1
|
Rochmah N, Soetjipto S, Faizi M, Hisbiyah Y, Perwitasari RK, Fedora K, Rosyidah LN, Endarko E, Kuswanto D, Rini EA. Frequent Self-Monitoring Blood Glucose Correlated to Better Medication Adherence and Glycemic Control in Children with Type 1 Diabetes Mellitus. Diabetes Metab Syndr Obes 2024; 17:2203-2209. [PMID: 38854446 PMCID: PMC11162244 DOI: 10.2147/dmso.s448508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/19/2024] [Indexed: 06/11/2024] Open
Abstract
Background Type 1 diabetes mellitus (T1DM) is the most common chronic disease in children, with several severe short and long-term complications. Glycemic control is an important aspect of diabetes management with the most influential factor being compliance with self-monitoring blood glucose (SMBG). Mostly, in Indonesia, the finger stick devices as a glucose monitoring tool were frequently used. About 20% of children follow the recommendation to measure blood glucose four to six times daily. Methods This is a single center, cross-sectional study that was conducted between July-November 2022. The Population is children with T1DM at the Pediatric Outpatient Clinic of Dr. Soetomo Hospital, Surabaya, Indonesia. Children with T1DM aged 4-18 years were enrolled using consecutive sampling. A compliance questionnaire was used to assess SMBG. Psychosocial conditions were assessed using the Pediatric Symptom Checklist 17, and medication adherence was evaluated using the Adherence to Refills and Medications Scale for Diabetes (ARMS-D). Pearson correlation and linear regression were employed for statistical analyses using Statistical Package for Social Sciences version 21.0, with p < 0.05 indicating statistical significance. Results A total of 36 children were included in this study. SMBG frequency over 4x per day was significantly associated with increased medication adherence as measured by the ARMS-D score (p = 0.012). Higher SMBG frequency was also correlated with decreased HbA1c (p = 0.014, r = 0.406) and nutritional status (p = 0.031, r = 0.360). Less than 50% of the patients in Indonesia adhered to the recommended guidelines for SMBG (ie, ≥4 times per day). Conclusion Higher SMBG frequency was correlated with better glycemic control. This finding suggests the need for further support in conducting SMBG based on the national guideline. However, due to it being conducted in a single center, we suggest increasing the sample size or conducting multi-centre collaborations in future studies. Originality/Value By specifically investigating the relationship between adherence to self-monitoring of blood glucose (SMBG) and glycemic control in children with type 1 diabetes mellitus (T1DM), our study represents a novel contribution to the field of pediatric diabetes management in Indonesia. While previous research has explored similar relationships in other populations, our study focuses exclusively on the unique context of Indonesia, where rates of adherence to SMBG in pediatric patients have not been well studied and are relatively low compared to global standards.
Collapse
Affiliation(s)
- Nur Rochmah
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Child Health, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Soetjipto Soetjipto
- Department of Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Muhammad Faizi
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Child Health, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Yuni Hisbiyah
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Child Health, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Rayi Kurnia Perwitasari
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Child Health, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Katherine Fedora
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Child Health, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | | | - Endarko Endarko
- Faculty of Science and Data Analysis, Sepuluh Nopember Institute of Technology, Surabaya, Indonesia
| | - Djoko Kuswanto
- Faculty of Creative Design and Digital Business, Sepuluh Nopember Institute of Technology, Surabaya, Indonesia
| | - Eka Agustia Rini
- Department of Child Health, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
| |
Collapse
|
2
|
Hirsch IB, Tirosh A, Navon A. Noninvasive Real-Time Glucose Monitoring Is in the Near Future. Diabetes Technol Ther 2024. [PMID: 38417015 DOI: 10.1089/dia.2024.0009] [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: 03/01/2024]
Abstract
Objective: Since the introduction of continuous glucose monitoring (CGM) technology, developers have rigorously researched the feasibility of creating a noninvasive glucose monitoring device. In a recent pilot study, investigators reported a strong correlation between glucose values obtained from novel noninvasive monitoring device (GWave) values to venous and capillary glucose measurements. Research Design and Methods: We investigated whether the level of accuracy observed in the pilot study could be reproduced in a larger cohort, using a smaller third-generation manufacturable device (Gen III GWave) containing a standardized sensor chip that can be mass produced for commercial use. The evaluation assessed concordance with capillary blood glucose, reproducibility between two Gen III devices, and accuracy during insulin-induced hypoglycemia. Results: Assessment of samples from 75 subjects (type 2 diabetes, n = 6; type 1 diabetes, n = 28; nondiabetic pregnant subjects, n = 10; and nondiabetic, n = 31) showed that 97% of values were in Zone A with 3% in Zone B of the Clarke Error Grid, with a mean absolute relative difference of 6.7% from reference blood glucose. Comparison between two independent Gen III GWave devices demonstrated reproducibility between the sensors (R2 = 0.95), with 100% of values within Zone A. In the hypoglycemia assessment, measurements from the Gen III sensor tightly followed the capillary glucose measurements down to 42 mg/dL (2.3 mmol/L), whereas the CGM measurements from two different CGM only converged with the GWave and capillary glucose readings after 90 min of decreasing glucose levels. Conclusion: Our results show promise as potentially the first noninvasive technology. Future studies will focus on larger number of people in all glucose ranges. Real-time noninvasive blood glucose monitoring is possible using GWave technology.
Collapse
Affiliation(s)
- Irl B Hirsch
- UW Medicine Diabetes Institute, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Amir Tirosh
- Division of Endocrinology, Diabetes, and Metabolism, Sheba Medical Center, Ramat Gan, Israel
| | - Ami Navon
- Department of Immunology and Regenerative Biology, The Weizmann Institute of Science, Rehovot, Israel
| |
Collapse
|
3
|
Baker M, Lauterwasser S, Valenti C, Kallenberger M, Stolte H. Evaluation of a hybrid protocol using continuous glucose monitoring and point-of-care testing in non-critically ill patients in a community hospital. Am J Health Syst Pharm 2024; 81:e261-e267. [PMID: 38146957 DOI: 10.1093/ajhp/zxad332] [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: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE Inpatient glycemic management typically involves use of point-of-care (POC) glucose measurements to inform insulin dosing decisions. This study evaluated a hybrid monitoring protocol using real-time continuous glucose monitoring (rtCGM) supplemented with POC testing at a community hospital. METHODS Adult inpatients receiving POC glucose testing were monitored using rtCGM in a telemetry unit. The hybrid monitoring protocol required a once-daily POC test but otherwise primarily relied on rtCGM values for insulin dosing decisions. Outcomes assessment included surveillance error grid (SEG) and Clarke Error Grid (CEG) analysis results, the mean absolute relative difference (MARD) for available rtCGM-POC value pairs before and after study protocol application, the number of POC tests avoided, and the number of hypoglycemic events involving a blood glucose value of <70 mg/dL identified by rtCGM and POC values. RESULTS Data were collected from 30 inpatients (the mean age was 69.4 years, 77% were female, 80% had type 2 diabetes, and 37% were at-home insulin users). With the protocol applied, a total of 202 rtCGM-POC pairs produced a MARD of 12.5%. SEG analysis showed 2 pairs in the "moderate" risk category, with all other pairs in the "none" or "slight" risk categories. CEG analysis showed 99% of paired values to be in the clinically acceptable range. Six hypoglycemic events in 5 patients were resolved without incident. Three hundred three POC tests were avoided, a 60% reduction for the study duration. CONCLUSION Use of a hybrid monitoring protocol of rtCGM and POC testing in a community hospital demonstrated sustained rtCGM accuracy and was found to reduce the frequency of POC testing to manage inpatient glycemia.
Collapse
Affiliation(s)
- Matt Baker
- North Kansas City Hospital, North Kansas City, MO, USA
| | | | | | | | | |
Collapse
|
4
|
Sun X, Zhou X, Li S, Ji L. Association between frequency of self-monitoring of blood glucose and glycemic control in patients with type 2 diabetes. Diabetes Res Clin Pract 2024; 209:111027. [PMID: 38000665 DOI: 10.1016/j.diabres.2023.111027] [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: 06/09/2023] [Revised: 11/09/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Abstract
AIM To determine the association between the frequency of self-monitoring of blood glucose (SMBG) and glycemic control in patients with type 2 diabetes. METHODS The retrospective study analyzed data from 3,630 patients with type 2 diabetes who were enrolled between August 2020 and July 2021. 2456 non-insulin-treated patients were divided into SMBG ≤ 6 times/week and > 6 times/week groups. 1174 insulin-treated patients were divided into SMBG ≤ 9 times/week and > 9 times/week groups. Propensity score matching was used to generate groups with well-balanced covariates. Primary outcomes were changes in fasting blood glucose (FBG) and postprandial blood glucose (PBG) from baseline to 6 months. RESULTS In the non-insulin-treated group, a comparison in FBG and PBG reduction between the SMBG > 6 times/week and ≤ 6 times/week groups was statistically significant (-0.59 vs. -0.18 mmol/l, P < 0.001; -0.91 vs. -0.36 mmol/l, P < 0.001). In the insulin-treated group, there was no statistically significant reduction in FBG or PBG, patients with baseline FBG > 8 or 9 mmol/l and SMBG > 9 times/week had a significant FBG reduction than the ≤ 9 times/week group. CONCLUSION Frequent SMBG was associated with better glycemic control in non-insulin-treated patients. Insulin-treated patients with poor glycemic control may benefit from frequent SMBG.
Collapse
Affiliation(s)
- Xiaoyan Sun
- Department of Endocrinology and Metabolism, Peking University People's Hospital, 11th South Street, Xicheng District, Beijing 100044, China
| | - Xianghai Zhou
- Department of Endocrinology and Metabolism, Peking University People's Hospital, 11th South Street, Xicheng District, Beijing 100044, China
| | - Shaobo Li
- Sinocare Inc., No. 265, Guyuan Road Hi-tech Zone, Changsha, Hunan, China.
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, 11th South Street, Xicheng District, Beijing 100044, China.
| |
Collapse
|
5
|
Langhinrichsen-Rohling J, Richie F, Kelley M, Selwyn C, Archer S, Blejwas E. Charitable Pharmacies as Catalysts for Coordinated Care: Pharmacist Management of Blood Glucose Among Under-Resourced Patients With Type 2 Diabetes. Health Promot Pract 2024; 25:254-262. [PMID: 36627769 DOI: 10.1177/15248399221115082] [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] [Indexed: 01/12/2023]
Abstract
This community-academic-pharmacy partnership evaluated the impact of a pharmacist-led approach to diabetes management in under-resourced charitable pharmacy patients. Charitable pharmacies serve a large volume of under-resourced patients; pharmacist involvement may improve blood glucose management due to the frequency with which patients access the pharmacy for medications. The purpose of this study was to examine the impact of a pharmacist-led approach to diabetes management (measured by blood glucose levels) by providing medication therapy management (MTM) and leveraging communication between the pharmacist and patients' primary care providers (PCPs). Study participants were Federally Qualified Health Center (FQHC) patients with type 2 diabetes who obtained free diabetes-related medications from the pharmacy. Participants were randomly assigned to treatment as usual (TAU), MTM, or MTM plus coordinated care between the pharmacist and the patient's PCP. The blood glucose levels of patients who received MTM remained stable throughout the duration of the study while blood glucose levels for TAU patients significantly increased. A previously non-existent communication channel between pharmacists and FQHC providers was established and recommendations were exchanged. This relatively small investment on behalf of the pharmacy (e.g., routinely checking blood glucose, sharing medication recommendations) led to a return on health outcomes for a high-risk, low-resource patient population. This study yielded a beneficial change in practice as the pharmacy has institutionalized measuring at-risk patients' blood glucose levels during pharmacy visits. The pharmacy has also continued to enhance their relationship with the FQHC to provide integrated, patient-centered care to this shared vulnerable patient population.
