Parent and adolescent perspectives on decision-making involvement: A qualitative comparison in sickle cell and diabetes clinics.

This randomized controlled trial evaluated the effects of a digital diabetes clinic continuous support program on metabolic, psychological, and social outcomes in individuals with type 2 diabetes who were recently initiated on insulin therapy. The study included 67 participants, with 35 in the intervention group and 32 in the control group. Data were collected at baseline, and at the third and sixth months using various instruments, including the Diabetes Individual Diagnosis Form, Hypoglycemic Confidence Scale (HCS), Hypoglycemia Fear Survey (HFS), Diabetes Empowerment Scale-Short Form (DES-SF), Psychological Insulin Resistance Scale (PIRS), Insulin Treatment Assessment Scale (ITAS), Perceived Social Support Scale (PSSS), and the Visual Analog Scale (VAS) for stress. The intervention group received digital education, counseling, continuous follow-up, and a structured daily self-management program over a 3-month period. 99% CIs were calculated for key outcome measures to support the interpretation and robustness of the results. The findings revealed significant improvements in the intervention group, including reductions in the frequency of hypoglycemia and hyperglycemia, emergency admissions, HbA1c, and lipid levels (P <.001). Furthermore, hypoglycemia fear and psychological insulin resistance decreased, while hypoglycemic confidence, diabetes empowerment, perceived social support, and stress levels significantly improved (P <.001). These results demonstrate that digital support programs delivered through a digital diabetes clinic can enhance treatment adherence, reduce anxiety, and improve self-management in individuals newly started on insulin, highlighting the effectiveness of telehealth in diabetes care. Newly initiated on insulin therapy, underscoring the potential of telehealth in diabetes care.

To help mitigate potential complications often experienced by adolescents with type 1 diabetes (T1D) during the transition to adult healthcare, transition care programs aim to provide developmentally appropriate healthcare, promote adolescent decision-making and self-care skills, and prepare adolescents for adult diabetes care. However, there is limited research considering parent/caregiver needs during the transition preparation process for adolescents with T1D.ObjectiveTo identify parent/caregiver perspectives prior to taking part in a transition care intervention involving group education sessions and peer support for parents/caregivers of adolescents with T1D.Design and SettingPre-intervention, semi-structured interviews were conducted with parents/caregivers of adolescents (14–16 years) with T1D followed in a tertiary care paediatric diabetes clinic and participating in a pilot, randomised controlled trial: The Group Education Trial to Improve Transition for Parents/Caregivers of Adolescents with T1D (ClinicalTrials.gov ID: NCT05445284). We conducted a reflexive thematic analysis to identify key aspects of the intervention that may help support parents/caregivers of adolescents with T1D during their transition to adult care.ParticipantsOf the 17 parents/caregivers randomized to the intervention group, 13 completed pre-intervention interviews.ResultsFour themes were generated from the parents/caregivers, including (1) Creating a Community of Learners (i.e., importance of fostering a bidirectional and supportive environment for parents/caregivers), (2) Psychological Perspectives of Parenting (i.e., acknowledgement of shifting parental/caregiver roles during adolescents’ transition), (3) Diabetes Management During Adolescence (i.e., identification of relevant diabetes education topics to be covered), and (4) Ideal Format and Delivery of the Program (i.e., practical recommendations for the logistics of the intervention).ConclusionsThe findings provide practical and pragmatic suggestions to refine the parent/caregiver-based transition of care intervention for a future, full-scale trial, including addressing parental/caregiver needs as they learn how to best support their adolescent with T1D during transition to adulthood. Future transition programmes for adolescents with T1D may also benefit by incorporating aspects of the current transition readiness program for parents/caregivers of adolescents with T1D.

