Diabetes Care Research Articles

Validity And Reliability Of Digital Health Education On Diabetic Foot Care Based On Health Belief Model Among Type Ii Diabetic Patients

The study aims to evaluate the effectiveness of digital health education on diabetic foot care among type II diabetic patients using the Health Belief Model (HBM). A total of 30 participants were recruited from local diabetes clinics to receive digital health education focused on diabetic foot care practices. To ensure the validity and reliability of the assessment tools, we employed multiple methods. Content validity was established through expert reviews, while construct validity was examined using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), which confirmed a good factor structure aligned with the HBM constructs. Reliability was assessed using Cronbach’s alpha for internal consistency, which showed acceptable values ranging from 0.67 to 0.84, and test-retest reliability with Intraclass Correlation Coefficients (ICC) ranging from 0.74 to 0.78. The results indicate that the digital health education program significantly improved the participants' understanding and practices related to diabetic foot care. These findings underscore the potential of digital education interventions for chronic disease management, particularly for enhancing self-care behaviors in diabetic patients. Future studies should consider larger sample sizes to further validate these tools and results. Overall, this study provides evidence supporting the effectiveness of digital health education for diabetic foot care and validates the reliability and validity of the instruments used.

The association between health literacy and quality of life of patients with type 2 diabetes mellitus: A cross-sectional study.

Health literacy-driven interventions in patients with type 2 diabetes have been found to play an important role in achieving glycemic control and enhancing diabetic self-management outcomes. The present study aimed to examine the role of health literacy as a predictor of quality of life among diabetic patients in Jordan. This cross-sectional study enrolled 400 Type 2 diabetic patients visiting the endocrinology department at the outpatient clinic at Al Basheer Hospital in Amman, Jordan. The data were collected between 1st of August and 28th of December 2023, using the validated Jordanian Diabetic Health Literacy Questionnaire and the EuroQol-5D tool. A quantile regression analysis was conducted to explore the factors associated with health-related quality of life among the study participants. This study included 68.8% females, with a median age of 58 (50-64) years. The median EQ5-D index score was 0.66 (0.41-0.78). Findings from regression analysis indicated as patients' age increased, their quality of life scores significantly decreased (-0.004, 95%CI (-0.006, -0.001), p = 0.002). Additionally, higher JDHLQ scores were significantly associated with higher EQ5-D scores (0.012, 95% CI (0.006-0.018), p<0.001). Moreover, patients with only an elementary education had significantly lower EQ5-D scores compared to those with a postgraduate education (-0.106, 95%CI (-0.190, -0.023), p = 0.013). The findings of the present study emphasize the importance of including health literacy assessments and interventions in the diabetes care plans of patients in Jordan.

A Comparative Study on the Impact of Fasting on Blood Glucose and Blood Pressure Among Diabetic and Non-Diabetic Individuals During Ramadan, Kurdistan Region, Iraq

Objective: The primary aim of this research was to evaluate the differential effects of regular and fasting dietary patterns on blood glucose levels and blood pressure among diabetic patients and non-diabetic control group. A comprehensive analysis was conducted to compare physiological responses on fasting versus non-fasting days during the holy Ramadan month. Methods: This observational study involved 92 participants, with a subset of 38 diabetic patients and 54 non-diabetic control group, aged 19-76 years, who were observed on regular and fasting days. Participants were monitored for pre-prandial, postprandial, evening blood sugar, and fasting blood glucose levels, as well as blood pressure. Statistical analysis was performed using paired sample t-tests to compare mean ± SD between regular and fasting days of both groups. The study cohort consisted of male and female adults diagnosed with type 1 or type 2 diabetes. Exclusion criteria included individuals under 18 years, pregnant women, and patients unable to fast during the study period. Results: Statistical analysis revealed significant differences in fasting blood glucose levels during Ramadan compared to non-fasting days. In the diabetic group, significant changes were observed in fasting blood glucose levels during Ramadan compared to after Ramadan ( postprandial blood sugar p=0.04, evening blood sugar p=0.019). In contrast, the non-diabetic group also showed significant changes in blood glucose levels during Ramadan compared to after Ramadan (postprandial blood sugar p=0.001, evening blood sugar p=0.020). Blood pressure showed no significant differences between these periods, suggesting that fasting does not alter blood pressure significantly in diabetic individuals. Additionally, a two-way ANOVA demonstrated significant dietary influences on post-Iftar glucose levels in non-diabetics (p&lt;0.001), but not in diabetics, suggesting differential metabolic responses to dietary intake during Ramadan. These findings emphasize the critical need for personalized dietary management and continuous monitoring to optimize diabetic care during fasting. Conclusion: Fasting significantly influences blood glucose levels in diabeticand non-diabetic individuals but does not affect blood pressure. This study underscores the necessity for personalized medical guidance and balanced meal planning to minimize complications and enhance diabetes management during fasting. Further research is warranted to explore the long-term effects of different fasting practices on diabetic health outcomes.

