Research

16 pages, 648 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

Transitioning to Telehealth during COVID-19: Experiences and Insights from Diabetes Prevention and Management Program Providers in Los Angeles County

by Sally L. Bullock, Telma Menendez, Liz Schwarte, Lisa Craypo, Jennifer T. Mosst, Gabrielle Green, Noel C. Barragan and Tony Kuo

Diabetology 2023, 4(1), 46-61; https://doi.org/10.3390/diabetology4010006 - 31 Jan 2023

Cited by 3 | Viewed by 2404

Abstract

The onset of the COVID-19 pandemic in March 2020 accelerated the efforts of several organizations providing the National Diabetes Prevention Program (National DPP) and the Diabetes Self-Management Education and Support (DSMES) program to rapidly transition from in-person service delivery to program administration via [...] Read more.

The onset of the COVID-19 pandemic in March 2020 accelerated the efforts of several organizations providing the National Diabetes Prevention Program (National DPP) and the Diabetes Self-Management Education and Support (DSMES) program to rapidly transition from in-person service delivery to program administration via telehealth. Semi-structured interviews were conducted with 35 National DPP and DSMES experts and providers in Los Angeles County to gain a better understanding of the challenges and benefits associated with this transition. Interviews were completed during June to October 2021. Thematic analyses were performed using the Social-Ecological Model as a guiding framework. The analyses revealed several factors that influenced the transition, including at the individual (e.g., technology and health behaviors), interpersonal (e.g., social connections and support), organizational (e.g., provider workload and program enrollment and retention), community (e.g., recruitment), and policy (e.g., government support and reimbursement for telehealth services) levels. Findings suggest that the transition to telehealth was challenging for most National DPP and DSMES providers. However, because of its lower cost, ability to reach long distances virtually, and potential efficiency when employed as part of a hybrid approach, this delivery modality remains viable, offering benefits beyond the traditional program models. Full article

(This article belongs to the Special Issue Diabetology: Feature Papers 2022)

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15 pages, 2724 KiB

Open AccessArticle

Investigating the Protective Effects of a Rhenium (V) Compound with Uracil-Derived Ligands on Liver Damage Associated with Prediabetes in Diet-Induced Prediabetic Rats

by Angezwa Siboto, Akinjide Moses Akinnuga, Muhammed Bilaal Ismail, Irvin Noel Booysen, Ntethelelo Hopewell Sibiya, Phikelelani Ngubane and Andile Khathi

Diabetology 2022, 3(4), 524-538; https://doi.org/10.3390/diabetology3040040 - 17 Oct 2022

Cited by 2 | Viewed by 1564

Abstract

Non-alcoholic fatty liver disease (NAFLD) is associated with prediabetes and can be treated by using a combination of metformin and dietary modification. However, people often fail to adhere to dietary modifications and become more dependent on pharmaceutical intervention, and this affects the effectiveness [...] Read more.

Non-alcoholic fatty liver disease (NAFLD) is associated with prediabetes and can be treated by using a combination of metformin and dietary modification. However, people often fail to adhere to dietary modifications and become more dependent on pharmaceutical intervention, and this affects the effectiveness of the drug. In this study, we investigated the effects of rhenium (V) compound with uracil-derived ligands on liver health in diet-induced prediabetic rats in both the presence and absence of dietary modification. Prediabetic male Sprague Dawley rats were treated with the rhenium (V) compound for 12 weeks in both the presence and absence of dietary modification while monitoring fasting blood glucose levels. Antioxidant enzyme activity, inflammation markers and liver enzymes were measured together with liver glycogen and plasma triglycerides after sacrificing. The administration of rhenium (V) compound to prediabetic rats in both the presence and absence of dietary modification resulted in reduced concentrations of fasting blood glucose and triglycerides. There was also reduced liver glycogen, oxidative stress and liver enzymes while increasing antioxidant enzymes. Altogether, the rhenium (V) compound ameliorated liver injury and prevented hepatotoxicity. Full article

(This article belongs to the Special Issue Diabetology: Feature Papers 2022)

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8 pages, 1216 KiB

Open AccessArticle

An Evaluation of Point-of-Care HbA1c, HbA1c Home Kits, and Glucose Management Indicator: Potential Solutions for Telehealth Glycemic Assessments

by Dessi P. Zaharieva, Ananta Addala, Priya Prahalad, Brianna Leverenz, Nora Arrizon-Ruiz, Victoria Y. Ding, Manisha Desai, Amy B. Karger and David M. Maahs

Diabetology 2022, 3(3), 494-501; https://doi.org/10.3390/diabetology3030037 - 13 Sep 2022

Cited by 5 | Viewed by 2409

Abstract

During the COVID-19 pandemic, fewer in-person clinic visits resulted in fewer point-of-care (POC) HbA1c measurements. In this sub-study, we assessed the performance of alternative glycemic measures that can be obtained remotely, such as HbA1c home kits and Glucose Management Indicator (GMI) values from [...] Read more.

