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45 of the Best Diabetes Dissertation Topics

Published by Owen Ingram at January 2nd, 2023 , Revised On August 16, 2023

The prevalence of diabetes among the world’s population has been increasing steadily over the last few decades, thanks to the growing consumption of fast food and an increasingly comfortable lifestyle. With the field of diabetes evolving rapidly, it is essential to base your dissertation on a trending diabetes dissertation topic that fills a gap in research. 

Finding a perfect research topic is one of the most challenging aspects of dissertation writing in any discipline . Several resources are available to students on the internet to help them conduct research and brainstorm to develop their topic selection, but this can take a significant amount of time. So, we decided to provide a list of well-researched, unique and intriguing diabetes research topics and ideas to help you get started. 

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List of Diabetes Dissertation Topics

• Why do people recently diagnosed with diabetes have such difficulty accepting reality and controlling their health?
• What are the reactions of children who have recently been diagnosed with diabetes? What can be done to improve their grasp of how to treat the disease?
• In long-term research, people getting intensive therapy for the condition had a worse quality of life. What role should health professionals have in mitigating this effect?
• Why do so many individuals experience severe depression the months after their diagnosis despite displaying no other signs of deteriorating health?
• Discuss some of the advantages of a low-carbohydrate, high-fat diet for people with diabetes
• Discuss the notion of diabetes in paediatrics and why it is necessary to do this research regularly.
• Explain the current threat and difficulty of childhood obesity and diabetes, stressing some areas where parents are failing in their position as guardians to avoid the situation
• Explain some of the difficulties that persons with diabetes have, particularly when obtaining the necessary information and medical treatment
• Explain some of the most frequent problems that people with diabetes face, as well as how they affect the prevalence of the disease. Put out steps that can be implemented to help the problem.
• Discuss the diabetes problem among Asian American teens
• Even though it is a worldwide disease, particular ethnic groups are more likely to be diagnosed as a function of nutrition and culture. What can be done to improve their health literacy?
• Explain how self-management may be beneficial in coping with diabetes, particularly for people unable to get prompt treatment for their illness
• Discuss the possibility of better management for those with diabetes who are hospitalized
• What current therapies have had the most influence on reducing the number of short-term problems in patients’ bodies?
• How have various types of steroids altered the way the body responds in people with hypoglycemia more frequently than usual?
• What effects do type 1, and type 2 diabetes have on the kidneys? How do the most widely used monitoring approaches influence this?
• Is it true that people from specific ethnic groups are more likely to acquire heart disease or eye illness due to their diabetes diagnosis?
• How has the new a1c test helped to reduce the detrimental consequences of diabetes on the body by detecting the condition early?
• Explain the difficulty of uncontrolled diabetes and how it can eventually harm the kidneys and the heart
• Discuss how the diabetic genetic strain may be handed down from generation to generation
• What difficulties do diabetic people have while attempting to check their glucose levels and keep a balanced food plan?
• How have some individuals with type 1 or type 2 diabetes managed to live better lives than others with the disease?
• Is it true that eating too much sugar causes diabetes, cavities, acne, hyperactivity, and weight gain?
• What effect does insulin treatment have on type 2 diabetes?
• How does diabetes contribute to depression?
• What impact does snap participation have on diabetes rates?
• Why has the number of persons who perform blood glucose self-tests decreased? Could other variables, such as social or environmental, have contributed to this decrease?
• Why do patients in the United States struggle to obtain the treatment they require to monitor and maintain appropriate glucose levels? Is this due to increased healthcare costs?
• Nutrition is critical to a healthy lifestyle, yet many diabetic patients are unaware of what they should consume. Discuss
• Why have injuries and diabetes been designated as national health priorities?
• What factors contribute to the growing prevalence of type ii diabetes in adolescents?
• Does socioeconomic status influence the prevalence of diabetes?
• Alzheimer’s disease and type 2 diabetes: a critical assessment of the shared pathological traits
• What are the effects and consequences of diabetes on peripheral blood vessels?
• What is the link between genetic predisposition, obesity, and type 2 diabetes development?
• Diabetes modifies the activation and repression of pro- and anti-inflammatory signalling pathways in the vascular system.
• Understanding autoimmune diabetes through the tri-molecular complex prism
• Does economic status influence the regional variation of diabetes caused by malnutrition?
• What evidence is there for using traditional Chinese medicine and natural products to treat depression in people who also have diabetes?
• Why was the qualitative method used to evaluate diabetes programs?
• Investigate the most common symptoms of undiagnosed diabetes
• How can artificial intelligence help diabetes patients?
• What effect does the palaeolithic diet have on type 2 diabetes?
• What are the most common diabetes causes and treatments?
• What causes diabetes mellitus, and how does it affect the United Kingdom?

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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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• Published: 02 December 2022

Diabetes-related research priorities of people with type 1 and type 2 diabetes: a cross-sectional study in Germany

• Sandra Olivia Borgmann   ORCID: orcid.org/0000-0001-9292-5737 1 , 2 , 3 ,
• Marlo Verket   ORCID: orcid.org/0000-0002-3361-3722 3 , 4   nAff7 ,
• Veronika Gontscharuk   ORCID: orcid.org/0000-0002-6306-8454 1 , 2 , 3 ,
• Bettina Bücker 5 ,
• Sabine Arnolds 6 ,
• Olaf Spörkel 3 , 4 ,
• Stefan Wilm   ORCID: orcid.org/0000-0002-1266-5064 5 &
• Andrea Icks   ORCID: orcid.org/0000-0002-4882-969X 1 , 2 , 3  

Scientific Reports volume  12 , Article number:  20835 ( 2022 ) Cite this article

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To investigate (i) the importance and priorities of research objectives for people with type 1 (T1DM) and type 2 diabetes (T2DM); (ii) subgroups with specific research priorities; (iii) associated factors (e.g., sociodemographic characteristics) of the subgroups. The cross-sectional survey was conducted in 2018 using data from 869 respondents (29.0% response, 31.2% female, mean age 61.3 years, 62.7% T2DM) from a German statutory health insurance population. Diabetes-related research priorities were assessed with a questionnaire. Subgroups and associated factors were identified using latent class analysis. Three subgroups were found in T1DM: (1) high priority for the research topic ‘healing diabetes’ and moderate priority for the research topic ‘prevention of long-term complications’, (2) priorities for simplifying handling (high) and stress reduction (moderate), (3) priorities for healing diabetes (high) and simplifying handling (high). Three subgroups were found in T2DM: (1) priorities for simplifying handling (moderate), diabetes prevention (moderate) and prevention of long-term complications (moderate), (2) priorities for stress reduction (high) and diabetes prevention (moderate), (3) priorities for simplifying handling (high) and stress reduction (high). Classes differed in age and HbA 1c . Knowledge about research priorities enables researchers to align their work with the needs of people with diabetes.

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Introduction

Diabetes mellitus (DM) is a chronic health condition that comprises different groups of heterogeneous diseases and has an increasing global prevalence 1 , 2 . To provide high quality care for people with DM, a patient-centred approach with a particular attention to patient and public involvement is a fundamental principle 3 . In early stages of diabetes research processes, patient-centredness can be achieved by incorporating the concerns, needs, and values of the stakeholders in the research agenda 4 , 5 , 6 .

The research priorities of physicians and scientists do not always match the needs and preferences of patients 5 , 7 , 8 , which remain insufficiently addressed 9 . A cluster-randomized controlled trial showed that when patients are involved, priorities for healthcare improvement can change and a higher level of agreement between patients and physicians can be achieved 10 . According to the Patient-Centered Outcomes Research Institute, the term ‘research priority setting’ includes the following engagement activities: ‘provide input on the research topic, prioritization/agenda setting and how to frame the research question’ 11 . Patients are seen as experts on the disease through their individual experiences in the healthcare system 12 .

Previous studies have shown that people with DM have a high interest in diabetes research 13 , 14 . A recent review by Harris et al. 15 investigated health outcomes in patient and community involvement in diabetes research projects. The main benefits of patient and public involvement on the research agenda were ‘initiating the research topic’ and ‘identifying different research questions’. Furthermore, several studies involved different groups of stakeholders (e.g. people with type 1 diabetes (T1DM), type 2 diabetes (T2DM) or other types of diabetes; relatives and health care providers) and used different study designs (e.g. mixed-methods and participatory approaches) to identify priorities in diabetes research 3 , 4 , 8 , 9 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 . However, it is still unclear how diverse these priorities are within the DM community. Brown et al. 17 suggest that the individual perspectives of patients (e.g. determined by age 26 ) have an influence on research priorities. Depending on the method used, there would be a risk for under-representing particular groups when setting research priorities (e.g. people with multiple comorbidities) 8 , 16 , 19 , 20 , 21 , 25 . In Germany, there was only one questionnaire study in 2011 23 that analyzed the research priorities of people with DM. However, it used a convenience sample from the readership of a popular German news magazine and did not investigate the differences between groups of people with different sociodemographic or diabetes-related characteristics.

The present questionnaire study aims to investigate (i) the importance and priorities of future diabetes-related research objectives for people with T1DM and T2DM in Germany; (ii) different subgroups of people with specific diabetes-related research priorities; and (iii) associated characteristics of the identified subgroups, such as sociodemographic and diabetes-related characteristics.

Study design and population

This quantitative cross-sectional study was conducted from September 2018 to November 2018. Data were collected using a postal questionnaire among a nationwide random patient sample of a German statutory health insurance (‘ pronova BKK ’). The inclusion criteria for a diabetes diagnosis based on health insurance data were adapted from other studies 28 , 29 . People between the ages of 18 and 80 years were included if they had ‘(i) a regular documentation of 10th International Classification of Diseases (ICD-10) diagnosis “diabetes” (E10–E14) in three of four quarters in 2016 or (ii) regular prescription of antihyperglycaemic drugs (Anatomical-Therapeutic-Chemical classification A10) at least two prescriptions in 2016 or (iii) a single prescription of an antihyperglycaemic drug 2016 and a diagnosis of “diabetes” or a single prescription of an antihyperglycaemic drug within 2016 and a blood glucose or hemoglobin A 1c (HbA 1c ) measurement in the same quarter’ 28 . Patients who had a caregiver, a care level 2–5, ICD F70–79 code (mental retardation) or ICD Z51.5 code (palliative care) were excluded.

The five-page questionnaire was sent out once via the health insurance by post to 3000 people (T1DM: n = 1000, mean age 53.6 years, 33.9% female; T2DM: n = 2000, mean age 65.3 years, 33.9% female, diabetes medication 69.9%). The questionnaires were returned to the Institute of Health Services Research and Health Economics by means of an enclosed prepaid envelope. Finally, a total of 869 people responded (29% response).

Assessment of the importance and priorities of diabetes-related research objectives

The questionnaire intended to measure the importance of and priorities for future diabetes research objectives 30 was based on a literature review and five focus groups consisting of people with T1DM and T2DM 30 . The focus group data were analyzed by a multidisciplinary, professional team (including several physicians, a psychologist, a nurse and several health economists) using qualitative inductive content analysis. As a result, the authors developed a questionnaire that included 18 diabetes-related research objectives. In a pretest phase, experts in the field of DM and questionnaire design were consulted, and cognitive pretests were conducted with patients treated by specialists in diabetes and with people from a diabetes self-help group. In addition, a final standard field pretest was conducted (n = 27). The final questionnaire can be found in Supplementary Material.

In the first section of the questionnaire, people with DM were asked the following: ‘How important is it for you personally that diabetes research accomplishes the following results in the next few years?’. Each of the 18 objectives could be answered on a 4-point Likert scale from ‘not very important’ to ‘extremely important’. In the second section of the questionnaire, the respondents were to indicate up to three of the 18 research objectives as their priorities. In our study, these 18 objectives were grouped into the following seven overarching topics (Supplementary Table S1 ): ‘treatment with the aim to cure diabetes’, ‘simplifying diabetes handling’, ‘stress reduction’, ‘prevention of long-term complications’, ‘prevention of acute complications’, ‘diabetes prevention’, and ‘information and personal responsibility’. A priority for the topic was assumed if at least one of the corresponding research objectives was chosen in the second section of the questionnaire.

Assessment of associated characteristics

We collected age (in years), sex and education as sociodemographic factors. Education was assessed by reference to the highest school graduation, which was dichotomized and coded as ‘other graduation’ (including those without a school graduation) or ‘university entrance qualification’. In addition, we included the type of diabetes coded as ‘type 1 diabetes’ and ‘type 2 diabetes’. The code ‘unknown’ was excluded from statistical analysis. Diabetes duration was measured by the question ‘How long have you had diabetes?’, and HbA 1c values were evaluated in percent by asking ‘What was your last HbA 1c ?’. Alternatively, the respondent had the option to mark ‘I don’t know’. HbA 1c values were categorized based on the guidelines for diabetes treatment and coded as ‘ < 6.5%’, ‘6.5% to < 7.5%’, and ‘ ≥ 7.5%’ 31 , 32 . Concerning diabetes treatment, participants were asked whether they injected insulin (yes/no) and whether they were primarily treated by a general practitioner or a diabetologist.

Statistical analysis

We obtained descriptive summaries for participant characteristics depending on the distribution of the variables by frequencies, percentages, means (M), standard deviations (SD), median and interquartile range. Data were analyzed and presented separately for the two types of diabetes, T1DM and T2DM. Latent class analyses (LCAs) were performed with Mplus Version 8.4 (Muthén & Muthén, 1998–2020); the remaining quantitative analyses were performed with SAS 9.4.

Analysis of diabetes-related research priorities using latent class analysis (LCA)

LCA is a statistical approach used to identify a finite set of mutually exclusive and exhaustive unobserved (latent) classes of individuals based on their pattern of observed multivariate categorical variables. To identify the optimal number of subgroups with specific diabetes-related research priorities and associated characteristics, LCAs without covariates were performed. We modelled latent classes with one to six classes based on the merged seven topics. In line with Lanza et al. 33 , we chose the best model by analyzing whether the classes were meaningful and had a minimum class prevalence of 5%. In addition, we also took into account the ‘law of parsimony’ 34 and considered the following indicators for model fit: Lower values of the Bayesian information criterion (BIC) indicated better fit. A (relative) entropy close to ‘one’ indicated high separation of classes.

