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Cheung NW, Redfern J, Thiagalingam A, Hng TM, Marschner S, Haider R, Faruquie S, Von Huben A, She S, McIntyre D, Cho JG, Chow CK. Effect of Mobile Phone Text Messaging Self-Management Support for Patients With Diabetes or Coronary Heart Disease in a Chronic Disease Management Program (SupportMe) on Blood Pressure: Pragmatic Randomized Controlled Trial. J Med Internet Res 2023; 25:e38275. [PMID: 37327024 PMCID: PMC10337246 DOI: 10.2196/38275] [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: 03/26/2022] [Revised: 09/07/2022] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Maintaining engagement and support for patients with chronic diseases is challenging. SMS text messaging programs have complemented patient care in a variety of situations. However, such programs have not been widely translated into routine care. OBJECTIVE We aimed to examine the implementation and utility of a customized SMS text message-based support program for patients with type 2 diabetes (T2D), coronary heart disease, or both within a chronic disease integrated care program. METHODS We conducted a 6-month pragmatic parallel-group, single-blind randomized controlled trial that recruited people with T2D or coronary heart disease. Intervention participants received 4 semipersonalized SMS text messages per week providing self-management support to supplement standard care. Preprogrammed algorithms customized content based on participant characteristics, and the messages were sent at random times of the day and in random order by a fully automated SMS text messaging engine. Control participants received standard care and only administrative SMS text messages. The primary outcome was systolic blood pressure. Evaluations were conducted face to face whenever possible by researchers blinded to randomization. Participants with T2D were evaluated for glycated hemoglobin level. Participant-reported experience measures were evaluated using questionnaires and focus groups and summarized using proportions and thematic analysis. RESULTS A total of 902 participants were randomized (n=448, 49.7% to the intervention group and n=454, 50.3% to the control group). Primary outcome data were available for 89.5% (807/902) of the participants. At 6 months, there was no difference in systolic blood pressure between the intervention and control arms (adjusted mean difference=0.9 mm Hg, 95% CI -1.1 to 2.1; P=.38). Of 642 participants with T2D, there was no difference in glycated hemoglobin (adjusted mean difference=0.1%, 95% CI -0.1% to 0.3%; P=.35). Self-reported medication adherence was better in the intervention group (relative risk=0.82, 95% CI 0.68-1.00; P=.045). Participants reported that the SMS text messages were useful (298/344, 86.6%) and easily understood (336/344, 97.7%) and motivated change (217/344, 63.1%). The lack of bidirectional messaging was identified as a barrier. CONCLUSIONS The intervention did not improve blood pressure in this cohort, possibly because of high clinician commitment to improved routine patient care as part of the chronic disease management program as well as favorable baseline metrics. There was high program engagement, acceptability, and perceived value. Feasibility as part of an integrated care program was demonstrated. SMS text messaging programs may supplement chronic disease management and support self-care. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616001689460; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371769&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-025923.
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Affiliation(s)
- Ngai Wah Cheung
- Department of Diabetes & Endocrinology, Westmead Hospital, Westmead, Australia
- Westmead Applied Research Centre, Faculty of Medicine & Health, University of Sydney, Westmead, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | | | | | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine & Health, University of Sydney, Westmead, Australia
| | - Rabbia Haider
- Department of Diabetes & Endocrinology, Westmead Hospital, Westmead, Australia
| | - Sonia Faruquie
- Department of Diabetes & Endocrinology, Westmead Hospital, Westmead, Australia
| | - Amy Von Huben
- Westmead Applied Research Centre, Faculty of Medicine & Health, University of Sydney, Westmead, Australia
| | - Shelley She
- Westmead Applied Research Centre, Faculty of Medicine & Health, University of Sydney, Westmead, Australia
| | - Daniel McIntyre
- Westmead Applied Research Centre, Faculty of Medicine & Health, University of Sydney, Westmead, Australia
| | - Jin-Gun Cho
- Department of Respiratory Medicine, Westmead Hospital, Westmead, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine & Health, University of Sydney, Westmead, Australia
- Department of Cardiology, Westmead Hospital, Westmead, Australia
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Demir Avci Y, Gözüm S, Karadag E. Effect of Telehealth Interventions on Blood Pressure Control: A Meta-analysis. Comput Inform Nurs 2022; 40:402-410. [PMID: 35120370 DOI: 10.1097/cin.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to find out the effects of telehealth interventions on blood pressure control by conducting a meta-analysis. Six databases were used. The literature review covered the period between December 1, 2020, and January 26, 2021. The meta-analysis was conducted by comprehensive Meta-Analysis Software version 2.2. Categorical variables were analyzed by odds ratios at a confidence interval of 95%. In data formatting and analysis, independent groups (sample size, P value); independent groups (mean, SD); Cohen's d, SE; and paired groups (N, P value) were used. The bias risk was assessed based on the Revised Cochrane Risk-of-Bias Tool for Randomized Trials. Total sample size including 22 studies was 11 120. It was determined that interventions performed through telehealth applications had a significant effect on blood pressure control (odds ratio = -0.14; 95% confidence interval = -0.20 to -0.08; P < .001). In telehealth applications, blood pressure values decreased more when the application was performed through a Web site (-0.31; 95% confidence interval = -0.49 to -0.13), duration of the intervention was 12 months or shorter (-0.18; 95% confidence interval = -0.28 to -0.010), stroke developed in case of hypertension (-0.31, 95% confidence interval = -0.76 to 0.12), and the study was conducted in the Far East countries (-0.24; 95% confidence interval = 0.40 to -0.07). Interventions with telehealth applications are effective in blood pressure management. PROSPERO ID: CRD42021228536.
