Search Results (121)

Aims: The purpose of this quality improvement (QI) initiative at a pediatric diabetes center was to integrate physical activity (PA) assessment into routine clinical care. This project had two aims: (1) to collect self-reported PA in youth and young adults with type 1 diabetes (T1D) and (2) to analyze levels of PA (none, some PA, at-goal PA, and at-goal vs. not-at-goal PA) and their relationship with demographics and clinical outcomes. PA goals were 60 min/day for youth and 150 min/week of moderate-to-vigorous aerobic PA for young adults. Methods: During clinical visits, a pediatric diabetes center used a three-question Physical Activity Vital Sign (PAVS) to assess and document PA, which was recorded as total minutes per week with intensity (light, moderate, and vigorous). We analyzed PAVS data from January 2020 to July 2022. Clinical variables were compared across the levels of PA. Results: This was a sample of 304 youth and young adults living with T1D: 87 young adults (29%) and 217 youth (71%), with a mean age of 14.2 (4.8) years. Half had an HbA1c between 7% (53.01 mmol/mol) and 9% (74.87 mmol/mol), and 56% used both continuous glucose monitoring and an insulin pump. Overall, 78% of the sample did not meet PA goals. LDL and blood pressure were significantly different across the two groups of PA achievement (not at goal vs. at goal). Only LDL levels remained significantly different across the three groups (none, some PA, and at-goal PA). Conclusions: Implementing PA assessment is feasible in a pediatric diabetes center. Next steps may include incorporating exercise prescriptions as part of routine clinical care. Full article

Type 2 diabetes (T2D) presents growing public health challenges due to its strong links to modifiable behaviors. This systematic review examined how researchers have studied behavioral domains such as diet, physical activity, medication adherence, and blood glucose monitoring in adults with T2D. A structured search of PubMed, Scopus, and Web of Science identified peer-reviewed studies published between 2003 and 2025, with studies from 2014 onward prioritized to reflect the rise in mobile health technologies. 30 core studies were systematically reviewed, with 10 additional comparative studies included for supplementary methodological insights. Quantitative approaches were most common, offering measurable outcomes but often relying on self-report. Qualitative studies provided valuable cultural and psychosocial context yet lacked generalizability. Mixed-methods designs integrated statistical and narrative insights but posed practical challenges in execution. Technology-assisted methods, such as mobile applications and wearable devices, supported real-time monitoring and improved accuracy but raised concerns regarding privacy and equitable access. Physical activity and dietary behaviors were most frequently studied, while medication adherence and glucose monitoring received less consistent attention. Despite methodological diversity, most studies relied on cross-sectional designs and underutilized culturally tailored frameworks. This review emphasizes the need for longitudinal, equity-focused research methodologies to improve diabetes prevention and management strategies. Full article

Background and Objectives: Type 2 diabetes mellitus (T2DM) remains a significant public health problem across Gulf Cooperation Council (GCC) nations because of advancements in urbanization alongside behavioural lifestyle changes and genetic predispositions. Specific self-management methods are fundamental in T2DM management because they provide better glycaemic control and decrease complications. Achieving a synthesis of updated evidence about self-management strategies and patient perception within GCC nations represents the primary objective of this narrative review. Materials and Methods: The studies included in the present review were retrieved from the Web of Science, Scopus, Medline, Saudi Digital Library, and Embase. We included peer-reviewed studies that were published from January 2020 to March 2025. The selected studies measured the self-management practices of adult T2DM patients by examining medication adherence, dietary patterns, blood glucose monitoring, and treatment barriers. Results: Research data indicate that patients demonstrate different levels of self-care management behaviours, where medication compliance is fair, but dietary patterns and physical activities remain areas of concern. High levels of knowledge deficits, cultural elements, and economic background substantially impact patients’ self-management practices. Patients indicate their need for enhanced and personalized care, better connections with healthcare providers, and interventions that consider their cultural backgrounds. Conclusions: Patients throughout the GCC region encounter ongoing difficulties that prevent them from performing their best at self-management, even though advanced healthcare facilities exist in this region. Therefore, it is critical to develop culturally sensitive patient-centered care, individualized educational programs, and adopt supportive digital solutions to enhance diabetes-related self-care management. Full article

