Welcome to Journal of Diabetes Science and Technology (DST) (www.journalofdst.org). This bimonthly peer reviewed electronic journal closely covers the field of diabetes technology. DST is published by Diabetes Technology Society, a non-profit organization, based in Foster City, California. The mission of DST is to produce a high quality journal that is: 1) the meeting ground between the science and practice of diabetes and technology; 2) the premiere source of information focused on diabetes and technology; and 3) the catalyst to advance development and utilization of new technologies to help people with diabetes. Journal of Diabetes Science and Technology is backed by an outstanding Editorial Board of scientists, clinicians, and government regulators to review articles and advise the editorial staff. It is noteworthy that such major United States government agencies as the Army, Centers for Disease Control and Prevention (CDC), Department of Veterans Affairs (VA), Food and Drug Administration (FDA), National Aeronautics and Space Administration (NASA), National Institutes of Health (NIH), National Space Biomedical Research Institute (NSBRI), and National Science Foundation (NSF) are all represented on the Editorial Board. Each of these agencies or organizations deals with maintaining health or developing technology for their constituents. The technologies that are being closely covered by DST relate to the 21 million Americans, and the 250 million people worldwide with diabetes. When administrators of these agencies or organizations look to acquire improved metabolic monitoring, physiologic modeling, or remote data transmission capabilities, they are increasingly turning to the diabetes technology community, and DST presents the advances that are emerging from this scientific community. Journal of Diabetes Science and Technology is supported by a Clinical Advisory Board, as well. This group of international experts in clinical applications of diabetes technology, based in the US, Europe, and Australia, reviews clinical articles and advises the editorial staff. This Board will be particularly active in identifying topics for the journal's regular section on “Clinical Applications of Diabetes Technology.” DST presents the latest information about developments in diabetes technology from basic science to clinical applications. Diabetes science refers to performing research or making observations to understand the abnormal physiology of diabetes and discover opportunities for treating this disease Diabetes technology refers to applying scientific principles or utilizing practical experience to create tools for people with diabetes and develop products for fighting this disease. DST emphasizes the spectrum of technologic applications derived from the physical sciences, which can be used to treat, monitor, diagnose, or prevent diabetes. At one end of the journal's spectrum are basic science articles written by engineers, chemists, physicists, and other physical scientists. These scientific articles cover physical principles and relationships that can be utilized to develop products. At the other end of the journal's spectrum are clinical trial articles written by physicians, nurses, pharmacists, and other healthcare providers. These articles cover the outcomes and potential benefits of investigational devices and drugs that can mimic or improve upon natural systems to compensate for the abnormal metabolic pathways that characterize diabetes. DST covers all forms of diabetes technology including: glucose monitoring; insulin and metabolic peptide delivery; artificial and bioartificial closed-loop control systems, telemedicine; software for modeling; physiologic monitoring; technology for managing obesity; diagnostic tests of glycation; and the use of bioengineered tools such as MEMS, new biomaterials, and nanotechnology to develop new sensors and actuators to be applied to diabetes. DST supports the mission of Diabetes Technology Society, which is to promote the use of science and engineering in the fight against diabetes. In DST, peer review of original articles and review articles is conducted by leaders in the field from academia, government, the non-profit sector, and industry. Commentary articles are published to express opinions about problems in diabetes technology, and their general format is to describe where we are, where we are going, and how we need to get there. Authors are asked to disclose potential financial conflicts of interest. DST contains a regular section on scientific and clinical developments in Obesity Technology, co-edited by Karl Friedl, Ph.D. from US Army TATRC, Fort Detrick, Maryland (Scientific Editor) and Frank Greenway, M.D., from Pennington Biomedical Research Institute of Louisiana State University (Clinical Editor). Diabetes Technology Society believes that technology will play an important role in reversing the global trend toward obesity and resultant type 2 diabetes. In the first issue of DST, this section contains a report about the NSF/NIH Workshop on Engineering Approaches to Energy Balance and Obesity: Opportunities for Novel Collaborations and Research, which took place in June, 2006 in Virginia. DST includes a section entitled, “Clinical Applications of Diabetes Technology.” In the journal's first issue, David Rodbard, M.D. has launched this section with an article entitled “Optimizing Display, Analysis, Interpretation and Utility of Self-Monitoring of Blood Glucose (SMBG) Data for Management of Patients with Diabetes.” DST includes a section entitled, “Controversies in Continuous Glucose Monitoring” to highlight the