journal article
LitStream Collection
Home
Jafar, Adnan; Pasqua, Melissa‐Rosina
doi: 10.1111/dom.15463pmid: 38263540
Postprandial glucose control can be challenging for individuals with type 1 diabetes, and this can be attributed to many factors, including suboptimal therapy parameters (carbohydrate ratios, correction factors, basal doses) because of physiological changes, meal macronutrients and engagement in postprandial physical activity. This narrative review aims to examine the current postprandial glucose‐management strategies tested in clinical trials, including adjusting therapy settings, bolusing for meal macronutrients, adjusting pre‐exercise and postexercise meal boluses for postprandial physical activity, and other therapeutic options, for individuals on open‐loop and closed‐loop therapies. Then we discuss their challenges and future avenues. Despite advancements in insulin delivery devices such as closed‐loop systems and decision‐support systems, many individuals with type 1 diabetes still struggle to manage their glucose levels. The main challenge is the lack of personalized recommendations, causing suboptimal postprandial glucose control. We suggest that postprandial glucose control can be improved by (i) providing personalized recommendations for meal macronutrients and postprandial activity; (ii) including behavioural recommendations; (iii) using other personalized therapeutic approaches (e.g. glucagon‐like peptide‐1 receptor agonists, sodium‐glucose co‐transporter inhibitors, amylin analogues, inhaled insulin) in addition to insulin therapy; and (iv) integrating an interpretability report to explain to individuals about changes in treatment therapy and behavioural recommendations. In addition, we suggest a future avenue to implement precision recommendations for individuals with type 1 diabetes utilizing the potential of deep reinforcement learning and foundation models (such as GPT and BERT), employing different modalities of data including diabetes‐related and external background factors (i.e. behavioural, environmental, biological and abnormal events).
Vora, Jiten; Cherney, David; Kosiborod, Mikhail N.; Spaak, Jonas; Kanumilli, Naresh; Khunti, Kamlesh; Lam, Carolyn S. P.; Bachmann, Michael; Fenici, Peter; ,
doi: 10.1111/dom.15485pmid: 38328853
Nakamura, Yuta; Horie, Ichiro; Kitamura, Tadahiro; Kusunoki, Yoshiki; Nishida, Kenro; Yamamoto, Akane; Hirota, Yushi; Fukui, Tomoyasu; Maeda, Yasutaka; Minami, Masae; Matsui, Takanori; Kawakami, Atsushi; Abiru, Norio
doi: 10.1111/dom.15458pmid: 38253809
Iijima, Hiroaki; Gouda, Maki; Hida, Hideaki; Mori‐Anai, Kazumi; Takahashi, Akiko; Minai, Ryoichi; Ninomiya, Hideki; Saito, Yoshiyuki; Miyawaki, Atsushi; Wada, Jun
doi: 10.1111/dom.15461pmid: 38413384
Showing 1 to 10 of 47 Articles
Cardiovascular, renal and metabolic (CaReMe) diseases are individually among the leading global causes of death, and each is associated with substantial morbidity and mortality. However, as these conditions commonly coexist in the same patient, the individual risk of mortality and morbidity is further compounded, leading to a considerable healthcare burden. A number of pathophysiological pathways are common to diseases of the CaReMe spectrum, including neurohormonal dysfunction, visceral adiposity and insulin resistance, oxidative stress and systemic inflammation. Because of the shared pathology and common co‐occurrence of the CaReMe diseases, the value of managing these conditions holistically is increasingly being realized. A number of pharmacological and non‐pharmacological approaches have been shown to offer simultaneous metabolic, cardioprotective and renoprotective benefits, leading to improved patient outcomes across the CaReMe spectrum. In addition, increasing value is being placed on interdisciplinary team‐based and coordinated care models built on greater integration between specialties to increase the rate of early diagnosis and adherence to practice guidelines, and improve clinical outcomes. This interdisciplinary approach also facilitates integration between primary and specialty care, improving the patient experience, optimizing resources, and leading to efficiencies and cost savings. As the burden of CaReMe diseases continues to increase, implementation of innovative and integrated care delivery models will be essential to achieve effective and efficient chronic disease management and to ensure that patients benefit from the best care available across all three disciplines.