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Wolverson M, O'Hare P, Patel V. An eye opener: improving attendance rates of retinopathy screening within the paediatric diabetes clinic. PRACTICAL DIABETES 2023. [DOI: 10.1002/pdi.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Paul O'Hare
- Warwick Medical School University of Warwick Warwick UK
| | - Vinod Patel
- Warwick Medical School University of Warwick Warwick UK
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2
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McVey LC, Kane N, Murray H, Meek RMD, Ahmed SF. Elective hip arthroplasty rates and related complications in people with diabetes mellitus. Hip Int 2022; 32:717-723. [PMID: 33334203 PMCID: PMC9726745 DOI: 10.1177/1120700020981573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Diabetes mellitus (DM), poor glycaemic control and raised body mass index (BMI) have been associated with postoperative complications in arthroplasty, although the relative importance of these factors is unclear. We describe the prevalence of DM in elective hip arthroplasty in a UK centre, and evaluate the impact of these factors. METHODS We analysed retrospective data for DM patients undergoing arthroplasty over a 6-year period and compared with non-diabetic matched controls (1 DM patient: 5 controls). DM was present in 5.7% of hip arthroplasty patients (82/1443). RESULTS Postoperative complications occurred in 12.2% of DM patients versus 12.9% of controls (p = 1.000); surgical complications were present in 6.1% of those with DM and 2.4% of controls (p = 0.087), while medical complications occurred in 8.5% of DM patients versus 10.7% of controls (p = 0.692). Complications developed in 23.1% of DM patients with poor glycaemic control (HbA1c > 53 mmol/mol) versus 9.8% with good control (p = 0.169). In DM patients and controls combined, complications occurred in 16.3% of obese patients versus 10.0% of non-obese patients (p = 0.043). In the DM cohort, 13.7% of overweight patients had complications versus 0% with a normal or low BMI (p = 0.587). CONCLUSIONS DM rates were lower than expected, and glycaemic control was good. Overall complication rates were unrelated to the presence of DM or to glycaemic control, although surgical complications were observed more frequently in those with DM and poor glycaemic control was uncommon within our cohort. Complications were more frequent in those with a higher BMI. Whether some patients with DM but without an increased risk of complications are currently being excluded from surgery requires exploration.
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Affiliation(s)
- Lindsey C McVey
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Glasgow, UK
| | - Nicholas Kane
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Helen Murray
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - RM Dominic Meek
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Glasgow, UK,S Faisal Ahmed, Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK.
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3
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Beverly EA, Hughes AS, Saunders A. Examination of Health Care Providers' Use of Language in Diabetes Care: A Secondary Qualitative Data Analysis. Clin Diabetes 2022; 40:434-441. [PMID: 36385976 PMCID: PMC9606549 DOI: 10.2337/cd21-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this secondary qualitative data analysis was to assess the frequency and context of stigmatizing language used by health care providers (HCPs). The authors conducted content and thematic analysis of in-depth face-to-face and telephone interviews with HCPs in southeastern Ohio. Participants frequently used labeling language, such as "diabetic" and "noncompliant," as well as language with negative connotations, such as "control," "testing," and "regimen." These findings offer a real-world glimpse of how HCPs communicate about people with diabetes in this region of the country.
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Affiliation(s)
- Elizabeth A. Beverly
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- Ohio University Diabetes Institute, Athens, OH
| | - Allyson S. Hughes
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- Ohio University Diabetes Institute, Athens, OH
| | - Amy Saunders
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
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4
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Carrier MA, Beverly EA. Focus on the Positive: A Qualitative Study of Positive Experiences Living With Type 1 or Type 2 Diabetes. Clin Diabetes 2021; 39:176-187. [PMID: 33981131 PMCID: PMC8061556 DOI: 10.2337/cd20-0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to identify positive experiences associated with diabetes from the perspective of adults diagnosed with type 1 or type 2 diabetes. We conducted in-depth face-to-face and telephone interviews with adults with diabetes. Participants focused on positive and supportive experiences with their peers and community, improved health behaviors, personal growth, and engagement in diabetes advocacy. Communicating positive experiences about diabetes may help clinicians and educators reframe the negative messages commonly shared with people with diabetes.
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Affiliation(s)
- Molly A. Carrier
- Exercise Physiology, Department of Applied Health Sciences and Wellness, Ohio University, Athens, OH
- Honors Tutorial College, Ohio University, Athens, OH
| | - Elizabeth A. Beverly
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- The Diabetes Institute, Ohio University, Athens, OH
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Brewster S, Bartholomew J, Holt RIG, Price H. Non-attendance at diabetes outpatient appointments: a systematic review. Diabet Med 2020; 37:1427-1442. [PMID: 31968127 DOI: 10.1111/dme.14241] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-attendance at diabetes outpatient appointments is a sizeable problem worldwide and has been associated with suboptimal health outcomes. We aimed to describe the characteristics, health outcomes and reasons given for non-attendance at doctor- or nurse-led diabetes appointments, and interventions to improve attendance. METHODS PubMed, EMBASE, CINAHL and PsychInfo were searched from database inception to February 2019. Included articles were peer-reviewed, published in English, related to adults or young people with type 1 or type 2 diabetes, and addressed one of the above aspects of non-attendance. Studies were excluded if reporting on other types of diabetes or reviewing attendance at structured education, retinal screening, paediatric, antenatal, podiatry or dietetic clinics. RESULTS Thirty-four studies of varied designs were identified (15 observational, 1 randomized control trial, 9 qualitative, 5 surveys, 4 service improvements). The definition of non-attendance varied. Younger adults, smokers and those with financial pressures were less likely to attend. Non-attendance was associated with higher HbA1c ; other outcomes were varied but typically worse in non-attenders. Reasons for non-attendance in qualitative studies fell into three categories: balancing the costs and benefits of attendance, coping strategies, and the relationships between the person with diabetes and healthcare professionals. Interventions included appointment management strategies, service improvements, patient navigators and WebCam appointments. CONCLUSIONS Non-attendance is only partially explained by logistical issues. Qualitative studies suggest complex psychosocial factors are involved. Interventions have progressed from simple appointment reminders in an attempt to address some of the psycho-social determinants, but more work is needed to improve attendance.
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Affiliation(s)
- S Brewster
- Research and Development Tom Rudd Unit, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, UK
| | - J Bartholomew
- CRN Wessex, NIHR Clinical Research Network (CRN), University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - H Price
- Research and Development Tom Rudd Unit, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, UK
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Tino S, Wekesa C, Kamacooko O, Makhoba A, Mwebaze R, Bengo S, Nabwato R, Kigongo A, Ddumba E, Mayanja BN, Kaleebu P, Newton R, Nyerinda M. Predictors of loss to follow up among patients with type 2 diabetes mellitus attending a private not for profit urban diabetes clinic in Uganda - a descriptive retrospective study. BMC Health Serv Res 2019; 19:598. [PMID: 31443649 PMCID: PMC6708238 DOI: 10.1186/s12913-019-4415-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/09/2019] [Indexed: 12/21/2022] Open
Abstract
Background Although the prevalence of type 2 diabetes mellitus is increasing in Uganda, data on loss to follow up (LTFU) of patients in care is scanty. We aimed to estimate proportions of patients LTFU and document associated factors among patients attending a private not for profit urban diabetes clinic in Uganda. Methods We conducted a descriptive retrospective study between March and May 2017. We reviewed 1818 out-patient medical records of adults diagnosed with type 2 diabetes mellitus registered between July 2003 and September 2016 at St. Francis Hospital - Nsambya Diabetes clinic in Uganda. Data was extracted on: patients’ registration dates, demographics, socioeconomic status, smoking, glycaemic control, type of treatment, diabetes mellitus complications and last follow-up clinic visit. LTFU was defined as missing collecting medication for six months or more from the date of last clinic visit, excluding situations of death or referral to another clinic. We used Kaplan-Meier technique to estimate time to defaulting medical care after initial registration, log-rank test to test the significance of observed differences between groups. Cox proportional hazards regression model was used to determine predictors of patients’ LTFU rates in hazard ratios (HRs). Results Between July 2003 and September 2016, one thousand eight hundred eighteen patients with type 2 diabetes mellitus were followed for 4847.1 person-years. Majority of patients were female 1066/1818 (59%) and 1317/1818 (72%) had poor glycaemic control. Over the 13 years, 1690/1818 (93%) patients were LTFU, giving a LTFU rate of 34.9 patients per 100 person-years (95%CI: 33.2–36.6). LTFU was significantly higher among males, younger patients (< 45 years), smokers, patients on dual therapy, lower socioeconomic status, and those with diabetes complications like neuropathy and nephropathy. Conclusion We found high proportions of patients LTFU in this diabetes clinic which warrants intervention studies targeting the identified risk factors and strengthening follow up of patients.