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Affiliation(s)
- Yasemin Demir Avci
- Author Affiliations: Department of Public Health Nursing, Faculty of Nursing (Dr Demir Avci), Department of Public Health Nursing, Faculty of Nursing (Dr Gözüm), and Department of Educational Sciences, Faculty of Education (Dr Karadag˘), Akdeniz University, Antalya, Turkey
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Hangaard S, Laursen SH, Andersen JD, Kronborg T, Vestergaard P, Hejlesen O, Udsen FW. The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression. J Diabetes Sci Technol 2021; 17:794-825. [PMID: 34957864 DOI: 10.1177/19322968211064633] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous systematic reviews have aimed to clarify the effect of telemedicine on diabetes. However, such reviews often have a narrow focus, which calls for a more comprehensive systematic review within the field. Hence, the objective of the present systematic review, meta-analysis, and meta-regression is to evaluate the effectiveness of telemedicine solutions versus any comparator without the use of telemedicine on diabetes-related outcomes among adult patients with type 2 diabetes (T2D). METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We considered telemedicine randomized controlled trials (RCT) including adults (≥18 years) diagnosed with T2D. Change in glycated hemoglobin (HbA1c, %) was the primary outcome. PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) were searched on October 14, 2020. An overall treatment effect was estimated using a meta-analysis performed on the pool of included studies based on the mean difference (MD). The revised Cochrane risk-of-bias tool was applied and the certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS The final sample of papers included a total of 246, of which 168 had sufficient information to calculate the effect of HbA1c%. The results favored telemedicine, with an MD of -0.415% (95% confidence interval [CI] = -0.482% to -0.348%). The heterogeneity was great (I2 = 93.05%). A monitoring component gave rise to the higher effects of telemedicine. CONCLUSIONS In conclusion, telemedicine may serve as a valuable supplement to usual care for patients with T2D. The inclusion of a telemonitoring component seems to increase the effect of telemedicine.
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Affiliation(s)
- Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Sisse H Laursen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Nursing, University College of Northern Denmark, Aalborg, Denmark
| | - Jonas D Andersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Kronborg
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Flemming W Udsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Leutualy V, Trisyany Y, Nurlaeci N. Effectivity of Health Education with Telenursing on the Self-care Ability of Coronary Artery Disease Patients: A Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Coronary artery disease (CAD) develops chronically and progressively, causes recurrence and premature death, so a good knowledge of changes in self-care behavior by patients is needed. Telenursing can be a medium for health education to allow patients to receive information and for nurses to follow up on health conditions without being obstructed by distance, place, time, and carried out sustainably. So far, telenursing has not been reviewed as a recent intervention to deliver education to CAD patients.
AIM: This systematic review aimed to determine the effectiveness of health education interventions with telenursing on the self-care of CAD patients based on the implementation media.
METHODS: Systematic reviews were conducted based on items found in CINAHL EBSCO, PubMed, ScienceDirect, and Google Scholar from 2008 to 2019. The combination of keywords used Indonesian and English language. All articles were assessed using the Joanna Briggs Institute critical appraisal tool for randomized controlled trial (RCT) and quasi-experiment. After that, the study found was synthesized narratively.
RESULTS: A total of 11.319 titles were identified, and seven studies met inclusion criteria with 3313 participants. Six studies were RCT studies, and one was a quasi-experimental study. The results of the narrative synthesis conducted on seven articles showed that health education by telenursing was effective in improving self-care ability, such as maintaining blood pressure, body mass index, hemoglobin A1c levels, fasting blood glucose, and low-density lipoprotein within normal limits. In addition, there was also an increase in physical activity, dietary compliance (consumption of fruits, vegetables and fish), control of salt intake, smoking, and alcohol cessation. The media used were phone calls and text messages.
CONCLUSION: This review provides evidence that health education interventions effectively improve the self-care abilities of CAD patients with the media used are text messages and telephone calls.