Finally, we performed LCA models for T1DM and T2DM with the favored number of classes including the following variables: age, sex, education, diabetes duration, HbA 1c values (including the answer ‘I don't know’), insulin injection and primary practitioner. The variables ‘insulin injection’ and ‘primary practitioner’ were excluded in models involving participants with T1DM, as T1DM patients are generally treated with insulin and in specialized practices by diabetologists.

Ethics approval and consent to participate

The present study was approved by the ethics committee of the Heinrich Heine University Düsseldorf (study reference number 5651, date of decision: April 06, 2017). The study was performed in accordance with the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study.

Participant characteristics

Table 1 shows the characteristics of the 869 participants, 295 of whom were diagnosed with T1DM and 523 with T2DM. Of those with T1DM, one-third were female and almost half had a university entrance qualification. The average duration of diabetes was about 21 years. Nearly all participants with T1DM reported being treated with insulin, predominantly by a diabetologist. Among those with T2DM, one-third was female, about one in five had a university entrance qualification, and the average duration of diabetes was about 13 years. Approximately 37% of participants with T2DM were taking insulin and about one-quarter were treated primarily by a diabetologist. Compared to the entire sample (T1DM, n = 1000; T2DM, n = 2000), the mean age of the respondents was slightly lower for those with T1DM (47.9 years vs. 53.6 years) and slightly higher for those with T2DM (68.4 years vs. 65.3 years). The percentage of female participants was similar in both groups (T1DM: 33.2% vs. 33.9%; T2DM: 29.6% vs. 33.9%).

Importance and priorities of objectives concerning future diabetes research

Respondents with T1DM have most often rated the objective ‘diabetes complications are detected early or, better yet, prevented’ as very or extremely important for future diabetes research (96.3%) (Fig.  1 ). In addition, more than 90% of respondents with T1DM indicated the research objectives ‘blood sugar levels are easy to measure and readily available’ and ‘I am independent from diabetes in everyday life’ as very or extremely important. In contrast, the research objective ‘in everyday life, people with diabetes are relieved of their responsibility to manage their disease’ was less frequently rated as very or extremely important (57.6%).

Importance of objectives concerning future diabetes research stratified by type of diabetes (T1DM n = 295, T2DM n = 523).

When asked to identify the top three research objectives, the majority of respondents with T1DM selected ‘diabetes complications are detected early or, better yet, prevented’ (32.9%) and ‘technical systems think and act independently when measuring blood sugar and injecting insulin’ (32.9%) (Fig.  2 ). The research objectives ‘it is easy to access comprehensible information on diabetes’ and ‘knowledge about nutrition in diabetes is conveyed in a practical way’ were rarely selected (1.4%, respectively).

Priorities of people with T1DM (n = 295) and T2DM (n = 523) regarding future diabetes-related research objectives.

Respondents with T2DM have also most often rated the research objective ‘diabetes complications are detected early or, better yet, prevented’ as very or extremely important (96.0%) (Fig.  1 ). Furthermore, over 90% of respondents with T2DM indicated the following research objective to be very or extremely important: ‘drugs allow for stable blood sugar levels’, ‘diabetes is detected early’, ‘blood sugar levels are easy to measure and readily available’ and ‘diabetes can be prevented’. The research objective ‘pancreas transplantation and cell therapy are standard options for diabetes treatment’ was less frequently rated as very or extremely important (75.1%).

When asked to identify the top three research objectives, the majority of respondents with T2DM selected the following two: ‘drugs allow for stable blood sugar levels’ (34.0%) and ‘diabetes complications are detected early or, better yet, prevented’ (33.1%) (Fig.  2 ). The research objectives ‘in everyday life, people with diabetes are relieved of their responsibility to manage their disease’ (4.2%) and ‘it is easy to access comprehensible information on diabetes’ were rarely selected (5.0%).

Priorities on research topics that include future diabetes-related research objectives

When grouping the research objectives into seven research topics, we see that most respondents with T1DM listed at least one objective on ‘simplifying diabetes handling’ (71.9%) among the top three (Fig.  3 ). Research objectives concerning ‘diabetes prevention’ (20.3%) and ‘information and personal responsibility’ (7.8%) were mentioned less frequently.

Priorities of people with T1DM (n = 295) and T2DM (n = 523) regarding categories of future diabetes-related research objectives.

Most respondents with T2DM also selected at least one research objective on ‘simplifying diabetes handling’ (65.2%). Research objectives concerning ‘information and personal responsibility’ (21.2%) and ‘prevention of acute complications’ (13.6%) were mentioned less frequently.

Subgroups with specific priorities regarding future diabetes-related research objectives

The analysis showed that a three-class model exhibited the best fit for people with T1DM and T2DM. This model had the lowest BIC value and the best entropy score. The model fit indicators are described in detail in Supplementary Table S2 .

For people with T1DM, we identified the following three research priority profiles (Fig.  4 ):

High priority for the research topic ‘treatment with the aim to cure diabetes’ and moderate priority for the research topic ‘prevention of long-term complications (class with priorities for healing diabetes (high) and preventing long-term complications’ (moderate)): This class included participants most likely to prioritize research objectives concerning ‘treatment with the aim to cure diabetes’ (96.0%). Here, the topic ‘prevention of long-term complications’ had the probability of 55.3%. For the other topics, the probability was between 0.0% and 48.2%. Overall, the estimated class prevalence was 17.1%.

High priority for the research topic ‘simplifying diabetes handling’ and moderate priority for the research topic ‘stress reduction’ (class with priorities for simplifying handling (high) and stress reduction (moderate)): This class included participants most likely to prioritize research objectives concerning ‘simplifying diabetes handling’ (79.1%). For ‘stress reduction’, the probability was 48.0%. For other topics, it lay between 0.0% and 36.5%. The estimated class prevalence was 53.3%.

High priority for the research topic ‘treatment with the aim to cure diabetes’ and for ‘simplifying diabetes handling’ ( class with priorities for healing diabetes (high) and simplifying handling (high) ): This class included participants who prioritize research objectives on the topics ‘treatment with the aim to cure diabetes’ and ‘simplifying diabetes handling’ (100.0% respectively). For other topics, the probability was between 1.2% and 20.0%. The estimated class prevalence was 29.6%.

For people with T2DM, we identified the following three research priority profiles (Fig.  4 ):

Moderate priority for the research topics ‘simplifying diabetes handling’, ‘diabetes prevention’ and ‘prevention of long-term complications’ (class with priorities for simplifying handling (moderate), diabetes prevention (moderate), and preventing long-term complications (moderate)): This class included participants most likely to prioritize research objectives on the topic ‘simplifying diabetes handling’ (68.9%). For the topics ‘diabetes prevention’ and ‘prevention of long-term complications’, the probability was 45.4% and 43.7%. For the others, the probability was between 0.0% and 29.8%. The estimated class prevalence was 54.7%.

High priority for the research topic ‘stress reduction’ and moderate priority for the research topic ‘diabetes prevention’ (class with priorities for stress reduction (high) and diabetes prevention (moderate)): This class included participants who prioritize research objectives on the topic ‘stress reduction’ (100%). In addition, half prioritize research objectives concerned with ‘diabetes prevention’ (50%). For the others, the probability was between 0.0% and 30.8%. The estimated class prevalence was 17.9%.

High priority for the research topics ‘simplifying diabetes handling’ and ‘stress reduction’ (class with priorities for simplifying handling (high) and stress reduction (high)): This class included participants who prioritize research objectives on the topics ‘simplifying diabetes handling’ and ‘daily stress’ (100% respectively). For other topics, the probability was between 5.0% and 19.3%. The estimated class prevalence was 27.4%.

LCA with 3 classes and covariates (T1DM, n = 287, T2DM, n = 435).

Associated characteristics of the identified subgroups

We found significant associations between belonging to one of the identified subgroups and age as well HbA 1c -values. In T1DM, the class ‘ priorities for healing diabetes (high) and preventing long-term complications (moderate)’ was younger than the class ‘ priorities for simplifying handling (high) and stress reduction (moderate)’ (Table 2 ). In addition, this class was more likely to have intermediate (6.5% to < 7.5%) than lower (< 6.5%) HbA 1c values compared with the class ‘priorities for simplifying handling (high) and stress reduction (moderate)’ and was more likely to have intermediate or higher (≥ 7.5%) than lower HbA 1c values compared with the class ‘ priorities for healing diabetes (high) and simplifying handling (high) ’. The class ‘priorities for simplifying handling (high) and stress reduction (moderate)’ was older than the other two and more likely to have lower than intermediate/unknown HbA 1c values compared with the classes ‘ priorities for healing diabetes (high) and preventing long-term complications (moderate)’/ ‘priorities for healing diabetes (high) and simplifying handling (high)’.

In T2DM, classes differed significantly in age. The class ‘ priorities for simplifying handling (high) and stress reduction (high)’ was younger than the class ‘ priorities for simplifying handling (moderate), diabetes prevention (moderate) and preventing long-term complications (moderate) ’. Respondents’ characteristics stratified by classes are presented in Table 3 and Supplementary Table S3 .

Main findings

Most respondents rated all future research objectives as at least very important, especially ‘diabetes complications are detected early or, better yet, prevented’. Research priorities primarily concerned research objectives related to the topic ‘simplifying diabetes handling’. Comparing T1DM and T2DM, people with T1DM assigned higher priority to the research topic ‘treatment with the aim of curing diabetes’ and people with T2DM to the research topic ‘diabetes prevention’. The following three classes of people with T1DM with different research priority profiles were identified: ‘ class with priorities for healing diabetes (high) and prevention of long-term complications (moderate)’ (prevalence 17.1%), ‘class with priorities for simplifying handling (high) and stress reduction (moderate)’ (53.3%), ‘class with priorities for healing diabetes (high) and simplifying handling (high)’ (29.6%) . They differed significantly in age and HbA 1c values. People with T2DM could be assigned to the following three classes: ‘class with priorities for simplifying handling (moderate), diabetes prevention (moderate), and prevention of long-term complications (moderate)’ (54.7%), ‘class with priorities for stress reduction (high) and diabetes prevention (moderate)’ (17.9%), and ‘class with priorities for simplifying handling (high) and stress reduction (high)’ (27.4%) . Two of them differed significantly in age.

Discussion of the findings and comparison to other studies

A high importance of the research objective ‘diabetes complications are detected early or, better yet, prevented’ was also found in other studies on T1DM and T2DM 3 , 18 , 19 , 25 . The present results showed that while this objective pertaining to the research topic ‘prevention of long-term complications’ matter greatly, other research topics were given even higher priority when objectives were grouped. In particular, respondents reported research priorities on ‘simplifying diabetes handling’, e.g. simple ways to measure blood glucose, which were also clearly expressed in previous work 23 , 30 . As discussed by other authors 25 , 30 , one explanation could be that research priorities of people with DM reflect basic needs and are therefore predominantly focused on short-term solutions that directly affect their current daily lives. A dialogue about different research priorities can increase the relevance of diabetes research, e.g. by raising awareness of everyday issues 15 . The findings support the recommendations of other studies 4 , 5 , 6 that research institutes and funders should involve patients more in decision-making about the research direction.

Differences in research priorities between respondents with T1DM and T2DM may be due to the heterogeneous health conditions, e.g., the underlying cause of increase in blood glucose levels 2 . In T1DM, prioritization of research objectives on the research topic ‘treatment with the aim to cure diabetes’ was also mentioned by others 18 and may occur due to frequent life-threatening complications 2 and lifelong insulin treatment 35 . In future, T1DM could be cured through biological approaches such as pancreas transplantation 36 , 37 . Respondents’ research priorities may be influenced by new scientific advances expected in the search for a cure in the coming years 36 . In T2DM, prioritization of research objectives on the research topic ‘diabetes prevention’ may be influenced by knowledge of several effective (lifestyle) interventions that have been shown to prevent T2DM 38 , 39 , 40 . Therefore, prevention is also of great importance in medical care 39 . Our findings were new compared to the previous German study where differences between diabetes types were not investigated 23 . Comparing the research priorities of the two studies, we see that the priorities identified by Arnolds et al. 23 in relation to the research topics ‘treatment with the aim to cure diabetes’ and ‘simplifying diabetes handling’ are more in line with the present profiles for T1DM. Arnolds et al. 23 found that research on psychological aspects and trainings were prioritized less frequently, while these had a higher priority in our study, especially for people with T2DM (e.g., within the research topic ‘information and personal responsibility’). In the light of our findings, we recommend considering the research priorities of people with T1DM and T2DM separately.

Although different research priority profiles were identified in people with T1DM and T2DM, the classes did not differ significantly in the characteristics collected (except for age and HbA 1c values). Therefore, this study was not able to identify ‘types’ of people 41 with specific research priorities and characteristics. The question arises whether the differences can be explained by other factors not collected in the present study, e.g., cultural background 17 and comorbidities 8 , 16 , 19 , 21 , 25 . Nevertheless, being aware of the different research priorities is important when involving people with T1DM and T2DM more specifically in research projects.

In T1DM, the largest and oldest class indicated research priorities for simplifying handling (high) and stress reduction (moderate) rather than for healing DM, as in the other two classes. This is surprising given that Gadsby 18 defined finding a cure as the overarching, long-term research priority in T1DM. One reason may lie in personal attitudes, as middle-aged persons with T1DM reported that they were less focused on hoping for a future cure and more on taking responsibility for their own diabetes management 42 . In contrast, the research topic ‘stress reduction’ was crucial addressed by the largest class in T1DM described here, which was also listed by Gadsby et al. 18 . Boddy et al. 8 emphasize the importance of such research topics for those affected, noting that these have often been neglected in funded research agendas 8 . The present results confirm the importance of involving a diverse group of people with different research priorities in setting research agendas to ensure that their varied interests are considered.

In T2DM, two of three classes that included most participants had priorities for simplifying DM handling, although insulin use was less common in T2DM than in T1DM. Nevertheless, those research objectives were of key priority, particularly the wish that ‘drugs allow for stable blood sugar levels’. As has already been shown 43 , achieving adequate HbA 1c levels is challenging for people with T2DM. Although no significant differences in HbA 1c values were found among priority classes, problems during the course of treatment leading to a change in treatment strategy may have affected the priorities reported. Further longitudinal studies should investigate possible changes in priorities over time, such as when DM treatment is adjusted (e.g., from no antihyperglycemic medication to medication with oral glucose-lowering drugs).