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Affiliation(s)
- Salome Tino
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.
| | - Clara Wekesa
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Onesmus Kamacooko
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Anthony Makhoba
- St. Francis Hospital Nsambya, P. O. Box, 7146, Kampala, Uganda
| | - Raymond Mwebaze
- St. Francis Hospital Nsambya, P. O. Box, 7146, Kampala, Uganda
| | - Samuel Bengo
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Rose Nabwato
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Aisha Kigongo
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Edward Ddumba
- St. Francis Hospital Nsambya, P. O. Box, 7146, Kampala, Uganda
| | - Billy N Mayanja
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Pontiano Kaleebu
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Rob Newton
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.,Department of Health Sciences, University of York, Heslington, York, YO10 5DD, United Kingdom
| | - Moffat Nyerinda
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
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7
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Wolff DL, Waldorff FB, von Plessen C, Mogensen CB, Sørensen TL, Houlind KC, Bogh SB, Rubin KH. Rate and predictors for non-attendance of patients undergoing hospital outpatient treatment for chronic diseases: a register-based cohort study. BMC Health Serv Res 2019; 19:386. [PMID: 31200720 PMCID: PMC6570866 DOI: 10.1186/s12913-019-4208-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 05/31/2019] [Indexed: 11/12/2022] Open
Abstract
Background Failure to keep medical appointments results in inefficiencies and, potentially, in poor outcomes for patients. The aim of this study is to describe non-attendance rate and to investigate predictors of non-attendance among patients receiving hospital outpatient treatment for chronic diseases. Methods We conducted a historic, register-based cohort study using data from a regional hospital and included patients aged 18 years or over who were registered in ongoing outpatient treatment courses for seven selected chronic diseases on July 1, 2013. A total of 5895 patients were included and information about their appointments was extracted from the period between July 1, 2013 and June 30, 2015. The outcome measure was occurrence of non-attendance. The associations between non-attendance and covariates (age, gender, marital status, education level, occupational status, specific chronic disease and number of outpatient treatment courses) were investigated using multivariate logistic regression models, including mixed effect. Results During the two-year period, 35% of all patients (2057 of 5895 patients) had one or more occurrences of non-attendance and 5% of all appointments (4393 of 82,989 appointments) resulted in non-attendance. Significant predictors for non-attendance were younger age (OR 4.17 for 18 ≤ 29 years as opposed to 80+ years), male gender (OR 1.35), unmarried status (OR 1.39), low educational level (OR 1.18) and receipt of long-term welfare payments (OR 1.48). Neither specific diseases nor number of treatment courses were associated with a higher non-attendance rate. Conclusions Patients undergoing hospital outpatient treatments for chronic diseases had a non-attendance rate of 5%. We found several predictors for non-attendance but undergoing treatment for several chronic diseases simultaneously was not a predictor. To reduce non-attendance, initiatives could target the groups at risk. Trial registration This study was approved by the Danish Data Protection Agency (Project ID 18/35695). Electronic supplementary material The online version of this article (10.1186/s12913-019-4208-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Donna Lykke Wolff
- Hospital of Southern Denmark, DK-6200, Aabenraa, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19, DK-5000, Odense C, Denmark.
| | - Frans Boch Waldorff
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christian von Plessen
- Direction Général de la Santé and Unisanté, Lausanne, Switzerland.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Backer Mogensen
- Hospital of Southern Denmark, DK-6200, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19, DK-5000, Odense C, Denmark
| | | | - Kim Christian Houlind
- Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19, DK-5000, Odense C, Denmark.,Department of Vascular Surgery, Kolding Hospital, Part of Hospital Lillebaelt, Kolding, Denmark
| | - Søren Bie Bogh
- OPEN-Open Patient data Explorative Network- Department of Clinical Research and Odense University Hospital, Region of Southern Denmark, Odense, Denmark
| | - Katrine Hass Rubin
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN-Open Patient data Explorative Network- Department of Clinical Research and Odense University Hospital, Region of Southern Denmark, Odense, Denmark
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8
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Beverly EA, Guseman EH, Jensen LL, Fredricks TR. Reducing the Stigma of Diabetes in Medical Education: A Contact-Based Educational Approach. Clin Diabetes 2019; 37:108-115. [PMID: 31057216 PMCID: PMC6468822 DOI: 10.2337/cd18-0020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IN BRIEF In this feasibility study, we evaluated the impact of a contact-based education patient panel in an Endocrine and Metabolism course on second-year medical students' diabetes attitudes and diabetes stigma. Prior to the patient panel, some medical students harbored stigma toward people with diabetes, thus confirming patients' reports in the literature of diabetes stigma on the part of health care professionals. Importantly, the one-time contact-based educational approach improved students' diabetes attitudes and reduced diabetes stigma.
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Affiliation(s)
- Elizabeth A. Beverly
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- The Diabetes Institute, Ohio University, Athens, OH
| | - Emily H. Guseman
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- The Diabetes Institute, Ohio University, Athens, OH
| | - Laura L. Jensen
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- The Diabetes Institute, Ohio University, Athens, OH
| | - Todd R. Fredricks
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
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9
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Barry V, Steffens C, Mattis S, Sidonio RF, Tran DQ, Kempton CL. A cross-sectional study of non-attendance among patients at a US hemophilia treatment center 2010-2014. Haemophilia 2018; 24:902-910. [DOI: 10.1111/hae.13553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 12/30/2022]
Affiliation(s)
- V. Barry
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
| | - C. Steffens
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
| | - S. Mattis
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
| | - R. F. Sidonio
- Division of Hematology/Oncology; Department of Pediatrics; Aflac Blood and Cancer Disorders; Emory University School of Medicine; Atlanta GA USA
| | - D. Q. Tran
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
| | - C. L. Kempton
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
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Dantas LF, Fleck JL, Cyrino Oliveira FL, Hamacher S. No-shows in appointment scheduling - a systematic literature review. Health Policy 2018; 122:412-421. [PMID: 29482948 DOI: 10.1016/j.healthpol.2018.02.002] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 12/20/2017] [Accepted: 02/07/2018] [Indexed: 12/29/2022]
Abstract
No-show appointments significantly impact the functioning of healthcare institutions, and much research has been performed to uncover and analyze the factors that influence no-show behavior. In spite of the growing body of literature on this issue, no synthesis of the state-of-the-art is presently available and no systematic literature review (SLR) exists that encompasses all medical specialties. This paper provides a SLR of no-shows in appointment scheduling in which the characteristics of existing studies are analyzed, results regarding which factors have a higher impact on missed appointment rates are synthetized, and comparisons with previous findings are performed. A total of 727 articles and review papers were retrieved from the Scopus database (which includes MEDLINE), 105 of which were selected for identification and analysis. The results indicate that the average no-show rate is of the order of 23%, being highest in the African continent (43.0%) and lowest in Oceania (13.2%). Our analysis also identified patient characteristics that were more frequently associated with no-show behavior: adults of younger age; lower socioeconomic status; place of residence is distant from the clinic; no private insurance. Furthermore, the most commonly reported significant determinants of no-show were high lead time and prior no-show history.
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Affiliation(s)
- Leila F Dantas
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil.
| | - Julia L Fleck
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil.
| | - Fernando L Cyrino Oliveira
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil.
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil.
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11
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Beverly EA, Ritholz MD, Wray LA, Chiu CJ, Suhl E. Understanding the Meaning of Food in People With Type 2 Diabetes Living in Northern Appalachia. Diabetes Spectr 2018; 31:14-24. [PMID: 29456422 PMCID: PMC5813303 DOI: 10.2337/ds16-0059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Food and eating convey memories and feelings and serve important functions in creating and maintaining relationships. Given the increasing rate of diabetes in the United States, research understanding the meaning of food may shed light on how patients negotiate everyday food choices while managing type 2 diabetes. The purpose of this qualitative study was to explore the meaning of food among adults with type 2 diabetes living in Northern Appalachia. METHODS In-depth, face-to-face interviews were conducted with type 2 diabetes patients. Interviews were coded and analyzed via thematic analysis. RESULTS Nineteen adults with type 2 diabetes (mean age 68.7 ± 10.6 years, mean A1C 7.4 ± 1.4%, mean diabetes duration 10.9 ± 11.9 years, 52.6% female, 100% white) participated in the study. Qualitative analysis revealed three themes: 1) "Sustaining Life:" Food and the Demands of Diabetes Management, in which participants described the role of food as operational and said that eating was dictated by time rather than hunger or pleasure; 2) "Diabetes Feels Like a Yield Sign:" Diabetes Changes Perceptions of Food, Enjoyment, and Social Relationships, in which most participants described a negative or ambivalent relationship with food after their diabetes diagnosis; and 3) "Food is Everywhere; It's Seducing:" Struggling With Diabetes Management in a Fast-Food Culture, in which participants discussed how the American fast-food culture was in direct conflict with the demands of diabetes and described how they struggled to follow a healthful diet in a culture that advertised the opposite in many venues. CONCLUSION Adults with diabetes may benefit from education that addresses both the personal and sociocultural factors that guide food choices.
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Affiliation(s)
| | | | | | - Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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12
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Fisher E, Lazar L, Shalitin S, Yackobovitch-Gavan M, de Vries L, Oron T, Tenenbaum A, Phillip M, Lebenthal Y. Association between Glycemic Control and Clinic Attendance in Emerging Adults with Type 1 Diabetes: A Tertiary Center Experience. J Diabetes Res 2018; 2018:9572817. [PMID: 30116747 PMCID: PMC6079433 DOI: 10.1155/2018/9572817] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/21/2018] [Accepted: 06/19/2018] [Indexed: 11/17/2022] Open
Abstract
AIMS The transition of emerging adults with type 1 diabetes (T1D) from pediatric diabetes clinics to adult clinics between 18 and 21 years of age could result in decreased clinic attendance and thus worsen glycemic control. Our institutional policy offering surveillance till age 30 enabled us to evaluate clinic attendance without the confounding effect of transition. Our aim was to determine the association between glycemic control (HbA1c) and attendance rate. METHODS The medical records of 261 (54% males) young adult T1D patients (median age 22.9 years) were reviewed. Patients were stratified according to the attainment/nonattainment of glycemic targets (HbA1c ≤ 7% versus HbA1c > 7% (53 mmol/mol)). The attendance rate was calculated as the number of clinic visits/number of scheduled appointments. RESULTS Median annual number of scheduled visits was 3 (3, 4); attendance rate was 75% (53.6%, 100%). Seventy-four (28.4%) patients attained glycemic targets (median HbA1c 6.5% (48 mmol/mol) (6.3%, 6.8% (45.51 mmol/mol)); 187 (71.6%) patients had a median HbA1c of 7.8% (62 mmol/mol) (7.4%, 8.4% (57.68 mmol/mol)). The attainment of the treatment target was more prevalent in older patients (P = 0.006), in male patients (P = 0.007), and in patients with higher education (P = 0.017). Higher attendance rate (β (2.483), P < 0.001) and male gender (β (0.746), P = 0.015) were associated with better metabolic control. CONCLUSIONS In emerging adults with T1D during the ongoing stable phase of diabetes management, higher attendance rate, rather than absolute number of clinic visits, was associated with the attainment of glycemic targets.
