Challenges In Diabetes Care Research Articles

Combined analysis of single-cell sequencing and bulk transcriptome sequencing reveals new mechanisms for non-healing diabetic foot ulcers.

Diabetic foot ulcers (DFUs) pose a significant challenge in diabetes care. Yet, a comprehensive understanding of the underlying biological disparities between healing and non-healing DFUs remains elusive. We conducted bioinformatics analysis of publicly available transcriptome sequencing data in an attempt to elucidate these differences. Our analysis encompassed differential analysis to unveil shifts in cell composition and gene expression profiles between non-healing and healing DFUs. Cell communication alterations were explored employing the Cellchat R package. Pseudotime analysis and cytoTRACE allowed us to dissect the heterogeneity within fibroblast subpopulations. Our findings unveiled disruptions in various cell types, localized low-grade inflammation, compromised systemic antigen processing and presentation, and extensive extracellular matrix signaling disarray in non-healing DFU patients. Some of these anomalies partially reverted in healing DFUs, particularly within the abnormal ECM-receptor signaling pathway. Furthermore, we distinguished distinct fibroblast subpopulations in non-healing and healing DFUs, each with unique biological functions. Healing-associated fibroblasts exhibited heightened extracellular matrix (ECM) remodeling and a robust wound healing response, while non-healing-associated fibroblasts showed signs of cellular senescence and complement activation, among other characteristics. This analysis offers profound insights into the wound healing microenvironment, identifies pivotal cell types for DFU healing promotion, and reveals potential therapeutic targets for DFU management.

Deciphering Diabetic Foot Wounds: A Comprehensive Review on Classification, Multidrug Resistance, Microbial Insights, Management & Treatment Strategies, and Advanced Diagnostic Tools.

Diabetic foot wounds and infections pose a significant and evolving challenge in diabetes care. Diabetic wound healing has become a major global concern for a very long time. Continuous research has been conducted to increase the healing process in diabetic ulcers to the rate of amputation. Wound healing is prolonged in diabetic patients due to various conditions, such as high glucose levels, neuropathy, poor blood circulation, and prolonged inflammation around the limbs, which causes the healing to be delayed compared to normal patients. Understanding the complexity of chronic foot wounds and the management and proper treatment would lead to a decrease in the risk of amputation. The medical team all over the world is constantly researching to lower the risk. This review paper offers a compelling journey through the multifaceted world of diabetic foot wounds and infections. It underscores the urgency of understanding classification, tackling multidrug resistance, and harnessing microbial insights to revolutionize the treatment and management of diabetic foot complications. Furthermore, it unveils state-of-the-art diagnostics, heralding a brighter future in the battle against this debilitating complication of diabetes.

Expert consensus recommendations on the evaluation and management of hypoglycemia in diabetes: DGENius Group Diabetes India

Abstract Background and Aim: Hypoglycemia, marked by low blood glucose levels, presents significant challenges in diabetes care. This review outlines the evidence-based recommendations formulated by the DGENius Experts Consensus Group for managing hypoglycemia in people with diabetes. The goal was to furnish well-defined, evidence-based recommendations for addressing and comprehending hypoglycemia within diverse contexts, encompassing diabetes management, and various medical conditions. Materials and Methods: The consensus statement was crafted through an extensive literature review involving peer-reviewed articles, clinical guidelines, and relevant publications. A diverse panel of experts with broad knowledge and experience convened for structured deliberation, followed by multiple rounds of rigorous review and meetings to reach the final consensus statement. Results: The consensus introduces the importance of effective hypoglycemia in people with diabetes management, addressing both type 1 and type 2 diabetes mellitus separately, with tailored recommendations. It also covers impact of hypoglycemia on cardiovascular health and related recommendations. The document extends its scope to co-existing medical conditions, encompassing chronic renal dysfunction, hepatic and neoplastic disorders; hypoglycemia in specialized circumstances, such as during physical exertion, administration of oral antidiabetic agents, fasting periods, hospital-based care, reduced symptomatic awareness, nocturnal episodes, alcohol intake, pregnancy, and following metabolic surgical interventions; hypoglycemia in the context of nonantidiabetic medications; and hypoglycemia among the elderly. Quality of life and patient awareness are emphasized, and the statement concludes with prevention, treatment, and technology utilization recommendations. Conclusion: This comprehensive consensus statement is designed to guide healthcare professionals in managing hypoglycemia optimally. The goal is to heighten awareness of this critical condition, improve patient outcomes, and enhance their quality of life.

