Comparative effectiveness of team-based care with a clinical decision support system versus team-based care alone on cardiovascular risk reduction among patients with diabetes: Rationale and design of the D4C trial

Validation of a Slovenian version of the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ) for use with patients in family medicine

BACKGROUND

Chronic non-communicable diseases are the world's leading cause of death and disability. The emerging field of lifestyle medicine requires equipping healthcare professionals with instruments, knowledge, skills and competencies. Measuring an individual's lifestyle with a valid and reliable instrument is the first step in promoting it. The aim of the study was to validate the Slovenian adaptation of the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ).

METHODS

A cross-sectional study was conducted among 666 questionnaire participants, and they were adult participants (aged 18 and above) from family medicine practices with cardiovascular diseases (CVDs) risk factors (e.g., hypertension, high cholesterol) but without a diagnosis of acute CVDs. The questionnaire included demographic data and anthropological measures and a translated English HLPCQ questionnaire. The instrument was translated using the forward-backwards translation method. The study was conducted in accordance with the principles of the World Medical Association Declaration of Helsinki. In addition to assessing the construct validity of the questionnaire, exploratory and confirmatory factor analyses were used to determine content and face validity, and internal consistency reliability.

RESULTS

The mean age of male participants was 41.34 (± 13.220) years, the mean age of female participants was 40.31 (± 11.905) years. The Cronbach's alpha was 0.852, and all questionnaire subscales had positive correlations. Sampling adequacy was confirmed by the Kaiser-Meyer-Olkin (KMO) index (0.851), and Bartlett's test of sphericity was significant (χ² = 4647.694, p < 0.001), indicating suitability for Principal Component Analysis (PCA). PCA revealed a five-factor solution, accounting for 50.67% of the total variance.

CONCLUSIONS

The most influential factors for a healthy lifestyle were daily routine, healthy dietary choices, avoidance of harmful dietary habits, organized physical activity, and social and mental balance. The Slovenian version had high factor validity and reliability. It can be used in Slovenian Community Health Centre to assess an individual's control over various lifestyle dimensions. The instrument also holds potential for use in public health initiatives, supporting early identification of lifestyle-related risk factors and promoting preventive care strategies in the primary care setting.

Impact of community public health care on treatment effect, health cognition, and self-management in patients with type 2 diabetes

BACKGROUND

At present, China has become the country with the largest number of individuals with diabetes mellitus (DM) in the world, with a total of approximately 140 million patients, the majority of whom have type 2 DM (T2DM). Based on conventional nursing methods, community home care has important clinical significance in controlling blood sugar and disease progression.

AIM

To explore the impact of community public health nursing on treatment effect, health cognition, and self-management in patients with T2DM.

METHODS

One hundred patients with T2DM were selected as the research subjects. The patients were divided into either a conventional nursing group or community nursing (CN) group using the random number table method. The conventional nursing group (50 cases) received routine care, while the CN group (50 cases) received community public health care in addition to routine care as that for the conventional nursing group. The rate of excellent and good blood glucose control, fasting blood glucose before and after care, 2-h postprandial blood glucose, health cognition, and self-management ability, and patient satisfaction were compared between the two groups.

RESULTS

The CN group had a higher rate of excellent blood sugar control than the conventional nursing group (88% vs 70%, P < 0.05). Before care, there was no significant difference in fasting blood glucose or 2-h postprandial blood glucose between the two groups of patients (P > 0.05). After nursing, fasting blood glucose and 2-h postprandial blood glucose were reduced to varying degrees in both groups, and both blood glucose levels in the CN group were lower than those of the conventional nursing group (P < 0.05). Compared with the scores before care, the cognitive level score for diabetes and self-management ability score improved after care in both groups. The cognitive level and self-management ability of patients in the CN group were higher than those of the conventional nursing group (P < 0.05). The overall satisfaction of the CN group was better than that of the conventional nursing group (98% vs 86%, P < 0.05).

CONCLUSION

Community public health care based on conventional care of T2DM can achieve better blood sugar control, and improve patients' health cognitive level and self-management ability.

Team-Based Approach to Reduce Malignancies in People with Diabetes and Obesity

PURPOSE OF REVIEW

Numerous observations have indicated an increased risk of developing various types of cancers, as well as cancer-related mortality, among patients with diabetes and obesity. The purpose of this review is to outline multiple-cancer screening among these patients through a team-based approach and to present the findings of a pioneering integrated care program designed for patients with obesity with a specific emphasis on cancer prevention.

