Pimpa Tantanasrigul1 | Apinya Sripha1 | Bunchai Chongmelaxme21
Department of Medical Services, Ministry of Public Health, Institute of Dermatology, Bangkok, Thailand | 2Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
Correspondence: Bunchai Chongmelaxme (该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。)
Received: 5 July 2024 | Accepted: 22 August 2024
Funding: The authors received no specific funding for this work.
Keywords: alpha-arbutin 5% | efficacy | kojic acid 2% | melasma | safety | triple combination cream
ABSTRACT
Background: While the gold standard treatment for melasma is triple combination cream (TCC), arbutin and kojic acid demonstrate their benefits and may be used as an alternative.
Aims: To investigate the efficacy of cream containing alpha-arbutin 5% and kojic acid 2% (AAK) compared with TCC for melasma treatment.
Patients/Methods: A split-faced, randomized study was conducted among 30 participants with melasma, and all were randomized to receive AAK or TCC on each side of their face for 12-week along with 4-week follow-up period. The melanin index (MI), modified Melasma Area Severity Index (mMASI), and physician global assessment (PGA) scores were used to measure the effectiveness of interventions. Recurrence of melasma after treatment discontinuation was evaluated by MI and mMASI. Patient satisfactions and adverse effects were also evaluated. In the analysis, the mean difference (MD) was used for MI and mMASI, while Wilcoxon signed-rank test was for the PGA scores, adverse effects, and patient satisfaction.
Results: The MD of MI and mMASI scores were not different between groups (mMASI [p=0.344] and MI [p=0.268]). The PGA scores only showed improvement on the TCC-treated side (p=0.032). Compared to the AKK group, the subjects with TCC showed higher severity of recurrence (MI [p=0.004] and mMASI [p=0.045]). No difference in patient satisfaction score between the groups, but erythema and stinging were higher in the TCC group.
Conclusions: The AAK cream appeared to be effective for melasma treatment, highlighting a lower recurrent rate and fewer adverse events than standard therapy.
Trial Registration: thaiclinicaltrials.org: TCTR20230124004
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.
A qualitative exploration of the prospective acceptability of the MiDerm app; a complex digital intervention for adults living with skin conditions
Rachael M. Hewitt1 | Carys Dale1 | Catherine Purcell1 | Rachael Pattinson2 | Chris Bundy1
1 School of Healthcare Sciences, Cardiff University, Wales, UK
2 School of Dentistry, Cardiff University, Wales, UK
Correspondence
Rachael M. Hewitt, School of Healthcare Sciences, Cardiff University, Heath Park Campus, Cardiff, CF14 4XN, UK.
Email: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。
Funding information
Beiersdorf
Abstract
Objectives: Skin conditions carry a substantial psychological burden but support for patients is limited. Digital technology could support patient self-management; we found preliminary evidence for the effectiveness and acceptability of digital psychological interventions for adults living with skin conditions. We have, therefore, developed a complex digital intervention called MiDerm with patients. This qualitative study explored the prospective acceptability of the complex intervention delivered via a smartphone application (app), and possible barriers and facilitators to use.
Design: Qualitative research involving a hybrid inductivedeductive approach. Data collection and analysis were theoretically informed by The Common-Sense Model of SelfRegulation, Theoretical Framework of Acceptability and the Capability, Opportunity, Motivation - Behaviour Model.
Methods: Eight synchronous online group interviews with 43 English-speaking adults (≥18 years) with skin conditions. Data were analysed using Reflexive Thematic Analysis.
Results: Three superordinate themes were generated: (1) Patients' attitudes and concerns about the MiDerm app; (2) Need for personal competence, autonomy and relatedness for effective self-management; and (3) Physical, psychological and social barriers to app use.
Conclusion: Adults with skin conditions, mainly those with vitiligo and psoriasis living in the UK, expressed the need for support to self-manage the psychological aspects of their condition(s). The idea of a new intervention comprised of informational, emotional, behavioural and peer support, delivered via a smartphone app was welcomed and may be especially beneficial for specific patients. Identified barriers must be addressed to maximize engagement and giving users choice, flexibility and control is imperative to this. We have since developed the MiDerm app using these findings.