Background: Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality, particularly in socioeconomically disadvantaged populations. Telemedicine offers a potential strategy to support risk factor management in such groups with limited access to care. Our aim was to assess the effectiveness of a telemedicine-supported intervention compared to usual care in improving cardiovascular risk parameters among adults from a socially deprived urban population. Materials and Methods: In this controlled intervention study, adult patients with one or more cardiovascular risk factors were recruited from a primary care center in a low-income urban neighborhood in Timişoara, Romania. Participants were allocated to either usual care or a six-month telemedicine-supported intervention group. The intervention consisted of regular phone calls by trained staff focusing on medication adherence, self-monitoring of blood pressure and glucose, smoking cessation, and lifestyle advice. No physical visits were delivered. Primary outcomes included changes in systolic and diastolic blood pressure, fasting glucose, and lipid profile. Data were collected at baseline and at six months. Results: A total of 144 patients were allocated to the telemedicine group and 142 to the usual care group. After 6 months, diastolic blood pressure decreased by 3.9 mmHg in the telemedicine group compared to 0.3 mmHg in the standard care group (p < 0.001). LDL-cholesterol was reduced by 18.0 mg/dL with telemedicine versus 5.7 mg/dL with usual care (p < 0.001). In contrast, fasting glucose improved more in the standard care group (–10.9 mg/dL vs. –2.0 mg/dL, p < 0.001). Patient satisfaction in the telemedicine group was high, with 84% rating the program as very useful. Conclusions: Basic telemedicine-supported interventions may represent a feasible and effective strategy for improving cardiovascular risk factors such as diastolic blood pressure and LDL-cholesterol in socially deprived populations. High satisfaction suggests strong acceptability; however, given the small sample size, short follow-up, and single-center design, these findings should be interpreted cautiously and confirmed in larger studies. Full article

Berberine, a natural isoquinoline alkaloid, has been shown to improve glycemic control, lipid metabolism, and blood pressure regulation. However, its poor bioavailability has limited widespread clinical use. ToBeRock^® is a self-emulsifying formulation designed to enhance the bioaccessibility of berberine. This retrospective, real-world pilot study conducted through community pharmacies with pharmaceutical care services aimed to evaluate the metabolic and hemodynamic effects of ToBeRock^® in adults with impaired fasting glucose (IFG). Sixty adults with IFG (FPG 100–125 mg/dL) were enrolled through territorial pharmacies offering pharmaceutical services. Patients were retrospectively grouped into two cohorts: a Low-Dose Group (ToBeRock^® 1 capsule/day) and a High-Dose Group (ToBeRock^® 2 capsules/day). Capillary blood sampling and in-pharmacy blood pressure measurements were recorded at baseline (T0), 4 weeks (T1), and 8 weeks (T2). Evaluated parameters included fasting glucose, HbA1c, lipid profile (total cholesterol, LDL, HDL, triglycerides), systolic and diastolic blood pressure (SBP/DBP), and oxidative stress markers (FORT, FORD). Both cohorts showed statistically significant reductions in fasting glucose (p < 0.001), LDL (p = 0.036 Low-Dose/p = 0.039 High-Dose), and triglycerides (p = 0.012/0.009) after 8 weeks of treatment. The High-Dose Group experienced a greater improvement in HbA1c (−0.26%, p = 0.041) and a mild but statistically significant increase in HDL (p = 0.049). Improvements in oxidative balance were observed with significant reductions in FORT (p = 0.019/0.011), increases in FORD (p = 0.033/0.008), and a favorable shift in the REDOX index (p = 0.012/0.006). Systolic blood pressure decreased by −6.3 mmHg in the Low-Dose Group (p = 0.031) and −7.6 mmHg in the High-Dose Group (p = 0.048), while diastolic pressure dropped by −3.9 mmHg (p = 0.044) and −4.2 mmHg (p = 0.051), respectively. This real-world, retrospective analysis highlights the potential clinical benefit of ToBeRock^® in improving glycemic, lipid, oxidative, and hemodynamic profiles. The High-Dose Group demonstrated more consistent and significant results, supporting the dose-responsive efficacy of the bioavailable formulation and the value of pharmacy-based monitoring of nutraceutical interventions. Full article

