days/week of vegetable consumption had a higher risk of prediabetes in 2018. From 2013 to 2018, urban and rural populations consumed excessive amounts of sweet food/drink, salty food, fatty/cholesterol/fried food, and meat/chicken/fish-based food with preservatives. In 2018, urban and rural populations who consumed sweet food/drink more than once daily had a higher risk of prediabetes and diabetes. The prevalence of active physical activity declined in normoglycemic individuals, while it increased in prediabetes and diabetes in urban and rural areas. In 2013, physical activity was a protective factor for prediabetes. (4) Conclusions: Lifestyle changes impacted prediabetes and diabetes prevalence. Further research is needed to promote healthy diets and lifestyle modifications. Full article

(This article belongs to the Special Issue Lifestyle Behavior Intervention for Diabetes Prevention and Management: 2nd Edition)

23 pages, 3216 KiB

Open AccessArticle

Impact of Hypoglycemia on Glucose Variability over Time for Individuals with Open-Source Automated Insulin Delivery Systems

by Arsalan Shahid and Dana M. Lewis

Diabetology 2024, 5(5), 514-536; https://doi.org/10.3390/diabetology5050038 - 21 Oct 2024

Abstract

This study investigates glucose conditions preceding and following various hypoglycemia levels in individuals with type 1 diabetes using open-source automated insulin delivery (AID) systems. It also seeks to evaluate relationships between hypoglycemia and subsequent glycemic variability. Methods: Analysis of continuous glucose monitor (CGM) [...] Read more.

This study investigates glucose conditions preceding and following various hypoglycemia levels in individuals with type 1 diabetes using open-source automated insulin delivery (AID) systems. It also seeks to evaluate relationships between hypoglycemia and subsequent glycemic variability. Methods: Analysis of continuous glucose monitor (CGM) data from 122 adults with type 1 diabetes using open-source AID from the OpenAPS Data Commons was conducted. This study comprehensively analyzed the effects of hypoglycemia on glycemic variability, covering time periods before and after hypoglycemia. Results: Glucose variability normalization post-hypoglycemia can take up to 48 h, with severe hypoglycemia (41–50 mg/dL) linked to prolonged normalization. A cyclical pattern was observed where hypoglycemia predisposes individuals to further hypoglycemia, even with AID system use. A rise in glucose levels often precedes hypoglycemia, followed by an elevated mean time above range (TAR) post-hypoglycemia, indicating a ‘rebound’ effect. The experimental results are further validated on T1DEXI data (n = 222), originating from commercial AID systems. Different hypoglycemia categorization approaches did not show significant differences in glycemic variability outcomes. The level of hypoglycemia does influence the pattern of subsequent glucose fluctuations. Conclusion: Hypoglycemia, especially at lower levels, significantly impacts subsequent glycemic variability, even with the use of open-source AID systems. This should be studied further with a broader set of commercial AID systems to understand if these patterns are true of all types of AID systems. If these patterns occur in all types of AID systems, it underscores potential opportunities for enhancements in AID algorithms and highlights the importance of educating healthcare providers and people with diabetes about post-hypoglycemia glucose variability. Full article

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13 pages, 254 KiB

Open AccessArticle

Application of the Summary of Diabetes Self-Care Activities Questionnaire in Evaluating the Self-Care of People with Diabetes

by Snježana Gaćina, Blaž Mlačak, Tomislav Bulum and Bojana Filej

Diabetology 2024, 5(5), 501-513; https://doi.org/10.3390/diabetology5050037 - 11 Oct 2024

Abstract

Objectives: This uncontrolled open study aimed to measure the levels of self-care of patients before and after education, their initial knowledge, and their knowledge two months after interacting with healthcare providers using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. Methods: The data [...] Read more.

