Diabetes Consultations Research Articles

Integrating Gender-Affirming Care in a Medical Spanish Endocrine System Curriculum.

With a growing Hispanic population in the United States, medical education is adapting to provide the necessary language skills and cultural competence for effective health care. However, the incorporation of gender-affirming care in the context of medical education for Hispanic populations requires further emphasis. This curriculum presented a 3-week medical Spanish endocrine system module designed for first-year medical students. The module aimed to enhance students' ability to communicate effectively with Spanish-speaking patients about endocrine health while integrating principles of gender-affirming care. It included classroom sessions, standardized patient practice, and clinical practice with peer tutors. Pre- and postmodule surveys and assessments were conducted to evaluate the module's effectiveness. Out of 76 participants, 72 completed the postmodule evaluation. Survey results indicated significant increases in confidence levels across various aspects of patient interaction in Spanish, with statistically significant gains observed in all assessed areas. Knowledge test outcomes revealed enhanced proficiency in Spanish terminology related to the endocrine system, with scores increasing from an average of 22.3 premodule to 25.7 postmodule (p = .002), as measured by the paired t test. Additionally, students performed well in the diabetic consultation objective structured clinical examination station, with a high mean score of 86%, surpassing the satisfactory threshold. This curriculum highlights the success of a comprehensive educational approach in expanding medical students' language proficiency and ability to provide gender-affirming care to address health care disparities and improve patient outcomes among diverse populations.

Treatment switch from multiple daily insulin injections to sulphonylureas in an African young adult diagnosed with HNF1A MODY: a case report

BackgroundMaturity onset diabetes of the young is one of the commonest causes of monogenic diabetes and can easily be mistaken for type 1 diabetes. A diagnosis of maturity onset diabetes of the young can have direct implications for genetic counseling, family screening, and precision diabetes treatment. However, the cost of genetic testing and identifying individuals to test are the main challenges for diagnosis and management in sub-Saharan Africa. We report the very first documented case of HNF1A maturity onset diabetes of the young in the sub-Saharan African region.Case presentationA 20-year-old female Black African young adult diagnosed with type 1 diabetes aged 14 presented for routine out-patient diabetes consultation. She was on multiple daily insulin injections; total combined dose 0.79 IU/kg/day with an HbA1c of 7.7%. The rest of her laboratory examinations were normal. On extended laboratory analysis, she had good residual insulin secretion with post-meal plasma C-peptide levels at 1150 pmol/L. She tested negative for glutamic acid decarboxylase (GAD65), islet antigen-2 (IA-2), and zinc transporter 8 (ZnT8) islet autoantibodies. Targeted next-generation sequencing (t-NGS) for monogenic diabetes was performed using DNA extracted from a buccal sample. She was diagnosed with HNF1A maturity onset diabetes of the young, with the c.607C > T; p.(Arg203Cys) pathogenic variant, which has never been reported in sub-Saharan Africa. Her clinical practitioners provided genetic and therapeutic counseling. Within 10 months following the diagnosis of maturity onset diabetes of the young, she was successfully switched from multiple daily insulin injections to oral antidiabetic tablets (sulphonylurea) while maintaining stable glycemic control (HBA1c of 7.0%) and reducing hypoglycemia. She expressed a huge relief from the daily finger pricks for blood glucose monitoring.ConclusionThis case reveals that HNF1A maturity onset diabetes of the young (and probably other causes of monogenic diabetes) can present in sub-Saharan Africa. A diagnosis of maturity onset diabetes of the young can have significant life-changing therapeutic implications.

Barriers and system improvements for physical activity promotion after gestational diabetes: A qualitative exploration of the views of healthcare professionals.

