Search Results (568)

Gestational Diabetes Mellitus (GDM) represents a significant public health concern due to its association with adverse maternal and neonatal outcomes, as well as elevated long-term metabolic risks. Its prevalence varies substantially depending on the diagnostic criteria used and the population studied. Women with GDM frequently experience heightened stress, anxiety, and uncertainty, underscoring the need for accessible information, counseling, and ongoing support to navigate glucose monitoring, dietary adjustments, and treatment regimens. Although clinical management has been extensively studied, research has largely focused on metabolic monitoring and therapeutic interventions, often underemphasizing prevention strategies, women’s informational needs, and maternal psychological well-being. Emerging evidence and international guidelines increasingly advocate for integrating these components into structured, woman-centered GDM care plans that actively involve families. Such approaches empower women to engage in self-management, enhance health literacy, support adherence to lifestyle and pharmacological interventions, and promote sustainable behavioral changes. This narrative review presents a comprehensive, holistic model of care across the perinatal continuum, emphasizing early risk identification, preventive strategies, and multidisciplinary coordination. Core elements include individualized antenatal education, empathetic communication, and family engagement, fostering self-efficacy, continuity of care, and integration of medical, educational, and psychosocial interventions. Equipping healthcare professionals with the competencies to deliver this holistic, woman-centered framework is essential to optimize maternal and neonatal outcomes and mitigate the long-term health consequences of GDM. Full article

Diabetic chronic wounds are often accompanied by excessive wound exudate maceration, which prolongs the inflammatory phase and increases the risk of infection. Such a complex wound microenvironment imposes more stringent requirements on multifunctional wound dressings. A multifunctional Cur Janus nanofibrous dressing is developed by integrating an electrospun poly(ε-caprolactone)/gelatin hydrophilic layer with a curcumin (Cur)-loaded PCL hydrophobic layer. Janus structure with asymmetric wettability, which exhibited unidirectional liquid transport properties both in vitro and in vivo. Its unique structure also makes it possible to carry both hydrophilic and hydrophobic drugs at the same time. The incorporation of curcumin endows the dressing with antibacterial and antioxidant functionalities, offering the potential to modulate the inflammatory microenvironment of diabetic chronic wounds. Furthermore, the wound healing ability and anti-inflammatory effects of Cur Janus nanofibers were evaluated in a diabetic mouse model. The results showed that Cur Janus nanofibers significantly reduced wound area, increased the proportion of pro-healing M2 macrophages, shortened the inflammatory phase, and ultimately accelerated diabetic wound healing. This work provides a multifunctional and scalable platform for advanced wound dressing design. Its excellent antibacterial, antioxidant (ROS scavenging) and anti-inflammatory (macrophage phenotype M1 to M2) properties, combined with the unidirectional fluid transport and dual-release potential of hydrophilic and hydrophobic drugs, demonstrate broad prospects in the management of diabetic wounds. Full article

