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Yan M, Zhang P, Yu J. Medication Bias During the Hospital-to-Family Transition Among Young and Middle-Aged Chinese Patients with Type 2 Diabetes: A Qualitative Study. Patient Prefer Adherence 2023; 17:2595-2603. [PMID: 37900056 PMCID: PMC10606344 DOI: 10.2147/ppa.s430903] [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: 07/16/2023] [Accepted: 10/14/2023] [Indexed: 10/31/2023] Open
Abstract
Objective This study aimed to examine the prevalence of medication non-adherence among young and middle-aged Chinese individuals diagnosed with type 2 diabetes, and to explore the underlying causes of such deviations. Methods The Medication Discrepancy Tool (MDT) was used to assess medication deviations in a cohort of 100 patients who had been discharged from the hospital. Furthermore, 15 subjects were interviewed to gain a better understanding of their medication non-adherence experiences. Results The rate of medication deviation in the studied cohort was 79.5%, with the most frequent deviation being a reduction in the types of drugs taken. The primary cause of this deviation was found to be patient-derived, with the most common reason being symptom improvement. Iatrogenic medication deviation was most often caused by incomplete or inaccurate medication education for medical staff at discharge, resulting in patients having to guess their own medication. Internal and extrinsic motivating factors were identified as the primary causes of medication deviation behavior. Conclusion This study has demonstrated that medication non-adherence is a major issue among young and middle-aged Chinese individuals diagnosed with type 2 diabetes. Therefore, it is essential for nurses to be aware of the importance of medication adherence management and working.
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Affiliation(s)
- Man Yan
- Department of Nursing, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, Jiangsu, People’s Republic of China
| | - Peiling Zhang
- Department of Nursing, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, Jiangsu, People’s Republic of China
| | - Jiaxiang Yu
- Department of Nursing, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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2
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Rodriguez HP, Rubio K, Miller-Rosales C, Wood AJ. US practice adoption of patient-engagement strategies and spending for adults with diabetes and cardiovascular disease. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad021. [PMID: 38770409 PMCID: PMC11103728 DOI: 10.1093/haschl/qxad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 05/22/2024]
Abstract
Patient-engagement strategies are being encouraged by payers and governments, but with limited evidence about whether practice adoption of these strategies impacts utilization and spending. We examine the association of physician practice adoption of patient-engagement strategies (low vs moderate vs high) with potentially preventable utilization and total spending for patients with type 2 diabetes and/or cardiovascular disease using US physician practice survey (n = 2086) and Medicare fee-for-service (n = 736 269) data. In adjusted analyses, there were no differences in potentially preventable utilization associated with practice adoption of patient-engagement strategies. Compared with patients attributed to practices with moderate adoption, patients attributed to practices with high adoption had higher total spending ($26 364 vs $25 991; P < .05) driven by spending for long-term services and supports, including home health agency, long-term care, skilled nursing facilities, and hospice payments. In contrast, patients attributed to practices with low adoption had higher total spending ($26 481 vs $25 991; P < .01) driven by spending for tests and acute care and clinical access spending. The results highlight that stakeholders that encourage the use of patient-engagement strategies should not necessarily expect reduced spending.
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Affiliation(s)
- Hector P Rodriguez
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, 2121 Berkeley Way West #5427, Berkeley, CA 94704, United States
| | - Karl Rubio
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, 2121 Berkeley Way West #5427, Berkeley, CA 94704, United States
| | - Chris Miller-Rosales
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, 2121 Berkeley Way West #5427, Berkeley, CA 94704, United States
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, United States
| | - Andrew J Wood
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, NH 03756, United States
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Hsu SH, Tang KP, Lin CH, Chen PC, Wang LH. Applying the theory of planned behavior to investigate type 2 diabetes patients' intention to receive injection therapy. Front Public Health 2023; 11:1066633. [PMID: 36875423 PMCID: PMC9978190 DOI: 10.3389/fpubh.2023.1066633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
Objectives This study applied the theory of planned behavior (TPB) in shared decision making (SDM) to understand behavioral intention in patients with type 2 diabetes with regard to injection therapy for blood sugar control. Methods A cross sectional study was conducted. Two hundred and fifty-four patients with type 2 diabetes participated this study and were interviewed by pharmacists in different clinics. A patient decision aid (PDA) entitled "Should I receive injection therapy regarding my type 2 diabetes condition?" was developed for this study and served as interview agenda which comprised 18 items to inquire their willingness to use injection therapy and related considerations during the SDM process. Results The questionnaires were revised using item analysis, exploratory factor analysis, and a criteria of Cronbach's α > 0.7. This resulted in three constructs for all questionnaires that fit the TPB model. Attitude (β = 0.432; P < 0.001) and PBC (β = 0.258; P < 0.001) were directly correlated with intention. TPB explained 35.2% of the variance in intention toward the use of injection therapy. Conclusions Attitude and PBC toward injection therapy positively and significantly influence the patients' intention to use injection therapy. Practical implications These findings identify a key association for understanding behavioral intention in patients with type 2 diabetes with regard to blood sugar control during SDM.