scientific, clinical, and economic growing pains that are accompanying the adoption of continuous glucose monitoring, which promises to revolutionize diabetes management. This section is co-edited by Bruce Buckingham, M.D. from Stanford University and Stuart Weinzimer, M.D. from Yale University. In the journal's first issue, James Nichols, Ph.D. and David Klonoff, M.D. have launched this section with an article entitled “The Need for Performance Standards for Continuous Glucose Monitors.” DST features a column entitled “Diabetes Computing & Internet Watch,” which is edited by Eldon Lehmann, M.D., Ph.D. from University of Toronto. This column alternates with a section entitled, “Diabetes Vascular and Neurologic Technology,” which is edited by Thomas Forst, M.D. from University of Mainz. DST will publish the Proceedings of the world's two most important meetings devoted to diabetes technology, the Diabetes Technology Meeting every Fall and the Clinical Diabetes Technology Meeting every Spring, as well as reports from meetings around the world. Journal of Diabetes Science and Technology is the world's first completely electronic journal devoted to diabetes. To provide quick access to back articles, DST sends subscribers a CD-ROM with the Table of Contents printed on the jacket for each issue of the journal. In this way, DST offers both the rapid turnaround time of a completely electronic journal as well as the archiving capability of a print journal. By publishing in an electronic format, it is possible to present letters to the editor online on the journal website with very little delay. We expect that DST will be occasionally controversial, frequently enlightening, and often entertaining. We hope that you will enjoy DST and will read it regularly. We invite you to submit an original article, a review article, a Commentary article, or a letter to the editor on a topic of diabetes science or technology. Journal of Diabetes Science and Technology is an electronic meeting place for the ever-expanding diabetes technology community. Together with our authors and readers we will advance the field of Diabetes Technology.
Cyberpsychology, Behavior, and Social NetworkingVol. 23, No. 7 EditorialConnecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding “Zoom Fatigue”Brenda K. WiederholdBrenda K. WiederholdBrenda K. Wiederhold, Editor-in-Chief Search for more papers by this authorPublished Online:10 Jul 2020https://doi.org/10.1089/cyber.2020.29188.bkwAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View article"Connecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding “Zoom Fatigue”." Cyberpsychology, Behavior, and Social Networking, 23(7), pp. 437–438FiguresReferencesRelatedDetailsCited byQuantitative analysis of communication changes in online medication counseling using the Roter Interaction SystemResearch in Social and Administrative Pharmacy, Vol. 20, No. 1“Who Said That?” Applying the Situation Awareness Global Assessment Technique to Social Telepresence13 December 2023 | ACM Transactions on Human-Robot Interaction, Vol. 12, No. 4The good and bad of an online asynchronous general education course: Students’ perceptions18 December 2023 | Psychology Teaching Review, Vol. 29, No. 2Face-to-face more important than digital communication for mental health during the pandemic17 May 2023 | Scientific Reports, Vol. 13, No. 1Videoconference fatigue from a neurophysiological perspective: experimental evidence based on electroencephalography (EEG) and electrocardiography (ECG)26 October 2023 | Scientific Reports, Vol. 13, No. 1The ‘Zoomification’ of Collaboration: How 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and Psychology of the Pandemic November Through the October 2021 | Education, Vol. No. Practice During COVID-19 to and of November 2021 | Vol. 36, No. as the of Exploring and Perspectives of of Telehealth by a Australian Service during COVID-19 October 2021 | International Journal of Environmental Research and Public Health, Vol. 18, No. with The of technology and consumer July 2021 | International Journal of Consumer Studies, Vol. 45, No. of June 2021 | Annals of Surgery, Vol. No. and of Virtual in Video and Effects on of the ACM on Human-Computer Interaction, Vol. 5, No. How a Virtual Network during the COVID-19 of the ACM on Human-Computer Interaction, Vol. 5, No. May 2021 | American Journal of Clinical Vol. No. to and Education in the of December 2021 | Journal of Education, Vol. No. between social communication and during the early of September 2021 | Journal of Social and Vol. No. September 2021 | Vol. 11, No. Bir September 2021 | Vol. 5, No. of During the COVID-19 Pandemic by the of Medical of A Survey September 2021 | Frontiers in Medicine, Vol. student under remote learning using digital A June 2021 | Education and Information Vol. No. of the COVID-19 Pandemic on Higher Education: the
