recent research on diabetes management

Recent Advances

ADA-funded researchers use the money from their awards to conduct critical diabetes research. In time, they publish their findings in order to inform fellow scientists of their results, which ensures that others will build upon their work. Ultimately, this cycle drives advances to prevent diabetes and to help people burdened by it. In 2018 alone, ADA-funded scientists published over 200 articles related to their awards!

Identification of a new player in type 1 diabetes risk

Type 1 diabetes is caused by an autoimmune attack of insulin-producing beta-cells. While genetics and the environment are known to play important roles, the underlying factors explaining why the immune system mistakenly recognize beta-cells as foreign is not known. Now, Dr. Delong has discovered a potential explanation. He found that proteins called Hybrid Insulin Peptides (HIPs) are found on beta-cells of people with type 1 diabetes and are recognized as foreign by their immune cells. Even after diabetes onset, immune cells are still present in the blood that attack these HIPs.

Next, Dr. Delong wants to determine if HIPs can serve as a biomarker or possibly even targeted to prevent or treat type 1 diabetes. Baker, R. L., Rihanek, M., Hohenstein, A. C., Nakayama, M., Michels, A., Gottlieb, P. A., Haskins, K., & Delong, T. (2019). Hybrid Insulin Peptides Are Autoantigens in Type 1 Diabetes. Diabetes , 68 (9), 1830–1840.

Understanding the biology of body-weight regulation in children

Determining the biological mechanisms regulating body-weight is important for preventing type 2 diabetes. The rise in childhood obesity has made this even more urgent. Behavioral studies have demonstrated that responses to food consumption are altered in children with obesity, but the underlying biological mechanisms are unknown. This year, Dr. Schur tested changes in brain and hormonal responses to a meal in normal-weight and obese children. Results from her study show that hormonal responses in obese children are normal following a meal, but responses within the brain are reduced. The lack of response within the brain may predispose them to overconsumption of food or difficulty with weight-loss.

With this information at hand, Dr. Schur wants to investigate how this information can be used to treat obesity in children and reduce diabetes.

Roth, C. L., Melhorn, S. J., Elfers, C. T., Scholz, K., De Leon, M. R. B., Rowland, M., Kearns, S., Aylward, E., Grabowski, T. J., Saelens, B. E., & Schur, E. A. (2019). Central Nervous System and Peripheral Hormone Responses to a Meal in Children. The Journal of Clinical Endocrinology and Metabolism , 104 (5), 1471–1483.

A novel molecule to improve continuous glucose monitoring

To create a fully automated artificial pancreas, it is critical to be able to quantify blood glucose in an accurate and stable manner. Current ways of continuously monitoring glucose are dependent on the activity of an enzyme which can change over time, meaning the potential for inaccurate readings and need for frequent replacement or calibration. Dr. Wang has developed a novel molecule that uses a different, non-enzymatic approach to continuously monitor glucose levels in the blood. This new molecule is stable over long periods of time and can be easily integrated into miniaturized systems.

Now, Dr. Wang is in the process of patenting his invention and intends to continue research on this new molecule so that it can eventually benefit people living with diabetes.

Wang, B. , Chou, K.-H., Queenan, B. N., Pennathur, S., & Bazan, G. C. (2019). Molecular Design of a New Diboronic Acid for the Electrohydrodynamic Monitoring of Glucose. Angewandte Chemie (International Ed. in English) , 58 (31), 10612–10615.

Addressing the legacy effect of diabetes

Several large clinical trials have demonstrated the importance of tight glucose control for reducing diabetes complications. However, few studies to date have tested this in the real-world, outside of a controlled clinical setting. In a study published this year, Dr. Laiteerapong found that indeed in a real-world setting, people with lower hemoglobin A1C levels after diagnosis had significantly lower vascular complications later on, a phenomenon known as the ‘legacy effect’ of glucose control. Her research noted the importance of early intervention for the best outcomes, as those with the low A1C levels just one-year after diagnosis had significantly lower vascular disease risk compared to people with higher A1C levels.

With these findings in hand, physicians and policymakers will have more material to debate and determine the best course of action for improving outcomes in people newly diagnosed with diabetes.

Laiteerapong, N. , Ham, S. A., Gao, Y., Moffet, H. H., Liu, J. Y., Huang, E. S., & Karter, A. J. (2019). The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study). Diabetes Care , 42 (3), 416–426.

A new way to prevent immune cells from attacking insulin-producing beta-cells

Replacing insulin-producing beta-cells that have been lost in people with type 1 diabetes is a promising strategy to restore control of glucose levels. However, because the autoimmune disease is a continuous process, replacing beta-cells results in another immune attack if immunosorbent drugs are not used, which carry significant side-effects. This year, Dr. Song reported on the potential of an immunotherapy he developed that prevents immune cells from attacking beta-cells and reduces inflammatory processes. This immunotherapy offers several potential benefits, including eliminating the need for immunosuppression, long-lasting effects, and the ability to customize the treatment to each patient.

The ability to suppress autoimmunity has implications for both prevention of type 1 diabetes and improving success rates of islet transplantation.

Haque, M., Lei, F., Xiong, X., Das, J. K., Ren, X., Fang, D., Salek-Ardakani, S., Yang, J.-M., & Song, J . (2019). Stem cell-derived tissue-associated regulatory T cells suppress the activity of pathogenic cells in autoimmune diabetes. JCI Insight , 4 (7).

A new target to improve insulin sensitivity

The hormone insulin normally acts like a ‘key’, traveling through the blood and opening the cellular ‘lock’ to enable the entry of glucose into muscle and fat cells. However, in people with type 2 diabetes, the lock on the cellular door has, in effect, been changed, meaning insulin isn’t as effective. This phenomenon is called insulin resistance. Scientists have long sought to understand what causes insulin resistance and develop therapies to enable insulin to work correctly again. This year, Dr. Summers determined an essential role for a molecule called ceramides as a driver of insulin resistance in mice. He also presented a new therapeutic strategy for lowering ceramides and reversing insulin resistance. His findings were published in one of the most prestigious scientific journals, Science .

Soon, Dr. Summers and his team will attempt to validate these findings in humans, with the ultimate goal of developing a new medication to help improve outcomes in people with diabetes.

Chaurasia, B., Tippetts, T. S., Mayoral Monibas, R., Liu, J., Li, Y., Wang, L., Wilkerson, J. L., Sweeney, C. R., Pereira, R. F., Sumida, D. H., Maschek, J. A., Cox, J. E., Kaddai, V., Lancaster, G. I., Siddique, M. M., Poss, A., Pearson, M., Satapati, S., Zhou, H., … Summers, S. A. (2019). Targeting a ceramide double bond improves insulin resistance and hepatic steatosis. Science (New York, N.Y.) , 365 (6451), 386–392.

Determining the role of BPA in type 2 diabetes risk

Many synthetic chemicals have infiltrated our food system during the period in which rates of diabetes has surged. Data has suggested that one particular synthetic chemical, bisphenol A (BPA), may be associated with increased risk for developing type 2 diabetes. However, no study to date has determined whether consumption of BPA alters the progression to type 2 diabetes in humans. Results reported this year by Dr. Hagobian demonstrated that indeed when BPA is administered to humans in a controlled manner, there is an immediate, direct effect on glucose and insulin levels.

Now, Dr. Hagobian wants to conduct a larger clinical trial including exposure to BPA over a longer period of time to determine precisely how BPA influences glucose and insulin. Such results are important to ensure the removal of chemicals contributing to chronic diseases, including diabetes.

Hagobian, T. A. , Bird, A., Stanelle, S., Williams, D., Schaffner, A., & Phelan, S. (2019). Pilot Study on the Effect of Orally Administered Bisphenol A on Glucose and Insulin Response in Nonobese Adults. Journal of the Endocrine Society , 3 (3), 643–654.

Investigating the loss of postmenopausal protection from cardiovascular disease in women with type 1 diabetes

On average, women have a lower risk of developing heart disease compared to men. However, research has shown that this protection is lost in women with type 1 diabetes. The process of menopause increases rates of heart disease in women, but it is not known how menopause affects women with type 1 diabetes in regard to risk for developing heart disease. In a study published this year, Dr. Snell-Bergeon found that menopause increased risk markers for heart disease in women with type 1 diabetes more than women without diabetes.

Research has led to improved treatments and significant gains in life expectancy for people with diabetes and, as a result, many more women are reaching the age of menopause. Future research is needed to address prevention and treatment options.

Keshawarz, A., Pyle, L., Alman, A., Sassano, C., Westfeldt, E., Sippl, R., & Snell-Bergeon, J. (2019). Type 1 Diabetes Accelerates Progression of Coronary Artery Calcium Over the Menopausal Transition: The CACTI Study. Diabetes Care , 42 (12), 2315–2321.

Identification of a potential therapy for diabetic neuropathy related to type 1 and type 2 diabetes

Diabetic neuropathy is a type of nerve damage that is one of the most common complications affecting people with diabetes. For some, neuropathy can be mild, but for others, it can be painful and debilitating. Additionally, neuropathy can affect the spinal cord and the brain. Effective clinical treatments for neuropathy are currently lacking. Recently, Dr. Calcutt reported results of a new potential therapy that could bring hope to the millions of people living with diabetic neuropathy. His study found that a molecule currently in clinical trials for the treatment of depression may be valuable for diabetic neuropathy, particularly the type affecting the brain.

Because the molecule is already in clinical trials, there is the potential that it can benefit patients sooner than later.

Jolivalt, C. G., Marquez, A., Quach, D., Navarro Diaz, M. C., Anaya, C., Kifle, B., Muttalib, N., Sanchez, G., Guernsey, L., Hefferan, M., Smith, D. R., Fernyhough, P., Johe, K., & Calcutt, N. A. (2019). Amelioration of Both Central and Peripheral Neuropathy in Mouse Models of Type 1 and Type 2 Diabetes by the Neurogenic Molecule NSI-189. Diabetes , 68 (11), 2143–2154.