KEYWORDS
dermatology, digital intervention, qualitative research
A comprehensive classification and analysis of oily sensitive facial skin: a cross-sectional study of young Chinese women
Xinjue Kuang1,2, Caini Lin1,2, Yuanyuan Fu3, YuhuiWang3, JunhuaGong3, Yong Chen3,4, Youting Liu3,4,6 & FanYi1,2,5
1 Key Laboratory of Cosmetic, China National Light Industry, Beijing Technology and Business University, Beijing,China.
2Institute of Cosmetic Regulatory Science, Beijing Technology and Business University, Beijing, China.
3 Beijing Uproven Medical Technology Co. LTD, Beijing, China.
4 Beijing Uproven Institute of Dermatology, Beijing,China.
5 Beijing Technology and Business University, No.11/33, Fucheng Road, Haidian District, Beijing 100048,China.
6 Beijing Uproven Institute of Dermatology, Room 1109, 11th Floor, Building 13, No. 5 Tianhua Street, Daxing District, Beijing 102600, China. email: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。
Oily sensitive skin is complex and requires accurate identification and personalized care. However, the current classification method relies on subjective assessment. This study aimed to classify skin type and subtype using objective biophysical parameters to investigate differences in skin characteristics across anatomical and morphological regions. This study involved 200 Chinese women aged 17–34 years. Noninvasive capture of biophysical measures and image analysis yielded 104 parameters. Key classification parameters were identified through mechanisms and characteristics, with thresholds set via statistical methods. This study identified the optimal ternary value classification method for dividing skin types into dry, neutral, and oily types based on tertiles of biophysical parameters and, further, into barrier-sensitive, neurosensitive, and inflammatory-sensitive types. Oily sensitive skin shows increased sebum, follicular orifices, redness, dullness, wrinkles, and porphyrins, along with a tendency for oiliness and early acne. Subtypes exhibited specific characteristics: barrier-sensitive skin was rough with a high pH and prone to acne; neurosensitive skin had increased TEWL (Transepidermal Water Loss) and sensitivity; and inflammatory-sensitive skin exhibited a darker tone, with low elasticity and uneven redness. This study established an objective classification system for skin types and subtypes using noninvasive parameters, clarifying the need for care for oily sensitive skin and supporting personalized skincare.
Keywords Oily sensitive skin, Noninvasive biophysical testing, Skin classification, Sensitivity subtypes, Personalized skincare
Does the point of healthcare contact affect successful diagnosis of diabetic Charcot neuroarthropathy?
Amy Sherratt, Jennie Hancox, Frances Game and Katie Gray
Citation: Sherratt A, Hancox J, Game F, Gray K (2024) Does the point-of-healthcare contact affect successful diagnosis of diabetic Charcot neuroarthropathy? The Diabetic Foot Journal 27(2): 44–8
Key words
- Charcot
- Diabetes
- Delay
- Foot
- Misdiagnosis
Article points
1. Delays in diagnosis increase the risk of severe long-term foot complications
2. A retrospective audit of patients with active Charcot neuroarthropathy examined the time to diagnosis, misdiagnosis rates, healthcare professional (HCP) and setting type at each contact, since symptom onset prior to their referral to a multidisciplinary foot team (MDFT) clinic
3. Results showed that non-specialist HCPs require a greater degree of awareness and understanding of Charcot neuroarthropathy to reduce diagnostic delays and misdiagnosis rates.
Authors
Amy Sherratt is a Diabetes Specialist and Research Podiatrist, University Hospitals of Derby and Burton & Derbyshire Community Health Services, Derbyshire; Jennie Hancox is a Lecturer at Loughborough University, School of Sport, Exercise and Health Sciences; Frances Game is a Consultant Diabetologist and Director of Research and Development, University Hospitals of Derby and Burton, Derbyshire and Katie Gray is a Diabetes Specialist and Research Podiatrist, University Hospitals of Derby and Burton & Derbyshire Community Health Services, Derbyshire.
Background: Charcot neuroarthropathy (CN) is a lesser-known and commonly misdiagnosed diabetic foot complication. Delays in diagnosis increase the risk of severe long-term foot complications. Aims: To undertake a retrospective audit of patients with active CN, recording the time to diagnosis, misdiagnosis rates, healthcare professional (HCP) and setting type at each contact since symptom onset prior to their referral to a multidisciplinary foot team (MDFT) clinic in a circumscribed part of England. Methods: Clinical notes of 46 consecutive patients attending a MDFT clinic in the East Midlands region of England during a 2-month period, with active CN were assessed. Results: Of the 46 included patients, 22 developed CN while in primary care. These patients had a mean time from symptom onset to confirmed diagnosis of 68 days, with 64% receiving a misdiagnosis. Non-specialist HCPs failed to suspect CN in 85% of contacts compared to 20% in specialist HCPs. Conclusions: Non-specialist HCPs need a greater degree of awareness and understanding of CN to reduce diagnostic delays and misdiagnosis rates.