Diabetes mellitus (DM) is a globally prevalent metabolic disorder with rising incidence. Diabetic peripheral neuropathy (DPN), the most common microvascular complication in DM, disrupts autonomic nervous system regulation of cardiac and circulatory functions, thereby increasing susceptibility to cardiovascular and cerebrovascular events. Elucidating the relationship between diabetic DPN and cardiovascular complications is critical for optimizing holistic management of diabetic patients. This study aimed to investigate the correlation between DPN and cardiovascular events in patients attending the Diabetes Clinic of Rafsanjan University of Medical Sciences, Iran. In this cross-sectional study, 260 patients with type 2 diabetes mellitus (T2DM), diagnosed per the American Diabetes Association (ADA) 2023 criteria, were enrolled via convenience sampling. The patients with cardiovascular complications group comprised 121 patients with T2DM and documented cardiovascular events, while the control group included 138 patients with T2DM and no cardiovascular history. Data on demographic characteristics, body mass index (BMI), blood pressure, clinical laboratory parameters, and neuropathy severity (assessed via the Michigan Neuropathy Screening Instrument [MNSI]) were collected. Statistical analysis was performed using SPSS version 22. The patients with cardiovascular complications had significantly higher neuropathy scores (p = 0.039), longer diabetes duration (p < 0.05), greater prevalence of hypertension (p < 0.001), and elevated serum creatinine (p = 0.020) compared to those without cardiovascular complications. In multivariable logistic regression, severe diabetic neuropathy (score > 4) was associated with increased odds of cardiovascular complications in the unadjusted model (OR = 1.73, 95% CI: 1.03-2.91) and after adjustment for demographic and lifestyle factors (adjusted OR = 2.07, 95% CI: 1.07-3.97; p = 0.030). A significant crude association was also observed for each one-unit increase in continuous neuropathy score (OR = 1.09, 95% CI: 1.01-1.18; p = 0.021). A significant association was found between peripheral neuropathy and increased odds of cardiovascular disease in T2DM patients. This underscores the potential role of neuropathy as a marker for cardiovascular risk. Further longitudinal studies are warranted to explore the mechanistic interplay between neuropathy progression and cardiovascular outcomes.

This quasi-experimental study examined the impact of computer-based cognitive rehabilitation on executive functions and brain flexibility in patients with diabetes. Thirty diabetic patients attending a diabetes clinic in Yazd were randomly assigned to intervention (n=15) and control (n=15) groups. The intervention group received 10 sessions of Attentive Rehabilitation of Attention and Memory (ARAM) over four weeks, while the control group received routine clinical care. Executive functions and brain flexibility were assessed at pre-test, post-test, and one-month follow-up using the Wisconsin Card Sorting Test. Mixed analysis of variance showed significant improvements in categories correctly sorted and reductions in perseverative errors in the intervention group compared to controls at post-test and follow-up. These findings indicate that structured cognitive rehabilitation can enhance executive functioning and brain flexibility in diabetic patients, potentially mitigating diabetes-related cognitive deficits.​

Knowledge of advanced carbohydrate counting among individuals with type 1 diabetes (T1D) is essential for achieving optimal glycaemic control. Our aim was to study, among individuals with T1D and their parents, knowledge of and adherence to carbohydrate counting and to investigate factors that might affect their knowledge and adherence. This was a cross-sectional questionnaire-based study in which a PedCarbQuiz (PCQ) questionnaire to test for carbohydrate counting knowledge was distributed to individuals with T1D seen at the paediatric diabetes clinic at Jordan University Hospital between February 2022 and January 2023. The possible associations between clinical and socioeconomic factors and the PCQ score were studied. Possible predictors of high scores and adherence were assessed using logistic regression analysis. The average knowledge score was 59.4±12.8 out of 78. Diabetes duration was negatively correlated with knowledge score and adherence. A higher frequency of blood glucose testing was associated with a higher score (p=0.006) and better adherence (p<0.001). Glycated haemoglobin was negatively correlated with the knowledge score (Pearson correlation=-0.233; p<0.001). A higher knowledge score was associated with a higher parental educational level and family income. The predictors of the knowledge score were diabetes duration and income. The predictors of adherence were diabetes duration and the number of clinic visits during the pastyear. Knowledge of advanced carbohydrate counting among individuals with T1D was associated with higher socioeconomic status. A longer duration of diabetes was associated with a lower knowledge score, which was associated with poorer glycaemic control.