ADA-funded researcher studying link between ageing and type 2 diabetes

One of the most important risk factors for developing type 2 diabetes is age. As a person gets older, their risk for developing type 2 diabetes increases. Scientists want to better understand the relationship between ageing and diabetes in order to determine out how to best prevent and treat type 2 diabetes. ADA-funded researcher Rafael Arrojo e Drigo, PhD, from the Salk Institute for Biological Studies, is one of those scientists working hard to solve this puzzle.

Recently, Dr. Arrojo e Drigo published results from his research in the journal Cell Metabolism . The goal of this specific study was to use high-powered microscopes and novel cellular imaging tools to determine the ‘age’ of different cells that reside in organs that control glucose levels, including the brain, liver and pancreas. He found that, in mice, the cells that make insulin in the pancreas – called beta-cells – were a mosaic of both old and young cells. Some beta-cells appeared to be as old as the animal itself, and some were determined to be much younger, indicating they recently underwent cell division.

Insufficient insulin production by beta-cells is known to be a cause of type 2 diabetes. One reason for this is thought to be fewer numbers of functional beta-cells. Dr. Arrojo e Drigo believes that people with or at risk for diabetes may have fewer ‘young’ beta-cells, which are likely to function better than old ones. Alternatively, if we can figure out how to induce the production of younger, high-functioning beta-cells in the pancreas, it could be a potential treatment for people with diabetes.

In the near future, Dr. Arrojo e Drigo’s wants to figure out how to apply this research to humans. “The next step is to look for molecular or morphological features that would allow us to distinguish a young cell from and old cell,” Dr. Arrojo e Drigo said.

The results from this research are expected to provide a unique insight into the life-cycle of beta-cells and pave the way to novel therapeutic avenues for type 2 diabetes.

Watch a video of Dr. Arrojo e Drigo explaining his research!

Arrojo E Drigo, R. , Lev-Ram, V., Tyagi, S., Ramachandra, R., Deerinck, T., Bushong, E., … Hetzer, M. W. (2019). Age Mosaicism across Multiple Scales in Adult Tissues. Cell Metabolism , 30 (2), 343-351.e3.

Researcher identifies potential underlying cause of type 1 diabetes

Type 1 diabetes occurs when the immune system mistakenly recognizes insulin-producing beta-cells as foreign and attacks them. The result is insulin deficiency due to the destruction of the beta-cells. Thankfully, this previously life-threatening condition can be managed through glucose monitoring and insulin administration. Still, therapies designed to address the underlying immunological cause of type 1 diabetes remain unavailable.

Conventional approaches have focused on suppressing the immune system, which has serious side effects and has been mostly unsuccessful. The American Diabetes Association recently awarded a grant to Dr. Kenneth Brayman, who proposed to take a different approach. What if instead of suppressing the whole immune system, we boost regulatory aspects that already exist in the system, thereby reigning in inappropriate immune cell activation and preventing beta-cell destruction? His idea focused on a molecule called immunoglobulin M (IgM), which is responsible for limiting inflammation and regulating immune cell development.

In a paper published in the journal Diabetes , Dr. Brayman and a team of researchers reported exciting findings related to this approach. They found that supplementing IgM obtained from healthy mice into mice with type 1 diabetes selectively reduced the amount of autoreactive immune cells known to target beta-cells for destruction. Amazingly, this resulted in reversal of new-onset diabetes. Importantly, the authors of the study determined this therapy is translatable to humans. IgM isolated from healthy human donors also prevented the development of type 1 diabetes in a humanized mouse model of type 1 diabetes.

The scientists tweaked the original experiment by isolating IgM from mice prone to developing type 1 diabetes, but before it actually occurred. When mice with newly onset diabetes were supplemented with this IgM, their diabetes was not reversed. This finding suggests that in type 1 diabetes, IgM loses its capacity to serve as a regulator of immune cells, which may be contribute to the underlying cause of the disease.

Future studies will determine exactly how IgM changes its regulatory properties to enable diabetes development. Identification of the most biologically optimal IgM will facilitate transition to clinical applications of IgM as a potential therapeutic for people with type 1 diabetes.    Wilson, C. S., Chhabra, P., Marshall, A. F., Morr, C. V., Stocks, B. T., Hoopes, E. M., Bonami, R.H., Poffenberger, G., Brayman, K.L. , Moore, D. J. (2018). Healthy Donor Polyclonal IgM’s Diminish B Lymphocyte Autoreactivity, Enhance Treg Generation, and Reverse T1D in NOD Mice. Diabetes .

ADA-funded researcher designs community program to help all people tackle diabetes

Diabetes self-management and support programs are important adjuncts to traditional physician directed treatment. These community-based programs aim to give people with diabetes the knowledge and skills necessary to effectively self-manage their condition. While several clinical trials have demonstrated the value of diabetes self-management programs in terms of improving glucose control and reducing health-care costs, whether this also occurs in implemented programs outside a controlled setting is unclear, particularly in socially and economically disadvantaged groups.

Lack of infrastructure and manpower are often cited as barriers to implementation of these programs in socioeconomically disadvantaged communities. ADA-funded researcher Dr. Briana Mezuk addressed this challenge in a study recently published in The Diabetes Educator . Dr. Mezuk partnered with the YMCA to evaluate the impact of the Diabetes Control Program in Richmond, Virginia. This community-academic partnership enabled both implementation and evaluation of the Diabetes Control Program in socially disadvantaged communities, who are at higher risk for developing diabetes and the complications that accompany it.

Dr. Mezuk had two primary research questions: (1) What is the geographic and demographic reach of the program? and (2) Is the program effective at improving diabetes management and health outcomes in participants? Over a 12-week study period, Dr. Mezuk found that there was broad geographic and demographic participation in the program. The program had participants from urban, suburban and rural areas, most of which came from lower-income zip codes. HbA1C, mental health and self-management behaviors all improved in people taking part in the Greater Richmond Diabetes Control Program. Results from this study demonstrate the value of diabetes self-management programs and their potential to broadly improve health outcomes in socioeconomically diverse communities. Potential exists for community-based programs to address the widespread issue of outcome disparities related to diabetes.  Mezuk, B. , Thornton, W., Sealy-Jefferson, S., Montgomery, J., Smith, J., Lexima, E., … Concha, J. B. (2018). Successfully Managing Diabetes in a Community Setting: Evidence from the YMCA of Greater Richmond Diabetes Control Program. The Diabetes Educator , 44 (4), 383–394.

Using incentives to stimulate behavior changes in youth at risk for developing diabetes

Once referred to as ‘adult-onset diabetes’, incidence of type 2 diabetes is now rapidly increasing in America’s youth. Unfortunately, children often do not have the ability to understand how everyday choices impact their health. Could there be a way to change a child’s eating behaviors? Davene Wright, PhD, of Seattle Children’s Hospital was granted an Innovative Clinical or Translational Science award to determine whether using incentives, directed by parents, can improve behaviors related to diabetes risk. A study published this year in Preventive Medicine Reports outlined what incentives were most desirable and feasible to implement. A key finding was that incentives should be tied to behavior changes and not to changes in body-weight.

With this information in hand, Dr. Wright now wants to see if incentives do indeed change a child’s eating habits and risk for developing type 2 diabetes. She is also planning to test whether an incentive program can improve behavior related to diabetes management in youth with type 1 diabetes. Jacob-Files, E., Powell, J., & Wright, D. R. (2018). Exploring parent attitudes around using incentives to promote engagement in family-based weight management programs. Preventive Medicine Reports , 10 , 278–284.

Determining the genetic risk for gestational diabetes

Research has identified more than 100 genetic variants linked to risk for developing type 2 diabetes in humans. However, the extent to which these same genetic variants might affect a woman’s probability for getting gestational diabetes has not been investigated.

Pathway to Stop Diabetes ® Accelerator awardee Marie-France Hivert, MD, of Harvard University set out to answer this critical question. Dr. Hivert found that indeed genetic determinants of type 2 diabetes outside of pregnancy are also strong risk factors for gestational diabetes. This study was published in the journal Diabetes .

The implications? Because of this finding, doctors in the clinic may soon be able to identify women at risk for getting gestational diabetes and take proactive steps to prevent it. Powe, C. E., Nodzenski, M., Talbot, O., Allard, C., Briggs, C., Leya, M. V., … Hivert, M.-F. (2018). Genetic Determinants of Glycemic Traits and the Risk of Gestational Diabetes Mellitus. Diabetes , 67 (12), 2703–2709.

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“When my son was diagnosed [with Type 1], I knew nothing about diabetes. I changed my research focus, thinking, as any parent would, ‘What am I going to do about this?’” says Douglas Melton.

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Breakthrough within reach for diabetes scientist and patients nearest to his heart

Harvard Correspondent

100 years after discovery of insulin, replacement therapy represents ‘a new kind of medicine,’ says Stem Cell Institute co-director Douglas Melton, whose children inspired his research

When Vertex Pharmaceuticals announced last month that its investigational stem-cell-derived replacement therapy was, in conjunction with immunosuppressive therapy, helping the first patient in a Phase 1/2 clinical trial robustly reproduce his or her own fully differentiated pancreatic islet cells, the cells that produce insulin, the news was hailed as a potential breakthrough for the treatment of Type 1 diabetes. For Harvard Stem Cell Institute Co-Director and Xander University Professor Douglas Melton, whose lab pioneered the science behind the therapy, the trial marked the most recent turning point in a decades-long effort to understand and treat the disease. In a conversation with the Gazette, Melton discussed the science behind the advance, the challenges ahead, and the personal side of his research. The interview was edited for clarity and length.

Douglas Melton

GAZETTE: What is the significance of the Vertex trial?

MELTON: The first major change in the treatment of Type 1 diabetes was probably the discovery of insulin in 1920. Now it’s 100 years later and if this works, it’s going to change the medical treatment for people with diabetes. Instead of injecting insulin, patients will get cells that will be their own insulin factories. It’s a new kind of medicine.

GAZETTE: Would you walk us through the approach?