Open source automated insulin delivery systems: benefits, limitations and challenges in diabetes care

Open source closed loop automated insulin delivery (CL-AID) systems are increasingly used in the treatment of diabetes. Assembled on a do-it-yourself (DIY) basis, these systems integrate insulin pumps, continuous glucose monitoring devices, and algorithms that control the rate of insulin delivery based on glucose levels. In this review, we consider the technological features of open source CL-AID systems (OpenAPS, AndroidAPS, Loop, etc.), advantages and barriers to their use in clinical practice. Advantages of open source CL-AID systems over commercially available ones included lower cost, a choice of devices, a wide range of user settings, as well as continuous improvement of algorithms. A growing body of evidence indicates that open source CL-AID systems, such as OpenAPS, AndroidAPS, and Loop, provide an excellent time in range with minimal risk of hypoglycaemia and increase treatment satisfaction in patients with type 1 diabetes. A wide range of settings makes open source systems an effective tool for managing diabetes in situations with rapidly changing insulin requirement. However, some technological, medical, legal and ethical issues associated with the use of non-commercial CL-AID systems still need to be addressed. Assembling the system requires skills in diabetes technology. The issue of cybersecurity is also relevant. Lack of official approvals, low awareness of medical professionals, and reimbursement issues are slowing down the introduction of the technology into clinical practice. The professional medical community at the international and national levels needs to determine its position regarding the use of open source CL-AID systems in the treatment of diabetes.

Challenges of Diabetes Care in Community-based Family Medicine

Challenges of Diabetes Care in Community-based Family Medicine

Challenges of diabetes care in India: Results from a Family Cohort Study.

Diabetes is a significant public health concern in India, with Kerala being labeled as the diabetes capital of the country. The study aims to evaluate the prevalence, treatment, and management of diabetes to examine the unmet need for care to propose cost-effective strategies. A cross-sectional study was conducted on a geographically defined cohort population in Ernakulam. This paper presents diabetes data of adults ≥30 years enrolled from the community cohort. The interviews were conducted with 997 participants at their residence. Random blood glucose was assessed for each participant using a finger prick test. The overall prevalence of diabetes was 30.1%, of which 4.1% of participants had undiagnosed diabetes. Among those with diabetes, 86.3% were aware of their diagnosis; among those aware, 86.5% were on treatment. Among those on treatment for diabetes, 54% achieved controlled blood sugar. The challenge in diabetes management is controlling the blood glucose levels of people who adhere to treatment. Younger employed females from lower-income quartiles have the highest risk. The study also raises questions about quality and strategies for medication compliance. The findings inspire future research on care needs, policies, and program responses to reduce the diabetes disease burden.

Psychometric validation of diabetes distress scale in Bangladeshi population

Diabetes Distress (DD)—an emotional or affective state arise from challenge of living with diabetes and the burden of self-care—negatively impact diabetes management and quality of life of T2DM patients. Early detection and management of DD is key to efficient T2DM management. The study aimed at developing a valid and reliable instrument for Bangladeshi patients as unavailability such a tool posing challenge in diabetes care. Linguistically adapted, widely used, 17-item Diabetes Distress Scale (DDS), developed through forward–backward translation from English to Bengali, was administered on 1184 T2DM patients, from four diabetes hospitals in Bangladesh. Psychometric assessment of the instrument included, construct validity using principal component factor analysis, internal consistency using Cronbach’s α and discriminative validity through independent t-test and test–retest reliability using intraclass-correlation coefficient (ICC) and Kappa statistics. Factor analysis extracted 4 components similar to original DDS domains, confirms the construct validity. The scale demonstrated satisfactory internal consistency (α = 0.838), stability (test–retest ICC = 0.941) and good agreement across repeated measurements (Kappa = 0.584). Discriminative validity revealed that patients with complication (p < 0.001) and those are on insulin (p < 0.001) had significantly higher distress scores in all domains. Bengali version of DDS is a valid and reliable tool for assessing distress among Bangladeshi T2DM patients.

