Diabetology, Volume 5, Issue 7 (December 2024) – 3 articles

Background: The Beat It program is a clinician-led, community-based group exercise intervention for adults with Type 2 Diabetes Mellitus (T2DM). While previous studies have demonstrated its effectiveness in improving physical and mental health outcomes, this study explores the perspectives of Beat It Trainers to identify key factors contributing to the program’s success and areas for improvement. Methods: Semi-structured interviews were conducted with 11 Accredited Exercise Physiologists who had delivered both in-person and online versions of the program. Interviews were thematically analyzed using inductive approaches. Results: Eight main themes emerged: customization to individual needs, capability building, outcome improvement, affordability, accessibility, sustainability, and a holistic approach delivered in a group setting. Challenges identified included managing group dynamics, maintaining participant commitment in a fully subsidized program, and providing nutrition advice within the trainers’ scope of practice. The program’s adaptability to both in-person and online delivery modes was highlighted as enhancing its accessibility and resilience. Conclusions: This study provides valuable insights into the factors contributing to the success of the Beat It program from the implementers’ perspective. The findings suggest that investing in comprehensive training for facilitators, particularly in group dynamics management, could benefit similar programs. While the program’s fully subsidized structure reduces financial barriers to entry, innovative strategies to enhance participant engagement and perceived value should be explored. The success of the online delivery mode indicates that hybrid models offering both in-person and virtual options could increase accessibility in future supervised, community-based exercise programs for T2DM management. Full article

Background: In the emergency department (ED), hyperglycemia may be overlooked due to non-diabetes mellitus (DM) primary diagnoses. We compared the risk of all-cause hospital revisits within 30 days after ED discharge in DM patients with normal blood glucose (BG), moderate hyperglycemia, and severe hyperglycemia. Methods: This was a retrospective cohort study of patients 18 years and older discharged from a tertiary care ED between 1 January and 31 March 2018. The severe hyperglycemia group had BG levels of 300 mg/dL (16.7 mmol/L) or greater. The moderate hyperglycemia group had a history of DM, all BG levels less than 300 mg/dL (16.7 mmol/L), and at least one BG level of 180 mg/dL (10 mmol/L) or greater. The normal BG group had a history of DM and BG less than 180 mg/dL (10 mmol/L). Results: Of 302 patients who met criteria, 118 had severe hyperglycemia, 67 had moderate hyperglycemia, and 117 had normal BG. No significant difference between the severe hyperglycemia, moderate hyperglycemia, and normal BG groups was found in 30-day all-cause hospital revisits (19.5% vs. 10.4% vs. 15.4%, respectively, p = 0.25). Patients with a past medical history (PMH) of atherosclerotic cardiovascular disease (ASCVD) or any ED visit in the year preceding the index visit each had an increased risk of a hospital revisit within 30 days (p = 0.025) after covariate adjustment; the adjusted risk of a 30-day hospital revisit among those with a PMH of ASCVD was 2.68 times greater than the risk among those without a history of ASCVD (95% CI: 1.59 to 4.53), and the adjusted RR of a 30-day revisit among those who had an ED visit in the prior year was 1.92 times greater than those without an ED visit in the prior year (95% CI: 1.10 to 3.35). Conclusions: The results suggest no significant association between hyperglycemia in the ED and 30-day hospital revisits. In any patient with DM with a history of ASCVD or any ED visit in the previous year, there may be an increased risk of revisits. Full article

Background: Effective self-management is crucial in diabetes care. This study investigates the impact of Personal Health Records (PHR) on diabetes management and person self-management behaviors. Methods: Retrospective cohort study was conducted involving individuals with diabetes using insulin and prescribed FreeStyle Libre^®. Participants were categorized into PHR users and non-users. Key metrics such as HbA1c, Time in Range (TIR), Time above Range (TAR), and body weight were analyzed. Results: Among 212 intermittently scanned continuous glucose monitoring (isCGM) users, 25 individuals used PHR. Comparing 21 individuals using a PHR with 42 matched controls, the TIR significantly increased (ΔTIR 17.2% vs. 1.90%, p = 0.020), and HbA1c levels showed a greater decrease (ΔHbA1c −0.83% vs. −0.22%, p = 0.023). A significant reduction was also observed in TAR among PHR users (ΔTAR −17.6% vs. −1.63%, p = 0.017). There were no significant changes in body weight (ΔBW −0.51 kg vs. −1.60 kg, p = 0.578). Conclusions: PHR systems demonstrate potential in improving diabetes management by enhancing self-management practices and glycemic control. Although the sample size of PHR users was relatively low, PHR should be more widely used. The study underscores the need for further research on PHR’s long-term impact and its applicability in diverse diabetic populations. Full article