Relationship between autonomic and peripheral neuropathies and cardiovascular outcomes in diabetes

This review explores the complex relationship between diabetic neuropathy and cardiovascular disease (CVD). Neuropathy, a common complication of type 1 and type 2 diabetes, is divided into autonomic and peripheral types, each impacting cardiovascular health. Cardiovascular autonomic neuropathy, a form of autonomic neuropathy, is associated with various CVD complications, including arrhythmias, impaired nocturnal blood pressure regulation, and increased mortality. The prevalence of cardiovascular autonomic neuropathy varies depending on the type and duration of diabetes and is influenced by factors like glycemic control and metabolic stress. Peripheral polyneuropathy, which is often linked to diabetic foot disease, is also correlated with elevated CVD risk; research suggests shared pathophysiological mechanisms between peripheral neuropathy and cardiovascular conditions. Screening for neuropathies using tools like the Michigan Neuropathy Screening Instrument and heart rate variability analyses can facilitate early detection of CVD risk. Additionally, emerging technologies, like deep learning models, have demonstrated promise in detecting early cardiovascular patterns associated with autonomic neuropathy through electrocardiogram analysis. These findings underscore the value of integrating novel diagnostic approaches for early intervention. As CVD represents a leading cause of death among patients with diabetes, this article emphasizes the need for thorough assessment and proactive management of neuropathy to mitigate cardiovascular risk. The review recommends a multidisciplinary approach to diabetes care, including early screening, accurate risk stratification, and targeted therapeutic strategies to prevent or slow the progression of CVD in patients with autonomic and peripheral neuropathies. Further research is warranted to clarify the optimal intervention strategies for reducing CVD risk in these populations.

Investigation of Ketosis Prevalence in Dairy Cows in Bingöl Province of Turkey

The aim of this study is to investigate the prevalence of ketosis in 7 different villages (Alibir, Ardıçtepe, Çavuşlar, Garip, Sudüğünü, Yamaç, and Yeşil) of Bingöl province. A total of 411 dairy cows, including Simmental, Holstein and crossbred breeds, were used in the study during the 3-week period after birth. Ketosis was diagnosed by measuring blood beta-hydroxy-butyric acid (BHBA) concentration. Blood BHBA concentrations were analyzed using the FreeStyle Optium Neo H (Abbott Diabetes Care Ltd., Witney, UK). Blood BHBA ≥2.6 mmol/L was determined as clinical ketosis (CK), BHBA≥1.2 mmol/L as subclinical ketosis (SCK), and BHBA