This study investigated the association and discriminative ability of six surrogate insulin resistance (IR) indices-TyG, TyG-BMI, TyG-WC, TyG-WHtR, METS-IR, and the TG/HDL-C ratio-for hypertension (HTN) in patients with type 2 diabetes (T2D). This cross-sectional, age- and gender-matched case-control study included 4236 patients with T2D (2167 with HTN and 2069 without) who attended a diabetes clinic between January 2014 and December 2024. Associations between surrogate IR indices and HTN were assessed using RCS and multivariable logistic regression. Discriminative ability and calibration were evaluated using ROC and calibration plots. The NRI and IDI analyses quantified the incremental value beyond a basic model. Each surrogate IR index showed a significant non-linear association with HTN. After adjusting for confounding factors, the ORs for HTN increased with higher values of each index. All indices demonstrated significant discriminative ability (AUCs > 0.690), with TyG-BMI showing the highest AUC (0.698; 95% CI: 0.664-0.733). A TyG-BMI cutoff of 144.5 identified HTN with 61% sensitivity and 71% specificity (p < 0.001). Calibration was relatively good, and the addition of surrogate IR indices to the basic model (age, gender, diabetes duration, LDL-C, HbA1c, and eGFR) significantly improved HTN identification. These findings support the use of surrogate IR indices as practical tools for identifying and assessing the risk of HTN in patients with T2D and highlight the potential role of IR in the development of HTN.

The Diabetic Clinic in Rajshahi and the Department of Preventive and Children Dentistry at Bangabandhu Sheikh Mujib Medical University (BSMMU) in Dhaka conducted a cross-sectional study from April to December 2023. Examining the role of chewing tobacco, betel nut, or both in the development of a higher periodontal index was the goal of the study. Between the ages of 19 and 79, 34 men and 47 women made up the study population. A semi-structured questionnaire was used for interviews and oral examinations to collect the data. The statistical analysis was conducted using SPSS 16.0. According to the study’s findings, every participant brushed their teeth on a frequent basis. Among the targeted diabetic individuals, the study revealed an intriguing correlation between tobacco use and chewing betel nut and periodontitis. It is believed that tobacco and betel nut users may benefit diabetics’ periodontal health in light of the study’s link. Nevertheless, more research is advised to ascertain the effects of tobacco and betel nut in lowering blood sugar and, consequently, periodontitis in diabetics. Journal of Dentistry and Allied Science, Vol. 8 No 2: 67-76

Introduction: Elevated AMH level is considered an indicator of anovulation in PCOS. It is postulated that the use of insulin sensitizers will lead to a reduction in insulin resistance, hyperandrogenism and consequently AMH levels, as a result of ovulation induction in these patients. Aims: The study aimed to determine the impact of therapy with the insulin sensitizers, Metformin and Myoinositol, on Anti-Mullerian hormone and to determine its association with insulin resistance in women with polycystic ovary syndrome. Material and methods: A prospective, randomized, clinical study was conducted at the University Clinic for Endocrinology, Diabetes and Metabolic Diseases in Skopje, in the period 2022/2023. The study included 64 women, aged 18 to 40 years, diagnosed with polycystic ovarian syndrome, according to the 2003 Rotterdam criteria. Patients were divided into two groups: group A received Metformin 1500 mg XR, and group B was on Myoinositol 2 gr TID, during 6 months. The parameters BMI, AMH, HOMA-IR (homeostasis model assessment index) and FAI (free androgen index) were monitored. Results: After completion of treatment, a significant decrease in AMH levels was observed in both groups - group A (p=0.0012) and group B (p=0.0014). This was accompanied with decline in HOMA IR and FAI values after the end of treatment in both groups. Conclusion: In line with the results obtained, AMH could be considered a marker of the efficacy of treatment with insulin sensitizers in PCOS.