During the COVID-19 pandemic, fewer in-person clinic visits resulted in fewer point-of-care (POC) HbA1c measurements. In this sub-study, we assessed the performance of alternative glycemic measures that can be obtained remotely, such as HbA1c home kits and Glucose Management Indicator (GMI) values from Dexcom Clarity. Home kit HbA1c (n = 99), GMI, (n = 88), and POC HbA1c (n = 32) were collected from youth with T1D (age 9.7 ± 4.6 years). Bland–Altman analyses and Lin’s concordance correlation coefficient (𝜌_c) were used to characterize the agreement between paired HbA1c measures. Both the HbA1c home kit and GMI showed a slight positive bias (mean difference 0.18% and 0.34%, respectively) and strong concordance with POC HbA1c (𝜌_c = 0.982 [0.965, 0.991] and 0.823 [0.686, 0.904], respectively). GMI showed a slight positive bias (mean difference 0.28%) and fair concordance (𝜌_c = 0.750 [0.658, 0.820]) to the HbA1c home kit. In conclusion, the strong concordance of GMI and home kits to POC A1c measures suggest their utility in telehealth visits assessments. Although these are not candidates for replacement, these measures can facilitate telehealth visits, particularly in the context of other POC HbA1c measurements from an individual. Full article

(This article belongs to the Special Issue Diabetology: Feature Papers 2022)

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17 pages, 1173 KiB

Open AccessFeature PaperArticle

Diabetic Ketoacidosis Was Associated with High Morbidity and Mortality in Hospitalized Patients with COVID-19 in the NYC Public Health System

by Sahana Parthasarathy, Natalia Chamorro-Pareja, Amrin Kharawala, Kenneth H Hupart, Joan Curcio, Christina Coyle, Daniel Buchnea, Dimitris Karamanis, Robert Faillace, Leonidas Palaiodimos and Preeti Kishore

Diabetology 2022, 3(3), 477-493; https://doi.org/10.3390/diabetology3030036 - 06 Sep 2022

Viewed by 2329

Abstract

Background: COVID-19 has been associated with a higher risk of death in patients with diabetes mellitus (DM). However, there is a dearth of data regarding the effects of diabetic ketoacidosis (DKA) in these patients. We explored the in-hospital outcomes of patients who presented [...] Read more.

Background: COVID-19 has been associated with a higher risk of death in patients with diabetes mellitus (DM). However, there is a dearth of data regarding the effects of diabetic ketoacidosis (DKA) in these patients. We explored the in-hospital outcomes of patients who presented with COVID-19 and DKA. Methods: A propensity score-matched observational retrospective cohort study was conducted in hospitalized patients with COVID-19 in the public healthcare system of New York City from 1 March 2020 to 31 October 2020. Patients were matched, and a subgroup analysis of patients with DKA and COVID-19 and patients without COVID-19 was conducted. Results: 13,333 (16.0%) patients with COVID-19 and 70,005 (84.0%) without COVID-19 were included in the analysis. The in-hospital mortality rate was seven-fold in patients with DKA and COVID-19 compared to patients with COVID-19 and without DKA (80 (36.5%) vs. 11 (5.4%), p < 0.001). Patients with COVID-19 and DKA had a two-fold higher likelihood for in-hospital death (OR: 1.95; 95% CI: 1.41–2.70; p < 0.001) after adjusting for multiple variables. Conclusions: DKA was associated with significantly higher in-hospital mortality in hospitalized patients with COVID-19. Full article

(This article belongs to the Special Issue Diabetology: Feature Papers 2022)

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13 pages, 566 KiB

Open AccessArticle

Narrative Review: Obesity, Type 2 DM and Obstructive Sleep Apnoea—Common Bedfellows

by Dimitar Sajkov, Bliegh Mupunga, Jeffrey J. Bowden, Christopher Langton and Nikolai Petrovsky

Diabetology 2022, 3(3), 447-459; https://doi.org/10.3390/diabetology3030033 - 08 Aug 2022

Cited by 2 | Viewed by 2227

Abstract

Obstructive sleep apnoea (OSA) and type 2 DM mellitus (T2DM) share obesity as a major risk factor. Furthermore, these conditions share overlapping mechanisms including inflammation, activation of the autonomic nervous system, and hypoxia-linked endocrinopathy. Hence, the pathogenesis of the two conditions may be [...] Read more.