Limitations and strengths

The major limitation is the low response rate (29.0%), which could have led to a non-responder bias. We are aware of studies with higher, but also with lower response rate (51.1% 44 ; 8.1% 45 ) among members of statutory health insurance. However, we performed a responder/non-responder analysis. The age and sex distribution were similar for the responders and the entire sample. But there are more people with T2DM who are treated with insulin in our sample compared to a representative study in 2010 (36.6% vs. 25.2%) 46 . Therefore, people who have received treatment specifically targeting lifestyle changes may be underrepresented. This could be due to the fact that people with DM who are treated with insulin and are therefore more likely to be affected by DM in their daily lives are more interested in participating in the study. Another limitation is the language. The questionnaire was provided only in German. A few recipients responded apologetically that they could not fill out the questionnaire due to insufficient comprehension. In future studies, the questionnaire could be translated into multiple languages to reach more participants from diverse cultural backgrounds. Another limitation is that we possibly did not capture the relevant associated factors (e.g., cultural background, comorbidities) that explain the differences among the identified research priority profiles for T1DM and especially for T2DM.

A strength of the study is the questionnaire used, which was developed using a qualitative and participatory approach based on the views of people with DM. In addition, the survey enabled us to reach a large number of people with T1DM and T2DM with different sociodemographic and clinical backgrounds nationwide. Other studies use various participatory and collaborative methods to set priorities, for example the SEED method 4 , the James Lind Alliance approach 3 , 18 , and multi-voting 20 . Clavisi et al. 5 reported that using only one method can limit the findings of prioritized questions. In addition, they recommended to involve further relevant stakeholders (e.g. clinicians, policy makers) when dealing with the challenge covering clinical and non-clinical research questions as broadly as possible 5 . We see our work as a first step towards a joint dialogue between patients and researchers as reported by Abma and Broerse 47 . Further discussions can build on our results.

Conclusions

Knowledge of diabetes-related research priorities enables researchers to improve their research on behalf of people with DM and to align research with their needs and wishes. In particular, objectives related to simplifying DM handling are important for patients. This study has shown that groups of people with T1DM and T2DM have divergent research priorities, focusing to different degrees on healing diabetes, prevention of long-term complications, diabetes prevention, stress reduction and simplifying handling. This highlights the importance of including both people with T1DM and people with T2DM more specifically in research projects. In addition, we join the current calls for a diverse group of people (with different research priority profiles) to be actively involved in setting research agendas to ensure that their varied interests are considered in research programs overall. Further research should investigate possible changes of research priorities during the course of the disease (e.g., through changes in diabetes treatment) and include the research priorities of other relevant stakeholders (e.g., physicians) to promote a broad collection of research priorities and a joint, cross-perspective dialogue. Research pathways can then be determined based on a reconciliation of what people with DM desire and what researchers deem important. In this way, both needs-based research on potentially short-term solutions and basic research or research on medium- and long-term solutions that may be prioritized by a group of scientists can be included equally in a common prioritization process.

Data availability

Data available on request from the corresponding author due to privacy/ethical restrictions.

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Open Access funding enabled and organized by Projekt DEAL. The present study was funded within the project ‘Regional Network of Innovation Diabetes’ (Regionales Innovationsnetzwerk (RIN) Diabetes) by the Ministry of Culture and Science of the German State of North Rhine-Westphalia.

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Marlo Verket

Present address: Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany

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Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225, Düsseldorf, Germany

Sandra Olivia Borgmann, Veronika Gontscharuk & Andrea Icks

Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

German Center for Diabetes Research (DZD), Partner Düsseldorf, Ingolstädter Landstraße 1, 85764, München-Neuherberg, Germany

Sandra Olivia Borgmann, Marlo Verket, Veronika Gontscharuk, Olaf Spörkel & Andrea Icks

National Diabetes Information Center, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225, Düsseldorf, Germany

Marlo Verket & Olaf Spörkel

Institute of General Practice, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

Bettina Bücker & Stefan Wilm

Profil Institut für Stoffwechselforschung GmbH, Hellersbergstraße 9, 41460, Neuss, Germany

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S.O.B., M.V., V.G., B.B., S.A., O.S., S.W., and A.I. contributed to the conceptualization, design, and drafting of the present study. S.O.B., M.V., V.G., O.S., S.W., and A.I. designed the analysis. S.O.B., V.G., and A.I. conducted the formal analysis. S.O.B. and A.I. supervised the analysis process. S.O.B., V.G., M.V., O.S., and A.I. were responsible for data acquisition and data management. S.O.B., V.G., and A.I. contributed to writing the manuscript; all authors were involved in editing. All authors read and approved the final manuscript. AI takes full responsibility for the work as a whole, including the study design, data access, and the decision to submit and publish the manuscript.

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Borgmann, S.O., Verket, M., Gontscharuk, V. et al. Diabetes-related research priorities of people with type 1 and type 2 diabetes: a cross-sectional study in Germany. Sci Rep 12 , 20835 (2022). https://doi.org/10.1038/s41598-022-24180-y

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Keep up with the latest diabetes and diabetes-related studies with these brief overviews. Each summary provides main points, methods, and findings and includes a link to the article.

Diabetes Management and Education

Reaching treatment goals could help people living with type 2 diabetes increase their life expectancy by 3 years or in some cases by as much as 10 years. Read the summary .

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In 2017, the total cost of diabetes complications was over $37 billion among Medicare beneficiaries 65 or older with type 2 diabetes. Read the summary .

Kids and teens can get both type 1 and type 2 diabetes. New research shows how diabetes rates in young people may rise by 2060. Read the summary .

New USPSTF and ADA guidelines lower the age for prediabetes and type 2 diabetes screening to 35. This study examined if testing practices aligned with guidelines and which populations were less likely to receive testing. Read the summary .

The SEARCH for Diabetes in Youth study reports trends in young people who are being diagnosed with type 1 and type 2 diabetes. Read the summary .

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Research Gaps Around Type 1 Diabetes

A large body of research on Type 2 diabetes has helped to develop guidance, informing how patients are diagnosed, treated, and manage their lifestyle. In contrast, Type 1 diabetes, often mistakenly associated only with childhood, has received less attention.

In this Q&A, adapted from the  April 17 episode of Public Health On Call , Stephanie Desmon speaks to Johns Hopkins epidemiologists  Elizabeth Selvin , PhD '04, MPH, and  Michael Fang , PhD, professor and assistant professor, respectively, in the Department of Epidemiology, about recent findings that challenge common beliefs about type 1 diabetes. Their conversation touches on the misconception that it’s solely a childhood condition, the rise of adult-onset cases linked to obesity, and the necessity for tailored approaches to diagnosis and care. They also discuss insulin prices and why further research is needed on medications like Ozempic in treating Type 1 diabetes.

I want to hear about some of your research that challenges what we have long understood about Type 1 diabetes, which is no longer called childhood diabetes. 

MF: Type 1 diabetes was called juvenile diabetes for the longest time, and it was thought to be a disease that had a childhood onset. When diabetes occurred in adulthood it would be type 2 diabetes. But it turns out that approximately half of the cases of Type 1 diabetes may occur during adulthood right past the age of 20 or past the age of 30.

The limitations of these initial studies are that they've been in small clinics or one health system. So, it's unclear whether it's just that particular clinic or whether it applies to the general population more broadly. 

We were fortunate because the CDC has collected new data that explores Type 1 diabetes in the U.S. Some of the questions they included in their national data were, “Do you have diabetes? If you do, do you have Type 1 or Type 2? And, at what age were you diagnosed?”

With these pieces of information, we were able to characterize how the age of diagnosis of Type 1 diabetes differs in the entire U.S. population.

Are Type 1 and Type 2 diabetes different diseases?

ES:  They are very different diseases and have a very different burden. My whole career I have been a Type 2 diabetes epidemiologist, and I’ve been very excited to expand work with Type 1 diabetes.

There are about 1.5 million adults with Type 1 diabetes in the U.S., compared to 21 million adults with Type 2 diabetes. In terms of the total cases of diabetes, only 5 to 10 percent have Type 1 diabetes. Even in our largest epidemiologic cohorts, only a small percentage of people have Type 1 diabetes. So, we just don't have the same national data, the same epidemiologic evidence for Type 1 diabetes that we have for Type 2. The focus of our research has been trying to understand and characterize the general epidemiology and the population burden of Type 1 diabetes.

What is it about Type 1 that makes it so hard to diagnose?

MF: The presentation of symptoms varies by age of diagnosis. When it occurs in children, it tends to have a very acute presentation and the diagnosis is easier to make. When it happens in adulthood, the symptoms are often milder and it’s often misconstrued as Type 2 diabetes. 

Some studies have suggested that when Type 1 diabetes occurs in adulthood, about 40% of those cases are misdiagnosed initially as Type 2 cases. Understanding how often people get diagnosed later in life is important to correctly diagnose and treat patients. 

Can you talk about the different treatments?

MF:  Patients with Type 1 diabetes are going to require insulin. Type 2 diabetes patients can require insulin, but that often occurs later in the disease, as oral medications become less and less effective.

ES: Because of the epidemic of overweight and obese in the general population, we’re seeing a lot of people with Type 1 diabetes who are overweight and have obesity. This can contribute to issues around misdiagnosis because people with Type 1 diabetes will have signs and will present similarly to Type 2 diabetes. They'll have insulin resistance potentially as a result of weight gain metabolic syndrome. Some people call it double diabetes—I don't like that term—but it’s this idea that if you have Type 1 diabetes, you can also have characteristics of Type 2 diabetes as well.

I understand that Type 1 used to be considered a thin person's disease, but that’s not the case anymore.  MF:  In a separate paper, we also explored the issue of overweight and obesity in persons with Type 1 diabetes. We found that approximately 62% of adults with Type 1 diabetes were either overweight or obese, which is comparable to the general U.S. population.

But an important disclaimer is that weight management in this population [with Type 1 diabetes] is very different. They can't just decide to go on a diet, start jogging, or engage in rigorous exercise. It can be a very, very dangerous thing to do.

Everybody's talking about Ozempic and Mounjaro—the GLP-1 drugs—for diabetes or people who are overweight to lose weight and to solve their diabetes. Where does that fit in with this population?

ES: These medications are used to treat Type 2 diabetes in the setting of obesity. Ozempic and Mounjaro are incretin hormones. They mediate satiation, reduce appetite, slow gastric emptying, and lower energy intake. They're really powerful drugs that may be helpful in Type 1 diabetes, but they're  not approved for the management of obesity and Type 1 diabetes. At the moment, there aren't data to help guide their use in people with Type 1 diabetes, but I suspect they're going to be increasingly used in people with Type 1 diabetes.

MF:   The other piece of managing weight—and it's thought to be foundational for Type 1 or Type 2—is dieting and exercising. However, there isn’t good guidance on how to do this in persons with Type 1 diabetes, whereas there are large and rigorous trials in Type 2 patients. We’re really just starting to figure out how to safely and effectively manage weight with lifestyle changes for Type 1 diabetics, and I think that's an important area of research that should continue moving forward.

ES: Weight management in Type 1 diabetes is complicated by insulin use and the risk of hypoglycemia, or your glucose going too low, which can be an acute complication of exercise. In people with Type 2 diabetes, we have a strong evidence base for what works. We know modest weight loss can help prevent the progression and development of Type 2 diabetes, as well as weight gain. In Type 1, we just don't have that evidence base.

Is there a concern about misdiagnosis and mistreatment? Is it possible to think a patient has Type 2 but they actually have Type 1? 

MF: I think so. Insulin is the overriding concern. In the obesity paper, we looked at the percentage of people who said their doctors recommended engaging in more exercise and dieting. We found that people with Type 1 diabetes were less likely to receive the same guidance from their doctor. I think providers may be hesitant to say, “Look, just go engage in an active lifestyle.”

This is why it's important to have those studies and have that guidance so that patients and providers can be comfortable in improving lifestyle management.

Where is this research going next?

ES:  What's clear from these studies is that the burden of overweight and obesity is substantial in people with Type 1 diabetes and it's not adequately managed. Going forward, I think we're going to need clinical trials, clear clinical guidelines, and patient education that addresses how best to tackle obesity in the setting of Type 1 diabetes.

It must be confusing for people with Type 1 diabetes who are   hearing about people losing all this weight on these drugs, but they go to their doctor who says, “Yeah, but that's not for you.”

ES: I hope it's being handled more sensitively. These drugs are being used by all sorts of people for whom they are not indicated, and I'm sure that people with Type 1 diabetes are accessing these drugs. I think the question is, are there real safety issues? We need thoughtful discussion about this and some real evidence to make sure that we're doing more good than harm.

MF:  Dr. Selvin’s group has published a paper, estimating that about 15% of people with Type 1 diabetes are on a GLP-1. But we don't have great data on what potentially can happen to individuals.

The other big part of diabetes that we hear a lot about is insulin and its price. Can you talk about your research on this topic?

MF:  There was a survey that asked, “Has there been a point during the year when you were not using insulin because you couldn’t afford it?” About 20% of adults under the age of 65 said that at some point during the year, they couldn't afford their insulin and that they did engage in what sometimes is called “cost-saving rationing” [of insulin].

Medicare is now covering cheaper insulin for those over 65, but there are a lot of people for whom affordability is an issue. Can you talk more about that? 

MF:  The fight is not over. Just because there are national and state policies, and now manufacturers have been implementing price caps, doesn't necessarily mean that the people who need insulin the most are now able to afford it. 

A recent study in the  Annals of Internal Medicine looked at states that adopted or implemented out-of-pocket cost caps for insulin versus those that didn't and how that affected insulin use over time. They found that people were paying less for insulin, but the use of insulin didn't change over time. The $35 cap is an improvement, but we need to do more.

ES: There are still a lot of formulations of insulin that are very expensive. $35 a month is not cheap for someone who is on insulin for the rest of their lives.

• Overweight and Obesity in People With Type 1 Diabetes Nearly Same as General Population
• The Impacts of COVID-19 on Diabetes and Insulin
• Why Eli Lilly’s Insulin Price Cap Announcement Matters

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357 Diabetes Essay Topics & Examples

When you write about the science behind nutrition, heart diseases, and alternative medicine, checking titles for diabetes research papers can be quite beneficial. Below, our experts have gathered original ideas and examples for the task.