Veeraswamy Seshiah: Father of Gestational Diabetes in India

Professor Dr. V. Seshiah, MD, FRCP, DSc, (Hony), is a distinguished professor at Tamil Nadu's Dr. MGR Medical University and established the First Department of Diabetology in India at Madras Medical College in 1978. He was the patron of the Research Society for the Study of Diabetes in India and the founder patron of the Diabetes in Pregnancy Study Group, India (DIPSI). Additionally, he served as the Vice-Chair of the Executive Board of the International Association of Diabetes and Pregnancy Study Group. Dr. V Balaji and Dr. V Seshiah Diabetes Care Center &amp; Research Institute, which he founded, received the Army Decorations "SAMAR SEVA STAR" and "SAINYA SEVA MEDAL" in 1965 with clasp HIMALAYAS. Dr. Seshiah was also the recipient of the DR. B.C.ROY National Award was given in 1988 for developing diabetology as the Indian College of Physicians provided a specialty in the country and the Master Teacher Award. Moreover, he was honored with the Lifetime Achievement Award by the International Diabetes Federation in 2017, being the first Indian to receive this award. In 2022, the President of India, Mr. Kovind, presented the Padma Shri to Dr. Veeraswamy Seshiah for Medicine.

Challenges in Beta Cell Replacement for Type 1 Diabetes.

Type 1 diabetes (T1D) presents a significant global health challenge, characterized by immune-mediated destruction of pancreatic beta-cells. Achieving therapeutic goals such as prevention of immune destruction, preservation of beta-cell mass, and automated insulin delivery remains complex due to the disease's heterogeneity. This review explores the advancements and challenges in beta-cell replacement therapies, including pancreas and islet cell transplantation, stem cell-derived β-cell generation, and biotechnological innovations. Pancreas transplantation, especially simultaneous pancreas and kidney transplantation (SPK), has evolved significantly, offering insulin independence and improved quality of life despite surgical and immunological complications. Allogeneic islet transplantation, though less invasive, faces challenges such as donor scarcity, immunosuppressive therapy, and variable long-term success. Innovations in stem cell therapy, particularly using human embryonic stem cells (hESCs) and induced pluripotent stem cells (iPSCs), promise an unlimited source of β-cells. However, translating these advances into clinical applications involves overcoming technical, biological, and ethical hurdles. Strategies such as immunomodulation, encapsulation, and genetic engineering are critical to enhancing the viability and integration of transplanted cells. This review provides a comprehensive overview of the scientific intricacies and potential of β-cell replacement therapies, emphasizing the need for continued research to address the remaining challenges and improve diabetes care outcomes.

Expert panel opinion on the optimal educational pathway for diabetes educators for training people with type 1 diabetes on the MiniMed™ 780G system: a Delphi consensus.

The MiniMed™ 780G system is an advanced insulin pump system incorporating an AHCL (Advanced Hybrid Close Loop) algorithm that automatically adjusts insulin delivery based on glucose levels. All guidelines recommend the use of Automated Insulin Delivery therapy for people with type 1 diabetes (PWT1D) and they highlight that a specifically trained and expert team should provide training on HCL systems for PWT1D, but none of the publications detail the curriculum profile that diabetes educators should have. This paper aims to establish a consensus on the optimal educational pathway for diabetes educators on the MiniMed™ 780G system. An Expert Panel (EP) of 11 key opinion educators in diabetes technology in the EMEA area was assembled. Using the Delphi method, a consensus questionnaire based on the literature research was created, discussed and validated by the EP members. An agreement level of ≥ 75% was considered a strong consensus. EP members had on average 16.3 years of clinical experience and followed at least 50 PWT1D using the MiniMed™ 780G system. All EP members agreed that a structured educational pathway to train diabetes educators in the use of the MiniMed™ 780G system is needed. 100% of the EP members agreed that the pathway should include a mentorship programme and in-field training; 90% agreed on using face-to-face training with the support of e-learning modules. The EP members believed that minimum competency standards for diabetes educators around the principles of diabetes care and education are needed. The educational pathway created by the EP showed that skills are needed at an advanced level and that mentorship in developing these skills is critical. This pathway is vital for supporting the implementation of diabetes technology into everyday life and can remove barriers and increase access to PWT1D.