Obstructive sleep apnoea (OSA) and type 2 DM mellitus (T2DM) share obesity as a major risk factor. Furthermore, these conditions share overlapping mechanisms including inflammation, activation of the autonomic nervous system, and hypoxia-linked endocrinopathy. Hence, the pathogenesis of the two conditions may be more closely related than previously recognised. This raises the question of whether treatment of OSA might assist resolution of obesity and/or T2DM. Here, we present a narrative review of the literature to identify clinical and scientific data on the relationship between obstructive sleep apnoea and T2DM control. We found there is a paucity of adequately powered well-controlled clinical trials to directly test for a causal association. While routine screening of all T2DM patients with polysomnography cannot currently be justified, given the high prevalence of sleep disordered breathing in the overweight/obese population, all T2DM patients should at a minimum have a clinical assessment of potential obstructive sleep apnoea risk as part of their routine clinical care. In particular, screening questionnaires can be used to identify T2DM subjects at higher risk of OSA for consideration of formal polysomnography studies. Due to morbid obesity being a common feature in both T2DM and OSA, polysomnography should be considered as a screening tool in such high-risk individuals. Full article

(This article belongs to the Special Issue Diabetology: Feature Papers 2022)

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16 pages, 2143 KiB

Open AccessArticle

Implementation of Chronic Care Model for Diabetes Self-Management: A Quantitative Analysis

by Rashid M. Ansari, Mark F. Harris, Hassan Hosseinzadeh and Nicholas Zwar

Diabetology 2022, 3(3), 407-422; https://doi.org/10.3390/diabetology3030031 - 06 Jul 2022

Cited by 5 | Viewed by 3914

Abstract

Objective: The main aim of this study was to implement the Chronic Care Model (CCM) for the self-management of type 2 diabetes in primary health care settings of rural areas of Pakistan and identify its effectiveness and develop strategies for overcoming its challenges. [...] Read more.

Objective: The main aim of this study was to implement the Chronic Care Model (CCM) for the self-management of type 2 diabetes in primary health care settings of rural areas of Pakistan and identify its effectiveness and develop strategies for overcoming its challenges. The two core elements of the Chronic Care Model: patient Self-Management Support (SMS) and Delivery System Design (DSD), were implemented to improve the quality of life and risk behaviour of type 2 diabetes patients in the middle-aged population of rural Pakistan. Methods: Thirty patients with type 2 diabetes and 20 healthcare professionals were included in this study consisting of 10 general practitioners and 10 nurses recruited from various clinics (medical centres) of Al-Rehman Hospital in Abbottabad, Pakistan. The quantitative content analysis method was used to identify the frequency of the most recurring statements. A t-test was performed to see the mean difference of HbA1c at baseline after 3-months and 6-months follow-up between male and female patients with diabetes. The hypothesis was tested to identify that diabetes self-management has a gendered dimension in rural areas of Pakistan. Results: The quantitative analysis demonstrated that diabetes self-management has a gendered dimension in the rural areas of Pakistan as the mean difference of HbA1c after a 6-month intervention of the two components of the chronic care model between male and female patients of diabetes was 0.83 (p = 0.039) with 95% CI (−0.05; −1.61). The mean difference in BMI after the intervention of 6 months between males and females was significant (p < 0.05). The mean difference was 4.97 kg/m², p = 0.040 with 95% CI (−0.24; −9.69). The results have shown that the two components of CCM were effective and improved clinical outcomes for diabetes patients of the rural areas of Pakistan. Conclusions: The application of the two Chronic Care Model’s components provided a viable structure for diabetes self-management education and assistance. As a result, developing systems that incorporate long-term diabetes self-management education has an effect on the health care system’s outcomes. Full article

(This article belongs to the Special Issue Diabetology: Feature Papers 2022)

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Review

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14 pages, 1465 KiB

Open AccessFeature PaperReview

Verapamil and Its Role in Diabetes

by Paul Zimmermann, Felix Aberer, Max L. Eckstein, Sandra Haupt, Maximilian P. Erlmann and Othmar Moser

Diabetology 2022, 3(3), 393-406; https://doi.org/10.3390/diabetology3030030 - 06 Jul 2022

Cited by 3 | Viewed by 3628

Abstract

Autoimmune pancreatic β-cell loss and destruction play a key role in the pathogenesis and development of type 1 diabetes, with a prospective increased risk for developing micro- and macrovascular complications. In this regard, orally administrated verapamil, a calcium channel antagonist, usually intended for [...] Read more.