🏆 Best Diabetes Essay Examples & Topics

⭐ most interesting diabetes research paper topics, ✅ simple & easy diabetes essay topics, 🎓 good research topics about diabetes, 💡 interesting topics to write about diabetes, 👍 good essay topics on diabetes, ❓ diabetes research question examples.

• Type 2 Diabetes The two major types of diabetes are type 1 diabetes and type 2 diabetes. Doctor: The first step in the treatment of type 2 diabetes is consumption of healthy diet.
• Living With a Chronic Disease: Diabetes and Asthma This paper will look at the main effects of chronic diseases in the lifestyle of the individuals and analyze the causes and the preventive measures of diabetes as a chronic disease.
• Diabetes Mellitus: Symptoms, Types, Effects Insulin is the hormone that controls the levels of glucose in the blood, and when the pancreas releases it, immediately the high levels are controlled, like after a meal.
• Adult-Onset Type 2 Diabetes: Patient’s Profile Any immediate care as well as post-discharge treatment should be explained in the best manner possible that is accessible and understandable to the patient.
• Leadership in Diabetes Management Nurses can collaborate and apply evidence-based strategies to empower their diabetic patients. The involvement of all key stakeholders is also necessary.
• Relation Between Diabetes And Nutrition Any efforts to lessen and eliminate the risk of developing diabetes must involve the dietary habit of limiting the consumption of carbohydrates, sugar, and fats. According to Belfort-DeAguiar and Dongju, the three factors of obesity, […]
• Type 2 Diabetes as a Public Health Issue In recent years, a steady increase in the incidence and prevalence of diabetes is observed in almost all countries of the world.
• Health Promotion: Diabetes Mellitus and Comorbidities This offers a unique challenge in the management of diabetes and other chronic diseases; the fragmented healthcare system that is geared towards management of short-term medical emergencies often is not well prepared for the patient […]
• Diabetes Management: Case Study Type 1 and Type 2 diabetes contrast based on their definitions, the causes, and the management of the conditions. Since the CDC promotes the avoidance of saturated fat and the increase of fiber intake for […]
• Diabetes Mellitus Management in the Elderly Diabetes mellitus is a health complication involving an increase in the concentration in the concentration of blood sugar either due to a failure by cells to effectively respond to the production of insulin in the […]
• The Aboriginal Diabetes Initiative in Canada The ADI’s goal in the CDS was to raise type 2 diabetes awareness and lower the incidence of associated consequences among Aboriginal people.
• Diabetes and Its Economic Effect on Healthcare For many years, there has been an active increase in the number of cases of diabetes of all types among the global population, which further aggravates the situation.
• Diabetes Issues: Insulin Price and Unaffordability According to the forecast of researchers from Stanford University, the number of people with type 2 diabetes who need insulin-containing drugs in the world will increase by about 79 million people by 2030, which will […]
• A Study of Juvenile Type 1 Diabetes in the Northwest of England The total number of children under seventeen years living with type 1 diabetes in North West England by 2009 was 2,630.
• The Minority Diabetes Initiative Act’s Analysis The bill provides the right to the Department of Health and Human Services to generate grants to public and nonprofit private health care institutions with the aim of providing treatment for diabetes in minority communities.
• Diabetes Self-Management: Evidence-Based Nursing The article by Seley and Weinger, improving diabetes self management attempts to address the possible barriers to patient education and the role of the nurse in assisting the patient to manage diabetes.
• Diabetes Mellitus Type 2: Pathophysiology and Treatment The primary etiologies linked to the patient’s T2DM condition include morbid obesity and family history. The genetic factors implicated in T2DM pathogenesis relate to a family history of the disease.
• Cure for Diabetes: The Impossible Takes a Little Longer The synthesis of the existing information about the available options for diabetes treatment is crucial to a better understanding of the problem and the identification of the most promising routes that the further studies should […]
• Gestational Diabetes in a 38-Year-Old Woman The concept map, created to meet B.’s needs, considers her educational requirements and cultural and racial hurdles to recognize her risk factors and interventions to increase her adherence to the recommended course of treatment.B.said in […]
• Type 2 Diabetes Mellitus and Its Implications You call an ambulance and she is taken in to the ED. Background: Jean is still very active and works on the farm 3 days a week.
• Development of Comprehensive Inpatient and Outpatient Programs for Diabetes Overcoming the fiscal and resource utilization issues in the development of a comprehensive diabetes program is essential for the improvement of health and the reduction of treatment costs.
• Healthcare Cost Depending on Chronic Disease Management of Diabetes and Hypertension A sufficient level of process optimization and the presence of a professional treating staff in the necessary number will be able to help improve the indicators.
• Improving Glycemic Control in Black Patients with Type 2 Diabetes Information in them is critical for answering the question and supporting them with the data that might help to acquire an enhanced understanding of the issue under research. Finally, answering the PICOT question, it is […]
• Shared Decision-Making That Affects the Management of Diabetes The article by Peek et al.is a qualitative study investigating the phenomenon of shared decision-making that affects the management of diabetes. The researchers demonstrate the racial disparity that can arise in the choice of approaches […]
• Managing Obesity as a Strategy for Addressing Type 2 Diabetes When a patient, as in the case of Amanda, requires a quick solution to the existing problem, it is necessary to effectively evaluate all options in the shortest possible time.
• Tests and Screenings: Diabetes and Chronic Kidney Disease The test is offered to patients regardless of gender, while the age category is usually above 45 years. CDC1 recommends doing the test regardless of gender and is conducted once or twice to check the […]
• Obesity Management for the Treatment of Type 2 Diabetes American Diabetes Association states that for overweight and obese individuals with type 2 diabetes who are ready to lose weight, a 5% weight reduction diet, physical exercise, and behavioral counseling should be provided.
• COVID-19 and Diabetes Mellitus Lim et al, in their article, “COVID-19 and diabetes mellitus: from pathophysiology to clinical management”, explored how COVID-19 can worsen the symptoms of diabetes mellitus.
• The Importance of Physical Exercise in Diabetes II Patients The various activities help to improve blood sugar levels, reduce cardiovascular cases and promote the overall immunity of the patient. Subsequently, the aerobic part will help to promote muscle development and strengthen the bones.
• Diabetes Education Workflow Process Mapping DSN also introduces the patient to the roles of specialists involved in managing the condition, describes the patient’s actions, and offers the necessary educational materials.
• Diabetes: Treatment Complications and Adjustments One of the doctor’s main priorities is to check the compatibility of a patient’s medications. The prescriptions of other doctors need to be thoroughly checked and, if necessary, replaced with more appropriate medication.
• The Type 2 Diabetes Mellitus PICOT (Evidence-Based) Project Blood glucose levels, A1C, weight, and stress management are the parameters to indicate the adequacy of physical exercise in managing T2DM.
• Chronic Disease Cost Calculator (Diabetes) This paper aims at a thorough, detailed, and exhaustive explanation of such a chronic disease as diabetes in terms of the prevalence and cost of treatment in the United States and Maryland.
• Diabetes Mellitus Epidemiology Statistics This study entails a standard established observation order from the established starting time to an endpoint, in this case, the onset of disease, death, or the study’s end. It is crucial to state this value […]
• Epidemiology: Type II Diabetes in Hispanic Americans The prevalence of type II diabetes in Hispanic Americans is well-established, and the search for inexpensive prevention methods is in the limelight.
• Diabetes: Risk Factors and Effects Trends in improved medical care and the development of technology and medicine are certainly contributing to the reduction of the problem. All of the above indicates the seriousness of the problem of diabetes and insufficient […]
• Barriers to Engagement in Collaborative Care Treatment of Uncontrolled Diabetes The primary role of physicians, nurses, and other healthcare team members is to provide patients with medical treatment and coordinate that care while also working to keep costs down and expand access.
• Hereditary Diabetes Prevention With Lifestyle Modification Yeast infections between the fingers and toes, beneath the breast, and in or around the genital organs are the common symptoms of type 2 diabetes.
• Health Equity Regarding Type 2 Diabetes According to Tajkarimi, the number of research reports focusing on T2D’s prevalence and characteristics in underserved minorities in the U. Adapting the program’s toolkits to rural Americans’ eating and self-management habits could also be instrumental […]
• Diabetes Mellitus: Treatment Methods Moreover, according to the multiple findings conducted by Park et al, Billeter et al, and Tsilingiris et al, bariatric surgeries have a positive rate of sending diabetes into remission.
• Diagnosing Patient with Insulin-Dependent Diabetes The possible outcomes of the issues that can be achieved are discussing the violations with the patient’s family and convincing them to follow the medical regulations; convincing the girl’s family to leave her at the […]
• Human Service for Diabetes in Late Adulthood The mission of the Georgia Diabetic Foot Care Program is to make a positive difference in the health of persons living with diabetes.
• Diabetes: Symptoms and Risk Factors In terms of the problem, according to estimates, 415 million individuals worldwide had diabetes mellitus in 2015, and it is expected to rise to 642 million by the year 2040.
• Diabetes: Types and Management Diabetes is one of the most prevalent diseases in the United States caused when the body fails to optimally metabolize food into energy.
• Type 2 Diabetes’ Impact on Australian Society Consequently, the most significant impact of the disease is the increased number of deaths among the population which puts their lives in jeopardy. Further, other opportunistic diseases are on the rise lowering the quality of […]
• Epidemiology of Diabetes and Forecasted Trends The authors note that urbanization and the rapid development of economies of different countries are the main causes of diabetes. The authors warn that current diabetes strategies are not effective since the rate of the […]
• Communicating the Issue of Diabetes The example with a CGM sensor is meant to show that doctors should focus on educating people with diabetes on how to manage their condition and what to do in extreme situations.
• Obesity and Diabetes Mellitus Type 2 The goal is to define the features of patient information to provide data on the general course of the illness and its manifestations following the criteria of age, sex, BMI, and experimental data.
• The Prevention of Diabetes and Its Consequences on the Population At the same time, these findings can also be included in educational programs for people living with diabetes to warn them of the risks of fractures and prevent them.
• Uncontrolled Type 2 Diabetes and Depression Treatment The data synthesis demonstrates that carefully chosen depression and anxiety treatment is likely to result in better A1C outcomes for the patient on the condition that the treatment is regular and convenient for the patients.
• Type 2 Diabetes: Prevention and Education Schillinger et al.came to the same conclusion; thus, their findings on the study of the Bigger Picture campaign effectiveness among youth of color are necessary to explore diabetes prevention.
• A Diabetes Quantitative Article Analysis The article “Correlates of accelerometer-assessed physical activity and sedentary time among adults with type 2 diabetes” by Mathe et al.refers to the global issue of the prevention of diabetes and its complications.
• A Type 2 Diabetes Quantitative Article Critique Therefore, the main issue is the prevention of type 2 diabetes and its consequences, and this paper will examine one of the scientific studies that will be used for its exploration.
• The Diabetes Prevention Articles by Ford and Mathe The main goal of the researchers was to measure the baseline MVPA of participants and increase their activity to the recommended 150 minutes per week through their participation in the Diabetes Community Lifestyle Improvement Program.
• Type 2 Diabetes in Hispanic Americans The HP2020 objectives and the “who, where, and when” of the problem highlight the significance of developing new, focused, culturally sensitive T2D prevention programs for Hispanic Americans.
• Diabetes Mellitus as Problem in US Healthcare Simultaneously, insurance companies are interested in decreasing the incidence of diabetes to reduce the costs of testing, treatment, and provision of medicines.
• Diabetes Prevention as a Change Project All of these queries are relevant and demonstrate the importance of including people at high risk of acquiring diabetes in the intervention.
• Evidence Synthesis Assignment: Prevention of Diabetes and Its Complications The purpose of this research is to analyze and synthesize evidence of good quality from three quantitative research and three non-research sources to present the problem of diabetes and justify the intervention to address it.
• Diabetes Mellitus: Causes and Health Challenges Second, the nature of this problem is a clear indication of other medical concerns in this country, such as poor health objectives and strategies and absence of resources.
• Diabetes in Adults in Oxfordshire On a national level, Diabetes Research and Wellness Foundation aims to prevent the spread of the decease through research of the causes and effective treatment of diabetes 2 type.
• Diabetes Mellitus (DM) Disorder Case Study Analysis Thus, informing the patient about the importance of regular medication intake, physical activity, and adherence to diet in maintaining diabetes can solve the problem.
• Diabetes Mellitus in Young Adults Thus, programs for young adults should predominantly focus on the features of the transition from adolescence to adulthood. As a consequence, educational programs on diabetes improve the physical and psychological health of young adults.
• A Healthcare Issue of Diabetes Mellitus Diabetes mellitus is seen as a primary healthcare issue that affects populations across the globe and necessitates the combination of a healthy lifestyle and medication to improve the quality of life of people who suffer […]
• Control of LDL Cholesterol Levels in Patients, Gestational Diabetes Mellitus In addition, some patients with hypercholesterolemia may have statin intolerance, which reduces adherence to therapy, limits treatment efficacy, and increases the risk of CVD.
• Exploring Glucose Tolerance and Gestational Diabetes Mellitus In the case of a glucose tolerance test for the purpose of diagnosing GDM type, the interpretation of the test results is carried out according to the norms for the overall population.
• Type 2 Diabetes Health Issue and Exercise This approach will motivate the patient to engage in exercise and achieve better results while reducing the risk of diabetes-related complications.
• Diabetes Interventions in Children The study aims to answer the PICOT Question: In children with obesity, how does the use of m-Health applications for controlling their dieting choices compare to the supervision of their parents affect children’s understanding of […]
• Diabetes Tracker Device and Its Advantages The proposed diabetes tracker is a device that combines the functionality of an electronic BGL tester and a personal assistant to help patients stick to their diet plan.
• Disease Management for Diabetes Mellitus The selection of the appropriate philosophical and theoretical basis for the lesson is essential as it allows for the use of an evidence-based method for learning about a particular disease.
• Latino People and Type 2 Diabetes The primary aim of the study is to determine the facilitators and barriers to investigating the decision-making process in the Latin population and their values associated with type 2 diabetes.
• Diabetes Self-Management Education and Support Program The choice of this topic and question is based on the fact that despite the high prevalence of diabetes among adolescents in the United States, the use of DSMES among DM patients is relatively low, […]
• Diabetes Mellitus Care Coordination The aim is to establish what medical technologies, care coordination and community resources, and standards of nursing practice contribute to the quality of care and safety of patients with diabetes.
• Healthy Lifestyle Interventions in Comorbid Asthma and Diabetes In most research, the weight loss in cases of comorbid asthma and obesity is reached through a combination of dietary interventions and physical exercise programs.
• Case Study of Patient with DKA and Diabetes Mellitus It is manifested by a sharp increase in glucose levels and the concentration of ketone bodies in the blood, their appearance in the urine, regardless of the degree of violation of the patient’s consciousness.
• PDSA in Diabetes Prevention The second step in the “Do” phase would be to isolate a few members of the community who are affected by diabetes voluntarily.
• Diabetes: Statistics, Disparities, Therapies The inability to produce adequate insulin or the body’s resistance to the hormone is the primary cause of diabetes. Diabetes is a serious health condition in the U.S.and the world.
• Type 2 Diabetes Prescriptions and Interventions The disadvantage is the difficulty of obtaining a universal model due to the complexity of many factors that can affect the implementation of recommendations: from the variety of demographic data to the patient’s medical history.
• Health Education for Female African Americans With Diabetes In order to address and inform the public about the challenges, nurses are required to intervene by educating the population on the issues to enhance their understanding of the risks associated with the conditions they […]
• Diabetes Risk Assessment and Prevention It is one of the factors predisposing patients suffering from diabetes to various cardiovascular diseases. With diabetes, it is important to learn how to determine the presence of carbohydrates in foods.
• Diabetes Mellitus: Preventive Measures In addition to addressing the medical specialists who will be of service in disease prevention, it will emphasize the intervention programs required to help control the spread of the illness.
• “The Diabetes Online Community” by Litchman et al. The researchers applied the method of telephone interviews to determine the results and effectiveness of the program. The study described the value of DOC in providing support and knowledge to older diabetes patients.
• Mobile App for Improved Self-Management of Type 2 Diabetes The central focus of the study was to assess the effectiveness of the BlueStar app in controlling glucose levels among the participants.
• Type 2 Diabetes in Minorities from Cultural Perspective The purpose of this paper is to examine the ethical and cultural perspectives on the issue of T2DM in minorities. Level 2: What are the ethical obstacles to treating T2DM in ethnic and cultural minorities?
• Ethics of Type 2 Diabetes Prevalence in Minorities The purpose of this article analysis is to dwell on scholarly evidence that raises the question of ethical and cultural aspects of T2DM prevalence in minorities.
• Type 2 Diabetes in Minorities: Research Questions The Level 2 research questions are: What are the pathophysiological implications of T2DM in minorities? What are the statistical implications of T2DM in minorities?
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• Type 2 Diabetes in Adolescents According to a National Diabetes Statistics Report released by the Centers for Disease Control and Prevention, the estimated prevalence of the disease was 25 cases per 10,000 adolescents in 2017. A proper understanding of T2D […]
• Analysis of Diabetes and Its Huge Effects In the US, diabetes is costly to treat and has caused much physical, emotional and mental harm to the people and the families of those who have been affected by the disease.
• Nursing: Self-Management of Type II Diabetes Sandra Fernandes and Shobha Naidu’s journal illustrates the authors’ understanding of a significant topic in the nursing profession.”Promoting Participation in self-care management among patients with diabetes mellitus” article exposes readers to Peplau’s theory to understand […]
• The Impact of Vegan and Vegetarian Diets on Diabetes Vegetarian diets are popular for a variety of reasons; according to the National Health Interview Survey in the United States, about 2% of the population reported following a vegetarian dietary pattern for health reasons in […]
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• Diabetes Disease of the First and Second Types It is a decrease in the biological response of cells to one or more effects of insulin at its average concentration in the blood. During the first type of diabetes, insulin Degludec is required together […]
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• Person-Centered Strategy of Diabetes and Dementia Care The population of focus for this study will be Afro-American women aged between sixty and ninety who have diabetes of the second type and dementia or are likely to develop dementia in the future.
• Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services For example, during one of my interactions with the patient, I was asked whether the hospital had the policy to avoid face-to-face interaction during the pandemic with the help of video examinations.
• Diets to Prevent Heart Disease, Cancer, and Diabetes In order to prevent heart disease, cancer, and diabetes, people are required to adhere to strict routines, including in terms of diet. Additionally, people wanting to prevent heart disease, cancer, and diabetes also need to […]
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• Depression in Diabetes Patients The presence of depression concomitant to diabetes mellitus prevents the adaptation of the patient and negatively affects the course of the underlying disease.
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• Pre-diabetes and Urinary Incontinence Most recent reports indicate that a physiotherapy procedure gives a positive result in up to 80% of patients with stage I or SUI and mixed form and 50% of patients with stage II SUI.
