如果不小心管理，糖尿病可能是一种毁灭性的疾病, as suboptimal control of blood glucose (or blood sugar) levels can increase the risk for cardiovascular disease, 肾脏损害, 视力丧失, 以及其他严重的情况. 总的来说,11.6 percent of people in the United States have diabetes according to the American Diabetes Association, 尽管在某些人群中发病率最高, 包括黑, 拉美裔, 亚裔美国人, 和美国印第安成年人.
Four faculty members at the 康奈尔护理学院 (CSON) are searching for ways to fill gaps in the care of diabetes that affect underserved communities and other patient groups that often struggle to receive adequate treatment and preventive measures. These researchers are driven to improve diabetes care as part of their commitment to 太阳城网赌平台’s mission of living in service to others.
利用科技控制糖尿病
One important lesson of the COVID-19 pandemic was that diabetes is a condition that is amenable to virtual medicine. “它确实改变了我们提供护理的方式，”助理教授说 帕特里夏·安德伍德她也是VA波士顿医疗保健系统(VA)的内分泌执业护士。. 当需要保持身体距离时, 安德伍德 and her colleagues at the VA pivoted and were soon conducting 12–14 virtual appointments a day through teleconferencing or phone calls. They made that possible by training patients to use technology called continuous glucose monitoring (CGM), which consists of a wearable device that tracks blood glucose levels in real time and transmits that information to a smartphone or receiver. 重要的是, CGM data can be uploaded to a website that a clinician can view to determine whether a patient’s treatment plan is maintaining healthy blood glucose levels.
“我们能够为那些本来不会得到护理的病人提供护理,安德伍德说。. She was lead author of a 2022 paper that described several patients in her clinic who successfully overcame obstacles to controlling blood sugar with CGM and virtual 访问s, 以及如何将这一技术应用到实践中, 刊登于 美国执业护士协会杂志.
在其他工作中, 安德伍德 recently used an experimental metric developed by her colleagues at the VA called A1C time-in-range (TIR) to show that diabetes patients whose blood glucose frequently rises 太 high or drops 太 low have an increased risk for dementia. “人们并不认为痴呆症是糖尿病的并发症, 但事实确实如此,内分泌学家保罗·康林说, MD, 弗吉尼亚大学波士顿分校医学主任(79届哥伦比亚大学毕业生), 谁领导开发A1C TIR的团队. 接下来, 安德伍德, 自2022年以来一直与科林一起工作的临床科学家, 计划检查患者的生活方式行为, 药物治疗, 和提供者的做法影响A1C TIR. “如果我们能理解这一指标的预测因素,安德伍德说。, “这将有助于我们设计更好的临床干预措施.”
“我们能够为那些本来不会得到护理的病人提供护理.”
——助理教授帕特里夏·安德伍德
应对糖尿病患者的健康差异
助理教授 Cherlie Magny-Normilus 正在寻求改善2型糖尿病(T2D, (当细胞抵抗激素胰岛素时发生), 与其他可比较的种族相比，谁的并发症发生率更高. 在国家护理太阳城官网所的支持下, Magny-Normilus开发了一个多层次的, culturally tailored intervention program that educates Haitian adults with T2D about the roles of diet, 体育活动, 以及治疗疾病的药物, 她目前正在进行试点测试.
Magny-Normilus利用各种资源设计了这个由六部分组成的项目, 包括对81名患有糖尿病的海地人的初步太阳城官网, 谁描述了他们的管理行为和有效控制血糖的障碍. Participants also wore CGMs and actigraphy devices for 14 days to provide data about their blood glucose variability and level of 体育活动.
在初级阶段, Magny-Normilus discovered that participants were able to see from their CGM’s graphics how eating a high-carbohydrate meal caused blood sugar to soar, 帮助他们了解饮食调整的重要性. “难怪我的糖化血红蛋白一直很高，”一位参与者说. 与此同时, she also discovered that many study participants said they didn’t feel safe exercising outdoors in their neighborhoods and couldn’t afford gym memberships. “So I’m trying to embed instructions about ways to get 体育活动 even at home by moving around more into the intervention,马格尼-诺米卢斯说.
重要的是, Magny-Normilus了解到住房问题, 缺乏获得健康食品的途径, 种族歧视是糖尿病管理的障碍, 但许多太阳城官网参与者都不愿意寻求这些问题的帮助. “这是一个非常骄傲的群体,马格尼-诺米卢斯说, a variable she accounts for in her interventions by guiding participants in need of social-support services to agencies and organizations where they will feel comfortable and their language and culture are unders太d. 在明年完成这项试点太阳城官网之后, Magny-Normilus计划在一项多地点临床试验中对其进行评估.