中国老年糖尿病诊疗指南（2024版）---16~完结
第十六章 糖尿病管理相关技术
一、血糖监测
血糖监测技术包括自我血糖监测、CCM、糖化白蛋白和HbA1c等。
HbA1c是临床上用以评价长期血糖控制状况的金标准,是调整治疗方案的重要依据。对于HbA.未达标的患者,建议每3个月检测一次。一旦达标后,可每6~12个月检测一次。但 HbA,也存在一定的局限性,如难以反映血糖波动,无法捕捉低血糖事件等。建议胰岛素治疗的老年糖尿病患者进行自我血糖监测,基本监测点为空腹和三餐前,以了解患者的血糖基线水平,如患者存在夜间低血糖风险,建议根据情况加测睡前和夜间血糖,对于口服降糖药治疗且血糖控制平稳的患者无需频繁监测血糖。
在老年糖尿病患者中，佩戴 CGM 能进一步改善HbA1c，同时降低血糖变异性，而不增加低血糖风险［321‑322］ 。T1DM 患者胰岛功能差、血糖波动大，更可能从CGM中获益。建议临床医师结合患者的血糖情况、认知水平、行动能力、经济情况等进行综合评估后提出是否佩戴CGM的建议。在使用基础胰岛素的老年T2DM患者中，使用CGM的患者较传统指血检测的患者 TIR 增加，其获益与年轻患者一致［323］ 。
TIR 是指 24 h 内葡萄糖在目标范围的时长或所占的百分比，成人糖尿病患者中TIR的血糖范围一般界定为3.9~10.0 mmol/L，但尚缺乏针对老年糖尿病患者的研究。近年来国际共识推荐 TIR 可作为成人 T1DM 和 T2DM 血糖控制情况的评价指标，同时 TBR和 TAR也可以作为评价治疗方案的有效参数。我国的研究表明，在 T2DM 中 TIR 独立于HbA1c与糖尿病微血管并发症相关（患者平均年龄60.4岁）［324］ ，与心血管死亡、全因死亡相关（患者平均年龄 61.7 岁）［325］ 。在老年糖尿病的管理中，TIR也可以作为评价血糖控制水平的补充指标，但尚需针对老年糖尿病患者的研究证实。TIR 目标的确定需考虑老年糖尿病患者的个体化差异和低血糖风险，并有待进一步的循证医学证据明确。研究显示，在 T1DM 中 TIR 与 TAR 相关性强，但与 TBR 相关性弱，对于使用自动胰岛素给药系统的老年患者，应优先考虑降低 TBR 以减少低血糖风险［326］ 。除了影响血糖控制外，CGM 对老年糖尿病还具有其他获益，例如患者可以与家人或其他照护者持续分享血糖结果；减少指血血糖检测次数，尤其是对于有身体残疾、认知障碍或视力障碍的患者；对于低血糖觉察能力降低或受损的患者，CGM 可以帮助患者觉察低血糖［327］ 。
二、注射技术
正确的皮下胰岛素注射技术包括每次注射后更换针头、选择合适的部位注射、轮换注射的部位、适当护理注射部位以及避免肌肉注射。推荐注射部位包括腹部、大腿、臀部和上臂。长期在同一部位进行 注射可能导致局部脂肪肥大或脂肪萎缩［328］，需定期并轮替变换注射部位 。 中国 ITIMPROVE 研究对中国糖尿病患者、医师和护士的问卷调查显示，34.7% 患者出现注射部位脂肪增生，针头重复使用以及注射部位轮换不当可分别使脂肪增生风险增加 3.15 倍和 1.27 倍，同时也增加HbA1c达标的风险［329］ 。
老年糖尿病患者如果存在痴呆、视力丧失、神经病变、活动能力差、手指灵活性差等情况，在进行胰岛素注射时出现遗漏注射、错误注射的风险增加，医师也无法准确了解患者胰岛素的实际注射情况。随着胰岛素注射笔的不断改良，更多的功能已被开发并应用。记忆功能可记录上次胰岛素注射的剂量和注射时间，帮助提高胰岛素治疗的依从性［330］ 。依托具有可连接功能、支持近距离无线通信的手机等智能设备进行连接，可以将胰岛素注射记录传输到智能手机等设备并通过应用程序生成可视化注册日志并分享。一项前瞻性临床研究提示，可连接胰岛素笔能显著减少43%的胰岛素注射遗漏，提高TIR，降低TAR和TBR［331］ 。
无针注射技术是《中国糖尿病药物注射技术指南》推荐的注射方法之一，能缓解患者对传统有针注射笔的恐针心理，降低注射痛感，从而提高患者依从性，改善血糖控制［332］ 。此外，无针注射可减少有针注射相关的不良反应，如皮下硬结、脂肪增生或萎缩，并减少了胰岛素的用量。有条件时可用于健康状态为良好（Group 1）和中等（Group 2）的老年糖尿病患者。但无针注射的操作相较于胰岛素笔注射复杂，需经专业人员指导，熟练掌握操作方法后方可自行注射。对于无法自行完成注射操作的患者，需教育患者家属积极协助或选用其他的注射方式。
三、胰岛素泵
胰岛素泵是采用人工智能控制的胰岛素输送装置，可以连续进行皮下胰岛素注射，最大程度模拟胰岛素的生理分泌，以帮助管理血糖。对于老年糖尿病患者，尤其是 T1DM，如采用多针胰岛素皮下注射治疗血糖波动大、低血糖风险高，建议试用胰岛素泵。采用多针胰岛素皮下注射难以精确调整胰岛素用量的患者也可考虑应用胰岛素泵。在老年 T2DM 患者中，有研究提示，相较于多针胰岛素皮下注射，使用胰岛素泵可以有效控制血糖，安全性和患者满意度良好［333］ 。有研究证实在平均年龄大于 60 岁的 T2DM 患者中应用自动胰岛素输注系统的安全性和有效性［334］ 。认知能力下降、视力下降、手指灵活性下降、无他人协助、缺乏胰岛素泵的知识等均可能是老年糖尿病患者使用胰岛素泵的限制因素［335］ 。临床医师需结合患者的个体情况决定是否采用胰岛素泵治疗，并对患者及家属进行胰岛素泵知识的充分教育，包括胰岛素泵的设置、报警的处理、潜在的并发症等。应建立良好的协助模式，在患者的胰岛素泵需要调整时能被快速有效地处理，以免出现胰岛素泵相关的急性不良事件。
