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Chowdhury HA, Joham AE, Kabir A, Rahman AKMF, Ali L, Harrison CL, Billah B. Exploring type 2 diabetes self-management practices in rural Bangladesh: facilitators, barriers and expectations-a qualitative study protocol. BMJ Open 2024; 14:e081385. [PMID: 38697759 PMCID: PMC11086285 DOI: 10.1136/bmjopen-2023-081385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a global public health crisis impacting low-income and middle-income countries such as Bangladesh. While self-management is encouraged for individuals with T2DM, there is a significant lack of knowledge regarding the factors of facilitators, barriers and expectations associated with T2DM self-management in Bangladesh. This research aims to investigate the potential elements that support, impede and are anticipated in the effective practice of self-management for T2DM in rural areas of Bangladesh. METHODS AND ANALYSIS This study will use an exploratory qualitative approach. 16 focus group discussions, 13 in-depth interviews and 9 key informant interviews will be conducted among multilevel stakeholders, including people with T2DM, their caregivers, healthcare providers, health managers/administrators and policy planners. Interviews will be audio-recorded, transcribed, translated and analysed using thematic analysis. ETHICS AND DISSEMINATION This research project has been approved by the Monash University Human Research Ethics Committee (project reference number: 39483) and the Ethical Review Committee of the Centre for Injury Prevention and Research, Bangladesh (Memo: CIPRB/ERC/2023/14). Research findings will be disseminated in peer-reviewed journals and conference presentations. Published reports will include group data. Individual data privacy will be strictly maintained.
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Affiliation(s)
- Hasina Akhter Chowdhury
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Anju E Joham
- Monash Centre for Health Research and Implementation-MCHRI, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
- Department of Diabetes, Monash University, Melbourne, Victoria, Australia
| | - Ashraful Kabir
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - A K M Fazlur Rahman
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Liaquat Ali
- Pothikrit Institute of Health Studies (PIHS), Dhaka, Bangladesh
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation-MCHRI, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Baki Billah
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Huang X, He Y, Xu H, Shen Y, Pan X, Wu J, Chen K. Association between sociodemographic status and the T2DM-related risks in China: implication for reducing T2DM disease burden. Front Public Health 2024; 11:1297203. [PMID: 38259760 PMCID: PMC10801005 DOI: 10.3389/fpubh.2023.1297203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024] Open
Abstract
Objective Analyzing the association between sociodemographic status and the type 2 diabetes mellitus (T2DM)-related risks in China to reduce the disease burden of T2DM. Methods We downloaded data from the Global Burden of Disease Study 2019 to estimate the disease burden of T2DM in China. Secondary analyses were performed by year, age, gender, summary exposure value (SEV), and sociodemographic index (SDI). Results In China, it is estimated that 3.74 (3.44-4.10) million incidence, 90.0 (82.3-98.5) million prevalence, 168.4 (143.2-194.0) thousand deaths, and 9.6 (7.6-11.9) million DALYs occurred in 2019, showing an increase of 96.8, 156.7, 162.8, and 145.4% compared to 1990. An inverse U-shaped curve was observed for the correlations between T2DM-related burden and SDI. A heavier burden was found in males. The top four risk factors were high body mass index (HBMI), dietary risks, air pollution and tobacco. HBMI, as the key risk, accounted for half of the disease burden of T2DM in China. Lower degree of SEV and higher level of attributable T2DM-related burden could be found in main risks, meaning their critical role of them in the development and progression of T2DM. An inverse U-shaped curve could be found in the association between age-standardized incidence, mortality, DALYs rate, and SDI. Conclusion The disease burden of T2DM has rapidly increased in China. Gender disparities, different age distributions and inconsistent socioeconomic levels all played an important role in it. The key risk was HBMI. With the improvement of socioeconomic level, the main risk factors for T2DM have changed from environmental factors to lifestyle factors. Targeted control and preventative strategies to address adjustable risk factors could put an end to this soaring burden.
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Affiliation(s)
- Xin Huang
- Department of Endocrinology and Metabolism, Lishui Municipal Central Hospital, Lishui, China
| | - Yinhui He
- Department of Endocrinology and Metabolism, Lishui Municipal Central Hospital, Lishui, China
| | - Haiyan Xu
- Department of Endocrinology and Metabolism, Lishui Municipal Central Hospital, Lishui, China
| | - Yuyan Shen
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of ZheJiang University School of Medicine, Zhejiang, China
| | - Xiaowen Pan
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of ZheJiang University School of Medicine, Zhejiang, China
| | - Junyun Wu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of ZheJiang University School of Medicine, Zhejiang, China
| | - Kai Chen
- Department of Endocrinology and Metabolism, Lishui Municipal Central Hospital, Lishui, China
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Powell J, Mulani SR. Partnering for Better Health: Using Continuous Glucose Monitoring and Clinical Pharmacist Collaboration to Improve Glycemic Control in Underserved Patients With Type 2 Diabetes. Clin Ther 2024; 46:e7-e11. [PMID: 38165024 DOI: 10.1016/j.clinthera.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/08/2023] [Accepted: 10/08/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE The purpose of this study was to examine the effect of initiating use of a continuous glucose monitor (CGM) in patients being treated for type 2 diabetes mellitus, specifically those who face barriers to obtaining this device because of its cost. METHODS This retrospective medical record review compared diabetes control of patients before and after use of a CGM device within a single primary care office. Patient medical records were reviewed 18 months after initial CGM was provided, and only those who received a CGM directly from the clinic were included in the review. Statistical analysis comparing the difference in mean baseline glycosylated hemoglobin (HbA1c) level with the first HbA1c level after CGM placement was completed using the paired t test for the primary outcome. FINDINGS A total of 41 patients who obtained at least 1 CGM reader and a minimum of a 30-day supply of sensors from the clinic were included in the review. The primary outcome resulted in a significant reduction in the mean (SD) first HbA1c level after CGM placements of -1.9% (2.5%) (P < .001) with a total of 10 and 22 patients with an HbA1c level <7% and 8%, respectively. This mean (SD) reduction in HbA1c level was also seen in both insulin-treated patients (-1.8% [2.8%], n = 30) and non-insulin-treated patients (-2% [2.8%], n=11). The largest reduction in the first HbA1c level after CGM placement was seen in those patients provided a CGM along with collaborative care with a clinical pharmacist. These patients saw a mean (SD) decrease of -2.5% [2.7%] (n = 26) in their HbA1c level with a mean (SD) decrease of -0.8% (1.6%) (n = 15) for those not comanaged by the clinical pharmacist. IMPLICATIONS The results of this study suggest that the use of CGM in the underserved population can lead to a significant improvement in glycemic control in patients with diabetes, regardless of treatment therapies used. Involving a multidisciplinary team in diabetes management, including clinical pharmacists, may further improve outcomes. Access to these devices in the underserved population may be crucial in reducing the risk of developing complications related to uncontrolled diabetes.
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Affiliation(s)
- Jason Powell
- University of Florida College of Pharmacy, Gainesville, Florida; University of Florida College of Medicine, Gainesville, Florida.
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Liu Y, Jiang J, You W, Gong D, Ma X, Wu M, Li F. Exploring facilitators and barriers to self-management engagement of Chinese people with type 2 diabetes mellitus and poor blood glucose control: a descriptive qualitative study. BMC Endocr Disord 2022; 22:294. [PMID: 36435767 PMCID: PMC9701421 DOI: 10.1186/s12902-022-01214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS To explore facilitators and barriers to self-management engagement of Chinese people with poorly controlled type 2 diabetes. METHODS Purposive sampling method was used for recruitment. Semi-structured interview and thematic analysis was used for data collection and analysis. RESULTS Twenty-six semi-structured interviews were conducted. Poor blood glucose control introduced awareness of susceptibility to complications, while mental disorders could be concomitant. General knowledge about healthy lifestyle and unhealthy habits impeded lifestyle management. Temporary remission of hyperglycemia and no perceived symptoms interfered engagement of medication therapy and regular blood glucose monitoring. Family and work environments could impact self-management engagement. Accessibility to reliable diabetes-related information influenced self-management engagement. CONCLUSIONS Awareness of susceptibility to complications motivated self-management engagement, while the awareness could cause mental disorders that need to be addressed. Customized lifestyle plans and behavior change technologies were crucial for lifestyle management. The progression of diabetes, importance of continuity of medication therapy, and the value of blood glucose monitoring should be clarified in diabetes education. Building diabetes-friendly social environments and providing reliable diabetes-related information were essential.
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Affiliation(s)
- Yuan Liu
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China.
| | - Jiajia Jiang
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China
| | - Wenjun You
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Dandan Gong
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Xiaoqing Ma
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Min Wu
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Feng Li
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
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Arterial Stiffness: Its Relation with Prediabetes and Metabolic Syndrome and Possible Pathogenesis. J Clin Med 2021; 10:jcm10153251. [PMID: 34362033 PMCID: PMC8348675 DOI: 10.3390/jcm10153251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/01/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022] Open
Abstract
Aims: To evaluate arterial stiffness indicators in people with prediabetes (PreD) and its possible pathogenesis. Materials and methods: Pulse wave velocity (PWV) was measured in 208 people with FINDRISC ≥ 13 (57 ± 8 years old, 68.7% women) and thereafter divided into those having either normal glucose tolerance (NGT) or PreD. In each subgroup we also identified those with/out insulin resistance (IR) measured by the triglyceride/HDL-c ratio (normal cut off values previously established in our population). Clinical and metabolic data were collected for all participants. PWV was compared between subgroups using independent t test. Results: Women and men had comparable clinical and metabolic characteristics with obesity (BMI ≥ 30) and antihypertensive-statin treatment, almost half with either NGT or PreD. Whereas 48% of NGT people presented IR (abnormally high TG/HDL-c ratio), 52% had PreD. PWV was significantly higher only in those with a complete picture of metabolic syndrome (MS). Conclusions: Since PWV was significantly impaired in people with a complete picture of MS, clinicians must carefully search for early diagnosis of this condition and prescribe a healthy life-style to prevent development/progression of CVD. This proactive attitude would provide a cost-effective preventive strategy to avoid CVD’s negative impact on patients’ quality of life and on health systems due to their higher care costs.