Prevalence of Health-Risk Behaviours Among Indigenous Australians With Diabetes: A Review

Aboriginal and Torres Strait Islander Australians are at high risk of Type 2 diabetes and its complications. Optimal lifestyle choices can improve health outcomes. A thematic review of original research publications related to smoking, nutrition, alcohol intake, physical activity and emotional wellness in Aboriginal and Torres Strait Islander Australians with diabetes was performed. Overall, 7118 English-language publications were identified by search engines (PubMed, CINAHL, Scopus, Medline-Web of Science, and Google Scholar) with search terms Indigenous Australians OR Aboriginal and Torres Strait Islanders AND diabetes AND lifestyle OR smoking OR nutrition OR alcohol OR physical activity OR emotional wellbeing and their common synonyms. After review of abstracts and publication reference lists, 36 articles met inclusion criteria and were reviewed. In general, the self-reported health-related behaviours of Aboriginal and Torres Strait Islander Australian adults with diabetes, which is predominantly Type 2 diabetes, was suboptimal. An important clinical challenge in diabetes care is to sustainably reduce smoking, improve nutrition (including alcohol use), increase physical activity, reduce sedentary time, and improve emotional wellbeing, which should lead to reduced rates of diabetes complications. Regular assessments and multi-stakeholder input, including individuals, communities, clinical, health policy, societal and government inputs and partnerships, are desirable to facilitate closing the gap in health between Aboriginal and Torres Strait Islander and non-Indigenous Australians.

Cerebral vs. Cardiovascular Responses to Exercise in Type 2 Diabetic Patients.

The human brain is constantly active and even small limitations to cerebral blood flow (CBF) may be critical for preserving oxygen and substrate supply, e.g., during exercise and hypoxia. Exhaustive exercise evokes a competition for the supply of oxygenated blood between the brain and the working muscles, and inability to increase cardiac output sufficiently during exercise may jeopardize cerebral perfusion of relevance for diabetic patients. The challenge in diabetes care is to optimize metabolic control to slow progression of vascular disease, but likely because of a limited ability to increase cardiac output, these patients perceive aerobic exercise to be more strenuous than healthy subjects and that limits the possibility to apply physical activity as a preventive lifestyle intervention. In this review, we consider the effects of functional activation by exercise on the brain and how it contributes to understanding the control of CBF with the limited exercise tolerance experienced by type 2 diabetic patients. Whether a decline in cerebral oxygenation and thereby reduced neural drive to working muscles plays a role for “central” fatigue during exhaustive exercise is addressed in relation to brain’s attenuated vascular response to exercise in type 2 diabetic subjects.

Assessment of a group-based comprehensive diabetes management program to improve glycemic control, quality of life and self-care behavior in patients with type 2 diabetes mellitus in a primary healthcare setting of a metropolitan city in India: CDMP MUM Trial

Resource-poor primary health settings in an urban slum presented with special challenges in diabetes care. The study evaluated a need-based, patient-friendly, acceptable, appropriate package of care and its implementation in primary healthcare setup. An open-label two-arm parallel randomized controlled trial with 40 patients in the control group who received medical management as prescribed by physician and patients in the intervention group receiving usual medical care + group-based comprehensive diabetes management program. HbA1c, weight, BMI, Quality of Life Instrument for Indian Diabetes Patients (QOLID) scores, and audit of Self Care Inventory-Revised Version (SCI-R) were assessed at baseline and 6 months. There was a significant reduction in mean HbA1c levels in the intervention arm (8.44, SD = 1.802 to 7.56, SD = 1.87) as compared with the control arm (8.4, SD = 1.87 to 8.19, SD = 1.77). Multiple linear regression model (R2 = 0.886, ANOVA F (7, 72) = 79.733, p < 0.001) found a fall in blood sugar levels (β = − 0.511, p < 0.001), improvement in QOLID scores (β = 0.221, p = 0.004), increase in physical activity (β = 0.198, p = 0.006), and fall in BMI (β = 0.153, p = 0.009) to be predictive of change in HbA1c. The patient profile consisted predominantly of homemakers, with low formal education and belonging to lower socio-economic strata. They depended primarily on the public health system for their health care needs and could benefit most from the implementation of the program. There was an improvement in knowledge, regular follow-up, compliance to medication, diet, and physical activity along with improvement in glycemic control, self-care behavior and quality of life of patients in the intervention arm.