第十七章 老年糖尿病与中医药学
糖尿病属中医“消渴病”范畴，我国传统医学治疗历史由来已久。中医认为，糖尿病的基本病机为阴虚燥热，因具有口干多饮、多食易饥、小便频数的临床特点，分别涉及肺、胃、肾等病位，其治疗相应可分上、中、下三消论治。中医药在糖尿病及其并发症的治疗中有一定效果。由于老年患者常伴器官功能衰退，多种并发症和合并症并存，中西药物使用情况复杂等多重因素，因此，需要在专业中医指导下接受中医、中西医结合治疗，并且在治疗过程中注意用药的安全性。
执笔者：
潘 琦（北京医院内分泌科 国家老年医学中心）
邓明群（北京医院内分泌科 国家老年医学中心）
虞睿琪（中国医学科学院北京协和医院内分泌科）
专家委员会名单（按照姓氏拼音排序）：
陈 宏（南方医科大学珠江医院内分泌科）
陈 丽（山东大学齐鲁医院内分泌科）
陈莉明（天津医科大学朱宪彝纪念医院内分泌科）
陈有信（中国医学科学院北京协和医院眼科）
窦京涛（解放军总医院第一医学中心内分泌科）
杜建玲（大连医科大学附属第一医院内分泌科）
段滨红（黑龙江省医院内分泌科）
郭立新（北京医院内分泌科 国家老年医学中心）
洪天配（北京大学第三医院内分泌科）
侯新国（山东大学齐鲁医院内分泌科）
胡 吉（苏州大学附属第二医院内分泌科）
姬秋和（空军军医大学西京医院内分泌科）
纪立农（北京大学人民医院内分泌科）
姜 昕（深圳市人民医院老年病科）
蒋 升（新疆医科大学第一附属医院内分泌科）
康 琳（中国医学科学院北京协和医院老年医学科）
匡洪宇（哈尔滨医科大学附属第一医院内分泌科）
邝 建（广东省人民医院内分泌科）
雷闽湘（中南大学湘雅医院内分泌科）
李春霖（解放军总医院第二医学中心内分泌科）
李全民（火箭军特色医学中心内分泌科）
李 兴（山西医科大学第二医院内分泌科）
李延峰（中国医学科学院北京协和医院神经内科）
李益明（复旦大学附属华山医院内分泌科）
李 勇（复旦大学附属华山医院心血管内科）
梁瑜祯（广西医科大学第二附属医院内分泌科）
林夏鸿（中山大学附属第七医院内分泌科）
刘 静（甘肃省人民医院内分泌科）
刘幼硕（中南大学湘雅二医院老年医学科）
鹿 斌（复旦大学附属华东医院内分泌科）
陆颖理（上海交通大学医学院附属第九人民医院内分泌科）
吕文山（青岛大学附属医院内分泌科）
母义明（解放军总医院第一医学中心内分泌科）
潘 琦（北京医院内分泌科 国家老年医学中心）
秦贵军（郑州大学第一附属医院内分泌科）
沈云峰（南昌大学第二附属医院内分泌科）
施 红（北京医院老年医学科 国家老年医学中心）
宋光耀（河北省人民医院内分泌科）
童南伟（四川大学华西医院内分泌科）
王建业（北京医院泌尿外科 国家老年医学中心 中国医学科学院老
年医学研究院）
王世东（北京中医药大学东直门医院内分泌科）
王颜刚（青岛大学附属医院内分泌科）
王正珍（北京体育大学运动医学与康复学院）
吴 静（中南大学湘雅医院内分泌科）
吴天凤（浙江医院内分泌科）
武晓泓（浙江省人民医院内分泌科）
肖建中（清华大学附属北京清华长庚医院内分泌科）
肖新华（中国医学科学院北京协和医院内分泌科）
谢晓敏（银川市第一人民医院内分泌科）
徐 静（西安交通大学第二附属医院内分泌科）
徐向进（解放军联勤保障部队第九〇〇医院内分泌科）
徐焱成（武汉大学中南医院内分泌科）
徐 勇（西南医科大学附属医院内分泌科）
徐玉善（昆明医科大学第一附属医院内分泌科）
许樟荣（解放军战略支援部队特色医学中心内分泌科）
薛耀明（南方医科大学第一临床医学院南方医院内分泌科）
杨 川（中山大学孙逸仙纪念医院内分泌科）
杨 静（山西医科大学第一医院内分泌科）
杨 涛（南京医科大学第一附属医院内分泌科）
杨 莹（云南大学附属医院内分泌科）
余学锋（华中科技大学同济医学院附属同济医院内分泌科）
袁慧娟（河南省人民医院内分泌科）
张 波（中日友好医院内分泌科）
张存泰（华中科技大学同济医学院附属同济医院老年医学科）
张俊清（北京大学第一医院内分泌科）
章 秋（安徽医科大学第一附属医院内分泌科）
赵家军（山东第一医科大学附属省立医院内分泌科）
利益冲突 所有作者声明无利益冲突
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中国老年糖尿病诊疗指南（2024版）---1~4章
国家老年医学中心 中华医学会老年医学分会
中国老年保健协会糖尿病专业委员会
通信作者：郭立新，北京医院内分泌科 国家老年医学中心 中国医学科学院老年医学研究院，北京 100730，Email：该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。；肖新华，中国医学科学院北京协和医学院