No AccessStand Alone Books1 Feb 2013Air pollution from motor vehiclesStandards and technologies for controlling emissionsAuthors/Editors: Asif Faiz, Christopher S. Weaver, and Michael P. WalshAsif Faiz, Christopher S. Weaver, and Michael P. Walshhttps://doi.org/10.1596/0-8213-3444-1SectionsAboutPDF (1.9 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This handbook presents a state-of-the-art review of vehicle emission standards and testing procedures and attempts to synthesize worldwide experience with vehicle emission control technologies and their applications in both industrialized and developing countries. It is one in a series of publications on vehicle-related pollution and control measures prepared by the World Bank in collaboration with the United Nations Environment Programme to underpin the Bank ' s overall objective of promoting transport development that is environmentally sustainable and least damaging to human health and welfare. Chapter 1 surveys vehicle emission standards adopted in various countries, emphasizing the international system of standards employed in North America and Europe. Chapter 2 discusses the test procedures used to quantify vehicle emissions in order to verify compliance and estimate emissions actually used. Chapter 3 describes the engine and aftertreatment technologies developed to enable new vehicles to comply with emission standards, as well as the costs and other impacts of these technologies. That measures to control emissions from in-use vehicles are an essential complement to emission standards for new vehicles is the subject explored in Chapter 4. Lastly, the role of fuels in reducing emissions is reviewed in Chapter 5, which discusses both the benefits of reformulating conventional gasoline and diesel fuels and the potential benefits of alternative cleaner fuels. 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No AccessEducationJul 2010Design Thinking for Social InnovationAuthors/Editors: Tim Brown, Jocelyn WyattTim BrownSearch for more papers by this author, Jocelyn WyattSearch for more papers by this authorhttps://doi.org/10.1596/1020-797X_12_1_29SectionsAboutView ChaptersPDF (0.2 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Designers have traditionally focused on enchancing the look and functionality of products. 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Assessment Using A Human-Centered Design Approach (Preprint)JMIR February mental health and in and mental framework for in of Cleaner Production, to Design Thinking to Creative and in Journal of & Design Education, August Theory in An Journal, March 2021Designing and for with January with design thinking: a case study from Journal of Environmental Education, Vol.52, January and the of Design: of Design and Design in No.122 May to Design with A for Design and July Case and the of Design Thinking in Public Education in August to Co-Created Digital to Support Activities for Socially Youth in February Innovation and Exchange a Lessons Learned from a Design Thinking Challenge in May October Sustainable Business and January Analysis of Agile Development Methodology Through Design June Sustainable Design to Environmental of Design November Case for Design May Learning in Design Thinking to April 2021Design Thinking as a Strategy to Learning in Education Across South April Inspection Management with October design methodology for A to community health and health in the Health of and Science, Vol.5, February 2021Using Design Thinking to the Educational of August factors of service design methodology for manufacturing Business & Management, Vol.8, February 2021Design and of an app for September 2021Design Innovation Methodology – Design in Journal, of the Health Mental Health Intervention for in and for a Research Vol.10, June Design Approach to Social a of Public and October Design Thinking in an Interdisciplinary Learning December Design Thinking to Design Thinking to Food Innovation for January of Design Thinking and to Food and January 2021Design Thinking to Engage in Food The January 2021Systemic and Design Towards Participatory The Journal of Design, and Innovation, Vol.7, Design Thinking October Research and Design Thinking for the Health and Social A para de de Vol.16,
HomeCirculationVol. 83, No. 1An updated coronary risk profile. A statement for health professionals. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBAn updated coronary risk profile. A statement for health professionals. K M Anderson, P W Wilson, P M Odell and W B Kannel K M AndersonK M Anderson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P W WilsonP W Wilson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P M OdellP M Odell Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. and W B KannelW B Kannel Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. Originally published1 Jan 1991https://doi.org/10.1161/01.CIR.83.1.356Circulation. 1991;83:356–362 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hespe C, Giskes K, Harris M and Peiris D (2022) Findings and lessons learnt implementing a cardiovascular disease quality improvement program in Australian primary care: a mixed method evaluation, BMC Health Services Research, 10.1186/s12913-021-07310-6, 22:1, Online publication date: 1-Dec-2022. Lemke E, Vetter V, Berger N, Banszerus V, König M and Demuth I (2022) Cardiovascular health is associated with the epigenetic clock in the Berlin Aging Study II (BASE-II), Mechanisms of Ageing and Development, 10.1016/j.mad.2021.111616, 201, (111616), Online publication date: 1-Jan-2022. 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No AccessHealth, Nutrition, and Population1 Feb 2013Better Health Systems for India's PoorFindings, Analysis, and OptionsAuthors/Editors: David H. Peters, Abdo S. Yazbeck, Rashmi R. Sharma, G. N. V. Ramana, Lant H. Pritchett, Adam WagstaffDavid H. Peters, Abdo S. Yazbeck, Rashmi R. Sharma, G. N. V. Ramana, Lant H. Pritchett, Adam Wagstaffhttps://doi.org/10.1596/0-8213-5029-3SectionsAboutPDF (1.3 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This report focuses on four areas of the health system in which reforms, and innovations would make the most difference to the future of the Indian health system: oversight, public health service delivery, ambulatory curative care, and inpatient care (together with health insurance). Part 1 of the report contains four chapters that discuss current conditions, and policy options. Part 2 presents the theory, and evidence to support the policy choices. The general reader may be most interested in the overview chapter, and in the highlights found at the beginning of each of the chapters in part 2. These highlights outline the empirical findings, and the main policy challenges discussed in the chapter. The report does not set out to prescribe detailed answers for India ' s future health system. It does however, have a goal: to support informed debate, and consensus building, and to help shape a health system that continually strives to be more effective, equitable, efficient, and accountable to the Indian people, and particularly to the poor. 