Objectives: Type1 diabetes (T1D) is one of the most common chronic diseases in pediatric age. Continuous glucose monitoring (CGM) has been shown to improve glycaemic control in adults compared to self-monitoring of blood glucose (SMBG); however, evidence about its use in the pediatric field is limited and fragmented and needs to be improved. This paper aims to address all the critical aspects linked to the use of CGM in a pediatric population while also describing a methodology for conducting health technology assessment (HTA) to support the decision-making process. Methods: The use of CGM and SMBG in a pediatric population was compared by using a decision-making support tool (DoHTA method). Twenty-seven Key Performance Indicators (KPIs) were identified, defining safety, clinical effectiveness, organizational, patient perspective, and economic aspects. Performance scores for both monitoring systems were assessed based on these KPIs, leading to a final comparative ranking. Results: CGM demonstrated a 29.3% performance advantage over SMBG, highlighting its benefits in terms of clinical effectiveness, patient perspectives, safety, and economic evaluation. No substantial differences were identified in terms of organizational aspects. Conclusions: This study critically evaluates the benefits and drawbacks of the use of CGM in a pediatric population. It integrates the assessment of the clinical effectiveness with the organizational aspects, the cost, the patient perspective, and the safety, providing a valuable proof of evidence as well as a reliable and transferable method for conducting decision-making processes in a hospital setting. Full article

Aim: The purpose of this study was to explore the broad experience of continuous glucose monitoring from the perspective of patients diagnosed with type 1 diabetes mellitus, including not only their emotions and feelings but also the lifestyle changes, perceptions, and social aspects associated with its use. Design: This is a phenomenological qualitative study. Patient or Public Contribution: The sample consisted of 10 adult patients diagnosed with type 1 diabetes who had been using the continuous glucose monitoring system for at least 6 months and were patients of the Endocrinology and Nutrition Service of the University Hospital Complex of Ourense. Methods: The recorded interviews were conducted in November 2024. The conversations were audio-recorded with the participants’ consent, and then transcribed for thematic analysis. Results: Three main categories were identified: “experience prior to continuous glucose monitoring” (accessibility, prior knowledge, and expectations), “experience with the use of continuous glucose monitoring” (perception of healthcare support, concerns, strengths, and alarm management), and “experience regarding the disease” (self-management of the disease and safety). Despite the fact that diabetes mellitus is a complex chronic disease, all participants provided a positive assessment of their progress and improved control through continuous glucose monitoring. Conclusions: All participants felt more secure and protected with continuous glucose monitoring, improving their quality of life. The main concern among the subjects was the possibility of the sensor failing. They positively valued the alarm system in case of hypoglycemia. The CGM is a highly effective tool for the management and self-control of diabetes and promotes the relationship between patients and professional health. Impact: The findings of this study have important implications for clinical care, highlighting the need for more training and more health education at the first level of health care, such as health centers. Full article

Background: Refractory epilepsy refers to a type of epilepsy in which anti-epileptic medications do not yield results, necessitating alternative medical interventions. The ketogenic diet (KD) is utilized as a non-pharmacologic treatment for refractory epilepsy. This study aims to assess details regarding caregivers’ awareness and practices, challenges faced, and other details regarding the KD as a treatment option for children with refractory epilepsy. Methods: A cross-sectional study included 15 caregivers of children with refractory epilepsy who adhere to the KD. Data were collected using an online, self-administered questionnaire including socio-demographic characteristics and descriptive aspects of KD on 15 caregivers. Results: Caregivers’ awareness scores varied, over half of the caregivers (53.3%) demonstrated low awareness levels, scoring below the midpoint on the awareness scale, while both caregivers’ adherence (t value = 31.5; p < 0.001) and patients’ adherence levels (t value = 26.1; p < 0.001) significantly exceeded the minimum expected thresholds, indicating effective implementation of the diet protocols. Challenges faced by caregivers were categorized as follow: logistical challenges (e.g., issues related to KD availability, cost, and weighing (15.6%)), behavioral challenges (e.g., avoiding prohibited foods (18.8%), feelings of hunger, the social environment, and never eating without caregivers), and medical challenges (e.g., frequent blood glucose monitoring (25%)). The most common side effects of the KD were gastrointestinal symptoms, including constipation (33.3%) and gastroesophageal reflux disease (GERD). Physical symptoms such as dyslipidemia were also reported by 13.3% of participants. In terms of neurological and behavioral improvements, the three most reduced symptoms following KD adoption were hyperactive attention deficit (25%), tremors (20%), and insomnia (20%). Conclusions: This study reveals a significant gap between high adherence and low awareness of the KD among caregivers of children with refractory epilepsy. While adherence is crucial for the success of KD, this discrepancy highlights the need for comprehensive caregiver education that not only focuses on practical implementation but also on the underlying rationale of the diet. This study underscores the importance of multidisciplinary support, by including dietitians, to bridge the knowledge gap. These findings suggest that dietary education programs should aim to improve caregivers’ understanding, ultimately enhancing adherence and long-term outcomes. Future research should explore the psychosocial factors influencing adherence and the role of trust in healthcare professionals in shaping caregiver behaviors. The findings also call for further exploration into the impact of caregiver education on child health outcomes in the long term. The varied knowledge among caregivers indicates a need for further educational interventions or increased visits from dietitians. Strategies need to be framed to overcome the challenges faced and improve adherence. Full article