Autoimmune pancreatic β-cell loss and destruction play a key role in the pathogenesis and development of type 1 diabetes, with a prospective increased risk for developing micro- and macrovascular complications. In this regard, orally administrated verapamil, a calcium channel antagonist, usually intended for use as an anti-arrhythmic drug, has previously shown potential beneficial effects on β-cell preservation in new-onset type 1 diabetes. Furthermore, observational data suggest a reduced risk of type 2 diabetes development. The underlying pathophysiological mechanisms are not well investigated and remain widely inconclusive. The aim of this narrative review was to detail the role of verapamil in promoting endogenous β-cell function, potentially eligible for early treatment in type 1 diabetes, and to summarize existing evidence on its effect on glycemia in individuals with type 2 diabetes. Full article

(This article belongs to the Special Issue Diabetology: Feature Papers 2022)

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15 pages, 822 KiB

Open AccessReview

Insulin in Frail, Older People with Type 2 Diabetes—Low Threshold for Therapy

by Ahmed Abdelhafiz, Shail Bisht, Iva Kovacevic, Daniel Pennells and Alan Sinclair

Diabetology 2022, 3(2), 369-383; https://doi.org/10.3390/diabetology3020028 - 20 Jun 2022

Cited by 6 | Viewed by 2373

Abstract

The global prevalence of comorbid diabetes and frailty is increasing due to increasing life expectancy. Frailty appears to be a metabolically heterogeneous condition that may affect the clinical decision making on the most appropriate glycaemic target and the choice of the most suitable [...] Read more.

The global prevalence of comorbid diabetes and frailty is increasing due to increasing life expectancy. Frailty appears to be a metabolically heterogeneous condition that may affect the clinical decision making on the most appropriate glycaemic target and the choice of the most suitable hypoglycaemic agent for each individual. The metabolic profile of frailty appears to span across a spectrum that starts at an anorexic malnourished (AM) frail phenotype on one end and a sarcopenic obese (SO) phenotype on the other. The AM phenotype is characterised by significant weight loss and less insulin resistance compared with the SO phenotype, which is characterised by significant obesity and increased insulin resistance. Therefore, due to weight loss, insulin therapy may be considered as an early option in the AM frail phenotype. Insulin-related weight gain and the anabolic properties of insulin may be an advantage to this anorexic phenotype. There is emerging evidence to support the idea that insulin may improve the muscle function of older people with diabetes, although this evidence still needs further confirmation in future large-scale prospective studies. Long acting insulin analogues have a lower risk of hypoglycaemia, comapred to intermediate acting insulins. Additionally their simple once daily regimen makes it more appropriate in frail older patients. Future research on the availability of new once-weekly insulin analogues is appealing. The goals of therapy are to achieve relaxed targets, avoid hypoglycaemia and to focus on the maintenance of quality of life in these vulnerable patients. Full article

(This article belongs to the Special Issue Diabetology: Feature Papers 2022)

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Other

Jump to: Research, Review

9 pages, 1683 KiB

Open AccessOpinion

Lipodystrophies from Insulin Injection: An Update of the Italian Consensus Statement of AMD-OSDI Study Group on Injection Technique

by Sandro Gentile, Ersilia Satta, Giuseppina Guarino and Felice Strollo

Diabetology 2023, 4(1), 119-127; https://doi.org/10.3390/diabetology4010013 - 03 Mar 2023

Viewed by 1938

Abstract

The causes and metabolic consequences of lipohypertrophy (LH) from incorrect insulin injection techniques have been well-known for a long time and are the subject of countless publications. However, only some researchers propose structured research modalities for LH and programs to teach patients how [...] Read more.