北京协和医院内分泌科，北京 100730，Email：该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。
本指南由《中华糖尿病杂志》《中华老年医学杂志》和《Aging Medicine》于 2024年 2月同步发表
【摘要】 随着我国老龄化的加剧，老年糖尿病的患病率明显增高，其规范化管理对改善老年糖尿病患者的临床结局至关重要。2021年国家老年医学中心、中华医学会老年医学分会以及中国老年保健协会糖尿病专业委员会组织专家撰写了我国首部老年糖尿病指南，即《中国老年糖尿病诊疗指南（2021年版）》，强调老年糖尿病患者存在高度异质性，需要综合评估，采取分层和个体化的管理策略，首次提出针对老年糖尿病患者的“简约治疗理念”和“去强化治疗策略”。这版指南为临床医师提供了实用的、可操作的临床指导，对我国老年糖尿病患者全方位、全周期的规范化综合管理起到了极大的推动作用，同时也推动了我国老年糖尿病及相关领域的临床和基础研究的广泛开展。指南发布近三年来，国内外老年糖尿病及相关领域的循证医学证据进一步积累，新的治疗理念、新型药物及治疗技术不断涌现，指南编委会及时对第一版指南进行了更新，对老年糖尿病的血糖管理路径进行了进一步细化和优化，编写了《中国老年糖尿病诊疗指南（2024年版）》，以期继续助力中国老年糖尿病患者的规范化管理及临床结局的改善。
【关键词】 糖尿病； 老年人； 指南； 治疗路径
Guideline for the management of diabetes mellitus in the elderly in China (2024 edition)
National Center of Gerontology, Chinese Society of Geriatrics, Diabetes Professional Committee of Chinese Aging Well Association
Corresponding authors: Guo Lixin, Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China, Email: glx1218@163. com; Xiao Xinhua, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China, Email: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。
目录
前言 ……………………………………………………… 148
编写说明 ………………………………………………… 148
第一章 老年糖尿病及其并发症的流行病学 ………… 149
第二章 老年糖尿病的诊断、分型及特点 …………… 149
第三章 老年糖尿病的三级预防 ……………………… 150
第四章 老年糖尿病患者的健康状态综合评估 ……… 150
第五章 老年糖尿病患者的健康教育 ………………… 151
第六章 老年糖尿病患者的血糖控制目标 …………… 152
第七章 老年糖尿病患者的生活方式干预 …………… 152
第八章 老年2型糖尿病患者的降糖药物及治疗路径……………………………………………… 154
第九章 老年糖尿病合并动脉粥样硬化性心血管疾病或危险因素的综合管理 ……………………… 159
第十章 老年糖尿病慢性并发症的筛查与处理 ……… 162
第十一章 老年糖尿病的急性并发症 ………………… 166
第十二章 老年糖尿病的共患疾病 …………………… 167
第十三章 老年糖尿病的多重用药 …………………… 171
第十四章 老年糖尿病的特殊情况 …………………… 172
第十五章 老年1型糖尿病及相关问题 ……………… 174
第十六章 糖尿病管理相关技术 ……………………… 174
第十七章 老年糖尿病与中医药学 …………………… 176
附录 ……………………………………………………… 177
Engaging with and optimising care for people under age 50 years with type 2 diabetes: The DiaST model of care
Nicola Milne