Background/Objectives: Postprandial hyperglycemia is a risk factor for diabetes and cardiovascular diseases, even in healthy individuals. Kanzaki mulberry leaf and water chestnut tea (MW tea), a blend of mulberry (Morus alba) leaves and water chestnut (Trapa japonica) leaves and husks, is rich in polyphenols and 1-deoxynojirimycin (DNJ) and may suppress postprandial glucose spikes, but evidence regarding its short-term daily intake is limited. This study aimed to evaluate the postprandial glycemic response and safety of two-week MW tea consumption using continuous glucose monitoring (CGM). Methods: We conducted a randomized, double-blind, placebo-controlled, two-period crossover trial involving 31 participants. Each intervention period lasted two weeks, separated by a one-week washout. Participants consumed either MW tea or a placebo before meals. Interstitial glucose levels were measured every 15 min using CGM. Postprandial glucose responses were recorded every 15 min for 180 min after a standardized meal on the first day of each period. The primary outcome was the coefficient of variation (CV) in glucose levels, calculated using data from the central 10 days of each intervention period. Safety was assessed using CGM-derived hypoglycemia metrics and blood test results. Results: The CV of glucose levels during the MW tea period was significantly lower than during the placebo period (mean difference: 0.02, p = 0.0006). A significant reduction in 1 h postprandial glucose area under the curve was also observed. No significant differences were found in hypoglycemia occurrence, liver/renal/inflammatory markers, or self-reported adverse symptoms. Notably, 1,5-anhydroglucitol (1,5-AG) levels significantly increased during MW tea intake, suggesting improved glycemic control. Conclusions: Short-term consumption of Kanzaki MW tea effectively suppressed postprandial glucose variability without safety concerns. These findings support MW tea as a promising natural supplement for glycemic management and the prevention of diabetes. Full article

Background/Objectives: Previous studies have shown that unformulated extracts of Passiflora ligularis leaves exhibit promising antidiabetic activity. This research aimed to demonstrate that formulating the extract into a self-emulsifying drug delivery system (PLE-SEDDS) enhanced its antidiabetic activity in a high-fat-diet/streptozotocin-induced diabetic mouse model. Methods: Blood glucose levels (BGLs) of diabetic mice were monitored during 21 days of oral administration of P. ligularis extract (PLE) and PLE-SEDDS. Control groups included metformin (positive control), vehicle, and SEDDS vehicle (negative controls). The animals underwent an oral glucose tolerance test (OGTT). The oxidative stress markers superoxide dismutase (SOD), catalase (CAT), and lipid peroxidation quantified by malondialdehyde (MDA) levels were measured in the kidney, liver, and pancreas, complemented with histopathological analysis. Additionally, plasma lipid profile parameters were evaluated. Results: The PLE-SEDDS formulation demonstrated superior efficacy compared to the PLE extract in improving antidiabetic outcomes. Animals treated with PLE-SEDDS exhibited a minimal increase in blood glucose levels (11.5%) during the OGTT, compared to 27.4% with PLE and over 77% in the vehicle groups. PLE-SEDDS also showed greater enhancement of SOD and CAT activity, along with a more pronounced reduction in MDA levels, indicating stronger protection against oxidative stress. Histological analysis revealed significant preservation of pancreatic islets, and lipid profile analysis showed greater reductions in triglycerides, cholesterol, and LDL-C, alongside increased HDL-C levels. Conclusions: Altogether, these findings suggest that PLE-SEDDS exhibits superior antihyperglycemic, hypolipidemic, and antioxidant effects compared to the unformulated extract, making this novel formulation a promising option for treating type 2 diabetes mellitus. Full article

