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Serrano-Fuentes N, Rogers A, Portillo MC. Beyond individual responsibility: Exploring lay understandings of the contribution of environments on personal trajectories of obesity. PLoS One 2024; 19:e0302927. [PMID: 38718062 PMCID: PMC11078422 DOI: 10.1371/journal.pone.0302927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/13/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Reversing the upward trajectory of obesity requires responding by including the multiple influences on weight control. Research has focused on individual behaviours, overlooking the environments where individuals spend their lives and shape lifestyles. Thus, there is a need for lay understandings of the impact of environments as a cause and solution to obesity. This research aimed to understand the influence of environments on the adoption of health practices in adults with obesity and to identify lay strategies with which to address environmental barriers to behaviour change. METHODS Nineteen adults with a history of obesity living in the United Kingdom were interviewed through video conferencing between May 2020 and March 2021. Semi-structured interviews and socio-demographic questionnaires were used, and data analysed through hermeneutic phenomenology informed reflexive thematic analysis. RESULTS Three main themes were created: living with convenience and normalcy: the increased accessibility of unhealthy food, people interacting with digital media for positive practice change, and the need to prioritise prevention in schools, the National Health Service and the food industry. CONCLUSIONS The food environment was the major barrier, while interactions with social media was the most important opportunity to adopt healthy practices. The National Health Service was considered an obesogenic environment, something relevant since it has been traditionally recognised as an obesity management system. The perceptions from individuals with a history of obesity provide new suggestions on the influence of previously overlooked environments to design more adequate and effective interventions and policies that consider, more than in the past, the environments where people spend their lives.
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Affiliation(s)
- Nestor Serrano-Fuentes
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Anne Rogers
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Mari Carmen Portillo
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Southampton, United Kingdom
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Mulyanto J, Wibowo Y, Ernawati DA, Lestari DWD, Kringos DS. Exploring Inequalities in the Use, Quality, and Outcome of the Diabetes Management Program of Indonesian National Health Insurance. Health Equity 2023; 7:644-652. [PMID: 37786529 PMCID: PMC10541918 DOI: 10.1089/heq.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 10/04/2023] Open
Abstract
Introduction Access to diabetes management programs is crucial to control the increasing contribution of diabetes to the global burden of disease. However, evidence regarding whether such services are equally accessible for all population groups is still lacking, particularly in the context of low-middle-income countries and under the National Health Insurance (NHI). This study aimed to assess the extent of socioeconomic and geographical inequalities in the use, quality, and outcome of a diabetes management program for beneficiaries of Indonesian NHI. Methods A total of 628 participants in the NHI diabetes management program in Banyumas District, Indonesia, were included in 2021 in this cross-sectional study. The main variables measured were regular visits to primary care facilities, standard medication, and glycemic control. The rate difference and rate ratio of age-sex standardized prevalence rates, as well as multiple logistic regressions, were used to measure the extent of inequalities. Results Around 70% of participants regularly visited primary care facilities and received standard medication, but only 35% had good glycemic control. Highly educated participants were more likely to have regular visits compared to low-educated participants (odds ratio [OR] 1.92; 95% confidence interval [95% CI]: 1.04-3.56). Based on employment and type of NHI beneficiaries, a small extent and even reverse inequalities were found although these findings were insignificant statistically. Urban residents were also more likely to have regular visits (OR 6.61; 95% CI: 2.90-15.08), receive standard medication (OR 9.73; 95% CI: 3.66-25.90), and have good glycemic control (OR 3.85; 95% CI: 1.68-8.83) compared to rural residents. Conclusions Evidence on the extent of socioeconomic inequalities is inconclusive but substantial geographical inequalities in the use, quality, and outcome of diabetes management programs exist among Indonesian NHI beneficiaries. Future implementation policies of the program should consider particularly the geographical characteristics of participants to avoid and reduce inequalities and, hence, the disease burden of diabetes.
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Affiliation(s)
- Joko Mulyanto
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Yudhi Wibowo
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Dwi Arini Ernawati
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Diyah Woro Dwi Lestari
- Department of Bioethics, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Dionne S. Kringos
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
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Bussière C, Sirven N, Rapp T, Sevilla-Dedieu C. Adherence to medical follow-up recommendations reduces hospital admissions: Evidence from diabetic patients in France. HEALTH ECONOMICS 2020; 29:508-522. [PMID: 31965683 DOI: 10.1002/hec.3999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/05/2019] [Accepted: 12/25/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to document the extent to which diabetic patients who adhered to required medical follow-ups in France experienced reduced hospital admissions over time. The main assumption was that enhanced monitoring and follow-up of diabetic patients in the primary care setting could be a substitute for hospital use. Using longitudinal claim data of diabetic patients between 2010 and 2015 from MGEN, a leading mutuelle insurance company in France, we estimated a dynamic logit model with lagged measures of the quality of adherence to eight medical follow-up recommendations. This model allowed us to disentangle follow-up care in hospitals from other forms of inpatient care that could occur simultaneously. We found that a higher adherence to medical guidance is associated with a lower probability of hospitalization and that the take-up of each of the eight recommendations may help reduce the rates of hospital admission. The reasons for the variation in patient adherence and implications for health policy are discussed.