Physical activity is an important behaviour for managing the ten times increased risk of type 2 diabetes after gestational diabetes. Previous studies exploring physical activity promotion in healthcare focus on general practitioners but have not explored the gestational diabetes pathway. Therefore, this paper explores the barriers to and suggestions for, activity promotion along the gestational diabetes healthcare pathway. The paper was written in accordance with the Standards for Reporting Qualitative Research. Patient and Public Involvement with women who had lived experiences of gestational diabetes informed purposeful sampling by identifying which healthcare professional roles should be targeted in participant recruitment. Participants were recruited through word-of-mouth, that is, email and connections with local healthcare service leads. Twelve participants took part in semi-structured one-to-one interviews, analysed using reflexive thematic analysis. Participants included a Public Health Midwife (n = 1), Diabetes Midwifes (n = 3), Diabetes Dietitian (n = 1), Diabetes Consultants (n = 2), Diabetes Specialist Nurse (n = 1), general practitioners (n = 2), Practice nurse (n = 1) and a Dietitian from the UK National Diabetes Prevention Program (n = 1). Six themes were generated: 'management of gestational diabetes takes precedent', 'poor continuity of care', 'lack of capacity to promote PA', 'beliefs about the acceptability of PA promotion', 'resources to support conversations about PA' and 'adapting healthcare services for women post-gestational diabetes'. During pregnancy messaging around physical activity is consistent, yet this is specific for managing gestational diabetes and is not followed through postnatally. Improvements in continuity of care are necessary, in addition to ensuring the availability and links with wider exercise and activity schemes.

Asking women with diabetes about sexual problems: An exploratory study of NHS professionals' attitudes and practice: A survey of healthcare professionals regarding communication and silences about sexual problems during the routine care of women with diabetes.

To explore UK healthcare professionals' practice and attitudes towards asking women with diabetes about sexual health problems, including symptoms of female sexual dysfunction (FSD). An online questionnaire to address the study aims was developed, piloted by ten healthcare professionals (HCPs) and completed by 111 eligible HCPs, recruited via professional networks and social media. Free text data were analysed and reported thematically. Two questions were analysed to test the hypothesis of differences between men's and women's responses. The majority of respondents did not ask women with diabetes about sexual problems. Multiple barriers to inquiry were reported, including inadequate training, time constraints, competing priorities, the perceived likelihood that questions will cause surprise or distress (especially for certain groups of women), the belief that sexual problems are to be expected as women age, and the belief that FSD is complex or untreatable, with unclear management pathways. Exploratory findings indicated significant differences in men and women's responses (men disagreed more strongly with prioritisation, and fewer reported routine inquiry about sexual problems in their usual practice). HCPs reported not asking women with diabetes about sexual problems during routine care. They described multiple factors reinforcing the silence about sexual health, including inadequate education and perceived social risk for individual HCPs who deviate from the patterns of topics usually discussed in diabetes consultations.

Healthy food delivery for type 2 diabetes management in rural clinics' patients: A comparative effectiveness randomized controlled trial protocol

BackgroundRural populations experience a higher prevalence of both food insecurity and type 2 diabetes mellitus (T2DM) than metropolitan populations and face many challenges in accessing resources essential to optimal T2DM self-management. This study aims to address these challenges by delivering a T2DM-appropriate food box and recipes directly to rural participants' homes. MethodsThis is a comparative effectiveness randomized controlled trial including 400 English- or Spanish-speaking rural adult participants with T2DM (HbA1c ≥6.5%) experiencing food insecurity. Participants are randomly assigned to a 3-month Healthy Food Delivery Intervention (HFDI) plus one 60-min virtual consultation with a diabetes educator or consultation only. The HFDI includes a weekly food box delivery with recipes. Data are collected at pre-intervention, 3-months (post-intervention), 9-months, and 15-months. The primary outcome is change in HbA1c, with secondary measures including diet quality (Healthy Eating Index-2015, calculated from one 24-h dietary recall at each data collection time point), cardio-metabolic risk factors (i.e., blood pressure, lipids, body mass index, glucose), and patient-centered outcomes (e.g., T2DM self-efficacy, T2DM-related distress). Process evaluation data (e.g., successful food box deliveries, diabetes educator consultation attendance, intervention satisfaction) are collected during and post-intervention (3-months). A cost-effectiveness analysis based on traditional cost per quality-adjusted life year gain thresholds will be conducted to estimate the incremental cost-effectiveness between HFDI plus consultation and consultation alone. ConclusionFindings from this study will provide evidence regarding the effectiveness of an intervention that promotes participant adherence and improves access to healthy food.Clinical Trial Registration:NCT04876053

Correlation of Serum levels of Chromium, Copper, and Manganese with the Glucose levels in Type 2 Diabetes Mellitus in Iraq