MELTON: Nearly two decades ago we had the idea that we could use embryonic stem cells to make functional pancreatic islets for diabetics. When we first started, we had to try to figure out how the islets in a person’s pancreas replenished. Blood, for example, is replenished routinely by a blood stem cell. So, if you go give blood at a blood drive, your body makes more blood. But we showed in mice that that is not true for the pancreatic islets. Once they’re removed or killed, the adult body has no capacity to make new ones.

So the first important “a-ha” moment was to demonstrate that there was no capacity in an adult to make new islets. That moved us to another source of new material: stem cells. The next important thing, after we overcame the political issues surrounding the use of embryonic stem cells, was to ask: Can we direct the differentiation of stem cells and make them become beta cells? That problem took much longer than I expected — I told my wife it would take five years, but it took closer to 15. The project benefited enormously from undergraduates, graduate students, and postdocs. None of them were here for 15 years of course, but they all worked on different steps.

GAZETTE: What role did the Harvard Stem Cell Institute play?

MELTON: This work absolutely could not have been done using conventional support from the National Institutes of Health. First of all, NIH grants came with severe restrictions and secondly, a long-term project like this doesn’t easily map to the initial grant support they give for a one- to three-year project. I am forever grateful and feel fortunate to have been at a private institution where philanthropy, through the HSCI, wasn’t just helpful, it made all the difference.

I am exceptionally grateful as well to former Harvard President Larry Summers and Steve Hyman, director of the Stanley Center for Psychiatric Research at the Broad Institute, who supported the creation of the HSCI, which was formed specifically with the idea to explore the potential of pluripotency stem cells for discovering questions about how development works, how cells are made in our body, and hopefully for finding new treatments or cures for disease. This may be one of the first examples where it’s come to fruition. At the time, the use of embryonic stem cells was quite controversial, and Steve and Larry said that this was precisely the kind of science they wanted to support.

GAZETTE: You were fundamental in starting the Department of Stem Cell and Regenerative Biology. Can you tell us about that?

MELTON: David Scadden and I helped start the department, which lives in two Schools: Harvard Medical School and the Faculty of Arts and Science. This speaks to the unusual formation and intention of the department. I’ve talked a lot about diabetes and islets, but think about all the other tissues and diseases that people suffer from. There are faculty and students in the department working on the heart, nerves, muscle, brain, and other tissues — on all aspects of how the development of a cell and a tissue affects who we are and the course of disease. The department is an exciting one because it’s exploring experimental questions such as: How do you regenerate a limb? The department was founded with the idea that not only should you ask and answer questions about nature, but that one can do so with the intention that the results lead to new treatments for disease. It is a kind of applied biology department.

GAZETTE: This pancreatic islet work was patented by Harvard and then licensed to your biotech company, Semma, which was acquired by Vertex. Can you explain how this reflects your personal connection to the research?

MELTON: Semma is named for my two children, Sam and Emma. Both are now adults, and both have Type 1 diabetes. My son was 6 months old when he was diagnosed. And that’s when I changed my research plan. And my daughter, who’s four years older than my son, became diabetic about 10 years later, when she was 14.

When my son was diagnosed, I knew nothing about diabetes and had been working on how frogs develop. I changed my research focus, thinking, as any parent would, “What am I going to do about this?” Again, I come back to the flexibility of Harvard. Nobody said, “Why are you changing your research plan?”

GAZETTE: What’s next?

MELTON: The stem-cell-derived replacement therapy cells that have been put into this first patient were provided with a class of drugs called immunosuppressants, which depress the patient’s immune system. They have to do this because these cells were not taken from that patient, and so they are not recognized as “self.” Without immunosuppressants, they would be rejected. We want to find a way to make cells by genetic engineering that are not recognized as foreign.

I think this is a solvable problem. Why? When a woman has a baby, that baby has two sets of genes. It has genes from the egg, from the mother, which would be recognized as “self,” but it also has genes from the father, which would be “non-self.” Why does the mother’s body not reject the fetus? If we can figure that out, it will help inform our thinking about what genes to change in our stem cell-derived islets so that they could go into any person. This would be relevant not just to diabetes, but to any cells you wanted to transplant for liver or even heart transplants. It could mean no longer having to worry about immunosuppression.

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Learn about NIH-funded technology breakthroughs advancing the science of diabetes.

Three NIH-funded research groups are developing innovative technologies that may change the way health care professionals understand, diagnose, and treat type 1 and type 2 diabetes. Learn more about these tools and advances below.

A tool to advance type 1 diabetes research

NIDDK-funded researchers are developing a new tool, called an islet chip, to study islets—groups of cells in the pancreas. Islets contain several types of cells, including beta cells that make insulin. In people with type 1 diabetes, the body’s immune system attacks and destroys the beta cells.

Islet chips are bioengineered three-dimensional models that imitate the way the human body supports islets to allow human islets to survive and function in the lab. Islet chips will allow researchers to study how the immune cells interact with beta cells to mimic aspects of the autoimmune process involved in type 1 diabetes.

“[Islet chips] will also serve as a platform for testing novel type 1 diabetes therapies, potentially saving time and money in terms of identifying the most promising therapies to test in people,” said NIDDK Director Dr. Griffin P. Rodgers, in 2019 testimony before the U.S. Senate’s Special Committee on Aging.

This research is part of the NIDDK’s Human Islet Research Network , which is conducting multiple avenues of research to better understand how beta cells that make insulin are lost in type 1 diabetes and to identify strategies to protect or replace them in people.

For more information about this project and other NIDDK-funded research on type 1 diabetes, read Redefining Reality: How the Special Diabetes Program is Changing the Lives of Americans with Type 1 Diabetes .

Replacing needles with lasers to monitor blood glucose

Researchers funded by the National Institute of Biomedical Imaging and Bioengineering (NIBIB) have developed a noninvasive device that can measure blood glucose levels without the standard finger prick.

Most people living with diabetes need to prick themselves several times a day to obtain a small blood sample to measure blood glucose levels with a glucometer. Monitoring blood glucose in this way is painful and inconvenient.

The noninvasive device, developed by researchers at the Massachusetts Institute of Technology and their collaborators at the University of Missouri School of Medicine, shines a laser onto a person’s skin and uses spectroscopy—a technique that measures different aspects of matter by observing how it reacts with light—to measure blood glucose levels. More research and development are needed to improve the device and make it more portable and convenient to use.

“With the rapid increase of diabetes in the population, the need for an accurate and noninvasive glucose monitoring system is becoming critical,” said Behrouz Shabestari, PhD, director of the NIBIB program in Optical Imaging and Spectroscopy.

For more information about the research, read the NIBIB science highlight.

A wearable ultrasound patch to measure blood pressure

NIBIB-funded researchers have also developed a flexible, wearable patch that can measure blood pressure and detect cardiovascular problems. This device could eventually help people living with diabetes, who are more likely to have high blood pressure and cardiovascular problems than people without diabetes.

The wearable patch emits ultrasound waves to monitor blood pressure by recording the diameter of a pulsating blood vessel. Software translates the measurements into information that can be used to detect high blood pressure, heart disease, and heart valve problems.

“I am optimistic that someday this device will be empowering to patients and improve public health care, but there are still barriers to get this to the bedside,” said Sheng Xu, PhD, the study’s senior investigator from the University of California San Diego. Currently, external wires are needed to connect the patch to a power source and data processing units, but researchers are working to make the patch wireless.

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• Patient Care & Health Information
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• Type 2 diabetes

Type 2 diabetes is usually diagnosed using the glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. Results are interpreted as follows:

• Below 5.7% is normal.
• 5.7% to 6.4% is diagnosed as prediabetes.
• 6.5% or higher on two separate tests indicates diabetes.

If the A1C test isn't available, or if you have certain conditions that interfere with an A1C test, your health care provider may use the following tests to diagnose diabetes:

Random blood sugar test. Blood sugar values are expressed in milligrams of sugar per deciliter ( mg/dL ) or millimoles of sugar per liter ( mmol/L ) of blood. Regardless of when you last ate, a level of 200 mg/dL (11.1 mmol/L ) or higher suggests diabetes, especially if you also have symptoms of diabetes, such as frequent urination and extreme thirst.

Fasting blood sugar test. A blood sample is taken after you haven't eaten overnight. Results are interpreted as follows:

• Less than 100 mg/dL (5.6 mmol/L ) is considered healthy.
• 100 to 125 mg/dL (5.6 to 6.9 mmol/L ) is diagnosed as prediabetes.
• 126 mg/dL (7 mmol/L ) or higher on two separate tests is diagnosed as diabetes.

Oral glucose tolerance test. This test is less commonly used than the others, except during pregnancy. You'll need to not eat for a certain amount of time and then drink a sugary liquid at your health care provider's office. Blood sugar levels then are tested periodically for two hours. Results are interpreted as follows:

• Less than 140 mg/dL (7.8 mmol/L ) after two hours is considered healthy.
• 140 to 199 mg/dL (7.8 mmol/L and 11.0 mmol/L ) is diagnosed as prediabetes.
• 200 mg/dL (11.1 mmol/L ) or higher after two hours suggests diabetes.

Screening. The American Diabetes Association recommends routine screening with diagnostic tests for type 2 diabetes in all adults age 35 or older and in the following groups:

• People younger than 35 who are overweight or obese and have one or more risk factors associated with diabetes.
• Women who have had gestational diabetes.
• People who have been diagnosed with prediabetes.
• Children who are overweight or obese and who have a family history of type 2 diabetes or other risk factors.

After a diagnosis

If you're diagnosed with diabetes, your health care provider may do other tests to distinguish between type 1 and type 2 diabetes because the two conditions often require different treatments.

Your health care provider will test A1C levels at least two times a year and when there are any changes in treatment. Target A1C goals vary depending on age and other factors. For most people, the American Diabetes Association recommends an A1C level below 7%.

You also receive tests to screen for complications of diabetes and other medical conditions.

More Information

• Glucose tolerance test

Management of type 2 diabetes includes:

• Healthy eating.
• Regular exercise.
• Weight loss.
• Possibly, diabetes medication or insulin therapy.
• Blood sugar monitoring.