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Affiliation(s)
- Eldad Fisher
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Liora Lazar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Shlomit Shalitin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Michal Yackobovitch-Gavan
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Liat de Vries
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Tal Oron
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Ariel Tenenbaum
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Moshe Phillip
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Yael Lebenthal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
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13
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Abstract
OBJECTIVE The objective of this study is to describe rates of clinic attendance of youth with sickle cell disease prescribed hydroxyurea and examine potential demographic and medical factors related to consistent clinic attendance. METHODS Participants included 148 youth diagnosed with sickle cell disease and prescribed hydroxyurea during a single calendar year. Clinic attendance and potential demographic and medical factors related to attendance were extracted via systematic retrospective medical chart review. RESULTS Youth attended 90.3% of scheduled appointments and 85.1% of youth attended at least 80% of scheduled clinic appointments during the study window. Adjusting for other factors, multivariate analysis revealed families with fewer children in the household, families with private insurance, youth experiencing fever, and youth not experiencing pain during the calendar year were more likely to consistently attend clinic visits. CONCLUSIONS Adherence to clinic appointments is critical to optimizing health outcomes for youth with sickle cell disease and integral for adequate monitoring of youth prescribed hydroxyurea, in particular. Findings may aid providers in appropriately identifying possible barriers to clinic attendance to develop attendance promotion interventions.
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Mamtora S, Sandinha T, Carey PE, Steel DHW. Optimizing Medical Management in Patients with Sight-Threatening Diabetic Retinopathy. Ophthalmol Ther 2016; 6:105-114. [PMID: 27858333 PMCID: PMC5449289 DOI: 10.1007/s40123-016-0069-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Diabetic retinopathy is a leading cause of blindness in adults of working age. Patients with sight-threatening diabetic retinopathy (STDR) often have poor control of modifiable risk factors, including blood pressure and blood glucose. Patients in our eye department with STDR whose diabetes was managed only by their general practitioner (GP) were referred to a diabetes specialist. We have reviewed these referrals and assessed the control of modifiable risk factors in these patients at the time of referral. METHODS A retrospective study was performed which identified 54 patients with STDR who had been referred from our eye department to a diabetes specialist between May 2013 and August 2014. Patient demographics, grades of retinopathy, glycated hemoglobin (HbA1c) levels, blood pressure, and lipid profiles were noted from the initial clinic visit and the first clinic appointment after 12 months. Initial management and any subsequent changes to management were recorded. RESULTS Of the 54 patients initially referred to the dedicated diabetic retinopathy clinic, data from 32 patients were available for analysis; 22 patients failed to attend the clinic. The majority of patients who presented to the clinic were found to have inadequate control of modifiable risk factors. At the initial clinic visit, nine of the 32 (28%) patients had a blood pressure that was less than the target of 130/80 mmHg and only two (6%) had a HbA1c level of less than the target of 48 mmol/L for type 2 diabetes and 58 mmol/L for type 1 diabetes, respectively. Changes were made to the management in 24 (75%) of the patients. Blood pressure management was changed in 18 (56%) patients. Overall, changes were made to blood pressure management and lipid and glycemic medication, including insulin. CONCLUSION The majority of patients with STDR were receiving suboptimal medical management. Collaboration between GPs, diabetes specialists, and ophthalmologists can lead to optimized medical management. All eye departments should develop protocols specifying when patients with diabetic retinopathy should be referred for to a diabetes specialist for input.
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Affiliation(s)
- Sunil Mamtora
- Sunderland Eye Infirmary, Queen Alexandra Rd, Sunderland, SR2 9HP, UK.
| | - Teresa Sandinha
- Sunderland Eye Infirmary, Queen Alexandra Rd, Sunderland, SR2 9HP, UK
| | - Peter E Carey
- Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK
| | - David H W Steel
- Institute of Genetic medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
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Hynes L, Byrne M, Dinneen SF, McGuire BE, O'Donnell M, Mc Sharry J. Barriers and facilitators associated with attendance at hospital diabetes clinics among young adults (15-30 years) with type 1 diabetes mellitus: a systematic review. Pediatr Diabetes 2016; 17:509-518. [PMID: 25080975 DOI: 10.1111/pedi.12198] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/04/2014] [Accepted: 07/01/2014] [Indexed: 12/31/2022] Open
Abstract
Regular clinic attendance is recommended to facilitate self-management of diabetes. Poor attendance is common among young adults with type 1 diabetes mellitus (DM). This systematic review aimed to produce a narrative synthesis of the evidence regarding factors which promote or impede regular attendance at adult diabetes clinics among young adults (15-30 years) with type 1 DM. Studies reporting facilitators and barriers to clinic attendance were identified by searching four electronic databases, checking reference lists, and contacting diabetes research networks. A total of 12 studies (8 quantitative and 4 qualitative) met the inclusion criteria. Young adult's experiences transitioning from paediatric to adult diabetes care can influence attendance at the adult clinic positively if there is a comprehensive transition programme in place, or negatively if the two clinics do not communicate and provide adequate support. Post-transition, relationship development and perceptions of the value of attending the clinic are important for regular attendance. Controlled research is required to better understand decisions to attend or not attend outpatient services among people with chronic conditions. Service delivery must be sensitive to the developmental characteristics of young adults and tailored support may be required by young adults at greatest risk of non-attendance.
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Affiliation(s)
- Lisa Hynes
- School of Psychology, Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland.
| | - Molly Byrne
- School of Psychology, Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland
| | - Sean F Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Brian E McGuire
- School of Psychology and Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland
| | - Máire O'Donnell
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Jennifer Mc Sharry
- School of Psychology, Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland
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16
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Winkley K, Stahl D, Chamley M, Stopford R, Boughdady M, Thomas S, Amiel SA, Forbes A, Ismail K. Low attendance at structured education for people with newly diagnosed type 2 diabetes: General practice characteristics and individual patient factors predict uptake. PATIENT EDUCATION AND COUNSELING 2016; 99:101-7. [PMID: 26319362 DOI: 10.1016/j.pec.2015.08.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The aims were to determine the association between individual and neighbourhood factors and attendance at structured education amongst people with newly diagnosed type 2 diabetes (T2DM). METHODS Multi-level analysis of questionnaire data from a prospective cohort of adults newly diagnosed T2DM. Setting was primary care, London, UK. Main outcome was attendance at structured education within 2 years. RESULTS Of 1790 people recruited, attendance data were available for 1626 (91%). Only 22.4% (n=365/1626) attended education. Attendance was independently associated with female gender (OR 1.28, 95% CI 1.05-1.46), lower HbA1c (OR 0.98 mmol/mol 95% CI 0.97-0.99) and non-smoker status (OR 1.36, 95% CI 1.07-1.55). General practice covariates, achievement of primary care targets for glycaemic control (OR 1.05, 95% C.I. 1.01-1.08) and recording of retinal screening (OR 0.96, 95% C.I. 0.93-0.99) were independently associated with attendance but unexplained general practice clustering accounted for 17% of the variance. CONCLUSION Education uptake is low amongst people with new onset T2DM. Attenders are more likely to be female, non-smokers with better HbA1c. General practices achieving glycaemic targets are more likely to have patients who attend education. PRACTICE IMPLICATIONS Strategies are needed to improve attendance at structured diabetes education particularly amongst hard to reach groups.