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Strong primary healthcare enhances resource efficiency and resilience. Type 2 diabetes poses a growing global health challenge, with Argentina's healthcare system struggling to detect and manage the disease effectively. Many patients bypass primary healthcare for secondary facilities, undermining continuity of care and increasing costs. Following a diagnostic process in collaboration with policymakers, we propose evaluating a redesigned primary care model consisting of codesigned evidence-based implementation strategies to improve type 2 diabetes management in Mendoza, Argentina. This is an efficient, parallel-arm cluster randomised controlled Hybrid Type II trial with 12 clusters (administrative areas with 2-3 health facilities) allocated 1:1 to control (usual care) or intervention. In phase I, we will codesign, pilot and refine an implementation strategy package. In phase II, we will conduct the trial: 9-month baseline data collection, 15-month intervention and 6-month sustainability period. We will enrol a cohort of 396 patients with type 2 diabetes at primary healthcare centres and follow them for 12 months during the intervention and 6 months sustainment using routine clinical records and patient surveys. In phase III, we will conduct analysis, report and disseminate findings. The primary outcome will be a composite outcome including glycaemic control (glycated haemoglobin (HbA1c) <8%); blood pressure control (<140/90 mm Hg) and statin prescription (limited to patients ≥40 years) from clinical records. The primary analysis will compare the proportion of patients achieving this composite clinical outcome between the trial arms at the end of the study. Secondary analyses include assessing patient experience and primary healthcare engagement; testing the implementation strategies' impact on service use patterns, system competence, user confidence and cost per visit; exploring inequalities by sociodemographic factors; and assessing patient empowerment. We will use all available data from all randomised clusters and conduct all analyses on the intention-to-treat population, regardless of intervention adherence. All study activities will comply with national and international ethics guidelines, presenting minimal risk to participants. The protocol was submitted and approved by the local independent ethics committee at the Mendoza Ministry of Health (Consejo Provincial de Evaluación ética en investigación en Salud-Provincial Health Research Ethics Review Board, Reference number: 149/2024). Facility-level permission will be obtained for participation and sharing of deidentified data. Written informed consent will be required from study participants, who will receive information on the study's purpose, procedures, risks and benefits. Dissemination activities and outputs will include writing and submitting manuscripts for publication; writing policy briefs to support strategy implementation in other regions or countries; and tailoring outputs for patients, clinicians and researchers. We anticipate that improvements in disease management and patient experience will have clinical and economic benefits related to reduced usage of secondary-level and tertiary-level facilities, lower cost per visit and a reduced number of clinical events related to diabetes. ISRCTN63277390.
Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.
Usage of diabetes technology by people living with diabetes does help them a lot with their daily diabetes management burden. Evidence for the efficacy of using systems for continuous glucose monitoring, automated insulin delivery, and so on has largely been derived from randomized controlled trials, which are pivotal for regulatory approvals and reimbursement decisions. However, evidence obtained from real-world usage of technology is crucial as it confirms the benefits also under such conditions. Data obtained from a detailed survey answered by health care professionals and people living with diabetes provides further insights into the reality of usage. They also help to understand the hurdles in daily life and what can be done to overcome these. In this special theme issue, a set of specific topics is addressed that are of academic and clinical importance: dropouts from automated insulin delivery systems, technology use in people living with type 2 diabetes, technology and aging, smart insulin pens, and green diabetes. The data basis for the analysis presented in these manuscripts is from Germany, Austria, and Switzerland. In the future, data from other European Countries will complement the insights gained. This will help to understand the similarities and differences between these countries, which have specific differences in their health care systems. This can lead to subsequent activities in the different countries to improve the clinical care of people living with diabetes.