1627-P: Real-World Comparison of Acute Complications in Adult Patients with Type 1 Diabetes in U.S. and European Registries

The study compares acute complications among adults with type 1 diabetes (T1D) by glycemic control in a U.S. Electronic Health Record database (T1PCO) with the German/Austrian Prospective Diabetes Follow-up (DPV). T1PCO included 31,430 and DPV 5,190 individuals in the analysis (age ≥18 years, T1D duration ≥2 years). During baseline (12 months prior to index date), ≥1 HbA1c and ≥1 insulin prescription was required. Baseline demographics, severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) were analyzed for overall populations, by age group, and glycemic control (HbA1c categories). In both databases, incidence of DKA was highest in those with HbA1c ≥9.0%. Additionally, the incidence of DKA (per year) increased with deteriorating control (HbA1c&amp;lt;8%: 1.3% vs. 1.7%, HbA1c≥10%: 19.9% vs. 22.9%; DPV and T1PCO respectively). In contrast, incidence of SH patterns differed between the databases. While in the T1PCO cohort SH increased with poorer glycemic control, the trend was reversed in DPV cohort (Figure). Real-world comparisons demonstrate the challenges in diabetes care across many countries around the world. Different patterns of incidence of SH by HbA1c may be related to differences in the capture of SH in databases, it may also reflect important differences in diabetes management including access to different types of insulin, CGM, pumps, education and type 1 savvy health care providers. Disclosure F.L. Zhou: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. J. Hermann: None. J. Pettus: Consultant; Self; Diasome Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., MannKind Corporation, Novo Nordisk Inc., Sanofi. W. Kerner: None. K. Miller: None. L. Stechemesser: None. S. Edelman: Advisory Panel; Self; Brightsight, InPen, Lexicon Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk A/S. Board Member; Self; Senseonics. Speaker’s Bureau; Self; AstraZeneca, MannKind Corporation, Merck &amp; Co., Inc., Sanofi. A.M. Ibald-Mulli: Employee; Self; Sanofi-Aventis. R.W. Holl: None. Funding Sanofi

Platelet lysate promotes the healing of long-standing diabetic foot ulcers: A report of two cases and in vitro study

Long-standing foot ulcers present a great challenge in diabetes care. Platelet products have been suggested as a possible therapeutic option. However, nor the effect of an injectable form of platelet lysate on the healing of ulcers nor that on primary cells of the epidermis have been studied. In the current study, we present two cases of an ongoing clinical trial showing the positive effect of autologous platelet lysate injected perilesional. Both clinical cases treated with injections of hPL showed complete healing of previously un-healed within 8 weeks of treatment. Further, we describe the in vitro effect of human platelet lysate (hPL) on primary human epidermal keratinocytes (HEK) in terms of chemotaxis, migration and proliferation. In vitro, HEK showed enhanced chemotaxis towards the hPL compared to keratinocyte-defined media (p < 0.0001). Their migration was also stimulated especially at hPL concentration of 10%V/V (p < 0.0001). In contrast, hPL significantly inhibited HEK proliferation measured through MTT assay (p < 0.0001). In conclusion, the findings presented here provide preliminary evidence of an explanatory mechanism for the effect of hPL on primary keratinocytes and therefore of their potential use in a clinical setting. hPL promotes keratinocyte migration and therefore closure of foot ulcers.

Trends in Diabetes Management Among US Adults: 1999-2016.