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Affiliation(s)
- Su-Han Hsu
- Department of Pharmacy, Taipei City Hospital Yangming Branch, Taipei, Taiwan.,School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy and Master Program, Tajen University, Pingtung City, Taiwan
| | - Kung-Pei Tang
- Department of Education and Humanities in Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Early Childhood and Family Education, College of Education, National Taipei University of Education, Taipei, Taiwan
| | - Chia-Hui Lin
- Department of Pharmacy, Taipei City Hospital Yangming Branch, Taipei, Taiwan.,Department of Pharmacy and Master Program, Tajen University, Pingtung City, Taiwan
| | - Pei-Chun Chen
- Department of Pharmacy, Taipei City Hospital Yangming Branch, Taipei, Taiwan
| | - Li-Hsuan Wang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan
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Jude EB, Malecki MT, Gomez Huelgas R, Prazny M, Snoek F, Tankova T, Giugliano D, Khunti K. Expert Panel Guidance and Narrative Review of Treatment Simplification of Complex Insulin Regimens to Improve Outcomes in Type 2 Diabetes. Diabetes Ther 2022; 13:619-634. [PMID: 35274219 PMCID: PMC8913205 DOI: 10.1007/s13300-022-01222-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/02/2022] [Indexed: 11/03/2022] Open
Abstract
Given the progressive nature of type 2 diabetes (T2D), most individuals with the disease will ultimately undergo treatment intensification. This usually involves the stepwise addition of a new glucose-lowering agent or switching to a more complex insulin regimen. However, complex treatment regimens can result in an increased risk of hypoglycaemia and high treatment burden, which may impact negatively on both therapeutic adherence and overall quality of life. Individuals with good glycaemic control may also be overtreated with unnecessarily complex regimens. Treatment simplification aims to reduce individual treatment burden, without compromising therapeutic effectiveness or safety. Despite data showing that simplifying therapy can achieve good glycaemic control without negatively impacting on treatment efficacy or safety, it is not always implemented in clinical practice. Current clinical guidelines focus on treatment intensification, rather than simplification. Where simplification is recommended, clear guidance is lacking and mostly focused on treatment of the elderly. An expert, multidisciplinary panel evaluated the current treatment landscape with respect to guidance, published evidence, recommendations and approaches regarding simplification of complex insulin regimens. This article outlines the benefits of treatment simplification and provides practical recommendations on simplifying complex insulin treatment strategies in people with T2D using illustrative cases.
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Affiliation(s)
- Edward B Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
- University of Manchester, Manchester, UK
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Ricardo Gomez Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Martin Prazny
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Frank Snoek
- Department of Medical Psychology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Dario Giugliano
- Division of Endocrinology and Metabolic Diseases, University Hospital, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK.