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Affiliation(s)
- Clémence Bussière
- LEDi (EA7467), Université de Bourgogne, France
- MGEN Foundation for Public Health, University of Bourgogne, Dijon, France, Paris, France
| | - Nicolas Sirven
- LIRAES (EA4470), Université de Paris Descartes, France
- IRDES, Paris, France
| | - Thomas Rapp
- LIRAES (EA4470), Université de Paris Descartes, France
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Has EMM, Aulia A, Kusumaningrum T, Efendi F. Ethnic Foods Diet Program Improve Self-Efficacy and Diet Compliance Among Type 2 Diabetic Patients. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i2.16642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A well-balanced diet is one of the four pillars of diabetes self-management. Patient's culture strongly influences intake food. Diabetic dietary guidelines which fit with the patient's culture is expected to improve patient's self-efficacy and diet compliance. This study was aimed to analyze the effect of ethnic foods diet program in improving self-efficacy and diet compliance among Type-2 Diabetes Mellitus (T2DM) patients. This was quasy experiment research with pre and post-test control design. The population was 112 T2DM patients from Sasak Tribes, West Nusa Tenggara. Samples were 36 respondents, divided into intervention (18) and control (18) groups. The independent variable was the ethnic food diet (EFD) program, while the dependent variables were patient's self-efficacy and diet compliance. Data were collected using self-efficacy questionnaire and a 24-hour dietary recall form. Data were then analyzed using Wilcoxon Signed Rank Test and Mann Whitney U Test. The result showed differences in self-efficacy between pre and post-test in the treatment group (p=0,001), but there were no differences in the control group. There were differences in diet compliance in the treatment group (p=0,001), but there were no differences in the control group. There were differences between treatment and control groups on self-efficacy (p=0,000) and diet compliance (p=0,000). Ethnic foods diet program can improve self-efficacy and diet compliance among T2DM patients because more comfortable and easier to be applied. Nurses can apply ethnic foods diet program as an intervention to promote healthy diet for T2DM patients.
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Icks A, Haastert B, Arend W, Konein J, Thorand B, Holle R, Laxy M, Schunk M, Neumann A, Wasem J, Chernyak N. Time spent on self-management by people with diabetes: results from the population-based KORA survey in Germany. Diabet Med 2019; 36:970-981. [PMID: 30267540 DOI: 10.1111/dme.13832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2018] [Indexed: 11/26/2022]
Abstract
AIMS Time needed for health-related activities in people with diabetes is assumed to be substantial, yet available data are limited. Time spent on self-management and associated factors was analysed using cross-sectional data from people with diagnosed diabetes enrolled in a population-based study. METHODS Mean total time spent on self-management activities was estimated using a questionnaire for all participants with diagnosed diabetes in the KORA FF4 study (n = 227, 57% men, mean age 69.7, sd 9.9 years). Multiple two-part regression models were fitted to evaluate associated factors. Multiple imputation was performed to adjust for bias due to missing values. RESULTS Some 86% of participants reported spending time on self-management activities during the past week. Over the entire sample, a mean of 149 (sd 241) min/week were spent on self-management-activities. People with insulin or oral anti-hyperglycaemic drug treatment, better diabetes education, HbA1c 48 to < 58 mmol/mol (6.5% to < 7.5%) or lower quality of life, spent more time on self-management activities. For example, people without anti-hyperglycaemic medication invested 66 min/week in self-management, whereas those taking insulin and oral anti-hyperglycaemic drugs invested 269 min/week (adjusted ratio 4.34, 95% confidence interval 1.85-10.18). CONCLUSIONS Time spent on self-management activities by people with diabetes was substantial and varied with an individual's characteristics. Because of the small sample size and missing values, the results should be interpreted in an explorative manner. Nevertheless, time needed for self-management activities should be routinely considered because it may affect diabetes self-care and quality of life.