Diabetes technologies, such as continuous glucose monitoring (CGM), insulin pumps, and automated insulin delivery (AID) systems, are increasingly used by people with type 2 diabetes (PWT2D), with growing clinical evidence supporting their therapeutic benefit. To describe the extent of adoption, perceived benefits, and future expectations, both health care professionals (HCPs) and PWT2D data from the dt-report 2025 were analyzed. From November to December 2025, HCP and PWT2D participated in the dt-report providing their attitudes, expectations, and predictions regarding the use of diabetes technology in type 2 diabetes. Frequencies from specific responses were analyzed. Data from 1078 HCPs and 450 PWT2D from the DACH region were analyzed for questions regarding the use of technology in type 2 diabetes. Continuous glucose monitoring was the most widely endorsed technology across both groups, with 58% of the survey participants using a CGM, and 1% using a pump. Health care professionals estimated 87% of PWT2D on intensive insulin therapy would benefit from CGM and saw indications among non-intensive insulin users (62%) and those on oral therapies (55%). Future use of CGM and AID systems was anticipated by both HCPs and PWT2D, including many currently not using such systems. Smart pens and stand-alone insulin pumps were viewed less favorably. Reported barriers included lack of awareness, reimbursement limitations, digital literacy, and usability concerns. The findings indicate growing openness toward diabetes technologies among PWT2D and broader perceived indications among HCPs. However, uptake remains limited, particularly outside of intensive insulin therapy. These insights are of relevance for future clinical guidance, access strategies, and patient education.
Quantifying the effect of meal composition (MC) on postprandial glucose excursions would allow optimizing insulin therapy, accounting for fat and protein that can affect gastric retention (GR), glucose rate of appearance (Ra), and insulin sensitivity (SI). Such variables can be estimated from continuous glucose monitor (CGM) and continuous subcutaneous insulin infusion (CSII) data using the Minimally-Invasive Oral Minimal Model (MI-OMM). In this work, we aim to quantify the effect of MC on those variables by applying the MI-OMM on a data set of prandial CGM and CSII profiles where MC information was available. A total of 120 individuals with type 1 diabetes (age = 15.5 ± 11.5 years, weight = 51.3 ± 28.0 kg) were monitored under free-living conditions while using CGM and CSII, and MC was carefully recorded. We extracted 353 CGM and CSII traces using predefined criteria and classified them into low or high fat content and low or high protein content. Finally, the MI-OMM was used to estimate GR, Ra, and SI in each meal. MI-OMM was able to fit CGM profiles and provided precise and physiologically plausible parameter estimates. Comparison among different classes of meals showed that a high content of fat and protein in the meal significantly slowed both GR (P < .01) and Ra (P < .01), and reduced SI (P < .05). In this work, the effect of MC on postprandial glucose excursion was quantified in real-life conditions with the help of a model-based methodology. These results are usable for redesigning current insulin therapies, accounting for the presence of fat and protein in meals.
Reducing health disparities in later life is an important yet challenging agenda, particularly in urban areas. The objective of this study was to examine the effectiveness of the Health and Wellness Program for Seniors (HWePS), a technology-enhanced, multilevel, integrated health equity intervention, on the health and well-being of older adults residing in urban, low-income communities. HWePS was a prospective, non-randomized, cluster-allocated quasi-experimental study conducted over 12 months in an intervention and a control neighborhood in Seoul, South Korea. Guided by proven models, the HWePS intervention includes four key components: a health literacy program tailored to individual and community needs, personalized self-care management with nurse coaching and peer support, a community initiative promoting healthy living and aging, and information and communication technology systems. Data were collected before and after the 12-week self-care program, which was the core component of a broader 12-month intervention period. The primary outcomes were self-reported health status and health-related quality of life. Secondary outcomes included walking practice, diabetes awareness, stress perception, and self-efficacy, among others. The analysis revealed a significant group-by-time interaction for self-rated health (B = 0.48, SE = 0.22, p = 0.0277), favoring the intervention group. For quality of life, only the main effects of group and time were significant, with no significant interaction (p = 0.8474). Among the secondary outcomes, walking practice rate (B = 0.93, SE = 0.19, p < 0.0001), diabetes awareness (B = 0.39; SE = 0.17; p = 0.0227), stress perception (B = -1.24, SE = 0.31, p < 0.0001), and self-efficacy (B = 1.91, SE = 0.90, p = 0.0354) were significantly improved compared to those of the control group. HWePS, an older people-empowering, community-mobilized health equity intervention, showed improvements in self-rated health and key health behaviors, providing preliminary evidence of its potential to reduce health disparities in a low-income urban community during the coronavirus disease 2019 pandemic. ISRCTN29103760; Ethical approval: SNU IRB No. 2011/002-016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5395967/.