These steps make it more likely that blood sugar will stay in a healthy range. And they may help to delay or prevent complications.

Healthy eating

There's no specific diabetes diet. However, it's important to center your diet around:

• A regular schedule for meals and healthy snacks.
• Smaller portion sizes.
• More high-fiber foods, such as fruits, nonstarchy vegetables and whole grains.
• Fewer refined grains, starchy vegetables and sweets.
• Modest servings of low-fat dairy, low-fat meats and fish.
• Healthy cooking oils, such as olive oil or canola oil.
• Fewer calories.

Your health care provider may recommend seeing a registered dietitian, who can help you:

• Identify healthy food choices.
• Plan well-balanced, nutritional meals.
• Develop new habits and address barriers to changing habits.
• Monitor carbohydrate intake to keep your blood sugar levels more stable.

Physical activity

Exercise is important for losing weight or maintaining a healthy weight. It also helps with managing blood sugar. Talk to your health care provider before starting or changing your exercise program to ensure that activities are safe for you.

• Aerobic exercise. Choose an aerobic exercise that you enjoy, such as walking, swimming, biking or running. Adults should aim for 30 minutes or more of moderate aerobic exercise on most days of the week, or at least 150 minutes a week.
• Resistance exercise. Resistance exercise increases your strength, balance and ability to perform activities of daily living more easily. Resistance training includes weightlifting, yoga and calisthenics. Adults living with type 2 diabetes should aim for 2 to 3 sessions of resistance exercise each week.
• Limit inactivity. Breaking up long periods of inactivity, such as sitting at the computer, can help control blood sugar levels. Take a few minutes to stand, walk around or do some light activity every 30 minutes.

Weight loss

Weight loss results in better control of blood sugar levels, cholesterol, triglycerides and blood pressure. If you're overweight, you may begin to see improvements in these factors after losing as little as 5% of your body weight. However, the more weight you lose, the greater the benefit to your health. In some cases, losing up to 15% of body weight may be recommended.

Your health care provider or dietitian can help you set appropriate weight-loss goals and encourage lifestyle changes to help you achieve them.

Monitoring your blood sugar

Your health care provider will advise you on how often to check your blood sugar level to make sure you remain within your target range. You may, for example, need to check it once a day and before or after exercise. If you take insulin, you may need to check your blood sugar multiple times a day.

Monitoring is usually done with a small, at-home device called a blood glucose meter, which measures the amount of sugar in a drop of blood. Keep a record of your measurements to share with your health care team.

Continuous glucose monitoring is an electronic system that records glucose levels every few minutes from a sensor placed under the skin. Information can be transmitted to a mobile device such as a phone, and the system can send alerts when levels are too high or too low.

Diabetes medications

If you can't maintain your target blood sugar level with diet and exercise, your health care provider may prescribe diabetes medications that help lower glucose levels, or your provider may suggest insulin therapy. Medicines for type 2 diabetes include the following.

Metformin (Fortamet, Glumetza, others) is generally the first medicine prescribed for type 2 diabetes. It works mainly by lowering glucose production in the liver and improving the body's sensitivity to insulin so it uses insulin more effectively.

Some people experience B-12 deficiency and may need to take supplements. Other possible side effects, which may improve over time, include:

• Abdominal pain.

Sulfonylureas help the body secrete more insulin. Examples include glyburide (DiaBeta, Glynase), glipizide (Glucotrol XL) and glimepiride (Amaryl). Possible side effects include:

• Low blood sugar.
• Weight gain.

Glinides stimulate the pancreas to secrete more insulin. They're faster acting than sulfonylureas. But their effect in the body is shorter. Examples include repaglinide and nateglinide. Possible side effects include:

Thiazolidinediones make the body's tissues more sensitive to insulin. An example of this medicine is pioglitazone (Actos). Possible side effects include:

• Risk of congestive heart failure.
• Risk of bladder cancer (pioglitazone).
• Risk of bone fractures.

DPP-4 inhibitors help reduce blood sugar levels but tend to have a very modest effect. Examples include sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta). Possible side effects include:

• Risk of pancreatitis.
• Joint pain.

GLP-1 receptor agonists are injectable medications that slow digestion and help lower blood sugar levels. Their use is often associated with weight loss, and some may reduce the risk of heart attack and stroke. Examples include exenatide (Byetta, Bydureon Bcise), liraglutide (Saxenda, Victoza) and semaglutide (Rybelsus, Ozempic, Wegovy). Possible side effects include:

SGLT2 inhibitors affect the blood-filtering functions in the kidneys by blocking the return of glucose to the bloodstream. As a result, glucose is removed in the urine. These medicines may reduce the risk of heart attack and stroke in people with a high risk of those conditions. Examples include canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance). Possible side effects include:

• Vaginal yeast infections.
• Urinary tract infections.
• Low blood pressure.
• High cholesterol.
• Risk of gangrene.
• Risk of bone fractures (canagliflozin).
• Risk of amputation (canagliflozin).

Other medicines your health care provider might prescribe in addition to diabetes medications include blood pressure and cholesterol-lowering medicines, as well as low-dose aspirin, to help prevent heart and blood vessel disease.

Insulin therapy

Some people who have type 2 diabetes need insulin therapy. In the past, insulin therapy was used as a last resort, but today it may be prescribed sooner if blood sugar targets aren't met with lifestyle changes and other medicines.

Different types of insulin vary on how quickly they begin to work and how long they have an effect. Long-acting insulin, for example, is designed to work overnight or throughout the day to keep blood sugar levels stable. Short-acting insulin generally is used at mealtime.

Your health care provider will determine what type of insulin is right for you and when you should take it. Your insulin type, dosage and schedule may change depending on how stable your blood sugar levels are. Most types of insulin are taken by injection.

Side effects of insulin include the risk of low blood sugar — a condition called hypoglycemia — diabetic ketoacidosis and high triglycerides.

Weight-loss surgery

Weight-loss surgery changes the shape and function of the digestive system. This surgery may help you lose weight and manage type 2 diabetes and other conditions related to obesity. There are several surgical procedures. All of them help people lose weight by limiting how much food they can eat. Some procedures also limit the amount of nutrients the body can absorb.

Weight-loss surgery is only one part of an overall treatment plan. Treatment also includes diet and nutritional supplement guidelines, exercise and mental health care.

Generally, weight-loss surgery may be an option for adults living with type 2 diabetes who have a body mass index (BMI) of 35 or higher. BMI is a formula that uses weight and height to estimate body fat. Depending on the severity of diabetes or the presence of other medical conditions, surgery may be an option for someone with a BMI lower than 35.

Weight-loss surgery requires a lifelong commitment to lifestyle changes. Long-term side effects may include nutritional deficiencies and osteoporosis.

People living with type 2 diabetes often need to change their treatment plan during pregnancy and follow a diet that controls carbohydrates. Many people need insulin therapy during pregnancy. They also may need to stop other treatments, such as blood pressure medicines.

There is an increased risk during pregnancy of developing a condition that affects the eyes called diabetic retinopathy. In some cases, this condition may get worse during pregnancy. If you are pregnant, visit an ophthalmologist during each trimester of your pregnancy and one year after you give birth. Or as often as your health care provider suggests.

Signs of trouble

Regularly monitoring your blood sugar levels is important to avoid severe complications. Also, be aware of symptoms that may suggest irregular blood sugar levels and the need for immediate care:

High blood sugar. This condition also is called hyperglycemia. Eating certain foods or too much food, being sick, or not taking medications at the right time can cause high blood sugar. Symptoms include:

• Frequent urination.
• Increased thirst.
• Blurred vision.

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS). This life-threatening condition includes a blood sugar reading higher than 600 mg/dL (33.3 mmol/L ). HHNS may be more likely if you have an infection, are not taking medicines as prescribed, or take certain steroids or drugs that cause frequent urination. Symptoms include:

• Extreme thirst.
• Drowsiness.
• Dark urine.

Diabetic ketoacidosis. Diabetic ketoacidosis occurs when a lack of insulin results in the body breaking down fat for fuel rather than sugar. This results in a buildup of acids called ketones in the bloodstream. Triggers of diabetic ketoacidosis include certain illnesses, pregnancy, trauma and medicines — including the diabetes medicines called SGLT2 inhibitors.

The toxicity of the acids made by diabetic ketoacidosis can be life-threatening. In addition to the symptoms of hyperglycemia, such as frequent urination and increased thirst, ketoacidosis may cause:

• Shortness of breath.
• Fruity-smelling breath.

Low blood sugar. If your blood sugar level drops below your target range, it's known as low blood sugar. This condition also is called hypoglycemia. Your blood sugar level can drop for many reasons, including skipping a meal, unintentionally taking more medication than usual or being more physically active than usual. Symptoms include:

• Irritability.
• Heart palpitations.
• Slurred speech.

If you have symptoms of low blood sugar, drink or eat something that will quickly raise your blood sugar level. Examples include fruit juice, glucose tablets, hard candy or another source of sugar. Retest your blood in 15 minutes. If levels are not at your target, eat or drink another source of sugar. Eat a meal after your blood sugar level returns to normal.

If you lose consciousness, you need to be given an emergency injection of glucagon, a hormone that stimulates the release of sugar into the blood.