Audit within Brooklands and Northenden Primary Care Network revealed that people with type 2 diabetes under the age of 50 years were an underserved population and were less likely to receive the recommended eight care processes than other age groups locally. This article outlines the initiatives carried out to address this inequality. The work involved a Diabetes Support Team (DiaST) model of care and embedded an array of actions to overcome barriers to engagement among this hardly reached group. The initiative has resulted in more than a doubling of the rate of care process achievement in this population, although disparities with other age groups remain. The article should serve as inspiration for services looking to make the most of NHS England’s T2Day (Type 2 Diabetes in the Young) programme to fund extended health checks for people aged 18–39 years living with type 2 diabetes.
Citation: Milne N (2023) Engaging with and optimising care for people under age 50 years with type 2 diabetes: The DiaST model of care. Diabetes & Primary Care 25: [Early view publication]
Key words
– Audit
– DiaST
– Early-onset type 2 diabetes
– Service delivery
Author
Nicola Milne, DiaST Lead, Brooklands and Northenden PCN.
Optimizing Multidisciplinary Care of Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus
Ellie Kelepouris . Wendy St. Peter . Joshua J. Neumiller .Eugene E. Wright
Received: March 27, 2023 / Accepted: April 19, 2023 / Published online: May 20, 2023 ＠ The Author(s) 2023
ABSTRACT
Diabetes is the leading cause of chronic kidney disease (CKD), a condition associated with significant morbidity and mortality. As these patients have a high risk of developing cardiovascular disease and end-stage kidney disease, there is a need for early detection and early initiation of appropriate therapeutic interventions that slow disease progression and prevent adverse outcomes. Due to the complex nature of diabetes and CKD management, a holistic, patient-centered, collaborative care approach delivered by a coordinated multidisciplinary team (ideally including a clinical pharmacist as part of a comprehensive medication management program) is needed. In this review, we discuss the barriers to effective care, the current multidisciplinary approach used for CKD prevention and treatment, and the potential ways that the multidisciplinary management of CKD associated with type 2 diabetes mellitus can be refined to improve patient outcomes.