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Affiliation(s)
- A Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University
- Institute for Health Services Research and Health Economics, German Diabetes Center at Heinrich-Heine-University, Leibniz-Center for Diabetes Research, Düsseldorf
- German Center for Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - B Haastert
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University
- mediStatistica, Neuenrade, Germany
| | - W Arend
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University
| | - J Konein
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University
| | - B Thorand
- German Center for Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - R Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - M Laxy
- German Center for Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - M Schunk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - A Neumann
- Institute for Health Care Management and Research, Essen University of Duisburg-Essen, Essen
| | - J Wasem
- Institute for Health Care Management and Research, Essen University of Duisburg-Essen, Essen
| | - N Chernyak
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University
- Institute for Health Services Research and Health Economics, German Diabetes Center at Heinrich-Heine-University, Leibniz-Center for Diabetes Research, Düsseldorf
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Forbes H, Fichera E, Rogers A, Sutton M. The Effects of Exercise and Relaxation on Health and Wellbeing. HEALTH ECONOMICS 2017; 26:e67-e80. [PMID: 28276112 PMCID: PMC5811789 DOI: 10.1002/hec.3477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/24/2016] [Accepted: 12/05/2016] [Indexed: 06/06/2023]
Abstract
Better management by individuals of their long-term conditions is promoted to improve health and reduce healthcare expenditure. However, there is limited evidence on the determinants and consequences of self-management activity. We investigate the determinants of two forms of self-management, exercise and relaxation, and their impact on the health and wellbeing of 3472 individuals with long-term health conditions over a 1-year period. We use simultaneous recursive trivariate models to estimate the effects of these two inputs on three health and wellbeing outcomes: the EuroQol five-dimensional (EQ-5D) score, self-assessed health and happiness. We reflect the opportunity cost of time and knowledge with employment status and education and find that employment reduces relaxation and education increases exercise. We find that neither exercise nor relaxation affects the EuroQol five-dimensional score, but exercise increases self-assessed health and relaxation increases happiness. Our findings show that individuals tailor their self-management activities to their economic constraints, with effects on different aspects of their utility. Interventions to encourage self-management should take account of heterogeneous effects and constraints. © 2017 The Authors. Health Economics Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Hannah Forbes
- Manchester Centre for Health EconomicsUniversity of ManchesterManchesterUK
| | - Eleonora Fichera
- Manchester Centre for Health EconomicsUniversity of ManchesterManchesterUK
| | - Anne Rogers
- NIHR CLAHRC Wessex, Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Matt Sutton
- Manchester Centre for Health EconomicsUniversity of ManchesterManchesterUK
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Gonzalez JS, Tanenbaum ML, Commissariat PV. Psychosocial factors in medication adherence and diabetes self-management: Implications for research and practice. ACTA ACUST UNITED AC 2017; 71:539-551. [PMID: 27690483 DOI: 10.1037/a0040388] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Diabetes is a chronic illness that places a significant self-management burden on affected individuals and families. Given the importance of health behaviors-such as medication adherence, diet, physical activity, blood glucose self-monitoring-in achieving optimal glycemic control in diabetes, interventions designed and delivered by psychologists hold promise in assisting children, adolescents, and adults with diabetes in improving their health status and lowering their risk of serious complications. This article first provides an overview of diabetes self-management and associated challenges and burdens. Socioeconomic status factors that may influence diabetes management and outcomes are briefly highlighted. We then review the evidence base for select psychosocial factors that may be implicated in diabetes self-management. Modifiable targets of psychological intervention are presented across 3 overarching domains: (a) knowledge, beliefs, and related cognitive constructs; (b) emotional distress and well-being; and (c) behavioral skills and coping. Important methodological issues facing future research are discussed, along with opportunities for psychologists in improving the care and treatment outcomes of individuals and families living with diabetes. In conclusion, we advocate for continued research emphasis on improving psychosocial aspects of living with diabetes, with greater attention to the situational context in which the self-regulatory processes underlying self-management occur. Psychologists have important roles to play in reducing emotional distress, improving patient knowledge, and providing training in behavioral skills to promote successful self-management and to support patient-centered diabetes care. (PsycINFO Database Record
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Chernyak N, Jülich F, Kasperidus J, Stephan A, Begun A, Kaltheuner M, Icks A. Time cost of diabetes: Development of a questionnaire to assess time spent on diabetes self-care. J Diabetes Complications 2017; 31:260-266. [PMID: 27411888 DOI: 10.1016/j.jdiacomp.2016.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Methods to measure patient time spent on health-related activities are currently not well elaborated or standardized. AIM The purpose of this study was to develop a recall questionnaire measuring patient time devoted to diabetes self-care and to examine its feasibility and validity under field conditions. METHODS The initial questionnaire was developed on the basis of instruments frequently used to assess self-care behavior in patients with diabetes, evaluated in two focus groups with patients with type 2 diabetes (N=15) and tested in a random sample of patients with type 2 diabetes (N=178). To assess the validity of the questionnaire, four hypotheses about expected differences in self-care time across various patient sub-groups were tested. RESULTS The final questionnaire includes thirteen items estimating time spent on regular diabetes-related activities undertaken in the previous seven days. 78% of respondents completed the questionnaire without item non-response or other evident problems. As hypothesized, respondents receiving insulin treatment, those with poor self-rated health and those with diabetes-related emotional distress (PAID-5 score ≥8) reported spending more time on diabetes self-care than the rest of the sample. Contrary to our assumption, no differences in time spent on diabetes self-care between employed and retired individuals were detected by the questionnaire. CONCLUSION The recall questionnaire measuring patient time devoted to a broad range of regular diabetes self-care activities was developed and its feasibility was proved under field conditions. Ideally, the questionnaire should be further validated within a variety of populations. Exploration of the convergent validity between the recall method and prospective diary may be also useful.