• Type 1 Diabetes: Recommendations for Alternative Drug Treatments Then, they have to assess the existing levels of literacy and numeracy a patient has. Tailoring educational initiatives to a person’s unique ethnic and cultural background is the basis of cultural competence in patient education.
• Type 2 Diabetes: A Pharmacologic Update Diabetes presents one of the most common diagnoses in causes of ED visits among adults and one of the leading causes of death in the United States.
• Type 2 Diabetes and Its Treatment The main difference in type 2 diabetes is the insensitivity of the body’s cells to the action of the hormone insulin and their insulin resistance.
• Diabetes: Vulnerability, Resilience, and Care In nursing care, resilience is a critical concept that shows the possibility of a person to continue functioning and meeting objectives despite the existing challenges.
• Diabetes Prevention in the United States The analysis of these policies and the other strategies provides the opportunity to understand what role they might play in the improvement of human health. NDPP policy, on the other hand, emphasizes the role of […]
• Teaching Experience: Diabetes Prevention The primary objective of the seminar is to reduce the annual number of diabetes cases and familiarize the audience with the very first signs of this disease.
• Summary of Type 2 Diabetes: A Pharmacologic Update The authors first emphasize that T2D is one of the most widespread diseases in the United States and the seventh leading cause of death.
• Insulin Effects in a Diabetes Person I will use this source to support my research because the perception of diabetes patients on insulin therapy is essential for understanding the impact they cause on the person.
• Diabetes and Medical Intervention In the research conducted by Moin et al, the authors attempted to define the scope of efficiency of such a tool as an online diabetes prevention program in the prevention of diabetes among obese/overweight population […]
• Diabetes Mellitus Type 2 and a Healthy Lifestyle Relationship The advantage of this study over the first is that the method uses a medical approach to determining the level of fasting glucose, while the dependences in the study of Ugandans were found using a […]
• Diabetes: Epidemiological Analysis I would like to pose the following question: how can epidemiology principles be applied to these statistics for further improvements of policies that aim to reduce the impact of diabetes on the U.S.population? The limited […]
• Pathogenesis and Prevention of Diabetes Mellitus and Hypertension The hormone is produced by the cells of the islets of Langerhans found in the pancreas. It is attributed to the variation in the lifestyle of these individuals in these two geographical zones.
• Parental Intervention on Self-Management of an Adolescent With Diabetes Diabetes development and exposure are strongly tied to lifestyle, and the increasing incidents rate emphasizes the severity of the population’s health problem.
• Addressing the Needs of Hispanic Patients With Diabetes Similarly, in the program at hand, the needs of Hispanic patients with diabetes will be considered through the prism of the key specifics of the community, as well as the cultural background of the patients.
• Diabetes: Epidemiologic Study Design For instance, the range of their parents’ involvement in the self-management practices can be a crucial factor in treatment and control.
• What to Know About Diabetes? Type 1 diabetes is caused by autoimmune reaction that prevent realization of insulin in a body. Estimated 5-10% of people who have diabetes have type 1.
• Diabetes in Saudi Arabia It is expected that should this underlying factor be discovered, whether it is cultural, societal, or genetic in nature, this should help policymakers within Saudi Arabia create new governmental initiatives to address the problem of […]
• “Medical Nutrition Therapy: A Key to Diabetes Management and Prevention” Article Analysis In the process of MNT application, the dietitian keeps a record of the changes in the main components of food and other components of the blood such as blood sugars to determine the trend to […]
• Nutrition and Physical Activity for Children With a Diabetes When a child understands that the family supports him or her, this is a great way to bring enthusiasm in dealing with the disease.
• Global and Societal Implications of the Diabetes Epidemic The main aim of the authors of this article seems to be alerting the reader on the consequences of diabetes to the society and to the whole world.
• Diabetes and Hypertension Avoiding Recommendations Thus, the promotion of a healthy lifestyle should entail the encouragement of the population to cease smoking and monitor for cholesterol levels.
• Pregnant Women With Type I Diabetes: COVID-19 Disease Management The grounded theory was selected for the given topic, and there are benefits and drawbacks of utilizing it to study the experiences of pregnant women with type I diabetes and COVID-19.
• Current Recommendations for the Glycemic Control in Diabetes Management of blood glucose is one of the critical issues in the care of people with diabetes. Therefore, the interval of the A1C testing should also depend on the condition of the patient, the physician’s […]
• Diabetes Mellitus: Types, Causes, Presentation, Treatment, and Examination Diabetes mellitus is a chronic endocrinologic disease, which is characterized by increased blood glucose concentration.
• Diabetes Problem at Country Walk Community: Intervention and Evaluation This presentation develops a community health nursing intervention and evaluation tool for the diabetes problem affecting Country Walk community.
• Communication Challenges Between Nurses and Patients With Type 2 Diabetes According to Pung and Goh, one of the limitations of communication in a multicultural environment is the language barrier that manifests itself in the direct interaction of nurses with patients and in the engagement work […]
• Diabetes Type 2 from Management Viewpoint Demonstrate the effects of type 2 diabetes and provide background information on the disease; Discuss the management plans of diabetes centers and critically analyze the frameworks implemented in the hospitals; Examine the existing methodology models […]
• Nursing Plan for the Patient with Diabetes Type 2, HTN, and CAD The health of the population is the most valuable achievement of society, so the preservation and strengthening of it is an essential task in which everyone should participate without exception.
• Diagnosis and Classification of Diabetes Mellitus Diabetes is a serious public health concern that introduces a group of metabolic disorders caused by changes in the sugar blood level.
• Diabetes Mellitus Type II: A Case of a Female Adult Patient In this presentation, we are going to develop a care plan for a 47-year-old woman with a 3-year-old history of Diabetes Mellitus Type 2 (also known as Type II DM).
• Diabetes Insipidus: Disease Process With Implications for Healthcare Professionals This presentation will consider the topic of Diabetes Insipidus (DI) with a focus on its etiology and progress.
• The Nature of Type 1 Diabetes Mellitus Type 1 diabetes mellitus is a chronic autoimmune disease that has an active genetic component, which is identified by increased blood glucose levels, also known as hyperglycemia.
• Imperial Diabetes Center Field Study The purpose is to examine the leadership’s practices used to maintain and improve the quality and safety standards of the facility and, using the observations and scholarly research, offer recommendations for improvement.
• Diabetes Risk Assessment After completing the questionnaire, I learned that my risk for the development of diabetes is above average. Modern risk assessment tools allow identifying the current state of health and possibilities of developing the disease.
• The Role of Telenursing in the Management of Diabetes Type 1 Telemedicine is the solution that could potentially increase the coverage and improve the situation for many t1DM patients in the world.
• Health Issues of Heart Failure and Pediatric Diabetes As for the population, which is intended to participate in the research, I am convinced that there is the need to specify the patients who should be examined and monitored.
• Juvenile Diabetes: Demographics, Statistics and Risk Factors Juvenile diabetes, also referred to as Type 2 diabetes or insulin-dependent diabetes, describes a health condition associated with the pancreas’s limited insulin production. The condition is characterized by the destruction of the cells that make […]
• Diabetes Mellitus: Pathophysiologic Processes The main function of insulin produced by cells within the pancreas in response to food intake is to lower blood sugar levels by the facilitation of glucose uptake in the cells of the liver, fat, […]
• Type 2 Diabetes Management in Gulf Countries One such study is the systematic review on the quality of type 2 diabetes management in the countries of the cooperation council for the Arab states of the Gulf, prepared by Alhyas, McKay, Balasanthiran, and […]
• Patient with Ataxia and Diabetes Mellitus Therefore, the therapist prioritizes using the cushion to the client and persuades the patient to accept the product by discussing the merits of the infinity cushion with a low profile in enabling the customer to […]
• Diabetes Evidence-Based Project: Disseminating Results In this presentation, the involvement of mentors and collaboration with administration and other stakeholders are the preferred steps, and the idea to use social networking and web pages has to be removed.
• The Problem of Diabetes Among African Americans Taking into consideration the results of the research and the information found in the articles, the problem of diabetes among African Americans has to be identified and discussed at different levels.
• Childhood Obesity, Diabetes and Heart Problems Based on the data given in the introduction it can be seen that childhood obesity is a real problem within the country and as such it is believed that through proper education children will be […]
• Hypertension and Antihypertensive Therapy and Type 2 Diabetes Mellitus In particular, Acebutolol impairs the functions of epinephrine and norepinephrine, which are neurotransmitters that mediate the functioning of the heart and the sympathetic nervous system.
• Diabetes: Diagnosis and Treatment The disease is characterized by the pancreas almost not producing its own insulin, which leads to an increase in glucose levels in the blood.
• How to Manage Type 2 Diabetes The article is significant to the current research problem as the researchers concluded that the assessment of metabolic processes in diabetic patients was imperative for adjusting in the management of the condition.
• Type 2 Diabetes Analysis Thus, type 2 diabetes has medical costs, or the difficulties of coping up with the illness, economic ones, which are the financial costs of managing it, and the organizational ones for the healthcare systems.
• Clinical Trial of Diabetes Mellitus On the other hand, type II diabetes mellitus is caused by the failure of the liver and muscle cells to recognize the insulin produced by the pancreatic cells.
• Diabetes: Diagnosis and Related Prevention & Treatment Measures The information presented on the articles offers an insight in the diagnosis of diabetes among various groups of persons and the related preventive and treatment measures. The study identified 3666 cases of initial stages of […]
• Reinforcing Nutrition in Schools to Reduce Diabetes and Childhood Obesity For example, the 2010 report says that the rates of childhood obesity have peaked greatly compared to the previous decades: “Obesity has doubled in Maryland over the past 20 years, and nearly one-third of youth […]
• The Connection Between Diabetes and Consuming Red Meat In light of reporting the findings of this research, the Times Healthland gave a detailed report on the various aspects of this research.
• Synthesizing the Data From Relative Risk Factors of Type 2 Diabetes Speaking of such demographic factors as race, the white population suffers from it in the majority of cases, unlike the rest of the races, the remaining 0.
• Using Exenatide as Treatment of Type 2 Diabetes Mellitus in Adults Kendal et al.analyzed the effects of exenatide as an adjunct to a combination of metformin and sulfonylurea against the combination of the same drugs without the adjunct.
• Enhancing Health Literacy for People With Type 2 Diabetes Two professionals, Andrew Long, a professor in the school of heath care in the University of Leeds, and Tina Gambling, senior lecturer in the school of health care studies from the University of Cardiff, conducted […]
• The Scientific Method of Understanding if Coffee Can Impact Diabetes The hypothesis of the experiment ought to be straightforward and understandable. The control group and the experiment group for the test are then identified.
• Gestational Diabetes Mellitus: Review This is because of the current patterns that show an increase in the prevalence of diabetes in offspring born to mothers with GDM.
• Health Service Management of Diabetes
• Necrotizing Fasciitis: Pathophysiology, Role of Diabetes
• The Benefits of Sharing Knowledge About Diabetes With Physicians
• Gestational Diabetes Mellitus – NSW, Australia
• Health and Wellness: Stress, Diabetes and Tobacco Related Problems
• 52-Year-Old Female Patient With Type II Diabetes
• Healthy People Project: Personal Review About Diabetes
• Nursing Diagnosis: Type 1 Diabetes & Hypertension
• Nursing Care For the Patient With Diabetes
• Nursing Care Development Plan for Diabetes and Hypertension
• Coronary Heart Disease Aggravated by Type 2 Diabetes and Age
• Diabetes as the Scourge of the 21st Century: Locating the Solution
• Psychosocial Implications of Diabetes Management
• Gestational Diabetes in a Pregnant Woman
• Diabetes Mellitus: Prominent Metabolic Disorder
• Holistic Approach to Man’s Health: Diabetes Prevention
• Holistic Image in Prevention of Diabetes
• Educational Strategies for Diabetes to Patients
• Diabetes and Obesity in the United Arab Emirates
• Epidemiological Problem: Diabetes in Illinois
• Diabetes as a Chronic Condition
• Managing Diabetes Through Genetic Engineering
• Diabetes, Functions of Insulin, and Preventive Practices
• Treating of Diabetes in Adults
• Counseling and Education Session in Type II Diabetes
• Diabetes II: Reduction in the Incidence
• Community Health Advocacy Project: Diabetes Among Hispanics
• Community Health Advocacy Project: Hispanics With Diabetes
• Hispanics Are More Susceptible to Diabetes That Non-Hispanics
• Rates Diabetes Between Hispanics Males and Females
• Diabetes Mellitus and HFSON Conceptual Framework
• Prince Georges County Community Health Concern: Diabetes
• Fats and Proteins in Relation to Type 2 Diabetes
• Alcohol Interaction With Medication: Type 2 Diabetes
• Diabetes Management and Evidence-Based Practice
• Critical Analysis of Policy for Type 2 Diabetes Mellitus in Australia
• The Treatment and Management of Diabetes
• Obesity and Diabetes: The Enemies Within
• Impact of Diabetes on the United Arab Emirates’ Economy
• Childhood Obesity and Type 2 Diabetes
• Health Nursing and Managing Diabetes
• Diabetes Management: How Lifestyle, Daily Routine Affect Blood Sugar
• Diabetes Management: Diagnostics and Treatment
• Diabetes Mellitus Type 2: The Family Genetic History
• Diabetes Type II: Hormonal Mechanism and Intracellular Effects of Insulin
• Social, Behavioral, and Psychosocial Causes of Diseases: Type 2 Diabetes
• Supportive Intervention in the Control of Diabetes Mellitus
• Enhancing Foot Care Practices in Patients With Diabetes
• Community Health Promotion: The Fight Against Diabetes in a Community Setting
• Diabetes in Australia and Saudi Arabia
• Diabetes: The Advantages and Disadvantages of Point of Care Testing
• Diabetes Mellitus Type 2 or Non-Insulin-Dependent Diabetes Mellitus
• Qualitative Research in Diabetes Management in Elderly Patient
• Diabetes Prevention Measures in the Republic of the Marshall Islands
• Impact of Diabetes on Healthcare
• Gestational Diabetes: American Diabetes Association Publishers
• Gestational Diabetes: Child Bearing Experience
• Diabetes Mellitus Effects on Periodontal Disease
• Diabetes Type II Disease in the Community
• The Relationship of Type 2 Diabetes and Depression
• Glycemic Control in Individuals With Type 2 Diabetes
• The Diagnosis of Diabetes in Older Adults and Adolescents
• Physical Activity in Managing Type-2 Diabetes
• High Risk of Developing Type 1 and Type 2 Diabetes Mellitus
• Children With Type 1 Diabetes in Clinical Practice
• Type 2 Diabetes Treatment Analysis
• Type 2 Diabetes Mellitus: Revealing the Diagnosis
• The Type 2 Diabetes Prevention: Lifestyle Choices
• Indigenous and Torres Strait Population and Diabetes
• Interpretation of the Diabetes Interview Transcript
• Type 1 Diabetes: Using Glucose Monitoring in Treatment
• Managing Type 2 Diabetes Patients’ Blood Sugar Prior to and After Surgical Procedures
• Dubai Diabetes… We Care: Leaflet Review
• Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes: Medical Terminology Definition
• Modern Diabetes Treatment Tools
• Diabetes: Encapsulation to Treat a Disease
• Current Dietary for the Treatment of Diabetes
• Diabetes: Discussion of the Disease
• Stranahan on Diabetes Impairs Hippocampal Function
• A Clinical-Based Study of Young Adults Who Have Diabetes
• Panax Ginseng for Diabetes Treatment
• Depression and Diabetes Association in Adults
• Is There Anu Cure For Diabetes?
• Diabetes Type 2 in Children: Causes and Effects
• Type 1 Diabetes Mellitus Case
• Health, Culture, and Identity as Diabetes Treatment Factors
• Diabetes Prevention in Chinese Elderly in Hunan
• “Experiences of Patients With Type 2 Diabetes Starting Insulin Therapy” by Phillips
• Type 2 Diabetes: Nursing Change Project
• Diabetes and Health Promotion Concepts
• Type 2 Diabetes Project Results Dissemination
• Type 2 Diabetes in Geriatric Patients
• Type 2 Diabetes and Geriatric Evidence-Based Care
• Cultural Empowerment. Diabetes in Afro-Americans
• Diabetes Self-Management: Relationships & Expectations
• Diagnosis and Classification of Diabetes Mellitus
• Improving Comprehensive Care for Patients With Diabetes
• Diabetes Impact on Cardiovascular and Nervous Systems
• Side Effects of Metformin in Diabetes Treatment
• Type 2 Diabetes and Drug Treatments
• Diabetes Mellitus and Health Determinants
• Nursing Leadership in Diabetes Management
• Diabetes Education for African American Women
• Latent Autoimmune Adult Diabetes
• Obesity: Epidemiology and Health Consequences
• Diabetes in Urban Cities of United States
• Diabetes in Australia: Analysis
• Type 2 Diabetes in the Afro-American Bronx Community
• Type 2 Diabetes From Cultural and Genetic Aspects
• Type 2 Diabetes in Bronx: Evidence-Based Practice
• Type 2 Diabetes in Bronx Project for Social Change
• Cardiovascular Care in Type 2 Diabetes Patients
• Ambition Diabetes and Diet on Macbeths’ Example
• Diabetes as Community Health Issue in the Bronx
• Diabetes Management Plan: Diagnosis and Development
• Diabetes Treatment and Care
• Transition from Pediatric to Adult Diabetes Care
• Diabetes Awareness Program and Strategic Planning
• Diabetes: Disease Control and Investigation
• Diabetes Pain Questionnaire and Patient Feedback
• Perception of Diabetes in the Hispanic Population
• Clinical Studies of Diabetes Mellitus
• Diabetes Mellitus and Problems at Work
• Diabetes in the US: Cost Effectiveness Analysis
• Diabetes Investigation in Space Flight Research
• Diabetes Care Advice by Food and Drug Administration
• Artificial Intelligence for Diabetes: Project Experiences
• Diabetes Patients’ Long-Term Care and Life Quality
• Chronic Care Model for Diabetes Patients in the UAE
• Diabetes Among British Adults and Children
• Endocrine Disorders: Diabetes and Fibromyalgia
• Future Technologies: Diabetes Treatment and Care
• Epidemiology of Type 1 Diabetes
• Diabetes: Treatment Technology and Billing
• Pathophysiology of Mellitus and Insipidus Diabetes
• Stem Cell Therapy as a Potential Cure for Diabetes
• Stem Cell Therapy and Diabetes Medical Research
• Type II Diabetes Susceptibility and Socioeconomic Status
• Obesity and Hypertension in Type 2 Diabetes Patients
• Strongyloides Stercoralis Infection and Type 2 Diabetes
• Socioeconomic Status and Susceptibility to Type II Diabetes
• Diabetes Mellitus: Differential Diagnosis
• Diabetes Disease in the USA Adults
• Education for African Americans With Type 2 Diabetes
• Diabetes Treatment and Funding in Fulton County
• Diabetes Care: Leadership and Strategy Plan
• Diabetes Mellitus’ New Treatment: Principles and Process
• Diet and Nutrition: European Diabetes
• Preventing the Proliferation Diabetes
• Diabetes: Symptoms, Treatment, and Prevention
• Diabetes and Cardiovascular Diseases in Medicine
• Ecological Models to Deal with Diabetes in Medicine
• Different Types of Diabetes Found in Different Countries
• Analysis of Program “Prevent Diabetes Live Life Well”
• The Effect of Physical, Social, and Health Variables on Diabetes
• Micro and Macro-Cosmos in Medicine and Care Models for Prevention of Diabetes
• Why Qualitative Method Was Chosen for Diabetes Program Evaluation
• Humanistic Image of Managing Diabetes
• Diabetes mellitus Education and hemoglobin A1C level
• Obesity, Diabetes and Heart Disease
• Illuminate Diabetes Event Design
• Cause and Diagnosis of Type 2 diabetes
• Patient Voices: Type 2 Diabetes. Podcast Review
• Type I Diabetes: Pathogenesis and Treatment
• Human Body Organ Systems Disorders: Diabetes
• Age Influence on Physical Activity: Exercise and Diabetes
• Hemoglobin A1C Test for Diabetes
• Why Injury and Diabetes Have Been Identified as National Health Priority?
• What Factors Are Involved in the Increasing Prevalence of Type II Diabetes in Adolescents?
• Does the Socioeconomic Position Determine the Incidence of Diabetes?
• What Are the Four Types of Diabetes?
• How Fat and Obesity Cause Diabetes?
• How Exercise Affects Type 2 Diabetes?
• How Does the Treatment With Insulin Affect Type 2 Diabetes?
• How Diabetes Does Cause Depression?
• Does Diabetes Prevention Pay For Itself?
• How Does Snap Participation Affect Rates of Diabetes?
• Does Overeating Sugar Cause Diabetes, Cavities, Acne, Hyperactivity and Make You Fat?
• Why Diabetes Mellitus and How It Affects the United States?
• Does Alcohol Decrease the Risk of Diabetes?
• How Does a Person With Diabetes Feel?
• Does Periodontal Inflammation Affect Type 1 Diabetes in Childhood and Adolescence?
• How Can the Paleolithic Diet Control Type 2 Diabetes?
• How Does Insulin Help Diabetes Be Controlled?
• Does Economic Status Matter for the Regional Variation of Malnutrition-Related Diabetes?
• How Can Artificial Intelligence Technology Be Used to Treat Diabetes?
• What Are the Main Causes and Treatments of Diabetes?
• What Evidence Exists for Treatments Depression With Comorbid Diabetes Using Traditional Chinese Medicine and Natural Products?
• Why Was Qualitative Method Chosen for Diabetes Program Evaluation?
• What Are the Three Types of Diabetes?
• How Does Poverty Affect Diabetes?
• What Is the Leading Cause of Diabetes?
• How Is Diabetes Diagnosed?
• What Are the Main Symptoms of Diabetes?
• How Diabetes Adversely Affects Your Body?
• What Are the Most Common Symptoms of Undiagnosed Diabetes?
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Knowledge gaps in diabetes research: an evidence mapping of the literature