Collapse
Affiliation(s)
| | - Fallon Richie
- University of South Alabama, Mobile, AL, USA
- The University of North Carolina-Charlotte, Charlotte, NC, USA
| | | | | | | | - Emily Blejwas
- Gulf States Health Policy Center, Bayou La Batre, AL, USA
| |
Collapse
|
6
|
Chao C, Andrade SB, Bergford S, Calhoun P, Welsh JB, Walker TC. Assessing non-adjunctive CGM safety at home and in new markets (ANSHIN). Endocrinol Diabetes Metab 2023; 6:e414. [PMID: 36864014 PMCID: PMC10164430 DOI: 10.1002/edm2.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/18/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Continuous glucose monitoring (CGM) can guide treatment for people with type 1 (T1D) and type 2 diabetes (T2D). The ANSHIN study assessed the impact of non-adjunctive CGM use in adults with diabetes using intensive insulin therapy (IIT). MATERIALS AND METHODS This single-arm, prospective, interventional study enrolled adults with T1D or T2D who had not used CGM in the prior 6 months. Participants wore blinded CGMs (Dexcom G6) during a 20-day run-in phase, with treatment based on fingerstick glucose values, followed by a 16-week intervention phase and then a randomized 12-week extension phase with treatment based on CGM values. The primary outcome was change in HbA1c. Secondary outcomes were CGM metrics. Safety endpoints were the number of severe hypoglycaemic (SH) and diabetic ketoacidosis (DKA) events. RESULTS Of the 77 adults enrolled, 63 completed the study. Those enrolled had mean (SD) baseline HbA1c of 9.8% (1.9%), 36% had T1D, and 44% were ≥65 years old. Mean HbA1c decreased by 1.3, 1.0 and 1.0 percentage points for participants with T1D, T2D or age ≥65, respectively (p < .001 for each). CGM-based metrics including time in range also improved significantly. SH events decreased from the run-in period (67.3 per 100 person-years) to the intervention period (17.0 per 100 person-years). Three DKA events unrelated to CGM use occurred during the total intervention period. CONCLUSIONS Non-adjunctive use of the Dexcom G6 CGM system improved glycaemic control and was safe for adults using IIT.
Collapse
Affiliation(s)
| | | | | | - Peter Calhoun
- Jaeb Center for Health Research, Tampa, Florida, USA
| | | | | | | |
Collapse
|
7
|
Saint K, Heisler M. Experiences of Participants Who Then Become Coaches in a Peer Coach Diabetes Self-Management Program: Lessons for Future Programs. Chronic Illn 2023; 19:265-275. [PMID: 34904881 DOI: 10.1177/17423953211064283] [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: 01/18/2023]
Abstract
OBJECTIVES Peer support programs are effective in improving outcomes among low-resource populations. Prior studies suggest that shared experiences improve peer partnerships. We hypothesized that participants in a peer coaching program who then became coaches might bring insight into their coaching role. We explored the motivations of coaches in a diabetes self-management coaching program who became coaches after completing the program as participants. METHODS Between June 2016 and April 2017 we conducted semi-structured interviews with eight participants-turned-coaches and four of their peer partners in a six-month peer coaching program for patients with poor glycemic control at the Detroit VA. The interviews were transcribed, reviewed and coded by two researchers in an iterative process until consensus was reached. Key themes were identified and analyzed. RESULTS Participants-turned-coaches reported the importance of their own peer coach in their decision to become a coach. Participants-turned-coaches described commitment to their partners, providing realistic encouragement, and fostering a reciprocal partnership. Participants-turned-coaches shared their own difficulties to motivate their partners and create a sense of commonality. DISCUSSION Encouraging participants who complete diabetes peer coach interventions to become coaches appears to be a useful strategy for developing peer coaches who bring sensitivity, commitment, and reciprocity to their role.
Collapse
Affiliation(s)
- Kirin Saint
- 173243Department of Internal Medicine, University of Michigan, USA.,Center for Clinical Management Research, 20034Ann Arbor Veterans' Affairs Healthcare System, USA
| | - Michele Heisler
- 173243Department of Internal Medicine, University of Michigan, USA.,Center for Clinical Management Research, 20034Ann Arbor Veterans' Affairs Healthcare System, USA.,Department of Health Behavior and Health Education, 51329School of Public Health, University of Michigan, USA
| |
Collapse
|
8
|
Butler N, Snyder IC, Korn TG, Nicholson RA, Robbins MS, Seng EK. Lifetime history of an anxiety or depression disorder and adherence to medications used for the acute treatment of migraine. Headache 2023; 63:368-376. [PMID: 36752627 DOI: 10.1111/head.14477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/24/2022] [Accepted: 01/10/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE In this secondary analysis of mobile health headache diary data, we evaluated the relationship between adherence to medication used for the acute treatment of migraine and lifetime history of an anxiety or depression disorder. BACKGROUND Medication non-adherence can produce poor clinical efficacy and may be associated with medication overuse. Medication overuse was defined by taking a migraine-specific medication (MSM) for ≥10 days/month, an opioid or barbiturate for ≥10 days/month, or a nonsteroidal anti-inflammatory drug for ≥15 days/month and having ≥15 headache days/month. Extant literature predominantly evaluates fixed-schedule medication adherence. Little is known about predictors of adherence to as-needed medication such as those used for the acute treatment of migraine. METHODS Adults with prior migraine diagnosis and at least 4 headache days/month completed baseline questionnaires assessing lifetime history of depression or anxiety disorder diagnoses and were asked to record 90 days of once-daily electronic headache diaries soliciting: Headache occurrence; symptoms; medication taken, if any, for the acute treatment of migraine; and their pain level (mild, moderate, severe) when the medication was taken. The 193 participants who completed ≥30 days of headache diary were included in this secondary analysis. RESULTS A MSM was used as the first medication taken on 45.7% (2825/6176) of headache days. Nearly a quarter of the sample (45/193, 23.3%) overused medications for acute treatment of migraine. Medication overuse was more common in patients with a history of an anxiety disorder, odds ratio (OR) 2.01 (95% confidence interval [CI] 1.01-3.69), but this relationship was not significant when headache days were accounted for, OR 2.02 (95% CI 0.83-4.91). Neither a history of a depression disorder, OR 1.40 (95% CI 0.90-2.16), nor an anxiety disorder, OR 1.11 (95% CI 0.71-1.72), was associated with taking medications early; however, duration of self-monitoring was associated with taking MSM early, OR 1.006 (95% CI 1.004-1.009). CONCLUSION Lifetime history of depression and anxiety were not associated with taking a MSM early. Medication overuse may be more common in patients who have both migraine and anxiety. Taking a MSM early improved over time for all participants, even when adjusting for a history of an anxiety and or a depression disorder.
Collapse
Affiliation(s)
- Nicole Butler
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
- Department of Psychiatry, Weill Cornell Medical College/New York-Presbyterian, New York, New York, USA
| | - Ivy C Snyder
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Talia G Korn
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Robert A Nicholson
- Medical Affairs, Neuroscience Business Unit, Eli Lilly and Company, Indianapolis, Indiana, USA
- Previously Affiliated at Mercy Health, St. Louis, Missouri, USA
| | - Matthew S Robbins
- Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Elizabeth K Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
9
|
Young‐Wolff KC, Ray GT, Alexeeff SE, Benowitz N, Adams SR, Does MB, Goler N, Ansley D, Conway A, Avalos LA. Association of cannabis use during pregnancy with severe acute respiratory syndrome coronavirus 2 infection: a retrospective cohort study. Addiction 2023; 118:317-326. [PMID: 36189777 PMCID: PMC9812868 DOI: 10.1111/add.16056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS Cannabis use is increasingly common among pregnant individuals and might be a risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to test whether prenatal cannabis use is associated with increased risk of SARS-CoV-2 infection during pregnancy. DESIGN This is a retrospective cohort study. SETTING The study was conducted in California, USA. PARTICIPANTS A total of 58 114 pregnancies (with outcomes from 5 March 2020 to 30 September 2021) among 57 287 unique pregnant women aged 14-54 years who were screened for prenatal substance use, enrolled in Kaiser Permanente Northern California (KPNC) (a health-care system) and had not tested positive for COVID-19 prior to pregnancy onset. MEASUREMENTS We utilized data from the KPNC electronic health record. Cannabis use status (current, recently quit and non-user) was based on universal screenings during prenatal care (including urine toxicology testing and self-reported use on a self-administered questionnaire). SARS-CoV-2 infection [based on polymerase chain reaction (PCR) tests] was estimated in time-to-event analyses using Cox proportional hazard regression models adjusting for covariates. Secondary analyses examined differences in (a) SARS-CoV-2 testing rates and (b) SARS-CoV-2 infection rates among those tested. FINDINGS We observed 348 810 person-months of follow-up time in our cohort with 41 064 SARS-CoV-2 PCR tests and 6% (n = 2414) of tests being positive. At the start of follow-up, 7% of pregnant individuals had current use, 12% had recently quit and 81% did not use cannabis. Adjusting for covariates, current use was associated with lower rates of SARS-CoV-2 infection [adjusted hazard ratio (aHR) = 0.60, 95% confidence interval (CI) = 0.49-0.74 than non-use. Those who had recently quit did not differ from non-cannabis users in infection rates (aHR = 0.96, 95% CI = 0.86-1.08). Sensitivity analyses among patients who received a SARS-CoV-2 test also found lower odds of infection associated with current versus no cannabis use (aOR = 0.76, CI = 0.61-0.93). CONCLUSIONS Current cannabis use appears to be associated with a reduced risk of SARS-CoV-2 infection among pregnant individuals.
Collapse
Affiliation(s)
- Kelly C. Young‐Wolff
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA,Department of Psychiatry and Behavioral SciencesUniversity of California, San FranciscoSan FranciscoCAUSA
| | - G. Thomas Ray
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | | | - Neal Benowitz
- Research Program in Clinical Pharmacology, Division of Cardiology, Department of Medicine and Center for Tobacco Control Research and EducationUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Sara R. Adams
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Monique B. Does
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Nancy Goler
- Regional OfficesKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Deborah Ansley
- Regional OfficesKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Amy Conway
- Regional OfficesKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Lyndsay A. Avalos
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| |
Collapse
|
10
|
Fiedorova K, Augustynek M, Kubicek J, Kudrna P, Bibbo D. Review of present method of glucose from human blood and body fluids assessment. Biosens Bioelectron 2022; 211:114348. [DOI: 10.1016/j.bios.2022.114348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 03/22/2022] [Accepted: 05/05/2022] [Indexed: 12/15/2022]
|
11
|
Ray GT, Altschuler A, Karmali R, Binswanger I, Glanz JM, Clarke CL, Ahmedani B, Andrade SE, Boscarino JA, Clark RE, Haller IV, Hechter R, Roblin DW, Sanchez K, Yarborough BJ, Bailey SR, McCarty D, Stephens KA, Rosa CL, Rubinstein AL, Campbell CI. Development and implementation of a prescription opioid registry across diverse health systems. JAMIA Open 2022; 5:ooac030. [PMID: 35651523 PMCID: PMC9150082 DOI: 10.1093/jamiaopen/ooac030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/21/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Develop and implement a prescription opioid registry in 10 diverse health systems across the US and describe trends in prescribed opioids between 2012 and 2018. Materials and Methods Using electronic health record and claims data, we identified patients who had an outpatient fill for any prescription opioid, and/or an opioid use disorder diagnosis, between January 1, 2012 and December 31, 2018. The registry contains distributed files of prescription opioids, benzodiazepines and other select medications, opioid antagonists, clinical diagnoses, procedures, health services utilization, and health plan membership. Rates of outpatient opioid fills over the study period, standardized to health system demographic distributions, are described by age, gender, and race/ethnicity among members without cancer. Results The registry includes 6 249 710 patients and over 40 million outpatient opioid fills. For the combined registry population, opioid fills declined from a high of 0.718 per member-year in 2013 to 0.478 in 2018, and morphine milligram equivalents (MMEs) per fill declined from 985 MMEs per fill in 2012 to 758 MMEs in 2018. MMEs per member declined from 692 MMEs per member in 2012 to 362 MMEs per member in 2018. Conclusion This study established a population-based opioid registry across 10 diverse health systems that can be used to address questions related to opioid use. Initial analyses showed large reductions in overall opioid use per member among the combined health systems. The registry will be used in future studies to answer a broad range of other critical public health issues relating to prescription opioid use.
