Guidelines for the treatment of diabetes-related ketoacidosis (DKA) recommend adding i.v. dextrose or enteral glucose when a patient's blood glucose level has decreased sufficiently to help prevent hypoglycemia. This study sought to determine whether a delay in this intervention was associated with a higher incidence of hypoglycemia. It found that patients are at increased risk for hypoglycemia during the active treatment window of DKA, as well as during the entire hospitalization, when the addition of dextrose or glucose is delayed.
This article reports on the feasibility and effectiveness of a 12-week program, including a low-calorie diet using a diabetes-specific nutritional formula meal replacement, a digitally enabled self-management app, and coaching, on measurable outcomes of weight, BMI, A1C levels, and blood pressure in adults with type 2 diabetes and excess body weight. Participation in the program reduced body weight by a mean 11 ± 6.5 kg, BMI by 3.7 ± 2.2 kg/m2, A1C by 1%, systolic blood pressure by 4.5 ± 16.1 mmHg, and diastolic blood pressure by 5.8 ± 16.9 mmHg (all P <0.01).
This systematic review describes factors associated with transition readiness and the transfer of care from pediatric to adult health care services among adolescents and young adults with diabetes. Overall, thirty-three international nonintervention, nonqualitative studies were identified between 2018 and 2023. Collectively, this review's findings identify targets for intervention and may inform policies and care practices related to transition, such as transition readiness, family and peer support, mental health support, and engagement in pediatric care.
Youth with type 2 diabetes are at a higher risk of adverse pregnancy outcomes than their adult counterparts, and addressing contraception in this population at puberty onset is strongly recommended. This retrospective study at an academic pediatric type 2 diabetes clinic found that 30% of youth achieved the primary composite outcome of documented preconception and contraceptive counseling, contraception prescription, and gynecology referral. Only 1.4% of youth aged 12-21 years had documented preconception counseling, and 27% had documented contraception counseling. By comparison, 18% of adults with preexisting diabetes at the same academic campus met the primary outcome. Adults had a higher rate of preconception counseling (14%) but a lower rate of contraception counseling (4%). This study identifies major gaps in preconception counseling and contraception education for youth with type 2 diabetes.
Glucagon-like peptide 1 (GLP-1) receptor agonists are prescribed as an adjunct to diet and exercise for the management of type 2 diabetes, yet adherence to healthy nutrition and physical activity is often suboptimal. As the use of these agents continues to rise, there are some concerns about the negative aspects of associated weight loss, including loss of muscle mass. This article highlights the benefits of healthy nutrition and physical activity for type 2 diabetes management irrespective of GLP-1 receptor agonist use or associated weight loss, identifies barriers to healthy nutrition and physical activity, and provides guidance for primary care clinicians to further educate and advise their patients on these important topics when initiating GLP-1 receptor agonist treatment.
Medication adherence is a barrier to achieving glycemic goals among Medicaid recipients with diabetes. The Diabetes Quality Improvement Program Collaborative recruited 19 primary care practices serving a high volume of Medicaid patients in Ohio with the goal of reducing the percentage of adults with type 2 diabetes with A1C >9.0% through a 1-year intervention. The mean medication possession ratio (MPR) improved from 71.6% during the pre-intervention period to 74.1% at year 1 post-intervention-a relative improvement of 3.4%. Factors associated with a lower MPR included younger age, identifying as non-Hispanic Black or Hispanic, and a pre-intervention A1C >9.0%. Although the initiative modestly improved medication adherence, addressing persistent disparities and expanding prescribing of therapies with cardiorenal benefits will be necessary to improve diabetes outcomes in the Medicaid population.
This randomized clinical trial compared the effects of Ganoderma lucidum and kombucha mushrooms on glycemic control in patients with type 2 diabetes. After the intervention, there were significant differences among the G. lucidum, kombucha mushroom, and control groups in fasting blood glucose, 2-hour postprandial glucose, and A1C. In the G. lucidum and kombucha mushroom groups, these measures all decreased significantly from baseline to after the intervention. The use of both G. lucidum and kombucha mushrooms was effective in glycemic control, and there was no significant difference in effectiveness between the two. Further studies of different doses and longer follow-up periods may clarify the best use of these substances.