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Affiliation(s)
- Nadja Chernyak
- Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany.
| | - Fabian Jülich
- Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany.
| | - Julia Kasperidus
- Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany.
| | - Astrid Stephan
- Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany.
| | - Alexander Begun
- German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Duesseldorf, Germany.
| | | | - Andrea Icks
- Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany; German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Duesseldorf, Germany; German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, Düsseldorf, Germany.
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Forbes H, Sutton M, Richardson G, Rogers A. The determinants of time spent on self-care. Chronic Illn 2016; 12:98-115. [PMID: 26661332 DOI: 10.1177/1742395315614380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 08/27/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE More input from the individual into the management of their health has the potential to reduce demand on the formal care system and improve health outcomes. A variety of interventions have been developed to encourage such 'self-care', particularly for populations with long-term conditions. However the equity consequences of such initiatives are relatively unknown as there is little evidence on the social and economic determinants of time spent on self-care. KEY METHODS We estimate the social and economic determinants of time spent on self-care. We also examine whether patients spend time on self-care because they are compensating for lack of access to formal health care. We undertook regression analyses of eight self-care and formal care measures from a dedicated survey of 300 patients with long-term conditions. MAIN RESULTS We found that higher income is associated with less time spent on self-care. Various measures of access to formal health care are found to not be associated with time spent on self-care. MAIN CONCLUSION People from a lower socioeconomic position spend more time managing their condition even when there is universal entitlement to health care.
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Affiliation(s)
- Hannah Forbes
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Matt Sutton
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | | | - Anne Rogers
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
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Szendroedi J, Saxena A, Weber KS, Strassburger K, Herder C, Burkart V, Nowotny B, Icks A, Kuss O, Ziegler D, Al-Hasani H, Müssig K, Roden M. Cohort profile: the German Diabetes Study (GDS). Cardiovasc Diabetol 2016; 15:59. [PMID: 27053136 PMCID: PMC4823856 DOI: 10.1186/s12933-016-0374-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/24/2016] [Indexed: 12/16/2022] Open
Abstract
Background The German Diabetes Study (GDS) is a prospective longitudinal cohort study describing the impact of subphenotypes on the course of the disease. GDS aims at identifying prognostic factors and mechanisms underlying the development of related comorbidities. Study design and methods The study comprises intensive phenotyping within 12 months after clinical diagnosis, at 5-year intervals for 20 years and annual telephone interviews in between. Dynamic tests, including glucagon, mixed meal, intravenous glucose tolerance and hyperinsulinemic clamp tests, serve to assess beta-cell function and tissue-specific insulin sensitivity. Magnetic resonance imaging and multinuclei spectroscopy allow quantifying whole-body fat distribution, tissue-specific lipid deposition and energy metabolism. Comprehensive analyses of microvascular (nerve, eye, kidney) and macrovascular (endothelial, cardiorespiratory) morphology and function enable identification and monitoring of comorbidities. The GDS biobank stores specimens from blood, stool, skeletal muscle, subcutaneous adipose tissue and skin for future analyses including multiomics, expression profiles and histology. Repeated questionnaires on socioeconomic conditions, patient-reported outcomes as quality of life, health-related behavior as physical activity and nutritional habits are a specific asset of GDS. This study will recruit 3000 patients and a group of humans without familiy history of diabetes. 237 type 1 and 456 type 2 diabetes patients have been already included. Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0374-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Szendroedi
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Aaruni Saxena
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Katharina S Weber
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Klaus Strassburger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Volker Burkart
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Bettina Nowotny
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Andrea Icks
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,Public Health Unit, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Oliver Kuss
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Hadi Al-Hasani
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Clinical Biochemistry and Pathobiochemistry German Diabetes Center, Leibniz Institute for Diabetes Research, Düsseldorf, Germany
| | - Karsten Müssig
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany. .,German Center for Diabetes Research (DZD), München-Neuherberg, Germany. .,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
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Wimalawansa SJ. Vitamin D Deficiency is a Surrogate Marker for Visceral Fat Content, Metabolic Syndrome, Type 2 Diabetes, and Future Metabolic Complications. ACTA ACUST UNITED AC 2016. [DOI: 10.15406/jdmdc.2016.03.00059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
PURPOSE This narrative review is concerned with the ways in which the relationships between time and chronic illnesses have been chartered in recent literature. It aims to identify types of time (referred to here as temporal structures) most commonly reported in chronic illness literature and to assess their bearing on people's lived experiences. METHODS Literature searches of three electronic databases (Google Scholar, MEDLINE, and PubMed) were carried out in November 2014 of articles published between 1970 and 2013 using the following search terms (and derivatives): chronic illness AND time AND (patient OR carer). The review followed four procedural steps: (a) comprehensive search, (b) temporal structure appraisal, (c) synthesis of findings, and (d) critical appraisal. RESULTS Forty studies met the inclusion criteria and were included for review. Four types of called temporal structures had a strong presence in the literature: calendar and clocked time, biographical time, past-present-future time, and inner time and rhythms. The first three temporal structures are largely understood socially, and the fourth is predominantly understood in and through the body. Several studies reported more than one temporal structure as informing people's chronic illness experiences. A wide array of chronic illnesses were represented in these studies. Few studies reported on the experiences of people with multi-morbid chronic illnesses. CONCLUSION Chronic illness induces new relationships to time. Drawing on Hyden (Sociol Health Illn 19(1):48-69, 1997), it is suggested that "narrative" storytelling--as a temporally informed analytic device---might prove effective for reconciling the tensions emergent from new and multiple relationships to time that chronic and multiple illnesses create. Opportunities exist for healthcare practitioners and health services to offer patients illness support that is cognisant of their relationships to time.