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Brown-Taylor L, Harris-Hayes M, Foraker R, Vasileff WK, Glaws K, Di Stasi S. Treatment decisions after interdisciplinary evaluation for nonarthritic hip pain: A randomized controlled trial. PM R 2022; 14:297-308. [PMID: 34181823 PMCID: PMC8712617 DOI: 10.1002/pmrj.12661] [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: 07/31/2020] [Revised: 04/14/2021] [Accepted: 04/27/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Physical therapy and hip arthroscopy are two viable treatment options for patients with nonarthritic hip pain (NAHP); however, patients may experience considerable decisional conflict when making a treatment decision. Interdisciplinary evaluation with a physical therapist and surgeon may better inform the decision-making process and reduce decisional conflict. OBJECTIVE To identify the extent to which an interdisciplinary evaluation between a surgeon, physical therapist, and patient influences treatment plans and decisional conflict of persons with NAHP. DESIGN Randomized controlled trial. SETTING Hip preservation clinic. PARTICIPANTS Adults with primary NAHP. INTERVENTIONS Participants were randomized to receive a standard (surgeon) or interdisciplinary (surgeon+physical therapist) evaluation. Surgeon evaluations included patient interview, strength and range-of-motion examination, palpation, gross motor observation, and special testing. Interdisciplinary evaluations started with the surgeon evaluation, then a physical therapist evaluated movement impairments during sitting, sit-to-stand, standing, single-leg stance, single-leg squat, and walking. All evaluations concluded with treatment planning with the respective provider(s). OUTCOME MEASURES Treatment plan and decisional conflict were collected pre- and postevaluation. Inclusion of physical therapy in participants' postevaluation treatment plans and postevaluation decisional conflict were compared between groups using chi-square tests and Mann-Whitney U tests, respectively. RESULTS Seventy-eight participants (39 in each group) met all eligibility criteria and were included in all analyses. Sixty-six percent of participants who received an interdisciplinary evaluation included physical therapy in their postevaluation treatment plan, compared to 48% of participants who received a standard evaluation (p = .10). Participants who received an interdisciplinary evaluation reported 6.3 points lower decisional conflict regarding their postevaluation plan (100-point scale; p = .04). The interdisciplinary and standard groups reduced decisional conflict on average 24.8 ± 18.9 and 23.6 ± 14.6 points, respectively. CONCLUSIONS Adding a physical therapist to a surgical clinic increased interest in physical therapy treatment, but this increase was not statistically significant. The interdisciplinary group displayed lower postevaluation decisional conflict; however, both groups displayed similar reductions in decisional conflict from pre- to postevaluation. This study also demonstrated the feasibility of an interdisciplinary evaluation in a hip preservation clinic.
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Affiliation(s)
- Lindsey Brown-Taylor
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH,Health and Rehabilitation Sciences Doctoral Program, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | - Marcie Harris-Hayes
- Program in Physical Therapy and Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Randi Foraker
- Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - W Kelton Vasileff
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH,Department of Orthopaedics, The Ohio State University, Columbus, OH
| | - Kathryn Glaws
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
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Cunningham AT, Arefi P, Gentsch AT, Mills GD, LaNoue MD, Doty AM, Carr BG, Hollander JE, Rising KL. Patient Markers of Successful Diabetes Management. Diabetes Spectr 2021; 34:275-282. [PMID: 34511854 PMCID: PMC8387618 DOI: 10.2337/ds20-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE For individuals with diabetes, diabetes health status may not align with A1C targets. Patients may use nonclinical targets when assessing their diabetes management success. Identifying these targets is important in developing patient-centered management plans. The purpose of this study was to identify patient markers of successful diabetes management among patients in an urban academic health system. METHODS A secondary analysis of semistructured interviews was completed with 89 adults with type 1 or type 2 diabetes. Participants had a recent diabetes-related emergency department (ED) visits or hospitalization or were primary care patients with an A1C >7.5%. Interviews were conducted to saturation. Demographic data were collected via self-report and electronic medical records. Interviews were analyzed using conventional content analysis. This analysis focused on patient perceptions of successful management coded to "measuring management success." RESULTS Although most participants cited A1C or blood glucose as a marker of successful diabetes management, they had varied understanding of these metrics. Most used a combination of targets from the following categories: 1) A1C, blood glucose, and numbers; 2) engagement in medical care; 3) taking medication and medication types; 4) symptoms; 5) diet, exercise, and weight; and 6) stress management and social support. CONCLUSION Individuals not meeting glycemic goals and/or with recent diabetes-related ED visits or hospitalizations had varied understanding of A1C and blood glucose targets. They use multiple additional markers of successful management and had a desire for management discussions that incorporate these markers. These measures should be incorporated into their care plans along with clinical targets.