• Medications for type 2 diabetes
• GLP-1 agonists: Diabetes drugs and weight loss
• Bariatric surgery
• Endoscopic sleeve gastroplasty
• Gastric bypass (Roux-en-Y)

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Lifestyle and home remedies

Careful management of type 2 diabetes can reduce the risk of serious — even life-threatening — complications. Consider these tips:

• Commit to managing your diabetes. Learn all you can about type 2 diabetes. Make healthy eating and physical activity part of your daily routine.
• Work with your team. Establish a relationship with a certified diabetes education specialist, and ask your diabetes treatment team for help when you need it.
• Identify yourself. Wear a necklace or bracelet that says you are living with diabetes, especially if you take insulin or other blood sugar-lowering medicine.
• Schedule a yearly physical exam and regular eye exams. Your diabetes checkups aren't meant to replace regular physicals or routine eye exams.
• Keep your vaccinations up to date. High blood sugar can weaken your immune system. Get a flu shot every year. Your health care provider also may recommend the pneumonia vaccine. The Centers for Disease Control and Prevention (CDC) also recommends the hepatitis B vaccination if you haven't previously received this vaccine and you're 19 to 59 years old. Talk to your health care provider about other vaccinations you may need.
• Take care of your teeth. Diabetes may leave you prone to more-serious gum infections. Brush and floss your teeth regularly and schedule recommended dental exams. Contact your dentist right away if your gums bleed or look red or swollen.
• Pay attention to your feet. Wash your feet daily in lukewarm water, dry them gently, especially between the toes, and moisturize them with lotion. Check your feet every day for blisters, cuts, sores, redness and swelling. Contact your health care provider if you have a sore or other foot problem that isn't healing.
• Keep your blood pressure and cholesterol under control. Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Take medication as prescribed.
• If you smoke or use other types of tobacco, ask your health care provider to help you quit. Smoking increases your risk of diabetes complications. Talk to your health care provider about ways to stop using tobacco.
• Use alcohol sparingly. Depending on the type of drink, alcohol may lower or raise blood sugar levels. If you choose to drink alcohol, only do so with a meal. The recommendation is no more than one drink daily for women and no more than two drinks daily for men. Check your blood sugar frequently after drinking alcohol.
• Make healthy sleep a priority. Many people with type 2 diabetes have sleep problems. And not getting enough sleep may make it harder to keep blood sugar levels in a healthy range. If you have trouble sleeping, talk to your health care provider about treatment options.
• Caffeine: Does it affect blood sugar?

Alternative medicine

Many alternative medicine treatments claim to help people living with diabetes. According to the National Center for Complementary and Integrative Health, studies haven't provided enough evidence to recommend any alternative therapies for blood sugar management. Research has shown the following results about popular supplements for type 2 diabetes:

• Chromium supplements have been shown to have few or no benefits. Large doses can result in kidney damage, muscle problems and skin reactions.
• Magnesium supplements have shown benefits for blood sugar control in some but not all studies. Side effects include diarrhea and cramping. Very large doses — more than 5,000 mg a day — can be fatal.
• Cinnamon, in some studies, has lowered fasting glucose levels but not A1C levels. Therefore, there's no evidence of overall improved glucose management.

Talk to your health care provider before starting a dietary supplement or natural remedy. Do not replace your prescribed diabetes medicines with alternative medicines.

Coping and support

Type 2 diabetes is a serious disease, and following your diabetes treatment plan takes commitment. To effectively manage diabetes, you may need a good support network.

Anxiety and depression are common in people living with diabetes. Talking to a counselor or therapist may help you cope with the lifestyle changes and stress that come with a type 2 diabetes diagnosis.

Support groups can be good sources of diabetes education, emotional support and helpful information, such as how to find local resources or where to find carbohydrate counts for a favorite restaurant. If you're interested, your health care provider may be able to recommend a group in your area.

You can visit the American Diabetes Association website to check out local activities and support groups for people living with type 2 diabetes. The American Diabetes Association also offers online information and online forums where you can chat with others who are living with diabetes. You also can call the organization at 800-DIABETES ( 800-342-2383 ).

Preparing for your appointment

At your annual wellness visit, your health care provider can screen for diabetes and monitor and treat conditions that increase your risk of diabetes, such as high blood pressure, high cholesterol or a high BMI .

If you are seeing your health care provider because of symptoms that may be related to diabetes, you can prepare for your appointment by being ready to answer the following questions:

• When did your symptoms begin?
• Does anything improve the symptoms or worsen the symptoms?
• What medicines do you take regularly, including dietary supplements and herbal remedies?
• What are your typical daily meals? Do you eat between meals or before bedtime?
• How much alcohol do you drink?
• How much daily exercise do you get?
• Is there a history of diabetes in your family?

If you are diagnosed with diabetes, your health care provider may begin a treatment plan. Or you may be referred to a doctor who specializes in hormonal disorders, called an endocrinologist. Your care team also may include the following specialists:

• Certified diabetes education specialist.
• Foot doctor, also called a podiatrist.
• Doctor who specializes in eye care, called an ophthalmologist.

Talk to your health care provider about referrals to other specialists who may be providing care.

Questions for ongoing appointments

Before any appointment with a member of your treatment team, make sure you know whether there are any restrictions, such as not eating or drinking before taking a test. Questions that you should regularly talk about with your health care provider or other members of the team include:

• How often do I need to monitor my blood sugar, and what is my target range?
• What changes in my diet would help me better manage my blood sugar?
• What is the right dosage for prescribed medications?
• When do I take the medications? Do I take them with food?
• How does management of diabetes affect treatment for other conditions? How can I better coordinate treatments or care?
• When do I need to make a follow-up appointment?
• Under what conditions should I call you or seek emergency care?
• Are there brochures or online sources you recommend?
• Are there resources available if I'm having trouble paying for diabetes supplies?

What to expect from your doctor

Your health care provider is likely to ask you questions at your appointments. Those questions may include:

• Do you understand your treatment plan and feel confident you can follow it?
• How are you coping with diabetes?
• Have you had any low blood sugar?
• Do you know what to do if your blood sugar is too low or too high?
• What's a typical day's diet like?
• Are you exercising? If so, what type of exercise? How often?
• Do you sit for long periods of time?
• What challenges are you experiencing in managing your diabetes?
• Professional Practice Committee: Standards of Medical Care in Diabetes — 2020. Diabetes Care. 2020; doi:10.2337/dc20-Sppc.
• Diabetes mellitus. Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm. Accessed Dec. 7, 2020.
• Melmed S, et al. Williams Textbook of Endocrinology. 14th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 3, 2020.
• Diabetes overview. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/all-content. Accessed Dec. 4, 2020.
• AskMayoExpert. Type 2 diabetes. Mayo Clinic; 2018.
• Feldman M, et al., eds. Surgical and endoscopic treatment of obesity. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Oct. 20, 2020.
• Hypersmolar hyperglycemic state (HHS). Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hyperosmolar-hyperglycemic-state-hhs. Accessed Dec. 11, 2020.
• Diabetic ketoacidosis (DKA). Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetic-ketoacidosis-dka. Accessed Dec. 11, 2020.
• Hypoglycemia. Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hypoglycemia. Accessed Dec. 11, 2020.
• 6 things to know about diabetes and dietary supplements. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/tips/things-to-know-about-type-diabetes-and-dietary-supplements. Accessed Dec. 11, 2020.
• Type 2 diabetes and dietary supplements: What the science says. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/providers/digest/type-2-diabetes-and-dietary-supplements-science. Accessed Dec. 11, 2020.
• Preventing diabetes problems. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/all-content. Accessed Dec. 3, 2020.
• Schillie S, et al. Prevention of hepatitis B virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recommendations and Reports. 2018; doi:10.15585/mmwr.rr6701a1.
• Diabetes prevention: 5 tips for taking control
• Hyperinsulinemia: Is it diabetes?

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A Narrative Review of the Significance of Popular Diets in Diabetes Mellitus Management

Affiliation.

• 1 Nutrition and Dietetics, Selçuk University, Konya, TUR.
• PMID: 38800782
• PMCID: PMC11127507
• DOI: 10.7759/cureus.61045

Diabetes mellitus is a collection of metabolic disorders marked by elevated levels of glucose in the blood due to irregularities in the generation or functioning of insulin. Medical nutrition therapy and weight loss are crucial elements in the management of diabetes and the prevention of complications. Several diets have become popular over time for the goal of achieving weight loss, but their popularity has declined due to a lack of reliable scientific evidence. This study classifies popular diets into three categories: diets that manage the composition of macronutrients, diets that restrict specific foods or food groups, and diets that manipulate meal timing. The review includes research studies that investigated the effects of popular diets on the prevention, management, and complications of diabetes. It is clear that different popular diets can have positive effects on both preventing and treating diabetes and preventing and treating complications related to diabetes. However, it is not practical to determine which diet is the most effective option for preventing or controlling diabetes. Thus, the main focus should be on common underlying factors that support well-being, such as decreasing the intake of refined grains and added sugar, choosing non-starchy vegetables, and giving priority to whole foods over processed foods whenever possible, until there is stronger evidence supporting the specific benefits of different dietary patterns.

Keywords: diabetes mellitus; gluten-free diet; high-protein diets; intermittent fasting; ketogenic diets; low-fat diets; paleolithic diet; plant-based diets; popular diets.

Copyright © 2024, Şahin Bayram et al.

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Trends in Diabetes Among Young People

• New cases of diabetes in young people are increasing in the United States.
• While many studies report on new cases of type 1 diabetes in young people, few report on new cases of type 2 diabetes for this age group.

What did this study examine?

The study examined trends in new diabetes cases (type 1 and type 2) among people younger than 20 from 2002 to 2018. Characteristics reported were age, sex, race and ethnicity, and month of diabetes diagnosis. Before this study, time-of-year data for young people diagnosed with type 2 diabetes had never been reported.

Study results

From 2002 to 2018, new cases of diabetes in young people (for both type 1 and type 2) increased in the United States. Below are the results:

More than 18,000 young people have type 1 diabetes, and more than 5,000 have type 2 diabetes.

In 2002, the number of young people newly diagnosed with type 1 diabetes per year was 20 per 100,000. By 2018, that number increased to 22 new cases per 100,000 per year. That's about a 2% increase per year in new cases of type 1 diabetes.

In 2002, the number of young people newly diagnosed with type 2 diabetes per year was 9 per 100,000. By 2018, that number doubled to 18 per 100,000 per year. That's about a 5% increase per year in new cases of type 2 diabetes.

A diagnosis of type 1 diabetes usually happened around age 10 for females and age 12 for males. A diagnosis of type 2 diabetes usually happened around age 16 for both males and females.