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Otieno FC, Mikhail T, Acharya K, Muga J, Ngugi N, Njenga E. Suboptimal glycemic control and prevalence of diabetes-related complications in Kenyan population with diabetes: cohort analysis of the seventh wave of the International Diabetes Management Practices Study (IDMPS). ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Chan JCN, Gagliardino JJ, Ilkova H, Lavalle F, Ramachandran A, Mbanya JC, Shestakova M, Dessapt-Baradez C, Chantelot JM, Aschner P. One in Seven Insulin-Treated Patients in Developing Countries Reported Poor Persistence with Insulin Therapy: Real World Evidence from the Cross-Sectional International Diabetes Management Practices Study (IDMPS). Adv Ther 2021; 38:3281-3298. [PMID: 33978906 PMCID: PMC8189989 DOI: 10.1007/s12325-021-01736-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Although poor adherence to insulin is widely recognised, periodic discontinuation of insulin may cause more severe hyperglycaemia than poor adherence. We assessed persistence with insulin therapy in patients with type 1 (T1D) or type 2 diabetes (T2D) in developing countries and the reasons for insulin discontinuation. METHODS The International Diabetes Management Practices Study collected real-world data from developing countries in seven waves between 2005 and 2017. In Wave 7 (2016-2017), we asked adult patients with T1D and insulin-treated T2D to report whether they had ever discontinued insulin, the estimated duration of discontinuation and underlying reasons. RESULTS Among 8303 patients recruited from 24 countries by 620 physicians, 4596 were insulin-treated (T1D: 2000; T2D: 2596). In patients with T1D, 14.0% (95% CI: 12.5-15.6) reported having self-discontinued insulin for a median duration of 1.0 month (IQR: 0.5, 3.5). The respective figures in patients with T2D were 13.7% (12.4-15.1) and 2.0 months (IQR: 1.0, 6.0). The main reasons for discontinuation were impact on social life (T1D: 41.0%; T2D: 30.5%), cost of medications and test strips (T1D: 34.4%; T2D: 24.5%), fear of hypoglycaemia (T1D: 26.7%; T2D: 28.0%) and lack of support (T1D: 26.4%; T2D: 25.9%). Other factors included age < 40 years, non-university education and short disease duration (T1D: ≤ 1 year; T2D: > 1-≤ 5 years). Patients with T1D who did not perform self-monitoring of blood glucose (SMBG) or self-adjust their insulin dosage, and patients with T1D or T2D without glucose meters were less likely to persist with insulin. Nearly 50% of patients who reported poor persistence had HbA1c > 75 mmol/mol (> 9%) and > 50% of physicians recommended diabetes education programmes to improve treatment persistence. CONCLUSION In developing countries, poor persistence with insulin is common among insulin-treated patients, supporting calls for urgent actions to ensure easy access to insulin, tools for SMBG and education.
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Affiliation(s)
- Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
| | - Juan José Gagliardino
- CENEXA, Center of Experimental and Applied Endocrinology (La Plata National University-La Plata National Scientific and Technical Research Council), La Plata, Argentina
| | - Hasan Ilkova
- Division of Endocrinology Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fernando Lavalle
- Facultad de Medicina de la Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Ambady Ramachandran
- India Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Jean Claude Mbanya
- Biotechnology Center, Doctoral School of Life Sciences, Health and Environment, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Marina Shestakova
- Endocrinology Research Center, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | | | - Pablo Aschner
- Javeriana University School of Medicine, Bogotá, Colombia
- San Ignacio University Hospital, Bogotá, Colombia
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Mbanya JC, Aschner P, Gagliardino JJ, İlkova H, Lavalle F, Ramachandran A, Chantelot JM, Chan JCN. Screening, prevalence, treatment and control of kidney disease in patients with type 1 and type 2 diabetes in low-to-middle-income countries (2005-2017): the International Diabetes Management Practices Study (IDMPS). Diabetologia 2021; 64:1246-1255. [PMID: 33594476 PMCID: PMC8099838 DOI: 10.1007/s00125-021-05406-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/11/2020] [Indexed: 01/13/2023]
Abstract
AIMS/HYPOTHESIS Diabetes is the leading cause of kidney disease worldwide. There is limited information on screening, treatment and control of kidney disease in patients with diabetes in low-to-middle-income countries (LMICs). METHODS The International Diabetes Management Practices Study is an ongoing, non-interventional study of clinical profiles and practices among patients receiving outpatient care mainly by internal medicine physicians and endocrinologists in LMICs. We examined screening, prevalence, treatment and control of kidney disease across seven waves (W) of data collection between 2005 and 2017. RESULTS Among 15,079 patients with type 1 and 66,088 patients with type 2 diabetes, screening for kidney disease increased between W2 and W3 followed by a plateau (type 1 diabetes: W2, 73.7%; W3, 84.1%; W7, 83.4%; type 2 diabetes: W2, 65.1%; W3, 82.6%; W7, 86.2%). There were also decreasing proportions of patients with microalbuminuria (type 1 diabetes: W1, 27.1%; W3, 14.7%; W7, 13.8%; type 2 diabetes: W1, 24.5%; W3, 12.6%; W7, 11.9%) and proteinuria (type 1 diabetes: W1, 14.2%; W3, 8.7%; W7, 8.2%; type 2 diabetes: W1, 15.6%; W3, 9.3%; W7, 7.6%). Fewer patients were reported as receiving dialysis for both type 1 diabetes (W2, 1.4%; W7, 0.3%) and type 2 diabetes (W2, 0.9%; W7, 0.2%) over time. While there was no change in mean HbA1c or prevalence of diagnosed hypertension (type 1 diabetes: W1, 22.7%; W7, 19.9%; type 2 diabetes: W1, 60.9%; W7, 66.2%), the use of statins had increased among patients diagnosed with dyslipidaemia (type 1 diabetes: W1, 77.7%; W7, 90.7%; type 2 diabetes: W1, 78.6%; W7, 94.7%). Angiotensin II receptor blockers (type 1 diabetes: W1, 18.0%; W7, 30.6%; type 2 diabetes: W1, 24.2%; W7, 43.6%) were increasingly used over ACE inhibitors after W1 (type 1 diabetes: W1, 65.0%; W7, 55.9%; type 2 diabetes: W1, 55.7%, W7, 41.1%) among patients diagnosed with hypertension. CONCLUSIONS/INTERPRETATION In LMICs, real-world data suggest improvement in screening and treatment for kidney disease in patients with type 1 and type 2 diabetes attending non-nephrology clinics. This was accompanied by decreasing proportions of patients with microalbuminuria and proteinuria, with fewer patients who reported receiving dialysis over a 12-year period.
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Affiliation(s)
- Jean Claude Mbanya
- Biotechnology Center, Doctoral School of Life Sciences, Health and Environment, University of Yaoundé I, Yaoundé, Cameroon.
- Department of Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Pablo Aschner
- Javeriana University School of Medicine, Bogotá, Colombia
- San Ignacio University Hospital, Bogotá, Colombia
| | - Juan J Gagliardino
- CENEXA (UNLP-CONICET-CEAS CICPBA), School of Medicine UNLP, La Plata, Argentina
| | | | - Fernando Lavalle
- Facultad de Medicina de la Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Ambady Ramachandran
- India Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | | | - Juliana C N Chan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Obesity and Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
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Aschner P, Gagliardino JJ, Ilkova H, Lavalle F, Ramachandran A, Mbanya JC, Shestakova M, Bourhis Y, Chantelot JM, Chan JCN. High Prevalence of Depressive Symptoms in Patients With Type 1 and Type 2 Diabetes in Developing Countries: Results From the International Diabetes Management Practices Study. Diabetes Care 2021; 44:1100-1107. [PMID: 33963019 PMCID: PMC8132319 DOI: 10.2337/dc20-2003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/19/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Depression is common in people with diabetes, but data from developing countries are scarce. We evaluated the prevalence and risk factors for depressive symptoms in patients with diabetes using data from the International Diabetes Management Practices Study (IDMPS). RESEARCH DESIGN AND METHODS IDMPS is an ongoing multinational, cross-sectional study investigating quality of care in patients with diabetes in real-world settings. Data from wave 5 (2011), including 21 countries, were analyzed using the 9-item Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Logistic regression analyses were conducted to identify risk factors of depressive symptoms. RESULTS Of 9,865 patients eligible for analysis, 2,280 had type 1 and 7,585 had type 2 diabetes (treatment: oral glucose-lowering drugs [OGLD] only, n = 4,729; OGLDs plus insulin, n = 1,892; insulin only, n = 964). Depressive symptoms (PHQ-9 score ≥5) were reported in 30.7% of those with type 1 diabetes. In patients with type 2 diabetes, the respective figures were 29.0% for OGLDs-only, 36.6% for OGLDs-plus-insulin, and 46.7% for insulin-only subgroups. Moderate depressive symptoms (PHQ-9 score 10-19) were observed in 8-16% of patients with type 1 or type 2 diabetes. Female sex, complications, and low socioeconomic status were independently associated with depressive symptoms. In type 1 diabetes and in the type 2 diabetes OGLDs-only group, depression was associated with poor glycemic control. CONCLUSIONS Depressive symptoms are common in patients with diabetes from developing countries, calling for routine screening, especially in high-risk groups, to reduce the double burden of diabetes and depression and their negative interaction.
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Affiliation(s)
- Pablo Aschner
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Juan José Gagliardino
- El Centro de Endocrinología Experimental y Aplicada (CENEXA) (UNLP-CONICET-CEAS CICPBA), Facultad de Ciencias Médicas, Universidad Nacional de La Plata (UNLP), La Plata, Buenos Aires, Argentina
| | - Hasan Ilkova
- Division of Endocrinology Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fernando Lavalle
- Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Ambady Ramachandran
- India Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Jean Claude Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | | | | | | | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Aschner P, Galstyan G, Yavuz DG, Litwak L, Gonzalez-Galvez G, Goldberg-Eliaschewitz F, Hafidh K, Djaballah K, Tu ST, Unnikrishnan AG, Khunti K. Glycemic Control and Prevention of Diabetic Complications in Low- and Middle-Income Countries: An Expert Opinion. Diabetes Ther 2021; 12:1491-1501. [PMID: 33840067 PMCID: PMC8099945 DOI: 10.1007/s13300-021-00997-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/06/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Trends on glycemic control and diabetes complications are known for high-income countries, but comprehensive data from low- and middle-income countries (LMIC) are lacking. METHODS This is an expert opinion based on two retrospective studies. Here we examine the recent subset analysis of relevant data from the IDMPS Wave 7 (International Diabetes Management-Practices Study, 2015-2016) and the GOAL study conducted in multiple LMICs. RESULTS Wave 7 sub-analysis was performed in 6113 people with type 2 diabetes from 24 LMIC. Poorly controlled diabetes (hemogloblin A1c [HbA1c] ≥ 7%) was found in 58.6, 73.0 and 78.3% of participants with diabetes duration of < 5, 5-12 and > 12 years, respectively (in association with a high prevalence of macro- and microvascular complications). Moreover, 37.7% of participants with diabetes duration of 5-12 years were treated only with oral antihyperglycemic drugs. The GOAL study investigated the efficacy of insulin in 2704 poorly controlled participants (mean HbA1c 9.7%; diabetes duration 10.1 ± 6.7 years; 10 LMIC). A significant 2% reduction in mean HbA1c levels was observed after 12 months of treatment. Only 7.2% of participants experienced a symptomatic episode of hypoglycemia (nocturnal or severe hypoglycemia events were infrequent). CONCLUSION The rate of well-controlled participants (HbA1c < 7.0%) in the Wave 7 sub-analysis was lower than that observed in the USA (NHANES survey) or in European countries (GUIDANCE study), and the incidence of microvascular complications was higher. The GOAL study showed that insulin treatment improves glycemic control and reduces this gap. The Expert Panel recommends intensifying diabetes treatment as soon as possible, as well as patients' education and other preventive measures, initiatives which require modest costs compared to hospitalization and treatment of diabetes complications.