Correlation of Serum levels of Chromium, Copper, and Manganese with the Glucose levels in Type 2 Diabetes Mellitus in Ira Background: The metabolism of many trace elements such as chromium, copper, and manganese were reported to be altered in type 2 diabetes militates. This element may have specific roles in the pathogenesis and progress of this disease. Objectives: To evaluate the serum levels of copper, chromium, and manganese in type 2 diabetic patients in Iraq. Patients and Methods: This case-control study included 100 type 2 diabetic patients, 35-60 years old, with high BMI as cases, and 100 non-diabetic subjects as controls who were healthy volunteers not suffering from type 2 diabetes (staff and student). The data was collected from October 2022 until January 2023. The cases were seen in the Diabetes Consultation Unit / Baghdad Teaching Hospital / Medical City. Serum chromium, copper, and manganese were measured using atomic absorption. ELISA was used to test for insulin. spectrophotometry to measure glucose and HPLC was used to measure whole-blood HbA1c. Insulin resistance was calculated using the semi-empirical formula: HOMA-IR = glucose * insulin / 405 (glucose in mg/dl). To test for the difference between means of numerical data across several parameters, ANOVA tests were utilized. Pearson’s. correlation was used to test the correlation between variables. Results: Diabetics had higher HbA1c, serum copper (P value<0.01), and blood glucose than healthy controls. Compared to controls, diabetics had lower serum chromium (P value<0.01) and manganese (P value < 0.01). In diabetics, chromium and manganese are highly negatively correlated with insulin resistance. Copper levels increase with increasing insulin resistance. Insulin levels were greater in type 2 diabetics (18.6 ± 4.1mlU/L) than in the control (6.2 ± 1.3) (p <0.01). Conclusions: Serum copper was high while serum chromium and manganese were low in type 2 diabetics. that indicates that these elements may have a role in the occurrence and development of type 2 diabetes. Received: May, 2023 Accepted: Oct., 2023 Published: Jan., 2024

Use of a Data-Sharing System During Diabetes Consultations.

Patient-gathered self-management data and shared decision-making are touted as the answer to improving an individual's health situation as well as collaboration between patients and their providers leading to more effective treatment plans. However, there is a gap between this ideal and reality - a lack of data-sharing technology. Here, we present the impact that the FullFlow System for sharing patient-gathered data during diabetes consultations, had on the patient-provider relationship and consultation discussion.

The prevalence of anxiety and depressive disorders in patients with diabetes

Introduction: Diabetes is a common chronic metabolic pathology that affects 7.3% of Moroccans. Many epidemiological studies have shown that diabetes and anxiety-depressive disorders are associated in a non-random way and complicate each other. Materials and methods: We conducted a cross-sectional study to the prevalence of depressive episode and anxiety in diabetic patients, and to trace their sociodemographic and medical profile. The study included 130 patients from the diabetes endocrinology department and the diabetes consultation of the Avicenna Military Hospital of Marrakech. The scale used was the HADS (Hospital Anxiety and Depression Scale) in its Arabic version. Sociodemographic and diabetes characteristics were collected by hetero-questionary. Results: The average age of our patients was 50.5 years, 52% were female. The prevalence of depressive disorder was 43% and that of anxiety disorder 50%. Data analysis showed some significant results by highlighting the factors associated with anxiety and depressive disorders: Factors related to sociodemographic characteristics (age and gender), socioeconomic characteristics (professional activity) and medical characteristics (Comorbidities, toxic antecedents and family antecedents of diabetes) characteristics related to the pathology itself (type and age of diabetes, its acute and chronic complications and the therapeutic regime). Conclusion: The research and treatment of anxiety-depressive disorders in diabetic patients should be systematic in order to improve the management and prognosis of diabetes.

Endocrinologists’ use of patient-reported outcome measures in the care of people with diabetes: A qualitative study

AimsDiabetesFlex Care is a patient-reported outcome (PRO)-based telehealth service for adults with type 1 diabetes, intended to enable patient perspectives in consultations. The study aimed to explore endocrinologists' experiences of using PRO to support dialog in diabetes consultations. MethodsThematic analysis was conducted on data from participant observations and semi-structured interviews with 13 endocrinologists engaging in DiabetesFlex consultations at a Danish hospital-based diabetes clinic. ResultsTwo themes were extracted: 'Perceiving PRO as ambiguous information' and 'Integrating PRO in the care for people with diabetes'. Endocrinologists perceived PRO as situational information with variable quality and validity, depending on patient competencies and commitment. Therefore, endocrinologists used different approaches to integrate PRO in their efforts to improve care for the individual patient. The study also showed that patients’ PRO-responses were rarely discussed among endocrinologists. ConclusionEndocrinologists experienced both potentials and challenges in using PRO to support diabetes consultations. To optimize DiabetesFlex Care and similar PRO-based diabetes consultations, a culture should be built up where clinicians share experiences to improve the quality and solve PRO-related problems in consultations.