Collapse
Affiliation(s)
- G Thomas Ray
- Division of Research, Kaiser Permanente Northern
California, Oakland, California, USA
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern
California, Oakland, California, USA
| | - Ruchir Karmali
- Division of Research, Kaiser Permanente Northern
California, Oakland, California, USA
- Mathematica, Oakland, California,
USA
| | - Ingrid Binswanger
- Institute for Health Research, Kaiser Permanente
Colorado, Denver, Colorado, USA
- Colorado Permanente Medical Group,
Denver, Colorado, USA
- Kaiser Permanente Bernard J. Tyson School of
Medicine, Pasadena, California, USA
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente
Colorado, Denver, Colorado, USA
- Department of Epidemiology, Colorado School of
Public Health, Aurora, Colorado, USA
| | - Christina L Clarke
- Institute for Health Research, Kaiser Permanente
Colorado, Denver, Colorado, USA
| | - Brian Ahmedani
- Center for Health Policy & Health Services
Research, Henry Ford Health System, Detroit, Michigan, USA
| | - Susan E Andrade
- Meyers Primary Care Institute, University of
Massachusetts Chan Medical School, Worcester, Massachusetts,
USA
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger
Clinic, Danville, Pennsylvania, USA
| | - Robin E Clark
- Department of Family Medicine and Community Health,
University of Massachusetts Chan School of Medicine, Worcester,
Massachusetts, USA
| | - Irina V Haller
- Essentia Institute of Rural Health,
Duluth, Minnesota, USA
| | - Rulin Hechter
- Kaiser Permanente Bernard J. Tyson School of
Medicine, Pasadena, California, USA
- Department of Research and Evaluation, Kaiser
Permanente Southern California, Pasadena, California, USA
| | - Douglas W Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser
Permanente, Rockville, Maryland, USA
| | - Katherine Sanchez
- Baylor Scott & White Research Institute,
Dallas, Texas, and School of Social Work, University of Texas at
Arlington, Arlington, Texas, USA
| | - Bobbi Jo Yarborough
- Center for Health Research, Kaiser Permanente
Northwest, Portland, Oregon, USA
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health
& Science University, Portland, Oregon, USA
| | - Dennis McCarty
- OHSU-PSU School of Public Health,
Portland, Oregon, USA
- Division of General and Internal Medicine, School
of Medicine, Oregon Health and Science University, Portland,
Oregon, USA
| | - Kari A Stephens
- Department of Family Medicine, University of
Washington, Seattle, Washington, USA
| | - Carmen L Rosa
- Center for the Clinicals Trials Network, National
Institute on Drug Abuse, National Institutes of Health, Bethesda,
Maryland, USA
| | - Andrea L Rubinstein
- Department of Pain Medicine, The Permanente Medical
Group, Santa Rosa, California, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern
California, Oakland, California, USA
- Kaiser Permanente Bernard J. Tyson School of
Medicine, Pasadena, California, USA
- Department of Psychiatry and Behavioral Sciences,
University of California San Francisco, San Francisco, California,
USA
| |
Collapse
|
12
|
Regular hospital visits and treatment outcomes among people living with type 1 diabetes: a 7-year study from South India. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
13
|
Harte R, Norton L, Whitehouse C, Lorincz I, Jones D, Gerald N, Estrada I, Sabini C, Mitra N, Long JA, Cappella J, Glanz K, Volpp KG, Kangovi S. Design of a randomized controlled trial of digital health and community health worker support for diabetes management among low-income patients. Contemp Clin Trials Commun 2022; 25:100878. [PMID: 34977421 PMCID: PMC8688867 DOI: 10.1016/j.conctc.2021.100878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 09/14/2021] [Accepted: 12/04/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Insulin-dependent diabetes is a challenging disease to manage and involves complex behaviors, such as self-monitoring of blood glucose. This can be especially challenging in the face of socioeconomic barriers and in the wake of the COVID-19 pandemic. Digital health self-monitoring interventions and community health worker support are promising and complementary best practices for improving diabetes-related health behaviors and outcomes. Yet, these strategies have not been tested in combination. This protocol paper describes the rationale and design of a trial that measures the combined effect of digital health and community health worker support on glucose self-monitoring and glycosylated hemoglobin. METHODS The study population was uninsured or publicly insured; lived in high-poverty, urban neighborhoods; and had poorly controlled diabetes mellitus with insulin dependence. The study consisted of three arms: usual diabetes care; digital health self-monitoring; or combined digital health and community health worker support. The primary outcome was adherence to blood glucose self-monitoring. The exploratory outcome was change in glycosylated hemoglobin. CONCLUSION The design of this trial was grounded in social justice and community engagement. The study protocols were designed in collaboration with frontline community health workers, the study aim was explicit about furthering knowledge useful for advancing health equity, and the population was focused on low-income people. This trial will advance knowledge of whether combining digital health and community health worker interventions can improve glucose self-monitoring and diabetes-related outcomes in a high-risk population.
Collapse
Affiliation(s)
- Rory Harte
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Community Health Workers, Penn Medicine, Philadelphia, PA, USA
| | - Lindsey Norton
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Community Health Workers, Penn Medicine, Philadelphia, PA, USA
| | - Christina Whitehouse
- Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, PA, USA
| | - Ilona Lorincz
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Denerale Jones
- Penn Center for Community Health Workers, Penn Medicine, Philadelphia, PA, USA
| | - Norma Gerald
- Penn Center for Community Health Workers, Penn Medicine, Philadelphia, PA, USA
| | - Irene Estrada
- Penn Center for Community Health Workers, Penn Medicine, Philadelphia, PA, USA
| | - Carolyn Sabini
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Community Health Workers, Penn Medicine, Philadelphia, PA, USA
| | - Nandita Mitra
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Judith A. Long
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Joseph Cappella
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin G. Volpp
- Penn Center for Health Incentives and Behavioral Economics, Departments of Medical Ethics and Health Policy and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shreya Kangovi
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Community Health Workers, Penn Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
14
|
Cheng AYY, Feig DS, Ho J, Siemens R. Blood Glucose Monitoring in Adults and Children with Diabetes: Update 2021. Can J Diabetes 2021; 45:580-587. [PMID: 34511234 DOI: 10.1016/j.jcjd.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 12/14/2022]
|
15
|
Alexeeff SE, Deosaransingh K, Liao NS, Van Den Eeden SK, Schwartz J, Sidney S. Particulate Matter and Cardiovascular Risk in Adults with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2021; 204:159-167. [PMID: 33662228 DOI: 10.1164/rccm.202007-2901oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: People with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular disease and may be more susceptible to air pollution exposure. However, no study has examined the association between long-term fine particulate matter exposure (≤2.5 μm in aerodynamic diameter) and risk of cardiovascular events in this potentially vulnerable population. Objectives: To estimate the association between long-term fine particulate matter and risk of cardiovascular events among adults with COPD. Methods: This retrospective cohort study included 169,714 adults with COPD who were members of the Kaiser Permanente Northern California health plan during 2007-2016. Electronic health record data were linked to 1 km modeled particulate matter ≤2.5 μm in aerodynamic diameter exposure estimates. We fit Cox proportional hazard models, adjusting for age, sex, race/ethnicity, calendar year, smoking, body mass index, comorbidities, medications, and socioeconomic status. In low exposure analyses, we examined effects below the current regulation limit (12 μg/m3). Measurements and Main Results: Among adults with COPD, a 10-μg/m3 increase in 1-year mean fine particulate matter exposure was associated with an elevated risk of cardiovascular mortality (hazard ratio, 1.10; 95% confidence interval [CI], 1.01-1.20). Effects were stronger in low exposure analyses (hazard ratio, 1.88; 95% CI, 1.56-2.27). Fine particulate matter exposure was not associated with acute myocardial infarction or stroke in overall analyses. Conclusions: Long-term fine particulate matter exposure was associated with an increased risk of cardiovascular mortality among adults with COPD. Current regulations may not sufficiently protect those with COPD.
Collapse
Affiliation(s)
- Stacey E Alexeeff
- Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, California; and
| | - Kamala Deosaransingh
- Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, California; and
| | - Noelle S Liao
- Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, California; and
| | | | - Joel Schwartz
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Stephen Sidney
- Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, California; and
| |
Collapse
|
16
|
May Measurement Month 2017-2019: A Community-Wide Opportunistic Blood Pressure Screening Campaign in Hong Kong. Int J Hypertens 2021; 2021:8891794. [PMID: 33532095 PMCID: PMC7834825 DOI: 10.1155/2021/8891794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/17/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Hypertension is a modifiable risk factor for multiple cardiovascular diseases. Early identification and intervention of new cases are crucial to improve patients' outcomes. May Measurement Month (MMM) is an annual global synchronised blood pressure (BP) screening campaign. Participants can have their BP measured at the screening sites. It may be a possible way to identify undiagnosed hypertensive patients in the population. Methods It was a cross-sectional study of BP among Hong Kong adults. Multiple screening sites were set in local community pharmacies and on the campus of the Chinese University of Hong Kong. Participants were asked to fill in a questionnaire regarding their demographics, medical history, and social history. Then, they took at least one BP reading using an automated sphygmomanometer after sitting at for 5 minutes. Up to three BP readings were taken and recorded for each participant, with one-minute intervals between readings. Results A total of 3224 adults participated in MMM between 2017 and 2019. The average BP among the 3224 participants was 139.8/75.5 mmHg. The prevalence of hypertension was 2282 (70.8%), of which 635 (27.8%) were undiagnosed before MMM. Among the 1647 participants previously diagnosed with hypertension, 1007 (61.1%) had uncontrolled hypertension. Conclusion A high number of cases can be identified with untreated, or treated but uncontrolled, hypertension from MMM. Citizens should be encouraged to check BP regularly and take follow-up actions if hypertension is suspected.
Collapse
|
17
|
Mak WH, Lau RWM. Predictors of self-monitoring of blood glucose among noninsulin-treated patients with type 2 diabetes in a primary care setting in Hong Kong: A cross-sectional study. SAGE Open Med 2021; 9:20503121211066150. [PMID: 34992780 PMCID: PMC8724976 DOI: 10.1177/20503121211066150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: The current study aimed to examine the relationship between patient characteristics (internal psychological, external psychological, internal physical, external physical, and educational) and self-monitoring of blood glucose among noninsulin-treated patients with type 2 diabetes in a local primary care setting. Methods: This was a cross-sectional study, in which data were collected by a structured questionnaire. Correlational and multivariate multiple regression analyses were performed. Three hundred seventy-four noninsulin-treated patients with type 2 diabetes were eligible and completed the questionnaire in August 2019. The response rate was 93.5%. The respondents’ self-reported self-monitoring of blood glucose adherence was the main outcome measure. Results: In predicting self-monitoring of blood glucose adherence, the current regression model accounted for 12.3% of the variance (Adjusted R2 = 0.123, p < 0.05), with internal psychological factors and educational factors being significant. External psychological factors, external physical factors, and internal physical factors were found to be statistically nonsignificant. Conclusion: The findings highlighted the facilitating role of internal psychological factors and educational factors in SMBG adherence in noninsulin-treated type 2 diabetic patients. Among these factors, the education aspect was relatively strongly associated with increased SMBG adherence. With adequate patient education on diabetes and SMBG, the increased literacy would possibly strengthen patients’ internal psychological factors and motivate them to uptake SMBG practice. Implications from the current findings suggested that further research on different SMBG parameters is warranted to fill the knowledge gap in structuring an individualized and targeted SMBG protocol for better diabetic care.
Collapse
Affiliation(s)
- Wing-hang Mak
- Family Medicine and Primary Health Care, Hong Kong East Cluster, Hospital Authority, Hong Kong SAR, China
| | - Rebecca Wing-man Lau
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
18
|
Al-Hariri M, Khan S, Albaker W, Al Malik W. Impact of Knowledge and Practice on Fasting Blood Glucose Levels among Diabetics During Ramadan Fasting. J Epidemiol Glob Health 2020; 9:288-293. [PMID: 31854171 PMCID: PMC7310796 DOI: 10.2991/jegh.k.190824.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022] Open
Abstract
The aim of the present study was to investigate the impact of knowledge and practice on the fasting blood glucose of diabetic patients during the month of Ramadan. The simple random sampling technique was used to calculate sample size and the computed sample size was 112. Participants were recruited from the diabetic outpatient clinics at King Fahad Hospital of the University, Dammam, Saudi Arabia. The participants included male and female adults with either type 1 or 2 diabetes, aged 15–70 years. Children, pregnant women, and those who were unable to complete at least 3 weeks of fasting during the study period were excluded from the study. Fasting blood glucose reading of the participants was extracted during Ramadan and in Shawwal (after 30 days) and a first-visit questionnaire related to the knowledge and practice was provided to them. Statistical Package for Social Sciences (version 22) was used for data entry and analysis. A two way ANOVA test, two independent sample t-tests and Chi-square test were used to compare between the groups. A p-value at 0.05 was considered statistically significant. The study found that fasting blood glucose of a participant during the holy month of Ramadan (144.2) was statistically significant with p-value 0.0003 as compared with after Ramadan (178.5). Moreover, it was found that as the level of knowledge (poor, average, good) improved, the fasting blood glucose goes down with p-values 0.036 and 0.037. Our results revealed that fasting during Ramadan significantly decreases blood glucose. The overall level of knowledge and practice concerning diabetes among the participants studied during the month Ramadan is average.