• Review article
• Published: 25 May 2022
• Volume 21 , pages 1139–1148, ( 2022 )

Cite this article

• Shahnaz Esmaeili 1 ,
• Fatemeh Bandarian 1 ,
• Fatemeh Gharishvandi 2 ,
• Farideh Razi 3 ,
• Shaghayegh Hosseinkhani 4 ,
• Nazli Namazi 5 ,
• Behnaz Esmaeili 6 ,
• Mahnaz Sanjari 7 ,
• Ali Tootee 1 ,
• Saeedeh Saeedi 8 ,
• Camelia Rambod 9 ,
• Maryam Aalaa 9 ,
• Noushin Fahimfar 10 ,
• Bagher Larijani 11 &
• Ensieh Nasli-Esfahani 1  

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Mapping the available evidence can be used to inform current diabetes research, identify relevant gaps, and prioritize future research. In this regard, we mapped diabetes research performed in Iran.

We searched the Scopus and PubMed databases from 01/01/2015 till 01/01/2020 using keywords such as diabetes and Iran. The included articles were classified according to their document types, level of evidence, and subject areas.

The majority of the included articles (53%) were related to diabetes types, followed by complications (28%). Most of the documents were original articles (82%), and reviews were 18% of the publications. Systematic reviews constitute only 6% of the total documents. Observational studies were the most common types of study designs (26%), followed by clinical trials (20%). Moreover, topics on control and management of diabetes were the most prevalent subject areas (58%), and fewer studies were on preventive strategies (6%). In diabetes management studies, less attention has been paid to evaluate psychological (10%), educational (9%), and physical activity-related (7%) interventions. There was a shortage of secondary studies related to physical activity, psychology, diagnostic, and screening-related studies.

To fill diabetes research gaps, more investment in cost-effectiveness interventions, such as preventive strategies and behavioral self-management programs, need. Moreover, we need to pay more attention on applied sciences and real world evidence to bridge translational gaps from bench to bedside. In this regard, further data synthesis can be helpful in evaluating the effectiveness of the available studies and avoiding unnecessary investigations.