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Affiliation(s)
- Kirsty Winkley
- Dept of Psychological Medicine, King's College London & Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Daniel Stahl
- Dept of Biostatistics, King's College London & Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Mark Chamley
- Lambeth Diabetes Clinical Lead, Crown Dale Medical Centre, Lambeth, London, UK
| | - Rosanna Stopford
- Dept of Psychological Medicine, King's College London & Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Monica Boughdady
- Dept of Diabetes & Nutrition, King's College London & School of Medicine, London, UK
| | - Stephen Thomas
- Dept of Diabetes & Endocrinology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Stephanie A Amiel
- Dept of Diabetes & Nutrition, King's College London & School of Medicine, London, UK
| | - Angus Forbes
- Dept of Primary and Intermediate Care, King's College London & Nightingale School of Nursing & Midwifery, London, UK
| | - Khalida Ismail
- Dept of Psychological Medicine, King's College London & Institute of Psychiatry, Psychology & Neuroscience, London, UK
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17
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Williams EM, Bruner L, Penfield M, Kamen D, Oates JC. Stress and Depression in Relation to Functional Health Behaviors in African American Patients with Systemic Lupus Erythematosus. RHEUMATOLOGY (SUNNYVALE, CALIF.) 2014; 2014:005. [PMID: 26618072 PMCID: PMC4662575 DOI: 10.4172/2161-1149.s4-005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE While increased psychological distress in SLE has been clinically and empirically reported, the relationship between emotional distress, treatment adherence, and disease activity are complex and even more unclear in African American lupus patients. In an effort to elucidate this phenomenon in these patients, this exploratory study aimed to investigate relationships between stress, depression, and various health behaviors in this group. METHODS Thirty patients invited to participate in this study were African American systemic lupus erythematosus (SLE) patients attending rheumatology clinics at the Medical University of South Carolina (MUSC). This study was part of a larger interventional pilot study, the Balancing Lupus Experiences with Stress Strategies (BLESS) study, that included a comprehensive battery of psychosocial, quality of life, and behavior change measures. RESULTS When looking at the association between anxiety/stress and functionality, levels of reported stress had strong effects upon functionality, especially between health distress and functionality. When looking at the association between depressive symptoms and functionality, depressive symptoms had moderate effects upon social/role limitations and nights spent in the hospital. CONCLUSION Not only did the larger pilot project demonstrate significant reductions in stress and depression as a result of workshop participation; this nested study also showed that those improvements were positively associated with improved health behaviors. These results could have implications for developing interventions to improve disease experience and quality of life in SLE patients with stress and depression.
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Affiliation(s)
- Edith M. Williams
- Institute for Partnerships to Eliminate Health Disparities, University of South Carolina; Columbia, SC, USA
| | - Larisa Bruner
- Office of Public Health Practice, University of South Carolina; Columbia, SC, USA
| | - Megan Penfield
- Institutional Assessment and Compliance, University of South Carolina; Columbia, SC, USA
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina; Charleston, SC, USA
| | - James C. Oates
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina; Charleston, SC, USA
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Casey R, O'Hara MC, Cunningham A, Wall D, Geoghegan R, Hynes L, McGuire B, Gately M, Bell M, Dinneen SF. Young adult type 1 diabetes care in the West of Ireland: an audit of hospital practice. QJM 2014; 107:903-8. [PMID: 24925824 DOI: 10.1093/qjmed/hcu103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is well recognised that management of young adults with type 1 diabetes (T1DM) poses difficult challenges for physicians and health care organisations as a whole. In Ireland and in particular the west of Ireland there has been little audit or research on young adults with T1DM and the services available to them. DESIGN In 2011 a retrospective review of this patient population in our territory referral centre was carried out. RESULTS The average glycaemic control in this population was poor at 81mmols/mol and diabetes related complications were present in 32%. Engagement by this population with services was poor with an average of 3 missed clinic appointments over a 24 month period. CONCLUSION These results have prompted a re think of how health care professionals can deliver a service that better suits the needs of this challenging patient group.
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Affiliation(s)
- R Casey
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - M C O'Hara
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - A Cunningham
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - D Wall
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - R Geoghegan
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - L Hynes
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - B McGuire
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - M Gately
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - M Bell
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - S F Dinneen
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
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Bottle A, Gaudoin R, Goudie R, Jones S, Aylin P. Can valid and practical risk-prediction or casemix adjustment models, including adjustment for comorbidity, be generated from English hospital administrative data (Hospital Episode Statistics)? A national observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02400] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BackgroundNHS hospitals collect a wealth of administrative data covering accident and emergency (A&E) department attendances, inpatient and day case activity, and outpatient appointments. Such data are increasingly being used to compare units and services, but adjusting for risk is difficult.ObjectivesTo derive robust risk-adjustment models for various patient groups, including those admitted for heart failure (HF), acute myocardial infarction, colorectal and orthopaedic surgery, and outcomes adjusting for available patient factors such as comorbidity, using England’s Hospital Episode Statistics (HES) data. To assess if more sophisticated statistical methods based on machine learning such as artificial neural networks (ANNs) outperform traditional logistic regression (LR) for risk prediction. To update and assess for the NHS the Charlson index for comorbidity. To assess the usefulness of outpatient data for these models.Main outcome measuresMortality, readmission, return to theatre, outpatient non-attendance. For HF patients we considered various readmission measures such as diagnosis-specific and total within a year.MethodsWe systematically reviewed studies comparing two or more comorbidity indices. Logistic regression, ANNs, support vector machines and random forests were compared for mortality and readmission. Models were assessed using discrimination and calibration statistics. Competing risks proportional hazards regression and various count models were used for future admissions and bed-days.ResultsOur systematic review and empirical analysis suggested that for general purposes comorbidity is currently best described by the set of 30 Elixhauser comorbidities plus dementia. Model discrimination was often high for mortality and poor, or at best moderate, for other outcomes, for examplec = 0.62 for readmission andc = 0.73 for death following stroke. Calibration was often good for procedure groups but poorer for diagnosis groups, with overprediction of low risk a common cause. The machine learning methods we investigated offered little beyond LR for their greater complexity and implementation difficulties. For HF, some patient-level predictors differed by primary diagnosis of readmission but not by length of follow-up. Prior non-attendance at outpatient appointments was a useful, strong predictor of readmission. Hospital-level readmission rates for HF did not correlate with readmission rates for non-HF; hospital performance on national audit process measures largely correlated only with HF readmission rates.ConclusionsMany practical risk-prediction or casemix adjustment models can be generated from HES data using LR, though an extra step is often required for accurate calibration. Including outpatient data in readmission models is useful. The three machine learning methods we assessed added little with these data. Readmission rates for HF patients should be divided by diagnosis on readmission when used for quality improvement.Future workAs HES data continue to develop and improve in scope and accuracy, they can be used more, for instance A&E records. The return to theatre metric appears promising and could be extended to other index procedures and specialties. While our data did not warrant the testing of a larger number of machine learning methods, databases augmented with physiological and pathology information, for example, might benefit from methods such as boosted trees. Finally, one could apply the HF readmissions analysis to other chronic conditions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alex Bottle
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Rene Gaudoin
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Rosalind Goudie
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Simon Jones
- Department of Health Care Management and Policy, University of Surrey, Surrey, UK
| | - Paul Aylin
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
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James S, Gallagher R, Dunbabin J, Perry L. Prevalence of vascular complications and factors predictive of their development in young adults with type 1 diabetes: systematic literature review. BMC Res Notes 2014; 7:593. [PMID: 25182937 PMCID: PMC4167503 DOI: 10.1186/1756-0500-7-593] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 08/04/2014] [Indexed: 11/30/2022] Open
Abstract
Background Vascular complications curtail life expectancy and quality of life in type 1 diabetes and development at younger ages is particularly detrimental. To date no review has summarised the prevalence or factors predicting their development in young adults. Methods A quantitative epidemiological systematic review was conducted to identify the prevalence and predictive factors for development of retinopathy, nephropathy and hypertension in young adults (sample age mean [plus 1SD] 18–30 years) with type 1 diabetes, using processes adapted from established review methods set out by the Centre for Reviews and Dissemination. MEDLINE (Ovid), Scopus (Elsevier), CINAHL, Science Direct (Elsevier), Google Scholar and Cochrane databases were searched to identify relevant articles published between 1993 and June 2014. From this eleven papers were retrieved, appraised and results summarised by three reviewers using established methods. Results Some form of retinopathy occurred in up to almost half of participants; more severe forms affected up to one in ten. One in six was reported with microalbuminuria; one in 14 had macroalbuminuria. Hypertension occurred in almost one in two participants. Applying out-dated high thresholds this decreased to approximately one in ten participants. Glycaemic control was a consistent predictor of vascular disease in this age group. Conclusion Prevalence rates of retinopathy, nephropathy and hypertension in young adults with type 1 diabetes emphasise the importance of regular complication screening for early detection and treatment. The predictive effect of glycaemic control reinforces its importance for prevention of vascular complications. Electronic supplementary material The online version of this article (doi:10.1186/1756-0500-7-593) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven James
- Huntsville District Memorial Hospital, Muskoka Algonquin Healthcare, 100 Frank Miller Drive, Huntsville, Ontario P1H 1H7, Canada.
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James S, Perry L, Gallagher R, Lowe J, Dunbabin J, McElduff P, Acharya S, Steinbeck K. Service usage and vascular complications in young adults with type 1 diabetes. BMC Endocr Disord 2014; 14:39. [PMID: 24884679 PMCID: PMC4017963 DOI: 10.1186/1472-6823-14-39] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 05/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have examined young adults with type 1 diabetes use of health services and the development of vascular complications. As part of the Youth Outreach for Diabetes (YOuR-Diabetes) project, this study identified health service usage, the prevalence and factors predictive of development of vascular complications (hypertension, retinopathy and nephropathy) in a cohort of young adults (aged 16-30 years) with type 1 diabetes in Hunter New England and the Lower Mid-North Coast area of New South Wales, Australia. METHODS A cross-sectional retrospective documentation survey was undertaken of case notes of young adults with type 1 diabetes accessing Hunter New England Local Health District public health services in 2010 and 2011, identified through ambulatory care clinic records, hospital attendances and other clinical records. Details of service usage, complications screening and evidence of vascular complications were extracted. Independent predictors were modelled using linear and logistic regression analyses. RESULTS A cohort of 707 patients were reviewed; mean (SD) age was 23.0 (3.7) years, with mean diabetes duration of 10.2 (5.8, range 0.2 - 28.3) years; 42.4% lived/ 23.1% accessed services in non-metropolitan areas.Routine preventative service usage was low and unplanned contacts high; both deteriorated with increasing age. Low levels of complications screening were found. Where documented, hypertension, particularly, was common, affecting 48.4% across the study period. Diabetes duration was a strong predictor of vascular complications along with glycaemic control; hypertension was linked with renal dysfunction. CONCLUSION Findings indicate a need to better understand young people's drivers and achievements when accessing services, and how services can be reconfigured or delivered differently to better meet their needs and achieve better outcomes. Regular screening is required using current best practice guidelines as this affords the greatest chance for early complication detection, treatment initiation and secondary prevention.