Collapse
Affiliation(s)
- Mohammed Al-Hariri
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Soban Khan
- Department of Clinical Affairs, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Walid Albaker
- Department of Internal medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Waleed Al Malik
- Department of Gynecology and Obstetrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
19
|
Palzes VA, Weisner C, Chi FW, Kline-Simon AH, Satre DD, Hirschtritt ME, Ghadiali M, Sterling S. The Kaiser Permanente Northern California Adult Alcohol Registry, an Electronic Health Records-Based Registry of Patients With Alcohol Problems: Development and Implementation. JMIR Med Inform 2020; 8:e19081. [PMID: 32706676 PMCID: PMC7407243 DOI: 10.2196/19081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 01/26/2023] Open
Abstract
Background Electronic health record (EHR)–based disease registries have aided health care professionals and researchers in increasing their understanding of chronic illnesses, including identifying patients with (or at risk of developing) conditions and tracking treatment progress and recovery. Despite excessive alcohol use being a major contributor to the global burden of disease and disability, no registries of alcohol problems exist. EHR-based data in Kaiser Permanente Northern California (KPNC), an integrated health system that conducts systematic alcohol screening, which provides specialty addiction medicine treatment internally and has a membership of over 4 million members that are highly representative of the US population with access to care, provide a unique opportunity to develop such a registry. Objective Our objectives were to describe the development and implementation of a protocol for assembling the KPNC Adult Alcohol Registry, which may be useful to other researchers and health systems, and to characterize the registry cohort descriptively, including underlying health conditions. Methods Inclusion criteria were adult members with unhealthy alcohol use (using National Institute on Alcohol Abuse and Alcoholism guidelines), an alcohol use disorder (AUD) diagnosis, or an alcohol-related health problem between June 1, 2013, and May 31, 2019. We extracted patients’ longitudinal, multidimensional EHR data from 1 year before their date of eligibility through May 31, 2019, and conducted descriptive analyses. Results We identified 723,604 adult patients who met the registry inclusion criteria at any time during the study period: 631,780 with unhealthy alcohol use, 143,690 with an AUD diagnosis, and 18,985 with an alcohol-related health problem. We identified 65,064 patients who met two or more criteria. Of the 4,973,195 adult patients with at least one encounter with the health system during the study period, the prevalence of unhealthy alcohol use was 13% (631,780/4,973,195), the prevalence of AUD diagnoses was 3% (143,690/4,973,195), and the prevalence of alcohol-related health problems was 0.4% (18,985/4,973,195). The registry cohort was 60% male (n=432,847) and 41% non-White (n=295,998) and had a median age of 41 years (IQR=27). About 48% (n=346,408) had a chronic medical condition, 18% (n=130,031) had a mental health condition, and 4% (n=30,429) had a drug use disorder diagnosis. Conclusions We demonstrated that EHR-based data collected during clinical care within an integrated health system could be leveraged to develop a registry of patients with alcohol problems that is flexible and can be easily updated. The registry’s comprehensive patient-level data over multiyear periods provides a strong foundation for robust research addressing critical public health questions related to the full course and spectrum of alcohol problems, including recovery, which would complement other methods used in alcohol research (eg, population-based surveys, clinical trials).
Collapse
Affiliation(s)
- Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, CA, United States
| | - Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, CA, United States
| | - Matthew E Hirschtritt
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, CA, United States.,Department of Psychiatry, Kaiser Permanente East Bay, Oakland, CA, United States
| | - Murtuza Ghadiali
- Department of Addiction Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, United States.,Department of Addiction Psychiatry, University of California, San Francisco, CA, United States
| | - Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| |
Collapse
|
20
|
Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management
of Type 2 Diabetes Mellitus 2020. Int J Diabetes Dev Ctries 2020. [PMCID: PMC7371966 DOI: 10.1007/s13410-020-00819-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology & Metabolism, UCMS-GTB Hospital, Delhi, India
| | - B. M. Makkar
- Dr Makkar’s Diabetes & Obesity Centre Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana India
| | | |
Collapse
|
21
|
Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Nikonova TV, Sukhareva OY, Pekareva EV, Ibragimova LI, Mikhina MS, Galstyan GR, Tokmakova AY, Surkova EV, Laptev DN, Kononenko IV, Egorova DN, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Gomova IS, Lipatov DV, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Klimontov VV, Mkrtumyan AM, Petunina NA, Suplotova LA, Ushakova OV, Khalimov YS, Ruyatkina LA. Diabetes mellitus type 1 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Vadim V. Klimontov
- Research Institute of Clinical and Experimental Lymphology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences
| | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | | | | | | |
Collapse
|
22
|
Wada E, Onoue T, Kobayashi T, Handa T, Hayase A, Ito M, Furukawa M, Okuji T, Okada N, Iwama S, Sugiyama M, Tsunekawa T, Takagi H, Hagiwara D, Ito Y, Suga H, Banno R, Kuwatsuka Y, Ando M, Goto M, Arima H. Flash glucose monitoring helps achieve better glycemic control than conventional self-monitoring of blood glucose in non-insulin-treated type 2 diabetes: a randomized controlled trial. BMJ Open Diabetes Res Care 2020; 8:8/1/e001115. [PMID: 32518063 PMCID: PMC7292039 DOI: 10.1136/bmjdrc-2019-001115] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The present study aimed to evaluate the effects of flash glucose monitoring (FGM) and conventional self-monitoring of blood glucose (SMBG) on glycemic control in patients with non-insulin-treated type 2 diabetes. RESEARCH DESIGN AND METHODS In this 24-week, multicenter, open-label, randomized (1:1), parallel-group study, patients with non-insulin-treated type 2 diabetes at five hospitals in Japan were randomly assigned to the FGM (n=49) or SMBG (n=51) groups and were provided each device for 12 weeks. The primary outcome was change in glycated hemoglobin (HbA1c) level, and was compared using analysis of covariance model that included baseline values and group as covariates. RESULTS Forty-eight participants in the FGM group and 45 in the SMBG group completed the study. The mean HbA1c levels were 7.83% (62.1 mmol/mol) in the FGM group and 7.84% (62.2 mmol/mol) in the SMBG group at baseline, and the values were reduced in both FGM (-0.43% (-4.7 mmol/mol), p<0.001) and SMBG groups (-0.30% (-3.3 mmol/mol), p=0.001) at 12 weeks. On the other hand, HbA1c was significantly decreased from baseline values in the FGM group, but not in the SMBG group at 24 weeks (FGM: -0.46% (-5.0 mmol/mol), p<0.001; SMBG: -0.17% (-1.8 mmol/mol), p=0.124); a significant between-group difference was also observed (difference -0.29% (-3.2 mmol/mol), p=0.022). Diabetes Treatment Satisfaction Questionnaire score was significantly improved, and the mean glucose levels, SD of glucose, mean amplitude of glycemic excursions and time in hyperglycemia were significantly decreased in the FGM group compared with the SMBG group. CONCLUSIONS Glycemic control was better with FGM than with SMBG after cessation of glucose monitoring in patients with non-insulin-treated type 2 diabetes. TRIAL REGISTRATION NUMBER UMIN000026452, jRCTs041180082.
Collapse
Affiliation(s)
- Eri Wada
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Onoue
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Kobayashi
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Handa
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ayaka Hayase
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Ito
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mariko Furukawa
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Okuji
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norio Okada
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shintaro Iwama
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mariko Sugiyama
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taku Tsunekawa
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Takagi
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Hagiwara
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Ito
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidetaka Suga
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryoichi Banno
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan
| | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Motomitsu Goto
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Arima
- Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
23
|
A Bibliometric Analysis on No-Show Research: Status, Hotspots, Trends and Outlook. SUSTAINABILITY 2020. [DOI: 10.3390/su12103997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
No-show is a thorny issue within the social scope. It not only affects the sustainability of service system operation but also causes heavy irretrievable losses. To maintain and develop the sustainability of service, this paper adopts bibliometric technology to reflect the current status and future prospects about no-show research. And we strive to explore and summarize appointment scheduling methods for no-show problems. The bibliometric analysis was carried out from various aspects including research areas, countries/regions, institutions, journals, authors and author keywords based on papers harvested from Web of Science Core Collection database. The total 1197 papers show that the United States is in a leading position in this field, followed by England and Canada. University of London is the most productive institution with the highest total citations and H-Index. BMC Health Services Research ranks first as the most productive journal, followed by European Journal of Operational Research and Production and Operations Management. Through the analysis of hot articles, we can conclude that how to reduce the impact of no-shows on the sustainability of service systems has become the main research direction. In addition to appointment scheduling, other effective methods are also mentioned. Further study on these methods will be a major research direction in the future.
Collapse
|
24
|
Graetz I, Huang J, Muelly ER, Fireman B, Hsu J, Reed ME. Association of Mobile Patient Portal Access With Diabetes Medication Adherence and Glycemic Levels Among Adults With Diabetes. JAMA Netw Open 2020; 3:e1921429. [PMID: 32074289 PMCID: PMC7646995 DOI: 10.1001/jamanetworkopen.2019.21429] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Online patient portals support self-management, and mobile devices expand portal access, but whether this translates to improvements in diabetes outcomes is unclear. OBJECTIVE To examine the association of adding mobile patient portal access with diabetes medication adherence and glycemic levels among adults with diabetes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients with diabetes treated at Kaiser Permanente Northern California, a large, integrated health care delivery system, from April 1, 2015, to December 31, 2017. Inclusion criteria were adults with diabetes with an oral diabetes prescription at baseline and no insulin use. Data were analyzed from March 2018 to March 2019. EXPOSURES Patient portal access status for each calendar month from April 2015 to December 2017, categorized as never used, used from a computer only, used from a mobile device only, or used from both computer and mobile device. MAIN OUTCOMES AND MEASURES Medication adherence, measured by monthly percentage of days covered (PDC), and glycemic levels, measured by changes in glycated hemoglobin A1c (HbA1c) levels. The association of portal access with study outcomes was assessed using linear regression with patient-level fixed effects and adjusting for time-changing variables, stratified by baseline HbA1c level. RESULTS Among 111 463 included patients (mean [SD] age, 63.79 [12.93] years; 59 918 [53.76%] men), the number of patients using the portal from both a computer and mobile device increased over time from 38 371 patients (34.42%) in April 2015 to 57 920 patients (61.71%) in December 2017. Among patients with no prior portal access, adding computer-only portal access was associated with an increase in PDC of 1.16 (95% CI, 0.63 to 1.70) percentage points and a change of -0.06 (95% CI, -0.08 to -0.03) percentage points in HbA1c level, and adding both mobile and computer portal access was associated with an increase in PDC of 1.67 (95% CI, 1.10 to 2.23) percentage points and a change of -0.13 (95% CI, -0.16 to -0.10) percentage points in HbA1c level. Among patients with higher baseline HbA1c level (>8.0%), changing from no portal access to both computer and mobile access was associated with an increase in PDC of 5.09 (95% CI, 3.78 to 6.40) percentage points and a change of -0.19 (95% CI, -0.27 to -0.15) percentage points in HbA1c level. CONCLUSIONS AND RELEVANCE These findings suggest that providing patients with computer patient portal access and combining it with mobile patient portal access are associated with significantly improved diabetes medication adherence and glycemic control, with greater benefits among patients with more clinical need. Convenient access to portal self-management tools through a mobile device could significantly improve diabetes management.
Collapse
Affiliation(s)
- Ilana Graetz
- Rollins School of Public Health, Department of Health Policy and Management, Emory University, Atlanta, Georgia
| | - Jie Huang
- Kaiser Permanente Division of Research, Oakland, California
| | | | - Bruce Fireman
- Kaiser Permanente Division of Research, Oakland, California
| | - John Hsu
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Mary E Reed
- Kaiser Permanente Division of Research, Oakland, California
| |
Collapse
|
25
|
Algorithmic comparison of patient-reported blood glucose diary records with meters’ memory in gestational diabetes. INFORMATICS IN MEDICINE UNLOCKED 2020. [DOI: 10.1016/j.imu.2020.100397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
26
|
Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2020. Indian J Endocrinol Metab 2020; 24:1-122. [PMID: 32699774 PMCID: PMC7328526 DOI: 10.4103/ijem.ijem_225_20] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, New Delhi, India
| | - B. M. Makkar
- Dr. Makkar's Diabetes and Obesity Centre, Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, Gujarat, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | | |
Collapse
|
27
|
Abstract
Abstract
Chronic disease poses a major burden to patients and health care systems. This review considers how patient self-testing can contribute to the management of chronic disease. Self-testing can only confer benefit if it occurs in the context of an empowered patient who has the skills and training to translate test results into meaningful actions. The benefits may include improved clinical outcomes, greater patient convenience and improved psychological well-being; separately and together these may contribute to reduced costs of care. As self-testing may be expensive and burdensome to patients, it is important that its use in chronic disease is supported by a robust evidence base confirming its utility and efficacy. The design of studies to assess the impact of self-testing poses challenges for the researcher and the quality of evidence presented is often variable. Randomised controlled trials (RCTs) provide more robust evidence than observational studies; the intervention under study is not just self-testing but includes the educational support to allow patients to use results effectively. This review discusses the evidence base relating to patient self-testing in diabetes, anticoagulant monitoring and in renal transplant patients and in particular highlights the impact of new technology developments such as flash glucose monitoring in diabetes.