Delivering Biopsychosocial Health Care Within Routine Care: Spotlight-AQ Pivotal Multicenter Randomized Controlled Trial Results.

Annual national diabetes audit data consistently shows most people with diabetes do not consistently achieve blood glucose targets for optimal health, despite the large range of treatment options available. To explore the efficacy of a novel clinical intervention to address physical and mental health needs within routine diabetes consultations across health care settings. A multicenter, parallel group, individually randomized trial comparing consultation duration in adults diagnosed with T1D or T2D for ≥6 months using the Spotlight-AQ platform versus usual care. Secondary outcomes were HbA1c, depression, diabetes distress, anxiety, functional health status, and healthcare professional burnout. Machine learning models were utilized to analyze the data collected from the Spotlight-AQ platform to validate the reliability of question-concern association; as well as to identify key features that distinguish people with type 1 and type 2 diabetes, as well as important features that distinguish different levels of HbA1c. n = 98 adults with T1D or T2D; any HbA1c and receiving any diabetes treatment participated (n = 49 intervention). Consultation duration for intervention participants was reduced in intervention consultations by 0.5 to 4.1 minutes (3%-14%) versus no change in the control group (-0.9 to +1.28 minutes). HbA1c improved in the intervention group by 6 mmol/mol (range 0-30) versus control group 3 mmol/mol (range 0-8). Moderate improvements in psychosocial outcomes were seen in the intervention group for functional health status; reduced anxiety, depression, and diabetes distress and improved well-being. None were statistically significant. HCPs reported improved communication and greater focus on patient priorities in consultations. Artificial Intelligence examination highlighted therapy and psychological burden were most important in predicting HbA1c levels. The Natural Language Processing semantic analysis confirmed the mapping relationship between questions and their corresponding concerns. Machine learning model revealed type 1 and type 2 patients have different concerns regarding psychological burden and knowledge. Moreover, the machine learning model emphasized that individuals with varying levels of HbA1c exhibit diverse levels of psychological burden and therapy-related concerns. Spotlight-AQ was associated with shorter, more useful consultations; with improved HbA1c and moderate benefits on psychosocial outcomes. Results reflect the importance of a biopsychosocial approach to routine care visits. Spotlight-AQ is viable across health care settings for improved outcomes.

Glucose Levels of the Oral Glucose Tolerance Test (oGTT) Can Predict Adverse Pregnancy Outcomes in Women with Gestational Diabetes (GDM).

Gestational diabetes (GDM) is a common pregnancy complication defined as a glucose intolerance diagnosis during pregnancy. GDM is strongly associated with adverse fetal and maternal outcomes. In Germany, to screen and diagnose GDM we use a 1 h 50 g oGCT (oral glucose challenge test) followed by a 2 h 75 g oGTT if the first was pathological. This analysis examines the correlation of 75 g oGTT glucose levels and fetomaternal outcome. Data from 1664 patients from a gestational diabetes consultation clinic at the Charité University Hospital in Berlin, Germany, were analyzed retrospectively from 2015 to 2022. The 75 g oGTT blood glucose levels were categorized into isolated fasting hyperglycemia (GDM-IFH), isolated post-load hyperglycemia (GDM-IPH) and combined hyperglycemia (GDM-CH), using the levels of the fasting, 1 h and 2 h values, after glucose application. These subtypes were compared based on their baseline characteristics as well as fetal and maternal outcome. GDM-IFH and GDM-CH women displayed higher pre-conceptional BMI and required insulin therapy more frequently (p < 0.001). The GDM-IFH group was at higher risk of having a primary cesarean section (p = 0.047), while GDM-IPH women were significantly more likely to have an emergent cesarean section (p = 0.013). The offspring of GDM-IFH and GDM-CH women were born with a significantly higher mean birthweight (p < 0.001) and birth weight percentiles (p < 0.001) and were at increased risk of being large for gestational age (LGA) (p = 0.004). Women from the GDM-IPH group delivered significantly more neonates who were small for gestational age (p = 0.027) or with low fetal weight <30th percentile (p = 0.003). This analysis shows a strong association between the glucose response pattern in the 75 g oGTT and adverse perinatal fetomaternal outcome. The differences among the subgroups, specifically concerning insulin therapy, mode of delivery and fetal growth, suggest an individualized approach to prenatal care after a GDM diagnosis.