The causes and metabolic consequences of lipohypertrophy (LH) from incorrect insulin injection techniques have been well-known for a long time and are the subject of countless publications. However, only some researchers propose structured research modalities for LH and programs to teach patients how to prevent them and minimize their effects, thus contributing to complete rehabilitation. Experts and scientific societies have produced consensus documents and recommendations to spread the culture of LH and its complications among clinicians. However, they should go deeper into LH detection methods. This short article analyzes the recent literature on the best way to explore and find more or less evident LH lesions by using a structured and validated clinical methodology to benefit the many clinicians without access to technological equipment such as ultrasonography. This text also aims to bring awareness that since the last published recommendations on injection techniques, new needles for insulin injection, more technologically advanced and suitable for specific populations, have come to market but still need a thorough evaluation. Full article

(This article belongs to the Special Issue Diabetology: Feature Papers 2022)

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14 pages, 600 KiB

Open AccessStudy Protocol

Multicenter, Open Label, Randomized Controlled Superiority Trial for Availability to Reduce Nocturnal Urination Frequency: Study Protocol for a TOP-STAR Study

by Hanako Nakajima, Hiroshi Okada, Akinori Kogure, Takafumi Osaka, Takeshi Tsutsumi, Toru Tanaka, Goji Hasegawa, Shinichi Mogami, Kazuteru Mitsuhashi, Noriyuki Kitagawa, Yoshitaka Hashimoto, Miho Yano, Muhei Tanaka, Akane Kitamura, Michiyo Ishii, Naoto Nakamura, Akio Kishi, Emi Ushigome, Masahide Hamaguchi and Michiaki Fukui

Diabetology 2022, 3(4), 620-633; https://doi.org/10.3390/diabetology3040048 - 07 Dec 2022

Cited by 1 | Viewed by 2003

Abstract

Nocturia is a common disease in patients with type 2 diabetes mellitus that can reduce the quality of life. Sodium glucose co-transporter 2 (SGLT2) inhibitors increase the urine volume and are often discontinued when polyuria occurs, although tofogliflozin, which has a short half-life [...] Read more.

Nocturia is a common disease in patients with type 2 diabetes mellitus that can reduce the quality of life. Sodium glucose co-transporter 2 (SGLT2) inhibitors increase the urine volume and are often discontinued when polyuria occurs, although tofogliflozin, which has a short half-life in the blood, may improve nocturia by managing hyperglycemia and hypertension, without aggravating nocturia. As excessive sodium intake worsens nocturia and increases urine volume, sodium restriction is also effective in managing nocturia. This multicenter, open-label, randomized parallel-group trial will examine 80 patients with type 2 diabetes who experienced nocturia. After the baseline examination, the patients are randomly stratified into two groups and receive tofogliflozin treatment with or without sodium restriction for 12 weeks. The primary outcome is nocturia frequency at 12 weeks. The secondary outcomes are the frequency of daytime urine, changes in urine volume, and changes in home blood pressure. Full article

(This article belongs to the Special Issue Diabetology: Feature Papers 2022)

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5 pages, 532 KiB

Open AccessCommentary

Insulin Injection-Related Skin Lipodystrophies: Blemish or Pathology?

by Felice Strollo, Ersilia Satta and Sandro Gentile

Diabetology 2022, 3(4), 615-619; https://doi.org/10.3390/diabetology3040047 - 01 Dec 2022

Cited by 1 | Viewed by 1844

Abstract

The number of adult individuals with insulin-treated diabetes mellitus (DM) is steadily increasing worldwide. The main local complications of insulin injection are lipohypertrophies (LHs), i.e., subcutaneous nodules consisting of aggregates of macro-adipocytes and fibrin. These nodules result from errors repeatedly made by patients [...] Read more.

The number of adult individuals with insulin-treated diabetes mellitus (DM) is steadily increasing worldwide. The main local complications of insulin injection are lipohypertrophies (LHs), i.e., subcutaneous nodules consisting of aggregates of macro-adipocytes and fibrin. These nodules result from errors repeatedly made by patients while injecting insulin. Despite being very common, LH lesions/nodules due to incorrect insulin injection techniques are often flat and hardly visible and thus require thorough deep palpation examination and ultrasonography (US) for detection. Identifying LHs is crucial, especially in elderly and frail subjects, because they may eventually result in poor diabetes control due to associated unpredictable insulin release patterns. Raising awareness of the adequate detection of LHs and their clinical consequences is crucial and urgent. A call to action is required on this topic at all levels of undergraduate and postgraduate education. Full article

(This article belongs to the Special Issue Diabetology: Feature Papers 2022)

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