Diabetes can be a devastating disease if not carefully managed, 由于血糖(或血糖)水平控制不佳，会增加患心血管疾病的风险, 肾脏损害, 视力丧失, 以及其他严重的情况. 总的来说,11.根据美国糖尿病协会的数据，6%的美国人患有糖尿病, though rates are highest within certain populations, 包括黑, 拉美裔, 亚裔美国人, 和美国印第安成年人.
康奈尔护理学院(CSON)的四名教员正在寻找方法，填补糖尿病护理方面的空白，这些空白影响到服务不足的社区和其他患者群体，这些群体往往难以获得适当的治疗和预防措施. 这些太阳城官网人员致力于改善糖尿病护理，这是他们对太阳城网赌平台为他人服务的使命的承诺的一部分.
EMBRACING TECHNOLOGY TO CONTROL DIABETES
2019冠状病毒病大流行的一个重要教训是，糖尿病是一种可以通过虚拟医学治疗的疾病. “It really changed the landscape of how we were able to deliver care,” 助理教授 帕特里夏·安德伍德, who is also an endocrine nurse practitioner at the VA Boston Healthcare System (VA). When physical distancing became necessary, 安德伍德和她在退伍军人事务部的同事们进行了转变，很快就通过电话会议或电话每天进行12-14次虚拟预约. 他们通过训练患者使用一种叫做连续血糖监测(CGM)的技术来实现这一目标。, 它包括一个可穿戴设备，可以实时跟踪血糖水平，并将信息传输到智能手机或接收器. 重要的是, CGM数据可以上传到一个网站，临床医生可以查看该网站，以确定患者的治疗计划是否维持健康的血糖水平.
安德伍德说:“我们能够为那些本来不会得到护理的病人提供护理。. 她是2022年一篇论文的主要作者，该论文描述了她诊所的几名患者通过CGM和虚拟就诊成功克服了控制血糖的障碍, and how to integrate this technology into practice, 刊登于 Journal of the American Association of Nurse Practitioners.
在其他工作中, 安德伍德最近使用了她在退伍军人管理局的同事开发的一种名为A1C时间范围(TIR)的实验指标，表明血糖经常过高或过低的糖尿病患者患痴呆症的风险增加. “People don’t think of dementia as a complication of diabetes, 但事实确实如此,内分泌学家保罗·康林说, MD, chief of medicine at VA Boston (and BC Class of ’79), who heads the team that developed the A1C TIR. 接下来, 安德伍德, who has 工作ed alongside Conlin as a clinical scientist since 2022, plans to examine how patient lifestyle behavior, 药物治疗, and provider practices affect A1C TIR. “If we can understand predictors of this metric,安德伍德说。, “it would help us to design better clinical interventions.”
“We were able to deliver care to patients who otherwise wouldn’t have received it.”
—助理教授 帕特里夏·安德伍德
COPING WITH HEALTH DISPARITIES IN DIABETES
助理教授 Cherlie Magny-Normilus is seeking to improve self-management of type 2 diabetes (T2D, which occurs when cells resist the hormone insulin) among Haitian immigrants in the United States, who experience higher rates of complications from the disease than other comparable ethnic groups. With support from the National Institute for Nursing 太阳城官网, Magny-Normilus has developed a multilevel, 针对不同文化量身定制的干预项目，教育患有糖尿病的海地成年人饮食的作用, 体育活动, and 药物治疗 in managing the disease, which she is currently pilot testing.
Magny-Normilus used a variety of resources to design the six-part program, including a preliminary study of 81 Haitians with T2D, who described their management behaviors and barriers to effective blood sugar control. 参与者还佩戴了CGMs和活动记录仪14天，以提供他们的血糖变异性和身体活动水平的数据.
在初级阶段, Magny-Normilus发现，参与者能够从他们的CGM图像中看到，吃高碳水化合物的食物是如何导致血糖飙升的, helping them understand the importance of diet modification. “No wonder my A1C continues to be high,” one participant said. 与此同时, 她还发现，许多太阳城官网参与者表示，他们觉得在社区户外锻炼不安全，也负担不起健身房的会员资格. “因此，我试图在干预中嵌入关于如何通过多走动来进行身体活动的指导,马格尼-诺米卢斯说.
重要的是, Magny-Normilus learned that housing issues, 缺乏获得健康食品的途径, and racial discrimination act as barriers to diabetes management, but many study participants were reluctant to seek help with these problems. “This is a population that is very prideful,马格尼-诺米卢斯说, 在她的干预中，她将需要社会支持服务的参与者引导到他们感到舒适的机构和组织，并在那里了解他们的语言和文化. After completing this pilot study next year, Magny-Normilus plans to evaluate it in a multi-site clinical trial.