Educational Interventions on Diabetic Foot Self-Care: A Study Protocol for a Pragmatic Randomized Controlled Trial

ABSTRACT Diabetic foot is one of the most serious complications of diabetes and foot ulcer recurrence has been associated with poor foot care. Educational programs may work as a vehicle for promoting knowledge and adequate foot self-care behaviors, reducing potential ulcerative complications in the diabetic foot, and promoting a better quality of life. This study protocol will analyze the impact of two different educational strategies – an instructive video (Experimental Group 1) compared to a foot care leaflet with real-time guided reading (Experimental Group 2) and standard care (Control Group) – on adherence and knowledge about diabetic foot care and patients’ perception of their foot health. This study is a Pragmatic Randomized Controlled Trial of a non-pharmacological treatment. Participants need to have a diabetic foot diagnosis and attend a Diabetic Foot Multidisciplinary Consultation at two hospitals from the North of Portugal. Participants will be assessed at the first appointment of the diabetic foot consultation (T0), two weeks after (T1), and three months later, at follow-up (T2). Primary outcomes will be adherence and knowledge about diabetic foot care and general foot health. Secondary outcomes will be illness representations regarding diabetic foot. The results of this study will inform educational interventions to decrease diabetic foot ulcers, amputation rates, and the costs associated with both, contributing to foot care adherence and improve patient’s quality of life.

Fukushima study for Engaging people with type 2 Diabetes in Behaviour Associated Change (FEEDBACK): study protocol for a cluster randomised controlled trial

BackgroundThe growing burden of type 2 diabetes mellitus (T2DM) and the rising cost of healthcare worldwide make it imperative to identify interventions that can promote sustained self-management behaviour in T2DM populations while minimising costs for healthcare systems. The present FEEDBACK study (Fukushima study for Engaging people with type 2 Diabetes in Behaviour Associated Change) aims to evaluate the effects of a novel behaviour change intervention designed to be easily implemented and scaled across a wide range of primary care settings.MethodsA cluster randomised controlled trial (RCT) with a 6-month follow-up will be conducted to evaluate the effects of the FEEDBACK intervention. FEEDBACK is a personalised, multi-component intervention intended to be delivered by general practitioners during a routine diabetes consultation. It consists of five steps aimed at enhancing doctor-patient partnership to motivate self-management behaviour: (1) communication of cardiovascular risks using a ‘heart age’ tool, (2) goal setting, (3) action planning, (4) behavioural contracting, and (5) feedback on behaviour. We aim to recruit 264 adults with T2DM and suboptimal glycaemic control from 20 primary care practices in Japan (cluster units) that will be randomly assigned to either the intervention or control group. The primary outcome measure will be the change in HbA1c levels at 6-month follow-up. Secondary outcome measures include the change in cardiovascular risk score, the probability to achieve the recommended glycaemic target (HbA1c <7.0% [53mmol/mol]) at 6-month follow-up, and a range of behavioural and psychosocial variables. The planned primary analyses will be carried out at the individual level, according to the intention-to-treat principle. Between-group comparisons for the primary outcome will be analysed using mixed-effects models. This study protocol received ethical approval from the research ethics committee of Kashima Hospital, Fukushima, Japan (reference number: 2022002).DiscussionThis article describes the design of a cluster RCT that will evaluate the effects of FEEDBACK, a personalised, multicomponent intervention aimed at enhancing doctor-patient partnership to engage adults with T2DM more effectively in self-management behaviour.Trial registrationThe study protocol was prospectively registered in the UMIN Clinical Trials Registry (UMIN-CTR ID UMIN000049643 assigned on 29/11/2022). On submission of this manuscript, recruitment of participants is ongoing.

