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Nexø MA, Baumgarten SV, Willaing I, Olesen K. Staff experiences of diabetes care in residential care facilities for people with severe disabilities in Denmark: a mixed-methods assessment of access to screening for diabetes complications. BMJ Open 2022; 12:e062403. [PMID: 36600431 PMCID: PMC9772667 DOI: 10.1136/bmjopen-2022-062403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To identify the prevalence of diabetes among adults (>18 years) living in residential care facilities in Denmark and to identify the structural, practical, and individual barriers and drivers related to their participation in screening programmes. DESIGN SETTING: The register-based study included all residents living in residential care facilities in Denmark. The survey and qualitative analysis were carried out exclusively in the Capital Region of Denmark. PARTICIPANTS For the register-based study, we identified 11 620 residents of care facilities in Denmark (>18 years) and identified the number of residents with diagnosis codes of type 1 or type 2 diabetes or dispensed prescriptions of blood glucose-lowering medication. Staff from 102 psychiatric facilities housing adults with severe psychiatric disabilities were invited to participate in the survey. Of these, 56 facilities participated with one responder each, of which n=16 also participated in follow-up qualitative interviews. RESULTS Register-based study: of the residents at the facilities, 954 (8%) were diagnosed with diabetes. Descriptive statistics of responses and results from content analysis of interviews were summarised in five themes that illuminated how a screening programme could be tailored to the care facilities: (1) characteristics of residents and care facilities, (2) the care needs of residents, (3) the way care was organised, (4) the specific barriers and drivers for participating in programmes, (5) number of hours and settings for screening programmes. CONCLUSION To increase the participation of people living in psychiatric care facilities in screening programmes, future programmes should be tailored to the identified needs and barriers experienced by the residential care staff.
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Watanabe H, Anezaki H, Kazawa K, Tamaki Y, Hashimoto H, Moriyama M. Long-term effectiveness of a disease management program to prevent diabetic nephropathy: a propensity score matching analysis using administrative data in Japan. BMC Endocr Disord 2022; 22:135. [PMID: 35596152 PMCID: PMC9123750 DOI: 10.1186/s12902-022-01040-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Existing reviews indicated that disease management for patients with diabetes may be effective in achieving better health outcomes with less resource utilization in the short term. However, the long-term results were inconsistent because of the heterogeneous nature of the study designs. In the present study, we evaluated the 5-year follow-up results of a local disease management program focused on diabetic nephropathy prevention under the universal public health insurance scheme in Japan. METHODS Patients diagnosed with type 2 diabetes who had stage 3 or 4 diabetic kidney disease and were aged between 20 and 75 years were invited to join a disease management program to support self-management and receive a recommended treatment protocol between 2011 and 2013. Follow-up data were collected from an electronic claims database for the public insurance scheme. Considering the non-random selection process, we prepared two control groups matched by estimated propensity scores to compare the incidence of diabetes-related complications, death, and resource utilization. RESULTS The treatment group was more likely to receive clinical management in accordance with the guideline-recommended medication. After propensity score matching, the treatment group had lower incidence of diabetic nephropathy and emergency care use than the control group selected from a beneficiary pool mainly under primary care. Comparisons between the treatment group and the control group with more selected clinical conditions did not show differences in the incidence rate and resource utilization. CONCLUSIONS The present results demonstrated limited effectiveness of the program for reducing complication incidence and resource utilization during the 5-year follow-up. Further research on the long-term effectiveness of co-management by primary care physicians, subspecialists in endocrinology and nephrology, and nurse educators is required for effective management of diabetes-related nephropathy.
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Affiliation(s)
- Hirohito Watanabe
- Chronic Care and Family Nursing, Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8553, Japan
- Group Business Development Division, Hankyu Hanshin Holdings Inc, Osaka, Japan
| | - Hisataka Anezaki
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kana Kazawa
- Chronic Care and Family Nursing, Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Yuya Tamaki
- Chronic Care and Family Nursing, Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Hideki Hashimoto
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Michiko Moriyama
- Chronic Care and Family Nursing, Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8553, Japan.
