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Chen M, Zhang P, Zhao Y, Duolikun N, Ji L. Where to Initiate Basal Insulin Therapy: Inpatient or Outpatient Department? Real-World Observation in China. Diabetes Metab Syndr Obes 2022; 15:3375-3385. [PMID: 36341227 PMCID: PMC9635311 DOI: 10.2147/dmso.s386230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This study aims to compare the effectiveness of initiating insulin therapy in inpatient and outpatient settings during a 6-month follow-up period among patients with type 2 diabetes mellitus (T2DM) in real-world settings. MATERIALS AND METHODS The study was based on the ORBIT study, a real-world observational study which recruited patients with inadequate glycemic control by oral antidiabetic drugs (OAD) and initiated basal insulin (BI). We compare difference in initiation and evolution of insulin therapy and glycemic control after six months were compared between patients initiating basal insulin in the inpatient department (inpatient initiators) and those starting in outpatient (outpatient initiators) among participants without rehospitalization during the six months follow-up. RESULTS Among all 18,995 participants in the ORBIT study, 56.0% were inpatient initiators and 44.0% outpatient. We conducted in-depth analysis among 14,860 patients without rehospitalization, 8129 inpatient initiators and 6731 outpatient initiators. (1) Inpatient initiators had lower insulin therapy persistence during six months (64.2%) than outpatient ones (78.6%) (p<0.001), which was mainly explained by more therapy switches from basal-bolus regimen to other therapies among inpatient initiators (50.1%) than that among outpatient initiators (37.5%) (p<0.001). (2) Inpatient initiation had a higher proportion of people achieving glucose targets (HbA1c <7%) than outpatient initiation. However, the benefit of inpatient initiation versus outpatient initiation was mainly observed among patients persisting with the initial insulin therapies (46.3% vs 39.5% p<0.001), rather than those nonpersistent (37.3% vs 36.2%, p=0.723). (3) Among patients with HbA1c <9%, taking only one OAD and without complications at baseline, inpatient insulin initiation did not show a higher proportion of people achieving glucose target than outpatient initiation (adjusted odds ratio=0.96, 95% CI: 0.76-1.21). CONCLUSION For patients with HbA1c ≥9%, who were taking more than one OAD and had complications at baseline, initiating insulin treatment during hospitalization has a higher proportion of people achieving glucose target than that in the outpatient department, but the premise is that the initial therapy is acceptable and can be maintained after discharge. Patient-centered approach with co-agreed decision-making to select a suitable insulin regimen should be strengthened.
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Affiliation(s)
- Minyuan Chen
- The George Institute for Global Health, China, Beijing, 100600, People’s Republic of China
| | - Puhong Zhang
- The George Institute for Global Health, China, Beijing, 100600, People’s Republic of China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2050, Australia
- Correspondence: Puhong Zhang, Diabetes Research Program, The George Institute for Global Health, China, Room 052A, Unit 1, Tayuan Diplomatic Office Building No. 14 Liangmahe Nan Lu, Chaoyang District, Beijing, 100600, People’s Republic of China, Tel/Fax +86 10 8280 0177, Email
| | - Yang Zhao
- The George Institute for Global Health, China, Beijing, 100600, People’s Republic of China
- WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, VIC, Australia
| | - Nadila Duolikun
- The George Institute for Global Health, China, Beijing, 100600, People’s Republic of China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, People’s Republic of China
- Linong Ji, Department of Endocrinology and Metabolism, Peking University People’s Hospital, No. 11, Xizhimen Nan Da Jie, Xicheng District, Beijing, 100044, People’s Republic of China, Tel +86 10 88325578, Fax +86 10 68358517, Email
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Domeyer PR, Tsimtsiou Z, Gkizlis V, Gougourelas D, Papaioannou A, Birka S, Sifaki-Pistolla D, Tsiligianni I. Modeling patients' choice between a primary care physician or a diabetes specialist for the management of type-2 diabetes using a bivariate probit analysis. Prim Care Diabetes 2021; 15:150-155. [PMID: 32768282 DOI: 10.1016/j.pcd.2020.07.010] [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: 04/27/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 11/17/2022]
Abstract
AIMS To determine the prevalence of type-2 diabetes patients that were initially and currently being treated by primary care physicians (PCPs) or diabetes specialists and assess predictors influencing their choice. METHODS This cross-sectional study was conducted in nine Greek primary healthcare units. Patients' choices were modeled using a bivariate probit analysis. RESULTS A total of 225 patients participated (84% response rate). Only 15.9% and 11.9% of the respondents acknowledged having chosen a diabetes specialist for their initial or current treatment, respectively. The family history of diabetes in siblings and the screening for diabetic retinopathy during the past year were significantly positively associated with choosing a diabetes specialist (initially p=0.033 or currently p=0.007), and resulted in a statistically significant reduction of the joint probabilities of choosing a PCP by 15.6% and 13.6%, respectively. Younger age (p=0.040), female sex (p=0.017), higher HbA1c (p=0.004), experience of hypoglycemia (p=0.029) and low cardiovascular morbidity index (p=0.016) emerged as important predictors for choosing a diabetes specialist for their treatment. CONCLUSIONS Our findings provide a better insight in diabetes patients' choices regarding the category of their treating physicians and their predictors. More studies are required to replicate them and identify patient subpopulations that may favor diabetes specialists' guidance.