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Affiliation(s)
- Pablo Aschner
- Javeriana University School of Medicine and San Ignacio University Hospital, Bogota, Colombia.
| | | | - Dilek G Yavuz
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
| | - Leon Litwak
- Endocrine, Metabolism and Nuclear Medicine Service, Diabetes Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | - Shih-Te Tu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
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AlKinani AA, Alkhrizi IM, Alkathiri SH, Alzubaidi HLA, Alghanmi AA, Alghanmi AM, Alnashri IA, B AAM. Diabetes Mellitus type 2: Management and follow up in Primary Health Care Center. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/mvmt9sdifp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Bridgwood BM, Wilson A, Clarke D, Eborall H. Understanding TIA: an ethnographic study of TIA consultations. Fam Pract 2020; 37:530-534. [PMID: 32016372 DOI: 10.1093/fampra/cmaa004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transient ischaemic attack (TIA) is a transient episode of neurological dysfunction. Rapid access TIA clinics have been set up as integrated 'one-stop' clinics that aim to investigate, diagnose, educate and implement treatment to reduce the risk of further TIA/stroke. OBJECTIVE This study aimed to examine how TIA consultations were conducted by observing the consultations and then interviewing patients. METHODS This ethnographic study observed fifteen patient-clinician consultations where a diagnosis of TIA was made within three different TIA outpatient clinics in the East Midlands. All fifteen patients, their accompanying family-members/carers and three stroke clinicians were interviewed. Data analysis was informed by the constant comparative approach. RESULTS There was considerable variation in the conduct of these consultations across sites and clinicians. This resulted in variation in patient experience and knowledge after the consultation including the ability to recognize TIA-associated risk factors and their management. As TIA symptoms resolve, patients may reduce their need to seek health care services in addition to demonstrating reduced concordance with secondary stroke prevention. Health professionals recognize that this single appointment provides patients with a large amount of information which may be difficult to process. Importantly, there was little discussion about future symptoms and how to respond. A management plan, which considered a patient's health belief, knowledge and encouraged the involvement of family members, improved information recall. CONCLUSIONS TIA is a complex medical diagnosis with multiple risk factors that may make the management complex and hence difficult for patients to undertake. Our findings found variability in the conduct, provision of information and patient understanding. Guidance on nationally agreed consultation framework may prove useful. Improved patient education may include individualized/sustained education utilizing multidisciplinary team members across family/primary and secondary care, video or greater online education and improved general public education.
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Affiliation(s)
| | - Andrew Wilson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - David Clarke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Helen Eborall
- Department of Health Sciences, University of Leicester, Leicester, UK
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Mbanya JC, Naidoo P, Kolawole BA, Tsymbal E, McMaster A, Karamchand S, Kaplan H, Rambiritch V, Cotton M, Malek R, Allen Distiller L, Leisegang RF. Management of adult patients with type 1 diabetes mellitus in Africa: A post-hoc cohort analysis of 12 African countries participating in the International Diabetes Management Practices Study (Wave 7). Medicine (Baltimore) 2020; 99:e20553. [PMID: 32569176 PMCID: PMC7310899 DOI: 10.1097/md.0000000000020553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There is a paucity of information on real world management of African adult patients with type 1 diabetes mellitus (T1DM). We aimed to describe a cohort of African adults with T1DM.The International Diabetes Management Practices Study is an observational survey conducted from 2005 to 2017. Data were collected in seven individual waves from countries in Asia, Africa, East Europe, and Latin America. Wave 7 was conducted from 2016 to 2017 and the African cohort included 12 countries. Questionnaires were administered to clinicians and patients. Analyses were mainly descriptive. Logistic regressions were performed to identify predictive factors for glycaemic control.A total of 788 patients were enrolled in the study. HbA1c values were available for 712 patients; only 16.6% had HbA1c values <7%. A total of 196 (24.9%) reported being hospitalized in the preceding year, with the most common reasons being diabetic ketoacidosis (58.1%, 93/160) and hypoglycaemia (31.1%; 52/167). Over half of the patients (55.4%) stated that the cost of test strips limited regular glycemic monitoring; a minority of patients (15%, 120/788) received structured diabetes education. Predictors of HbA1c <7% included patients receiving diabetes education (odds ratio [OR] [95% confidence interval, CI] = 2.707 [1.157-6.335] P = .022), following a healthy diet and exercise plan (OR [95% CI] = 2.253 [1.206-4.209], P < .001) and self-managing (monitoring glucose levels and adjusting insulin accordingly) (OR [95% CI] 2.508 [1.500-4.191] P < .001).African adults with T1DM have suboptimal glycemic control with almost one-quarter reporting hospitalization within the preceding year. Most patients felt comfortable with self-adjustment of insulin dose but said that the cost of test strips was the main factor that limited regular monitoring. Reducing direct costs of testing strips and insulin, and improving education will address major challenges within these settings.
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Affiliation(s)
- Jean Claude Mbanya
- Medicine and Endocrinology, Faculty of Medicine and Biological Science, University of Yaoundé
- Biotechnology Center and Doctoral School of Life, Health and Environmental Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Poobalan Naidoo
- Medical Affairs, Sanofi, Johannesburg, South Africa
- Department of Health Informatics, School of Health Professions, Rutgers, State University of New Jersey, NJ
| | | | | | | | - Sumanth Karamchand
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | | | - Virendra Rambiritch
- University of KwaZulu-Natal, Biomedical Research Ethics Committee and Discipline of Pharmaceutical Sciences, KwaZulu-Natal
| | - Mark Cotton
- Family Clinical Research Unit (FAMCRU), Tygerberg Hospital, Department of Pediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Rachid Malek
- Department of Internal Medicine, CHU Sétif, Algeria
| | | | - Rory Forseth Leisegang
- Clinical Pharmacology & Toxicology, University Hospital / Inselspital Bern, Bern, Switzerland
- Pharmacometrics, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
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14
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Aschner P, Gagliardino JJ, Ilkova H, Lavalle F, Ramachandran A, Mbanya JC, Shestakova M, Chantelot JM, Chan JCN. Persistent poor glycaemic control in individuals with type 2 diabetes in developing countries: 12 years of real-world evidence of the International Diabetes Management Practices Study (IDMPS). Diabetologia 2020; 63:711-721. [PMID: 31901950 PMCID: PMC7054372 DOI: 10.1007/s00125-019-05078-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/26/2019] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS We evaluated the secular trend of glycaemic control in individuals with type 2 diabetes in developing countries, where data are limited. METHODS The International Diabetes Management Practices Study provides real-world evidence of patient profiles and diabetes care practices in developing countries in seven cross-sectional waves (2005-2017). At each wave, each physician collected data from ten consecutive participants with type 2 diabetes during a 2 week period. The primary objective of this analysis was to evaluate trends of glycaemic control over time. RESULTS A total of 66,088 individuals with type 2 diabetes were recruited by 6099 physicians from 49 countries. The proportion of participants with HbA1c <53 mmol/mol (<7%) decreased from 36% in wave 1 (2005) to 30.1% in wave 7 (2017) (p < 0.0001). Compared with wave 1, the adjusted ORs of attaining HbA1c ≤64 mmol/mol (≤8%) decreased significantly in waves 2, 5, 6 and 7 (p < 0.05). Over 80% of participants received oral glucose-lowering drugs, with declining use of sulfonylureas. Insulin use increased from 32.8% (wave 1) to 41.2% (wave 7) (p < 0.0001). The corresponding time to insulin initiation (mean ± SD) changed from 8.4 ± 6.9 in wave 1 to 8.3 ± 6.6 years in wave 7, while daily insulin dosage ranged from 0.39 ± 0.21 U/kg (wave 1) to 0.33 ± 0.19 U/kg (wave 7) for basal regimen and 0.70 ± 0.34 U/kg (wave 1) to 0.77 ± 0.33 (wave 7) U/kg for basal-bolus regimen. An increasing proportion of participants had ≥2 HbA1c measurements within 12 months of enrolment (from 61.8% to 92.9%), and the proportion of participants receiving diabetes education (mainly delivered by physicians) also increased from 59.0% to 78.3%. CONCLUSIONS In developing countries, glycaemic control in individuals with type 2 diabetes remained suboptimal over a 12 year period, indicating a need for system changes and better organisation of care to improve self-management and attainment of treatment goals.
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Affiliation(s)
- Pablo Aschner
- Javeriana University School of Medicine, San Ignacio University Hospital, Carrera 7 # 40-62, Bogotá, 110231, Colombia.
| | - Juan J Gagliardino
- CENEXA, Center of Experimental and Applied Endocrinology (La Plata National University National Scientific and Technical Research Council), La Plata, Argentina
| | - Hasan Ilkova
- Division of Endocrinology Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Fernando Lavalle
- Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Ambady Ramachandran
- India Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Jean Claude Mbanya
- Biotechnology Center, Doctoral School of Life Sciences, Health and Environment, University of Yaounde I, Yaounde, Cameroon
- Department of Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | | | | | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Ren Q, Ji LN, Lu JM, Li YF, Li QM, Lin SS, Lv XF, Wang L, Xu Y, Guo XH, Guo QY, Ma L, Du J, Chen YL, Zhao CL, Zhang QL, She QM, Jiao XM, Lu MH, Sun XM, Gao Y, Zhang J. Search for clinical predictors of good glycemic control in patients starting or intensifying oral hypoglycemic pharmacological therapy: A multicenter prospective cohort study. J Diabetes Complications 2020; 34:107464. [PMID: 31771933 DOI: 10.1016/j.jdiacomp.2019.107464] [Citation(s) in RCA: 4] [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: 05/20/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 11/22/2022]
Abstract
AIMS Our aim was to search for clinical predictors of good glycemic control in patients starting or intensifying oral hypoglycemic pharmacological therapy. METHODS A multicenter, prospective cohort of 499 diabetic subjects was enrolled in this study: patients with newly diagnosed diabetes (NDM group) or poor glycemic control with oral antidiabetic drugs (OADs) (PDM group). All subjects then started or intensified OADs therapy and followed up for 91 days. Glycemic control was determined according to HbA1c at day 91 with HbA1c <7% considered good. RESULTS The proportions of patients with good glycemic control after follow up for 91 days were 66.9% and 34.8% in NDM group and PDM group respectively. Logistic regression analysis showed that the change in GA at 28 days was the only predictor of good glycemic control in NDM patients (OR = 1.630, 95% CI 1.300-2.044, P < 0.001). In PDM patients, changes in GA at 28 days, CPI, baseline HbA1c, diabetic duration, and BMI were all independent predictors of good glycemic control (All P < 0.05). CONCLUSIONS GA decline is a good predictor of future success in newly diagnosed patients. In patients intensifying therapy, beside GA decline, other individualized clinical characteristics should also be considered.