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Affiliation(s)
- Steven James
- Huntsville District Memorial Hospital, 100 Frank Miller Drive, Huntsville, Ontario P1H 1H7, Canada
| | - Lin Perry
- University of Technology, Sydney, 15 Broadway, Ultimo, New South Wales 2007, Australia
| | - Robyn Gallagher
- University of Technology, Sydney, 15 Broadway, Ultimo, New South Wales 2007, Australia
| | - Julia Lowe
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Janet Dunbabin
- University of Newcastle, University Drive, Callaghan, Newcastle, New South Wales 2308, Australia
| | - Patrick McElduff
- University of Newcastle, University Drive, Callaghan, Newcastle, New South Wales 2308, Australia
| | - Shamasunder Acharya
- Hunter New England Local Health District, New Lambton Heights, New South Wales 2305, Australia
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Abstract
PURPOSE A systematic review of the literature was conducted to identify the level of evidence and to describe the evidence on the transition from pediatric to adult healthcare services among youth with diabetes. BACKGROUND The transition from pediatric to adult healthcare services is an expectation of youth with diabetes; however, little is known to guide policy and procedures on such transitions. DESCRIPTION OF PROJECT The literature was first searched and screened according to predetermined criterion and then evaluated for level of evidence. OUTCOME There were 16 mixed qualitative and/or quantitative studies, 23 quantitative studies, and 2 expert opinion articles reviewed. Most of the evidence was from uncontrolled studies. Youth report challenges in making the transition in services. Delay in seeking adult services and poor clinic attendance are issues for these youth. However, it is unclear if these problems are a result of the transition in services. Several promising transition programs have been evaluated and, overall, are found acceptable and useful by youth. In general, evidence suggests that these programs improve glycemic control. CONCLUSIONS More research is needed in this challenging area to guide policies and procedures. IMPLICATIONS Expert opinion is a guide for policy and procedures at this point in time.
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Affiliation(s)
- Kathleen M Hanna
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA.
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Beverly EA, Fitzgerald SM, Brooks KM, Hultgren BA, Ganda OP, Munshi M, Weinger K. Impact of reinforcement of diabetes self-care on poorly controlled diabetes: a randomized controlled trial. DIABETES EDUCATOR 2013; 39:504-14. [PMID: 23640303 DOI: 10.1177/0145721713486837] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of the study was to assess the value of reinforcing diabetes self-management for improving glycemia and self-care among adults with type 2 diabetes who had at least 3 hours of prior diabetes education. METHODS In this randomized controlled trial, 134 participants (75% white, 51% female, 59 ± 9 years old, 13 ± 8 years with diabetes, A1C = 8.4% ± 1.2%) were randomized to either a group map-based program (intervention) or group education on cholesterol and blood pressure (control). Participants were assessed for A1C levels, diabetes self-care behaviors (3-day pedometer readings, 6-minute walk test, blood glucose checks, frequency of self-care), and psychosocial factors (distress, frustration, quality of life) at baseline, 3, 6, and 12 months post intervention and health literacy at baseline. RESULTS Groups did not differ on baseline characteristics including A1C levels, health literacy, or self-care; however, the intervention group had more years of education than controls. Intervention arm participants modestly improved A1C levels at 3 months post intervention but did not maintain that improvement at 6 and 12 months while control patients did not improve A1C levels at any time during follow-up. Importantly, frequency of self-reported self-care, diabetes quality of life, diabetes-related distress, and frustration with diabetes self-care improved in both groups over time. CONCLUSIONS Reinforcing self-care with diabetes education for patients who have not met glycemic targets helps improve A1C and could be considered a necessary component of ongoing diabetes care. The best method to accomplish reinforcement needs to be established.
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Affiliation(s)
- Elizabeth A Beverly
- Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts (Dr Beverly, Mr Fitzgerald, Ms Brooks, Ms Hultgren, Dr Ganda, Dr Munshi, Dr Weinger),Harvard Medical School, Boston, Massachusetts (Dr Beverly, Dr Ganda, Dr Munshi, Dr Weinger)
| | - Shane M Fitzgerald
- Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts (Dr Beverly, Mr Fitzgerald, Ms Brooks, Ms Hultgren, Dr Ganda, Dr Munshi, Dr Weinger)
| | - Kelly M Brooks
- Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts (Dr Beverly, Mr Fitzgerald, Ms Brooks, Ms Hultgren, Dr Ganda, Dr Munshi, Dr Weinger)
| | - Brittney A Hultgren
- Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts (Dr Beverly, Mr Fitzgerald, Ms Brooks, Ms Hultgren, Dr Ganda, Dr Munshi, Dr Weinger)
| | - Om P Ganda
- Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts (Dr Beverly, Mr Fitzgerald, Ms Brooks, Ms Hultgren, Dr Ganda, Dr Munshi, Dr Weinger)
| | - Medha Munshi
- Harvard Medical School, Boston, Massachusetts (Dr Beverly, Dr Ganda, Dr Munshi, Dr Weinger)
| | - Katie Weinger
- Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts (Dr Beverly, Mr Fitzgerald, Ms Brooks, Ms Hultgren, Dr Ganda, Dr Munshi, Dr Weinger),Harvard Medical School, Boston, Massachusetts (Dr Beverly, Dr Ganda, Dr Munshi, Dr Weinger)
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Currie CJ, Peyrot M, Morgan CL, Poole CD, Jenkins-Jones S, Rubin RR, Burton CM, Evans M. The impact of treatment non-compliance on mortality in people with type 1 diabetes. J Diabetes Complications 2013; 27:219-23. [PMID: 23157988 DOI: 10.1016/j.jdiacomp.2012.10.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/05/2012] [Accepted: 10/06/2012] [Indexed: 12/31/2022]
Abstract
AIMS To determine if a diagnostic record of poor treatment compliance (medication non-compliance and/or non-attendance at medical appointments) was associated with all-cause mortality in people with type 1 diabetes. METHODS This is an observational cohort study of data extracted from The Health Improvement Network (THIN) database, comprising data on patients served by over 350 primary care practices in the U.K. Participants were included in the study if they had diagnostic codes indicative of type 1 diabetes. Treatment non-compliance was defined as missing one or more scheduled appointment, or one or more codes indicating medication non-compliance. RESULTS Of 2946 patients with type 1 diabetes, 867 (29.4%) had a record of either appointment non-attendance or medication non-compliance in the 30 month compliance assessment period. The crude, unadjusted mortality rate for those patients who were treatment non-compliant was 1.462 (95% CI 0.954-2.205). Following adjustment for confounding factors, treatment non-compliance was associated with increased all-cause mortality (HR=1.642; 95% CI 1.055-2.554). CONCLUSIONS Treatment non-compliance was associated with increased all-cause mortality in patients with type 1 diabetes. Understanding and addressing factors that contribute to patient treatment non-compliance will be important in improving the life expectancy of patients with type 1 diabetes.
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Affiliation(s)
- Craig J Currie
- Department of Medicine, School of Medicine, Cardiff University, Cardiff, UK.
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Akhter K, Dockray S, Simmons D. Exploring factors influencing non-attendance at the diabetes clinic and service improvement strategies from patients' perspectives. PRACTICAL DIABETES 2012. [DOI: 10.1002/pdi.1670] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
AIMS To study the reasons for attendance behaviour from the patient viewpoint at a young adult diabetes outpatient clinic. METHODS Attendance rates for 231 clinic appointments over 19 months for 102 patients were calculated. Semi-structured interviews were conducted with a purposive sample of 17 of the 102. The interviews encouraged participants to describe routines, thoughts and feelings around clinic appointments. Observations were made of the clinic system. Themes arising from patients' emotional and practical issues around attendance were generated from the data. RESULTS 'Did not attend' rates for the clinic over the study period were 15.7%. However, bureaucratic problems created many 'missed' appointments; most instances of 'did not attend' investigated were attributable to communication failures. Participants did not divide neatly into 'attenders'/'non-attenders'; many had complex mixed attendance records. Most weighed the value of attendance against immediate obstacles such as incompatible work/clinic hours. Reminders were seen as important, particularly for this age group. Respondents identified fear of being judged for 'poor control' as a major factor in attendance decisions, suggesting that having a high HbA1c level may lead to non-attendance, rather than vice versa. CONCLUSIONS Health professionals' supportive, non-judgemental attitude is important to patients considering clinic attendance. In this study, improved communication, reminders and flexible hours might reduce 'did not attend' rates.
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Affiliation(s)
- R Snow
- NIHR King's Patient Safety and Service Quality Research Centre, King's College London, UK.