Objectives: This uncontrolled open study aimed to measure the levels of self-care of patients before and after education, their initial knowledge, and their knowledge two months after interacting with healthcare providers using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. Methods: The data for this study were collected over 14 months from 396 patients with diabetes. This study was conducted in three phases: initial questionnaire testing, education, and retesting after two months. The education included specific diabetes-related topics: nutrition, exercise, self-monitoring of blood glucose, foot care, and smoking. Results: The results showed that all self-care activities between the first and second assessments were different. The initial assessment showed that the more successful the general diet, the specific diet, and physical activity were, the better the hemoglobin A1c value was. When considering the impact of gender on self-care effectiveness results, it was noted that women were more successful in foot care and specific diet in the initial testing, while men excelled in physical activity. The most successful age group in the scales of general diet, physical activity, and blood glucose testing was 31–45 years. Those with type 1 diabetes (36% of the study population) were more successful in self-care in the first and second measurements but without any differences in self-care in the retesting. Conclusions: our study observed a difference in self-care results between the two measurements of self-care activities in patients with diabetes, evaluated by the SDSCA questionnaire. Full article

(This article belongs to the Special Issue Lifestyle Behavior Intervention for Diabetes Prevention and Management)

10 pages, 1011 KiB

Open AccessArticle

Improved Diabetic Foot Ulcer Outcomes in Medicaid Beneficiaries with Podiatric Care Access

by Ivan Y. Luu, Alexander T. Hong, Ashton Lee, Juan C. Arias, Chia-Ding Shih, David G. Armstrong and Tze-Woei Tan

Diabetology 2024, 5(5), 491-500; https://doi.org/10.3390/diabetology5050036 - 10 Oct 2024

Abstract

Objectives: This study aims to examine the association between state Medicaid coverage of podiatry services and the outcomes of beneficiaries with new diabetic foot ulcers (DFUs). Methods: Medicaid beneficiaries who developed a DFU between 2010 and 2015 were identified using the PearlDiver claims [...] Read more.

Objectives: This study aims to examine the association between state Medicaid coverage of podiatry services and the outcomes of beneficiaries with new diabetic foot ulcers (DFUs). Methods: Medicaid beneficiaries who developed a DFU between 2010 and 2015 were identified using the PearlDiver claims database. The states were categorized into covered states (CS) and non-covered states (NCS) based on podiatric coverage during the study period. The outcomes included major amputation, minor amputation, and hospitalization due to foot infection within 12 months of index diagnosis. Logistic regression was used to assess the association of state coverage type and outcomes, controlling for age, sex, and the Charlson Comorbidity Index (CCI). Results: Our study included 16,905 Medicaid beneficiaries who developed new DFUs: 14,748 in CS and 2157 in NCS. The overall major amputation rate was 2.6%. The risk of major amputation was 48% lower among Medicaid beneficiaries in CS (OR 0.52, 95% CI 0.31–0.90) than in NCS. The Medicaid beneficiaries in CS had a 24% lower risk of hospitalization for foot infection (OR 0.76, 95% CI 0.67–0.85) but had a 58% higher risk of minor amputation (OR 1.58, 95% CI 1.22–2.07) than in NCS. Conclusions: Medicaid coverage of podiatry services might be associated with lower rates of major amputation and reduced risk of hospitalization for foot infection. Full article

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17 pages, 1900 KiB

Open AccessReview

Uses of African Plants and Associated Indigenous Knowledge for the Management of Diabetes Mellitus

by John Awungnjia Asong, Peter Tshepiso Ndhlovu, Ahmed Olatunde and Adeyemi Oladapo Aremu

Diabetology 2024, 5(5), 476-490; https://doi.org/10.3390/diabetology5050035 - 27 Sep 2024

Abstract

Diabetes mellitus (DM) is a common non-communicable and chronic metabolic disorder regarded as a global epidemic with high morbidity and mortality. Although, conventional medicines are available for the management of DM, Indigenous knowledge, including the use of botanicals, has contributed to the management [...] Read more.

Diabetes mellitus (DM) is a common non-communicable and chronic metabolic disorder regarded as a global epidemic with high morbidity and mortality. Although, conventional medicines are available for the management of DM, Indigenous knowledge, including the use of botanicals, has contributed to the management of this life-threatening disease in Africa. This is due to the perceived effectiveness and minimal side effects associated with plants and plant-derived compounds as an affordable remedy against DM. This review focuses on the contribution of Indigenous African plants to the management of DM. Relevant literatures were reviewed from online scientific databases, such as PubMed, ScienceDirect, and Google Scholar, using keywords singly and in combination. The review revealed that Indigenous health practitioners use several medicinal plants in the management of DM, with a range of 14–255 botanicals recorded. Approximately 80 compounds with antidiabetic potency have been isolated from different parts of African medicinal plants, with the majority belonging to flavonoids and terpenoids. Particularly, compounds such as apigenin, combretin B, convallatoxin, kaempferol, and quercetin remain the most promising antidiabetic compounds isolated from African medicinal plants. Limited clinical trials have been conducted on these compounds despite these milestones. There is, therefore, the need for further investigations to explain their antidiabetic effects, particularly under clinical conditions. Plants from which these compounds were isolated were selected based on ethnopharmacological knowledge. With these developments, medicinal plants and Indigenous knowledge remain an integral part of the global strategy to combat DM. Full article