Collapse
Affiliation(s)
- Maurice J. O’Kane
- Clinical Chemistry Laboratory, Altnaglevin Hospital , Western Health and Social Care Trust , Londonderry , Northern Ireland , UK
| |
Collapse
|
28
|
Pokhrel S, Shrestha S, Timilsina A, Sapkota M, Bhatt MP, Pardhe BD. Self-Care Adherence And Barriers To Good Glycaemic Control In Nepalese Type 2 Diabetes Mellitus Patients: A Hospital-Based Cross-Sectional Study. J Multidiscip Healthc 2019; 12:817-826. [PMID: 31632050 PMCID: PMC6791337 DOI: 10.2147/jmdh.s216842] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/13/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose The patient believes in adherence to medication rather than to self-care adherence and lifestyle changes for the management of diabetes. This study was carried out to establish the association of self-care adherence and their barriers in poor glycemic control in our diabetic population. Patients and methods This cross-sectional study was conducted among 480 already diagnosed diabetes outpatients attended in our two hospitals. Glycaemic control was defined by levels of HbA1c. Socio-demographic data, lifestyle variables and anthropometric measurements were recorded using a standard questionnaire. Fasting blood glucose, HbA1c and lipid profiles were estimated using the manufacturer’s guideline. Student’s t-test and one-way ANOVA were used for comparison between different groups and the correlation was established by Spearman correlation. Risk factors associated with poor glycaemic control were verified by logistic regression analysis. Results The mean HbA1c of the study population was 7.4±1.3% and 65.4% had poor glycaemic control with mean 8.0±1.1%. Higher HbA1c levels were significantly associated with duration of diabetes, a number of drugs used, patient–physician relationship and knowledge about diabetes. The poor glycaemic control was significantly associated with low adherence of following the meal plan, regular medication and regular exercising (p<0.001). Among all the barriers, a too busy schedule for following the meal plan, taking medications and exercising regularly was significantly correlated with HbA1c levels. Multivariable logistic regression analysis showed irregular meal plan (OR=5.27), irregular exercise (OR=2.25), number of medication used (OR= 0.19) and lesser extent patient–physician relationship (OR=2.68) were independent risk factors for poor glycaemic control. Conclusion The poor glycaemic control was associated with poor adherence to self-care adherence and their barriers in our diabetic population. Integrated knowledge on diabetes management should be targeted to improve glycaemic control in our communities.
Collapse
Affiliation(s)
- Sushant Pokhrel
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Sneha Shrestha
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Alaska Timilsina
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Manisha Sapkota
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Mahendra Prasad Bhatt
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Bashu Dev Pardhe
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| |
Collapse
|
29
|
Mariye T, Girmay A, Tasew H, Teklay G, Ayele E, Gerensea H, Mokonnen H. Determinants of hypertension among diabetic patients in Public Hospitals of the Central Zone, Tigray, Ethiopia 2018: unmatched case-control study. Pan Afr Med J 2019; 33:100. [PMID: 31489078 PMCID: PMC6711702 DOI: 10.11604/pamj.2019.33.100.17094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 05/07/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Hypertension, among diabetic patients, is a worldwide public-health challenge and a leading modifiable risk factor for other cardiovascular diseases. The main purpose of this study was to identify determinants of hypertension among diabetic patients. Methods Data were collected from January to March 2018 using an interviewer-administered structured questionnaire. Data collectors and supervisors were trained before the period of data collection. The questionnaire was pretested on 5% of the sample at Suhul hospital. Bivariable logistic regression was employed to examine the crude associations between the outcome variable and determinant variables. This was followed by multivariable analysis to examine the determinants of hypertension among diabetic patients by selecting variables which had p value ≤0.2 in the bivariable analysis. Results The age range of the respondents was 18-80 years, with the median age of 51.56±14.92 years. Not attending diabetes mellitus education sessions (AOR=2.61, 95% CI (1.12,6.1), duration since diagnosis with diabetes (AOR=8.52; 95% CI (1.97, 36.84), poor glycemic control (AOR=22.99, 95CI (5.92,89.28), overweight (AOR=4.84, 95%CI (1.42,16.51), and non-adherence to diabetes medication (AOR=4.66, 95% CI (2.22,9.79), diet (AOR=9.70,95% CI (3.34,28.22), exercise (AOR= 5.47, 95% CI (2.35,12.75), and self-monitoring blood glucose (AOR=6.62, 95% CI (3.16, 13.86) were found to be the determinants of hypertension among diabetic patients. Conclusion This research concludes that longer duration with diabetes, nonattendance of diabetes education sessions, poor glycemic control, and not-adherence to antidiabetic medications, diet, exercise and self-monitoring blood glucose were found to be the determinants of hypertension among diabetic patients.
Collapse
Affiliation(s)
- Teklewoini Mariye
- Department of Adult Health Nursing, Aksum University, Tigray, Ethiopia
| | - Alem Girmay
- Department of Adult Health Nursing, Aksum University, Tigray, Ethiopia
| | - Hagos Tasew
- Department of Pediatric Nursing, Aksum University, Tigray, Ethiopia
| | - Girmay Teklay
- Department of Pediatric Nursing, Aksum University, Tigray, Ethiopia
| | - Ebud Ayele
- Department of Nutrition, Aksum University, Tigray, Ethiopia
| | - Hadgu Gerensea
- Department of Pediatric Nursing, Aksum University, Tigray, Ethiopia
| | - Hussen Mokonnen
- Department of Nursing and Midwifery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
30
|
Mamo Y, Bekele F, Nigussie T, Zewudie A. Determinants of poor glycemic control among adult patients with type 2 diabetes mellitus in Jimma University Medical Center, Jimma zone, south west Ethiopia: a case control study. BMC Endocr Disord 2019; 19:91. [PMID: 31464602 PMCID: PMC6716911 DOI: 10.1186/s12902-019-0421-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 08/20/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE AND BACKGROUND In 2015 approximately 5.0 million people were estimated to have died from diabetes. Poor glycemic control is the most determinant of diabetes-related complication and death. The percentage of patients whose blood glucose level are not well controlled remains high yet. The aim of this study is to identify the determinants of poor glycemic control at the diabetes clinic of the Jimma University Medical Center from April 01 to June 30/2017. METHODS Facility-based case-control study design was conducted on patients with type 2 diabetes mellitus on follow-up at the diabetes clinic of Jimma University medical center. The consecutive sampling technique was employed and data were collected from April to June 2017. The data were entered using Epidata manager version 4.0.2 and exported to SPSS Version 21 for analysis. Logistic regression analysis was performed and variables with the p-value of less than 0.05 were considered as statistically significant determinants of poor glycemic control. RESULT The study was conducted on 410 patients, of which 228 males and 182 females. The determinants of poor glycemic control were comorbidities [Adjusted odd ratio(AOR) = 2.56, 95%CI = 1.10-5.96], lack of self-monitoring blood glucose [AOR = 3.44,95%CI = 1.33-8.94], total cholesterol level of 200 mg/dl or more [AOR = 3.62, 95%CI = 1.46-8.97], diabetes duration of greater than 7 years [AOR = 3.08, 95%CI = 1.33-7.16], physical activity of three or less than three days [AOR = 4.79, 95%CI = 1.70-13.53], waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female [AOR = 3.52, 95%CI = 1.23-10.11], being on metformin plus insulin [AOR = 9.22, 95%CI = 2.90-29.35] and being on insulin [AOR = 4.48, 95%CI = 1.52-13.16]. CONCLUSION Lack of Self-monitoring blood glucose, presence of comorbidities, duration of diabetes mellitus, physical activity of three or less than three days, total cholesterol of 200 mg/dl or more, waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female, and types of antidiabetic medication were the independent predictors of poor glycemic control. Effort should be made towards reducing these factors by the concerned body.
Collapse
Affiliation(s)
- Yitagesu Mamo
- Department of Pharmacy, College of medicine and health science, Mizan Tepi University, Mizan Teferi, Ethiopia
| | - Fekede Bekele
- Department of Pharmacy, Jimma University Institute of Health Science, Jimma, Ethiopia
| | - Tadesse Nigussie
- Department of Public Health, College of medicine and health science, Mizan Tepi University, Mizan Teferi, Ethiopia
| | - Ameha Zewudie
- Department of Pharmacy, College of medicine and health science, Mizan Tepi University, Mizan Teferi, Ethiopia
| |
Collapse
|
31
|
Frías-Ordoñez JS, Pérez-Gualdrón CE. Self-monitoring of blood glucose as control tool in the different management contexts for Type 2 Diabetes Mellitus. What is its current role in non-insulin users? REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n3.69687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: Self-monitoring blood glucose (SMBG) has been considered a key element in the management of Type 2 Diabetes Mellitus (T2DM). However, its role in glycemic control in non-insulin users has been long discussed.Objective: To conduct a narrative literature review of the benefits of SMBG in non-insulin-treated patients with T2DM.Materials and Methods: A scientific literature search was conducted in the following databases: Pubmed, ScienceDirect, Embase, SciELO, Cochrane and Medline. Relevant articles were selected according to the established criteria. In addition, some studies included in the references of the initially selected articles were added to the review since they were considered relevant for its objective.Results: The following records were included in the review: 14 controlled clinical trials, 13 observational studies, 10 clinical practice guidelines, 7 narrative reviews, 5 meta-analyses, and 1 systematic review.Conclusion: based on the evidence found in this review it is possible to say that the use of SMBG in patients with T2DM is beneficial and that it has a positive impact on non-insulin users in terms of achieving glycemic control and defining therapeutic changes.
Collapse
|
32
|
Messaaoui A, Tenoutasse S, Crenier L. Flash Glucose Monitoring Accepted in Daily Life of Children and Adolescents with Type 1 Diabetes and Reduction of Severe Hypoglycemia in Real-Life Use. Diabetes Technol Ther 2019; 21:329-335. [PMID: 31058545 DOI: 10.1089/dia.2018.0339] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Flash glucose monitoring (FGM) is covered by the Belgian public health insurance for type 1 diabetes since 2016. The objective of this study was to describe the use of FGM and diabetes outcomes in type 1 diabetic children and adolescents 1 year after reimbursement. Methods: All patients had the choice to convert to FGM or to continue with self-monitoring of blood glucose (SMBG). Clinical data were collected at baseline, at the next visit, and after 12 months; glucose profiles at next visit and after 12 months. Regression analyses were performed to identify predictors of FGM acceptance and changes in metabolic control. Results: A total of 334 subjects were included, of whom 278 (83.2%) switched to FGM. They were younger (13.6 vs. 15.2 years; P = 0.012) and performed more SMBG testing at baseline than patients who did not switch (4.3 vs. 4.1 tests daily; P = 0.008). At the end of follow-up, the rate of severe hypoglycemia decreased by 53% in the group of FGM users (P = 0.012) while it remained stable in SMBG users. Median glycated hemoglobin did not change significantly in both groups. Among subjects who switched to FGM, 15.8% reverted to SMBG after a median use of 5.3 months. Adverse events, diabetes duration, and FGM utilization were independent predictors of the risk for reverting. FGM-related adverse events were associated with a fivefold increased risk to revert to SMBG (hazard ratio = 5.12; P < 0.0001). Conclusions: FGM is relatively well accepted and decreases the risk of severe hypoglycemic events in our pediatric population. FGM is more often discontinued in patients experiencing adverse events and with longer diabetes duration.