The number of adults with diabetes and older age is increasing, yet little is known about age-related differences in real-world diabetes technology use. This analysis examines how uptake, clinical outcomes, and user experience vary across age groups in people with type 1 or type 2 diabetes. Self-reported data from 2056 individuals with diabetes in Germany, Austria, and Switzerland who completed the diabetes technology report 2024/2025 survey were analyzed. Age-related trends in the use of continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (CSII), and automated insulin delivery (AID) were assessed using generalized additive and segmented logistic regression models. Outcomes included HbA1c, diabetes distress (PAID-5), severe hypoglycemia (SH), and, among AID users, satisfaction. Among people with type 1 diabetes, CGM usage was consistently high across age groups (eg, 94% in 20-29 years; 92% in ≥70 years). Automated insulin delivery usage peaked in adolescents (81% in 10-19 years) and declined to 36% in adults ≥70 years. In type 2 diabetes, CGM use increased with age (48% in 35-44 years; 72% in ≥70 years). The HbA1c remained stable over the age span (±0.25%). Diabetes distress declined with age (Problems Areas in Diabetes Ouestionnaire - 5 Items (PAID-5): 7.8 in <30 vs 4.2 in ≥70 years). The risk of SH did not increase with age; among CSII users, older participants had lower odds of SH (OR 0.03, p = .001). Automated insulin delivery satisfaction was highest in adults aged 60 to 69 years (88.7/100) and lowest in adolescents (79.1/100). Diabetes technologies are widely used and well tolerated across age groups. Older adults benefit comparably, but barriers to AID use remain.
Automated identification of postprandial glucose responses (PPGR) from continuous glucose monitoring (CGM) profiles may detect early dysglycemia in people without diabetes. However, no standard approach for this task currently exists. We developed a wavelet transform-based AI algorithm to identify PPGRs using only CGM data. The algorithm was evaluated on a public CGM dataset of 25 normoglycemic adults and three independent validation cohorts (n = 65 total) with a mix of normoglycemia and prediabetes. Performance metrics included mealtime prediction error and total and incremental areas under the PPGR curve (tAUC and iAUC, respectively). Associations between AI-derived PPGR parameters and clinical markers such as HbA1c and fasting glucose were also examined. In the public dataset, 25 participants (age 40 ± 14 years, BMI 26 ± 6 kg/m2, HbA1c 5.4 ± 0.4%) provided 3 ± 1 days of paired CGM data and ground-truth mealtimes. The algorithm predicted PPGR start time with a median error of 10 [IQR: 4, 19] minutes relative to ground-truth mealtimes. Postprandial glucose response parameters including tAUC and iAUC derived using ground-truth mealtimes versus AI-predicted mealtime were similar (all P > .1), indicating the algorithm faithfully captured PPGR characteristics. In adjusted analysis, AI-derived PPGR iAUC was independently associated with laboratory markers including HbA1c (β = 0.57 [95% CI: 0.19, 0.95], P = .006) and fasting glucose (β = 0.52 [95% CI: 0.12, 0.92], P = .013). Algorithm performance remained consistent across the three validation cohorts. The wavelet AI algorithm accurately identified PPGRs from CGM data in people without diabetes, offering a novel automated approach to monitor early signs of postprandial dysglycemia in this population.
Diabetes technology use is increasing, yet disparities remain in adoption among people with type 1 diabetes (PwT1D). The Best Practice Advisories to Reduce Inequities in Technology Use ("BPA-TECH") study is a multi-site quality improvement (QI) initiative that seeks to develop, deploy, and evaluate a BPA aimed at standardizing prescribing of diabetes technologies. This mixed-methods study sought feedback from PwT1D, their care partners, and diabetes clinicians through the T1D Exchange QI Collaborative (T1DX-QI) using electronic surveys, interviews, and focus groups to develop and refine the BPA. The T1DX annual survey with general BPA questions was completed by 56 participating centers (38 pediatric and 18 adult), and 31 diabetes care clinicians from eight T1DX-QI centers (five pediatric and three adult) participated in focus groups. An online survey was completed by 101 PwT1D and/or their care partners, followed by structured interviews with nine adult PwT1D and ten care partners. In response to the annual survey, 48% of pediatric and 28% of adult centers thought a BPA would be useful for increasing automated insulin delivery (AID) use. During focus groups, clinicians expressed concerns about workflow integration and alert fatigue. On surveys, most PwT1D and care partner stakeholder groups (96%) said a BPA would help remind diabetes clinicians to discuss technology with patients, and 77% agreed that a BPA could help PwT1D use these technologies, recommending a cadence of every three months. Successful BPA development and implementation requires addressing clinician concerns about workflow and alert fatigue, while aligning with PwT1D and care partners' expectations for the cadence of conversations on AID systems.