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Affiliation(s)
- Qian Ren
- Department of Endocrinology, Peking University People's Hospital, Beijing 100035, China
| | - Li-Nong Ji
- Department of Endocrinology, Peking University People's Hospital, Beijing 100035, China.
| | - Ju-Ming Lu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Yu-Feng Li
- Department of Endocrinology, Pinggu Hospital, Beijing 101200, China
| | - Quan-Min Li
- Department of Endocrinology, The Second Artillery General Hospital of PLA, 100088, China
| | - Shan-Shan Lin
- Department of Endocrinology, Shijingshan Hospital, 100049, China
| | - Xiao-Feng Lv
- Department of Endocrinology, General Hospital of Beijing Military Command, Beijing 100010, China
| | - Li Wang
- Department of Endocrinology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Yuan Xu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100023, China
| | - Xiao-Hui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
| | - Qi-Yu Guo
- Department of Endocrinology, Navy General Hospital, Beijing 100048, China
| | - Li Ma
- Department of Endocrinology, Guang An Men Hospital, China Academy of Chinese Medical Science, Beijing 102600, China
| | - Jin Du
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ying-Li Chen
- Department of Endocrinology, Peking University People's Hospital, Beijing 100035, China
| | - Cui-Ling Zhao
- Department of Endocrinology, Pinggu Hospital, Beijing 101200, China
| | - Qiu-Lan Zhang
- Department of Endocrinology, The Second Artillery General Hospital of PLA, 100088, China
| | - Qi-Mei She
- Department of Endocrinology, Shijingshan Hospital, 100049, China
| | - Xiu-Min Jiao
- Department of Endocrinology, General Hospital of Beijing Military Command, Beijing 100010, China
| | - Mei-Hua Lu
- Department of Endocrinology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Xiao-Meng Sun
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100023, China
| | - Ying Gao
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
| | - Jie Zhang
- Department of Endocrinology, Guang An Men Hospital, China Academy of Chinese Medical Science, Beijing 102600, China
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16
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Jude EB, O'Leary C, Myland M, Nixon M, Gooch N, Shaunik A, Lew E. Evaluating glycaemic control in patients poorly controlled on oral antidiabetic drugs in real-world setting: Results from assessing the Appropriate Timing of Type 2 diAbetes INtensification (ATTAIN). Endocrinol Diabetes Metab 2020; 3:e00094. [PMID: 31922021 PMCID: PMC6947702 DOI: 10.1002/edm2.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/11/2019] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Many patients with type 2 diabetes mellitus (DM) fail to achieve glycaemic control despite recommended treatment strategies to reduce glycated haemoglobin (HbA1c). This real-world retrospective cohort study compared HbA1c change and treatment patterns between those intensifying and not intensifying therapy with oral antidiabetic drugs (OADs). MATERIALS AND METHODS Patients suboptimally controlled on OADs (>58 mmol/mol [>7.5%] or >64 mmol/mol [>8.0%] for high risk, index 1) were included from IQVIA Medical Research Data. Intensifiers within 12 months of index 1 were matched (1:1) to nonintensifiers. Primary outcomes were HbA1c change and proportion of participants achieving HbA1c targets 6 and 12 months post-index 2 (date of intensification [intensifiers] or pseudodate [nonintensifiers]). Therapy adherence was also assessed. RESULTS A total of 10 832 participants (5539 intensifiers and 5293 nonintensifiers) were included. Mean HbA1c decrease from baseline to 6 months was -1.13% (intensifiers) vs -0.75% (nonintensifiers), with no substantial further change at 12 months. Cox proportional hazards (PH) analysis suggested a nearly 20% greater chance of target achievement at 6 months for intensifiers vs nonintensifiers (hazard ratio [HR]: 0.79 [95% confidence interval [CI]: 0.73-0.86]), which was similar at 12 months (HR: 0.80 [95% CI: 0.74-0.86]). Intensifiers tended towards greater adherence to baseline therapy (90% [standard deviation (SD): 14.9] vs nonintensifiers 87% [SD: 16.0]), which decreased following intensification. CONCLUSIONS Significant reductions in HbA1c were evident at 6 months and were greater in intensifiers vs nonintensifiers. Little additional clinical benefit was seen 12 months postintensification. Despite good treatment adherence, many participants failed to achieve target HbA1c; actions beyond improved adherence are needed to improve suboptimal HbA1c.
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Affiliation(s)
- Edward B. Jude
- Diabetes CentreTameside General HospitalAshton‐under‐LyneUK
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17
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Gagliardino JJ, Chantelot JM, Domenger C, Ramachandran A, Kaddaha G, Mbanya JC, Shestakova M, Chan J. Impact of diabetes education and self-management on the quality of care for people with type 1 diabetes mellitus in the Middle East (the International Diabetes Mellitus Practices Study, IDMPS). Diabetes Res Clin Pract 2019; 147:29-36. [PMID: 30218744 DOI: 10.1016/j.diabres.2018.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/10/2018] [Indexed: 11/27/2022]
Abstract
AIMS Self-management (self-monitoring of blood glucose, plus self-adjustment of insulin dose) is important in diabetes care, but its complexity presents a barrier to wider implementation, which hinders attainment and maintenance of glycemic targets. More evidence on self-management is needed to increase its implementation and improve metabolic outcomes. METHODS Data from 1316 participants with type 1 diabetes mellitus who were enrolled from Middle East countries into the International Diabetes Management Practices Study (IDMPS), a multinational observational survey, were analyzed to assess the impact of education on disease management and outcomes. RESULTS A majority (78%) of participants failed to achieve glycemic target (HbA1c < 7.0% [<53 mmol/mol]). Participants who had received diabetes education (59%) were more likely to practice self-management than those who had not (odds ratio [OR]: 2.51; 95% confidence interval [CI]: 1.7-3.69; p < 0.001), and those who practiced self-management were more likely to attain target HbA1c than those who did not (OR: 1.49; 95% CI: 1.06-2.09; p = 0.023). CONCLUSIONS These relationships between diabetes education, self-management and glycemic control suggest that diabetes education provides knowledge and skills to optimize self-management, favoring HbA1c target attainment. Middle East health authorities should search for ways to facilitate access to diabetes education to optimize treatment outcomes.
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Affiliation(s)
- Juan José Gagliardino
- CENEXA Center of Experimental and Applied Endocrinology (La Plata National University - La Plata National Scientific and Technical Research Council), La Plata, Argentina.
| | | | | | - Ambady Ramachandran
- India Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
| | - Ghaida Kaddaha
- Diabetology Unit, Government of Dubai, Dubai Health Authority, Dubai, United Arab Emirates
| | - Jean Claude Mbanya
- Biotechnology Center, Doctoral School of Life Sciences, Health and Environment, and Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Marina Shestakova
- Endocrinology Research Center, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Juliana Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
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Gagliardino JJ, Chantelot JM, Domenger C, Ilkova H, Ramachandran A, Kaddaha G, Claude Mbanya J, Chan J, Aschner P. Diabetes education and health insurance: How they affect the quality of care provided to people with type 1 diabetes in Latin America. Data from the International Diabetes Mellitus Practices Study (IDMPS). Diabetes Res Clin Pract 2019; 147:47-54. [PMID: 30118748 DOI: 10.1016/j.diabres.2018.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/09/2018] [Indexed: 01/06/2023]
Abstract
AIMS This study aimed to evaluate the impact of diabetes education and access to healthcare coverage on disease management and outcomes in Latin America. METHODS Data were obtained from a sub-analysis of 2693 patients with type 1 diabetes mellitus recruited from 9 Latin American countries as part of the International Diabetes Mellitus Practices Study (IDMPS), a multinational, observational survey of diabetes treatment in developing regions. RESULTS Results from the Latin American cohort show that only 25% of participants met HbA1c target value (< 7% [53 mmol/mol]). Attainment of this target was significantly higher among participants who had received diabetes education than those who hadn't (28% vs. 19%, p < 0.001), and among those who practiced self-management (27% vs. 21% no self-management, p = 0.001). Multivariate analysis showed that participants who had received diabetes education were more likely to manage their diabetes (OR:1.65 [95% CI: 1.24, 2.19]; p = 0.001), and to attain HbA1c target values (OR:1.48 [95% CI: 1.14, 1.93]; p = 0.003). CONCLUSIONS Given the association between uncontrolled diabetes and long-term complications, health authorities and care providers should increase efforts to ensure widespread healthcare coverage and access to self-management education to reduce the socioeconomic and humanistic burden of type 1 diabetes.
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Affiliation(s)
- Juan José Gagliardino
- CENEXA, Center of Experimental and Applied Endocrinology (La Plata National University -National Scientific and Technical Research Council), La Plata, Argentina.
| | | | | | - Hasan Ilkova
- Istanbul University, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Endocrinology Metabolism and Diabetes, Turkey.
| | - Ambady Ramachandran
- India Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
| | - Ghaida Kaddaha
- Consultant & Head of Diabetology Unit, Government of Dubai, Dubai Health Authority, Dubai, United Arab Emirates.
| | - Jean Claude Mbanya
- Biotechnology Center, Doctoral School of Life Sciences, Health and Environment, and Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | - Juliana Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
| | - Pablo Aschner
- Javeriana University School of Medicine and San Ignacio University Hospital, Bogotá, Colombia.
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Elliott JA, Das D, Cavailler P, Schneider F, Shah M, Ravaud A, Lightowler M, Boulle P. A cross-sectional assessment of diabetes self-management, education and support needs of Syrian refugee patients living with diabetes in Bekaa Valley Lebanon. Confl Health 2018; 12:40. [PMID: 30214472 PMCID: PMC6134700 DOI: 10.1186/s13031-018-0174-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with diabetes require knowledge and skills to self-manage their disease, a challenging aspect of treatment that is difficult to address in humanitarian settings. Due to the lack of literature and experience regarding diabetes self-management, education and support (DSMES) in refugee populations, Medecins Sans Frontieres (MSF) undertook a DSMES survey in a cohort of diabetes patients seen in their primary health care program in Lebanon. METHODS Structured interviews were conducted with diabetes patients in three primary care clinics between January and February 2015. Scores (0-10) were calculated to measure diabetes core knowledge in each patient (the DSMES score). Awareness of long-term complications and educational preferences were also assessed. Analyses were conducted using Stata software, version 14.1 (StataCorp). Simple and multiple linear regression models were used to determine associations between various patient factors and the DSMES Score. RESULTS A total of 292 patients were surveyed. Of these, 92% had type 2 diabetes and most (70%) had been diagnosed prior to the Syrian conflict. The mean DSMES score was 6/10. Having secondary education, previous diabetes education, a 'diabetes confidant', and insulin use were each associated with a higher DSMES Score. Lower scores were significantly more likely to be seen in participants with increasing age and in patients who were diagnosed during the Syrian conflict. Long-term complications of diabetes most commonly known by patients were vision related complications (68% of patients), foot ulcers (39%), and kidney failure (38%). When asked about the previous Ramadan, 56% of patients stated that they undertook a full fast, including patients with type 1 diabetes. Individual and group lessons were preferred by more patients than written, SMS, telephone or internet-based educational delivery models. CONCLUSIONS DSMES should be patient and context appropriate. The variety and complexities of humanitarian settings provide particular challenges to its appropriate provision. Understanding patient baseline DSMES levels and needs provides a useful basis for humanitarian organizations seeking to provide diabetes care.