Who took care of patients with diabetes during the COVID-19-pandemic? A registry-based study

Abstract Background The rise of people with chronic diseases strains our healthcare system. Chronic disease management programs (CDMP) provide accessible care for patients with a chronic disease, aiming to prevent further development of the disease and avoid the need for (more costly and severe) hospital treatments. During the COVID-19 pandemic, CDMP provided at general practices (GP) for diabetic patients were downscaled. It remains unknown whether this downsizing led to increased care in other healthcare settings. We examined the changes in healthcare utilization by Dutch diabetic patients in 2020 and 2021 compared to 2019 regarding; 1) CDMP consultations, 2) hospital care for diabetes and 3) regular GP care. Methods In this retrospective observational study, data from electronic health records of GPs, participating in Nivel Primary Care Database, of 15,247 Dutch diabetic patients who were enrolled in CDMP, were linked to hospital claims data. Differences in healthcare utilization in 2020 and 2021 compared to 2019 were assessed quarterly using regression analyses. Results Results show that CDMP care was notably lower in 2020 and 2021, compared to 2019 (-35%). From Q1 2021 onwards, patients received more hospital care for diabetes (+13%) and regular GP care increased from Q3 2020 onwards (+14%). Compared to 2019, reduced CDMP contacts in 2020 were significantly associated (p = 0.001) with increased regular GP care in 2021. In the short-term, decreased CDMP in the first half of 2021 was significantly associated with increased regular GP care (p = 0.033) and hospital care (p = 0.037) in the second half of 2021. Conclusions Temporarily downscaling CDMP care during the COVID-19-pandemic was associated with increased hospital and regular GP care for diabetic patients. These findings contribute to making informed decisions regarding measures during future pandemics. Key messages • Chronic disease management programs at GPs appear to be effective in preventing disease exacerbations, and may help prevent (expensive) utilization of hospital care. • This research prompts further investigation into the desirability of CDMPs among patients, GPs, hospitals and policymakers, crucial for assessing undesirable healthcare shifts in diabetic patients.

Twelve-Month Real-World Use of an Advanced Hybrid Closed-Loop System Versus Previous Therapy in a Dutch Center For Specialized Type 1 Diabetes Care.

Complexity of glucose regulation in persons with type 1 diabetes (PWDs) necessitates increased automation of insulin delivery (AID). This study aimed to analyze real-world data over 12 months from PWDs who started using the MiniMed 780G (MM780G) advanced hybrid closed-loop (aHCL) AID system at the Diabeter clinic, focusing on glucometrics and clinical outcomes. Persons with type 1 diabetes switching to the MM780G system were included. Clinical data (e.g. HbA1c, previous modality) was collected from Diabeter's electronic health records and glucometrics (time in range [TIR], time in tight range [TITR], time above range [TAR], time below range [TBR], glucose management indicator [GMI]) from CareLink Personal for a 12-month post-initiation period of the MM780G system. Outcomes were age-stratified, and the MM780G system was compared with previous use of older systems (MM640G and MM670G). Longitudinal changes in glucometrics were also evaluated. A total of 481 PWDs were included, with 219 having prior pump/sensor system data and 334 having monthly longitudinal data. After MM780G initiation, HbA1c decreased from 7.6 to 7.1% (P < .0001) and the percentage of PWDs with HbA1c <7% increased from 30% to 50%. Glucose management indicator and TIR remained stable with mean GMI of 6.9% and TIR >70% over 12 months. Age-stratified analysis showed consistent improvements of glycemic control across all age groups, with older participants achieving better outcomes. Participants using recommended system settings achieved better glycemic outcomes, reaching TIR up to 77% and TTIR up to 55%. Use of MM780G system results in significant and sustained glycemic improvements, consistent across age groups and irrespective of previous treatment modalities.