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Luciani M, Fabrizi D, Rebora P, Rossi E, Di Mauro S, Kohl Malone S, Ausili D. Self-care in People with Type 2 Diabetes Mellitus Research Protocol of a Multicenter Mixed Methods Study (SCUDO). PROFESSIONI INFERMIERISTICHE 2019; 72:203-12. [PMID: 31884779 DOI: 10.7429/pi.2019.723203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
About 11% of the adult global populations is estimated to be living with type 2 diabetes mellitus (T2DM) by 2040. T2DM requires people to make decisions regarding complex therapeutic regimes, to maintain their well-being and quality of life, to manage symptoms and to reduce disease complications. All these behaviours, requiring knowledge, motivation, experience, and skills, have been referred to the concept of self-care. The intricacy and multidimensionality of T2DM self-care requires a complex approach to its overall comprehension. This Embedded Mixed Method study aims to investigate the experience of self-care in Type 2 Diabetes Mellitus adult patients. It comprises a prospective observational design, and an interpretive description. Quantitative data will be collected with validated questionnaires from 300 patients at baseline and once a year for two years on: diabetes self-care, quality of life, diabetes related distress, and sleep quality. Socio-demographic and clinical data will be collected from medical records. Qualitative data will be collected using semi-structured interviews on circa 10-20 patients, at baseline and once a year for two years, analysed according to interpretive description. Quantitative and qualitative data will be analysed separately and then merged and interpreted. This study will expand our understanding of self-care in people with T2DM. The expected outcome will be a better understanding of the effect of self-care on glycaemic control and therefore clinical outcomes and costs.
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Affiliation(s)
- Michela Luciani
- RN, MSc, PhD. Università di Milano – Bicocca, Dipartimento di Medicina e
Chirurgia. Monza, Italy
| | - Diletta Fabrizi
- RN, MSc, PhDs. Università di Milano – Bicocca, Dipartimento di Medicina e Chirurgia. Monza, Italy. Corrispondence e-mail:
| | - Paola Rebora
- PhD. Università di Milano Bicocca, Centro di Biostatistica ed Epidemiologia Clinica, Dipartimento di Medicina e Chirurgia. Monza, Italy
| | - Emanuela Rossi
- PhD. Università di Milano Bicocca, Centro di Biostatistica ed Epidemiologia Clinica, Dipartimento di Medicina e Chirurgia. Monza, Italy
| | - Stefania Di Mauro
- RN, MSc. Università di Milano – Bicocca, Dipartimento di Medicina e Chirurgia. Monza, Italy
| | - Susan Kohl Malone
- PhD. New York University, Rory Meyers College of Nursing. New York, USA
| | - Davide Ausili
- RN, MSc, PhD. Università di Milano – Bicocca, Dipartimento di Medicina e Chirurgia. Monza, Italy
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Pasquel FJ, Gregg EW, Ali MK. The Evolving Epidemiology of Atherosclerotic Cardiovascular Disease in People with Diabetes. Endocrinol Metab Clin North Am 2018; 47:1-32. [PMID: 29407046 DOI: 10.1016/j.ecl.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is a leading global cause of death and accounts for most deaths among individuals with diabetes. This article reviews the latest observational and trial data on changes in the relationship between diabetes and ASCVD risk, remaining gaps in how the role of each risk factor is understood, and current knowledge about specific interventions. Differences between high-income countries and low-income and middle-income countries are examined, barriers and facilitators are discussed, and a discussion around the concept of ideal cardiovascular health factors (Life's Simple 7) is focused on.
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Affiliation(s)
- Francisco J Pasquel
- Division of Endocrinology, Emory University School of Medicine, 69 Jesse Hill Jr. Drive Southeast, Atlanta, GA 30303, USA.