Objectives: Type 1 diabetes is characterized by hyperglycemic episodes influenced by diet, sleep quality, chronotype, and physical activity, among others. While aerobic exercise is known to improve glycemic control, its effect on blood glucose regulation remains underexplored. Thus, this case study aimed to evaluate the effects of a prolonged and differentiated indoor and outdoor exercise intervention on glycemic control in an individual with type 1 diabetes. Methods: The participant (age: 23 years; weight: 95 kg; height: 1.90 m; Body Mass Index: 26.3 kg/m²; waist to hip ratio: 0.98; basal metabolic rate: 2015 kcal; Heart Rate Maximum (HRmax): 197 beats·min⁻¹) completed two outdoor (~3800 m) and two indoor sessions with self-selected speed, in the initial 2 min stage, at a 0% grade slope. The grade increased by 2% at each stage during the uphill phase until reaching volitional fatigue, followed by a 2% decrease at each stage during the downhill phase until returning to a 0% grade. Blood pressure was assessed before and after each session. Daily nutrition intake, insulin intake, and blood glucose were continuously monitored. Dietary adherence (PREvención con DIeta MEDiterránea), sleep quality (Pittsburgh Sleep Quality Index), chronotype (Morningness–Eveningness Questionnaire), and physical activity levels (International Physical Activity Questionnaire) were assessed before each session. The Physical Activity Enjoyment Scale was used to measure enjoyment after each session. Results: The sessions were completed in ~44 and ~39 min with the participant achieving 84% (outdoor) and 96% (indoor) of their theoretical HRmax. The intervention resulted in glycemic improvements, with time spent in hyperglycemia (>250 mg/dL) decreasing from 56.46% to 0%, while time in the normal range (70–180 mg/dL) increased to 63.96%. A 47% reduction in insulin units showed that insulin sensitivity also improved. Conclusions: Despite differences in intensity, indoor and outdoor activities yielded comparable benefits, with outdoor activities being perceived as more enjoyable (outdoor: 28.5 ± 0.7; indoor: 24.0 ± 5.6) and positively impacting glycemic control, thus supporting the need for tailored strategies in diabetes management. Full article

Objective: This study intends to evaluate simulated experiences provided to pharmacy students that directly compare the perspective of patients managing chronic disease states through traditional means without compliance aids to those using compliance aids, such as continuous glucose monitors (CGMs) and other devices. Methods: This simulation was conducted with third-year pharmacy students enrolled in the ambulatory care elective course at the University of Florida College of Pharmacy. It was designed to simulate a patient responsible for self-administering an array of medications for multiple chronic diseases that the students are likely to encounter during clinical practice. For the first week, students were tasked with adhering to a complex medication schedule from their associated pill bottles without the use of compliance aids (pill organizers, alarms, etc.) and checking their blood glucose twice daily using a traditional glucometer. In the second week, students continued the role of the patient; however, they were provided with compliance aids and encouraged to set alarms and use CGMs. Using a questionnaire developed based on the traditional Likert scale model, the students were able to quantify their experiences in a way that allowed the investigators to observe any changes. Results: Regarding the overall implications of this experience, most participants (>80%) agreed that this project increased their understanding of the value of compliance aids and devices and encouraged them to not only incorporate them into their future patient care plans but also advocate for accessibility to improve health outcomes. Conclusion: Students who completed this experience reported better adherence to chronic disease state control using compliance aids and, in turn, the applicability of the use of compliance aids in managing those with complex medication regimens. This simulation may encourage future pharmacists to incorporate compliance aids with their patients to improve health outcomes. Full article