Background: Patient-reported outcome comparisons require measurement equivalence, which is seldom tested in low- and middle-income country (LMIC) diabetes research. We examined equivalence of the Diabetes Self-Management Instrument-35 (DSMI-35), Diabetes Distress Scale-17 (DDS-17), and Asian Diabetes Quality of Life (AsianDQOL) scale across sex, fasting-glucose stratum, and educational attainment in Vietnamese adults with type 2 diabetes. Methods: We conducted a secondary analysis of 374 adults (female 152, male 222; lower-FBG < 154 mg/dL, n = 212; higher-FBG n = 162; secondary-or-lower n = 202; tertiary-or-higher n = 172). Multi-group CFA (lavaan) tested configural, metric, and scalar equivalence of a parcel-level three-factor model (parcel-level equivalence does not imply item-level equivalence). Path equality was evaluated with scaled Satorra–Bentler likelihood-ratio tests; indirect effects were bootstrapped (n = 5000). Results: Scalar-equivalence change-index criteria (ΔCFI ≤ 0.010; ΔRMSEA ≤ 0.015) were met for all groupings; however, for fasting glucose the configural baseline fit was weak (RMSEA 0.117–0.119), so fasting-glucose equivalence is reported only as provisional and is not interpreted at the level of the sex and education findings. McDonald’s ω was ≥ 0.959 in every subgroup. Structural paths did not differ by sex (Δχ²(3) = 1.18, p = 0.758; not powered for equivalence) but differed by education (Δχ²(3) = 71.16, p < 0.001), with the cross-sectional association structure differing by education (distress-channelled in tertiary-or-higher and partly direct in secondary-or-lower participants); because the data are cross-sectional, these are differences in association structure, not established mediation. The fasting-glucose structural comparison was not interpretable because the lower-FBG subgroup (FBG < 154 mg/dL, n = 212) had a non-positive-definite latent covariance matrix. Conclusions: Scalar equivalence criteria were met for sex and education and only preliminarily supported for fasting-glucose stratum, where elevated configural RMSEA (0.119) cautions against firm interpretation. The self-management → distress → quality-of-life pathway showed no detected sex difference but differed by educational attainment. Measurement equivalence testing, including configural-fit assessment, should be routine in LMIC patient-reported outcome validation. Full article

Patients with diabetes and/or peripheral artery disease (PAD) are at risk for lower limb amputation and a subsequently higher mortality risk. Peer support interventions have been shown to increase diabetes self-management and glycemic control. This scoping review aims to synthesize the current literature on peer support interventions in reducing lower limb amputations. A PubMed search was conducted in June of 2023, excluding publications prior to 2000, focusing on two themes: (1) peer support and (2) the patient population of interest (i.e., individuals with diabetic foot disease and/or PAD). Studies were included if they addressed the population of interest, involved a peer support intervention to improve lower extremity health, and had outcomes pertaining to the health of the lower extremities or programmatic metrics such as participant satisfaction or program adherence. Out of 1730 publications initially identified, six met the inclusion criteria. These six studies were categorized as group foot care education studies (n = 4) or group cognitive behavioral studies (n = 2). The group foot care education studies showed mixed results, which varied from no effect to significant improvements in foot care, self-management, and complications. There was a trend of improvement in self-management behaviors and physical activity in cognitive behavioral interventions. Despite showing promise in other settings, there have been limited investigations of peer support interventions to improve lower extremity outcomes and avert amputations in persons with diabetes and/or PAD. Further studies are required to conclusively determine the efficacy of peer support interventions to reduce lower extremity amputation rates. Full article

Diabetic wounds are characterized by persistent hyperglycemia, excessive ROS accumulation, sustained inflammation, and impaired angiogenesis, yet current treatments remain suboptimal. To address these challenges, we developed a mild heat stimulating and microenvironment reprogramming hydrogel (termed C-4-N) via a green synthetic strategy. L-Arginine (L-Arg) triggered the spontaneous self-polymerization of protocatechuic aldehyde (PA) into poly (protocatechuic aldehyde) (PPA) nanoparticles, onto which ginsenoside Compound K (CK) was subsequently loaded, yielding CK/L-Arg/PPA nanoparticles. These nanoparticles were then uniformly embedded into a dynamic disulfide network composed of α-lipoic acid (LA)-modified chitosan (CS-LA) and 4-arm-PEG-SH under UV irradiation without toxic photo-initiators, forming the C-4-N hydrogel. The C-4-N hydrogel reprogrammed the diabetic wound microenvironment through three synergistic mechanisms, lowering blood glucose and scavenging ROS via the coordinated actions of LA, CK and PPA, promoting M1-to-M2 macrophage polarization via downregulation of pro-inflammatory cytokines (TNF-α, IL-6) and upregulation of anti-inflammatory cytokines (IL-10, TGF-β1), further amplified by mild photothermal stimulation of 40–43 °C. In a diabetic rat model, the C-4-N hydrogel achieved a near-complete wound closure rate of 99.49 ± 0.10% on day 13 upon mild photothermal stimulation, accompanied by enhanced re-epithelialization, organized collagen deposition, vascular maturation, and systemic glucose regulation. In summary, this green synthesized, mild heat-stimulating hydrogel establishes a synergistic microenvironment reprogramming paradigm for chronic diabetic wound managements. Full article