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Affiliation(s)
- James A. Elliott
- Médecins Sans Frontières/Doctors Without Borders Canada, 551 Adelaide St W, Toronto, ON M5V 0N8 Canada
- Médecins Sans Frontières, Rue de Lausanne 78, Geneva, 1202 Switzerland
- Karolinska Institute, Stockholm, Sweden
- T1International, Cheltenham, UK
| | - Debashish Das
- Médecins Sans Frontières, Rue de Lausanne 78, Geneva, 1202 Switzerland
| | | | - Fabien Schneider
- Médecins Sans Frontières/Doctors Without Borders Canada, 551 Adelaide St W, Toronto, ON M5V 0N8 Canada
| | - Maya Shah
- Médecins Sans Frontières, Rue de Lausanne 78, Geneva, 1202 Switzerland
| | - Annette Ravaud
- Médecins Sans Frontières, Rue de Lausanne 78, Geneva, 1202 Switzerland
| | - Maria Lightowler
- Médecins Sans Frontières, Rue de Lausanne 78, Geneva, 1202 Switzerland
| | - Philippa Boulle
- Médecins Sans Frontières, Rue de Lausanne 78, Geneva, 1202 Switzerland
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Structured peer-led diabetes self-management and support in a low-income country: The ST2EP randomised controlled trial in Mali. PLoS One 2018; 13:e0191262. [PMID: 29357380 PMCID: PMC5777645 DOI: 10.1371/journal.pone.0191262] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/28/2017] [Indexed: 01/11/2023] Open
Abstract
Objectives Our objective was to evaluate the effectiveness of peer-led self-management education in improving glycaemic control in patients with type 2 diabetes in a low-income country (Mali). Methods We conducted an open-label randomised controlled trial. A total of 151 adults (76% women, mean age 52.5) with type 2 diabetes (HbA1c≥8%), treated in the diabetes consultation units of two secondary health centres in Bamako, were allocated to peer-led structured patient education (n = 76) or conventional care alone (n = 75). The intervention group received 1 year of culturally tailored structured patient education (3 courses of 4 sessions) delivered in the community by five trained peer educators. Both groups underwent conventional diabetes monitoring and follow-up. Primary outcome was the mean absolute change in HbA1c from baseline to 12 months. Results 177 education sessions were delivered to the intervention group. Patient attrition was 8%. From baseline to 12 months, the decrease in HbA1c levels was 1.05% (SD = 2.0; CI95%: 1.54;-0.56) in the intervention group compared with 0.15% (SD = 1.7; CI95%: -0.56; 0.26) in the control group, p = 0.006. Mean BMI change was -1.65 kg/m2 (SD = 2.5; CI95%: -2.25; -1.06) in the intervention group and +0.05 kg/m2 (SD = 3.2; CI95%: -0.71; 0.81) in the control group, p = 0.0005. Mean waist circumference decreased by 3.34 cm (SD = 9.3; CI95%: -5.56;-1.13) in the intervention group and increased by 2.65 cm (SD = 10.3; CI95%: 0.20; 5.09) in the control group, p = 0.0003. Conclusions Peer-led structured patient education delivered over 1 year to patients with poorly controlled type 2 diabetes in Mali yielded substantial improvements in glycaemic control and anthropometric parameters. This is of importance for the scaling up of efficient interventions in low-resource settings in the future. Trial registration ClinicalTrials.gov NCT01485913
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Chan WB, Chen JF, Goh SY, Vu TTH, Isip-Tan IT, Mudjanarko SW, Bajpai S, Mabunay MA, Bunnag P. Challenges and unmet needs in basal insulin therapy: lessons from the Asian experience. Diabetes Metab Syndr Obes 2017; 10:521-532. [PMID: 29276400 PMCID: PMC5733912 DOI: 10.2147/dmso.s143046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Basal insulin therapy can improve glycemic control in people with type 2 diabetes. However, timely initiation, optimal titration, and proper adherence to prescribed basal insulin regimens are necessary to achieve optimal glycemic control. Even so, glycemic control may remain suboptimal in a significant proportion of patients. Unique circumstances in Asia (eg, limited resources, management of diabetes primarily in nonspecialist settings, and patient populations that are predominantly less educated) coupled with the limitations of current basal insulin options (eg, risk of hypoglycemia and dosing time inflexibility) amplify the challenge of optimal basal insulin therapy in Asia. Significant progress has been made with long-acting insulin analogs (insulin glargine 100 units/mL and insulin detemir), which provide longer coverage and less risk of hypoglycemia over intermediate-acting insulin (Neutral Protamine Hagedorn insulin). Furthermore, recent clinical evidence suggests that newer long-acting insulin analogs, new insulin glargine 300 units/mL and insulin degludec, may address some of the unmet needs of current basal insulin options in terms of risk of hypoglycemia and dosing time inflexibility. Nevertheless, more can be done to overcome barriers to basal insulin therapy in Asia, through educating both patients and physicians, developing better patient support models, and improving accessibility to long-acting insulin analogs. In this study, we highlight the unique challenges associated with basal insulin therapy in Asia and, where possible, propose strategies to address the unmet needs by drawing on clinical experiences and perspectives in Asia.
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Affiliation(s)
- Wing Bun Chan
- Qualigenics Diabetes Centre, Hong Kong SAR, People’s Republic of China
| | - Jung Fu Chen
- Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Thi Thanh Huyen Vu
- Out-patient Department and Department of Internal Medicine, National Geriatric Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Iris Thiele Isip-Tan
- Section of Endocrinology, Diabetes and Metabolism, University of the Philippines–Philippine General Hospital, Manila, Philippines
| | - Sony Wibisono Mudjanarko
- Diabetes and Nutrition Centre, Dr. Soetomo Hospital, School of Medicine Airlangga University, Surabaya, Indonesia
| | | | | | - Pongamorn Bunnag
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Doucette ED, Salas J, Wang J, Scherrer JF. Insurance coverage and diabetes quality indicators among patients with diabetes in the US general population. Prim Care Diabetes 2017; 11:515-521. [PMID: 28619242 DOI: 10.1016/j.pcd.2017.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 04/03/2017] [Accepted: 05/19/2017] [Indexed: 11/27/2022]
Abstract
This study explores associations between health insurance and diabetes quality indicators. Data were obtained from 8305 patients with diabetes who reported no insurance, Medicaid or private insurance in the 2013 BRFSS in 26 states in the US. Six diabetes quality indicators were assessed: HgbA1c testing, foot exam, eye exam, influenza immunization, pneumococcal immunization and diabetes education. Logistic regression was performed comparing quality indicators by insurance group adjusting for covariates. Subjects with private insurance or Medicaid were more likely than the uninsured to have HgbA1c testing (OR=2.60, 95%CI: 2.02-3.35; OR=2.04, 95%CI: 1.55-2.69, respectively), a foot exam (OR=1.72, 95%CI: 1.32-2.25; OR=1.64, 95%CI: 1.23-2.18, respectively) and an eye exam (OR=2.01, 95%CI: 1.56-2.58; OR=2.50, 95%CI: 1.91-3.27, respectively). Those with private insurance were more likely than the uninsured to have influenza immunization (OR=1.75, 95%CI: 1.37-2.25) and diabetes education (OR=1.36, 95%CI: 1.06-1.74). Uninsured persons with diabetes are less likely to receive standard diabetes services compared to the insured, but most quality indicators were similar in publicly and privately insured groups.
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Affiliation(s)
- Emily D Doucette
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
| | - Jing Wang
- College of Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA.
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
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Kim HS, Kim H, Yang HK, Lee EY, Jeong YJ, Kim TM, Yang SJ, Baik SY, Lee SH, Cho JH, Choi IY, Yim HW, Cha BY. Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes. Diabetes Metab J 2017; 41:187-194. [PMID: 28537057 PMCID: PMC5489499 DOI: 10.4093/dmj.2017.41.3.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/18/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND When patients with diabetes mellitus (DM) are first referred to a hospital from primary health care clinics, physicians have to decide whether to administer an oral hypoglycemic agent (OHA) immediately or postpone a medication change in favor of diabetes education regarding diet or exercise. The aim of this study was to determine the effect of diabetes education alone (without alterations in diabetes medication) on blood glucose levels. METHODS The study was conducted between January 2009 and December 2013 and included patients with DM. The glycosylated hemoglobin (HbA1c) levels were evaluated at the first visit and after 3 months. During the first medical examination, a designated doctor also conducted a diabetes education session that mainly covered dietary management. RESULTS Patients were divided into those who received no diabetic medications (n=66) and those who received an OHA (n=124). Education resulted in a marked decrease in HbA1c levels in the OHA group among patients who had DM for <1 year (from 7.0%±1.3% to 6.6%±0.9%, P=0.0092) and for 1 to 5 years (from 7.5%±1.8% to 6.9%±1.1%, P=0.0091). Those with DM >10 years showed a slightly lower HbA1c target achievement rate of <6.5% (odds ratio, 0.089; P=0.0024). CONCLUSION For patients who had DM for more than 5 years, higher doses or changes in medication were more effective than intensive active education. Therefore, individualized and customized education are needed for these patients. For patients with a shorter duration of DM, it may be more effective to provide initial intensive education for diabetes before prescribing medicines, such as OHAs.
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Affiliation(s)
- Hun Sung Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyunah Kim
- Sookmyung Women's University College of Pharmacy, Seoul, Korea
| | - Hae Kyung Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo Jin Jeong
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tong Min Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Jung Yang
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seo Yeon Baik
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Young Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong Yun Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Park SY, Kim SY, Lee HM, Hur KY, Kim JH, Lee MK, Sim KH, Jin SM. Diabetes Camp as Continuing Education for Diabetes Self-Management in Middle-Aged and Elderly People with Type 2 Diabetes Mellitus. Diabetes Metab J 2017; 41:99-112. [PMID: 28447438 PMCID: PMC5409007 DOI: 10.4093/dmj.2017.41.2.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 11/18/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite the established benefits of diabetes camps for the continuing education of children with type 1 diabetes mellitus, little is known about the long-term metabolic benefits of diabetes camps for middle-aged and elderly people with type 2 diabetes mellitus (T2DM), especially in terms of glycosylated hemoglobin (HbA1c) variability. METHODS The 1-year mean and variability of HbA1c before and after the diabetes camp was compared between the participants of the diabetes camp (n=57; median age 65 years [range, 50 to 86 years]; median diabetes duration 14 years [range, 1 to 48 years]). Additional case-control analysis compared the metabolic outcomes of the participants of the diabetes camp and their propensity score-matched controls who underwent conventional diabetes education (n=93). RESULTS The levels of HbA1c during the first year after the diabetes camp were comparable to those of the matched controls (P=0.341). In an analysis of all participants of the diabetes camp, the 1-year mean±standard deviation (SD) of HbA1c decreased (P=0.010 and P=0.041) after the diabetes camp, whereas the adjusted SD and coefficient of variance (CV) of HbA1c did not decrease. The adjusted SD and CV significantly decreased after the diabetes camp in participants whose 1-year mean HbA1c was ≥6.5% before the diabetes camp (n=40) and those with a duration of diabetes less than 15 years (n=32). CONCLUSION The 1-year mean and SD of HbA1c decreased after the diabetes camp, with significant reduction in the adjusted SD and CV in those with higher baseline HbA1c and a shorter duration of diabetes.
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Affiliation(s)
- So Young Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Young Kim
- Diabetes Education Unit, Diabetes Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Mi Lee
- Diabetes Education Unit, Diabetes Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Kyu Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kang Hee Sim
- Diabetes Education Unit, Diabetes Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sang Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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25
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Gagliardino JJ, Atanasov PK, Chan JCN, Mbanya JC, Shestakova MV, Leguet-Dinville P, Annemans L. Resource use associated with type 2 diabetes in Africa, the Middle East, South Asia, Eurasia and Turkey: results from the International Diabetes Management Practice Study (IDMPS). BMJ Open Diabetes Res Care 2017; 5:e000297. [PMID: 28123754 PMCID: PMC5253437 DOI: 10.1136/bmjdrc-2016-000297] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/01/2016] [Accepted: 12/03/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Type 2 diabetes (T2D) and its complications form a global healthcare burden but the exact impact in some geographical regions is still not well documented. We describe the healthcare resource usage (HRU) associated with T2D in Africa, the Middle East, South Asia, Eurasia and Turkey. RESEARCH DESIGN AND METHODS In the fifth wave of the International Diabetes Management Practices Study (IDMPS; 2011-2012), we collected self-reported and physician-reported cross-sectional data from 8156 patients from 18 countries across 5 regions, including different types of HRU in the previous 3-6 months. Negative binomial regression was used to identify parameters associated with HRU, using incidence rate ratios (IRRs) to express associations. RESULTS Patients in Africa (n=2220), the Middle East (n=2065), Eurasia (n=1843), South Asia (n=1195) and Turkey (n=842) experienced an annual hospitalization rate (mean±SD) of 0.6±1.9, 0.3±1.2, 1.7±4.1, 0.4±1.5 and 1.3±2.7, respectively. The annual number of diabetes-related inpatient days (mean±SD) was 4.7±22.7, 1.1±6.1, 16.0±30.0, 1.5±6.8 and 10.8±34.3, respectively. Despite some inter-regional heterogeneity, macrovascular complications (IRRs varying between 1.4 and 8.9), microvascular complications (IRRs varying between 3.4 and 4.3) and, to a large extent, inadequate glycemic control (IRRs varying between 1.89 and 10.1), were independent parameters associated with hospitalization in these respective regions. CONCLUSIONS In non-Western countries, macrovascular/microvascular complications and inadequate glycemic control were common and important parameters associated with increased HRU.