Background/Objectives: Chronic somatic diseases are significant risk factors for the development of mental disorders. Type 1 diabetes mellitus (T1D) is the most common chronic endocrine pathology in children. Treatment requires nutrition management, physical activity, lifelong insulin therapy, and proper self-monitoring of blood glucose. It is complicated and therefore may result in a variety of psychosocial problems for children, adolescents, and their families. Considering the rapidly growing incidence of type 1 diabetes in the pediatric population of Latvia, it is important to detect and prevent the risks of anxiety and depression in families with children suffering from type 1 diabetes. Methods: This was a quantitative interdisciplinary cross-sectional study to determine the prevalence of anxiety and depression in adolescents with T1D and their parents. Two tools were used to detect the presence of symptoms of anxiety and depression: the Generalized Anxiety Disorder Scale-7 (GAD-7) and the Patient Health Questionnaire 9 (PHQ-9) scale. Results: A total of 812 respondents were eligible for screening. Anxiety and depression symptoms were seen significantly more frequently in the study group than in the control group. The study found negative effects of anxiety and depression on the compensation of diabetes. Conclusions: Adolescents with type 1 diabetes and their parents are more predisposed to anxiety and depression symptoms than somatic healthy children and their parents, thus worsening disease control and prognosis. Full article

Background: Limited data exist on managing type 1 diabetes mellitus (T1DM) during long-distance endurance events such as marathons. This study aimed to assess glycemic control and participant safety during a marathon. Methods: Five men with T1DM, participating in the 22nd Poznan Marathon, were recruited. They completed health questionnaires and received training on glycemic management. Their physical capacity was assessed (including maximal oxygen uptake on a cycle ergometer). Participants reduced their insulin doses and consumed breakfast 2.5–3 h before the race. During the marathon, self-monitoring blood glucose (SMBG) and ketone levels were measured at five checkpoints (start, 10 km, 19 km, 30 km, and finish). The medical team followed a pre-approved protocol, providing carbohydrate and fluid supplementation as needed. Glycemia was monitored by two continuous glucose monitoring (CGM) systems (FreeStyle Libre 2 and Dexcom G6) and SMBG. Results: The participants’ median age was 44 years (34–48), with a diabetes duration of 10 years (6–14), and a BMI of 22.5 kg/m² (22.0–23.3). All finished the marathon in an average time of 4:02:56 (±00:43:11). Mean SMBG was 125.6 (±43.5) mg/dL, while CGM readings were 149.6 (±17.9) mg/dL (FreeStyle Libre 2) and 155.4 (±12.9) mg/dL (Dexcom G6). One participant experienced prolonged hypoglycemia undetected by CGM, whereas another developed symptomatic hypoglycemia between SMBG measurements. Conclusions: Safe marathon completion in people with T1DM requires individualized insulin dose adjustments, appropriate carbohydrate supplementation, and dedicated medical support at checkpoints. Combining CGM with periodic SMBG measurements further enhances safety and helps to detect potential glycemic excursions. Full article

Diabetes, a chronic medical condition, affects millions of people worldwide and requires consistent monitoring of blood glucose levels (BGLs). Traditional invasive methods for BGL monitoring can be challenging and painful for patients. This study introduces a non-invasive, deep learning (DL)-based approach to estimate BGL using photoplethysmography (PPG) signals. Specifically, a Deep Sparse Capsule Network (DSCNet) model is proposed to provide accurate and robust BGL monitoring. The proposed model’s workflow includes data collection, preprocessing, feature extraction, and predictions. A hardware module was designed using a PPG sensor and Raspberry Pi to collect patient data. In preprocessing, a Savitzky–Golay filter and moving average filter were applied to remove noise and preserve pulse form and high-frequency components. The DSCNet model was then applied to predict the sugar level. Two models were developed for prediction: a baseline model, DSCNet, and an enhanced model, DSCNet with self-attention. DSCNet’s performance was evaluated using Mean Absolute Percentage Error (MAPE), Mean Absolute Error (MAE), Mean Squared Error (MSE), Root Mean Squared Error (RMSE), Mean Absolute Relative Difference (MARD), and coefficient of determination (R²), yielding values of 3.022, 0.05, 0.058, 0.062, 10.81, and 0.98, respectively. Full article