Background: Exercise plays a crucial role in the prevention and management of type 2 diabetes. During self-motion, optic flow provides visual information about heading direction and influences postural control. This study investigated postural responses and muscle activation in individuals with type 2 diabetes exposed to optic flow stimuli simulating self-motion, and examined whether these responses varied according to habitual physical activity over 12 months. Methods: Surface electromyographic (EMG) and stabilometric data were collected from 23 individuals during quiet standing under different visual motion conditions. Participants were classified as physically active or inactive based on standardized criteria. EMG activity was recorded bilaterally from the tibialis anterior and soleus muscles at baseline, 6, and 12 months. Center of pressure (COP) displacement was measured using two force platforms. Results: Stabilometric analysis revealed a significant effect of visual stimulus on COP displacement in both antero-posterior and medio-lateral directions, as well as on COP speed, indicating that optic flow modulates postural control. COP speed changes over time differed by sex, while medio-lateral sway showed time-dependent variations across sides and physical activity groups. EMG analysis showed a significant effect of visual stimulus on soleus activation, with no consistent effects for tibialis anterior. Conclusions: Optic flow significantly modulated postural control and lower-limb muscle activation in individuals with type 2 diabetes. Preliminary differences in response profiles associated with habitual physical activity level were observed, though these should be interpreted cautiously given the exploratory nature of the study. Larger, adequately powered studies are warranted to further investigate these associations. Full article

Background/Objectives: Uncontrolled diabetes and associated comorbidities disproportionately affect African American (AA) adults. Medication adherence is key to diabetes control yet is often suboptimal, particularly among AA adults. This study examined associations between patient characteristics and adherence among AA adults with uncontrolled diabetes and compared two medication adherence instruments for predicting diabetes control. Methods: This cross-sectional analysis used baseline data from the Management of Diabetes in Everyday Life (MODEL) study, a clinical trial to improve diabetes self-care among AA adults with uncontrolled diabetes. Internal consistency of the 12-item Adherence to Medication Refills and Medications Scale for diabetes medications (ARMS-D) was evaluated by comparing its Cronbach α to the standardized Cronbach α calculated from MODEL data. Associations with variables were examined using correlations, t-tests, or ANOVA, as appropriate. Stepwise multiple regression identified predictors of diabetes control assessed by hemoglobin A1c (HbA1c). Results: Among 665 participants (mean age = 54 years, HbA1c = 10.24%; 67% female; 73% high health literacy), 75% reported perfect adherence on the Summary of Diabetes Self-Care Activities Medications Subscale (SDSCA-MS) versus 7.3% on ARMS-D. ARMS-D showed strong internal consistency (α = 0.81). Lower adherence by ARMS-D was associated with younger age, higher social complexity, and depression (all p ≤ 0.001). ARMS-D score, age, depression, and insulin, dipeptidyl peptidase 4 inhibitor, and sodium-glucose co-transporter 2 inhibitor use predicted baseline HbA1c. Conclusions: This study demonstrates that younger age, depression, and high social complexity are associated with lower medication adherence measured using the ARMS-D. Adherence gaps identified by ARMS-D may validly predict diabetes control and help guide interventions to improve diabetes care in AA adults with uncontrolled diabetes. Full article