The use of gabapentin, a first-line drug for diabetic peripheral neuropathy (DPN), is limited by its side effects, leading to more frequent use of vitamin B as an alternative. This randomized controlled trial of 237 patients with diabetes and at least probable DPN assessed pain outcomes using the Revised Thai Short-Form McGill Pain Questionnaire, Visual Analog Scale, Present Pain Intensity, and monofilament risk score at baseline and 4 and 12 weeks. Gabapentin showed superior improvement across all measures compared with vitamin B1-6-12 and B12, supporting its role as first-line therapy. However, vitamin B1-6-12 remains a cost-effective alternative with lower side effect, warranting further economic evaluation.
This article provides an overview for primary care physicians of recently published evidence-based clinical practice guidelines for managing the risks of atherosclerotic cardiovascular disease and chronic kidney disease in people with type 2 diabetes. The authors also share practical guidance and example case studies on how to initiate effective communication with patients to mitigate these risks.
Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an initiative to improve the rate of lipid profile screening in youth with type 2 diabetes at a tertiary children's hospital in Southern California.
This article reports on a retrospective study examining associations between neighborhood opportunity and glycemic trajectory and health care utilization among youth with diabetes using current Child Opportunity Index (COI) data linked to ZIP codes. The study found that glycemic control and health care utilization were worse in the setting of adverse COI and individual social determinants of health, but both were also independently associated with race.
This article describes a pharmacist-led deprescribing initiative to reduce the incidence of inappropriate rapid-acting insulin use among admitted older adults at an acute care community hospital. Inappropriate use was defined as at least one episode of severe hypoglycemia (blood glucose <40 mg/dL) within 24 hours of insulin lispro administration, two or more episodes of hypoglycemia (blood glucose <70 but >40 mg/dL) within 24 hours of insulin lispro administration, or five or more held administrations of insulin lispro because of euglycemia in a 48-hour period. The initiative led to a 66% observed relative reduction of inappropriate rapid-acting insulin use over 7 months.
Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an initiative to reduce the incidence of diabetic ketoacidosis in children with type 1 diabetes at high risk for complications.
Prior to the 1940s, type 2 diabetes was considered a rare disease in American Indian and Alaska Native (AI/AN) individuals. However, because of multiple complex factors, it rapidly progressed and became endemic within a matter of decades. Despite community-led interventions to prevent diabetes onset and progression, AI/AN individuals are disproportionately affected by diabetes and remain grossly underrepresented in diabetes treatment research. To provide equitable health care for AI/ANs with diabetes, clinicians should develop an understanding of important socioeconomic and environmental factors that influence health outcomes.
Optimal management of hyperglycemia during illness has been hindered by a lack of comprehensive sick-day guidance, particularly for adults with diabetes. Managing glycemia can be challenging during illness because of adaptive counterregulatory hormonal changes, acute stress of illness, altered dietary intake, and effects of medications. People with diabetes may be at risk for severe hypoglycemia and hyperglycemic crisis during illness unless mitigated by close monitoring and medication adjustment. This article provides practical guidance to health care professionals and people with diabetes for safe glycemic management during illness, including considerations for insulin and noninsulin medications, use of insulin technologies, prevention of hypoglycemia and ketoacidosis, steroid use, and pregnancy.
Although patient preferences are heterogeneous, the out-of-pocket cost and accuracy of continuous glucose monitoring (CGM) systems are the two most important attributes for patients with type 2 diabetes. Surprisingly, receiver screen information is not considered important when choosing a CGM system. Identifying important attributes could facilitate patient-provider communications in choosing a preferred CGM system and potentially increase adherence. Improving patient education on interpreting the information on the receiver screen could enhance the benefit of using CGM.