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All data generated or analysed during this study are included in this published article [and its supplementary information files].

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SH.E: the data collection and extraction, thematic synthesis of information, the data classification, write the manuscript draft, revised it, and approved final manuscript.

F.R, N.N, M.S., M.A, F.B,, A.T, S.S, C.R: the data screening.

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N.F, F.B: critically reviewed the manuscript.

B.L: provided the study concept and critically reviewed the manuscript and approved final manuscript.

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Esmaeili, S., Bandarian, F., Gharishvandi, F. et al. Knowledge gaps in diabetes research: an evidence mapping of the literature. J Diabetes Metab Disord 21 , 1139–1148 (2022). https://doi.org/10.1007/s40200-022-01037-9

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• v.21(2); 2018 Apr

Diabetes‐related complications: Which research topics matter to diverse patients and caregivers?

Maman joyce dogba.

1 Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada

2 Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada

Mylène Tantchou Dipankui

Selma chipenda dansokho, france légaré, holly o. witteman.

3 Centre Hospitalier Universitaire de Québec (CHU de Québec) Research Centre [Health of populations and best health practices axis], Quebec City, QC, Canada

Associated Data

Diabetes is a chronic disease with increasing prevalence worldwide. Although research has improved its treatment and management, little is known about which research topics matter to people living with diabetes, particularly among under‐represented groups.

To explore the importance of research topics among a diverse range of people living with any type of diabetes or caring for someone living with any type of diabetes.

We used a convergent mixed‐method design with quantitative and qualitative aspects. We surveyed a national sample of people living with diabetes and caregivers of people with diabetes, asking them to rate the importance of 10 predetermined important research topics. We also held three focus groups in two major cities to explore research concerns of people who are under‐represented in research.

469 adults (57% men, 42% women) in Canada completed the online survey, indicating that all 10 areas of research mattered to them, with the highest ratings accorded to preventing and treating kidney, eye and nerve complications. Fourteen individuals participated in three focus groups and similarly noted the importance of research on those three complications. Additionally, focus group participants also noted the importance of research around daily management. No new topics were identified.

Conclusions

This study confirmed the importance of research topics among a population of people living with or caring for someone with diabetes. Findings from this study were used to inform the vision for Diabetes Action Canada—a pan‐Canadian Strategy for Patient‐Oriented Research ( SPOR ) Network on diabetes and its complications.

1. INTRODUCTION

Diabetes is a chronic disease with increasing prevalence worldwide. 1 In 2014, an estimated 422 million adults, representing 8.5% of the global population, were living with diabetes. 2 The economic burden of this disease and its complications account for a growing proportion of local and national budgets. 3 , 4 For individuals, diabetes has negative psychosocial consequences that diminish quality of life. 5 While research has improved the treatment and management of diabetes and increased longevity, 6 mismatches between the focus of research and what matters to patients may lead to research waste. 7 , 8 Involving patients in the early stages of research is the first step in reducing such waste, as it helps increase the relevance of topics studied regarding such chronic diseases as diabetes. 9 People living with chronic diseases may develop a high degree of expertise which can provide new insight into how to improve their conditions and self‐care. 10 , 11 The patient perspective may complement that of the clinician and researcher by providing a more holistic interpretation of health and the experience of a health condition. 11

When seeking to involve patients as partners in research, it is critical to avoid reproducing or even exacerbating health inequities. Major disparities persist in the diagnosis, treatment, disease management and health outcomes of groups such as ethnic minorities, immigrants, people living in poverty, people whose mental health require regular follow‐up with a psychiatrist and seniors, all of whom are more vulnerable to diabetes‐related complications. 12 , 13 , 14 , 15 , 16 In spite of these continuing disparities, minority groups continue to be under‐represented in research, and engagement in defining research questions is no exception. Additionally, there is little guidance on how to facilitate the full participation of members of these groups in setting research priorities. 17 , 18 For example, although previous research in the United Kingdom has identified research priorities among people living with type 1 diabetes, those involved were predominantly white and female. 19

This study aimed to involve a national sample of people living with diabetes and caregivers of people living with diabetes in rating the importance of research topics around diabetes‐related complications. We further sought to capture the perspectives of people who are under‐represented in research. Our primary research question was as follows: What topics are most important to people living with or caring for someone living with diabetes regarding disease‐related complications as a means to help better orient future research priorities?

2.1. Study design

We used a multipronged mixed‐methods (QUAN + QUAL) approach with a convergent design 20 to capture what was important to people living with diabetes and caregivers regarding research on diabetes‐related complications. 21 , 22 According to the convergent mixed‐methods design, quantitative and qualitative methods are complementary during data collection, data analysis or both. In our case, we combined 21 the quantitative and qualitative data after we completed both sets of data collection. The study consisted of two components accordingly: (i) quantitative: an anonymous online survey to poll a national sample of people living with diabetes or caregivers of people living with diabetes on the importance of 10 predetermined research topics; and (ii) qualitative: holding focus groups with people living with diabetes who are members of under‐represented groups, in order to explore the views and experiences of those predicted to be under‐represented in the online survey. 23

2.2. Research ethics

This study was approved by the Research Ethics Board of the Centre Hospitalier Universitaire de Québec (Quebec City, approval #: 2016‐2578). In agreeing to follow the link and take the online survey, participants provided implied consent. No survey questions were mandatory, meaning that respondents could skip questions if they wished. No attention filter was included. Prior to each focus group, we described the project and allowed participants to ask questions. Verbal consent of focus group participants was recorded.

2.3. Procedures

2.3.1. online survey.

The online survey included questions on socio‐demographics, the person's experience with diabetes‐related complications and analog scales to rate the importance of 10 pertinent disease‐related complication research topics. These topics were identified in the literature describing previous priority‐setting exercises conducted with people living with type 1 diabetes, 19 and via email consultation with researchers, clinicians, representatives of patient organizations, caregivers and patient partners as part of a 6‐month funding application planning process.

Demographic data gathered from participants included: age, gender, ethnicity, income and education levels, geographical location and country of birth (inside or outside of Canada). Prior to finalizing the survey, all survey questions were iteratively reviewed by a person living with type 1 diabetes, a person living with type 2 diabetes, and a parent of a child with type 1 diabetes. The survey also contained three validated scales 24 , 25 , 26 , 27 , 28 to measure fear or distress associated with living with diabetes and its complications (see Appendix S1 ). These scales were included because we believed that fear or distress might influence how individuals rate the importance of research topics relative to the levels of fear they experience regarding these complications. If we were to observe large variations in ratings of importance, these data would allow us to explore potential reasons for the variation. The survey also included comment boxes where participants could provide additional information, including an open‐ended question asking for their ideas on additional topics concerning diabetes and diabetes‐related complications that require more research.

2.3.2. Survey participants

Over a 3‐day period in September 2015, we recruited participants through Qualtrics online sampling services. 29 To be included in the study, participants had to be living in Canada, aged ≥18 years, living with type 1 or type 2 diabetes, or caring for a child or an adult with diabetes and able to complete the survey in English or French. To ensure demographic diversity and offset variations in response rates, we established desired quotas based on gender (50/50 men and women), type of diabetes and relationship with diabetes (people with diabetes themselves, parents of children with diabetes, caregivers for adults with diabetes). We could not put quotas in place regarding ethnicity due to sampling constraints. In keeping with standard amounts for surveys administered by panel services, participants who completed the survey received $1.00‐$1.50 in compensation for their time answering our questions. We aimed for approximately 500 respondents. This target was selected as an achievable sample size that would allow for a broad sample of respondents and aligned with previous, similar research that sought feedback from 583 people living with diabetes about research questions they would like to see addressed. 19

2.3.3. Focus groups

Members of some groups may be less likely to complete online surveys, and thus, be under‐represented in survey‐based research. Therefore, we held 3 focus groups with patients and caregivers who were members of such groups. 30 To ensure variation in perspectives, we partnered with community organizations working with seniors, economically disadvantaged people, immigrants and people whose mental health requires follow‐up with a psychiatrist. 31 , 32 , 33 Two experienced qualitative researchers (MJD and MDT) conducted the focus groups using an established protocol. During the focus groups, patients were invited to discuss their experience with diabetes and its related complications, their perspectives and their concerns about the long‐term complications of diabetes. Participants also explained why, in their view, the concerns raised should be investigated by researchers.

2.3.4. Focus group participants

We used a convenience sample of members of under‐represented populations in the province of Quebec. We recruited focus group participants through three community‐based organizations that provide services to seniors, immigrants and people whose mental health requires regular follow‐up with a psychiatrist. To be eligible to participate in the focus groups, participants needed to be: living in Canada, aged ≥18 years, living with type 1 diabetes, type 2 diabetes or caring for a person with diabetes, and able to understand and express themselves in French. Participants who were unable to comfortably express themselves in French were excluded from the study.

To recruit participants, the organizations circulated information about the study to its clients or members. Interested participants contacted the research associate either by email or by phone. The research associate contacted all potential participants to explain the study, assess their eligibility, answer questions and discuss logistics. A reminder call and/or email was sent to all participants 2 days prior to the scheduled focus group to confirm the time and location.

We held the three focus groups at times convenient for participants. Furthermore, to increase accessibility, the focus groups were held in the offices of the partnering community organizations; a common practice when working with members of vulnerable populations. 34 We conducted two focus groups in Quebec City: (i) seniors; and (ii) people whose mental health requires regular follow‐up with a psychiatrist. We conducted the third in Montreal with a group of immigrants. Each focus group was audio‐recorded and lasted between 70 and 90 minutes. Participants received $50 in appreciation for their time and 10$ for transportation. 19

2.4. Data analysis

Our interest in conducting both qualitative and quantitative portions was to ensure inclusion of diverse perspectives. In other words, while research often uses quantitative and qualitative methods to collect different types of data from the same population to inform a research question, we used different methods to collect data from groups both more and less likely to participate in different types of research, in an attempt to capture more representative results. Therefore, we carried out quantitative and qualitative analyses separately before bringing both parts together. Our first step was to conduct descriptive statistics using SPSS version 22 (Armonk, NY, USA: IBM Corp.) to measure central tendency and examine the range of variation in responses to our questions about the importance of 10 important diabetes research areas. We recorded focus group discussions and transcribed them verbatim. We performed a six‐stage thematic analysis 35 , 36 using NVivo qualitative analysis software (QSR International Pty Ltd. Version 10, 2012). We started by generating initial codes and themes, and inductively refining these themes based on the data. MTD analysed focus group data under the guidance of MJD. The codes were labelled with short phrases using the words of participants. Then, MTD sorted codes into potential themes and collated all relevant coded data extracts within the identified themes and subthemes. During this analysis, the codes, themes and subthemes were revised and refined. We used field notes 37 to validate and complete the information gathered during the focus groups. After separate analyses were completed, we combined the findings from each study to analyse how complementary or contradictory they were. We additionally examined how focus group findings could improve our interpretation of the statistical analysis.

3.1. Characteristics of participants

3.1.1. online survey.

Of the 500 participants surveyed, 31 were excluded from our analyses because they either completed the survey in a time deemed too fast to provide thoughtful answers (ie, 10 minutes or less) or because their responses were inconsistent with the questions. The remaining 469 participants were 57% men, had a mean age of 44 (SD = 15), came from across the 10 provinces and 3 territories of Canada, and represented a broad range of educational backgrounds and income levels. In line with our concerns and predictions about representation, participants predominantly identified as White or Caucasian (93%). Participants completed the survey in English (78%) or French (22%) and were either living with diabetes (96%) and/or caring for a child (<1%) or adult with diabetes (3%). Ten percent (10%) of participants were dealing with type 1 diabetes; 89% with type 2 diabetes; and 1% with another or unknown type. Median time living with diabetes was 19.5 years for type 1 diabetes (IQR 9.8‐30.0 years) and 8.0 years for type 2 diabetes (IQR 4.0‐15.0 years.) (See Table  1 A,B).

Online Survey Data

SD, sample standard deviation; IQR, interquartile range.

A vast majority of participants with type 1 or type 2 diabetes (45% and 60%, respectively) reported other health concerns, some of which may be diabetes‐related complications (see Table S1 ). These concerns were, for types 1 and 2 respectively, eye complications (34% and 15% of participants), heart complications (13% and 24% of participants), kidney complications (22% and 8% of participants), mental health complications (34% and 27% of participants) and nerve complications (40% and 30% of participants). Many participants reported not having been screened for these complications in the previous year. Of those with type 1 and type 2 diabetes, respectively, 63% and 78% reported not receiving screening for eye complications within the past year; 71% and 68% reported not receiving screening for heart complications; 53% and 70% reported not receiving screening for kidney complications; 68% and 86% reported not receiving screening for mental health complications; and 61% and 70% reported not receiving screening for nerve complications.

3.1.2. Focus groups

Of the 23 people who initially expressed an interest in participating in the study, 5 were ineligible because they neither had diabetes nor cared for a person with diabetes; 2 withdrew because they were unavailable on the day of the focus group and 2 withdrew without explanation. Of the 14 remaining individuals who participated in the 3 focus groups, 7 (50%) were female and 3 total (21%) were living with type 1 diabetes. The characteristics of participants are shown in Table  2 .

Focus Groups: Characteristics of the 14 participants

3.2. Data analysis

3.2.1. online survey.

We report here the medians rather than the means because the distribution of responses to the survey questions about the importance of research topics regarding preventing and treating the complications of diabetes was not symmetrical. The median scores for people with both type 1 and type 2 diabetes were between 84 and 100 (on a 0 to 100 rating scale, with 100 indicating extremely important) indicating that participants assigned high importance to all 10 predetermined research topics with relatively little variation between topics. Topics that had the highest median scores and the least variation in responses were preventing and treating kidney, eye, heart and nerve problems. Research topics for which participants had the widest interquartile range in scores were as follows: preventing and treating mental health problems, developing and testing smart insulin, patient and caregiver education, and artificial pancreas research (type 1) (see Table  3 ).