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-75, Atlanta, GA 30341, USA
| | - Mohammed K Ali
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-75, Atlanta, GA 30341, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA; Department of Family and Preventive Medicine, Emory University School of Medicine, 4500 North Shallowford Road, Suite B, Atlanta, GA 30338, USA
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Li YB, Wu Q, Liu J, Fan YZ, Yu KF, Cai Y. miR‑199a‑3p is involved in the pathogenesis and progression of diabetic neuropathy through downregulation of SerpinE2. Mol Med Rep 2017; 16:2417-2424. [PMID: 28677735 PMCID: PMC5547973 DOI: 10.3892/mmr.2017.6874] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 04/04/2017] [Indexed: 12/28/2022] Open
Abstract
The present study aimed to investigate the expression status of miRNA‑199a‑3p in patients with diabetic neuropathy (DN) and the mechanism by which this miRNA is involved in the genesis of DN. The expression of miRNA‑199a‑3p in plasma of peripheral blood was compared between patients with diabetes and a family history of diabetes and control volunteers by reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR); in 60 diabetes patients, 45 (75%) demosntrated upregulated miR‑199a‑3p expression compared with control volunteer plasma. RT‑qPCR was also used to detect miRNA‑199a‑3p expression in paired lower limb skin tissues from 30 patients with DN and 20 control volunteers; miR‑199a‑3p expression in patients with DN was significantly higher than in the control group. Next miR‑199a‑3p expression levels were evaluated with respect to the clinic‑pathological parameters of diabetes; increased expression of miR‑199a‑3p was significantly associated with increased disease duration (P=0.041), glycated hemoglobin (HbA1C) levels (P=0.033), and fibrinogen levels (P=0.003). Finally, the effects on downstream mRNA expression levels were investigated as a result of manipulating miR‑199a‑3p levels. miR‑199a‑3p overexpression inhibited the expression of the extracellular serine protease inhibitor E2 (SerpinE2). Therefore, it may be hypothesized that miR‑199a‑3p can induce DN via promoting coagulation in skin peripheral circulation, through the downregulation of SerpinE2. The present findings suggested that miR‑199a‑3p may have potential as a novel therapeutic target for the treatment of patients with DN.
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Affiliation(s)
- Ying-Bo Li
- Department of Pain Management, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, P.R. China
| | - Qun Wu
- Department of Pain Management, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, P.R. China
| | - Jie Liu
- Department of Pathology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, P.R. China
| | - Yong-Zhi Fan
- Department of Pain Management, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, P.R. China
| | - Kai-Feng Yu
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, P.R. China
| | - Yi Cai
- Department of Pain Management, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, P.R. China
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Micheletti JM, Hendrick AM, Khan FN, Ziemer DC, Pasquel FJ. Current and Next Generation Portable Screening Devices for Diabetic Retinopathy. J Diabetes Sci Technol 2016; 10:295-300. [PMID: 26888973 PMCID: PMC4773980 DOI: 10.1177/1932296816629158] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Diabetic retinopathy (DR) is the leading cause of legal blindness in the United States, and with the growing epidemic of diabetes, a global increase in the incidence of DR is inevitable, so it is of utmost importance to identify the most cost-effective tools for DR screening. Emerging technology may provide advancements to offset the burden of care, simplify the process, and provide financially responsible methods to safely and effectively optimize care for patients with diabetes mellitus (DM). We review here currently available technology, both in production and under development, for DR screening. Preliminary results of smartphone-based devices, "all-in-one" devices, and alternative technologies are encouraging, but are largely pending verification of utility when used by nonophthalmic personnel. Further research comparing these devices to current nonportable telemedicine strategies and clinical fundus examination is necessary to validate these techniques and to potentially overcome the poor compliance around the globe of current strategies for DR screening.
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Affiliation(s)
- J Morgan Micheletti
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew M Hendrick
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Farah N Khan
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - David C Ziemer
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Francisco J Pasquel
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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