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Affiliation(s)
- Amy T. Cunningham
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Corresponding author: Amy T. Cunningham,
| | - Pouya Arefi
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Alexzandra T. Gentsch
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Geoffrey D. Mills
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Marianna D. LaNoue
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Amanda M.B. Doty
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Brendan G. Carr
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Judd E. Hollander
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Kristin L. Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Li Z, Jin Y, Lu C, Luo R, Wang J, Liu Y. Effects of patient decision aids in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Int J Nurs Pract 2021; 27:e12914. [PMID: 33657667 DOI: 10.1111/ijn.12914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/13/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
AIMS This study aimed to systematically evaluate the effectiveness of patient decision aids on knowledge, decisional conflict and decisional self-efficacy outcomes in patients with diabetes. METHODS A comprehensive database search was performed using the Web of Science, Cochrane Library, PubMed, Embase, PsycINFO (Ovid), CINAHL (EBASCO), CNKI, VIP, Wan Fang Database and the Ottawa Decision Aid Library Inventory (http://decisionaid.ohri.ca/index.html) from inception to 13 October 2019. Two reviewers independently searched databases, screened articles, extracted data and evaluated the risk bias of included studies. Then Rev Man 5.3 software was adopted for statistical analysis. RESULTS Ten articles containing 1,452 people with diabetes were selected. The results of meta-analysis showed that patient decision aids had a positive effect on reducing decisional conflict and improving decisional self-efficacy among patients with type 2 diabetes. Meanwhile, this article also revealed that patient decision aids have beneficial short-term effects on improving knowledge, but there was no significant long-term effect. CONCLUSION Patient decision aids are capable of becoming support tools to improve shared decision making. Further implementation studies are required to transform patient decision aids tools into clinical practice.
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Affiliation(s)
- Zimeng Li
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yinghui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Center for Evidence-Based and Translational Medicine, Wuhan University, Hubei, China
| | - Cui Lu
- Emergency Department, Tianjin TEDA Hospital, Tianjin, China
| | - Ruzhen Luo
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jiayao Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yanhui Liu
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Maneze D, Weaver R, Kovai V, Salamonson Y, Astorga C, Yogendran D, Everett B. "Some say no, some say yes": Receiving inconsistent or insufficient information from healthcare professionals and consequences for diabetes self-management: A qualitative study in patients with Type 2 Diabetes. Diabetes Res Clin Pract 2019; 156:107830. [PMID: 31465812 DOI: 10.1016/j.diabres.2019.107830] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/29/2019] [Accepted: 08/23/2019] [Indexed: 01/01/2023]
Abstract
AIMS To explore the information-seeking experiences of patients with Type 2 diabetes and how these influenced self-management behaviours. METHODS We interviewed 18 patients with Type 2 Diabetes attending outpatient diabetes centers in South Western Sydney. Data were analyzed thematically. RESULTS Patients described a number of challenges they faced when seeking information about diabetes self-management. One major challenge was receiving inconsistent and insufficient information from healthcare professionals, which consequently undermined patients' ability to self-manage diabetes. This became a disincentive in carrying out self-management tasks, and led to confusion and mistrust regarding the veracity of information received. Participants also described finding reliable information, and difficulty understanding and accessing relevant information as challenges. Medical jargon and lack of comprehensive explanations exacerbated knowledge deficits compounded by the complex maze of internet resources that some patients accessed. In response to what they perceived as confusing or inconsistent information, some patients followed "their own way" of managing their diabetes. CONCLUSIONS Inconsistent information not tailored to the needs of patients adversely affects self-management. Taking time to provide simple explanations and assisting patients in navigating reliable web resources is becoming a vital role of healthcare professionals to reduce knowledge gaps in patients with low health literacy.
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Affiliation(s)
- Della Maneze
- Health Promotion Service, South Western Sydney Local Health District (SWSLHD), Australia, Liverpool, NSW, Australia; Western Sydney University, School of Nursing and Midwifery, Penrith, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
| | - Roslyn Weaver
- Western Sydney University, School of Nursing and Midwifery, Penrith, NSW, Australia.
| | - Vilas Kovai
- Health Promotion Service, South Western Sydney Local Health District (SWSLHD), Australia, Liverpool, NSW, Australia.
| | - Yenna Salamonson
- Western Sydney University, School of Nursing and Midwifery, Penrith, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
| | - Cecilia Astorga
- Liverpool Diabetes Centre, South Western Sydney Local Health District (SWSLHD), Liverpool, NSW, Australia.
| | - Daisy Yogendran
- Macarthur Diabetes Service, South Western Sydney Local Health District (SWSLHD), Campbelltown, NSW, Australia.
| | - Bronwyn Everett
- Western Sydney University, School of Nursing and Midwifery, Penrith, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
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