Diabetic peripheral neuropathy (DPN) is one of the most significant chronic complications in people with diabetes. It is a highly heterogeneous condition that affects various parts of the nervous system and presents with a wide range of symptoms. Early diagnosis of diabetic neuropathy is possible if regular screening for this complication is conducted using modern diagnostic methods. Every diabetes clinic should perform annual screening for DPN to identify the risk of diabetic foot disease using a monofilament and tuning fork (or biothesiometer). The treatment of diabetic neuropathy remains limited, as studies on causal therapy have shown conflicting results. In most cases, treatment is restricted to achieving optimal glucose control, symptomatic therapy and the management of the painful form of diabetic neuropathy. Ultimately prevention of complications secondary to neuropathy is paramount and it can lead to foot ulcerations, deformities and amputations.Diabetic neuropathy represents a major health challenge for individuals with diabetes, necessitating ongoing research and public health initiatives aimed at improving screening, prevention and treatment strategies.

Diabetic neuropathy has an estimated prevalence of 50% among individuals with longstanding diabetes, with distal symmetric polyneuropathy (DSPN) being the most common manifestation. Poor glycaemic control is a recognised risk factor for DSPN. This study aimed to determine the prevalence of symptomatic DSPN in patients with type 2 diabetes mellitus (T2D) using a validated symptom-screening questionnaire - the diabetic neuropathy symptom (DNS) score. In addition, the association between haemoglobin A1c (HbA1c) and DSPN was investigated. A cross-sectional study was performed at the diabetes clinic at Helen Joseph Tertiary Hospital, Johannesburg, South Africa. A total of 206 consecutive patients with T2D were included. Underlying comorbidities and HbA1c values were obtained from patient records. The DNS score was used to assess for the presence of symptomatic DSPN. The prevalence of symptomatic DSPN was 61.2%. Among those who screened positive for DSPN, 58% were not receiving pharmacological treatment for DSPN. Patients with HbA1c values of 7% - 10% and 10% were 2.9 and 3.7 times, respectively, likely to have DSPN (prevalence ratio [PR] = 2.9; 95% confidence interval [CI] 1.5-5.4,p= 0.001; PR = 3.7; 95% CI 2.0-7.0,p 0.001, respectively), compared with those with an HbA1c value 7%. A higher than expected prevalence of symptomatic DSPN was observed in this study population, indicating the need for enhanced screening. Furthermore, a significant proportion of symptomatic patients were not receiving treatment. Poor glycaemic control with HbA1c values 7% significantly increases the risk of DSPN.Contribution:The DNS score can easily be implemented at a primary care level to detect symptomatic neuropathy and facilitate prompt treatment.

Introduction: Type 1 diabetes mellitus (T1DM) is a condition requiring lifelong insulin therapy and specialized care. Access to endocrinologists remains limited, leaving many primary care providers (PCPs) to manage insulin therapies and diabetes technologies. Pharmacists have demonstrated effectiveness in type 2 diabetes management, yet their role in T1DM within primary care remains underexplored. This study evaluated the impact of a pharmacist-led intervention for adults with T1DM in a primary care setting lacking in-house endocrinology services. Methods: This retrospective cohort study reviewed electronic health records of adults with T1DM referred to a clinical pharmacist in 2023. Individuals with ≥2 PCP visits, ≥2 A1c results, and ≥1 pharmacist consultation were included. The pharmacist provided individualized assessments, insulin adjustments, and technology counseling under a collaborative practice agreement. The primary outcome was change in A1c at 3-6 months post-consultation. Secondary outcomes included subgroup analyses by insulin delivery methods, visit frequencies and A1c comparison with non-referred T1DM patients. Results: Thirty-eight patients met inclusion criteria. Referred patients experienced a mean A1c reduction from 8.8% to 8.2% (-0.6%, 95% CI: -1.00 to -0.12; P = .013) at 3-6 months. No significant differences were observed in continuous glucose monitoring metrics or visit frequency. Compared with 49 non-referred patients, referred individuals initially had poorer glycemic control but showed convergence over time. Discussion: Pharmacist integration into primary care significantly improved glycemic outcomes for adults with T1DM, particularly in underserved regions with limited endocrinology access. This collaborative model may offer a scalable solution to expand advanced diabetes management in primary care.