The annual increase in new cases of type 1 and type 2 diabetes was highest among young people who were:

• Asian/Pacific Islander
• Non-Hispanic Black

January was the peak month of diagnosis for young people diagnosed with type 1. August was the peak month of diagnosis for young people diagnosed with type 2.

What's important about this study?

Increases in new cases of diabetes in young people means more people will live with the condition longer. This can put young people at higher risk of developing diabetes-related complications by early adulthood.

Asian/Pacific Islander, Hispanic, and Black young people also have a higher risk. These findings highlight the importance of focused diabetes prevention and management efforts for young people at increased risk.

Diabetes is a chronic disease that affects how your body turns food into energy. About 1 in 10 Americans has diabetes.

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Diabetes describes a group of metabolic diseases characterized by high blood sugar levels. Diabetes can be caused by the pancreas not producing insulin (type 1 diabetes) or by insulin resistance (cells do not respond to insulin; type 2 diabetes).

Cells destroy donated mitochondria to build blood vessels

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A nutrient responsive lipase mediates gut-brain communication to regulate insulin secretion in Drosophila

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Navigating Diabetes: Enhancing Self-Management through Education among Diabetic People at the Early Stages of the Disease—A Systematic Review

Emirjona kiçaj.

1 Faculty of Medicine, Transylvania University, 500019 Brasov, Romania; [email protected] (R.Ç.); [email protected] (V.P.); [email protected] (S.Q.); or.vbtinu@anailil_r (L.R.)

2 Faculty of Health, University “Ismail Qemali” Vlore, 9401 Vlore, Albania; [email protected]

Aurela Saliaj

Rudina Çerçizaj, vasilika prifti, sonila qirko, liliana rogozea, associated data.

Data sharing does not apply to this article as no datasets were generated or analysed during the current study.

Diabetes self-management education helps to improve health outcomes and qualities of life for diabetic patients. This systematic review examines the effectiveness of several types of diabetes self-management education for patients at the early stages of type 2 diabetes mellitus (T2DM). A review of studies that have researched the use and impacts of health education on diabetic patients with T2DM was conducted using the electronic databases PubMed, Elsevier, JSTORE, Walters Kluwer, and the Cochrane Library between January 2017 and November 2022. We found 789 studies, and after selecting the PRISMA flowchart, we selected 19 studies, including those of 2512 adult patients diagnosed with T2DM. Biomedical results presented the pooled effect of a glycated hemoglobin (HbA1c) of −0.64% and a fasting blood glucose (FBG) of −0.32. Emotional and social results and behavioral effects were evaluated in 10 and nine studies, respectively. The education and support of diabetic patients at the early stages of the disease impact various aspects, including the biomedical profile, lifestyle, emotional and social well-being, and anthropometric parameters. Among the factors that have been identified to enhance the effectiveness of educational interventions are the following: conducting individualized sessions (or at least in small groups of patients), extending the duration of interventions by at least 12 months, adopting a combined approach that includes both face-to-face and online components, and ensuring the involvement of a multidisciplinary healthcare team.

1. Introduction

Diabetes mellitus is mentioned as being among the major health problems in the world in terms of its widespread occurrence, the impact it has on socioeconomic development, and the severe influence it has on the quality of life of patients [ 1 ]. According to the International Diabetes Federation (IDF), in 2019, the number of diabetic adults aged 20–79 years was approximately 463 million, a number predicted to increase to 700 million individuals worldwide by 2045, with 90% of the cases being diabetes mellitus type 2 (T2DM) [ 2 , 3 , 4 ]. The IDF reported that although the incidence of T2DM is decreasing or stable in developed countries [ 2 ], a rapid increase in T2DM has been observed in developing countries [ 5 ]. An increasing number of effective treatments should be sought for diabetes, and the goal of the United Nations (UN) is to reduce premature deaths from non-communicable diseases, including diabetes [ 6 ]. Glucose control is the cornerstone of T2DM treatment, but crucial aspects of treatment are also the implementation of programs that include lifestyle modification, the careful use of oral anti-hyperglycemic medications, and the initiation of insulin when necessary [ 7 , 8 , 9 , 10 ]. Patients with type 2 diabetes should receive professional guidance to improve their self-care behaviors, leading to improved glucose control [ 11 ]. The four best times to provide this guidance are at the time of the diagnosis, annually or when objectives are not met, upon the emergence of factors influencing complications, and during significant life care transitions [ 12 ].

The utilization of diabetes self-management education contributes to enhanced health outcomes, the quality of care, and the overall quality of life for diabetic patients, ultimately leading to reduced expenses and bringing about positive changes in lifestyle and self-care management [ 12 , 13 , 14 ]. Implementing lifestyle interventions in newly diagnosed diabetic patients with T2DM leads to improvements in cardiometabolic parameters, offering long-term health and well-being benefits [ 15 ]. According to the American Diabetes Association (ADA), individuals diagnosed with diabetes should receive comprehensive information and guidance at the time of the diagnosis, with ongoing education and support thereafter [ 12 ]. The moment of the diagnosis serves as a critical juncture when patients actively seek information about their new health situation and must adapt to new health behaviors [ 16 ]. The support required to implement and sustain coping skills and behaviors needs to be on an ongoing basis, helped by social groups, and provided by healthcare professionals [ 17 , 18 ].

A previous systematic review has examined the overall impact of diabetes self-management among newly diagnosed patients with type 2 diabetes mellitus (T2DM). However, it is essential to conduct a critical appraisal to discern various educational approaches and their effects on patients with T2DM in the early stages of the disease [ 19 ].

Our systematic review aims to address this gap by evaluating the effectiveness of several types of diabetes self-management education specifically tailored to this population. We aim to identify key elements that can enhance educational interventions. By synthesizing the latest evidence, our study seeks to provide crucial insights that can assist healthcare professionals and policymakers in improving diabetes education programs for individuals at the early stages of the disease. Ultimately, our goal is to enhance health outcomes and quality of life.

2. Materials and Methods

2.1. study design.

This is a systematic review study.

2.2. Search Methods

A literature search was conducted using the electronic databases of PubMed, Scopus, Elsevier, JSTORE, Walter Kluwer, and the Cochrane Library. This search was conducted for four months from August to November 2022, using the elements of the PICO model (P—population/patients; I—intervention; C—comparator/control; and O—outcomes). The search included the use of the following keywords:

• – Population-related terms: “diabetes mellitus type 2”, “diabetes mellitus II”, “type 2 diabetic patients”, “patients with T2DM”, “patients diagnosed within the last 0–5 years”;
• – Intervention-related terms: “educational intervention”, “diabetes self-management education program evaluation”, “diabetes self-management program effectiveness”, “diabetes self-care education”, and “lifestyle intervention”;
• – Comparator/control-related terms: “assessing changes in the intervention group (IG) and control group (CG)” and “evaluating changes in IG (intervention group) and CG (control group)”;
• – Outcome-related terms: “assessment”, “evaluation”, “examination”, “measurement”.

This study was conducted using the PRISMA guidelines for reporting systematic reviews [ 20 ].

We conducted a thorough electronic search, carefully applying filters to ensure the inclusion of articles that genuinely cater to the well-being of adults with T2DM. The focus of these articles encompasses various aspects, including educational interventions, such as multi-intervention programs, nutritional literacy or health literacy, and face-to-face or online intervention. Furthermore, we sought studies that not only assessed these educational interventions but also provided insights into measured outcomes, spanning biomedical, behavioral, emotional, and social improvements. This approach reflects our commitment to understand and address the holistic needs of individuals with T2DM.

We limited the inclusion criteria based on the participants’ ages (participants had to be older than 18 years), articles published in English between 2017 and 2022, and availability of full-text publications in peer-reviewed journals. This selection aimed to ensure a thoughtful and focused approach, considering the accessibility and language proficiency of the content while also respecting the ethical considerations associated with participants’ ages. The inclusion and exclusion criteria are presented in Table 1 .

Inclusion and exclusion criteria.

1 RCTs—randomized controlled studies; 2 nonintervention studies—qualitative studies, case control studies, review studies, and observational studies. 3 Early stages of disease include recent diagnoses (0–1 year after diagnosis) and short-term diagnoses (1–5 years after diagnosis).

We manually searched the reference lists of pertinent publications to identify relevant articles according to our inclusion and exclusion criteria.

Following the removal of duplicate results, two researchers (E.K. and A.S.) individually reviewed the titles and abstracts to identify the most suitable articles. Collaboratively, they referred to the screening process and addressed any discrepancies and then proceeded to independently read the abstracts and select the most relevant ones.

Throughout this screening phase, any ambiguities were resolved through group discussion among the researchers, ensuring alignment with the eligibility criteria established for including or excluding articles.

Figure 1 displays the PRISMA flow diagram, depicting the systematic review process for searching for and selecting studies for inclusion.

The PRISMA flowchart of included and excluded studies.

2.3. Data Extraction

All the data were extracted by two researchers (E.K. and A.S.). The data included the details of the publications (title, authors, journal, year of publication, and country of origin), methods (the aim of the study, design, and duration of the intervention), participants (number of patients in the intervention group and in the control group, age, and sex), interventions (type of intervention, settings, descriptions of the intervention and the standard care, the duration of the intervention, timing, delivery, method of follow-up, providers), and outcomes (clinical parameters and psychological and behavioral outcomes).

2.4. Synthesis of the Results

A summary of the information from the studies included in this analysis was carried out according to the place of the study, population, duration of education, and details about the educational interventions, such as the method of delivery, the people who carried out the educational interventions, the theoretical materials offered, the frequency and duration of the educational sessions, and a summary of the outcomes of these interventions among diabetic patients. The studies included in this review had different interventions and durations. For this, we have made a narrative summary, presenting the clinical results (HbA1, FBG, postprandial blood glucose—PBG, anthropometric parameters, and blood pressure) using means ± standard deviation.

Risk of Bias: Eleven (57.89%) of the included studies had poor quality. This assessment was carried out following the revised Cochrane risk-of-bias tool [ 21 ]. Most of the studies were conducted without blinding the participants and personnel because of the nature of educational interventions ( Table 2 ).