Cardiovascular disease (CVD) remains the leading global cause of death, with approximately 17.9 million mortalities annually. Studies have shown that adopting healthy behaviors, i.e., a balanced diet, regular physical activity, and weight management, can reduce CVD risk. However, evaluating their long-term impact requires extensive data collection and analysis, which are both time-consuming and challenging. This study developed a novel mathematical framework integrating an agent-based model (ABM) to simulate CVD risk progression and established clinical guidelines into synthetic training data for machine learning (ML) classification. The ML model was trained entirely on synthetic data generated from World Health Organization/International Society of Hypertension cardiac risk indications, and validated using outcomes from a NetLogo simulation. The workflow does not use real patient data; instead, the expected simulation results serve as a reference to assess the ML model and synthetic data. The ABM, designed in NetLogo, exchanges agent characteristics with a trained ML model to classify individuals into appropriate CVD risk levels based on lifestyle and clinical parameters. The simulation indicated measurable risk progression (5–12%) by year 20 in individuals with both smoking and diabetes. A combined effect of high dietary intake and low physical activity showed over 20% risk increase, demonstrating the model’s capacity to capture dynamic risk interactions. The relationship between CVD risk and systolic blood pressure was also effectively reproduced. Additional scenarios confirmed the alignment of model outcomes with real-world trends, showing model self-consistency, identifying critical thresholds and population-level risk shifts through detailed tabular analysis. Beyond confirming known associations, the findings support the internal consistency of the model, highlighting its potential as a simulation based tool for studying cardiovascular risk patterns and supporting risk monitoring within controlled settings. Full article

Parents of children and adolescents with type 1 diabetes (T1D) are responsible for intensive daily disease management and often experience high levels of emotional distress. This study examined whether fear of hypoglycemia mediates the association between parents’ emotion regulation strategies and diabetes-related distress. Participants were recruited through Facebook and WhatsApp groups for parents of children and adolescents with T1D, and data was collected via self-report online questionnaires. A total of 102 parents, 92.2% mothers (aged 32–58 years) of children with T1D aged 8–17 years, completed measures of fear of hypoglycemia (Hypoglycemia Fear Survey—Parent Version), diabetes distress (Problem Areas in Diabetes-Parent Revised) and emotion regulation strategies (Emotion Regulation Questionnaire), along with a sociodemographic questionnaire. Four mediation models were tested using PROCESS, including cognitive reappraisal and expressive suppression as predictors and the worry and behavior subscales of fear of hypoglycemia as mediators. Results revealed a significant indirect effect of worry on the relationship between cognitive reappraisal and diabetes distress (indirect effect = −0.15, 95% CI [−0.35, −0.02]), highlighting worry as a potential mediator between these variables, while the direct effect was negative but non-significant. No significant indirect effects were found for expressive suppression on the behavior subscale (indirect effect = 0.12; 95% IC [−0.07; 0.36]) or on the worry subscale (indirect effect = 0.07; 95% IC [−0.08; 0.24]). These findings suggest that cognitive reappraisal may be associated with lower diabetes-related distress through lower levels of excessive worry about hypoglycemia. Clinically, the results highlight fear-related cognition can be a relevant intervention target, alongside emotion regulation skills, in psychosocial support programs for parents of youth with T1D. Full article

Background/Objectives: Family dyad-focused support plays an important role in health outcomes and has been incorporated in diabetes interventions to enhance diabetes self-management. The purpose of this meta-analysis was to examine the pooled efficacy of dyad-focused diabetes interventions on glycemic control for people with Type 2 diabetes (T2D). Methods: The PRISMA was used to guide the study. Four databases (PubMed, Embase, CINAHL, and Scopus) were searched from inception through 18 December 2025 to identify randomized controlled trials (RCTs) that tested glycemic control (A1C) of family-based diabetes interventions for people with T2D. Controlled vocabulary and key terms included “Diabetes, Mellitus, Type 2,” “type 2 diabetes,” “self-management,” “self-care,” “spouses,” “dyad,” “caregiver,” and “partner support”. Studies were excluded if they were not RCTs, contained peer-support dyads, lacked family/friend dyads, or did not measure glycemic control. Results: Nineteen eligible RCTs were included in this meta-analysis. Short-term efficacy (3–6 months) was reported in 17 studies with a total of 863 dyads; long-term efficacy (9–12+ months) was reported in 9 studies with a total of 707 dyads. Compared to the control groups, dyad-focused interventions showed a statistically significant reduction in A1C in both short-term (−0.50; 95% CI −0.72, −0.28) and long-term (−0.52; 95% CI −0.77, −0.27) measurement points (p < 0.001). The meta-analyses showed low or moderate detectable heterogeneity (I² = 38%, 45%). The funnel plot suggested no obvious evidence of publication bias. Conclusions: Meta-analysis provided evidence on the efficacy of family dyad-focused diabetes intervention on improving glycemic control. Future large RCTs are warranted to explore innovative strategies to better incorporate family/friend dyad support in diabetes self-management. Full article