The Impact of Health Literacy on Diabetes Control

Abstract Introdution People with diabetes have a significant impact on treatment outcomes through their daily decisions. Therefore, health literacy (HL) is crucial for effectively managing the disease and maintaining overall health. This study aimed to explore the relationships between different dimensions of health literacy, self-care behaviors, and Diabetes Control (HbA1c). Methods HLwas assessed using the Health Literacy Questionnaire. 706 individuals with diabetes participated in the study, the majority of whom were male (60.2%), had more than 9 years of schooling (84.7%), and over half were employed (52.4%). To examine the relationship between dimensions of HLand HbA1c, multiple linear regression analysis was conducted. Results The study revealed a significant association between higher levels of HLand lower HbA1c levels. There is a statistically significant positive linear correlation between adherence to general nutrition and HLdimensions. In terms of physical activity, a positive correlation was also found with HLdimensions, and blood glucose monitoring showed a positive correlation with health literacy. Greater adherence to nutrition was linked to a decrease in HbA1c levels, while higher adherence to self-monitoring and medication was associated with an increase in HbA1c levels Conclusions This study emphasizes the importance of HLin managing diabetes. It underscores the impact of HLin diabetes compensation. The results reveal that higher levels of feeling understood and supported by healthcare professionals, having sufficient information to manage health, actively managing health, and appraising health information among people with diabetes lead to better adherence to blood glucose self-monitoring. Based on these findings, a crucial aspect of effectively managing diabetes will involve empowering individuals with the necessary skills for self-management of their condition, overall health, and treatment regimen. Key messages • The present research reinforces the importance of health literacy for diabetes compensation and self care activies. • One critical success factor in dealing with diabetes will be investing of health literacy of people with diabetes and health care providers responsiveness.

Advancing diabetes management: Exploring pancreatic beta-cell restoration’s potential and challenges

Diabetes mellitus, characterized by chronic hyperglycemia due to insulin deficiency or resistance, poses a significant global health burden. Central to its pathogenesis is the dysfunction or loss of pancreatic beta cells, which are res-ponsible for insulin production. Recent advances in beta-cell regeneration research offer promising strategies for diabetes treatment, aiming to restore endogenous insulin production and achieve glycemic control. This review explores the physiological basis of beta-cell function, recent scientific advan-cements, and the challenges in translating these findings into clinical applications. It highlights key developments in stem cell therapy, gene editing technologies, and the identification of novel regenerative molecules. Despite the potential, the field faces hurdles such as ensuring the safety and long-term efficacy of regen-erative therapies, ethical concerns around stem cell use, and the complexity of beta-cell differentiation and integration. The review highlights the importance of interdisciplinary collaboration, increased funding, the need for patient-centered approaches and the integration of new treatments into comprehensive care strategies to overcome these challenges. Through continued research and collaboration, beta-cell regeneration holds the potential to revolutionize diabetes care, turning a chronic condition into a manageable or even curable disease.

Predicting diabetes prognosis using machine learning techniques in a Hungarian clinical database

Abstract Background Chronic conditions such as type 2 diabetes mellitus have great impact on patients’ quality of life. Although clinical databases provide a perfect base for research aimed at improving diabetes care, analyzing such databases requires extensive pre-processing, mainly due to the large amount of unstructured data. Our study aimed to present the steps of generating a dataset from a large clinical database, and to apply machine learning-based analytical techniques regarding. Methods Data of the Clinical Center of University of Debrecen was used. To structure the unstructured data, regular expressions and natural language processing methods were used. The main machine learning models were as follows: Gradient Boosting Machines to predict the risk of complication development; Long Short-Term Memory Networks to forecast future health outcomes. All analysis and procedures were done using Python. Results The database contains approximately 1600 tables, with a total size of 1.9 terabytes, where the largest table is 21.07 gigabytes with approximately 44.64 million rows. The final dataset consisted of 40,332 patients. Most variables originate from the unstructured data, including complications and comorbidities of diabetes, as well as physical and laboratory parameters. Related to laboratory parameters, the number of measurements and the median value for every half-year were available. The diagnosis time of the complications’ occurrence is also presented. Machine learning methods were more accurate compared with traditional statistical methods in predicting the prognosis (p &amp;lt; 0.05). Discussion Our research highlights the importance of clinical data in chronic disease management. There are challenges in pre-processing and managing datasets, but machine learning-based methods are very efficient not only in extracting useful information from unstructured data but also in predicting the prognosis and identifying potential intervention points for better care. Key messages • Natural language processing can be used to obtain useful information from unstructured clinical data. • Using machine learning techniques on clinical data could improve diabates care.

Monitoring of the Analytical Performance of Four Different Blood Glucose Monitoring Systems: A Post-market Performance Follow-Up Study.