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Pilot S, Cohen R, Reach G, Cosson E, Le Clesiau H, Hercberg S, Bihan H. Food insecurity in French patients with diabetes. DIABETES & METABOLISM 2014; 40:314-316. [PMID: 24679595 DOI: 10.1016/j.diabet.2014.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/12/2014] [Accepted: 02/18/2014] [Indexed: 06/03/2023]
Affiliation(s)
- S Pilot
- Department of Endocrinology, Diabetology, Metabolic Disease, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, 127, route de Stalingrad, 93009 Bobigny, France
| | - R Cohen
- Department of Endocrinology, Diabetology, Metabolic Disease, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, 127, route de Stalingrad, 93009 Bobigny, France
| | - G Reach
- Department of Endocrinology, Diabetology, Metabolic Disease, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, 127, route de Stalingrad, 93009 Bobigny, France
| | - E Cosson
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, 93143 Bondy, France; UMR U557 Inserm/U1125 Inra/Cnam/Université Paris 13, Sorbonne Paris Cité, 93009 Bobigny, France
| | - H Le Clesiau
- Centre d'Examens de Santé de la Caisse Primaire d'Assurance Maladie de Seine-Saint-Denis, 93009 Bobigny, France
| | - S Hercberg
- UMR U557 Inserm/U1125 Inra/Cnam/Université Paris 13, Sorbonne Paris Cité, 93009 Bobigny, France
| | - H Bihan
- Department of Endocrinology, Diabetology, Metabolic Disease, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, 127, route de Stalingrad, 93009 Bobigny, France; UMR U557 Inserm/U1125 Inra/Cnam/Université Paris 13, Sorbonne Paris Cité, 93009 Bobigny, France.
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Coyle ME, Francis K, Chapman Y. Self-management activities in diabetes care: a systematic review. AUST HEALTH REV 2014; 37:513-22. [PMID: 24018058 DOI: 10.1071/ah13060] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/29/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify the range of self-management activities people diagnosed with diabetes engage in to manage their disease, the frequency of use, and whether self-management practices change over time. METHODS A systematic review of the literature was undertaken. Thirty-two studies identified through electronic databases met the inclusion criteria and were included in the review. RESULTS The study found that people living with diabetes undertake regular self-management activities and that compliance with medication regimes is high. Adherence, however, varied with respect to blood glucose testing, diet, physical activity and foot care. Levels of physical activity were not found to change over time. Evidence suggests that some people with diabetes modify their self-management practices in response to factors such as holidays. CONCLUSIONS The review suggests that the majority of people with diabetes self-manage, although there is variation in adherence to key self-management activities. How self-management practices change over time and whether this impacts on health outcomes is an area for future research.
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Affiliation(s)
- Meaghan E Coyle
- RMIT University, Plenty Road, PO Box 71, Bundoora, Vic. 3083, Australia
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Yen L, McRae IS, Jowsey T, Gillespie J, Dugdale P, Banfield M, Matthews P, Kljakovic M. Health work by older people with chronic illness: how much time does it take? Chronic Illn 2013; 9:268-82. [PMID: 23463322 DOI: 10.1177/1742395313476720] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE People living with chronic illness report spending a lot of time managing their health, attempting to balance the demands of their illness/es with other activities. This study was designed to measure the time older people with chronic illness spend on specific health-related activities. Key methods: Data were collected in 2010 using a national survey of people aged 50 years and over selected from the membership of National Seniors Australia, the Diabetes Services Scheme and The Lung Foundation. Respondents provided recall data on time used for personal health care, non-clinical health activity; and health service interactions. MAIN RESULTS While most people with a chronic illness spend on average less than 30 minutes a day on health-related activities, the highest decile of respondents averaged at least 2 hours each day. People with COPD report the highest expenditure of time. The greatest amount of time was spent on daily personal health care activities. MAIN CONCLUSION For a minority of people with chronic illness, time demands for health-related activities can be so great that other activities must be affected. Some time demands are amenable to system interventions that would result in a more patient-centered organisation of care.