Background: Adults with type 2 diabetes increasingly use patient portals, telemonitoring systems, mobile applications, text messaging programs, and other digital services to support self-management. In practice, however, these approaches often still depend on nursing support to help patients understand, use, and sustain digital care in everyday settings. This scoping review mapped how nurses are involved in supporting adults with type 2 diabetes to use digital tools, information, and services for self-management across care settings. Methods: This scoping review followed Joanna Briggs Institute methodology and was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The review question was guided by the Population, Concept, and Context framework. A literature search was conducted in January 2026 in PubMed, Scopus, Embase, and EBSCO/CINAHL. A total of 230 records were identified, 71 duplicates were removed, and 159 records underwent title and abstract screening. Fifty-three full-text articles were assessed for eligibility, and 15 studies met the inclusion criteria. Data were extracted using a structured charting table and synthesized descriptively and thematically. Results: The 15 included studies were published between 2021 and 2026 and represented evidence from 10 countries across primary care, community health centers, telehealth programs, and hospital-linked services. Five interrelated themes were identified: nurses as digital self-management educators; nurses as remote monitors and care coordinators; nurses as facilitators of digital engagement, confidence, and supported use; nurses as implementation partners in digital diabetes care; and equity, access, and context as shaping conditions of digital diabetes support. Only one study directly measured digital health literacy, whereas the remaining studies addressed digital engagement more indirectly through onboarding, portal communication, telemonitoring, reminders, tailored feedback, and implementation work. Common barriers included workload, unclear responsibilities, technical difficulties, age- or literacy-related access challenges, language needs, and uneven infrastructure. Conclusions: The included studies suggest that nurses commonly contributed to making digital diabetes care more understandable, usable, and actionable for adults with type 2 diabetes. Their roles were described across education, monitoring, coordination, implementation, and support for digital engagement. Future studies could measure digital health literacy more explicitly, describe nursing tasks in greater detail, and examine how equity-related factors shape digital diabetes care. Full article

Background/Objectives: Diabetes mellitus is a major global health burden, and inadequate glycemic control increases the risk of microvascular and macrovascular complications. Self-monitoring of blood glucose (SMBG) is essential for diabetes management, but conventional finger-prick sampling may reduce adherence due to pain and repeated skin injury. This study evaluated the analytical performance, clinical accuracy, and usability of a novel laser-assisted blood glucose monitoring system, HandyRay-Glu. Methods: A prospective clinical evaluation study was conducted in accordance with ISO 15197:2013. Capillary blood glucose values obtained using the HandyRay-Glu system were compared with reference measurements generated by the cobas c111 analyzer. Analytical performance was assessed by evaluating repeatability, linearity, hematocrit effect, and interference. Clinical performance was assessed according to ISO 15197:2013 system accuracy criteria, and method comparison was performed using Passing–Bablok regression and Bland–Altman analyses. Usability was evaluated using a structured participant questionnaire. Results: A total of 100 adult participants with diabetes mellitus were included. Overall, 97.8% of results met the ISO 15197:2013 accuracy criteria. Passing–Bablok regression showed strong agreement between HandyRay-Glu and the reference method (y = 1.694 + 0.9859x, r = 0.992). Bland–Altman analysis demonstrated a mean bias of −1.763 mg/dL, with 95% limits of agreement ranging from −29.333 to 25.808 mg/dL. Analytical evaluations showed acceptable repeatability, linearity across the tested measurement range, and no clinically significant interference. More than 97% of participants reported satisfaction with device usability. Conclusions: The HandyRay-Glu system met the performance requirements of ISO 15197:2013 and demonstrated high analytical accuracy, acceptable agreement with the reference method, and favorable usability. Laser-assisted blood sampling combined with electrochemical glucose measurement may offer a potential alternative to conventional SMBG systems, and its possible role in improving patient acceptance of regular monitoring warrants further investigation. Full article

