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La Grotta R, Pellegrini V, Prattichizzo F, Amata O, Panella L, Frizziero A, Visconti M, Averame G, Brasesco PC, Calabrese I, Vaccaro O, Ceriello A. Feasibility of a Type 2 Diabetes Prevention Program at Nationwide Level in General Practice: A Pilot Study in Italy. J Clin Med 2024; 13:1127. [PMID: 38398440 PMCID: PMC10888610 DOI: 10.3390/jcm13041127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Lifestyle interventions halt the progression of prediabetes to frank type 2 diabetes (T2D). However, the feasibility of a diabetes prevention program promoting tailored interventions on a national scale and conducted by primary care physicians is unclear. METHODS General practitioners located in ten different regions throughout Italy enrolled random subjects without known metabolic diseases to identify individuals with prediabetes and prescribe them an intervention based on physical activity. Using a simple stepwise approach, people referring to their primary care physician for any reason were screened for their diabetes risk with a web-based app of the Findrisc questionnaire. Those at risk for T2D, i.e., with a Findrisc score >9, were invited to come back after overnight fasting to measure fasting glycaemia (FG). Those with 100 ≤ FG < 126 mg/dL were considered as people with prediabetes and compiled the Physical Activity Readiness Questionnaire (PAR-Q) to then receive a personalised prescription of physical activity. RESULTS Overall, 5928 people were enrolled and compiled the questionnaire. Of these, 2895 (48.8%) were at risk for T2D. Among these, FG was measured in 2168 subjects (participation rate 75%). The numbers of individuals with undetected prediabetes and T2D according to FG were 755 and 79 (34.8% and 3.6% of those assessing FG), respectively. Of the 755 subjects in the prediabetes range, 739 compiled the PAR-Q and started a personalised program of physical activity (participation rate 97%). Physicians involved in the study reported a mean of 6 min to perform the screening. CONCLUSIONS Overall, these data suggest the feasibility of a national diabetes prevention program developed by general practitioners using a simple stepwise approach starting from a web app to intercept individuals with prediabetes.
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Affiliation(s)
- Rosalba La Grotta
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Via Fantoli 16/15, 20138 Milan, Italy
| | - Valeria Pellegrini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Via Fantoli 16/15, 20138 Milan, Italy
| | - Francesco Prattichizzo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Via Fantoli 16/15, 20138 Milan, Italy
| | - Oriana Amata
- Department of Rehabilitation, Azienda Socio Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Lorenzo Panella
- Department of Rehabilitation, Azienda Socio Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Antonio Frizziero
- Department of Rehabilitation, Azienda Socio Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Marco Visconti
- Consorzio Sanità (Co.S.), Via Marconi 3, 26015 Soresina, Italy
| | - Gabriella Averame
- Consorzio Sanità (Co.S.), Via Marconi 3, 26015 Soresina, Italy
- Medicoopliguria, Via Peschiera 33, 16121 Genova, Italy
| | - Pier Claudio Brasesco
- Consorzio Sanità (Co.S.), Via Marconi 3, 26015 Soresina, Italy
- Medicoopliguria, Via Peschiera 33, 16121 Genova, Italy
| | - Ilaria Calabrese
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Antonio Ceriello
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Via Fantoli 16/15, 20138 Milan, Italy
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Jerene D, Muleta C, Ahmed A, Tarekegn G, Haile T, Bedru A, Gebhard A, Wares F. High rates of undiagnosed diabetes mellitus among patients with active tuberculosis in Addis Ababa, Ethiopia. J Clin Tuberc Other Mycobact Dis 2022; 27:100306. [PMID: 35284658 PMCID: PMC8904591 DOI: 10.1016/j.jctube.2022.100306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Tuberculosis (TB) and diabetes mellitus (DM) have negative synergistic impact on each other. Global guidelines recommend collaborative efforts to address this synergy, but implementation has been slow. Part of the reason is lack of adequate evidence on the operational feasibility of existing tools and mechanisms of collaboration. The objective of this study was to assess the yield of DM screening among TB patients using risk scoring tools combined with blood tests as a feasible strategy for early detection to improve TB/DM treatment outcomes. Methods Between September 2020 and December 2021, we conducted a cross-sectional study among patients receiving TB treatment in public health facilities in Addis Ababa, Ethiopia. Trained health workers collected data on symptoms and risk scoring checklists before testing for random and fasting blood glucose levels. We used logistic regression analyses techniques to determine factors associated with increased DM detection. A receiver-operating characteristic curve was constructed to determine the performance of the risk scoring checklist. Results Of 2381 TB patients screened, 197 (8.3%) had DM of which 48.7% were newly diagnosed. Having a family history of DM predicted DM with Odds Ratio (OR) of 5.36 (95% Confidence Interval, [3.67, 7.83]) followed by age ≥ 45 years (OR = 4.64, [3.18, 6.76]). Having one or more “symptoms” of DM was a significant predictor (OR 2.88, 95% CI, 2.06–4.01). Combining risk scores with symptoms predicted DM diagnosis with sensitivity of 94.7%, but specificity was low at 29.4%. In patients with known treatment outcome status, death rate was high. Conclusions Almost a half of TB patients with DM did not know their status. A simple tool that combined risk factors with symptoms accurately predicted a subsequent diagnosis of DM. Such tools can help avoid high rates of death among TB patients suffering from DM through early detection.