Type 2 diabetes mellitus (T2DM) has emerged as a pressing global health challenge, and tobacco exposure constitutes a major modifiable risk factor-particularly among middle-aged and elderly populations. However, a comprehensive understanding of the global burden of tobacco exposure-attributable mortality and disability-adjusted life years (DALYs) in this demographic remains limited. This study is aimed at quantifying the global burden of deaths and DALYs attributable to tobacco exposure among middle-aged and elderly individuals with T2DM from 1990 to 2021. Simultaneously, this study assesses disparities across regions, genders, and age groups; examines associations with the sociodemographic index (SDI); and forecasts trends in disease burden from 2022 to 2042. Utilizing data from the Global Burden of Disease (GBD) 2021 study, which encompasses 204 countries and territories, we assessed burden counts and rates per 100,000 population among individuals aged 55 years and older. We further computed the estimated annual percentage changes (EAPCs) and applied age-period-cohort (APC) modeling, frontier analysis, and Bayesian age-period-cohort (BAPC) forecasting models to enable comprehensive analysis. Globally, tobacco exposure-attributable T2DM deaths increased by 101.10%, and DALYs rose by 140.38%, though the mortality rate decreased by 9.13%. Regions with middle and low-middle SDI shouldered the highest burden of tobacco-attributable T2DM. High-SDI regions demonstrated the most substantial declines in burden rates, whereas low-middle-SDI regions experienced the largest relative increases. Males exhibited greater mortality and DALYs counts compared to females, while females showed more pronounced reductions in burden trends. APC modeling further indicated that advancing age correlated with elevated risks of tobacco exposure-attributable T2DM outcomes, whereas younger birth cohorts showed lower risks. Frontier analysis identified middle-SDI countries (e.g., Kiribati) as exhibiting the greatest deviation from optimal performance. Projections through 2042 indicate that the mortality rate is projected to continue declining: It will reach 9.25 per 100,000 aged ≥ 55 population in 2030 (95% CI: 8.64-9.85) and 8.57 per 100,000 aged ≥ 55 population in 2042 (95% CI: 6.89-10.24). Tobacco exposure-attributable T2DM burden demonstrates marked variations across geographic regions, sex, and age groups, highlighting the imperative for targeted interventions in low-middle-SDI regions. Tobacco control strategies from high-SDI regions serve as scalable models for mitigating this preventable disease burden.
The rapid rise of diabetes technology has markedly improved glycemic outcomes, quality of life, and empowerment of people living with diabetes (PwD). However, the increased use of devices such as continuous glucose monitoring systems, insulin pumps, and smart pens has also introduced significant environmental concerns, contributing to waste from plastic, electronics (e-waste) and packaging, and greenhouse gas emissions. In this paper, we describe results from an online survey conducted in Germany, Austria, and Switzerland, between November and December 2024, focused on the level of concern PwD have, regarding the environmental impacts of single-use medical device, supplies and packaging, resulting from diabetes treatment, and whether these considerations influence technology choices. Among 1934 PwD surveyed, 1332 (69%) favored more reusable devices, and 865 (45%) expressed concern about packaging waste. However, environmental factors ranked far below safety, effectiveness, and usability when selecting diabetes technologies. Expecting PwD to drive substantial environmental improvements is therefore neither realistic nor fair given prevailing priorities on safety and outcomes. Meaningful progress toward greener diabetes care will depend on manufacturers, policymakers, and healthcare systems embracing eco-design, establishing recycling infrastructure, and integrating sustainability into regulatory and reimbursement frameworks. Only through coordinated efforts can optimal diabetes management be achieved alongside environmental stewardship.