A sizeable minority of commercially available blood glucose monitoring (BGM) systems fail to satisfy regulatory accuracy requirements, such as ISO 15197:2013, after approval. This study assessed whether the BGMs tested could consistently meet these ISO requirements by investigating their accuracy in a non-standardized setting. In this 18-month post-market performance study, using the ISO criteria, healthcare professionals tested the accuracy of four CE-marked BGM systems (Roche Diabetes Care, Mannheim, Germany) on European adults with diabetes mellitus. ISOcriteria included 95% of blood glucose (BG) values being within ± 15mg/dl of a reference measurement for BG < 100mg/dl or ± 15% for BG ≥ 100mg/dl and, in the Parkes Consensus Error grid for type 1 diabetes comparing capillary BGM measurements versus reference method, 99% of BG values falling within zone A (no effect on clinical action or outcome) and zone B (altered clinical action with little or no effect on clinical outcome). BGM readings were obtained from 1650 participants, and the number of readings per BGM system was between 1712 and 2376. The percentage of BGM readings that fell within ISO 15197:2013 limits ranged from 99.4 to 99.9%. For all meter types, 100% of data points fell within zone A or zone B, and most data points for each meter (≥ 99.9%) were in zone A. All four CE-marked BGM models showed results within the accuracy limits defined by ISO 15197 in a non-standardized setting and thus consistently met regulatory accuracy requirements.

Effectiveness of specialist involvement in case discussion conferences with primary healthcare providers on the management of type 2 diabetes patients: a study protocol for a cluster randomized controlled trial

BackgroundIn supporting primary healthcare in delivering high-quality care for individuals with type 2 diabetes mellitus (T2DM), previous research emphasized strategies to facilitate communication and collaboration between primary healthcare providers and hospitals. This study aims to evaluate the effectiveness of case discussion conferences between specialists from hospitals and primary healthcare providers in China on the optimization of diabetes management and the improvement of patient health outcomes.MethodsThis study will be a parallel cluster randomized controlled trial in which primary healthcare institutions in Shouguang city and Shangsi County will be randomly allocated to the intervention and control groups. The intervention will involve regular case discussion conferences where attendants will meet to discuss complex cases with patients diagnosed with type 2 diabetes mellitus, exchange experiences, and seek and provide expert advice. Family doctor teams from primary healthcare institutions and specialists from secondary or tertiary hospitals will engage in these conferences. Data will be collected at baseline and at the 6- and 12-month follow-ups. The primary clinical outcome measures will focus on the changes in the HbA1c and FBG levels of patients under management. The secondary outcomes will include other physiological indicators, such as blood pressure, BMI, and cholesterol. The evaluation will extend to changes in the capabilities and behaviors of primary healthcare providers. Furthermore, the feasibility and adherence of this intervention will be thoroughly assessed.DiscussionThis study is designed to generate robust evidence on the effectiveness of case discussion conferences, an interprofessional collaboration strategy, in enhancing diabetes care delivery in primary healthcare, with the ultimate goal of improving patient health outcomes.Trial registrationChinese Clinical Trial Registry ChiCTR2300078829. Registered on December 19, 2023. https://www.chictr.org.cn/showproj.html?proj=210293

An insight on Diabetes Mellitus: A comprehensive review

This paper thoroughly overviews diabetes mellitus, focusing on its introduction, classification, and management strategies. Initially, the paper outlines the fundamental concepts of diabetes mellitus, including its impact on global health and its underlying pathophysiological mechanisms. It distinguishes between the two primary types of diabetes: Type 1 diabetes (T1D), an autoimmune condition leading to the destruction of insulin-producing beta cells, and Type 2 diabetes (T2D), characterized by insulin resistance and relative insulin deficiency. The paper further explores gestational diabetes and its implications for maternal and fetal health. Management strategies for diabetes are examined in detail, encompassing lifestyle modifications, pharmacotherapy, Anthropo-therapeutic Healing, and technological interventions. Key aspects include dietary management, physical activity, and blood glucose monitoring to achieve glycemic control. Additionally, advancements in diabetes care, such as novel pharmacological agents, insulin delivery systems, and continuous glucose monitoring, are discussed. The paper aims to provide a comprehensive understanding of the types of diabetes mellitus and their management, offering insights into current practices and future directions for improving patient outcomes and enhancing quality of life.