Study of preferences of patients with diabetes regard to pharmaceutical services

Pharmacies are a component of the healthcare. Pharmaceutical care and pharmaceutical services improve disease control, quality of patients life and reduce of the burden on healthcare. The implementation of pharmaceutical care and pharmaceutical services for patients with diabetes according to the standards of the GPP is relevant for the domestic pharmacy. Therefore, it is advisable to determine the preferences of patients with diabetes because they have their own needs for treatment and control.&#x0D; The purpose of the study was to study the views of patients with diabetes regarding to function of pharmacies, pharmaceutical services and determine their preferences.&#x0D; The survey of patients with diabetes by the questionnaire method was carried out. Relevant questionnaires of 510 patients with type 1 and type 2 diabetes were included in the study.&#x0D; The results of the survey showed that the majority of patients with diabetes would like to be served in a specialized pharmacy that specializes in drugs and medical products for diabetes. On the basis of the study, the preferences of patients with diabetes regarding to the activities of pharmacies were determined: availability of a wide rang of product; loyalty program for special products related to diabetes, additional services and pharmaceutical consultations. The majority of those interviewed noted that they need a pharmacist's consultation on taking medications. This type of service requires training of pharmacists in diabetes in order to provide pharmaceutical care at an appropriate level. Pharmaceutical services which patients with diabetes need were identificated. There are: testing of blood glucose, cholesterol, blood pressure, weight check, calculation of body mass index and interpretation of results. The creation of a «diabetes self-management school» based on pharmacies will improve the availability of education for patients with diabetes. It is necessary to study the demand directly in the area of the pharmacy before introduction this type of service. It is important to implement systematic special events in pharmacies for the World Diabetes Day. Thes is appropriated for the general population, but also for patients with diabetes. From the point of view of patients with diabetes during this event, they are interested in: consultation of an endocrinologist and nutritionist; blood glucose test; test of diabetes risk; information materials about diabetes.&#x0D; The results of the survey can be prospectively used to improve the service of patients with diabetes and provide for their needs.

An Old Theme and New Technology: Marked Glucocorticoid-Induced Hyperglycemia in a Hospitalized Patient Uncovered Retrospectively by Her Flash Glucose Monitoring

Abstract Background Glucocorticoid-induced hyperglycemia is a problem-facing endocrinologists and internal medicine specialists in hospital wards. Case History A 63-year-old woman with type 2 diabetes was admitted to the hospital with acute exacerbation of chronic obstructive airway disease. She was treated with a short course of intravenous hydrocortisone followed by oral prednisolone. On discharge, she attended her regular diabetes consultation. Throughout the period, she had her flash glucose monitoring (FGM) sensor in place, and she was monitoring her blood glucose regularly. As part of her diabetes clinic routine, the meter data uploaded and ambulatory glucose profiles were examined. These revealed three distinctly different blood glucose levels before, during, and after glucocorticoid therapy. Glucocorticoid therapy resulted in a marked rise in blood glucose that lasted for a further week before it returned to the pre-treatment levels. This old phenomenon has yet to be demonstrated using the new FGM technology. Conclusions The story (1) asserts the significant impact of glucocorticoid therapy on glycemic control, (2) demonstrates the prolonged impact on glycemic control following discontinuation of glucocorticoids, (3) suggests a lack of adequate monitoring and timely recognition of hyperglycemia in the hospital, and poor management glucocorticoid-induced hyperglycemia either due to failure of conventional monitoring methods or a degree of complacency to appreciate its magnitude.

Hospital Readmission Risk and Risk Factors of People with a Primary or Secondary Discharge Diagnosis of Diabetes.

Hospital readmission among people with diabetes is common and costly. A better understanding of the differences between people requiring hospitalization primarily for diabetes (primary discharge diagnosis, 1°DCDx) or another condition (secondary discharge diagnosis, 2°DCDx) may translate into more effective ways to prevent readmissions. This retrospective cohort study compared readmission risk and risk factors between 8054 hospitalized adults with a 1°DCDx or 2°DCDx. The primary outcome was all-cause hospital readmission within 30 days of discharge. The readmission rate was higher in patients with a 1°DCDx than in patients with a 2°DCDx (22.2% vs. 16.2%, p < 0.01). Several independent risk factors for readmission were common to both groups including outpatient follow up, length of stay, employment status, anemia, and lack of insurance. C-statistics for the multivariable models of readmission were not significantly different (0.837 vs. 0.822, p = 0.15). Readmission risk of people with a 1°DCDx was higher than that of people with a 2°DCDx of diabetes. Some risk factors were shared between the two groups, while others were unique. Inpatient diabetes consultation may be more effective at lowering readmission risk among people with a 1°DCDx. These models may perform well to predict readmission risk.