BackgroundThe COVID-19 pandemic has intensified the burden of noncommunicable diseases, particularly diabetes mellitus. This study aims to examine the impact of the COVID-19 pandemic on the trend of diabetic care and its indices in Iran by comparing the periods before and during the pandemic.MethodsIn this trend analysis study, we used data from the National Program for Prevention and Control of Diabetes (NPPCD) database from March 2017 to June 2021 alongside national data on COVID-19 infection and mortality from February 2020 to June 2021. The t-test and general linear models were used to compare diabetes care indices before and during the COVID-19 pandemic and to analyze the weekly and monthly trends of visits in relation to COVID-19 infection and mortality, respectively.ResultsThe results of this study revealed significant disruptions in outpatient diabetic care during the COVID-19 pandemic. The average weekly visits to diabetes outpatient clinics showed an inverse trend to COVID-19 infections and deaths. Comparing the pre-pandemic to the pandemic period, a notable shift observed in the gender distribution toward an increase in male patients (from 32.82% pre-pandemic to 35.94% during the pandemic, p-value, 0.018). Smoking prevalence rose significantly from 4.65% to 5.86% (p-value = 0.001). Hyperlipidemia decreased from 54.36% to 46.77% (p-value < 0.001), and metabolic syndrome prevalence declined from 63.2% to 61.98% (p-value < 0.001). Cardiovascular disease decreased from 21.04% to 18.63% (p-value = 0.013), while hypertension increased from 35.61% to 38.54% (p-value = 0.023). Regarding glucose-lowering therapies, the use of oral medications dropped significantly from 83.73% pre-pandemic to 78.94% during the pandemic (p-value < 0.001), while insulin use increased from 38.91% to 46.75% (p-value < 0.001). Analysis of laboratory findings showed a significant reduction in LDL > 100 mg/dl (36.69% to 33.03%, p-value = 0.006) and TG > 150 mg/dl (49.59% to 48.79%, p-value = 0.006). However, no significant differences were observed in HbA1c > 7% or diabetic complications (p-value > 0.05).ConclusionThe COVID-19 pandemic has profoundly impacted the care and management of diabetic patients in Iran, leading to contrasting trends in various diabetic care indices among diabetic patients who receive care in outpatient diabetes clinics. Notable improvements were observed in the prevalence of CVD, hyperlipidemia, and metabolic syndrome, while the prevalence of smoking and hypertension deteriorated. These findings underscore the need for adaptable healthcare strategies, especially for managing chronic conditions during health crises. Further studies are necessary to evaluate the long-term effects of the pandemic on diabetic care and patient outcomes.