Collapse
Affiliation(s)
- Anissa Messaaoui
- 1 Diabetology Clinic, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium-Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Sylvie Tenoutasse
- 1 Diabetology Clinic, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium-Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Laurent Crenier
- 2 Department of Endocrinology, Hôpital Erasme, Brussels, Belgium-Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| |
Collapse
|
33
|
Jones LV, Ray A, Moy FM, Buckley BS. Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes. Cochrane Database Syst Rev 2019; 5:CD009613. [PMID: 31120549 PMCID: PMC6532756 DOI: 10.1002/14651858.cd009613.pub4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND There are a number of ways of monitoring blood glucose in women with diabetes during pregnancy, with self-monitoring of blood glucose (SMBG) recommended as a key component of the management plan. No existing systematic reviews consider the benefits/effectiveness of different techniques of blood glucose monitoring on maternal and infant outcomes among pregnant women with pre-existing diabetes. The effectiveness of the various monitoring techniques is unclear. This review is an update of a review that was first published in 2014 and subsequently updated in 2017. OBJECTIVES To compare techniques of blood glucose monitoring and their impact on maternal and infant outcomes among pregnant women with pre-existing diabetes. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (1 November 2018), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs comparing techniques of blood glucose monitoring including SMBG, continuous glucose monitoring (CGM), automated telemedicine monitoring or clinic monitoring among pregnant women with pre-existing diabetes mellitus (type 1 or type 2). Trials investigating timing and frequency of monitoring were also eligible for inclusion. RCTs using a cluster-randomised design were eligible for inclusion but none were identified. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS This review update includes a total of 12 trials (863) women (792 women with type 1 diabetes and 152 women with type 2 diabetes). The trials took place in Europe, the USA and Canada. Three of the 12 included studies are at low risk of bias, eight studies are at moderate risk of bias, and one study is at high risk of bias. Four trials reported that they were provided with the continuous glucose monitors free of charge or at a reduced cost by the manufacturer.Continuous glucose monitoring (CGM) versus intermittent glucose monitoring, (four studies, 609 women)CGM may reduce hypertensive disorders of pregnancy (pre-eclampsia and pregnancy-induced hypertension) (risk ratio (RR) 0.58, 95% confidence interval (CI) 0.39 to 0.85; 2 studies, 384 women; low-quality evidence), although it should be noted that only two of the four relevant studies reported data for this composite outcome. Conversely, this did not translate into a clear reduction for pre-eclampsia (RR 0.65, 95% CI 0.39 to 1.08; 4 studies, 609 women, moderate-quality evidence). There was also no clear reduction in caesarean section (average RR 0.94, 95% CI 0.75 to 1.18; 3 studies, 427 women; I2 = 41%; moderate-quality evidence) or large-for-gestational age (average RR 0.84, 95% CI 0.57 to 1.26; 3 studies, 421 women; I2 = 70%; low-quality evidence) with CGM. There was not enough evidence to assess perinatal mortality (RR 0.82, 95% CI 0.05 to 12.61, 71 infants, 1 study; low-quality evidence), or mortality or morbidity composite (RR 0.80, 95% CI 0.61 to 1.06; 1 study, 200 women) as the evidence was based on single studies of low quality. CGM appears to reduce neonatal hypoglycaemia (RR 0.66, 95% CI 0.48 to 0.93; 3 studies, 428 infants). Neurosensory disability was not reported.Other methods of glucose monitoringFor the following five comparisons, self-monitoring versus a different type of self-monitoring (two studies, 43 women); self-monitoring at home versus hospitalisation (one study, 100 women), pre-prandial versus post-prandial glucose monitoring (one study, 61 women), automated telemedicine monitoring versus conventional system (three studies, 84 women), and constant CGM versus intermittent CGM (one study, 25 women), it is uncertain whether any of the interventions has any impact on any of our GRADE outcomes (hypertensive disorders of pregnancy, caesarean section, large-for-gestational age) because the quality of the evidence was found to be very low. This was due to evidence largely being derived from single trials, with design limitations and limitations with imprecision (wide CIs, small sample sizes, and few events). There was not enough evidence to assess perinatal mortality and neonatal mortality and morbidity composite. Other important outcomes, such as neurosensory disability, were not reported in any of these comparisons. AUTHORS' CONCLUSIONS Two new studies (406 women) have been incorporated to one of the comparisons for this update. Although the evidence suggests that CGM in comparison to intermittent glucose monitoring may reduce hypertensive disorders of pregnancy, this did not translate into a clear reduction for pre-eclampsia, and so this result should be viewed with caution. No differences were observed for other primary outcomes for this comparison. The evidence base for the effectiveness of other monitoring techniques analysed in the other five comparisons is weak and based on mainly single studies with very low-quality evidence. Additional evidence from large well-designed randomised trials is required to inform choices of other glucose monitoring techniques and to confirm the effectiveness of CGM.
Collapse
Affiliation(s)
- Leanne V Jones
- The University of LiverpoolCochrane Pregnancy and Childbirth, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Amita Ray
- DM Wayanad Institute of Medical SciencesDepartment of Obstetrics and GynaecologyNaseera Nagar ,Meppadi (PO)WayanadWayanadKeralaIndia673577
| | - Foong Ming Moy
- Faculty of Medicine, University of MalayaJulius Centre University of Malaya, Department of Social and Preventive MedicineKuala LumpurWilayah PersekutuanMalaysia50603
| | - Brian S Buckley
- University of the Philippines, ManilaDepartment of SurgeryManilaPhilippines
| | | |
Collapse
|
34
|
Beverly EA, Guseman EH, Jensen LL, Fredricks TR. Reducing the Stigma of Diabetes in Medical Education: A Contact-Based Educational Approach. Clin Diabetes 2019; 37:108-115. [PMID: 31057216 PMCID: PMC6468822 DOI: 10.2337/cd18-0020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IN BRIEF In this feasibility study, we evaluated the impact of a contact-based education patient panel in an Endocrine and Metabolism course on second-year medical students' diabetes attitudes and diabetes stigma. Prior to the patient panel, some medical students harbored stigma toward people with diabetes, thus confirming patients' reports in the literature of diabetes stigma on the part of health care professionals. Importantly, the one-time contact-based educational approach improved students' diabetes attitudes and reduced diabetes stigma.
Collapse
Affiliation(s)
- Elizabeth A. Beverly
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- The Diabetes Institute, Ohio University, Athens, OH
| | - Emily H. Guseman
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- The Diabetes Institute, Ohio University, Athens, OH
| | - Laura L. Jensen
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- The Diabetes Institute, Ohio University, Athens, OH
| | - Todd R. Fredricks
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| |
Collapse
|
35
|
Griggs S, Redeker NS, Grey M. Sleep characteristics in young adults with type 1 diabetes. Diabetes Res Clin Pract 2019; 150:17-26. [PMID: 30790611 PMCID: PMC6525057 DOI: 10.1016/j.diabres.2019.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/18/2019] [Accepted: 02/13/2019] [Indexed: 01/14/2023]
Abstract
Only 14% of young adults with Type 1 Diabetes (T1D) achieve targets for glycemic control (HbA1C < 7.0%), with deterioration over time. Complex cognitive processes required to manage glycemia are vulnerable to sleep deficiency. Using Whittemore and Knafl's approach, we conducted an integrative review of research literature on sleep characteristics and glycemia in these young adults. Quality was assessed using the Mixed Methods Appraisal Tool (v. 2011). Multiple databases were searched for articles published in English in peer-reviewed journals from 2003 to 2018, using search terms 'sleep' and 'T1D' with age limiters 18-40. Of 218 studies initially retrieved, 17 original studies met the inclusion criteria. The following themes were identified in young adults with T1D: (1) They had poorer objective and subjective sleep quality, more variability, and impaired awakening response to hypoglycemia compared with controls; (2) They had poorer glycemic control that was associated with shorter sleep duration, poorer sleep quality, and less time in deep sleep; and (3) Hypoglycemia negatively impacted diabetes management, sleep quality, and next day functioning. Sleep deficiency, as indicated by short sleep duration is associated with a range of negative health outcomes for people with T1D; therefore, optimizing sleep should be a priority in practice and research.
Collapse
|
36
|
Tentolouris A, Eleftheriadou I, Tzeravini E, Athanasakis K, Anastasiou IA, Kyriopoulos J, Tentolouris N. Management of diabetes mellitus and patients' attitude towards the disease: Data from a nationwide study in Greece. Diabetes Metab Syndr 2019; 13:1159-1164. [PMID: 31336459 DOI: 10.1016/j.dsx.2019.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/18/2019] [Indexed: 01/03/2023]
Abstract
AIM To examine management of diabetes mellitus (DM) and patients' attitude towards DM in a random sample of the adult Greek population. METHODS s: We selected a random sample of adults with self-reported DM (n = 1002) from a population-based nationwide study using the effective random sampling technique. Collection of data was performed through phone interviews. RESULTS Prevalence of type 1 DM was 3.5% and of type 2 DM 96.5%. Prevalence of type 1 DM declined while of type 2 DM increased with age. No gender or residency differences were found between type 1 and type 2 DM. A total of 72.0% of subjects with type 2 DM were treated with oral antidiabetic drugs (OAD), 11.5% were treated with insulin and 7.1% were treated with both OAD and insulin. Internists specialized in DM were mainly doctors who started insulin treatment. Almost half of insulin naive subjects were skeptical towards insulin initiation and their main concern was the needle punch. CONCLUSIONS In a random nationwide sample of the adult population in Greece the majority of subjects with self-reported DM had type 2 DM. Most patients with type 2 were treated with OAD. Almost half of insulin naive subjects were skeptical towards insulin initiation.
Collapse
Affiliation(s)
- Anastasios Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Eleftheriadou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Evangelia Tzeravini
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Kostas Athanasakis
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - Ioanna A Anastasiou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - John Kyriopoulos
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - Nikolaos Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
| |
Collapse
|
37
|
Ajjan R, Slattery D, Wright E. Continuous Glucose Monitoring: A Brief Review for Primary Care Practitioners. Adv Ther 2019; 36:579-596. [PMID: 30659511 PMCID: PMC6824352 DOI: 10.1007/s12325-019-0870-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Indexed: 12/17/2022]
Abstract
Glycated hemoglobin A1c (HbA1c) is routinely used as a marker of average glycemic control, but it fails to provide data on hypoglycemia and glycemic variability, both of which are associated with adverse clinical outcomes. Self-monitoring of blood glucose (SMBG), particularly in insulin-treated patients, is a cornerstone in the management of patients with diabetes. SMBG helps with treatment decisions that aim to reduce high glucose levels while avoiding hypoglycemia and limiting glucose variability. However, repeated SMBG can be inconvenient to patients and difficult to maintain in the long term. By contrast, continuous glucose monitoring (CGM) provides a convenient, comprehensive assessment of blood glucose levels, allowing the identification of high and low glucose levels, in addition to evaluating glycemic variability. CGM using newer detection and visualization systems can overcome many of the limitations of an HbA1c-based approach while addressing the inconvenience and fragmented glucose data associated with SMBG. When used together with HbA1c monitoring, CGM provides complementary information on glucose levels, thus facilitating the optimization of diabetes therapy while reducing the fear and risk of hypoglycemia. Here we review the capabilities and benefits of CGM, including cost-effectiveness data, and discuss the potential limitations of this glucose-monitoring strategy for the management of patients with diabetes. FUNDING: Sanofi US, Inc.
Collapse
Affiliation(s)
- Ramzi Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, The LIGHT Laboratories, University of Leeds, Leeds, UK.
| | - David Slattery
- Endocrinology and Metabolic Medicine, York Teaching Hospital, NHS Foundation Trust, York, UK
| | - Eugene Wright
- Department of Medicine and Community and Family Medicine, Duke Southern Regional AHEC, Fayetteville, NC, USA
| |
Collapse
|
38
|
Blalock DV, Zullig LL, Bosworth HB, Taylor SS, Voils CI. Self-reported medication nonadherence predicts cholesterol levels over time. J Psychosom Res 2019; 118:49-55. [PMID: 30782354 DOI: 10.1016/j.jpsychores.2019.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Self-report measures of medication nonadherence are frequently adapted to new clinical populations without evidence of validity. We evaluated the predictive validity of a medication nonadherence measure previously validated in patients with hypertension among patients taking cholesterol-reducing medications. METHOD This secondary analysis involves data from a randomized trial (VA HSR&D IIR 08-297) conducted at the Durham Veterans Affairs Medical Center. At baseline, 6-months, and 12-months, serum cholesterol was obtained and participants (n = 236) completed a 3-item measure of extent of nonadherence to cholesterol-reducing medications. Two cross-lagged panel models with covariates, in addition to growth curve analysis, were used to examine the predictive utility of self-reported nonadherence on concurrent and future cholesterol levels, while accounting for potential reverse-causation. RESULTS Extent of nonadherence items produced reliable scores across time and fit a single-factor model (CFI = 0.99). Nonadherence, and changes in nonadherence, moderately predicted future cholesterol values, and changes in cholesterol values (7 of 9 longitudinal associations were significant at p < .05; B's ranged from 0.16 to 0.35). Evidence for reverse associations was weaker (3 of 9 longitudinal associations were significant at p < .05; B's ranged from 0.16 to 0.36). CONCLUSION Analyses support the predictive validity of this medication nonadherence measure over the competing reverse-causation hypothesis.
Collapse
Affiliation(s)
- Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 411 W. Chapel Hill St., Suite 600, Durham, NC 27701, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27710, USA.
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 411 W. Chapel Hill St., Suite 600, Durham, NC 27701, USA; Department of Population Health Sciences, Duke University Medical Center, 2200 W. Main St., Durham, NC 27705, USA.