Updating national trends in diabetes management is important for identifying areas of progress and remaining gaps in diabetes care. Evaluate trends in diabetes management. Three nationally representative, serial cross-sectional surveys (National Health and Nutrition Examination Survey [n = 5800], National Health Interview Survey [n = 48,519], and Behavioral Risk Factor Surveillance System [n = 741,497]) were used to estimate trends in diabetes management from 1999 to 2016. Non-pregnant US adults (aged ≥ 18years) diagnosed with diabetes. American Diabetes Association's general recommendations for glycemic and cardiovascular risk factor control, medication usage, physical activity, preventive practices, and dietary intake. From 1999 to 2016, the proportion of US adults with diabetes who attained glycemic control (HbA1c < 7.0%) followed a quadratic trend (49.6% in 1999-2004 to 58.6% in 2005-2010 to 55.8% in 2011-2016, P < 0.05 for trend). Control of blood pressure (< 140/90mmHg) and lipids (LDL cholesterol < 100mg/dl) increased by 6.6 and 18.7 percentage points, respectively (P < 0.05 for trends). The proportion that attained glycemic, blood pressure, and lipid control followed a quadratic trend (13.3% in 1999-2004 to 24.8% in 2005-2010 to 20.2% in 2011-2016, P < 0.05 for trend). Use of antidiabetic, antihypertensive, and statin medication among those who were eligible rose by 8.6, 5.0, and 24.0 percentage points, respectively (P < 0.05 for trends). Aerobic inactivity declined 7.1 percentage points, while adherence to aerobic activity (≥ 150min/week) and resistance training (≥ 2 times/week) recommendations grew 3.4 and 3.2 percentage points, respectively (P < 0.05 for trends). Engagement in preventive practices (e.g., receipt of vaccinations) consistently increased for 6 out of 8 outcomes. However, the adherence to saturated fat (< 10% of total daily calories) and sodium (< 2300mg/day) recommendations fell by 6.5 and 5.2 percentage points (P < 0.05 for trends). Despite notable improvements, declines in glycemic control and adherence to dietary recommendations may be growing challenges in diabetes care.

Process, quality and challenges of diabetes care in primary care: a study of district health network in Thailand.

This study aimed to describe the process of care, assess the quality of care based on defined indicators, and identify challenges associated with providing diabetes care via sub-district health promotion hospital (SHPH) facilities in Thailand. Primary care policy has directed that diabetes care be delivered via SHPH in order to reduce hospital congestion and minimize travel costs for patients. Limited data is available regarding the structure for providing care. Likewise, barriers to delivery of optimal care have not been well defined, especially from the perspective of health care providers. This study employed mixed-methods research, which included semi-structured interviews to gain insights into the current diabetes care process, a descriptive study to evaluate quality of care, and use of a focus group to identify challenges associated with delivery of diabetic care via SHPH. Diabetes care processes in primary care included multiple steps and involved collaboration between various health care providers at both the hospital and SHPH. Four process indicators and one outcome had been achieved but performance of other indicators was apparently low. Three factors were found to pose challenges to providing this service: the resources of the health service, the delivery of services, and patient factors. SHPH require additional support, particularly in the areas of primary care workforce, finance, medical device procurement, and patient information systems. While delivery of diabetes care via primary care centers has been well established in Thailand, regional differences in the quality of care persist. Additional support is required to strengthen the primary care system nationwide.

Disparities in glycaemic control, monitoring, and treatment of type 2 diabetes in England: A retrospective cohort analysis.

