Background: Podiatrists are important members of the multidisciplinary foot care team, but little is known about their collaboration with physicians. The aim of this online survey was therefore to assess the state of the interdisciplinary collaboration between podiatrists and physicians in diabetic sensorimotor polyneuropathy (DSPN) including podiatrists' preferences for service materials. Methods: This survey, conducted as part of the National Awareness Initiative (NAI) on DSPN, included 114 podiatrists from 12 federal states who answered an online questionnaire with 13 questions on the collaboration between podiatrists and physicians in DSPN and on preferences for educational materials. Results: 95 % of respondents desired to improve cooperation with referring physicians by educating physicians about the importance of podiatric services and their eligibility for reimbursement. In 57 % of the cases the findings on DSPN were communicated to the treating physician by the patients themselves, while in 17 % of the cases DSPN findings were not conveyed. The service materials offered on the NAI website were used by 14 % of respondents. Educational materials about DSPN for patients were desired by 90 % of respondents. Conclusion: In view of the high disease burden and costs for people with diabetic foot syndrome, there is an urgent need to improve the interdisciplinary collaboration between podiatrists and physicians, including appreciation of podiatric occupation.
People with type 1 diabetes are at increased risk of oral pathologies, particularly gingivitis and periodontal disease, even in the era of modern insulin delivery and apparently adequate metabolic control. This risk likely reflects the combined effects of hyperglycaemia-related changes in saliva and vasculature and early, subtle alterations in the oral microenvironment, including the microbiome and metabolome. Routine screening for oral symptoms and timely dental evaluation should therefore be incorporated into diabetes care, alongside clear patient education on daily oral hygiene and the importance of regular dental visits. Implementing these measures requires close collaboration between diabetology teams and dental professionals, including training diabetes nurses to deliver basic oral health counseling and facilitate referrals. Finally, further high-quality, multi-omic studies across oral niches are needed to define early biomarkers and develop evidence-based, diabetes-specific recommendations for prevention and management.
Type 1 diabetes is an autoimmune disease that targets and destroys insulin-producing beta cells in the pancreatic islets. The incidence of type 1 diabetes is rising globally. At the clinical diagnosis of type 1 diabetes, between 20
Continuous glucose monitoring (CGM) has evolved over the past decade from an adjunctive aid to a central pillar of modern diabetes therapy. As the number of CGM manufacturers increases, the need for reliable quality criteria likewise grows: imprecise sensor readings can mislead insulin-dosing algorithms and precipitate acute hypo-or hyperglycemia. In the United States (USA), the integrated CGM (iCGM) label, introduced in 2018, addresses this by setting binding thresholds for point and trend accuracy as well as interference testing. The European Medical Device Regulation (EU MDR) requires quality evaluation, but leaves quantitative requirements for accuracy in the hypoglycemic range, rate-of- change (RoC) accuracy and long-term stability undefined, a gap that allows CE-marked (Conformit & eacute; Europ & eacute;enne) systems to enter the market with insufficient quality evidence. To close this gap promptly, the present article argues that either an existing FDA (Food and Drug Administration) iCGM authorization or results from a study conducted according to the forthcoming International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) guideline proposal should be adopted without delay as the minimum standard for approval, procurement and reimbursement in Europe.
With the introduction of continuous glucose monitoring in 1999 new metrics for assessing glycemic control were also introduced. CGM profiles showed that not only the mean value of glucose concentration is relevant, which also correlates well with the HbA(1c) value. Parameters that describe hyperglycemia, but especially hypoglycemia and glucose variability, are also relevant. These depend on each other in various ways, so they must be considered in a complex manner. However, in everyday clinical practice, the time available for comprehensive analyses is limited, so it seems sensible to create a single parameter that describes glycemia as comprehensively as possible. To do this, composite metrics would have to be found that correlate as closely as possible with the HbA(1c) value. Various composite metrics have already been published. However, they are all quite complex. The possibilities of combining the variety of relevant parameters from the CGM measurements in composite metrics and combining them into a variable that describes the quality of the settings are described below.Three composite metrics are calculated below using data from a non-interventional, retrospective cross-sectional study conducted at Karlsburg Hospital. Their good correlation with each other and with the HbA(1c) value demonstrates their suitability for comprehensive glycemic assessment, including the risk for the development of diabetic secondary diseases.