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide and are traditionally considered acute and self-limited conditions. However, growing evidence suggests that recurrent or persistent UTIs may contribute to chronic kidney disease (CKD) progression through complex interactions between uropathogens and host responses. This review examines the pathophysiological links of UTIs caused by uropathogenic Escherichia coli, Klebsiella spp., and Enterococcus spp. and the development of chronic renal injury. Pathogen-specific persistence mechanisms, including intracellular survival, biofilm formation, and chronic colonization, may promote sustained inflammation, oxidative stress, and maladaptive repair responses. These processes are associated with tubular injury and progressive fibrotic remodeling. In addition, host-related factors such as diabetes, immune dysfunction, and antimicrobial resistance may further influence disease progression. Emerging biomarkers of inflammation, tubular injury, and fibrosis may improve early detection and risk stratification in patients with recurrent or complicated UTIs. Collectively, these findings support the concept that recurrent UTIs may represent potential contributors to CKD progression in susceptible individuals and highlight the importance of early recognition, pathogen-oriented management, and improved diagnostic strategies. Full article

Diabetes disproportionately affects rural populations in the United States where prevalence and associated complications remain among the highest in the nation. Access to diabetes education and support services is often limited by geography, socioeconomic barriers, and workforce shortages. This study qualitatively explored participant experiences in a telehealth-based Diabetes Self-Management Education and Support (DSMES) program. This study uses interview techniques and takes a phenomenological approach to exploring the lived experiences of 27 program participants. Transcripts were analyzed through three cycles of coding to identify shared themes. Four themes emerged: (1) structural benefits of the program, (2) knowledge gained, (3) lifestyle changes implemented, and (4) improved quality of life. Participants consistently emphasized the value of personalized coaching, emotional encouragement, and practical nutrition education. Findings suggest that individualized telehealth coaching plays an important role in diabetes self-management, particularly in rural and underserved populations. By combining personalization with education and encouragement, programs can improve patient engagement, enhance self-efficacy, and support meaningful behavior change. Full article

Background: A bidirectional association between diabetes and oral health is well established, yet oral self-care is overlooked in diabetes management. Health Belief Model (HBM)-guided oral care interventions have exhibited promising outcomes in the literature but have not been used to guide oral self-care interventions designed for people with diabetes (PWD). Positioned at the early conceptualization and design stage of such a program, this developmental study was to identify self-perceived needs in oral self-care practices and to obtain preliminary feedback among PWD about the blueprint of a new program—DiaOral^©. Methods: We conducted semi-structured interviews with 15 PWD recruited from a large healthcare system, with a goal to recruit patients from racially/ethnically diverse urban/suburban zip codes. Interviews explored participants’ oral self-care practices in relation to diabetes. Sample DiaOral^© content and images on a blueprint were presented and feedback was solicited. Braun and Clarke’s reflexive thematic analysis was used to code and interpret transcripts, aligning emerging themes with HBM constructs through team-based consensus. Results: Three major themes and 27 sub-themes emerged: (1) lack of knowledge on optimal oral care, (2) low perceived importance of preventive care and oral health in diabetes, and (3) low self-efficacy for performing effective oral self-care. Participants expressed satisfaction with the content and their perceived confidence and interest potentially in using the DiaOral^© program based on their preliminary review of the blueprint. Conclusions: Findings support the relevance of HBM constructs in shaping oral self-care among PWD. This developmental study suggests that the DiaOral^© blueprint is ready to move forward to website prototype development. Future work will finalize the program and evaluate its efficacy among PWD. Full article