PLAIN LANGUAGE SUMMARY
People living with type 2 diabetes mellitus are at risk of developing chronic kidney disease. Having chronic kidney disease means that over time the kidneys may not work as well as they should. Some people with chronic kidney disease will eventually need a new kidney (transplant) or will need to use a machine that does the job of their kidneys (dialysis). To slow the rate at which the kidneys get worse, chronic kidney disease needs to be detected and treated early. A multidisciplinary team of healthcare professionals is needed to help people with type 2 diabetes reduce their chances of getting chronic kidney disease, or to prevent their chronic kidney disease from getting worse. Some healthcare teams include a clinical pharmacist who makes sure medicines are given in the correct amount and at the correct time. It is important that the healthcare team members communicate well and include the person with type 2 diabetes and chronic kidney disease and their family members or caregivers (if needed) in the decision-making process to achieve better health results. Barriers stopping people with type 2 diabetes and chronic kidney disease from getting good healthcare include a shortage of nephrologists, not having enough healthcare insurance, limited access to healthcare, and poor understanding about what chronic kidney disease is and how it can be treated. This review article discusses the barriers to better healthcare in chronic kidney disease and how the current healthcare team approach could be changed to improve health results.
Keywords: Chronic kidney disease; Type 2 diabetes mellitus; Multidisciplinary care; Multidisciplinary team; Care optimization; Prevention
Key Summary Points
Chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) are chronic conditions associated with long-term health, financial, and quality-of-life consequences for patients.
Barriers to optimized CKD care in people with T2DM include a shortage of specialist clinicians (nephrologists), delays in initiation or appropriate adjustment of evidence-based therapies, inconsistent screening practices, poor health literacy, inadequate healthcare insurance coverage, and limited access to healthcare.
An effective and well-coordinated multidisciplinary team (MDT), especially one that includes a clinical pharmacist as part of a comprehensive medication management (CMM) program, should proactively address many of these barriers to effective care.
Implementation of a collaborative care MDT approach (incorporating CMM) for CKD associated with T2DM across the USA is recommended.
DIGITAL FEATURES
This article is published with digital features, including a graphical plain language summary, to facilitate understanding of the article. To view digital features for this article go to https:// doi.org/https://doi.org/10.6084/m9.figshare.22644406.
Do sex differences in paediatric type 1 diabetes care exist? A systematic review
Silvia A. G. de Vries1 iD Carianne L. Verheugt1 iD Dick Mul2 iD Max Nieuwdorp1 iD Theo C. J. Sas2,3
Received: 26 April 2022 /Accepted: 25 November 2022
© The Author(s) 2023
Abstract
Aims/hypothesis Sex differences are present in cardiovascular care and in outcomes among adults with type 1 diabetes mellitus, which typically commences in childhood. Whether sex influences care and outcomes in childhood is not known. This systematic review provides an overview of sex differences in children with type 1 diabetes, focusing on patient and disease characteristics, treatment, comorbidities and complications.
Methods Literature in MEDLINE up to 15 June 2021 was searched, using the terms diabetes mellitus, sex characteristics, sex distribution, children and/or adolescents. All primary outcome studies on children with type 1 diabetes that mentioned a sex difference in outcome were included, with the exception of qualitative studies, case reports or case series. Studies not pertaining to the regular clinical care process and on incidence or prevalence only were excluded. Articles reporting sex differences were identified and assessed on quality and risk of bias using Joanna Briggs Institute critical appraisal tools. Narrative synthesis and an adapted Harvest plot were used to summarise evidence by category.
