Managing Diabetes and Dementia

Effects of multidisciplinary teamwork in non-hospital settings on healthcare and patients with chronic conditions: a systematic review and meta-analysis

BACKGROUND

There is evidence that multidisciplinary teams can improve health outcomes for patients with chronic conditions, enhance the quality and coordination of care, and promote teamwork among staff in hospital settings. However, their effectiveness in non-hospital settings remains unclear. Therefore, we conducted a systematic review and meta-analysis to assess the effects of multidisciplinary teams on patients with chronic conditions, health professionals, and healthcare in non-hospital settings.

METHODS

We searched PubMed, Web of Science, Embase, EconLit, OpenGrey, China National Knowledge Infrastructure (CNKI), and WanFang for randomised controlled trials published before March 2025. Narrative syntheses were used to synthesise the characteristics of multidisciplinary teams, interventions, and effects. Data were statistically pooled using both random-effects and fixed-effects meta-analyses to synthesize the outcomes. The methodological quality of the included studies was assessed using Cochrane's risk of bias tool.

RESULTS

Thirty-nine studies were analyzed, with a total of 8186 participants. Nurses, general practitioners, and specialists were the most common members of the multidisciplinary teams. Staffing models, shared care and role expansion or task shifting are the most common multidisciplinary teamwork interventions. Narrative syntheses revealed improvements in self-management, self-efficiency, satisfaction, health behaviours, and knowledge. A meta-analysis found a significant reduction in hospitalisation days for patients with chronic obstructive pulmonary disease (MD=-0.66, 95% CI -1.05 to -0.26, I2 = 0%) and significant improvement in quality of life for patients with chronic heart failure (MD=-4.63, 95% CI: -8.67 to -0.60, I2 = 0%). There is no consistent evidence of other indicators of this effect.

CONCLUSIONS

Multidisciplinary teamwork can improve patient-reported outcomes for patients with chronic conditions in non-hospital settings, but the effects on clinical outcomes, health utilisation, and costs are not evident.

TRIAL REGISTRATION

The study protocol was registered with PROSPERO on January 21, 2019, with the registration number CRD42019121109.

Type 2 diabetes is associated with increased risk of dementia, but not mild cognitive impairment: a cross-sectional study among the elderly in Chinese communities

Background: Previous studies have confirmed that diabetes is associated with cognitive impairment, but there is little data on this among older Chinese. Methods: This study included 192 dementia patients, 610 patients with mild cognitive impairment (MCI), and 2,218 normal controls. Their general demographic information (such as gender, age, education, etc.), disease-related information (hypertension), and diabetes information (such as whether you have diabetes, course of the disease, etc) were collected by standardized questionnaires. The mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to assess their overall cognitive function, Moreover, 84 healthy, randomly selected older adults also underwent brain MRI scans at the same time, and the target brain regions included the hippocampus, the third, fourth, and fifth ventricles. Results: The proportion of type 2 diabetes was significantly higher in the dementia group (25.5%) than that in the normal elderly group (15.6%) and the MCI group (17.7%). By using stepwise multiple logistics regression analysis, we found that type 2 diabetes was associated with dementia (p = 0.005*, OR = 1.805, 95%CI: 1.199-2.761), but not with MCI (p > 0.05). The volume of the fourth ventricle of the healthy elderly with diabetes was significantly larger than that of the healthy elderly without diabetes (p < 0.05), but there was no statistical difference (p > 0.05) in the volume of the hippocampus, the third ventricle, and the fifth ventricle between the two groups. However, we did not find an association between the fourth ventricle and cognitive scores (MMSE and MoCA). Conclusions: In conclusion, type 2 diabetes in elderly Chinese people is associated with dementia, but not MCI. Type 2 diabetes may impair cognitive function by affecting the volume of the fourth ventricle. However, larger longitudinal follow-up studies are needed to confirm these conclusions.

Alzheimer's disease in elderly COVID-19 patients: potential mechanisms and preventive measures

Advanced age correlates with higher morbidity and mortality among patients affected with the novel coronavirus disease 2019 (COVID-19). Because systemic inflammation and neurological symptoms are also common in severe COVID-19 cases, there is concern that COVID-19 may lead to neurodegenerative conditions such as Alzheimer’s disease (AD). In this review, we summarize possible mechanisms by which infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, may cause AD in elderly COVID-19 patients and describe preventive measures to mitigate risk. Potential mechanisms include NLRP3 inflammasome activation and IL-1β release, renin-angiotensin system hyperactivation, innate immune activation, oxidative stress, direct viral infection, and direct cytolytic β-cell damage. Anti-inflammatory therapies, including TNF-α inhibitors and nonsteroidal anti-inflammatory drugs, antioxidants such as the vitamin E family, nutritional intervention, physical activity, blood glucose control, and vaccination are proposed as preventive measures to minimize AD risk in COVID-19 patients. Since several risk factors for AD may converge during severe SARS-CoV-2 infection, neurologists should be alert for potential symptoms of AD and actively implement preventive measures in patients presenting with neuropsychiatric symptoms and in high-risk patients such as the elderly.