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Masding MG, Klejdys S, MacHugh B, Gale S, Brown A, McAulay A. Non-attendance at a diabetes transitional clinic and glycaemic control. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/pdi.1456] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Paterson BL, Charlton P, Richard S. Non-attendance in chronic disease clinics: a matter of non-compliance? ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1752-9824.2010.01048.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Spray J. Type 1 diabetes: identifying and evaluating patient injection technique. ACTA ACUST UNITED AC 2009; 18:1100-5. [DOI: 10.12968/bjon.2009.18.18.44550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bruno G, Cerutti F, Merletti F, Novelli G, Panero F, Zucco C, Cavallo-Perin P. Short-term mortality risk in children and young adults with type 1 diabetes: the population-based Registry of the Province of Turin, Italy. Nutr Metab Cardiovasc Dis 2009; 19:340-344. [PMID: 18674891 DOI: 10.1016/j.numecd.2008.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Revised: 03/17/2008] [Accepted: 03/31/2008] [Indexed: 10/21/2022]
Abstract
Short-term mortality risk in young diabetic people is an indicator of quality of care. We assessed this in the Italian incident population-based registry of Turin. The study base included 1210 incident cases (n=677 aged 0-14 years and n=533 aged 15-29 years) with diabetes, onset period 1974-2000 in the Province of Turin, Italy. The relevant timescale for analysis was the time since the onset of diabetes to death, or till 31 December 2003. Standardized mortality ratio (SMR) for all-cause mortality was computed using the Italian population as a standard, by 5 years, age group, sex, and calendar period. Mean attained age of the incident cohort was 29.7 years (range 5.2-49.7 years). During a mean follow-up period of 15.8 years (range 2.0-29.9 years), there were 19 deaths in 15,967. Nine person-years of observation (n=9.5 expected deaths), giving an all-cause mortality rate of 1.19/1000 person-years (95% CI 0.76-1.87) and an SMR of 1.96 (1.25-3.08). In no cases did death occur at the onset of diabetes or in childhood. Out of 19 deaths, 9 were diabetes related (n=6 coma and n=3 end-stage renal disease). In Cox regression analysis, the hazard ratio (HR) was higher in adult-onset than in childhood-onset diabetes (HR=3.90, 95% CI 1.14-13.39), independently of calendar period and gender. (1) Children and young adults with type 1 diabetes experienced a two-fold higher short-term mortality risk than Italian people of similar age and sex and (2) the risk was higher in adult-onset than in childhood-onset diabetes. The quality of diabetes care should be improved to prevent early deaths.
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Affiliation(s)
- G Bruno
- Department of Internal Medicine, University of Torino, Torino, Italy.
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Abstract
AIMS The importance of getting transition right for young people with diabetes is increasingly recognized and a strong professional consensus has emerged on best practice in this domain. Research evidence to inform the design of transitional healthcare services is weak, however, and prevailing views about 'the problem of transition' are based on a number of assumptions about adolescence, adulthood and chronic disease management which have been accepted uncritically. METHODS Drawing on youth studies and the sociology of chronic disease management, in this paper we describe how 'the problem of transition' has been defined in the professional and UK policy literature and examine the assumptions that underpin it. RESULTS We argue that the overwhelming emphasis is on how best to support young people in fitting in with the healthcare system. This has produced an orientation which is more concerned with supporting young people in the process of becoming adults rather than giving attention to their contemporaneous experiences and needs. Two years after the introduction of the UK National Service Framework for diabetes, the challenge of transitional services remains. CONCLUSIONS We suggest that the time has come to consider alternative formulations of the 'problem'. Rather than asking how best to manage transition, we might ask how best to meet the needs of young people with diabetes at this stage of the life course. This requires an understanding of their experiences, the social networks in which they are embedded and consideration of how self-management might be supported by the healthcare system.
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Affiliation(s)
- D Allen
- Nursing and Midwifery Studies, Cardiff University, Cardiff, UK.
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Saunders SA, Wallymhamed M, Macfarlane IA. Improvements in glycaemic control and cardiovascular risk factors in a cohort of patients with type 1 diabetes over a 5-year period. QJM 2009; 102:29-34. [PMID: 18829712 DOI: 10.1093/qjmed/hcn125] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Management of patients with type 1 diabetes in the UK has changed over the past 20 years. The targets for glycaemic control, blood pressure and cholesterol are lower. We examined a cohort of patients with type 1 diabetes who have been through these changes to assess their effects. DESIGN AND METHODS A cohort of patients with type 1 diabetes who attended a secondary care outpatient diabetes clinic between 1991 and 1996 were reviewed in 2001 and 2006. Comparison is made between current biophysical markers and those obtained in 2001. RESULTS Only 81.9% (n = 214) of the original cohort attended in 2006. These patients had an average duration of diabetes of 23.46 (SD +/- 8.06) years. There were 134 male patients (62.62%). In these patients HbA1c had reduced by 0.4% (absolute reduction); a relative reduction of 4.41% (P = 0.0001). Statistically significant reductions in diastolic blood pressure (74-68 mmHg) and total cholesterol (5.37-4.62 mmol/l) occurred. However, weight (75.04-82.31 kg) and BMI (25.32-27.72 kg/m(2)) significantly increased. There was no statistically significant change in insulin dose (units/kg), serum creatinine, urinary ACR or systolic blood pressure. CONCLUSION An urban setting, mobile population and patient non-attendance can complicate modern diabetes care. Despite these difficulties, input by the diabetes team working with the patients can achieve small improvements in Hba1c and cardiovascular risk factors by increased use of long acting insulins, metformin, statins and blood pressure medication.
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Affiliation(s)
- S A Saunders
- St. Helens and Knowsley NHS Trust, Whiston Hospital, Warrington Road, Prescot, Merseyside L355DR, UK.
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Thornton R, Ballard K. Why Military Personnel Fail to Keep Medical Appointments. J ROY ARMY MED CORPS 2008; 154:26-30. [DOI: 10.1136/jramc-154-01-08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Holloway SM, Bernhard B, Campbell H, Cetnarskyj R, Lam WWK. Inequality of use of cancer genetics services by members of breast, ovarian and colorectal cancer families in South East Scotland. Fam Cancer 2008; 7:259-64. [PMID: 18246448 DOI: 10.1007/s10689-008-9184-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 01/18/2008] [Indexed: 01/25/2023]
Abstract
Some studies have found a deficiency of male, younger and more socially deprived individuals amongst referrals to and/or attendees at cancer genetics clinics. We investigated this inequality of use of genetics services from data on 4,178 Scottish patients with a family history of breast and/or ovarian cancer (BOC) or colorectal cancer (CRC) referred from 2000--2006. Some 98% BOC and 60% CRC referrals were female. Median age of female referrals was greater in the CRC than the BOC group (45.3 vs. 38.7 years, P < 0.001). Both groups of referrals were less socially deprived than the general population (P < 0.001) and the CRC less deprived than the BOC group (P < 0.001). Some 88% patients attended the first appointment offered. Attendance was greater in the CRC group (P < 0.001) and in older patients (P < 0.001) and in the BOC group was highly significantly lower in more socially deprived patients (P < 0.001). Male relatives may feel counselling is less relevant and relatives of both sexes may delay counselling until approaching the age of onset of cancer in a relative. We suggest that medical professionals and the general public may have more knowledge about the genetics of BOC than of CRC. Thus relatives in CRC families seeking counselling are likely to be those with access to more information. The lower attendance amongst more deprived relatives in BOC families may result from poor understanding of the reason for referral. These findings confirm the need to provide male, younger and more socially deprived relatives with more helpful information on cancer genetics.
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Affiliation(s)
- Susan M Holloway
- Department of Clinical Genetics, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK.
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Lawson VL, Lyne PA, Bundy C, Harvey JN. The role of illness perceptions, coping and evaluation in care-seeking among people with type 1 diabetes. Psychol Health 2007. [DOI: 10.1080/14768320600774546] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Skrivarhaug T, Bangstad HJ, Stene LC, Sandvik L, Hanssen KF, Joner G. Low risk of overt nephropathy after 24 yr of childhood-onset type 1 diabetes mellitus (T1DM) in Norway. Pediatr Diabetes 2006; 7:239-46. [PMID: 17054444 DOI: 10.1111/j.1399-5448.2006.00204.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM To estimate the risk of diabetic nephropathy and associated risk factors in a nationwide cohort of childhood-onset type 1 diabetes mellitus (T1DM) and 19-30 yr of diabetes duration. METHODS Patients diagnosed with childhood-onset T1DM (<15 yr) from 1973 through 1982, who previously (1989-1990) participated in a clinical examination to assess diabetic complications, were invited for a new examination in 2002-2003. Of 355 eligible patients, 299 participated (84.2%), and complete urine samples for evaluation of albuminuria were obtained from 295 patients, with a mean age of 33 yr (range 20.9-44.0) and mean diabetes duration of 24 yr (range 19.3-29.9). Persistent microalbuminuria and overt nephropathy [albumin excretion rate (AER) 15-200 microg/min and AER > 200 microg/min, respectively] in at least two out of three consecutive overnight urine samples were defined as diabetic nephropathy. RESULTS Overt nephropathy was found in 7.8% [95% confidence interval (CI) 4.7-10.9] and persistent microalbuminuria in 14.9% (95% CI 10.8-19.0) of the subjects. Hemoglobin A1c (HbA1c) (p = 0.001), systolic blood pressure (BP) (p = 0.002), total cholesterol (p = 0.019), and C-reactive protein (CRP) (p = 0.019) were associated with diabetic nephropathy. Significant predictors in 1989-1990 for the development of diabetic nephropathy in 2002-2003 were HbA1c (p < 0.001), AER (p = 0.007), and cholesterol (p = 0.022). CONCLUSIONS In a subgroup of patients diagnosed with childhood-onset T1DM in 1973-1982, 7.8% had overt nephropathy after 19-30 yr of diabetes duration, which is low compared with studies from other countries. HbA1c, systolic BP, total cholesterol, and CRP were each independently associated with diabetic nephropathy.