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12 pages, 1214 KiB

Open AccessArticle

A Pilot Study on the Fecal Microbiota in Mexican Women with Gestational Diabetes Mellitus and Their Newborns

by Dennise Lizárraga, Alejandra García-Gasca, Teresa García-Gasca, Gertrud Lund, Abraham Guerrero, Efrén Peraza-Manjarrez and Bruno Gómez-Gil

Diabetology 2024, 5(5), 464-475; https://doi.org/10.3390/diabetology5050034 - 25 Sep 2024

Abstract

Introduction: The gut microbiota plays important roles in physiological and immune processes. Some metabolic disorders and complications during pregnancy, such as gestational diabetes mellitus (GDM), have been associated with alterations in the gut microbiota. The aim of this study was to characterize alterations [...] Read more.

Introduction: The gut microbiota plays important roles in physiological and immune processes. Some metabolic disorders and complications during pregnancy, such as gestational diabetes mellitus (GDM), have been associated with alterations in the gut microbiota. The aim of this study was to characterize alterations in fecal microbiota (as a non-invasive proxy of the gut microbiota) by 16S rRNA (V3-V4) taxonomic fingerprinting in Mexican women with GDM and their newborns. Methods: A total of 17 pregnant women (GDM = 8 and control = 9) were recruited between April 2021 and August 2022, and fecal samples were collected in the third trimester of gestation and during cesarean section. A total of 16 newborns (GDM = 8 and control = 8) participated in the study; meconium samples were taken immediately after birth. Results: The maternal microbiota (both at the third trimester and cesarean section) exhibited higher alpha diversity and a different bacterial community structure compared to that of their newborns. The maternal fecal microbiota of the third trimester from the GDM group showed a significant increase in the abundance of Firmicutes, Lachnospiraceae, Ruminococcaceae, Blautia, Rosebura, and Faecalibacterium, and a significant decrease in Peptostreptococcaceae, Anaerococcus, and Finegoldia, compared to the control group; these taxa correlated with blood glucose levels (except for Ruminococcaceae) but not with body mass index (BMI). No significant differences were observed between GDM and control groups in the relative abundance of maternal fecal microbiota collected in the cesarean section. The meconium microbiota of newborns from mothers with GDM showed a significant increase in Faecalibacterium compared with newborns from normoglycemic mothers and correlated with the mothers’ BMI and fasting glucose levels. Conclusions: The results indicate that GDM is associated with alterations in the fecal microbiota of women with GDM in the third trimester, in particular, with taxa known to be associated with metabolic disorders and other types of diabetes, and modifications in the meconium microbiota of their newborns. Full article

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17 pages, 1861 KiB

Open AccessArticle

A Randomized Crossover Study Comparing the Effects of Diabetes-Specific Formula with Common Asian Breakfasts on Glycemic Control and Satiety in Adults with Type 2 Diabetes Mellitus

by Sing Teang Kong, Dieu Thi Thu Huynh, Weerachai Srivanichakorn, Weerapan Khovidhunkit, Chaiwat Washirasaksiri, Tullaya Sitasuwan, Chengrong Huang, Swapnil Paunikar, Menaka Yalawar and Siew Ling Tey

Diabetology 2024, 5(4), 447-463; https://doi.org/10.3390/diabetology5040033 - 19 Sep 2024

Abstract

Postprandial hyperglycemia was shown to be an independent risk factor for microvascular and macrovascular complications in type 2 diabetes mellitus (T2D). We aimed to investigate the glucose, insulin, and subjective appetite at 0, 15, 30, 45, 60, 90, 120, 150, and 180 min [...] Read more.