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Affiliation(s)
- Juan J Gagliardino
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET), La Plata, Argentina
| | | | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jean C Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Marina V Shestakova
- Endocrinology Research Centre, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Lieven Annemans
- Department of Public Health, Ghent University, Ghent, Belgium
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26
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Fan MH, Huang BT, Tang YC, Han XH, Dong WW, Wang LX. Effect of individualized diabetes education for type 2 diabetes mellitus: a single-center randomized clinical trial. Afr Health Sci 2016; 16:1157-1162. [PMID: 28479909 DOI: 10.4314/ahs.v16i4.34] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To evaluate the effect of individualized education for patients with type 2 diabetes mellitus (T2DM). METHODS A total of 280 patients (158 males, mean age 63 ± 10 years) with T2DM were randomly divided into study and control group. Eysenck Personality questionnaire was used to assess the personality of the patients in the study group, which was provided us one-on-one counseling and individualized management plan. Group education was provided to the control group. RESULTS At the end of the study, the body mass index (21.5±2.5 vs 23.6±1.6 kg/m2, P =0.002), waist circumference (83.7±6.4 vs 85.7±7.7 cm, P =0.03), fasting blood glucose (6.0±0.8 vs 6.9±2.1 mmol/L, P =0.004), HbA1c (6.2±0.6% vs 6.9±3.1%, P =0.03), systolic blood pressure (130.1±8.8 vs 135.1±8.4 mmHg, P =0.003),triglyceride (1.21±0.66 vs 1.46±0.58 mmol/L) and low-density lipoprotein (2.36±0.44 vs 2.84±0.64 mmol/L, P =0.03) in the study group was lower than in the control group. CONCLUSION Individualized diabetes education is more effective than group education in facilitating the control of type 2 diabetes.
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Affiliation(s)
| | | | | | | | | | - Le-Xin Wang
- Cardiology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, 252000, P.R.China
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW 2650, Australia
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27
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Chadli A, El Aziz S, El Ansari N, Ajdi F, Seqat M, Latrech H, Belmejdoub G. Management of diabetes in Morocco: results of the International Diabetes Management Practices Study (IDMPS) - wave 5. Ther Adv Endocrinol Metab 2016; 7:101-9. [PMID: 27293539 PMCID: PMC4892401 DOI: 10.1177/2042018816643227] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The International Diabetes Mellitus Practice Study (IDMPS) is a 5-year survey documenting changes in diabetes treatment practices in developing countries. The primary objective of this survey was to assess the therapeutic management of type 2 diabetes mellitus (T2DM) in real-life medical practice. The secondary objectives were to evaluate the clinical management of type 1 diabetes mellitus (T1DM) and to assess the proportion of all diabetic patients failing to reach the glycated haemoglobin (HbA1c) <7% target. METHODS Data were analysed for 738 patients (240 with T1DM and 498 with T2DM) included in wave 5 of the IDMPS in Morocco in 2011. RESULTS Nearly two-thirds (61%) of T2DM patients were treated with oral glucose-lowering drugs (OGLDs) alone, 13.1% were treated with insulin alone and 23.3% were treated with OGLDs plus insulin. Insulin use was less frequent, was initiated later and involved a greater use of premixes versus basal/prandial schedules compared to other populations evaluated in the IDMPS. The majority (92.5%) of T1DM patients were treated with insulin alone and the remainder received insulin plus an OGLD. Insulin protocols included basal + prandial dosing (37.5%) and premix preparations (41.3%). The recommended target of HbA1c <7% was achieved by only 22.2% of T1DM patients and 26.8% of T2DM patients. More macrovascular but fewer microvascular complications were reported in T2DM compared to T1DM patients. Late complications increased with disease duration so that 20 years after diagnosis, 75.7% of T2DM patients were found to have at least one late complication. CONCLUSIONS The clinical burden of diabetes is high in Morocco and the majority of patients do not achieve the recommended glycaemia target, suggesting that there is a huge gap between evidence-based diabetic management and real-life practice. Better education of patients and improved compliance with international recommendations are necessary to deliver a better quality of diabetic care.
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Affiliation(s)
- Asmae Chadli
- Ibn Rushd University Hospital, Casablanca, Morocco
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28
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Nieto-Martínez R, González-Rivas JP, Lima-Martínez M, Stepenka V, Rísquez A, Mechanick JI. Diabetes Care in Venezuela. Ann Glob Health 2016; 81:776-91. [DOI: 10.1016/j.aogh.2015.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Lavalle-González FJ, Chiquete E. Patients' empowerment, physicians' perceptions, and achievement of therapeutic goals in patients with type 1 and type 2 diabetes mellitus in Mexico. Patient Prefer Adherence 2016; 10:1349-57. [PMID: 27555751 PMCID: PMC4968990 DOI: 10.2147/ppa.s107437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Physicians' perception may not parallel objective measures of therapeutic targets in patients with diabetes. This is an issue rarely addressed in the medical literature. We aimed to analyze physicians' perception and characteristics of adequate control of patients with diabetes. PATIENTS AND METHODS We studied information on physicians and their patients who participated in the third wave of the International Diabetes Management Practices Study registry in Mexico. This analysis was performed on 2,642 patients, 203 with type 1 diabetes mellitus (T1DM) and 2,439 with type 2 diabetes mellitus (T2DM), treated by 200 physicians. RESULTS The patients perceived at target had lower hemoglobin A1c (HbA1c) and fasting blood glucose than those considered not at target. However, overestimation of the frequency of patients with HbA1c <7% was 41.5% in patients with T1DM and 31.7% in patients with T2DM (underestimation: 2.8% and 8.0%, respectively). The agreement between the physicians' perception and the class of HbA1c was suboptimal (κ: 0.612). Diabetologists and endocrinologists tested HbA1c more frequently than primary care practitioners, internists, or cardiologists; however, no differences were observed in mean HbA1c, for both T1DM (8.4% vs 7.2%, P=0.42) and T2DM (8.03% vs 8.01%, P=0.87) patients. Nevertheless, insulin users perceived at target, who practiced self-monitoring and self-adjustment of insulin, had a lower mean HbA1c than patients without these characteristics (mean HbA1c in T1DM: 6.8% vs 9.6%, respectively; mean HbA1c in T2DM: 7.0% vs 10.1%, respectively). CONCLUSION Although there is a significant physicians' overestimation about the optimal glycemic control, this global impression and characteristics of patients' empowerment, such as self-monitoring and self-adjustment of insulin, are associated with the achievement of targets.
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Affiliation(s)
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Correspondence: Erwin Chiquete, Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlapan, Ciudad de México, Código Postal 14000, México, Tel +52 54 87 0900 ext 5052, Fax +52 56 55 1076, Email
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Yuan X, Tao Y, Zhao JP, Liu XS, Xiong WN, Xie JG, Ni W, Xu YJ, Liu HG. Long-term efficacy of a rural community-based integrated intervention for prevention and management of chronic obstructive pulmonary disease: a cluster randomized controlled trial in China's rural areas. ACTA ACUST UNITED AC 2015; 48:1023-31. [PMID: 26352697 PMCID: PMC4671529 DOI: 10.1590/1414-431x20154385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 02/12/2015] [Indexed: 01/04/2023]
Abstract
This study aimed to assess the efficacy of a rural community-based integrated
intervention for early prevention and management of chronic obstructive pulmonary
disease (COPD) in China. This 18-year cluster-randomized controlled trial
encompassing 15 villages included 1008 patients (454 men and 40 women in the
intervention group [mean age, 54 ± 10 years]; 482 men and 32 women in the control
group [mean age, 53 ± 10 years]) with confirmed COPD or at risk for COPD. Villages
were randomly assigned to the intervention or the control group, and study
participants residing within the villages received treatment accordingly.
Intervention group patients took part in a program that included systematic health
education, smoking cessation counseling, and education on management of COPD. Control
group patients received usual care. The groups were compared after 18 years regarding
the incidence of COPD, decline in lung function, and mortality of COPD. COPD
incidence was lower in the intervention group than in the control group (10%
vs 16%, <0.05). A decline in lung function was also
significantly delayed in the intervention group compared to the control group of COPD
and high-risk patients. The intervention group showed significant improvement in
smoking cessation compared with the control group, and smokers in the intervention
group had lower smoking indices than in the control group (350 vs
450, <0.05). The intervention group also had a significantly lower cumulative
COPD-related death rate than the control group (37% vs 47%,
<0.05). A rural community-based integrated intervention is effective in reducing
the incidence of COPD among those at risk, delaying a decline in lung function in
COPD patients and those at risk, and reducing mortality of COPD.
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Affiliation(s)
- X Yuan
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Y Tao
- Department of Respiratory and Critical Care Medicine, Xinhua Hospital of Hubei Province, Wuhan, China
| | - J P Zhao
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - X S Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - W N Xiong
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - J G Xie
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - W Ni
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Y J Xu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - H G Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Dube L, Van den Broucke S, Housiaux M, Dhoore W, Rendall-Mkosi K. Type 2 diabetes self-management education programs in high and low mortality developing countries: a systematic review. DIABETES EDUCATOR 2014; 41:69-85. [PMID: 25392297 DOI: 10.1177/0145721714558305] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE Although self-management education is a key factor in the care for diabetes patients, its implementation in developing countries is not well documented. This systematic review considers the published literature on diabetes self-management education in high and low mortality developing countries. The aim is to provide a state of the art of current practices and assess program outcomes, cultural sensitivity, and accessibility to low literate patients. METHODS The Cochrane Library, PubMed, MEDLINE, PsycInfo, and PsycArticles databases were searched for peer-reviewed articles on type 2 diabetes published in English between 2009 and 2013. The World Bank and WHO burden of disease criteria were applied to distinguish between developing countries with high and low mortality. Information was extracted using a validated checklist. RESULTS Three reviews and 23 primary studies were identified, 18 of which were from low mortality developing countries. Studies from high mortality countries were mostly quasi-experimental, those from low mortality countries experimental. Interventions were generally effective on behavior change and patients' glycemic control in the short term (≤9 months). While 57% of the studies mentioned cultural tailoring of interventions, only 17% reported on training of providers, and 39% were designed to be accessible for people with low literacy. CONCLUSIONS The limited studies available suggest that diabetes self-management education programs in developing countries are effective in the short term but must be tailored to conform to the cultural aspects of the target population.