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Affiliation(s)
- Laurann Yen
- 1Australian Primary Health Care Research Institute, The Australian National University, Australia
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16
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Kuvaja-Köllner V, Valtonen H, Komulainen P, Hassinen M, Rauramaa R. The impact of time cost of physical exercise on health outcomes by older adults: the DR's EXTRA Study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:471-479. [PMID: 22532236 DOI: 10.1007/s10198-012-0390-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 03/22/2012] [Indexed: 05/31/2023]
Abstract
When the motivation for exercise is high and people are retired, the cost of time used for physical exercise may be lower and individuals may exercise more compared to individuals with a low motivational level and in working life. The aim was to study the effect of time cost of physical exercise on the amount of physical exercise and on health-related quality of life. We used 2-year data (n = 1,292) from a 4-year randomised controlled trial in a population-based sample of Eastern Finnish men and women, 57-78 years of age at baseline, in 2005-2006. In the statistical analysis, physical exercise and health outcomes were assumed to be endogenous variables explained with a set of exogenous variables. The statistical modelling was done by panel data instrumental variable regressions. Health-related quality of life was evaluated by the RAND 36-item survey and motives for exercise with a questionnaire. Joy as the motivation for physical exercise and retirement increased the amount of physical exercise per week (p < 0.001). A higher amount of exercise was associated with physical (p < 0.001) and mental (p < 0.001) components of quality of life. Moreover, a higher amount of physical exercise decreased the metabolic risk factor score (p < 0.001). The motivation and extra time, i.e. retirement, have a significant impact on the time spent on physical exercise (p < 0.001). Our data agree with the theory that high motivation and retirement lower the time cost of physical exercise. The results emphasise that motivation and the labour market position are important in determining the cost of physical exercise.
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Affiliation(s)
- Virpi Kuvaja-Köllner
- Department of Health and Social Management, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
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Abstract
Background The management of health care, particularly for people with chronic conditions, combines the activities of health professionals, patients, informal carers and social networks that support them. Understanding the non-professional roles in health management requires information about the health related activities (HRA) that are undertaken by patients and informal carers. This understanding allows management planning that incorporates the capacity of patients and informal carers, as well as identifying the particular skills, knowledge and technical support that are necessary. This review was undertaken to identify how much time people with chronic illness and their informal carers spend on HRA. Methods Literature searches of three electronic databases (CINAHL, Medline, and PubMed) and two journals (Time and Society, Sociology of Health and Illness) were carried out in 2011 using the following search terms (and derivatives): chronic illness AND time AND consumer OR carer. The search was aimed at finding studies of time spent on HRA. A scoping literature review method was utilised. Results Twenty-two peer reviewed articles published between 1990 and 2010 were included for review. The review identified limited but specific studies about time use by people with a chronic illness and/or their carers. While illness work was seen as demanding, few studies combined inquiry about both defined tasks and defined time use. It also identified methodological issues such as consistency of definition and data collection methods, which remain unresolved. Conclusions While HRA are seen as demanding by people doing them, few studies have measured actual time taken to carry out a comprehensive range of HRA. The results of this review suggest that both patients with chronic illness and informal carers may be spending 2 hours a day or more on HRA. Illnesses such as diabetes may be associated with higher time use. More empirical research is needed to understand the time demands of self-management, particularly for those affected by chronic illness.
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Patient Time Costs Associated with Sensor-Augmented Insulin Pump Therapy for Type 1 Diabetes. Med Decis Making 2012; 33:215-24. [DOI: 10.1177/0272989x12464824] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Sensor-augmented pump therapy (SAPT) leads to lower glycated hemoglobin levels than multiple daily injections of insulin (MDI) in patients with type 1 diabetes. Patient time and costs associated with SAPT are not known. Objective. We compared time spent on diabetes-related care, changes in time, and associated patient time costs between patients randomly assigned to SAPT or MDI. Design, Setting, and Participants. During a 52-week clinical trial, participants aged 7 to 70 years (n = 483) reported total time per week spent on diabetes-related care. Measurements. Patient time, including comparisons during pump initiation, 52-week patient time costs, and changes in weekly time estimates after pump initiation. Results. At baseline, patients in the MDI group reported spending an average of 4.0 hours per week on diabetes-related care. During the pump initiation period (weeks 1–7), SAPT patients spent 1.9 hours more per week than MDI patients (95% confidence interval [CI], 1.2–2.6). After the initiation period (weeks 8–52), SAPT patients spent 1 hour more per week (95% CI, 0.4–1.7) than MDI patients (i.e., 4.4 v. 3.4 hours); patients in both groups spent progressively less time on diabetes-related care by 1.2 minutes per week (95% CI, −1.7 to −0.7). Overall, mean time costs per person were $4600 with the SAPT group and $3523 with the MDI group (difference, $1077; 95% CI, $491–$1638). Limitations. Time spent on specific activities was not collected, and the estimates do not explicitly account for caregiver time associated with diabetes care activities. Conclusions. Patients receiving SAPT v. MDI spent approximately 2 hours more per week on diabetes-related care during pump initiation and 1 hour more per week thereafter, resulting in higher patient time costs.