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 411 W. Chapel Hill St., Suite 600, Durham, NC 27701, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27710, USA; Department of Population Health Sciences, Duke University Medical Center, 2200 W. Main St., Durham, NC 27705, USA; School of Nursing, Duke University Medical Center, 307 Kent Dr., Durham, NC 27710, USA.
| | - Shannon S Taylor
- Department of Behavioral, Social, and Population Health Sciences, University of South Carolina School of Medicine, Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA; Department of Surgery, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave., Madison, WI 53792, USA.
| |
Collapse
|
39
|
Klatman EL, Jenkins AJ, Ahmedani MY, Ogle GD. Blood glucose meters and test strips: global market and challenges to access in low-resource settings. Lancet Diabetes Endocrinol 2019; 7:150-160. [PMID: 30072234 DOI: 10.1016/s2213-8587(18)30074-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 12/23/2022]
Abstract
Blood glucose meters and test strips for self-monitoring of blood glucose (SMBG) are often inaccessible to, and infrequently used by, people with diabetes in countries with limited resources for health care. Supplies for measuring blood glucose can also be scarce in health facilities, despite being needed in a myriad of clinical settings at all levels of the health system. Numerous studies and international guidelines emphasise the value of SMBG in diabetes care, particularly in people with type 1 diabetes. In this Review, we assess global access to blood glucose meters and test strips, collating published information on cost, availability, system accuracy, competitive bidding, technological trends, and non-financial barriers. We also provide new information on global market share data and prices, taxes and tariffs, and product availability. Blood glucose meters and test strips should be viewed similarly to essential medicines, with issues of access prioritised by relevant international agencies. Efforts are needed to reduce tariffs and taxes and to create unified global system accuracy requirements and accountable post-marketing evaluations. Preferential pricing arrangements, pooled procurement, and best-purchasing practices could help to lower direct costs. SMBG supplies should also be included in national health insurance schemes. Enhanced diabetes education of health professionals and patients is crucial to ensure effective use of SMBG. Finally, as technology advances for people who can afford new interstitial fluid glucose monitoring systems, blood glucose meters and test strips must remain available and become more affordable in low-resource settings.
Collapse
Affiliation(s)
- Emma Louise Klatman
- International Diabetes Federation Life for a Child Program, Sydney, NSW, Australia.
| | | | | | - Graham David Ogle
- International Diabetes Federation Life for a Child Program, Sydney, NSW, Australia; Diabetes NSW and ACT, Sydney, NSW, Australia
| |
Collapse
|
40
|
Ringuette C, Finley J, Prinyawiwatkul W, King JM. Market Surveys to Determine Availability of Reduced Glycemic Load/High Fiber Products. JOURNAL OF CULINARY SCIENCE & TECHNOLOGY 2019. [DOI: 10.1080/15428052.2017.1399951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Christopher Ringuette
- School of Nutrition and Food Sciences, LSU AgCenter, Louisiana State University, Baton Rouge, Louisiana, USA
| | - John Finley
- School of Nutrition and Food Sciences, LSU AgCenter, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Witoon Prinyawiwatkul
- School of Nutrition and Food Sciences, LSU AgCenter, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Joan M. King
- School of Nutrition and Food Sciences, LSU AgCenter, Louisiana State University, Baton Rouge, Louisiana, USA
| |
Collapse
|
41
|
van Mark G, Lanzinger S, Barion R, Degenhardt M, Badis S, Noll H, Danne T, Bramlage P, Seufert J, Holl RW. Patient and disease characteristics of adult patients with type 1 diabetes in Germany: an analysis of the DPV and DIVE databases. Ther Adv Endocrinol Metab 2019; 10:2042018819830867. [PMID: 30834104 PMCID: PMC6396055 DOI: 10.1177/2042018819830867] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/21/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND An understanding of the current status of patients with type 1 diabetes mellitus (T1DM) can help to provide appropriate treatment. METHODS This was a retrospective analysis of the DIabetes Versorgungs-Evaluation (DIVE) and the Diabetes-Patienten-Verlaufsdokumentation (DPV) databases for Germany. RESULTS The analysis included 56,250 people with T1DM (54.2% male), a median age of 36.8 years, and a median diabetes duration of 12.4 years. 15.3% were obese (body mass index ≥ 30kg/m2). Long-acting insulin analogs were used by 53.3%, short-acting analogs by 72.1%, and oral antidiabetic drugs by 4.7%. Patients had a median glycosylated hemoglobin (HbA1c) of 7.8%. There was a drop in HbA1c and an increase in the rate of hypertension, oral antidiabetic drug use, and in the rate of severe hypoglycemia (all p < 0.01) with age. Flash glucose monitoring (FGM) showed the best glucose values with fewer complications compared to other monitoring systems. HbA1c and FBG were lower in patients using a pump versus multiple daily injections (MDIs; 7.7 versus 7.9% and 7.8 versus 8.7 mmol/l; all adjusted p < 0.01). Patients had a lower risk of at least one severe hypoglycemic or DKA episode during the most recent treatment year with pump treatment compared to MDI (9.4% versus 10.5% and 4.7% versus 6.1%, both adjusted p < 0.01). CONCLUSION The data demonstrated less-than-optimal glycemic control in the young, an increasing metabolic pattern in T1DM with increasing age, a benefit of FGM to improve HbA1c control and adverse effects, as well as benefits of pump treatment over MDIs.
Collapse
Affiliation(s)
- Gesine van Mark
- Institut für Pharmakologie und Präventive Medizin, Cloppenburg, Germany
| | - Stefanie Lanzinger
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany Deutsches Zentrum für Diabetesforschung Eingetragener Verein, München-Neuherberg, Germany
| | - Ralf Barion
- Diabetespraxis Rhein-Sieg, Niederkassel-Rheidt, Germany
| | | | | | - Horst Noll
- Klinik für Innere Medizin und interdisziplinäre Intensivmedizin, Sankt Marienkrankenhaus Rodalben, Germany
| | - Thomas Danne
- Kinderkrankenhaus auf der Bult, Diabeteszentrum für Kinder und Jugendliche, Hannover, Germany
| | | | - Jochen Seufert
- Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Reinhard W. Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany Deutsches Zentrum für Diabetesforschung Eingetragener Verein, München-Neuherberg, Germany
| |
Collapse
|
42
|
Gibson CJ, Huang AJ, McCaw B, Subak LL, Thom DH, Van Den Eeden SK. Associations of Intimate Partner Violence, Sexual Assault, and Posttraumatic Stress Disorder With Menopause Symptoms Among Midlife and Older Women. JAMA Intern Med 2019; 179:80-87. [PMID: 30453319 PMCID: PMC6583410 DOI: 10.1001/jamainternmed.2018.5233] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Little is known about the prevalence of traumatic exposures among midlife and older women and the association of these traumatic exposures with health issues. OBJECTIVE To examine the associations of intimate partner violence (IPV), sexual assault, and posttraumatic stress with menopause symptoms among midlife and older women. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of data from a multiethnic cohort of 2016 women 40 to 80 years of age in the Kaiser Permanente Northern California health care system was conducted from November 15, 2008, to March 30, 2012. Statistical analysis was conducted from June 8, 2016, to September 6, 2017. EXPOSURES Lifetime physical or emotional IPV, sexual assault, and current symptoms of posttraumatic stress disorder, assessed with standardized questionnaires. MAIN OUTCOMES AND MEASURES Difficulty sleeping, vasomotor symptoms, and vaginal symptoms, assessed with standardized questionnaires. RESULTS Among the 2016 women enrolled, the mean (SD) age was 60.5 (9.5) years, and 792 of 2011 with race/ethnicity data (39.4)% were non-Latina white (403 [20.0%] Latina, 429 [21.3%] black, and 387 [19.2%] Asian). Lifetime emotional IPV was reported by 423 women (21.0%), lifetime physical IPV was reported by 316 women (15.7%), sexual assault was reported by 382 women (18.9%), and 450 of 2000 women (22.5%) had current clinically significant symptoms of posttraumatic stress disorder. In multivariable analyses adjusted for age, race/ethnicity, educational level, body mass index, menopause status, hormone therapy, and parity, symptoms of posttraumatic stress disorder were associated with difficulty sleeping (odds ratio [OR], 3.02; 95% CI, 2.22-4.09), vasomotor symptoms (hot flashes: OR, 1.69; 95% CI, 1.34-2.12; night sweats: OR, 1.72; 95% CI, 1.37-2.15), and vaginal symptoms (vaginal dryness: OR, 1.73; 95% CI, 1.37-2.18; vaginal irritation: OR, 2.20; 95% CI, 1.66-2.93; pain with intercourse: OR, 2.16; 95% CI, 1.57-2.98). Emotional IPV was associated with difficulty sleeping (OR, 1.36; 95% CI, 1.09-1.71), night sweats (OR, 1.50; 95% CI, 1.19-1.89), and pain with intercourse (OR, 1.60; 95% CI, 1.14-2.25). Physical IPV was associated with night sweats (OR, 1.33; 95% CI, 1.03-1.72). Sexual assault was associated with vaginal symptoms (vaginal dryness: OR, 1.41; 95% CI, 1.10-1.82; vaginal irritation: OR, 1.42; 95% CI, 1.04-1.95; pain with intercourse: OR, 1.44; 95% CI, 1.00-2.06). CONCLUSIONS AND RELEVANCE Lifetime history of IPV or sexual assault and current clinically significant symptoms of posttraumatic stress disorder are common and are associated with menopause symptoms. These findings highlight the need for greater recognition of these exposures by clinicians caring for midlife and older women.
Collapse
Affiliation(s)
- Carolyn J Gibson
- Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, California.,Mental Health Service, San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco
| | - Alison J Huang
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Brigid McCaw
- Division of Research, Kaiser Permanente, Oakland, California
| | - Leslee L Subak
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - David H Thom
- Department of Family and Community Medicine, University of California, San Francisco
| | | |
Collapse
|
43
|
Joo EY, Lee JE, Kang HS, Park SG, Hong YH, Shin YL, Sohn M. Frequency of Self-Monitoring of Blood Glucose during the School Day Is Associated with the Optimal Glycemic Control among Korean Adolescents with Type 1 Diabetes. Diabetes Metab J 2018; 42:480-487. [PMID: 30113142 PMCID: PMC6300445 DOI: 10.4093/dmj.2018.0018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/16/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the relationship between the frequency of self-monitoring of blood glucose (SMBG) and glycosylated hemoglobin (HbA1c) levels among Korean adolescents with type 1 diabetes mellitus (T1DM). Factors affecting the SMBG frequency were analyzed in order to improve their glycemic control. METHODS Sixty-one adolescents aged 13 to 18 years with T1DM were included from one tertiary center. Clinical and biochemical variables were recorded. Factors associated with SMBG frequency were assessed using structured self-reported questionnaires. RESULTS Average total daily SMBG frequency was 3.8±2.1 and frequency during the school day was 1.3±1.2. The mean HbA1c level was 8.6%±1.4%. As the daily SMBG frequency increased, HbA1c levels declined (P=0.001). The adjusted odds of achieving the target HbA1c in participants who performed daily SMBG ≥5 significantly increased 9.87 folds (95% confidence interval [CI], 1.58 to 61.70) compared with those performed SMBG four times a day. In the subjects whose SMBG frequency <1/day during the school day, an 80% reduction in the adjusted odds ratio 0.2 (95% CI, 0.05 to 0.86) showed compared to the group with performing two SMBG measurements in the school setting. The number of SMBG testing performed at school was significantly high for individuals assisted by their friends (P=0.031) and for those who did SMBG in the classrooms (P=0.039). CONCLUSION Higher SMBG frequency was significantly associated with lower HbA1c in Korean adolescents with T1DM. It would be necessary to establish the school environments that can facilitate adequate glycemic control, including frequent SMBG.