Online survey results regarding the importance of diabetes‐related research topics

Cronbach's alphas were .94, .93 and .94, respectively, for the Fear of Complications Scale, 28 Hypoglycemia Fear Scale 24 , 25 , 26 and Diabetes Distress Scale. 27 People with type 1 diabetes and type 2 diabetes had mean scores of 23 (SD 10) and 18 (SD 10), respectively, on the Fear of Complications Scale (range 0‐45). Participants with type 1 diabetes had a mean score of 34 (SD 17) on the Hypoglycemia Fear Scale (range 0‐108) indicating sometimes fearing hypoglycaemia, while participants with type 2 diabetes had a mean score of 21 (SD 16) indicating being concerned less often. Finally, participants with type 1 diabetes and type 2 diabetes had mean scores of 2.81 (SD 1.23) and 2.23 (SD 1.27) on the Diabetes Distress Scale. Using the cut‐off score recommended by Fisher et al 38 this indicates that on average, participants with type 1 diabetes had moderate but non‐clinical levels of distress (threshold = 3) (see Table S1 ).

Comments provided by participants in the open box sections of the survey aligned with the quantitative findings and illustrate the emotional distress linked to diabetes and diabetes management, the fear associated with episodes of hypoglycaemia and its consequences, and with the long‐term complications of the disease (see Table  3 ).

3.2.2. Focus groups

The thematic analysis allowed us to identify a set of general concerns about diabetes‐related complications as reported by members of under‐represented groups.

3.3. General concerns about diabetes‐related complications

Participants in the focus groups provided further insight into the nature of their concerns about the impact of diabetes on their quality of life, life‐expectancy (Table  4 , citation 1) and vulnerability to other diseases (Table  4 , citation 2). Most participants reported being most afraid of complications that potentially lead to functional impairment (blindness), additional morbidity (chronic renal failure) or death (hypoglycaemia) (Table  4 , citation 3). Furthermore, participants pointed to the challenge of continuously monitoring and managing the disease (Table  4 , citations 4, 5 and 6).

Citations from focus groups participants

In addition to these general and common concerns, four specific themes arose from the focus group discussions:

Theme 1: The bidirectional relation between individual history and socio‐economic context, and the management of diabetes

Two aspects of individual history and context were mentioned by participants: (i) the influence of previous life‐experiences on the management of diabetes; and (ii) the impact of socio‐economic conditions on the outcomes of the disease. Regarding the first point, participants said they suspected a strong relation between their previous life‐experiences and the management of diabetes‐related complications. They wished that this relation could be investigated. For example, one participant talked about adopting bad eating habits such as dieting during the day and binging at night because she saw a loved one in a diabetic coma. (Table  4 , citations 7 and 8).

With respect to the second point, discussions in both focus groups focused on the need for studies examining the cost of diabetes treatment (Table  4 , citation 9). For example, some participants argued that they sometimes had to choose between paying their rent and buying insulin and complained that this should be a concern to researchers.

Theme 2: The need to better understand the danger of polymedication toxicity in patients with multiple comorbidities

Focus group participants who were either elderly or had experienced mental health problems expressed their concerns about toxic drug interactions resulting from polymedication. They stressed the urgent need to understand, whether and/or to what extent, there may be interactions between their diabetes medication and other treatments (Table  4 , citation 10).

Theme 3: The need to better understand barriers to quality care for immigrants living with diabetes

Focus group participants who were immigrants had two core concerns regarding diabetes and its related complications for researchers to address, notably: (i) how to improve access to quality care for immigrants with diabetes; and (ii) how to make health‐care professionals more knowledgeable about the specific care needs of immigrants living with diabetes. Most immigrants in the study talked about cultural or linguistic barriers to navigating the health system. For example, one participant talked about how she had learned to be assertive in expressing her needs (Table  4 , citation 11). Another participant talked about his experience going back and forth between the doctor and the pharmacist without answers to his needs (Table  4 , citation 12). Finally, participants who were immigrants unanimously reported that health‐care professionals were inadequately trained to detect symptoms and diagnose diabetes among individuals who are newcomers to the country. One participant, for example, said that this led to a failure to recognise pre‐diabetes symptoms, forcing this person to consult multiple physicians before a glycaemia test was requested (Table  4 , citation 13).

Theme 4: The need for better dissemination of the research results on diabetes

Focus group participants also expressed concerns about not having access to updated information on diabetes. They reported being aware of on‐going research, but were never informed by community organizations about the research results (Table  4 , citations 14 and 15).

Participants also pointed to a need for better information for their loved ones and relatives, to help them understand and provide better support in the management of the disease (Table  4 , citations 16, 17, 18).

4. DISCUSSION

This study aimed to explore the importance of diabetes‐related complication research topics relevant to those living with or caring for someone living with diabetes. Additionally, we wished to explore the reasons why these topics are important from the perspective of under‐represented populations. Findings from both the quantitative and qualitative components of the study complement each other and can be summarized in three main points.

First, the alignment of what is important for patients in diabetes research. Both survey and focus group participants indicated the importance of preventing and treating well‐known complications of diabetes such as kidney, eye and nerve problems. This finding confirms that research on such complications matters to patients and caregivers. Second, the need for more research about the bidirectional influence of the “life context” on diabetes.   Our participants also pointed out that there are a number of individual and contextual factors, such as individual circumstances (eg, life conditions, previous experiences), socio‐economic status and the experience of managing the condition that need further exploration, especially for the most under‐represented people included in this study. Finally, the third point was the need to deepen diabetes‐related research in under‐represented populations. Our results further suggest that research topics should be tailored to address specific challenges such as access to culturally relevant care for immigrants. 39

Consistent with other studies, 40 , 41 our quantitative data show that participants had moderate levels of emotional distress around diabetes‐related complications. Our qualitative analysis provided some insight into the nature of these concerns. For example, the fear that diabetes‐related complications (eg, kidney failure or blindness) may result in functional impairment or death (eg, as a result of a hypoglycaemia). Additionally, fears were often amplified not only by personal experience as shown in other studies, 42 , 43 , 44 , 45 , 46 but also by witnessing others dealing with such complications (such as having seen a loved one with kidney failure or experiencing a hypoglycaemic episode). These experiences impact how research topics are rated by those whose lives are touched by the disease. Unfortunately, further investigation of these questions was not possible with this study for two reasons: (i) the focus group participants were not asked to rate the complications as did online survey participants; and (ii) the focus groups were conducted separately from the quantitative portion of the study.

Overall, our findings point to a need for more research on diabetes, its complications and the bidirectional influence of a number of individual and contextual factors such as individual circumstances (eg, life conditions, previous experiences, emotional distress); socio‐economic status; and the experience of managing the condition, especially for the most under‐represented groups included in this study. It was suggested that research topics should be tailored to address specific challenges, such as access to culturally competent care for immigrants. 39

Our study did, however, have a few limitations. Due to time and budget constraints, focus group activities were restricted to Montreal and Quebec City, where our team is based. This limited our ability to recruit in other cities across Canada and also limited a true representation of the country's population. Although our respondents and their experiences reflect a broad sample of the population of Canada, several other groups who may have particular needs (eg, pregnant women, Indigenous peoples, parents or guardians of children with diabetes, as well as caregivers) were under‐represented in the online survey and were absent in the focus groups. Therefore, our sample lacks representation of some other under‐represented populations in Canada. Additionally, language barriers may have limited our selection of participants and excluded individuals, particularly those from under‐represented groups such as immigrants. Furthermore, because this online survey and focus group based study relied on participant self‐reports, the data could be limited by the subjects’ ability for introspection, their individual interpretations and social desirability bias. 47 Finally, because this was a preliminary study aimed at exploring the importance of different research topics to those living with diabetes and caregivers in Canada, we did not undertake prioritization activities that require trading‐off one priority against another to produce a ranked list. Such activities are planned for future research.

One strength of this study is its use of qualitative and quantitative methods to help capture the experiences of under‐represented groups and diverse participants from across Canada. This approach proved feasible as a method for efficiently exploring patients’ and caregivers’ preliminary views on research topics within a short period of time.

5. CONCLUSIONS

This study confirmed the importance of research topics regarding diabetes‐related complications within a population of people living with diabetes or caring for someone with diabetes, and further explored reasons why these topics might be important for certain groups of under‐represented people. The results of this study about what matters most to people living with, and caring for those living with diabetes, including people from under‐represented populations, informed the research program of a 5‐year pan‐Canadian Strategy for Patient‐Oriented Research Network on Diabetes and its related complications (2016‐2021). 39 A broad range of people living with diabetes are now involved as patient partners in this network, collaborating on research projects, research planning and supporting network governance. We anticipate that our results and on‐going work will contribute to the development of targeted interventions better aligned with improving the health and well‐being of people whose lives are touched by diabetes.

AUTHOR CONTRIBUTIONS

M.J.D. provided the study concept and design, supervised the protocol development and research, enrolled patients for the qualitative stage, facilitated focus groups, analysed data and provided the first draft of the manuscript. S.C.D. conducted the descriptive statistics, wrote the quantitative part of the manuscript, reviewed and edited the manuscript. M.T.D. enrolled patients for the qualitative stage, facilitated focus groups, analysed data and wrote the manuscript. F.L. reviewed and edited the manuscript. H.O.W. supervised the survey data collection, reviewed and edited the manuscript. M.J.D. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

CONFLICT OF INTEREST

The authors report no conflict of interest.

Supporting information

Acknowledgements.

The authors thank people living with diabetes, their caregivers and community organizations across Canada for their invaluable contributions to this study. The authors thank Judith Kashul for linguistic editing of this manuscript. Additionally, we thank Mary Zettl, for her contribution editing, coordinating and finalizing this article for publication.

Dogba MJ, Dipankui MT, Chipenda Dansokho S, Légaré F, Witteman HO. Diabetes‐related complications: Which research topics matter to diverse patients and caregivers? Health Expect . 2018; 21 :549–559. https://doi.org/10.1111/hex.12649 [ PMC free article ] [ PubMed ] [ Google Scholar ]

This study was funded through a subgrant of the Canadian Institutes of Health Research (CIHR SCD 139932)

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How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

• dairy or plant-based dairy products
• nonstarchy vegetables
• protein foods
• whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

• foods high in saturated fat
• foods high in sodium, a mineral found in salt
• sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

• what medicines you take for diabetes
• what your level of physical activity or your work schedule is
• whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

• Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
• Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
• Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

• lower blood glucose, blood pressure, and cholesterol levels
• better heart health
• healthier weight
• better mood and sleep
• better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

• following a healthy meal plan
• consuming fewer calories
• being physically active
• getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

• lower your feelings of stress, depression, or anxiety
• manage problems sleeping or remembering things
• see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

• how changing when you eat may affect body weight and metabolism
• how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
• whether low-carbohydrate meal plans can help lower blood glucose levels
• which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.

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April 19, 2024

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Clinical recommendations for newer diabetes treatments

by American College of Physicians

A new guideline from the American College of Physicians (ACP) offers clinical recommendations for the use of newer pharmacological treatments of adults with type 2 diabetes. This is an update of ACP's 2017 guideline and is based on the best available evidence for effectiveness, comparative benefits and harms, consideration of patients' values and preferences, and costs. Newer Pharmacological Treatments in Adults with Type 2 Diabetes: A Clinical Guideline from the American College of Physicians is published in Annals of Internal Medicine .

In the updated clinical guideline , ACP recommends adding a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or glucagon-like peptide-1 (GLP-1) agonist to metformin and lifestyle interventions in patients with type 2 diabetes and inadequate glycemic control.

Use SGLT-2 inhibitor to reduce the risk of all-cause mortality, major adverse cardiovascular events, progression of chronic kidney disease, and hospitalization due to congestive heart failure or use GLP-1 agonist to reduce the risk of all-cause mortality, major adverse cardiovascular events, and stroke.

ACP, however, recommends against adding a dipeptidyl peptidase-4 (DPP-4) inhibitor to metformin and lifestyle modifications in adults with type 2 diabetes and inadequate glycemic control because high-certainty evidence showed that adding a DPP-4 inhibitor does not reduce morbidity or all-cause mortality.

This clinical guideline is based on systematic reviews of the benefits, harms, and cost-effectiveness of newer pharmacological treatments for type 2 diabetes. ACP prioritized the following outcomes, which were evaluated using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach: all-cause mortality, major adverse cardiovascular events, myocardial infarction , stroke, hospitalization for congestive heart failure, progression of chronic kidney disease, serious adverse events, and severe hypoglycemia.

Weight loss, as measured by percentage of participants who achieved at least 10% total body weight loss , was a prioritized outcome, but data were insufficient for network meta-analysis and not rated with GRADE.

The updated ACP guideline did not look at the effects of treatment for glycemic control, though this is a common treatment goal. It is known that all included treatments can improve glycemic control in adults with type 2 diabetes. Instead, the guideline focuses on clinical benefit outcomes, such as whether the treatments improve cardiovascular outcomes.

ACP guidelines emphasize shared decision-making, recognizing that each patient's needs and circumstances are unique. ACP encourages physicians to consider individual patient characteristics like age, comorbidities, and personal preferences when discussing a treatment plan for type 2 diabetes. SGLT-2s and GLP-1s are costly, but lower cost options (like sulfonylureas) were inferior in reducing all-cause mortality and morbidity. There are currently no generic formulations for GLP-1s and SGLT-2.

The author of an accompanying editorial from Duke University Division of General Internal Medicine suggests that cost presents a significant barrier to GLP1 agonists and SGL2T inhibitors.

Patients with obesity and diabetes need easier access to these medications, especially given their unmatched effectiveness for glucose control and weight reduction. According to the author, the cost-effectiveness of GLP1 agonists and SGLT2 inhibitors as initial diabetes therapy in the setting of various comorbid conditions warrants careful exploration.

Along with the supporting review articles, the ACP clinical guideline is published with an accompanying visual clinical guideline aimed to efficiently interact with and visualize the data supporting these recommendations.

Editorial: https://www.acpjournals.org/doi/10.7326/M24-0861

Review: https://www.acpjournals.org/doi/10.7326/M23-1490

Review: https://www.acpjournals.org/doi/10.7326/M23-1492

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• Frontiers in Endocrinology
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Cardiovascular Diseases Related to Diabetes and Obesity

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The dramatic increase in the prevalence of diabetes and obesity worldwide has seriously threatened human health since its associated complications cause high morbidity and mortality. Among the complications, cardiovascular diseases are the predominant component. Although various controls for blood glucose and ...

Keywords : Diabetic Complications, Cardiovascular Diseases, Obesity

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