Postprandial hyperglycemia was shown to be an independent risk factor for microvascular and macrovascular complications in type 2 diabetes mellitus (T2D). We aimed to investigate the glucose, insulin, and subjective appetite at 0, 15, 30, 45, 60, 90, 120, 150, and 180 min of three treatments: diabetes-specific formula (DSF), noodle soup, and glutinous rice. This was a randomized, crossover study with a one-week interval between treatments. Sixty-four T2D adults with oral glucose-lowering medication and HbA1c between 7% and <10% were randomized. The glucose positive area under the curve from 0 to 180 min (pAUC) was significantly lower with DSF than with glutinous rice (LSM ± SE: DSF 354 ± 32 vs. glutinous rice 451 ± 32 mmol.min/L, p = 0.033). The insulin pAUC was significantly lower with DSF (median [IQR]: 2733 [1542, 4204]) compared to glutinous rice (3359 [2193, 4744] µIU.min/mL), p = 0.042). The insulinogenic index at 30 min was significantly higher in DSF (median [IQR], 8.1 [4.2, 19.7]) compared to glutinous rice (5.4 [2.7, 11.7], p < 0.001). No significant differences were found in subjective appetite between the three treatments (all, p ≥ 0.827). There were also no significant differences in hunger, fullness, desire to eat, and prospective consumption ratings between DSF and the other two breakfasts (all p ≥ 0.181). Noodle soup led to the shortest time for hunger to return to baseline (165 min), 21 min earlier than DSF (186 min) and 32 min earlier than glutinous rice (197 min). DSF significantly reduced postprandial glucose and insulin responses compared with glutinous rice and had a higher satiating value than noodle soup in T2D adults. Replacing common Asian breakfasts with DSF may improve glycemia and hunger control. Full article

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17 pages, 1387 KiB

Open AccessReview

The Prevalence of Gestational Diabetes Mellitus in Polycystic Ovary Disease—A Systematic Review, Meta-Analysis, and Exploration of Associated Risk Factors

by Rajani Dube, Taniqsha Bambani, Sahina Saif, Noha Hashmi, Mohamed Anas Mohamed Faruk Patni and Noopur Ramesh Kedia

Diabetology 2024, 5(4), 430-446; https://doi.org/10.3390/diabetology5040032 - 4 Sep 2024

Abstract

Polycystic ovary syndrome (PCOS) is a common condition in reproductive-age women. Women with PCOS are at higher risk of pregnancy complications, including gestational diabetes (GDM). The prevalence of PCOS and GDM varies according to the diagnostic criteria used. The mechanism for the occurrence [...] Read more.

Polycystic ovary syndrome (PCOS) is a common condition in reproductive-age women. Women with PCOS are at higher risk of pregnancy complications, including gestational diabetes (GDM). The prevalence of PCOS and GDM varies according to the diagnostic criteria used. The mechanism for the occurrence of GDM in women with PCOS is still unclear. Materials and Methods: A systematic search of the electronic database was done using keywords like PCOS and GDM to include studies between April 2008 and March 2023 where uniform diagnostic criteria were used. After assessing the risk of bias, studies with a high risk (of bias) were excluded, and a meta-analysis was conducted using relative risks and confidence intervals. Results and Discussion: Out of 1896 search results, 95 were selected for full-text review. The quality of the studies was scrutinized and a total of 28 studies were included as they fulfilled the inclusion criteria. The incidence of GDM in women with PCOS was found to be 10.55% (2.9–54.9%) from pooled data involving 1,280,245 women. The prevalence of PCOS in women diagnosed with GDM, based on pooled data from 36,351 women across retrospective studies, was found to be 2.47% (ranging from 1.5% to 50.1%). Selection predominantly included cohort studies, most commonly from China. The meta-analysis found that the risk of GDM is higher in women with PCOS than in those without PCOS (HR: 1.59, 95% CI: 1.27–1.91, p < 0.001). Family history of diabetes, ethnicity, high pre-pregnancy BMI, insulin resistance, gestational weight gain, use of assisted reproductive techniques, and multifetal gestation were found to be associated with GDM in women with PCOS. Conclusion: The prevalence of GDM in patients with PCOS is high, but the causality is complex. The newer predictive models are promising in clarifying the causative relationships, yet use various parameters with different cut-offs. There is a need for the development of universally acceptable parameters for the early prediction of GDM in women with PCOS. Full article

(This article belongs to the Special Issue Women’s Special Issue Series: Diabetology)

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