Collapse
Affiliation(s)
- Eun Young Joo
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
| | - Ji Eun Lee
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea.
| | - Hee Sook Kang
- Diabetes Endocrinology Center, Inha University School of Medicine, Incheon, Korea
| | - Shin Goo Park
- Department of Occupational & Evironmental Medicine, Inha University School of Medicine, Incheon, Korea
| | - Yong Hee Hong
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Young Lim Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Min Sohn
- Department of Nursing, Inha University College of Medicine, Incheon, Korea
| |
Collapse
|
44
|
Pfützner A, Strobl S, Demircik F, Redert L, Pfützner J, Pfützner AH, Lier A. Evaluation of a New Noninvasive Glucose Monitoring Device by Means of Standardized Meal Experiments. J Diabetes Sci Technol 2018; 12:1178-1183. [PMID: 29451016 PMCID: PMC6232728 DOI: 10.1177/1932296818758769] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Frequent blood glucose readings are the most cumbersome aspect of diabetes treatment for many patients. The noninvasive TensorTip Combo Glucometer (CoG) component employs dedicated mathematical algorithms to analyze the collected signal and to predict tissue glucose at the fingertip. This study presents the performance of the CoG (the invasive and the noninvasive components) during a standardized meal experiment. METHODS Each of the 36 participants (18 females and males each, age: 49 ± 18 years, 14 healthy subjects, 6 type 1 and 16 type 2 patients) received a device for conducting calibration at home. Thereafter, they ingested a standardized meal. Blood glucose was assessed from capillary blood samples by means of the (non)invasive device, YSI Stat 2300 plus, Contour Next at time points -30, 0, 15, 30, 45, 60, 75, 90, 120, 150, and 180 minutes. Statistical analysis was performed by consensus error grid (CEG) and calculation of mean absolute relative difference (MARD) in comparison to YSI. RESULTS For the noninvasive (NI) CoG technology, 100% of the data pairs were found in CEG zones A (96.6%) and B (3.4%); 100% were seen in zone A for the invasive component and Contour Next. MARD was calculated to be 4.2% for Contour Next, 9.2% for the invasive component, and 14.4% for the NI component. CONCLUSIONS After appropriate individual calibration of the NI technology, both the NI and the invasive CoG components reliably tracked tissue and blood glucose values, respectively. This may enable patients with diabetes to monitor their glucose levels frequently, reliably, and most of all pain-free.
Collapse
Affiliation(s)
- Andreas Pfützner
- Pfützner Science & Health Institute,
Mainz, Germany
- Sciema UG, Mainz, Germany
- Technical University, Bingen,
Germany
- Andreas Pfützner, MD, PhD, Diabetes Center
& Practice, Pfützner Science & Health Institute, Parcusstr 8, Mainz,
D-55116, Germany.
| | | | - Filiz Demircik
- Pfützner Science & Health Institute,
Mainz, Germany
- Technical University, Bingen,
Germany
| | | | | | | | | |
Collapse
|
45
|
Seng EK, Prieto P, Boucher G, Vives-Mestres M. Anxiety, Incentives, and Adherence to Self-Monitoring on a Mobile Health Platform: A Naturalistic Longitudinal Cohort Study in People With Headache. Headache 2018; 58:1541-1555. [PMID: 30334248 DOI: 10.1111/head.13422] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate factors associated naturalistically with adherence to a mobile headache diary. BACKGROUND Self-monitoring (keeping a headache diary) is commonly used in headache to enhance diagnostic accuracy and evaluate the effectiveness of headache therapies. Mobile applications are increasingly used to facilitate keeping a headache diary. Little is known about the factors associated with adherence to mobile headache diaries. METHODS In this naturalistic longitudinal cohort study, people with headache (n = 1561) registered to use Curelator Headache® (now called N1-Headache®), an application that includes a mobile headache diary, through their physician (coupon), or directly through the website or app store using either a paid or free version of the application. Participants completed baseline questionnaires and were asked to complete daily recordings of headache symptoms and other factors for at least 90 days. Baseline questionnaires included headache characteristics and migraine disability. Daily recordings included headache symptoms and anxiety ratings. Adherence to keeping the headache diary was conceptualized as completion (kept the headache diary for 90 days), adherence rate (proportion of diary days completed 90 days after registration), and completion delay (the number of days past 90 days after registration required to complete 90 days of headache diary). RESULTS The majority of participants reported migraine as the most common headache type (90.0%), and reported an average of 30.8 headache days/90 days (SD = 24.2). One-third of participants completed 90 days of headache diary (32.4%). Endorsing higher daily anxiety scores (8/10 OR = 0.97 [95% CI = 0.96, 0.99]; 10/10 OR = 0.96 [95% CI = 0.91, 0.99]) was associated with lower odds of completion, whereas higher age (OR = 1.04 [95% CI = 1.03, 1.05]), and downloading the app paid vs free (OR = 4.27 [95% CI = 2.62, 7.06]), paid vs coupon (OR = 2.43, 95% CI = 1.41, 4.26]), or through a physician coupon vs free (OR = 1.75 [95% CI = 1.27, 2.42]) were associated with higher odds of completion. The median adherence rate at 90 days was 0.34 (IQR = 0.10-0.88), indicating that half of participants kept 34 or fewer days 90 diary days after registration. Endorsing high daily anxiety scores (5/10 OR = 0.98 [95% CI = 0.97, 1.00]; 8/10 OR = 0.96 [95% CI = 0.94, 0.98]; 10/10 OR = 0.96 [9% CI = 0.92, 0.98]) and higher age (OR = 1.05 [95% CI = 1.04, 1.07]) were associated with lower odds of adhering at 90 days, whereas downloading the app paid vs free (OR = 9.63 [95% CI = 4.61, 25.51]), paid vs coupon (OR = 2.39, 95% CI = 1.27, 5.10]), or through a physician coupon vs free (OR = 4.01 [95% CI = 2.54, 7.26]) were associated with higher odds of adhering at 90 days. Among completers, the median completion delay was 6.0 days (IQR = 2.0-15.0). Among completers, endorsing high daily anxiety scores (9/10 OR = 1/06 [95% CI = 1.01, 1.12]) and younger age (OR = 0.98 [95% CI = 0.97, 1.00]) was associated with completion delay; downloading the app through physician coupon vs free (OR = 0.40 [95% CI = 0.22, 0.71]) or paid vs free (OR = 0.38 [95% CI = 0.20, 0.72]) was associated with lower odds of completing 90 diary days in 90 calendar days. CONCLUSION This naturalistic observational study confirmed evidence from clinical observation and research: adherence to mobile headache diaries is a challenge for a significant proportion of people with headache. Endorsing higher levels of daily anxiety, younger age, and downloading the app for free (vs either paying for the self-monitoring app or receiving a physician referral coupon) were associated with poorer adherence to keeping a mobile headache diary.
Collapse
Affiliation(s)
- Elizabeth K Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.,Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
| | | | | | | |
Collapse
|
46
|
Robbins T, Lim Choi Keung SN, Sankar S, Randeva H, Arvanitis TN. Diabetes and the direct secondary use of electronic health records: Using routinely collected and stored data to drive research and understanding. Digit Health 2018; 4:2055207618804650. [PMID: 30305917 PMCID: PMC6176528 DOI: 10.1177/2055207618804650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction Electronic health records provide an unparalleled opportunity for the use of
patient data that is routinely collected and stored, in order to drive
research and develop an epidemiological understanding of disease. Diabetes,
in particular, stands to benefit, being a data-rich, chronic-disease state.
This article aims to provide an understanding of the extent to which the
healthcare sector is using routinely collected and stored data to inform
research and epidemiological understanding of diabetes mellitus. Methods Narrative literature review of articles, published in both the medical- and
engineering-based informatics literature. Results There has been a significant increase in the number of papers published,
which utilise electronic health records as a direct data source for diabetes
research. These articles consider a diverse range of research questions.
Internationally, the secondary use of electronic health records, as a
research tool, is most prominent in the USA. The barriers most commonly
described in research studies include missing values and misclassification,
alongside challenges of establishing the generalisability of results. Discussion Electronic health record research is an important and expanding area of
healthcare research. Much of the research output remains in the form of
conference abstracts and proceedings, rather than journal articles. There is
enormous opportunity within the United Kingdom to develop these research
methodologies, due to national patient identifiers. Such a healthcare
context may enable UK researchers to overcome many of the barriers
encountered elsewhere and thus to truly unlock the potential of electronic
health records.
Collapse
Affiliation(s)
- Tim Robbins
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Sailesh Sankar
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Harpal Randeva
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | |
Collapse
|
47
|
Abstract
Erectile dysfunction is a common condition of men in middle and older ages. Twin studies suggest that about one-third of the risk is due to genetic factors, independent of other known erectile dysfunction risk factors. However, studies that have searched for specific genetic contributors have been limited due to small sample sizes, candidate gene approaches, and weak phenotyping. As a result, there are no confirmed genetic risk factors for erectile dysfunction. This study finds a specific genetic cause for erectile dysfunction. Erectile dysfunction affects millions of men worldwide. Twin studies support the role of genetic risk factors underlying erectile dysfunction, but no specific genetic variants have been identified. We conducted a large-scale genome-wide association study of erectile dysfunction in 36,649 men in the multiethnic Kaiser Permanente Northern California Genetic Epidemiology Research in Adult Health and Aging cohort. We also undertook replication analyses in 222,358 men from the UK Biobank. In the discovery cohort, we identified a single locus (rs17185536-T) on chromosome 6 near the single-minded family basic helix-loop-helix transcription factor 1 (SIM1) gene that was significantly associated with the risk of erectile dysfunction (odds ratio = 1.26, P = 3.4 × 10−25). The association replicated in the UK Biobank sample (odds ratio = 1.25, P = 6.8 × 10−14), and the effect is independent of known erectile dysfunction risk factors, including body mass index (BMI). The risk locus resides on the same topologically associating domain as SIM1 and interacts with the SIM1 promoter, and the rs17185536-T risk allele showed differential enhancer activity. SIM1 is part of the leptin–melanocortin system, which has an established role in body weight homeostasis and sexual function. Because the variants associated with erectile dysfunction are not associated with differences in BMI, our findings suggest a mechanism that is specific to sexual function.
Collapse
|
48
|
Hellmund R, Weitgasser R, Blissett D. Cost Calculation for a Flash Glucose Monitoring System for Adults with Type 2 Diabetes Mellitus Using Intensive Insulin - a UK Perspective. EUROPEAN ENDOCRINOLOGY 2018; 14:86-92. [PMID: 30349600 PMCID: PMC6182928 DOI: 10.17925/ee.2018.14.2.86] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/12/2018] [Indexed: 01/28/2023]
Abstract
Aims: Estimate the costs associated with flash glucose monitoring as a replacement for routine self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes mellitus (T2DM) using intensive insulin, from a UK National Health Service (NHS) perspective. Methods: The base-case cost calculation used the frequency of SMBG and healthcare resource use observed in the REPLACE trial. Scenario analyses considered SMBG at the flash monitoring frequencies observed in the REPLACE trial (8.3 tests per day) and a real-world analysis (16 tests per day). Results: Compared with 3 SMBG tests per day, flash monitoring would cost an additional £585 per patient per year, offset by a £776 reduction in healthcare resource use, based on reductions in emergency room visits (41%), ambulance call-outs (66%) and hospital admissions (77%) observed in the REPLACE trial. Per patient, the estimated total annual cost for flash monitoring was £191 (13.4%) lower than for SMBG. In the scenarios based on acquisition cost alone, flash monitoring was cost-neutral versus 8.3 SMBG tests per day (5% decrease) and cost-saving at higher testing frequencies. Conclusion: From a UK NHS perspective, for patients with T2DM using intensive insulin, flash monitoring is potentially cost-saving compared with routine SMBG irrespective of testing frequency.
Collapse
Affiliation(s)
| | - Raimund Weitgasser
- Abteilung fur Innere Medizin, Privatklinik Wehrle-Diakonissen, Salzburg, Austria.,Paracelsus Medizinische Privatuniversitat Salzburg, Austria
| | | |
Collapse
|
49
|
Abe-Doi M, Oe M, Murayama R, Zushi Y, Tanabe H, Sanada H. Impact of Squeezing Condition to Obtain Sufficient Blood Volume for Self-Monitoring of Blood Glucose Using an Automatic Puncturing and Sampling System. J Diabetes Sci Technol 2018; 12:1041-1044. [PMID: 30168370 PMCID: PMC6134621 DOI: 10.1177/1932296818771108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Blood sampling for self-monitoring of blood glucose is difficult for the elderly with low dexterity. We developed and tested the utility of an automatic puncturing and sampling (APS) system as a part of an automatic SMBG device, but success rates of securing sufficient blood volume was low (61.9%). Thus, the squeezing condition was changed to increase its success rate. The aim of this study is to investigate the impact to the amount of bleeding by making changes to the squeezing condition. In our previous experiment, blood sampling was performed simultaneously with squeezing, whereas the present study tested blood sampling after squeezing. This method increased the success rate (75%) among eight subjects who had a low success rate (25%) in the previous experiment using the APS system.
Collapse
Affiliation(s)
- Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo
- Global Nursing Research Center, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo
| | - Makoto Oe
- Global Nursing Research Center, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo
- Global Nursing Research Center, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo
| | | | - Hidenori Tanabe
- Department of Advanced Nursing Technology, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo
- Terumo R&D CENTER, Kanagawa, Japan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo
- Hiromi Sanada, PhD, RN, WOCN, Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| |
Collapse
|
50
|
RSSDI consensus on self-monitoring of blood glucose in types 1 and 2 diabetes mellitus in India. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0677-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|