Stress reduction interventions for patients with chronic diabetic foot ulcers: a qualitative study into patients and caregivers’ perceptions

BackgroundThe present study aimed to assess the perceptions of patients with chronic diabetic foot ulcers (DFUs) and their family caregivers regarding the impact of two stress reduction interventions on DFU and psychological wellbeing. The intervention included progressive muscle relaxation and hypnosis sessions.MethodsThis study used a qualitative exploratory design and included individual interviews with eight patients with chronic DFUs and six family caregivers, using a semi-structured interview guide. Transcript analysis employed thematic content analysis.ResultsFour key themes common to patients and their caregivers were found: 1) perspectives regarding the intervention; 2) intervention effectiveness; 3) perceived importance of psychology in the DFU treatment; and 4) emotional consequences associated with DFUs. Although themes were common to both intervention groups, sub-themes from the last two themes differed for patients that received muscle relaxation versus those who received hypnosis.ConclusionPatients and caregivers reported perceived benefits from both interventions, regarding DFU healing and emotional wellbeing. Patients who received hypnosis and their caregivers also reported lasting effects. Participants suggested that psychological interventions such as stress reduction interventions could be included in the DFU standard treatment as an adjuvant to the clinical protocol for DFU treatment, preferably offered early on, when patients begin treatment at the diabetic foot consultation.

Telemedizinische Anwendungen in der diabetologischen Schwerpunktpraxis

Since the start of the coronavirus disease 2019 (COVID-19) pandemic-related restrictions, digital consultation hours and online training have become an integral part of the care of people with diabetes in both in- and outpatient practices specializing in diabetes. Despite advancing digitalization and the use of modern diabetes technology, only a few model projects and specialized practices with dedicated diabetes teams were previously using these new communication options. With the improvement of the technology, the framework conditions, the expansion of the information technology (IT) infrastructure and, above all, the expectations of the patients, the digital consultation hour is also, even after COVID-19, a good addition and alternative to in-person consultations. To start digital consultations requires careful preparation. In addition to personal willingness to expand patient communication, appropriate structural and process quality standards are necessary in medical practice. Legal requirements, technical prerequisites, and integration into the existing practice workflow must be implemented. Digital consultation hours and online training are presented from the perspective of a diabetes consultant and diabetologist from a practice specializing in diabetes. Difficulties at the beginning, practical tips for a successful start, the advantages of video consultation, and problems in daily practice routine are presented. Demographic developments, increasing prevalence of diabetes, fewer treatment facilities, diabetologists and diabetic teams, location-independent consultation, and also the expectations of our patients support the implementation of digital consultation hours in daily practice. Although not yet optimal, the significantly improved remuneration is also an incentive for the new developments in communication. Treatment structures in diabetology practice and treatment success are improved by digital consultation hours.

Research on diabetes Prediction and Intelligent Diagnosis System Based on Machine Learning

This paper mainly focuses on the diagnosis and prediction of diabetes, and uses machine learning algorithm to study the prediction model of diabetes and intelligent consultation recommendation system. First, based on the public dataset of diabetes in UCL database, logistic regression model was used to screen variables, and four main characteristics were obtained: Pregnancies, Glucose, BMI and DPF. Secondly, four machine learning algorithms, K-nearest neighbor algorithm (KNN), naive Bayesian algorithm, decision tree and support vector machine, are used to establish the prediction model of diabetes. The model results show that the decision tree algorithm and K-nearest neighbor algorithm have high accuracy in specificity and negative case hit rate; However, the ROC curves of K-nearest neighbor algorithm and support vector machine algorithm are overlapped. Therefore, AUC value is further used to compare the prediction results of the two models. Finally, the prediction model based on support vector machine has certain advantages in prediction accuracy. Finally, taking diabetes patients as the object, on the basis of early prediction, using data mining technology, an intelligent diagnosis system for diabetes based on Java and fuzzy reasoning is constructed. The system functions include system user management, user information management, diabetes diagnosis and advice, system management and other functional modules, of which diabetes diagnosis and advice module is the core module of the system. The intelligent diagnosis system can provide basic medical diagnosis and suggestions, thus improving the diagnosis efficiency and becoming an important auxiliary tool for medical diagnosis.

ISPAD Clinical Practice Consensus Guidelines 2022: Ramadan and other religious fasting by young people with diabetes.

ISPAD Clinical Practice Consensus Guidelines 2022: Ramadan and other religious fasting by young people with diabetes.