RECENT FINDINGS

A community-based multi-cancer prevention program, which provides all services in one location and utilizes team-based approaches, is reported to be feasible and has the potential to enhance the uptake rate of multiple cancers screening among patients with diabetes and obesity. The team-based approach is a commonly utilized method for managing patients with diabetes, obesity, and cancer, and has been shown to be efficacious. Nevertheless, research on team-based cancer screening programs for patients with diabetes and obesity remains limited. Providing a comprehensive screening for colorectal, prostate, and breast cancer, as well as metabolic syndrome, during a single clinic visit has been proven effective and well-received by participants.

Comparative Effectiveness of Team-Based Care With and Without a Clinical Decision Support System for Diabetes Management : A Cluster Randomized Trial

BACKGROUND

Uncontrolled hyperglycemia, hypercholesterolemia, and hypertension are common in persons with diabetes.

OBJECTIVE

To compare the effectiveness of team-based care with and without a clinical decision support system (CDSS) in controlling glycemia, lipids, and blood pressure (BP) among patients with type 2 diabetes.

DESIGN

Cluster randomized trial. (ClinicalTrials.gov: NCT02835287).

SETTING

38 community health centers in Xiamen, China.

PATIENTS

11 132 persons aged 50 years or older with uncontrolled diabetes and comorbid conditions, 5475 receiving team-based care with a CDSS and 5657 receiving team-based care alone.

INTERVENTION

Team-based care was delivered by primary care physicians, health coaches, and diabetes specialists in all centers. In addition, a computerized CDSS, which generated individualized treatment recommendations based on clinical guidelines, was implemented in 19 centers delivering team-based care with a CDSS.

MEASUREMENTS

Coprimary outcomes were mean reductions in hemoglobin A_1c (HbA_1c) level, low-density lipoprotein cholesterol (LDL-C) level, and systolic BP over 18 months and the proportion of participants with all 3 risk factors controlled at 18 months.

RESULTS

During the 18-month intervention, HbA_1c levels, LDL-C levels, and systolic BP significantly decreased by -0.9 percentage point (95% CI, -0.9 to -0.8 percentage point), -0.49 mmol/L (CI, -0.53 to -0.45 mmol/L) (-19.0 mg/dL [CI, -20.4 to -17.5 mg/dL]), and -9.1 mm Hg (CI, -9.9 to -8.3 mm Hg), respectively, in team-based care with a CDSS and by -0.6 percentage point (CI, -0.7 to -0.5 percentage point), -0.32 mmol/L (CI, -0.35 to -0.29 mmol/L) (-12.5 mg/dL [CI, -13.6 to -11.3 mg/dL]), and -7.5 mm Hg (CI, -8.4 to -6.6 mm Hg), respectively, in team-based care alone. Net differences were -0.2 percentage point (CI, -0.3 to -0.1 percentage point) for HbA_1c level, -0.17 mmol/L (CI, -0.21 to -0.12 mmol/L) (-6.5 mg/dL [CI, -8.3 to -4.6 mg/dL]) for LDL-C level, and -1.5 mm Hg (CI, -2.8 to -0.3 mm Hg) for systolic BP. The proportion of patients with controlled HbA_1c, LDL-C, and systolic BP was 16.9% (CI, 15.7% to 18.2%) in team-based care with a CDSS and 13.0% (CI, 11.7% to 14.3%) in team-based care alone.

LIMITATION

There was no usual care control, and clinical outcome assessors were unblinded; the analysis did not account for multiple comparisons.

CONCLUSION

Compared with team-based care alone, team-based care with a CDSS significantly reduced cardiovascular risk factors in patients with diabetes, but the effect was modest.

PRIMARY FUNDING SOURCE

Xiamen Municipal Health Commission.

Targeting Trimethylamine N-Oxide: A New Therapeutic Strategy for Alleviating Atherosclerosis

Atherosclerosis (AS) is one of the most common cardiovascular diseases (CVDs), and there is currently no effective drug to reverse its pathogenesis. Trimethylamine N-oxide (TMAO) is a metabolite of the gut flora with the potential to act as a new risk factor for CVD. Many studies have shown that TMAO is involved in the occurrence and development of atherosclerotic diseases through various mechanisms; however, the targeted therapy for TMAO remains controversial. This article summarizes the vital progress made in relation to evaluations on TMAO and AS in recent years and highlights novel probable approaches for the prevention and treatment of AS.