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Affiliation(s)
- Loveness Dube
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium (Miss Dube, Prof Van den Broucke, Dr Housiaux)
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium (Miss Dube, Prof Van den Broucke, Dr Housiaux)
| | - Marie Housiaux
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium (Miss Dube, Prof Van den Broucke, Dr Housiaux)
| | - William Dhoore
- Institute of Health and Society, Université catholique de Louvain, Belgium (Prof Dhoore)
| | - Kirstie Rendall-Mkosi
- School of Health Systems and Public Health, University of Pretoria, South Africa (Dr Rendall-Mkosi)
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Elgart JF, Asteazarán S, De La Fuente JL, Camillucci C, Brown JB, Gagliardino JJ. Direct and indirect costs associated to type 2 diabetes and its complications measured in a social security institution of Argentina. Int J Public Health 2014; 59:851-7. [PMID: 25189732 DOI: 10.1007/s00038-014-0604-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/18/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To estimate direct and indirect costs of care of type 2 diabetes (T2DM) and its complications in Argentina, and compare them with those recorded in people without diabetes (ND). METHODS Observational retrospective case-control study performed in one institution of the Social Security System of Argentina. Participants were identified and randomly selected from the Institution's electronic medical records. We recruited persons with T2DM with (387) or without (387) chronic complications and 774 ND, matched by age and gender. Data were obtained by telephone interviews and supplemented with data from the Institution's records. Parametric and non-parametric tests were used for group comparisons. RESULTS Direct costs were higher in people with T2DM than in ND: twice as high in people with T2DM without complications and 3.6 times in those with complications. Absenteeism was only higher in T2DM with complications, but there were no differences among groups either in the duration or in the cost of such absenteeism. CONCLUSIONS T2DM and the development of its complications are positively associated with higher direct costs in Argentina.
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Affiliation(s)
- Jorge F Elgart
- CENEXA, Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina,
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Comorbidity, health-related quality of life and self-care in type 2 diabetes: a cross-sectional study in an outpatient population. Ir J Med Sci 2014; 184:623-30. [PMID: 25168194 DOI: 10.1007/s11845-014-1190-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/22/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Comorbid conditions may be related (concordant) or unrelated (discordant) to diabetes. Comorbidity in patients with type 2 diabetes (T2DM) is associated with reduced health-related quality of life (HRQoL) and self-care. AIM To examine the impact of comorbidity on HRQoL and self-care in T2DM patients attending an outpatient setting. METHODS A cross-sectional questionnaire was sent to 498 patients with T2DM, aged 25-80 years, previously attending (August 2011-July 2012) an outpatient diabetes service in a Dublin hospital. The EuroQoL-5 Dimension (EQ-5D) and a modified summary of diabetes self-care activities scale were used to assess HRQoL and self-care, respectively. Comorbidity was assessed using a simplified version of the self-administered comorbidity Questionnaire. Mann-Whitney and Kruskal-Wallis tests were used to examine the association between EQ-5D index scores or self-care, and the number and type of comorbidities. Multiple linear regression, adjusting for age and sex, was used to examine the association between EQ-5D score, comorbidity score and type. RESULT EQ-5D scores decreased with an increasing number of comorbidities and with discordant comorbidity (P = 0.0001). Comorbidity type was associated with physical activity. The highest level of physical activity was reported in respondents with no comorbidity (median 4.5 IQR 3-6), while the lowest was in patients with both concordant and discordant comorbidity (median 2.5 IQR 0-5). CONCLUSIONS Health professionals should be aware of the fall in HRQoL associated with comorbidity. This should be taken into account in the management of patients. Patients with discordant comorbidity should be advised and supported to maintain levels of physical activity.
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Grintsova O, Maier W, Mielck A. Inequalities in health care among patients with type 2 diabetes by individual socio-economic status (SES) and regional deprivation: a systematic literature review. Int J Equity Health 2014; 13:43. [PMID: 24889694 PMCID: PMC4055912 DOI: 10.1186/1475-9276-13-43] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 05/21/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction Quality of care could be influenced by individual socio-economic status (SES) and by residential area deprivation. The objective is to synthesize the current evidence regarding inequalities in health care for patients with Type 2 diabetes mellitus (Type 2 DM). Methods The systematic review focuses on inequalities concerning process (e.g. measurement of HbA1c, i.e. glycolised haemoglobin) and intermediate outcome indicators (e.g. HbA1c level) of Type 2 diabetes care. In total, of n = 886 publications screened, n = 21 met the inclusion criteria. Results A wide variety of definitions for ‘good quality diabetes care’, regional deprivation and individual SES was observed. Despite differences in research approaches, there is a trend towards worse health care for patients with low SES, concerning both process of care and intermediate outcome indicators. Patients living in deprived areas less often achieve glycaemic control targets, tend to have higher blood pressure (BP) and worse lipid profile control. Conclusion The available evidence clearly points to the fact that socio-economic inequalities in diabetes care do exist. Low individual SES and residential area deprivation are often associated with worse process indicators and worse intermediate outcomes, resulting in higher risks of microvascular and macrovascular complications. These inequalities exist across different health care systems. Recommendations for further research are provided.
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Affiliation(s)
| | | | - Andreas Mielck
- Helmholtz Zentrum Muenchen, Institute of Health Economics and Health Care Management, PO Box 1129, Neuherberg D-85758, Germany.
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Escalante M, Gagliardino JJ, Guzmán JR, Tschiedel B. Call-to-action: timely and appropriate treatment for people with type 2 diabetes in Latin America. Diabetes Res Clin Pract 2014; 104:343-52. [PMID: 24835577 DOI: 10.1016/j.diabres.2014.01.004] [Citation(s) in RCA: 10] [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: 05/20/2013] [Revised: 08/27/2013] [Accepted: 01/01/2014] [Indexed: 01/27/2023]
Abstract
Latin America faces a unique set of challenges in the treatment of type 2 diabetes mellitus (T2DM). This report identifies these challenges and provides a framework for implementation of the strategies, policies and education programs which are needed to optimize the management of this condition. In order to improve future diabetes care, it will be necessary to address existing problems such as limitation of resources, inadequate management of hyperglycemia, and inappropriate education of healthcare team members and people with diabetes. Achieving these goals will require collaborative efforts by many individuals, groups and organizations. These include policymakers, international organizations, healthcare providers, those responsible for setting medical school curricula, patients and society as a whole. It is anticipated that improved/continuing education of healthcare professionals, diabetes self-management education and development of a team approach for T2DM care will lead to optimization of patient-centered care. Implementation of multicentric demonstration studies and rational use of antidiabetic treatments will be necessary to demonstrate the long-term favorable impact of these strategies upon quality of care, prevention of chronic complications, mortality, healthcare costs and patient quality of life.
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Affiliation(s)
- Miguel Escalante
- Hospital de Especialidades, Centro Medico Nacional de Occidente, Mexican Institute of Social Security, Guadalajara, Mexico.
| | - Juan José Gagliardino
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET La Plata), PAHO/WHO Collaborating Centre for Diabetes, Facultad de Ciencias Médicas UNLP, La Plata, Argentina
| | - Juan Rosas Guzmán
- Centro de Especialidades Medicas de Celaya, Latin University of Mexico in Celaya, Guanajuato, Mexico
| | - Balduino Tschiedel
- Institute for Children with Diabetes in Porto Alegre and the Brazilian Diabetes Society, Porto Alegre, Brazil
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Elgart JF, Caporale JE, Asteazarán S, De La Fuente JL, Camilluci C, Brown JB, González CD, Gagliardino JJ. Association between socioeconomic status, type 2 diabetes and its chronic complications in Argentina. Diabetes Res Clin Pract 2014; 104:241-7. [PMID: 24629409 DOI: 10.1016/j.diabres.2014.02.010] [Citation(s) in RCA: 10] [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: 09/11/2013] [Revised: 12/20/2013] [Accepted: 02/13/2014] [Indexed: 01/18/2023]
Abstract
AIM To compare the socioeconomic status (SES) of people with type 2 diabetes (T2DM) in Argentina (Córdoba) with and without major chronic complications of diabetes, with that recorded in persons without diabetes matched by age and gender. METHODS For this descriptive and analytic case-control study, potential candidates were identified from the electronic records of one institution of the Social Security System of the city of Córdoba. We identified and recruited 387 persons each with T2DM with or without chronic complications and 774 gender- and age-matched persons without T2DM (recruitment rate, 83%). Data were obtained by telephone interviews and supplemented with data from the institution's records. Group comparisons were performed with parametric or non-parametric tests as appropriate. We used ordinary least squares to regress household income and the difference between income and household expenses on diabetes status, age, sex, education and body mass index. RESULTS Persons with T2DM, particularly those with complications, reported fewer years of general education (13.6±4.2 years vs. 12.2±4.4 years), a lower percentage of full time jobs (43.0% vs. 26.9%), lower salaries and monthly household income among those with full-time jobs (> 5000 ARG$: 52.6% vs. 24.5%), and a higher propensity to spend more money than they earned (expenditure/income ratio≥1: 10.2% vs. 16.0%). The percentage of unmarried people was also higher among people with type 2 diabetes (7.0% vs. 10.9%). CONCLUSION T2DM and the development of its complications are each positively associated with lower SES and greater economic distress in Argentina.
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Affiliation(s)
- Jorge F Elgart
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina.
| | - Joaquín E Caporale
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina
| | - Santiago Asteazarán
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina
| | | | | | - Jonathan B Brown
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina
| | - Claudio D González
- Department of Pharmacology, University of Buenos Aires School of Medicine, Argentina
| | - Juan J Gagliardino
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina
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Valinsky L, Mishali M, Endevelt R, Preiss R, Dopelt K, Heymann AD. Reducing resistance to treatment, through group intervention, improves clinical measurements in patients with type 2 diabetes. BMC Endocr Disord 2013; 13:61. [PMID: 24373686 PMCID: PMC3909345 DOI: 10.1186/1472-6823-13-61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have shown that group Therapeutic Patient Education (TPE) may empower patients with type 2 diabetes to better manage their disease. The mechanism of these interventions is not fully understood. A reduction in resistance to treatment may explain the mechanism by which TPE empowers participants to improve self-management. The Objective of this study was to examine the effectiveness of diabetes groups in reducing resistance to treatment and the association between reduced resistance and better management of the disease. METHODS In a program evaluation study, we administered validated questionnaires to measure resistance to treatment (RTQ) in 3 time periods: before the intervention (T1), immediately after the intervention (T2) and six months later (T3). Clinical measures (HbA1C, blood pressure, HDL, LDL and total cholesterol, Triglycerides and BMI) were retrieved from Maccabi Healthcare Services computerized systems, for T1;T2 and a year post intervention (T3). Linear mixed models were used adjusting for age, gender, social support and family status. RESULTS 157; 156 and 106 TPE participants completed the RTQ in T1; T2 and T3 respectively. HbA1C and systolic and diastolic blood pressure were significantly reduced in the group which achieved a reduction in three out of the five RTQ components. For the other clinical measurements no significant changes were observed. CONCLUSION Our findings suggest that reducing resistance to treatment, through an educational program for patients with diabetes, is associated with a better disease control. Identifying patients with higher resistance to treatment, and including components that reduce resistance in patient education programs, have the potential to increase the effectiveness of these programs.