IntroductionYoung adults living with type 1 diabetes face unique challenges as they transition to greater independence, balancing diabetes management in all other dimensions of life. In Sweden, the transfer from pediatric to adult diabetes care at the age of 18 adds to these challenges. This study aimed to translate and evaluate the Swedish version of the T1DAL (Type 1 Diabetes and Life) self-report questionnaire for young adults living with type 1 diabetes.Method and MaterialsThe T1DAL questionnaire was translated into Swedish and was completed by 191 young adults aged 18–25 who were registered at a diabetes clinic in three Swedish hospitals. An expert group tested content validity. To determine the number of underlying factors, a parallel analysis (PA) was conducted. The questionnaire’s latent structure was further examined through exploratory factor analysis, in which the items were constrained to a four-factor solution as recommended and found in the original version.ResultsThe content validity index of the total score was 0.94. The response distribution analysis revealed the presence of floor or ceiling effects. An EFA with a four-factor solution was conducted, yielding a Model Fit Measure with a χ² of 326.68 and df = 249, resulting in a cmin/df of 1.31, an RMSEA of 0.04, and a TLI of 0.92. Internal consistency was assessed for the subscales suggested by the factor structure, based on the items that loaded onto each factor. Cronbach’s alpha values ranged from 0.75 to 0.89, indicating acceptable to high internal consistency. The four-factor solution explained 45.04% of the total variance.ConclusionThe Swedish T1DAL questionnaire showed good factorial validity and reliability. The Swedish version requires further testing with potential item reduction; however, it is still expected to be valuable in assessing health-related quality of life among young adults living with type 1 diabetes.Clinical implicationsThe Swedish T1DAL questionnaire, particularly its domains related to emotional experiences, managing diabetes effectively, and peer relationships outlines the characteristics of young adulthood and can be used to empower the target group, and is expected to be feasible to implement in clinical practice.

Background: The relationship between glycaemia and the variables of haematocrit, serum total protein and lipids possibly plays a role in pathological processes and hence is a subject of interest. Estimated blood viscosity causes impaired blood flow and is a factor in other vascular diseases. Blood viscosity is correlated with glycated haemoglobin, but the mechanism of this association has not been extensively investigated. Objective: To assess if changes in glycated haemoglobin translate into changes in blood viscosity through impact on haematocrit, serum protein or dyslipidaemia. Method: This was a clinical laboratory-based retrospective data analysis of patients attending a diabetic clinic. Analysis involved seven variables comprising serum total protein level, high-density lipoprotein cholesterol, total cholesterol, triglyceride, age and glycated haemoglobin. The statistical evaluations were descriptive, comparative and correlational. Results: A total of 12,986 sets of data represented the participants in this study. After excluding three with incomplete data of interest, the groups that were created for comparison comprised the following: good glycaemic control (2694), moderate glycaemic control (4075) and poorly controlled (6194). Serum levels of high-density lipoprotein cholesterol, total cholesterol, haematocrit and proteinaemia gradually decreased with worsening glycaemic control, while serum triglyceride and age increased. In the correlation analysis, serum triglyceride level was positively correlated with glycated haemoglobin r = 0.177, while haematocrit and proteinaemia were negatively related, at −0.045 and −0.103, respectively. Conclusions: Increase in glycated haemoglobin was inversely related to haematocrit and proteinaemia; therefore, this did not always increase with the determinants of estimated whole blood viscosity. The implication of this is that further studies are required to substantiate the observation of higher whole blood viscosity levels in patients with poorly controlled diabetes.