Heart failure (HF) is a complex clinical condition requiring resource-intensive management and substantial health expenditure. The adverse economic impact of medical care on patients or financial burden is increasingly recognised as a significant non-clinical entity affecting HF management in low- and middle-income countries (LMIC). We explored the factors associated with Financial Burden (FB) in HF patients in India. We recruited HF patients from 21 hospitals across India, selected to reflect regional diversity and varying stages of epidemiological transition. Trained personnel collected clinical and economic data using a validated and structured questionnaire. Expenditures were recorded in Indian rupees (INR) and converted to international dollars (INT$). We recruited 1,859 participants. Nearly one-third of participants (30.2%) were women. The mean age was 55.9 (11.3) years, and the mean duration of formal education was 11.3 (3.8) years. Health insurance coverage was reported in one-third (32.2%) of the study population. The average annual out-of-pocket (OOP) expenditure was INR 1,06,566 (INT$ 4,709.10), constituting 92.6% (95% CI: 92.5-92.7) of the total health expenditure. Compared to the previous year, a decline in monthly income was reported by 32.3% of individuals and 36.2% of households. Catastrophic health spending (CHS) and distress financing (DF) were observed in 37.7% (35.5-39.9) and 17.7% (15.9-19.4) of the households, respectively. However, CHS and DF were lower [30.8% (26.2-35.4) and 13.6% (10.2-17.0), respectively] among those with health insurance compared to the uninsured [40.3% (37.6-43.0) and 18.9% (16.7-21.1), respectively]. Seven out of 10 HF patients in India lack financial health protection. OOP expenditures, accounting for over 90% of total health spending, contribute significantly to economic distress in HF patients. Financial burden, affecting more than one-third of HF patients, carries profound implications for individual well-being. Addressing this financial burden, including CHS and DF, is essential for improving clinical outcomes and ensuring health equity.
Diabetes poses a major global public health challenge, carrying significant economic implications worldwide. In China, the ongoing implementation of Diagnosis Related Groups (DRG) payment reforms, especially within Traditional Chinese Medicine (TCM) contexts, is critical in improving diabetes patient care and alleviating associated economic burdens. We examined 2,804 hospitalized diabetes patients at Qingyang City Hospital of Chinese Medicine in Gansu Province from 2017 to 2022. Using univariate and interrupted time-series (ITS) analyses, we compared patient visit data, healthcare-related costs, and length of stay pre- and post-DRG reform. Following DRG reform at Qingyang City Hospital of Chinese Medicine, significant differences were noted in patients' age, visit times, type of diabetes, complications and comorbidities, use of Chinese medicine diagnostic and therapeutic equipment, and surgeries and operations, compared with the pre-reform period (p < 0.05). Post-reform, there was a noteworthy decrease in hospitalization cost and Western medicine cost, and TCM treatment cost (p < 0.05), while Chinese medicine cost remained stable but the overall cost level increased (p > 0.05). Additionally, there was a slight reduction in length of stay after the reform, although this change did not reach statistical significance (p > 0.05). DRG reform significantly reduces hospitalization cost, TCM treatment cost, and Western medicine cost for diabetes patients in TCM hospitals. However, its impact on Chinese medicine cost and length of stay is limited. Future reforms should capitalize on the unique strengths of TCM treatment, enhance cost management strategies, and focus on minimizing length of stay and medical expenses while ensuring effective patient care.
To develop a chain mediation model to elucidate the relationship among physical performance, instrumental activities of daily living (IADL), regular exercise, and cognitive function among older adults who are comorbid with diabetes mellitus and hypertension (OA-DM&HTN). A total of 656 participants were investigated with the Mini-Mental State Examination, the Short Physical Performance Battery, the Instrumental Activities of Daily Living, and a questionnaire on regular exercise frequency between January and September 2022. Sequential multiple mediation models were conducted to analyze the data. The average age of the participants was 73.47 ± 7.40 years, and 49.24% (n = 323) of participants were female. The average cognitive function score was 22.36 ± 6.14, and 32.62% (n = 214) of participants exhibited cognitive impairment. Cognitive performance exhibited significant associations with demographic factors, including gender, age, marriage status, educational background, and income level (p < 0.05). Chain mediation analysis indicated that physical performance directly predicted cognitive function (β = 0.525, 95% CI: 0.000-1.050); physical performance had indirect effects mediated by IADL (β = 0.917, 95% CI: 0.635-1.230) and regular exercise (β = 0.076, 95% CI: 0.003-0.180). A significant chain-mediating effect involving both IADL and regular exercise was also observed on the relationship between physical performance and cognitive function (β = 0.034, 95% CI: 0.002-0.071). Physical performance is a significant predictor of cognitive function, and it can also affect cognitive function through the independent or chain-mediating effects of IADL and regular exercise among OA-DM&HTN. Therefore, to delay cognitive decline among OA-DM&HTN, it is essential to provide tailored functional training, encourage improvement in IADL, and promote regular exercise among OA-DM&HTN.