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Affiliation(s)
- Liora Valinsky
- Department of Clinical Quality, Meuhedet Health Care, 124 Ibn-Gvirol St, Tel Aviv, Israel
| | - Moshe Mishali
- Department of Psychology, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Endevelt
- Department of Preventive Medicine, Maccabi Heathcare Services, Tel Aviv, Israel
- School of public health Haifa University Carmel, Haifa, Israel
| | - Rachel Preiss
- Department of Preventive Medicine, Maccabi Heathcare Services, Tel Aviv, Israel
| | - Keren Dopelt
- Department of Health Systems Management, Ben Gurion University of the Negev, Beer Sheva, Israel
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Colles SL, Singh S, Kohli C, Mithal A. Dietary beliefs and eating patterns influence metabolic health in type 2 diabetes: A clinic-based study in urban North India. Indian J Endocrinol Metab 2013; 17:1066-1072. [PMID: 24381886 PMCID: PMC3872687 DOI: 10.4103/2230-8210.122626] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Almost 15% of India's urban adult populace now lives with type 2 diabetes. This study aimed to characterize the eating patterns, knowledge, beliefs, and determinants of food choice, and assess associations with the metabolic health among urban Asian Indians with type 2 diabetes. MATERIALS AND METHODS A cross-sectional study of 258 individuals (mean age 55.7 ± 10 years; body mass index 27.1 ± 4.8 kg/m(2); diabetes duration 10.1 ± 6.5 years) attending two out-patient clinics in New Delhi, India. Food-related information was collected during a semi-structured interview. Clinical, anthropometric, and biochemical data were recorded. RESULTS Beliefs related to health and diabetes played a role determining food choice and dietary patterns; erroneous views were associated with the poor food choices and greater metabolic perturbations. Average consumption of fruits/vegetables was low. Intakes were positively associated with intentions to manage diabetes; inversely associated with the waist circumference and negatively correlated with one's degree of personal responsibility for food choice. Household saturated fat usage was common. High fat intakes were positively associated with the taste preference, ratings of perceived "health-value;" waist circumference, glycosylated haemoglobin percentage (HbA1c%) and lipids. CONCLUSIONS Strategies to enhance diabetes control among Asian Indians are required and should encourage fruit/vegetable intake, personal accountability, and consider individual beliefs and preferences. Greater emphasis and resources directed to regular dietary and behavioral counseling may assist.
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Affiliation(s)
- Susan L. Colles
- Charles Darwin University, Menzies School of Health Research, Wellbeing and Chronic Diseases Division, Darwin, Australia
| | - Shweta Singh
- Division of Endocrinology and Diabetes, Medanta The Medicity, Gurgaon, Haryana, India
| | - Chhavi Kohli
- Division of Endocrinology and Diabetes, Medanta The Medicity, Gurgaon, Haryana, India
| | - Ambrish Mithal
- Division of Endocrinology and Diabetes, Medanta The Medicity, Gurgaon, Haryana, India
- Department of Endocrinology, Indraprasthra Apollo Hospital, New Delhi, India
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Lounsbury DW, Hirsch GB, Vega C, Schwartz CE. Understanding social forces involved in diabetes outcomes: a systems science approach to quality-of-life research. Qual Life Res 2013; 23:959-69. [PMID: 24062243 DOI: 10.1007/s11136-013-0532-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The field of quality-of-life (QOL) research would benefit from learning about and integrating systems science approaches that model how social forces interact dynamically with health and affect the course of chronic illnesses. Our purpose is to describe the systems science mindset and to illustrate the utility of a system dynamics approach to promoting QOL research in chronic disease, using diabetes as an example. METHODS We build a series of causal loop diagrams incrementally, introducing new variables and their dynamic relationships at each stage. RESULTS These causal loop diagrams demonstrate how a common set of relationships among these variables can generate different disease and QOL trajectories for people with diabetes and also lead to a consideration of non-clinical (psychosocial and behavioral) factors that can have implications for program design and policy formulation. CONCLUSIONS The policy implications of the causal loop diagrams are discussed, and empirical next steps to validate the diagrams and quantify the relationships are described.
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Affiliation(s)
- David W Lounsbury
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Ji LN, Lu JM, Guo XH, Yang WY, Weng JP, Jia WP, Zou DJ, Zhou ZG, Yu DM, Liu J, Shan ZY, Yang YZ, Hu RM, Zhu DL, Yang LY, Chen L, Zhao ZG, Li QF, Tian HM, Ji QH, Liu J, Ge JP, Shi LX, Xu YC. Glycemic control among patients in China with type 2 diabetes mellitus receiving oral drugs or injectables. BMC Public Health 2013; 13:602. [PMID: 23800082 PMCID: PMC3729491 DOI: 10.1186/1471-2458-13-602] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 05/14/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) is increasing rapidly among Chinese adults, and limited data are available on T2DM management and the status of glycemic control in China. We assessed the efficacy of oral antidiabetes drugs (OADs), glucagon-like peptide-1 (GLP-1) receptor agonists, and insulin for treatment of T2DM across multiple regions in China. METHODS This was a multicenter, cross-sectional survey of outpatients conducted in 606 hospitals across China. Data from all the patients were collected between April and June, 2011. RESULTS A total of 238,639 patients were included in the survey. Eligible patients were treated with either OADs alone (n=157,212 [65.88%]), OADs plus insulin (n=80,973 [33.93%]), or OADs plus GLP-1 receptor agonists (n=454 [0.19%]). The OAD monotherapy, OAD + insulin, and OAD + GLP-1 receptor agonist groups had mean glycosylated hemoglobin (HbA1c) levels (±SD) of 7.67% (±1.58%), 8.21% (±1.91%), and 7.80% (±1.76%), respectively. Among those three groups, 34.63%, 26.21%, and 36.12% met the goal of HbA1c <7.0%, respectively. Mean HbA1c and achievement of A1c <7.0% was related to the duration of T2DM. CONCLUSIONS Less than one third of the patients had achieved the goal of HbA1c <7.0%. Glycemic control decreased and insulin use increased with the duration of diabetes.
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Affiliation(s)
- Li-Nong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, No. 11 Xizhimen Nandajie, Beijing 100044, China.
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Javed F, Thafeed Alghamdi AS, Mikami T, Mehmood A, Ahmed HB, Samaranayake LP, Tenenbaum HC. Effect of glycemic control on self-perceived oral health, periodontal parameters, and alveolar bone loss among patients with prediabetes. J Periodontol 2013; 85:234-41. [PMID: 23659422 DOI: 10.1902/jop.2013.130008] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The effect of glycemic control on severity of periodontal inflammatory parameters in patients with prediabetes is unknown. The aim of the present study is to assess the effects of glycemic control on self-perceived oral health, periodontal parameters, and marginal bone loss (MBL) in patients with prediabetes. METHODS A total of 303 individuals were included. Hemoglobin A1c (HbA1c) and fasting blood glucose levels (FBGLs) were recorded. Participants were divided into three groups: 1) group A: 75 patients with prediabetes (FBGLs = 100 to 125 mg/dL [HbA1c ≥5%]); 2) group B: 78 individuals previously considered prediabetic but having FBGLs <100 mg/dL (HbA1c <5%) resulting from dietary control; and 3) control group: 150 medically healthy individuals. Self-perceived oral health, socioeconomic status, and education status were determined using a questionnaire. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and clinical attachment loss (AL) were recorded. Premolar and molar MBLs were measured on panoramic radiographs. RESULTS Periodontal parameters (PI, BOP, PD, and AL) (P <0.01) and MBL (P <0.01) were worse among individuals in group A than those in group B. Self-perceived gingival bleeding (P <0.001), pain on chewing (P <0.001), dry mouth (P <0.001), and oral burning sensations (P <0.05) were worse among patients in group A than those in group B. There was no difference in periodontal parameters, MBL, and self-perceived oral symptoms among patients with prediabetes in group B and healthy controls. CONCLUSIONS Self-perceived oral health, severity of periodontal parameters, and MBL are worse in patients with prediabetes than controls. Glycemic control significantly reduces the severity of these parameters as well as the state of prediabetes in affected individuals.
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Affiliation(s)
- Fawad Javed
- Eng. A.B. Research Chair for Growth Factors and Bone Regeneration, Three-Dimensional Imaging and Biomechanical Laboratory, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Meillet L, Combes J, Penfornis A. [Management of type 2 diabetes: patient education]. Presse Med 2013; 42:880-5. [PMID: 23523080 DOI: 10.1016/j.lpm.2013.02.311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 02/18/2013] [Indexed: 11/19/2022] Open
Abstract
Patient education emerged initially as an essential component of the management of type 1 diabetes. Patient education has also been for long an integral part of the recommendations for managing type 2 diabetes. Studies about patient education and type 2 diabetes have demonstrated the effectiveness of patient education by studying the evolution of bioclinic markers including HbA1c. However, if we return to the foundations of patient education definition, we cannot summarize the effectiveness of patient education on the only decrease of HbA1c. So, if the aim of patient education is to support patients to take better care of themselves, it might be interesting to use other types of evaluation methodology, including qualitative studies, to reflect the different dimensions of patient education, especially psychosocial.
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Affiliation(s)
- Lucie Meillet
- CHU de Besançon, hôpital Jean-Minjoz, université de Franche-Comté, service d'endocrinologie-métabolisme et diabétologie-nutrition, EA 3920, 25030 Besançon cedex, France
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Lorenzo L. Partnering with patients to promote holistic diabetes management: Changing paradigms. J Am Assoc Nurse Pract 2013; 25:351-61. [DOI: 10.1111/1745-7599.12004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lavalle-González FJ, Chiquete E, de la Luz J, Ochoa-Guzmán A, Sánchez-Orozco LV, Godínez-gutiérrez SA. Achievement of therapeutic targets in Mexican patients with diabetes mellitus. ACTA ACUST UNITED AC 2012; 59:591-8. [DOI: 10.1016/j.endonu.2012.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 06/25/2012] [Accepted: 07/03/2012] [Indexed: 11/26/2022]
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Goldfarb-Rumyantzev AS, Rout P, Sandhu GS, Barenbaum A, Patibandla BK, Narra A, Chawla V, Williams M. Social adaptability index predicts overall mortality in patients with diabetes. J Diabetes Complications 2012; 26:44-9. [PMID: 22321220 DOI: 10.1016/j.jdiacomp.2011.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 12/19/2011] [Accepted: 12/19/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND A quantifiable assessment of socioeconomic status and its bearing on clinical outcome in patients with diabetes is lacking. The social adaptability index (SAI) has previously been validated in the general population and in patients with chronic kidney disease, including those on dialysis and with kidney transplant. We hypothesize that SAI could be used in diabetes practice to identify a disadvantaged population at risk for inferior outcomes. METHODS The NHANES-3 database of patients who have diabetes was analyzed. The association of the SAI (calculated as the linear combination of indicators of education status, employment, income, marital status, and substance abuse) with patient survival was evaluated using Cox model. RESULTS The study population consisted of 1634 subjects with diabetes mellitus with mean age of 61.9±15.3 years; 40.9% males; 38.5% white, 27.7% African American, and 31.3% Mexican American. The highest SAI was in whites (6.9±2.5), followed by Mexican Americans (6.5±2.3), and then African Americans (6.1±2.6) (ANOVA, P<.001). SAI was higher in subjects living in metropolitan areas (6.8±2.6) compared to the rural population (6.3±2.4) (T test, P<.001). Also, SAI was greater in males (7.1±2.4) than in females (6.1±2.4) (T test, P<.001). SAI had significant association with survival (hazard ratio 0.9, P<.001) in the entire study population and in most of the subgroups (divided by race, sex, and urban/rural location). Furthermore, SAI divided into tertiles (≤5, 6 to 8, >8) demonstrated a significant and "dose-dependent" association with survival. CONCLUSION Social adaptability index is associated with mortality in the diabetic population and is useful in identifying individuals who are at risk for inferior outcomes.
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