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Lifetime and recent prostate specific antigen (PSA) screening of men for prostate cancer in Canada. Canadian Journal of Public Health 2006. [PMID: 16827400 DOI: 10.1007/bf03405578] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In spite of national guidelines which do not recommend prostate specific antigen (PSA) screening for prostate cancer or are inconclusive, Canadian men may be accessing the screening test. METHODS For the purpose of informing prostate screening policy, cross-sectional self-reported data from the Canadian Community Health Survey (2000-2001) were analyzed to determine the lifetime and recent PSA screening prevalence of Canadian men aged 50 and older with no prostate cancer, and to explore the socio-demographic characteristics associated with ever being screened. Multivariate binomial regression analyses were used to calculate prevalence rate ratios as a measure of association between respondents' characteristics and PSA screening behaviour. RESULTS Almost half of Canadian men over the age of 50 years (47.5%; 95% CI=46.4-48.5) reported receiving PSA screening during their lifetime. Seventy-two percent (71.8%) of PSA screening was performed within one year prior to the survey or recently. Lifetime prevalence was highest among men aged 60-69 (53.1%; 95% CI=51.1-55.1). Next to advanced age, having a family doctor was the most predictive of screening behaviour (PRR=1.83, p<0.01). Black ethnicity, a risk factor for prostate cancer, failed to be predictive of screening (PRR=1.04, NS). Not speaking French or English was strongly associated with not obtaining a PSA screen (PRR=0.66, p< or =0.01). INTERPRETATION Our finding that Canadian men commonly reported PSA screening for prostate cancer is not congruent with national guidelines. While we wait for randomized controlled trial evidence of the effectiveness of PSA screening in reducing mortality due to prostate cancer, PSA screening has emerged as a public health issue.
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Hearnshaw H, Lindenmeyer A. What do we mean by adherence to treatment and advice for living with diabetes? A review of the literature on definitions and measurements. Diabet Med 2006; 23:720-8. [PMID: 16842475 DOI: 10.1111/j.1464-5491.2005.01783.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS In order to measure the effectiveness of interventions claiming to improve adherence in diabetes, valid measurement of adherence is necessary. Any measurement must first be based on a definition. This study aimed to identify and categorize definitions and measurements of adherence in living with diabetes, from a review of the literature. METHODS Publications were identified from the medline database. Adherence, compliance and concordance were used as terms in the search algorithm, along with diabetes, diabetes mellitus and treatment. Two hundred and ninety-three papers were identified. Abstracts of these papers were read by two researchers independently. Two hundred and thirty-nine papers did not contain definitions or measures of adherence and were discarded. Of the remaining 54 papers, 26 included definitions and 46 described measurements of adherence. RESULTS Definitions and measurements fell into five categories: coincidence of behaviour with professional advice, relationship as part of the process of care, outcome and process targets, taking the medication as prescribed and others. No single definition of adherence emerged. Many authors did not provide definitions of adherence. Glycated haemoglobin was the most common measurement of adherence, although this can raise problems. CONCLUSIONS Research which claims to show an intervention has, or has not, improved adherence must be interpreted cautiously. Interventions which appear to fail may actually succeed in aspects of adherence which were not defined or measured in the study. Clinicians and researchers could use clear definitions and measurements, such as the ones presented in this review.
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Affiliation(s)
- H Hearnshaw
- Warwick Diabetes Care, Warwick Medical School, University of Warwick, Warwick, UK.
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Weinger K, McMurrich SJ, Yi JP, Lin S, Rodriguez M. Psychological characteristics of frequent short-notice cancellers of diabetes medical and education appointments. Diabetes Care 2005; 28:1791-3. [PMID: 15983337 PMCID: PMC1584304 DOI: 10.2337/diacare.28.7.1791] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Katie Weinger
- Section on Behavioral and Mental Health Research, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215, USA.
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40
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Rhee MK, Slocum W, Ziemer DC, Culler SD, Cook CB, El-Kebbi IM, Gallina DL, Barnes C, Phillips LS. Patient adherence improves glycemic control. DIABETES EDUCATOR 2005; 31:240-50. [PMID: 15797853 DOI: 10.1177/0145721705274927] [Citation(s) in RCA: 240] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE The purpose of this study was to assess the influence of appointment keeping and medication adherence on HbA1c. METHODS A retrospective evaluation was performed in 1560 patients with type 2 diabetes who presented for a new visit to the Grady Diabetes Clinic between 1991 and 2001 and returned for a follow-up visit and HbA1c after 1 year of care. Appointment keeping was assessed by the number of scheduled intervening visits that were kept, and medication adherence was assessed by the percentage of visits in which self-reported diabetes medication use was as recommended at the preceding visit. RESULTS The patients had an average age of 55 years, body mass index (BMI) of 32 kg/m2, diabetes duration of 4.6 years, and baseline HbA1c of 9.1%. Ninety percent were African American, and 63% were female. Those who kept more intervening appointments had lower HbA1c levels after 12 months of care (7.6% with 6-7 intervening visits vs 9.7% with 0 intervening visits). Better medication adherence was also associated with lower HbA1c levels after 12 months of care (7.8% with 76%-100% adherence). After adjusting for age, gender, race, BMI, diabetes duration, and diabetes therapy in multivariate linear regression analysis, the benefits of appointment keeping and medication adherence remained significant and contributed independently; the HbA1c was 0.12% lower for every additional intervening appointment that was kept (P = .0001) and 0.34% lower for each quartile of better medication adherence (P = .0009). CONCLUSION Keeping more appointments and taking diabetes medications as directed were associated with substantial improvements in HbA1c. Efforts to enhance glycemic outcomes should include emphasis on these simple but critically important aspects of patient adherence.
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Affiliation(s)
- Mary K Rhee
- The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
| | - Wrenn Slocum
- The Strategic National Stockpile Program, Program Preparedness Branch, the Centers for Chronic Disease Control and Health Prevention, Atlanta, Georgia (Mr Slocum)
| | - David C Ziemer
- The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
| | - Steven D Culler
- The Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Culler)
| | - Curtiss B Cook
- The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
| | - Imad M El-Kebbi
- The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
| | - Daniel L Gallina
- The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
| | - Catherine Barnes
- The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
| | - Lawrence S Phillips
- The Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee, Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips)
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Musabayane CT, Mahlalela N, Shode FO, Ojewole JAO. Effects of Syzygium cordatum (Hochst.) [Myrtaceae] leaf extract on plasma glucose and hepatic glycogen in streptozotocin-induced diabetic rats. JOURNAL OF ETHNOPHARMACOLOGY 2005; 97:485-490. [PMID: 15740884 DOI: 10.1016/j.jep.2004.12.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Revised: 11/26/2004] [Accepted: 12/02/2004] [Indexed: 05/24/2023]
Abstract
The present study investigates the hypoglycaemic effect of Syzygium cordatum (Hochst.) [Myrtaceae] leaf extract in non-diabetic and streptozotocin (STZ)-induced diabetic rats. Oral glucose tolerance tests (OGGT) were conducted in non-diabetic and STZ-diabetic rats using orally administered glucose (1.4 g 100 g(-1) body weight) followed by either the leaf extract (6 mg 100 g(-1) body weight) or subcutaneous (sc) injection of metformin (50 mg 100 g(-1)). Weekly plasma glucose and terminal hepatic glycogen concentrations were recorded in control STZ-diabetic rats and diabetic rats orally treated with the leaf extract once every third day for 4 weeks. Administration of the leaf extract decreased plasma glucose from 7.7+/-0.9 mmol l(-1) to 3.7+/-0.6 mmol l(-1) (n = 6), and 21.1+/-2.2 mmol l(-1) to 12.5+/-1.8 mmol l(-1) (n = 7) by 2 1/2 h in non-diabetic and STZ-diabetic rats, respectively. OGTT data in metformin-treated rats were similar at the corresponding time in all groups, except for significant blood glucose reduction by the drug in non-diabetic rats between 1 and 1 1/2 h after treatment. Oral administration of the extract did not affect plasma glucose concentration in STZ-diabetic rats after 4 weeks, although it significantly increased hepatic glycogen content by comparison with untreated STZ-diabetic rats (28+/-5 mg 100 g(-1) body weight, n = 7, versus 16+/-3 mg 100 g(-1) body weight, n = 6). We conclude that Syzygium cordatum leaf extract contains compounds that could be effective in mild diabetes mellitus or in cases of glucose tolerance impairment. The possible mechanism(s) involved in the short-term hypoglycaemic effect of the extract could not be established by the current study.
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Affiliation(s)
- C T Musabayane
- Department of Human Physiology and Physiological Chemistry, School of Medical Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa.