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Wilson C, Alam R, Latif S, Knighting K, Williamson S, Beaver K. Patient access to healthcare services and optimisation of self-management for ethnic minority populations living with diabetes: a systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:1-19. [PMID: 21749529 DOI: 10.1111/j.1365-2524.2011.01017.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A higher risk of diabetes mellitus in South Asian and Black African populations combined with lower reported access and self-management-related health outcomes informed the aims of this study. Our aims were to synthesise and evaluate evidence relating to patient self-management and access to healthcare services for ethnic minority groups living with diabetes. A comprehensive search strategy was developed capturing a full range of study types from 1995-2010, including relevant hand-searched literature pre-dating 1995. Systematic database searches of MEDLINE, Cochrane, DARE, HTA and NHSEED, the British Nursing Index, CAB abstracts, EMBASE, Global Health, Health Management Information Consortium and PsychInfo were conducted, yielding 21,288 abstracts. Following search strategy refinement and the application of review eligibility criteria; 11 randomised controlled trials (RCTs), 18 qualitative studies and 18 quantitative studies were evaluated and principal results extracted. Results suggest that self-management practices are in need of targeted intervention in terms of patients' knowledge and understanding of their illness, inadequacy of information and language and communication difficulties arising from cultural differences. Access to health-care is similarly hindered by a lack of cultural sensitivity in service provision and under use of clinic-based interpreters and community-based services. Recommendations for practice and subsequent intervention primarily rest at the service level but key barriers at patient and provider levels are also identified.
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Affiliation(s)
- Charlotte Wilson
- School of Nursing, Midwifery and Social Work, University of Manchester, UK.
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Salanitro AH, Safford MM, Houston TK, Williams JH, Ovalle F, Payne-Foster P, Allison JJ, Estrada CA. Patient complexity and diabetes quality of care in rural settings. J Natl Med Assoc 2011; 103:234-40. [PMID: 21671526 DOI: 10.1016/s0027-9684(15)30297-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Even though pay-for-performance programs are being rapidly implemented, little is known about how patient complexity affects practice-level performance assessment in rural settings. We sought to determine the association between patient complexity and practice-level performance in the rural United States. BASIC PROCEDURES Using baseline data from a trial aimed at improving diabetes care, we determined factors associated with a practice's proportion of patients having controlled diabetes (hemoglobin A1c<or=7%): patient socioeconomic factors, clinical factors, difficulty with self-testing of blood glucose, and difficulty with keeping appointments. We used linear regression to adjust the practice-level proportion with A1c controlled for these factors. We compared practice rankings using observed and expected performance and classified practices into hypothetical pay-for-performance categories. MAIN FINDINGS Rural primary care practices (n=135) in 11 southeastern states provided information for 1641 patients with diabetes. For practices in the best quartile of observed control, 76.1% of patients had controlled diabetes vs 19.3% of patients in the worst quartile. After controlling for other variables, proportions of diabetes control were 10% lower in those practices whose patients had the greatest difficulty with either self testing or appointment keeping (p<.05 for both). Practice rankings based on observed and expected proportion of A1c control showed only moderate agreement in pay-for-performance categories (kappa=0.47; 95% confidence interval, 0.32-0.56; p<001). PRINCIPAL CONCLUSIONS Basing public reporting and resource allocation on quality assessment that does not account for patient characteristics may further harm this vulnerable group of patients and physicians.
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Affiliation(s)
- Amanda H Salanitro
- VA Tennessee Valley Geriatric Research, Education, and Clinical Center and Section of Hospital Medicine at Vanderbilt University, Room A-414, 1310 24th Ave S, Nashville, TN 37212, USA.