BackgroundDisparities in type 2 diabetes (T2D) care provision and clinical outcomes have been reported in the last 2 decades in the UK. Since then, a number of initiatives have attempted to address this imbalance. The aim was to evaluate contemporary data as to whether disparities exist in glycaemic control, monitoring, and prescribing in people with T2D.Methods and findingsA T2D cohort was identified from the Royal College of General Practitioners Research and Surveillance Centre dataset: a nationally representative sample of 164 primary care practices (general practices) across England. Diabetes healthcare provision and glucose-lowering medication use between 1 January 2012 and 31 December 2016 were studied. Healthcare provision included annual HbA1c, renal function (estimated glomerular filtration rate [eGFR]), blood pressure (BP), retinopathy, and neuropathy testing. Variables potentially associated with disparity outcomes were assessed using mixed effects logistic and linear regression, adjusted for age, sex, ethnicity, and socioeconomic status (SES) using the Index of Multiple Deprivation (IMD), and nested using random effects within general practices. Ethnicity was defined using the Office for National Statistics ethnicity categories: White, Mixed, Asian, Black, and Other (including Arab people and other groups not classified elsewhere). From the primary care adult population (n = 1,238,909), we identified a cohort of 84,452 (5.29%) adults with T2D. The mean age of people with T2D in the included cohort at 31 December 2016 was 68.7 ± 12.6 years; 21,656 (43.9%) were female. The mean body mass index was 30.7 ± SD 6.4 kg/m2. The most deprived groups (IMD quintiles 1 and 2) showed poorer HbA1c than the least deprived (IMD quintile 5). People of Black ethnicity had worse HbA1c than those of White ethnicity. Asian individuals were less likely than White individuals to be prescribed insulin (odds ratio [OR] 0.86, 95% CI 0.79–0.95; p < 0.01), sodium-glucose cotransporter-2 (SGLT2) inhibitors (OR 0.68, 95% CI 0.58–0.79; p < 0.001), and glucagon-like peptide-1 (GLP-1) agonists (OR 0.37, 95% CI 0.31–0.44; p < 0.001). Black individuals were less likely than White individuals to be prescribed SGLT2 inhibitors (OR 0.50, 95% CI 0.39–0.65; p < 0.001) and GLP-1 agonists (OR 0.45, 95% CI 0.35–0.57; p < 0.001). Individuals in IMD quintile 5 were more likely than those in the other IMD quintiles to have annual testing for HbA1c, BP, eGFR, retinopathy, and neuropathy. Black individuals were less likely than White individuals to have annual testing for HbA1c (OR 0.89, 95% CI 0.79–0.99; p = 0.04) and retinopathy (OR 0.82, 95% CI 0.70–0.96; p = 0.011). Asian individuals were more likely than White individuals to have monitoring for HbA1c (OR 1.10, 95% CI 1.01–1.20; p = 0.023) and eGFR (OR 1.09, 95% CI 1.00–1.19; p = 0.048), but less likely for retinopathy (OR 0.88, 95% CI 0.79–0.97; p = 0.01) and neuropathy (OR 0.88, 95% CI 0.80–0.97; p = 0.01). The study is limited by the nature of being observational and defined using retrospectively collected data. Disparities in diabetes care may show regional variation, which was not part of this evaluation.ConclusionsOur findings suggest that disparity in glycaemic control, diabetes-related monitoring, and prescription of newer therapies remains a challenge in diabetes care. Both SES and ethnicity were important determinants of inequality. Disparities in glycaemic control and other areas of care may lead to higher rates of complications and adverse outcomes for some groups.

2019 Diabetes Atlas: Achievements and challenges in diabetes care in Taiwan

The 2019 Diabetes Atlas delineated both accomplishments and challenges in diabetes care in Taiwan between 2005 and 2014. The series reported that Taiwan had significantly improved aspects of care quality for patients with diabetes. For example, the mortality rate decreased, the difference between the life expectancies of patients with diabetes and those of the general population decreased, and the rates of hospitalization because of heart diseases, cerebrovascular diseases, chronic kidney diseases, and unsatisfactory glycemic control decreased. However, despite these achievements, the 2019 Diabetes Atlas also reported some substantial challenges that have not been overcome. For example, the incidence of diabetes among women aged <19 years and 20-39 years increased by 27% and 33%, respectively. Furthermore, a high prevalence of macrovascular complications, a continuous increase in the dialysis prevalence rates among men with diabetes of all ages, and a low participation rate (<20%) of patients with diabetes in the pay-for-performance program were observed. The publication of the 2019 Diabetes Atlas is a milestone that demonstrates a strong will in medical societies to improve the quality of diabetes care. We expect this initiative can be reorganized every 5 years to report the results of continuous monitoring and surveillance and update the epidemiological features of diabetes in Taiwan.