Results A total of 8640 articles were identified, rendering 90 studies for review (n=643,217 individuals). Studies were of observational design and comprised cohort, cross-sectional and case–control studies. Most of the included studies showed a higher HbA1c in young female children both at diagnosis (seven studies, n=22,089) and during treatment (20 out of 21 studies, n=144,613), as well as a steeper HbA1c increase over time. Many studies observed a higher BMI (all ages, ten studies, n=89,700; adolescence, seven studies, n=33,153), a higher prevalence of being overweight or obese, and a higher prevalence of dyslipidaemia among the female sex. Hypoglycaemia and partial remission occurred more often in male participants, and ketoacidosis (at diagnosis, eight studies, n=3561) and hospitalisation was more often seen in female participants. Most of the findings showed that female participants used pump therapy more frequently (six studies, n=211,324) and needed higher insulin doses than male participants. Several comorbidities, such as thyroid disease and coeliac disease, appeared to be more common in female participants. All studies reported lower quality of life in female participants (15 studies, n=8722). Because the aim of this study was to identify sex differences, studies with neutral outcomes or minor differences may have been under-targeted. The observational designs of the included studies also limit conclusions on the causality between sex and clinical outcomes.
Conclusions/interpretation Sex disparities were observed throughout diabetes care in children with type 1 diabetes. Several outcomes appear worse in young female children, especially during adolescence. Focus on the cause and treatment of these differences may provide opportunities for better outcomes.
Registration This systematic review is registered in PROSPERO (CRD42020213640)
Keywords Child . Diabetes mellitus . Narrative synthesis . Sex differences . Systematic review . Type 1 diabetes
* Silvia A. G. de Vries
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1 Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
2 Diabeter, Center for Paediatric and Adult Diabetes Care and Research, Rotterdam, the Netherlands
3 Department of Paediatrics, Division of Paediatric Endocrinology, Erasmus University Medical Center, Sophia Children’s Hospital, Rotterdam, the Netherlands
https://doi.org/10.1007/s00125-022-05866-4
/ Published online: 26 January 2023
超快超强激光及其科学应用发展趋势研究
刘军，曾志男，梁晓燕，冷雨欣，李儒新
（中国科学院上海光学精密机械研究所，上海 201800）
摘要：超快超强激光兼具超快时域特性和超高峰值功率特性，为人类在实验室中创造出了前所未有的超快时间、超高强场、超高温度和超高压力等极端物理条件，成为用于拓展人类认知的前沿基础科学研究最重要的工具之一。本文从超快激光和超强激光的应用与发展需求出发，系统调研了国内外研究和科学应用的现状，提出了我国超快激光和超强激光的发展思路与目标以及为实现这些目标需要重点发展的相关方法和技术。针对超高峰值功率和高重复频率超强激光面向未来的重要方向，分析了我国分阶段发展的重点内容，突出了相关技术与配套元器件研究的重要性。此外，在注重基础研究、多方面吸引和培育人才、加强国际合作、促进产业化等方面提出了超快超强激光发展的措施建议，以期为我国激光技术与科学应用的稳步发展提供方向参照。
关键词：超快超强激光；飞秒激光；阿秒激光；拍瓦激光；发展趋势
中图分类号：O437 文献标识码：A
Development Trend of Ultrafast and Ultraintense
Lasers and Their Scientific Application
Liu Jun, Zeng Zhinan, Liang Xiaoyan, Leng Yuxin, Li Ruxin
(Shanghai Institute of Optics and Fine Mechanics, Chinese Academy of Sciences, Shanghai 201800, China)
Abstract: Ultrafast and ultraintense lasers have ultrafast temporal and ultraintense focal intensity properties. They can create unprecedentedly extreme experimental conditions with ultrahigh time resolution, temperature, and pressure as well as ultrahigh-strength field. The ultrafast and ultraintense laser is one of the important tools for frontier fundamental research meant for extending the knowledge of mankind. This paper starts with the analysis of the application and development demands of the ultrafast and ultraintense lasers and then systematically investigates the research status of these lasers in China and abroad. Based on this, the developing routes and targets of ultrafast and ultraintense lasers as well as the related technologies needed for achieving these targets are proposed. Particularly, we proposed the respective key steps for developing ultraintense lasers with ultrahigh peak power and those with high repetition frequency, and emphasized the study of related technologies and ancillary components. Furthermore, several suggestions are proposed for the development of ultrafast and ultraintense lasers in China, including strengthening fundamental researches, improving personnel training, enhancing international cooperation, and promoting market application, hoping to provide references for the steady development of China’s laser technologies.
Keywords: ultraintense and ultrashort laser; femtosecond laser; attosecond laser; petawatt laser; development trend