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Steen Carlsson K, Landin-Olsson M, Nyström L, Arnqvist HJ, Bolinder J, Ostman J, Gudbjörnsdóttir S. Long-term detrimental consequences of the onset of type 1 diabetes on annual earnings--evidence from annual registry data in 1990-2005. Diabetologia 2010; 53:1084-92. [PMID: 20020097 DOI: 10.1007/s00125-009-1625-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 11/16/2009] [Indexed: 11/26/2022]
Abstract
AIMS/HYPOTHESIS Young adults in the early stages of their participation in the labour market may be particularly vulnerable to the effects of onset of a chronic disease. Our aim was to quantify the consequences of the onset of type 1 diabetes in young adults on annual earnings, using individual-level longitudinal data before and after the onset of diabetes. METHODS The Econ-DISS database contains annual socioeconomic information for 1990-2005 from Statistics Sweden. Econ-DISS includes data for persons with diabetes onset at the age of 15-34 years between 1983 and 2005, registered in the national Diabetes Incidence Study in Sweden (DISS) database, and for controls. Considering the onset of type 1 diabetes as an unanticipated and significant life event, we compared the progression of annual earnings for 3,650 cases born between 1949 and 1970 before and after onset of diabetes with that of 14,629 controls. Possible confounders--education, participation in the labour market, sick leave and parental education--were analysed. RESULTS We found no differences between the groups in annual earnings or participation in the labour market before onset of diabetes. After onset, persons with type 1 diabetes gradually lagged behind the controls. Their median annual earnings were lower in each year from 1995 to 2005 (p < 0.01). The difference in 2005 was euro (EUR) 1,411 (5.3%). Controlling for confounders, duration of type 1 diabetes > or = 10 years was associated with 4.2% (men) and 8.1% (women) lower average annual earnings for persons with upper secondary education only who were active in the labour market. CONCLUSION/INTERPRETATION The onset of type 1 diabetes in young adults has long-term detrimental consequences on earnings that cannot be attributed to confounders.
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Affiliation(s)
- K Steen Carlsson
- Department of Health Sciences, Malmö University Hospital, Clinical Research Centre House 28 Floor 10, SE-205 02 Malmö, Sweden.
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Affiliation(s)
- Yin Xu
- College of Nursing, Criminal Justice, and Human Services, University of Cincinnati, Cincinnati, Ohio 45221-0038, USA.
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Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP, Selby JV. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA 2009; 301:1565-72. [PMID: 19366776 PMCID: PMC2782622 DOI: 10.1001/jama.2009.460] [Citation(s) in RCA: 699] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Although acute hypoglycemia may be associated with cognitive impairment in children with type 1 diabetes, no studies to date have evaluated whether hypoglycemia is a risk factor for dementia in older patients with type 2 diabetes. OBJECTIVE To determine if hypoglycemic episodes severe enough to require hospitalization are associated with an increased risk of dementia in a population of older patients with type 2 diabetes followed up for 27 years. DESIGN, SETTING, AND PATIENTS A longitudinal cohort study from 1980-2007 of 16,667 patients with a mean age of 65 years and type 2 diabetes who are members of an integrated health care delivery system in northern California. MAIN OUTCOME MEASURE Hypoglycemic events from 1980-2002 were collected and reviewed using hospital discharge and emergency department diagnoses. Cohort members with no prior diagnoses of dementia, mild cognitive impairment, or general memory complaints as of January 1, 2003, were followed up for a dementia diagnosis through January 15, 2007. Dementia risk was examined using Cox proportional hazard regression models, adjusted for age, sex, race/ethnicity, education, body mass index, duration of diabetes, 7-year mean glycated hemoglobin, diabetes treatment, duration of insulin use, hyperlipidemia, hypertension, cardiovascular disease, stroke, transient cerebral ischemia, and end-stage renal disease. RESULTS At least 1 episode of hypoglycemia was diagnosed in 1465 patients (8.8%) and dementia was diagnosed in 1822 patients (11%) during follow-up; 250 patients had both dementia and at least 1 episode of hypoglycemia (16.95%). Compared with patients with no hypoglycemia, patients with single or multiple episodes had a graded increase in risk with fully adjusted hazard ratios (HRs): for 1 episode (HR, 1.26; 95% confidence interval [CI], 1.10-1.49); 2 episodes (HR, 1.80; 95% CI, 1.37-2.36); and 3 or more episodes (HR, 1.94; 95% CI, 1.42-2.64). The attributable risk of dementia between individuals with and without a history of hypoglycemia was 2.39% per year (95% CI, 1.72%-3.01%). Results were not attenuated when medical utilization rates, length of health plan membership, or time since initial diabetes diagnosis were added to the model. When examining emergency department admissions for hypoglycemia for association with risk of dementia (535 episodes), results were similar (compared with patients with 0 episodes) with fully adjusted HRs: for 1 episode (HR, 1.42; 95% CI, 1.12-1.78) and for 2 or more episodes (HR, 2.36; 95% CI, 1.57-3.55). CONCLUSIONS Among older patients with type 2 diabetes, a history of severe hypoglycemic episodes was associated with a greater risk of dementia. Whether minor hypoglycemic episodes increase risk of dementia is unknown.
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Affiliation(s)
- Rachel A Whitmer
- Kaiser Permanente, Division of Research, Section of Etiology and Prevention, 2000 Broadway, Oakland, CA 94612, USA.
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