1362-P: Puberty Changes Everything: Longitudinal Multitrajectory Modeling of Metabolic Control, Body Mass Index, and Insulin Dose among 9,239 Children with T1D from the DPV Registry

Worsening metabolic control, weight changes and increasing insulin dose during puberty have emerged as a challenge in diabetes care. However, individual variation is large. Data from the German/Austrian/Luxembourgian diabetes registry DPV were used to identify distinct patterns of hemoglobin A1c (HbA1c), age/sex-standardized body mass index (BMI-SDS) and daily insulin dose from childhood to young adulthood. Longitudinal data from 9,239 participants with T1D aged 8 to 18 years with duration &amp;gt;=2 years and &amp;gt;=5 years of follow-up were analyzed. We applied group-based multitrajectory (GBMT) modeling, a generalization of the group-based trajectory approach, to identify latent groups of subjects following similar developmental curves over time across multiple variables (Nagin, 2018). The GBMT approach revealed five unique groups of heterogeneous HbA1c, BMI-SDS and insulin dose patterns over time (Fig1). Differences in age at onset, gender, migration background as well as height-SDS, insulin pump and CGM usage, frequency of SMBG and physical activity were found across all groups. The present study identified for the first time five distinct multitrajectories of HbA1c, BMI-SDS and insulin dose during puberty. This approach demonstrates that variability between individuals is obscured by statistics on central tendency. Disclosure A. Schwandt: None. O. Kuss: None. D.P. Dunstheimer: None. B. Karges: None. T.M. Kapellen: None. T. Meissner: None. M. Witsch: None. M. Flury: Other Relationship; Self; Pfizer Inc. S. Straubinger: None. R.W. Holl: None. Funding German Center for Diabetes Research; Robert Koch Institute; German Diabetes Association

Challenges of Diabetes Care in Older People With Type 2 Diabetes and the Role of Basal Insulin.

IN BRIEF The use of long-acting basal insulin analogs is a recommended strategy in older people with diabetes because of their lower risk of hypoglycemia compared to intermediate-acting insulins. In this article, we review the results from recent clinical trials of second-generation basal insulin preparations. We conclude that, although these preparations have improved the management of insulin-requiring older people with type 2 diabetes, there is a need for additional and more specific studies to address the complexities of hyperglycemia management in this population.

Comparative adherence to diabetes drugs: An analysis of electronic health records and claims data

Non-adherence to medications is a major challenge in diabetes care. The objective of this brief report is to compare adherence rates for 6 major classes of diabetes medications: metformin, sulfonylurea, thiazolidinedione, basal insulin, DPP-4 inhibitors, and GLP-1 receptor agonists. We used a data source that linked electronic prescriptions with insurance claims to assess whether new electronic prescriptions for diabetes medications were followed by dispensing claims consistent with that prescription. After one year of follow-up, the daily medication possession probability (MPP) - a measure of overall adherence - at one year for sulfonylurea was 0.49 and for metformin was 0.46. Thiazolidinediones and basal insulin had a similar final daily MPP at 0.36 and 0.39, respectively, which was significantly lower than that for sulfonylurea or metformin (P < .05). GLP-1 receptor agonists and DPP-4 inhibitors were also comparable to one another at a final daily MPP of .30 and .21, respectively (P < .05 compared to any of the aforementioned drug classes). In summary, the rates at which diabetes drugs are prescribed, and the rates at which patients actually take them, differ substantially. Physicians should be aware of potentially significant challenges concerning adherence to newer agents.

Integrative Review on Adherence in Haitians With Diabetes

In light of a marked increase in the incidence and prevalence of diabetes in the United States in recent years with associated health costs totaling $245 billion for 2012, diabetes has become a major health and fiscal concern. Haitian Americans as a cultural group have unique obstacles to effective treatment and management of diabetes. This paper analyzes recent studies relevant to these challenges in anticipation of new research pertaining to this population. Although medication compliance is generally referred to as adherence, it is a complex concept and key challenge in diabetes care. Accordingly, this paper will further define adherence by describing its relevance in effective treatment and management. It will also analyze key theoretical perspectives in diabetes care, summarize recent research, and make recommendations for effective future research on the impact of diabetes education in Haitian Americans.