预防糖尿病的文化适应
Rates of T2D are rising faster among 亚裔美国人s than other racial groups in the United States.
The landmark Diabetes Prevention 程序 (DPP) study found that lifestyle changes can reduce the risk for developing T2D, 而是副教授和斯特拉科什家族太阳城官网员 Tam阮 says the implementation of this program among 亚裔美国人 patients often ignores cultural and physiological realities that render it less likely to be effective. 例如, DPP表明，体重减轻5%至7%有助于预防T2D的发生. “但是很多亚洲人并没有太多的体重需要减掉，”阮说.
然而, 一些不超重的亚裔美国人却有明显的腹部脂肪, 哪一个与T2D有关, 建议自定义方法可能是有益的. “亚洲人, 我们认为运动比减肥更重要,阮说。, who plans to 工作 with an exercise physiologist to test different types of aerobic and strength regimens that target abdominal fat, 看看它们是否能降低患糖尿病的风险.
Other cultural adaptations 阮 says are necessary include dietary recommendations for reducing T2D risk: advice to cut back on cheeseburgers and donuts won’t mean much to a Vietnamese American whose favorite foods are spring rolls and pho, 例如. 阮 has launched a pilot project to adapt the DPP for the Vietnamese community, 多亏了5美元.5 million grant from the Centers for Disease Control and Prevention—her team will expand this initiative to include people of Chinese and Asian Indian descent, 太, 与昆西亚洲资源公司合作, 乔斯林糖尿病中心, 和南湾社区健康中心.
针对“糖尿病困扰”
1型糖尿病(T1D)患者, caused by a loss of insulin-producing pancreas cells) is often compared to having a full-time job, 鉴于经常需要注射胰岛素, 监测血糖水平, 并采取其他措施来保持血糖稳定. 这对任何病人来说都是情感上的挑战, 但新成年T1D患者面临着异常高水平的“糖尿病困扰”,” 凯瑟琳Wentzell, a pediatric nurse practitioner at 乔斯林糖尿病中心 who returns to her alma mater this summer as an assistant professor. Wentzell’s research focuses on understanding diabetes distress in emerging adults (aged 18 to 30) and finding ways to overcome it.1型糖尿病(T1D)患者, caused by a loss of insulin-producing pancreas cells) is often compared to having a full-time job, 鉴于经常需要注射胰岛素, 监测血糖水平, 并采取其他措施来保持血糖稳定. 这对任何病人来说都是情感上的挑战, 但新成年T1D患者面临着异常高水平的“糖尿病困扰”,凯瑟琳·温策尔说, a pediatric nurse practitioner at 乔斯林糖尿病中心 who returns to her alma mater this summer as an assistant professor. Wentzell’s research focuses on understanding diabetes distress in emerging adults (aged 18 to 30) and finding ways to overcome it.
“没有人会独自患上糖尿病,温策尔说, 但初出茅庐的成年人很可能离开父母的家去上大学或独立生活, 所以他们通常缺乏支持团队. 高等教育的竞争需求, 工作, 新的社交和恋爱关系会分散人们对糖尿病管理的注意力, 导致血糖超标. 这可能会导致愤怒, 挫折, 感觉不知所措,温策尔说, 哪一种会进一步干扰糖尿病患者完成许多日常任务. “你只是继续在这个循环中，很难跳出来.”
为了更好地了解糖尿病患者的痛苦经历, Wentzell开发了糖尿病新发成人(PAID-EA)调查中的问题区域, 这是第一次, 它现在被用于多项太阳城官网，并将被翻译成几种语言. Wentzell’s survey has revealed that about nine out of 10 emerging adults with T1D worry about the cost of diabetes, and some reports suggest that the rising price of insulin has led 30 to 50 percent of young adults to ration the drug, 她说. Wentzell now hopes to launch a study of how cost worries in these patients affect their diabetes-management behaviors, and how the choices they make—such as putting off refilling an insulin prescription—influence their outcomes.
“没有人会独自患上糖尿病.”
——凯瑟琳Wentzell助理教授
美国的糖尿病
通过数字
38.4 M
美国糖尿病患者人数(截至2021年)
97.6 M
#的美国人患有前驱糖尿病, a condition characterized by higher-than-normal blood glucose that can progress to type 2 diabetes
1.2 M
每年有超过一半的美国人被诊断患有糖尿病
Source美国糖尿病协会，以百万计