Assessment of bias risk in the included studies.

Note: (+) shows low risk of bias; (−) shows high risk of bias; (?) shows unclear risk of bias.

Nineteen studies met the inclusion criteria established in advance for this review study.

3.1. Overview of the Studies

The evaluated participants’ characteristics and interventions are presented in Table 3 and Table 4 , respectively. These studies were conducted in different countries, such as China [ 22 , 23 , 24 , 25 , 26 , 27 ], India [ 28 , 29 , 30 , 31 ], and the Netherlands [ 32 , 33 ] and one study each in Spain [ 34 ], Mexico [ 35 ] Italy [ 36 ], USA [ 37 ], the United Kingdom [ 38 ], Germany [ 39 ], and Lebanon [ 40 ].

Characteristics of study participants.

Characteristics of the educational interventions evaluated in the studies included in the review.

This study encompassed 2512 newly diagnosed diabetic patients with a sample size ranging from 17 to 358 patients. The mean age range of the participants was from 25 to 74 years, with 75% of the studies involving a population of over 50 years old. The mean duration of the diabetes ranged from 3 months to 5 years ( Table 3 ).

While analyzing the studies, various interventions were identified, each characterized by distinct features, durations, and assessment methods. The purpose of the included studies was to evaluate the impacts of various educational interventions within a period from 1.4 to 30 months. We included 19 studies, of which 16 used methods for comparing interventions with a control group, while three of them did not use any control group. Among the 19 studies, nine were randomized controlled trials (RCTs) [ 22 , 26 , 28 , 29 , 31 , 32 , 33 , 38 ], one was an experimental study [ 23 ], four were intervention studies [ 24 , 36 , 37 , 39 ], two were program evaluation studies [ 35 , 40 ], two were prospective studies [ 27 , 34 ], and one was a non-randomized controlled study [ 25 ].

The interventions assessed in these studies include a multi-intervention program (73.68%) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 32 , 33 , 34 , 35 , 37 , 38 ], physical activity intervention (10.5%) [ 30 , 31 ], nutritional intervention (10.5%) [ 39 , 40 ], and a single study that evaluated psychological interventions [ 36 ]. Educational interventions included groups of participants in 47.36% of the studies, individual interventions in 47.36%, and a combination of the two in only one study ( Table 4 ).

In terms of intervention methods, 26.3% of the studies utilized telephone applications, and one study used text messages directed to the participants. Face-to-face interventions were implemented in most studies (68.4%). Educational interventions for newly diagnosed diabetic patients with T2DM were conducted by different healthcare professionals (physicians, nurses, dieticians, pharmacists, and diabetes educators). Twenty-one percent of the studies [ 22 , 25 , 34 , 35 ] included educational interventions delivered by a team of more than one member, including a nurse. Meanwhile, nurses delivered educational interventions in 26.3% of the studies [ 23 , 24 , 26 ] ( Table 4 ).

The evaluation included five programs that were evaluated as the AADE 7 Self-Care Behaviors program [ 22 ] PAET-Debut DM2 program [ 34 ] Omaha System-based integrated nursing management model [ 25 ], CAIPadi model [ 35 ], and nurse-led integrative-medicine-based structured education program–multi intervention program [ 26 ] ( Table 4 ).

Biomedical outcomes were reported in 16 studies; psychosocial outcomes, in 12 studies; behavioral outcomes, in 10 studies. Six studies included elements in all the outcome categories [ 26 , 28 , 32 , 34 , 35 , 37 ].

3.2. Impacts of Educational Interventions on Biomedical Results

3.2.1. the impacts of educational interventions on hba1c levels ( table 5 ).

The effects of educational interventions on HbA1c levels were evaluated in 12 studies (60%) [ 22 , 23 , 26 , 27 , 28 , 30 , 32 , 34 , 35 , 36 , 37 , 40 ]. A comparison of the results between the intervention and control groups is presented in nine studies, where we evaluated the absolute effect. Improvement in HbA1c values was significant in the intervention group in 10 (83.3% of the) studies and in the control group in three studies. Six studies showed significant differences in the effects on HbA1c values between the two study groups (IG and CG). Notably, in a study conducted in the Netherlands, there was no evident change in HbA1c levels after the intervention; in fact, there was a very slight increase (0.1%) in HBa1c values [ 32 ]. The differences in the intervention and control groups were 1.18% and 0.277%, respectively. The absolute effect of the educational intervention on HbA1c was −0.64.

The effects of educational interventions on HbA1c, FBG, and PGB.

Notes: * Significant difference between pre- and post-intervention in the same group. * # Non-significant difference between pre- and post-intervention in the same group. ** Significantly different effects between IG and CG. $ No statistical comparison or no data about significance. Studies without control group are not included in the calculation of absolute effects on HbA1c, FBG, and PBG levels.

Educational interventions demonstrate visible effects in reducing HbA1c levels, particularly in cases with fewer patients attending educational sessions and interventions lasting 12 months [ 34 , 36 , 40 ]. Additionally, a combination of face-to-face and online educational methods [ 22 , 28 , 40 ] has proven to be effective.

Concerning the personnel involved in the educational interventions, cases with only one type of professional yielded more satisfactory results (The absolute effect on the level of HbA1c was −0.87 ± 0.67). When interventions were conducted by nurses, the absolute effect was −0.50 ± 0.15. Conversely, when interventions were carried out by a team, the absolute effect was −0.56 ± 0.78.

Individual interventions emerged as the most efficient in 55% of the studies assessing HbA1c levels. These individual interventions demonstrated a notable improvement in the HbA1 level by 1.12% [ 22 , 27 , 28 , 30 , 35 , 40 ], while group-based education resulted in a less pronounced effect of 0.50%.

3.2.2. The impacts of Educational Interventions on FBG and PBG Values

Seven studies (35%) assessed the impacts of educational interventions on FBG levels [ 23 , 24 , 25 , 28 , 32 , 38 ]. In one study, very slight increases in FBG values were observed in both the intervention and control groups [ 32 ]. Significant changes in FBG values within the intervention group were reported in four studies [ 23 , 24 , 25 , 28 ], whereas this difference was significant in the control group in one of these studies [ 28 ]. Notably, significantly different effects between intervention and control groups were observed in three studies [ 24 , 25 , 28 ].

Four studies (20%) investigated the effects of educational interventions on PBG levels [ 23 , 24 , 25 , 28 ]. All these studies demonstrated a significant difference between pre- and post-intervention levels in the intervention group, with significant differences observed between the intervention and control groups in only two studies [ 24 , 25 ]. Collectively, the mean change (improvement) in FBG levels after the intervention was 0.32% and in PBG levels was 1.59%. The absolute effect of the educational intervention on FBG was −0.32 ± 1.16 and on PBG was −1.598 ± 0.23 ( Table 5 ).

3.2.3. The Impacts of Educational Interventions on Lipid Profiles

Five studies examined the impacts of educational interventions on lipid profiles (total cholesterol (T-Chol), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDLC), and triglycerides (TGs)) [ 23 , 32 , 34 , 39 , 40 ]. These studies used different units of measurement to assess lipid levels, making it impossible to statistically evaluate the mean ± SD.

Significant differences in T-Chol between pre- and post-intervention in the intervention group were observed in two studies [ 34 , 39 ] and for LDL-C in two studies [ 32 , 39 ]. Changes in HDL-C and triglyceride levels were not statistically significant.

3.2.4. The impacts of Educational Interventions on Anthropometric Parameters

The impacts of educational interventions on the bodyweights of diabetic patients with T2DM were assessed in five studies [ 22 , 31 , 32 , 38 , 39 ] and on body mass indices (BMIs) in 11 studies [ 22 , 23 , 27 , 31 , 32 , 34 , 35 , 37 , 38 , 39 , 40 ].

Four studies revealed a decrease in bodyweight, but only one study reported a significant change in body weight [ 22 ]. The absolute effect of educational interventions, among studies with two groups (intervention and control groups), on weight was 2.94%.

Of the 11 studies evaluating the effects of educational interventions on the BMIs of diabetic patients, five studies did not compare the results with a control group [ 34 , 35 , 37 , 39 , 40 ]. BMI decreased in both groups without a significant intervention effect, except for one study in which the effect size was insignificant or small [ 38 ]. The absolute effect of educational interventions among studies with two groups (intervention group and control group) on BMI was 0.39% ( Table 6 ).

The effects of educational interventions on anthropometric parameters.

Notes: * Significant difference between pre- and post-intervention in the same group. ** Significantly different effect between IG and CG. Studies without a control group are not included in the calculation of the absolute effect on anthropometric parameters.

3.2.5. The Impacts of Educational Interventions on Blood Pressures

Eight studies [ 22 , 23 , 31 , 32 , 34 , 35 , 38 , 40 ] evaluated the impacts of educational interventions on arterial pressures among newly diagnosed patients with T2DM, and six compared arterial pressure values between the two study groups (intervention and control groups) [ 22 , 23 , 31 , 32 , 38 ]. Only one study reported a statistically significant difference in systolic blood pressure (SBP) and diastolic blood pressure (DBP) [ 40 ].

The mean changes in the SBP and DBP of the intervention group were −2.3 ± 6.5 mmHg and −0.87 ± 4.5 mmHg, respectively. The absolute effect of educational interventions on the SBP was −0.34 ± 7.9 mmHg and on the DBP was −0.36 ± 5.5 mmHg ( Table 7 ).

The effects of educational interventions on blood pressures.

Notes: * Significant difference between pre- and post-intervention in the same group.

3.3. The impacts of Educational Interventions on Emotional and Social Results

To assess the emotional and social impacts of educational interventions among newly diagnosed diabetics, we collected information on improvements in knowledge, illness perception, anxiety and depression, diabetes distress, empowerment, diabetes self-efficacy, diabetes self-management, and quality of life.