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Marschner S, Chow C, Thiagalingam A, Simmons D, McClean M, Pasupathy D, Smith BJ, Flood V, Padmanabhan S, Melov S, Ching C, Cheung NW. Effectiveness of a customised mobile phone text messaging intervention supported by data from activity monitors for improving lifestyle factors related to the risk of type 2 diabetes among women after gestational diabetes: protocol for a multicentre randomised controlled trial (SMART MUMS with smart phones 2). BMJ Open 2021; 11:e054756. [PMID: 34535488 PMCID: PMC8451310 DOI: 10.1136/bmjopen-2021-054756] [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] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Gestational diabetes (GDM) contributes substantially to the population burden of type 2 diabetes (T2DM), with a high long-term risk of developing T2DM. This study will assess whether a structured lifestyle modification programme for women immediately after a GDM pregnancy, delivered via customised text messages and further individualised using data from activity monitors, improves T2DM risk factors, namely weight, physical activity (PA) and diet. METHODS AND ANALYSIS This multicentre randomised controlled trial will recruit 180 women with GDM attending Westmead, Campbelltown or Blacktown hospital services in Western Sydney. They will be randomised (1:1) on delivery to usual care with activity monitor (active control) or usual care plus activity monitor and customised education, motivation and support delivered via text messaging (intervention). The intervention will be customised based on breastfeeding status, and messages including their step count achievements to encourage PA. Messages on PA and healthy eating will encourage good lifestyle habits. The primary outcome of the study is healthy lifestyle composed of weight, dietary and PA outcomes, to be evaluated at 6 months. The secondary objectives include the primary objective components, body mass index, breastfeeding duration and frequency, postnatal depression, utilisation of the activity monitor, adherence to obtaining an oral glucose tolerance test post partum and the incidence of dysglycaemia at 12 months. Relative risks and their 95% CIs will be presented for the primary objective and the appropriate regression analysis, adjusting for the baseline outcome results, will be done for each outcome. ETHICS AND DISSEMINATION Ethics approval has been received from the Western Sydney Local Health District Human Research Ethics Committee (2019/ETH13240). All patients will provide written informed consent. Study results will be disseminated via the usual channels including peer-reviewed publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ACTRN12620000615987; Pre-results.
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Affiliation(s)
- Simone Marschner
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Clara Chow
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Penrith South, New South Wales, Australia
- Macarthur Diabetes School, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Mark McClean
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
- Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Dharmintra Pasupathy
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben J Smith
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Flood
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Suja Padmanabhan
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Melov
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Cellina Ching
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
| | - N Wah Cheung
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
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Waller K, Furber S, Bauman A, Allman-Farinelli M, van den Dolder P, Hayes A, Facci F, Franco L, Webb A, Moses R, Cook R, Gugusheff J, Owen K, Colagiuri S. Effectiveness and acceptability of a text message intervention (DTEXT) on HbA1c and self-management for people with type 2 diabetes. A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2021; 104:1736-1744. [PMID: 33334634 DOI: 10.1016/j.pec.2020.11.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Determine the effectiveness and acceptability of a text message intervention (DTEXT) on HbA1c and self-management behaviors for Australian adults with type 2 diabetes. METHODS Using intention to treat analysis and generalized estimating equations, this randomized controlled trial of 395 adults determined change in HbA1c at 3 and 6 months between the intervention and control group. Secondary outcomes included change in nutrition, physical activity, blood lipid profile, body mass index, quality of life, self-efficacy, medication taking and program acceptability. RESULTS No significant difference was observed between the intervention or control group for HbA1c at 3 months (P = 0.23) or 6 months (P = 0.22). Significant improvements were seen in consumption of vegetables at 3 months (P < 0.001) and 6 months (P = 0.04); fruit at 3 months (P = 0.046) and discretionary sweet foods at 3 months (P = 0.02). No other significant effects seen. The intervention demonstrated high rates of acceptability (94.0%) and minimal withdrawal (1.5%). CONCLUSIONS DTEXT was an acceptable text message intervention that improved some nutritional behaviors in people with type 2 diabetes, but did not significantly improve HbA1c or other outcomes. Further research is required to optimize DTEXT. PRACTICE IMPLICATIONS DTEXT provides an acceptable, feasible form of self-management support that may complement existing diabetes care.