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Affiliation(s)
- Degu Jerene
- KNCV Tuberculosis Foundation, Technical Division, The Hague, Netherlands
- Corresponding author at: KNCV Tuberculosis Foundation, Maanweg 174, 2516 AB Den Haag, Netherlands.
| | - Chaltu Muleta
- KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Abdurezak Ahmed
- Addis Ababa University, Black Lion Specialized Hospital, Department of Internal Medicine, Diabetic Clinic, Addis Ababa, Ethiopia
| | - Getahun Tarekegn
- Addis Ababa University, Black Lion Specialized Hospital, Department of Internal Medicine, Diabetic Clinic, Addis Ababa, Ethiopia
| | - Tewodros Haile
- Addis Ababa University, College of Health Sciences and Tikur Anbessa Specialized Hospital, Department of Internal Medicine, Pulmonary and Critical Care Medicine Unit, Addis Ababa, Ethiopia
| | - Ahmed Bedru
- KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Agnes Gebhard
- KNCV Tuberculosis Foundation, Technical Division, The Hague, Netherlands
| | - Fraser Wares
- KNCV Tuberculosis Foundation, Technical Division, The Hague, Netherlands
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Francois ME, Oetsch KM. Prediabetes: Challenges, Novel Solutions, and Future Directions. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/21-00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Prediabetes: Prediabetes is a salient state of hyperglycaemia and/or hyperinsulinaemia that often precedes a diagnosis of Type 2 diabetes (T2D). It is projected that by 2040, almost 8% of the global population will have prediabetes, with approximately 70% progressing to T2D within their lifetime. Abnormal glucose tolerance increases the risk of associated complications, including cardiovascular disease, stroke, and microvascular diseases, all of which are major contributors to the global healthcare burden. T2D alone is predicted to cost the healthcare system upwards of 490 billion USD by 2030, thus addressing this growing burden is vital.
Challenge One. Diagnosis and classification: Diagnosis poses a challenge and there is debate between leading world expert panels regarding thresholds, notably between the World Health Organization (WHO) and American Diabetes Association (ADA) for impaired fasting glucose. Hyperinsulinaemia may also go undetected as this is not currently routinely tested or used as diagnostic criteria. This has been largely due to cost and lack of consensus data for appropriate diagnostic threshold; however, with disease burden costs estimated to be close to half a billion USD by the end of the decade, an in-depth cost analysis for benefits-costs of early detection and treatment or prevention is warranted.
Challenge Two. Health messaging and public perception: Prediabetes can revert to normoglycaemia with diet and lifestyle interventions. This, however, is not conveyed well in public health messaging. In addition to public perception about the likelihood of disease progression to T2D, prediabetes is not considered a disease state, which may also influence public perception regarding perceived urgency of treatment and necessity for intervention.
Challenge Three. Intervention and treatment: Diet and lifestyle interventions are heralded as best practice when it comes to prediabetes management, and metformin for those at greatest risk of future T2D. Synergistic use of the available novel and promising interventions including low carbohydrate diets, higher protein diets, time restricted feeding, and high intensity interval training may help time-poor individuals achieve improvements in risk-factors including weight loss and glycaemic control (HbA1c and fasting plasma glucose). As large-scale feasibility and adherence are major obstacles to contend with in the rollout of diet and lifestyle interventions, personalised approaches, coupled with counselling based on social cognitive theory, may be increasingly utilised to target specific groups and individuals as programmes can be tailored to meet specific needs and preferences.
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Affiliation(s)
- Monique E Francois
- School of Medicine, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Katie M Oetsch
- School of Medicine, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, Wollongong, Australia
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Brunetti P, Baldessin L, Pagliacci S. Prediabetes, undiagnosed diabetes and diabetes risk in Italy in 2017-2018: results from the first National screening campaign in community pharmacies. J Public Health (Oxf) 2021; 44:499-506. [PMID: 33837433 DOI: 10.1093/pubmed/fdab046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Effective policies for diabetes prevention remain urgent. We conducted a mass screening campaign in Italy to identify subjects potentially having undiagnosed diabetes, prediabetes or at diabetes risk. METHODS This cohort study was conducted in community pharmacies joining the unitary National federation of pharmacy holders (Federfarma) and participating in the 7-day screening campaign 'DiaDay' in 2017-2018. Capillary blood glucose levels and the risk of developing diabetes in 10 years (through the Finnish Diabetes Risk Score) were assessed. RESULTS 145 651 volunteers aged ≥20 years without known diabetes were screened at 5671 community pharmacies in 2017 and 116 097 at 5112 in 2018. Overall, 3.6% had glucose values suggestive of undiagnosed diabetes; under fasting conditions (N = 94 076), 39.9% and 16.4% had values suggestive of prediabetes by the American Diabetes Association and the World Health Organization criteria, respectively. Of those without diabetes (N = 252 440), 19.2% had scores compatible with a high risk (1:3) and 2.7% with a very high risk (1:2) of developing the disease; in the prediabetes group, the risk rose with higher impaired fasting glucose values. CONCLUSIONS DiaDay, the first National screening campaign, highlights the need to screen the population and the key role of the pharmacist both in screening activities and education promotion.
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Affiliation(s)
- P Brunetti
- Department of Internal Medicine, University of Perugia, 06123 Perugia, Italy
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