CULTURAL ADAPTATION FOR PREVENTING DIABETES
亚裔美国人患T2D的比例比美国其他种族群体上升得更快.
具有里程碑意义的糖尿病预防计划(DPP)太阳城官网发现，改变生活方式可以降低患糖尿病的风险, but Associate Professor and Strakosch Family Fellow Tam阮 说，在亚裔美国患者中实施这一项目往往忽视了文化和生理现实，这使得它不太可能有效. 例如, the DPP demonstrated that losing 5 to 7 percent of body weight can help prevent the onset of T2D. “But a lot of Asians just don’t have a lot of weight to lose,阮说。.
然而, some 亚裔美国人s who are not overweight nonetheless have significant abdominal fat, 哪一个与T2D有关, suggesting that a custom approach may be beneficial. “亚洲人, we think that exercise is more important than weight loss,阮说。, 谁打算和运动生理学家一起测试针对腹部脂肪的不同类型的有氧和力量方案, 看看它们是否能降低患糖尿病的风险.
阮说，其他必要的文化适应包括减少T2D风险的饮食建议:减少芝士汉堡和甜甜圈的建议对一个最喜欢春卷和越南粉的越南裔美国人来说意义不大, 例如. 阮 has launched a pilot project to adapt the DPP for the Vietnamese community, 多亏了5美元.美国疾病控制与预防中心(Centers for Disease Control and prevention)拨款500万美元，她的团队将把这项计划扩大到包括中国人和亚裔印度人后裔, 太, in collaboration with Quincy Asian 资源, 乔斯林糖尿病中心, and South Cove 社区 Health Center.
针对“糖尿病困扰”
1型糖尿病(T1D)患者, (由分泌胰岛素的胰腺细胞的损失引起)经常被比作有一份全职工作, 给n the frequent need to administer insulin, 监测血糖水平, and take other steps to maintain stable blood sugar. That’s emotionally challenging for any patient, but emerging adults with T1D face unusually high levels of “diabetes distress,” 凯瑟琳Wentzell, 她是乔斯林糖尿病中心的儿科执业护士，今年夏天她将以助理教授的身份回到母校. Wentzell的太阳城官网重点是了解新成人(18至30岁)的糖尿病困扰，并找到克服糖尿病的方法.1型糖尿病(T1D)患者, (由分泌胰岛素的胰腺细胞的损失引起)经常被比作有一份全职工作, 给n the frequent need to administer insulin, 监测血糖水平, and take other steps to maintain stable blood sugar. That’s emotionally challenging for any patient, but emerging adults with T1D face unusually high levels of “diabetes distress,凯瑟琳·温策尔说, 她是乔斯林糖尿病中心的儿科执业护士，今年夏天她将以助理教授的身份回到母校. Wentzell的太阳城官网重点是了解新成人(18至30岁)的糖尿病困扰，并找到克服糖尿病的方法.
“没有人会独自患上糖尿病,温策尔说, but emerging adults have likely left their parents’ home to attend college or live independently, 所以他们通常缺乏支持团队. Competing demands of higher education, 工作, and new social and romantic relationships can distract from diabetes management, resulting in out-of-range blood glucose. 这可能会导致愤怒, 挫折, 感觉不知所措,温策尔说, which can further interfere with completing the many daily tasks of diabetes. “And you just continue in this cycle that’s really hard to get out of.”
To better understand the experience of diabetes distress in this patient population, Wentzell developed the Problem Areas in Diabetes-Emerging Adult (PAID-EA) survey, 这是第一次, which is now being used in multiple studies and will be translated into several languages. Wentzell的调查显示，大约90%的新成年T1D患者担心糖尿病的费用, 一些报告显示，胰岛素价格的上涨已经导致30%到50%的年轻人限量服用这种药物, 她说. Wentzell现在希望开展一项太阳城官网，太阳城官网这些患者对成本的担忧如何影响他们的糖尿病管理行为, 以及他们做出的选择——比如推迟再开胰岛素处方——如何影响他们的结果.
“没有人会独自患上糖尿病.”
—助理教授 凯瑟琳Wentzell
美国的糖尿病
通过数字
38.4 M
# of Americans who have diabetes (as of 2021)
97.6 M
#的美国人患有前驱糖尿病, 一种以血糖高于正常水平为特征的疾病，可发展为2型糖尿病
1.2 M
# of Americans diagnosed with diabetes each year
Source: American Diabetes Association, numbers in millions