Five studies evaluated the impacts of educational interventions on the knowledge of patients with diabetes, using different assessment tools [ 22 , 25 , 29 ]. All five studies reported improvements in knowledge at the end of the interventions, with a noticeable significant difference in knowledge between the intervention group (IG) and the control group (CG) stated in three particular studies [ 22 , 25 , 29 ].

Among these studies, only one assessed illness perception using the “Illness Perceptions Questionnaire” (IPQ-R). Immediately after the education program, the intervention group showed a significantly higher belief in having diabetes than did the control group [ 33 ].

Depression and anxiety were evaluated in three studies; anxiety, in two studies [ 23 , 35 ]; depression, in three studies [ 23 , 35 , 37 ]. All these studies revealed that educational interventions positively reduced anxiety, depression, and other symptoms in patients with T2DM.

Two studies showed significant improvements in diabetes distress as a result of educational interventions [ 35 , 37 ], whereas another study did not show any improvement in this aspect [ 33 ].

Diabetic patient empowerment was assessed in three studies using different assessment methods, such as the Diabetes Empowerment Scale-Short Form [DESSF] [ 35 ] and the Diabetes Empowerment Scale (DES) [ 33 , 37 ]. All three of these studies reported significant improvements in the intervention groups.

Quality of life was evaluated in six studies [ 24 , 25 , 28 , 32 , 34 , 35 ], with two of them lacking a data comparison between the intervention and control groups. The instruments used to evaluate interventions in the quality of life were SF-36, EuroQol-5d, Diabetes-Specific Quality-of-Life scale (DSQL), Diabetes Quality-of-Life Measure (DQoL), and Diabetes-Dependent Quality-of-Life (ADDQoL). In four studies [ 24 , 25 , 34 , 35 ], significant improvements were observed in the quality of life of patients with T2DM, whereas in the other two studies, patients presented negative effects that did not change over time [ 28 , 32 ].

3.4. The Impacts of Educational Interventions on Behavioral Results

The studies included in this analysis employed diverse assessment methods.

Three studies assessed the changes in tobacco use. In one study, there were moderate but significant reductions in smoking and alcohol consumption [ 34 ]. In two other studies, a moderate reduction in tobacco use was observed, although the difference was not statistically significant [ 26 , 33 ].

Eight studies reported physical activity, assessed in six studies through standardized questionnaires [ 26 , 28 , 31 , 32 , 33 , 35 ], the use of a mobile application [ 38 ], or through subjective measures [ 40 ]. Hernandez et al., reported an improvement in physical activity [ 35 ], while in other studies, these changes were not significant between the intervention and control groups.

Changes in dietary behavior were reported in five studies. In four of them, the impact of educational interventions was evaluated through the use of validated methods [ 26 , 32 , 33 , 34 ] and the self-reporting of patients regarding the use of high- and low-carbohydrate foods [ 37 ]. Initially, changes in two of these studies were not significant [ 32 , 34 ]. Participants in the intervention group exhibited significantly better self-management behaviors related to the intakes of fruits and vegetables at both the immediate post-intervention and 12th-week follow-ups [ 32 ]. Meanwhile, in another study, although immediately after the program was used [ 33 ], the results showed an increase in the consumption of fruits and vegetables, these effects were no longer present six months after the interventions. Oser et al. reported satisfactory results in terms of reducing the use of high-carbohydrate foods, even three months after the interventions [ 37 ].

The self-care activity has been evaluated in five studies, all of which presented a positive impact of educational interventions, thereby increasing patients’ awareness [ 26 , 32 , 33 , 34 , 35 ].

4. Discussion

The results of this study reveal the effectiveness of educational interventions implemented for newly diagnosed patients with T2DM to promote the importance of healthcare education since the beginning of the diagnosis.

In this systematic review, we uncovered compelling evidence supporting the effectiveness of diabetes self-management education during the early stages of type 2 diabetes mellitus (T2DM). Our analysis delineated the variances among several types of educational approaches: individual versus team training, personalized versus group counseling, short-term versus ongoing support, and online versus face-to-face interaction. We observed how these factors contributed to enhanced glucose control and improved health outcomes among this population.

Early educational interventions possess the potential to empower patients to embrace healthy behaviors and self-care practices, thereby mitigating the risk of complications associated with T2DM.

Based on the overall analysis of the impacts of various educational interventions for diabetic patients regarding their clinical or other parameters, significant results were found.

According to the American Diabetes Association (ADA), educational interventions can cause a reduction by 1% in HbA1c levels among diabetic patients [ 17 ].

Our results showed that there was a significant improvement in HbA1c levels in the intervention group in most of the included studies, with an absolute effect size of −0.64%, a lower result compared to another study conducted in 2020 [ 41 ] but slightly higher compared to two other reviews, one in 2020, with an absolute effect of 0.21% [ 32 , 33 , 34 , 35 ]. The factors, mentioned in these studies, that improve the control of glycemia are the implementation periods of educational interventions; use of various techniques, such as the combination of face-to-face with online methods; use of different intervention strategies; and use of means to help to achieve expected results, such as online applications or providing supportive materials for patients to improve their knowledge of diabetes and glycemic control.

Regarding clinical parameters, four studies assessed changes in an FBG of 0.32 and changes in a PBG of 1.59. However, the results for lipid profile changes were inconclusive because of variations in the measurement units.

Anthropometric parameters, specifically the BMI, showed a difference of 0.87% in 11 studies and a 0.39% difference in the intervention group. The changes in the arterial pressure were not statistically significant.

Nine studies evaluated changes in HbA1c compared to a control group, revealing that better changes were achieved when the interventions lasted for more than one year [ 34 , 36 ], were conducted face-to-face, and were implemented by one healthcare professional. When we compared the absolute effect on HbA1c levels for different approaches of educational interventions, the model of face-to-face combined with online interventions, such as a text message or a mobile application, offered better results in glycemic control.

Support from healthcare teams is crucial for diabetes management [ 42 ]. The most interesting result in our review was that better results were achieved when the intervention was conducted by one healthcare professional compared with the interventions offered by a team of healthcare professionals. This result is similar to that in another review that concluded that the healthcare education offered by pharmacists improved the clinical results of newly diagnosed diabetic patients [ 43 ]. The factors that may have impacted the improvement could have been the consistent approach, expertise of the professionals, clear and easy communication, and instructions only with one individual, and personalized attention.

Our systematic review presented the need to implement educational interventions individually, as they improved the control of the hyperglycemia. Additionally, Odgers-Jewelle et al. suggested that group-based diabetes self-management education is related to improved clinical and psychosocial results in people with type 2 diabetes [ 44 ]. However other studies have concluded that individual and group interventions show positive clinical results [ 45 ].

Our study found that there were more significant improvements in HbA1c levels in studies in which educational interventions were provided by one healthcare specialist. This result is consistent with a study that showed that individual-based education can achieve greater glycemic improvement than team-based education [ 41 ].

Educational interventions demonstrated modest effects on the BMIs and bodyweights of diabetic patients, exhibiting noticeable reductions in both parameters, especially in studies associated with individual interventions. These parameters, especially the body mass index (BMI), showed a difference of 0.87% in 11 studies and a 0.39% difference in the intervention group.

The duration of the education is important to obtain better results in glycemic control in diabetes management. According to the ADA, from 6 to 12 months is the best time duration for educational sessions among diabetes patients [ 46 ]. Our study found that we had significant improvement in HbA1c levels in those cases where patients’ education was followed for 12 months.

Regarding emotional and social findings, six studies assessed knowledge levels, showing significant improvements in the intervention groups. Similar results were reported in a previous study [ 41 ]. Furthermore, 50% of the studies focused on emotional and social aspects, with noticeable changes in anxiety, illness perception, empowerment, depression, diabetes distress, diabetes self-efficacy, and quality of life.

Patients recently diagnosed with T2DM have a better tendency to engage in positive behavioral changes [ 44 ]. In our systematic review, behavioral results indicated positive changes, including lifestyle changes, such as reductions in smoking and alcohol use. Physical activity was found in eight studies, while adherence to healthy diets was evaluated in five studies. Significant changes were reported immediately after the intervention, but these effects were not sustained over time. A result similar to ours was presented by Tanaka et al. [ 15 ].

This systematic review provides valuable information regarding the effectiveness of educational interventions among diagnosed diabetes patients at the early stages of the disease, treating various aspects, contents of education, and factors that impact the achievement of better results. This study has both strengths and weaknesses. This study followed the Preferred Reporting Items for Systematic Reviews guidelines to collect and evaluate the collected studies, but we only used some electronic databases. A meta-analysis could not be performed because of the heterogenicity of the data and methods that were used. Populations included in the study were from different parts of the world and countries with significant changes in their economic development, which could be a reason for the heterogeneous results.

5. Conclusions

In conclusion, our research highlights the profound influence that educational interventions by healthcare professionals can have on the management of type 2 diabetes mellitus (T2DM) in the early stages of diabetes. These interventions impact various aspects, including biomedical profiles, lifestyles, emotional and social well-beings, as well as anthropometric parameters.

Among the factors that have been identified to enhance the effectiveness of educational interventions are the following: conducting individualized sessions (or at least in small groups of patients), extending the duration of interventions to at least 12 months, adopting a combined approach that includes both face-to-face and online components, and ensuring the involvement of a multidisciplinary healthcare team.

Researchers should assess the sustainability of educational interventions, thus evaluating the long-term effects and preservation of knowledge in the long run, behavioral changes, and improvement in clinical results longer than the period of the healthcare education.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, E.K. and L.R.; data curation, E.K.; formal analysis, E.K.; investigation, E.K. and A.S.; methodology, E.K., A.S., R.Ç. and V.P.; project administration, E.K., A.S. and L.R.; resources, E.K. and A.S.; supervision, L.R.; validation, A.S. and L.R.; visualization, E.K. and S.Q.; writing—original draft preparation, E.K. and V.P.; writing—review and editing, R.Ç., V.P. and S.Q. All authors have read and agreed to the published version of the manuscript.

Data Availability Statement

Conflicts of interest.

The authors declare no conflicts of interest.

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