Thanks to the efforts made in the last century many patients with Type 1 Diabetes (T1D) are reaching and surpassing the age of 75, however, data on their clinical characteristics, prevalence of diabetes complications and quality of care are lacking. This multicenter, observational, retrospective study includes data from participants with T1D aged over 75 years, regularly evaluated in the year 2023 in 296 Diabetes Clinics in Italy included in the Associazione Medici Diabetologi (AMD) Annals Initiative. Socio-demographic characteristics, data on glycemic, lipid, and blood pressure control, data on the current insulin therapy regimen, the use of insulin pumps, as well as data on the prevalence of microvascular and macrovascular complications of diabetes was evaluated. Additionally, we evaluated some indicators of quality of care. We included 2443 participants with mean age of 79.9 ± 3.9 years, in prevalence (54.9%) female. The mean duration of diabetes was 34.1 ± 17.5 years. Participants were evaluated regularly in person at the diabetes clinic on average 2.7 ± 2.1 times per year. 5% of participants were treated with insulin pumps. Mean glycated hemoglobin (HbA1c) was 7.8 ± 1.1. In comparison to standard therapy, better glycemic control was seen in participants on insulin pumps. Despite the high prevalence of diabetic retinopathy (33.3%) and chronic kidney disease (CKD) (39%) only a small portion of participants presented with end-stage complication, with 2.3% of participants having Proliferative Retinopathy (0.4% vision loss), 0.3% being on dialysis, and 2.5% having a history of amputation or foot ulcer. Cardiovascular disease was detected in 17.8% of participants. 77% of participants with previous CV event were treated with anti-platelet therapy. 68% of participants with proteinuria were treated with renin-angiotensin-aldosterone system (RAAS) inhibitors. LDL target of < 100mg/dl was achieved in almost 2/3 of participants. Overall quality of care, expressed as Q-Score, was 27.4 ± 8.2. Our data show that a consistent number of T1D participants regularly followed up by Italian diabetes centers reached an advanced age. The overall quality of care for participants regularly followed was good, within a lower-than-expected burden of end-stage renal disease, visual loss, and diabetic foot. Management of CV risk factors could be improved, as well as the use of technology in this setting.

BackgroundMaintaining optimal glycemic control in pregnant women with type 1 diabetes (T1D) remains a clinical challenge despite advancements in technology. Although not all automated insulin delivery (AID) systems are approved for gestational use, their use has increased in clinical practice. Limited real-world data exists on their effectiveness and safety throughout pregnancy as well as delivery.MethodsRetrospective case series including ten women with T1D who used AID systems (MiniMed 780G or Control-IQ) from preconception or early pregnancy through delivery at a single Italian Diabetes and Pregnancy Clinic between January 2020 and March 2025. Glucose metrics were analyzed from data-sharing portals across five time points (preconception, each trimester and delivery). Anthropometric data, safety and pregnancy outcomes were also evaluated.ResultsMean preconception HbA1c was 7.2 ± 1.0% and improved to 6.2 ± 0.3% by the third trimester. Time in range rose progressively, averaging 70.7 ± 11.2% in late pregnancy, with 5/10 individuals achieving the > 70% target. Coefficient of variation and time above range decreased with no severe hypoglycemia. Most women maintained AID mode during labor; mean TIRp at delivery was 70.1 ± 14.6%. Neonatal outcomes were generally favorable, with no stillbirths or neonatal deaths.ConclusionsAID systems can efficiently and safely support glycemic control during pregnancy and delivery in women with T1D when guided by expert teams and specific protocols. Although not currently approved for use during pregnancy, these systems may represent a viable alternative to pregnancy-specific algorithms.

Exploring the interpretive processes of symptom perception among diabetes patients in eastern region of Ghana

Acromegaly in the diabetes clinic

Background: This study aimed to investigate the relationship between stigma associated with type 2 diabetes and subjective well-being measures (life satisfaction and positive/negative affect) mediated by emotional stress and illness perception in people with type 2 diabetes. Methods: The present research was descriptive based on correlation models. The statistical population included patients with type 2 diabetes who referred to the diabetes clinic of Ayatollah Taleghani hospital in Kermanshah, 207 adults were selected using the convenient sampling method and data were collected using questionnaires Type 2 Diabetes Stigma Assessment Scale (DSAS-2) (Browne et al., 2016), life satisfaction (Diener, 1985), Positive/Negative Affect Schedule (Watson et al., 1988), Illness Perception (Broadbent et al., 2006) then analyzed with SPSS and Amos software. Results: The results showed that there was a significant relationship between stigma, life satisfaction, and positive/negative affect (P &lt; 0.01). Stigma was also able to predict life satisfaction indirectly and negatively through emotional distress, and negative affect indirectly and positively through emotional distress and illness perception. Conclusion: The results indicate the need for interventions to reduce the stigma associated with type 2 diabetes and improve the mental well-being of people with this disease