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Saunders SA, Democratis J, Martin J, Macfarlane IA. Intravenous drug abuse and Type 1 diabetes: financial and healthcare implications. Diabet Med 2004; 21:1269-73. [PMID: 15569127 DOI: 10.1111/j.1464-5491.2004.01325.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To determine the morbidity, mortality and healthcare costs of intravenous drug-abusing patients with Type 1 diabetes (IVDA-DM), who are admitted to hospital. METHODS Retrospective case note analysis of admissions, complications and cost estimation over a 6-year period. Each drug-abusing patient (IVDA-DM) (n = 9) was compared with two controls (n = 18) with Type 1 diabetes but without a history of intravenous drug abuse (DM-controls). Admissions were also analysed for patients with intravenous drug abuse, but without Type 1 diabetes (IVDA-controls) (n = 198). Admissions were at a University teaching hospital in Liverpool, UK. DM-controls were drawn from a population attending diabetes outpatient clinics between 1997 and 2002 at the same hospital. The main outcome measures were: the duration and healthcare costs of hospital admissions per year, outpatient attendances per year, glycated haemoglobin (HbA(1c)), weight, micro- and macrovascular complications and mortality. RESULTS Multiple admissions, mainly related to ketoacidosis, led to marked differences in mean (95% CI) inpatient days per year per patient [IVDA-DM 28.1 (13.6-42.7) vs. DM-control 1.1 (0.2-1.9); P < 0.0001], mean inpatient days per year per patient in critical care bed (IVDA-DM 1.7 (-0.7-4.2) vs. DM-control 0; P < 0.02) and mean costs of admission, per patient per year (pound sterling 7320 vs. pound sterling 230). The IVDA-DM group frequently omitted insulin, were underweight, failed to attend as outpatients and five had died by the end of 2002. The IVDA-controls spent considerably less time in hospital [3.4 (2.8-3.9) days per patient per year]. CONCLUSION IVDA-DM patients have higher rates of diabetes complications, are admitted more frequently and have a high mortality compared with DM and IVDA-controls. The cost of inpatient care of this small group of patients was considerable.
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Affiliation(s)
- S A Saunders
- University Hospitals Aintree NHS Trust, Liverpool, UK
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Abstract
BACKGROUND In the Diabetes Control and Complications Trial (DCCT, 1993) tight diabetes control (HbA1c <7%) was associated with significantly less microvascular complications compared to 'conventionally' treated type 1 patients. AIM To assess the effectiveness of a dedicated young-adult type 1 diabetes clinic in achieving HbA1c levels <7% between 1991 and 2001. DESIGN Retrospective review of case-notes. METHODS All patients who attended the clinic in the first six years (1991 to 1996) were studied. All were offered at least two appointments per year. Case-notes were reviewed up to December 2001. RESULTS We treated 386 type 1 patients (59.8% male, mean age 28.7 years, mean duration diabetes 9.5 years). After a mean follow-up of 7.7 years, 261 (67.6%) had attended in the past 2 years, 22 (5.8%) were known to have died, 11 (2.8%) had transferred to another clinic and 92 (23.8%) had repeatedly failed to attend appointments for 2 years. Over 11 years, the total mean (SD) HbA1c was 9.19% (1.3). Only 3.4% of patients achieved an average HbA1c of <7% during the study period, and 80% of patients had average HbA1c levels of >8%. DISCUSSION Despite regular specialist physician, specialist diabetes nurse and dietician input, encouragement of multiple daily insulin injections and repeatedly following-up failed appointments (including home visits), fewer than 1:20 patients achieved the DCCT target of mean HbA1c <7%. Tight diabetes control is rare in a routine clinic setting.
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Affiliation(s)
- S A Saunders
- University Department of Diabetes and Endocrinology, Clinical Sciences Centre, University Hospital Aintree, Liverpool L9 7AL, UK.
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Uribe AG, Alarcón GS, Sanchez ML, McGwin G, Sandoval R, Fessler BJ, Bastian HM, Friedman AW, Baethge BA, Reveille JD. Systemic lupus erythematosus in three ethnic groups. XVIII. Factors predictive of poor compliance with study visits. ACTA ACUST UNITED AC 2004; 51:258-63. [PMID: 15077269 DOI: 10.1002/art.20226] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the baseline factors predictive of poor compliance with study visits in a longitudinal multiethnic lupus cohort study. METHODS Patients with systemic lupus erythematosus (n = 344) representing a total of 2,069 potential study visits were studied. Of the participants, 24.4% were Hispanic, 43.3% African American, and 32.3% Caucasian. Noncompliance was defined as missing 2 or more study visits. For the purpose of these analyses, visits completed only by review of medical records were considered missing. Baseline socioeconomic-demographic, clinical, and psychosocial features between compliant and noncompliant patients were compared. Variables with P < 0.10 were then entered into a multivariable logistic regression analysis with compliance being the dependent variable. RESULTS There were 178 compliant and 166 noncompliant patients. Noncompliant patients were more likely to be young, unmarried, of African American ethnicity, live closer to the medical centers, and have longer disease duration and greater disease activity as assessed by the physician than the compliant patients. In the multivariable model, longer disease duration (P = 0.010), higher level of disease activity (P = 0.009), and shorter distance to travel to study visits (P = 0.046) were predictors of noncompliance; their odds ratios and confidence intervals were below 1. CONCLUSIONS We have identified baseline patient characteristics that may predict noncompliance with study visits (disease duration, disease activity, and distance to the medical center). This information will serve as the basis for developing interventions to curtail noncompliance. Our data may have applicability in other lupus cohort studies.
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Vogt TM, Glass A, Glasgow RE, La Chance PA, Lichtenstein E. The safety net: a cost-effective approach to improving breast and cervical cancer screening. J Womens Health (Larchmt) 2004; 12:789-98. [PMID: 14588129 DOI: 10.1089/154099903322447756] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purposes of the study were (1). to assess the cost-effectiveness of three interventions to deliver breast and cervical cancer screening to women unscreened for >or=3 years and (2). to determine the relation of an invasive cervical cancer diagnosis to the interval since the last true screening test. METHODS In a randomized trial, women were randomly assigned to (1). usual care, (2). letter plus follow-up letter, (3). letter plus follow-up phone call, (4). phone call plus follow-up phone call. Screening within 12 weeks was the outcome. A 5-year retrospective review of cervical cancer cases and screening histories was done. RESULTS The 8% of women not screened for >or=5 years had 62% of the invasive cervical cancer cases. Mammography outreach led to screening in 10%, 24%, 51%, and 50% of controls, letter/letter, letter/phone, and phone/phone interventions groups, respectively. Cervical cancer screening outreach led to screening in 17%, 22%, 54%, and 50% of the respective groups. Letter reminders alone produced fewer tests at substantially higher costs than did personalized telephone notification. CONCLUSIONS For cervical cancer, only 1 person in 12 was not screened in the preceding 5 years, but these accounted for nearly two thirds of invasive cancers. Aggressive outreach to the rarely screened is an important part of screening programs. Letter reminder, followed by a telephone appointment call, was the most cost-effective approach to screening rarely screened women. Lack of accurate information on prior hysterectomy adds substantial unnecessary costs to a screening reminder program.
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Affiliation(s)
- Thomas M Vogt
- Kaiser Permanente Center for Health Research Hawaii, Honolulu, Hawaii 96817, USA.
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Channon S, Smith V, Alcolado J, Gregory JW. Current methods of transfer of young people with type 1 diabetes to adult services. Diabet Med 2003; 20:1034. [PMID: 14632706 DOI: 10.1111/j.1464-5491.2003.00919.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bain SC, Gill GV, Dyer PH, Jones AF, Murphy M, Jones KE, Smyth C, Barnett AH. Characteristics of Type 1 diabetes of over 50 years duration (the Golden Years Cohort). Diabet Med 2003; 20:808-11. [PMID: 14510860 DOI: 10.1046/j.1464-5491.2003.01029.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Type 1 diabetes mellitus is associated with high levels of premature morbidity and mortality. Prolonged survival is possible, however, and some patients appear to be protected from the long-term complications of this condition. METHODS Diabetes UK awards medals to patients who have had Type 1 diabetes for 50 years or more. By examining medal-holders, we have established the clinical and biochemical features of a group of 400 subjects (54% male) with Type 1 diabetes of long duration. RESULTS Mean age of the subjects was 68.9 years and mean age-at-onset of diabetes 13.7 years. Features of long duration diabetes in this cohort include normal body mass (mean BMI 25.0 kg m-2), low insulin dose (mean 0.52 units kg-2) and greatly elevated HDL-cholesterol (mean 1.84 mmol/l). Mean HbA1c was 7.6% (normal range 3.8-5.0%) and no patient had a normal HbA1c at the time of venesection. As a group, they have long-lived parents and consume moderate amounts of alcohol. Medical contact has often been sporadic. A significant proportion (29%) were taking anti-hypertensive medication. Screening for micro- and macroalbuminuria was positive in 35.7%. CONCLUSIONS Patients with long-duration (> 50 years) Type 1 diabetes are relatively protected from clinical diabetic nephropathy and large vessel disease; our data are consistent with protection possibly being genetically determined in part via elevated HDL-cholesterol levels. An abnormal urinary albumin/creatinine ratio is common in these patients, despite their low risk of significant renal deterioration; this may have implications for microalbuminuria screening programmes.
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Affiliation(s)
- S C Bain
- Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK.
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Sharp DJ, Hamilton W. Non-attendance at general practices and outpatient clinics. BMJ (CLINICAL RESEARCH ED.) 2001; 323:1081-2. [PMID: 11701560 PMCID: PMC1121587 DOI: 10.1136/bmj.323.7321.1081] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bunting BP, Coates V. Stability and predictors of blood glucose levels: An intra- and inter-individual analysis. PSYCHOL HEALTH MED 2000. [DOI: 10.1080/713690196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
A review of the evidence of the causes of diabetic foot ulceration and the importance of prevention strategies.
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Affiliation(s)
- W Tyrrell
- Faculty of Community Health Sciences, University of Wales Institute, Cardiff, UK
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