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Affiliation(s)
- Karen Waller
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, Australia; School of Health and Society, University of Wollongong, Keiraville, Australia.
| | - Susan Furber
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, Australia; School of Public Health and Community Medicine, University of NSW, Kensington, Australia
| | - Adrian Bauman
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Paul van den Dolder
- Ambulatory and Primary Health Care, Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Alison Hayes
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Franca Facci
- Integrated Chronic Disease Management Stream, Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Lisa Franco
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Alison Webb
- Illawarra Shoalhaven Diabetes Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Robert Moses
- Illawarra Shoalhaven Diabetes Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Rebecca Cook
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Jessica Gugusheff
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Epidemiology and Evidence, NSW Ministry of Health, St Leonards, Australia
| | - Katherine Owen
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Stephen Colagiuri
- Boden Collaboration of Obesity, Nutrition, Exercise and Eating Disorders. University of Sydney, Sydney, Australia; WHO Collaborating Centre on Physical Activity, Nutrition and Obesity. University of Sydney, Sydney, Australia
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Chioma Ebuenyi M, Schnoor K, Versluis A, Meijer E, Chavannes NH. Short message services interventions for chronic disease management: A systematic review. CLINICAL EHEALTH 2021. [DOI: 10.1016/j.ceh.2020.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ganapathy S, de Korne DF, Chong NK, Car J. The Role of Text Messaging and Telehealth Messaging Apps. Pediatr Clin North Am 2020; 67:613-621. [PMID: 32650857 DOI: 10.1016/j.pcl.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article focuses on the role of text messaging and messaging applications, discusses technical and legal issues, and reviews current examples of the application of text messaging in the clinical adult and pediatric practice. Reviews of current examples of text messaging in adult and pediatric practice show uptake has been increasing substantially in recent years. In pediatric care text messaging has been used for behavior intervention and outcomes tracking. Although applications are promising, the potential of nonsynchronic messaging in the formal delivery of care is still in the neonatal phase compared with its grown-up existence in day-to-day modern life.
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Affiliation(s)
- Sashikumar Ganapathy
- KK Women's & Children's Hospital, 100, Bukit Timah Road 229899 Singapore; Duke-NUS School of Medicine, Singapore, Singapore
| | - Dirk F de Korne
- Duke-NUS School of Medicine, Singapore, Singapore; Medical Innovation & Care Transformation, KK Women's & Children's Hospital, Singapore, Singapore; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands; Care & Welfare, SVRZ Cares in Zeeland, Middelburg, SVRZ, Koudekerkseweg 143, Middelburg 4335 SM, Netherlands. https://twitter.com/dirkdekorne
| | - Ng Kee Chong
- KK Women's & Children's Hospital, 100, Bukit Timah Road 229899 Singapore; Duke-NUS School of Medicine, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Clinical Sciences Building, 11 Mandalay Road, Singapore 308232, Singapore.
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Shi R, Wu B, Niu Z, Sun H, Hu F. Nomogram Based on Risk Factors for Type 2 Diabetes Mellitus Patients with Coronary Heart Disease. Diabetes Metab Syndr Obes 2020; 13:5025-5036. [PMID: 33376372 PMCID: PMC7756175 DOI: 10.2147/dmso.s273880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/21/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION This study aimed to study risk factors for coronary heart disease (CHD) in type 2 diabetes mellitus (T2DM) patients and establish a clinical prediction model. RESEARCH DESIGN AND METHODS A total of 3402 T2DM patients were diagnosed by clinical doctors and recorded in the electronic medical record system (EMRS) of six Community Health Center Hospitals from 2015 to 2017, including the communities of Huamu, Jinyang, Yinhang, Siping, Sanlin and Daqiao. From September 2018 to September 2019, 3361 patients (41 patients were missing) were investigated using a questionnaire, physical examination, and biochemical index test. After excluding the uncompleted data, 3214 participants were included in the study and randomly divided into a training set (n = 2252) and a validation set (n = 962) at a ratio of 3:1. Through lead absolute shrinkage and selection operator (LASSO) regression analysis and logistic regression analysis of the training set, risk factors were determined and included in a nomogram. The C-index, receiver operating characteristic (ROC) curve, calibration plot and decision curve analysis (DCA) were used to validate the distinction, calibration and clinical practicality of the model. RESULTS Age, T2DM duration, hypertension (HTN), hyperuricaemia (HUA), body mass index (BMI), glycosylated haemoglobin A1c (HbA1c), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) were significant factors in this study. The C-index was 0.750 (0.724-0.776) based on the training set and 0.767 (0.726-0.808) based on the validation set. Through ROC analysis, the set area was 0.750 for the training set and 0.755 for the validation set. The calibration test indicated that the S:P of the prediction model was 0.982 in the training set and 0.499 in the validation set. The decision curve analysis showed that the threshold probability of the model was 16-69% in the training set and 16-73% in the validation set. CONCLUSION Based on community surveys and data analysis, a prediction model of CHD in T2DM patients was established.
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Affiliation(s)
- Rong Shi
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Birong Wu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Zheyun Niu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Hui Sun
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Fan Hu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Correspondence: Fan HuSchool of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of ChinaTel/Fax +862151322466 Email
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