Exploring cutting-edge approaches in diabetes care: from nanotechnology to personalized therapeutics.

Diabetes mellitus (DM) is a persistent condition characterized by high levels of glucose in the blood due to irregularities in the secretion of insulin, its action, or both. The disease was believed to be incurable until insulin was extracted, refined, and produced for sale. In DM, insulin delivery devices and insulin analogs have improved glycemic management even further. Sulfonylureas, biguanides, alpha-glucosidase inhibitors, and thiazolidinediones are examples of newer-generation medications having high efficacy in decreasing hyperglycemia as a result of scientific and technological advancements. Incretin mimetics, dual glucose-dependent insulinotropic polypeptide, GLP-1 agonists, PPARs, dipeptidyl peptidase-4 inhibitors, anti-CD3 mAbs, glucokinase activators, and glimins as targets have all performed well in recent clinical studies. Considerable focus was placed on free FA receptor 1 agonist, protein tyrosine phosphatase-1B inhibitors, and Sparc-related modular calcium-binding protein 1 which are still being studied. Theranostics, stem cell therapy, gene therapy, siRNA, and nanotechnology are some of the new therapeutic techniques. Traditional Chinese medicinal plants will also be discussed. This study seeks to present a comprehensive analysis of the latest research advancements, the emerging trends in medication therapy, and the utilization of delivery systems in treating DM. The objective is to provide valuable insights into the application of different pharmaceuticals in the field of diabetes mellitus treatment. Also, the therapeutic approach for diabetic patients infected with COVID-19 will be highlighted. Recent clinical and experimental studies evidence the Egyptian experience. Finally, as per the knowledge of the state of the art, our conclusion and future perspective will be declared.

Diabetes Care in the School Setting: A Statement of the American Diabetes Association

Diabetes Care in the School Setting: A Statement of the American Diabetes Association

Consequences of Disintegrated Care for Dual Tuberculosis and Diabetes in Tanzania: A Case Report on Recurrent Tuberculosis with Severe Haemoptysis in a Patient with Dysregulated Diabetes

Consequences of Disintegrated Care for Dual Tuberculosis and Diabetes in Tanzania: A Case Report on Recurrent Tuberculosis with Severe Haemoptysis in a Patient with Dysregulated Diabetes

Barriers and Facilitators of Management of Type-1 Diabetes in Children: A Socio-Cultural Enquiry of Caregivers’ Perspectives Living in Resource-Constrained Settings

Purpose Caregivers are key stakeholders in management of children with Type 1 Diabetes (T1D), but their perspectives have remained understudied, especially in the developing countries. This study explores their perspectives on the barriers and facilitators of management of a child with T1D in a resource-constrained setting. Methods This qualitative study, conducted in a tertiary level diabetes clinic in India, included parents of children with T1D, selected from subgroups varying in disease duration, education, habitat, and socioeconomic status, who participated in one of the five Focused Group Discussions (FGDs) of 60–90 min duration. The topic guide included questions like "What are the barriers you face related to diabetes care of your child at home or school?" and "What do you think helps you in managing a child with diabetes?" FGDs were audio-recorded, transcribed verbatim, and inductive coding was done independently by two authors. Results Twenty-eight parents (nineteen mothers and nine fathers, mean age: 35.1 years) of children aged between 2–13 years, were recruited till data saturation. Themes related to barriers of management were, ‘balancing nutrition and glycemic control is challenging’, ‘diabetes management involves psychological burden’ and ‘operational challenges’. Parents opined that family support, gaining decision-making and problem-solving attitude and optimal school-time management helped. Conclusion Parents living in resource-constrained circumstances perceive unique challenges during management of T1D in their children like social stigma, illiteracy, financial and logistic issues like procuring and storing essential supplies. A better understanding of these factors can aid healthcare professionals in managing them.