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Affiliation(s)
- Philippe-Richard Domeyer
- School of Social Sciences, Hellenic Open University, Aristotelous 18, 26335 Patra, Greece; Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece.
| | - Zoi Tsimtsiou
- Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece; Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece; Health Center of Evosmos, Tegopoulou 2 and Patron Street, 56226 Thessaloniki, Greece.
| | - Vasileios Gkizlis
- Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece; Rural Practice of Maurommati, 43060 Mavrommati Karditsa, Greece.
| | - Dimitrios Gougourelas
- Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece; Health Center of Goura, 20014 Goura Korinthia, Greece.
| | - Anastasia Papaioannou
- Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece; Health Center of N. Makri, Artemidos & Marathonos Avenue, 19005 Athens, Greece.
| | - Sofia Birka
- Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece; Health Center of Evosmos, Tegopoulou 2 and Patron Street, 56226 Thessaloniki, Greece.
| | - Dimitra Sifaki-Pistolla
- Department of Social Medicine, Faculty of Medicine, University of Crete, 71003 Heraklion Crete, Greece.
| | - Ioanna Tsiligianni
- Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece; Department of Social Medicine, Faculty of Medicine, University of Crete, 71003 Heraklion Crete, Greece.
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Orozco-Beltrán D, Guillen-Mollá A, Cebrián-Cuenca AM, Navarro-Pérez J, Gil-Guillén VF, Quesada JA, Pomares-Gómez FJ, Lopez-Pineda A, Carratalá-Munuera C. Hospital admissions trends for severe hypoglycemia in diabetes patients in Spain, 2005 to 2015. Diabetes Res Clin Pract 2021; 171:108565. [PMID: 33242511 DOI: 10.1016/j.diabres.2020.108565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 02/03/2023]
Abstract
AIMS To analyze hospital admissions trends, inpatient mortality, and mean length of hospital stay due to hypoglycemia in patients with diabetes in Spain from 2005 to 2015. METHODS National Institute of Statistics provided information on hospital discharge and mortality. Hospital admissions due to severe hypoglycemia were identified using ICD-9 codes. Age-adjusted admission and mortality rates were stratified by sex and year. Joinpoint regression models were used to estimate trends. RESULTS Admissions rates per 100,000 population were higher for men than women in 2005 (30.2, 95%CI:29.3, 31.0 versus 21.5, 95%CI:20.9, 22.1) and 2015 (23.7, 95%CI:23.0, 24.4 versus 13.2, 95%CI:12.7, 13.6). Mortality per 100,000 population was also higher for men in both years (2005: 9.4, 95%CI:7.8, 11.0 versus 8.6, 95%CI:7.4, 9.8; 2015: 6.4, 95%CI:5.3, 7.6 versus 4.1, 95%CI:3.3, 4.8). Mortality dropped 5.2 percentage points annually (95%CI:-8.4, -1.9) in men and 7.0 percentage points annually (95%CI:-8.7, -5.2) in women from 2005 to 2015. Mean length of hospital stay changed only for women: 7.8 days (95%CI:7.5, 8.0) to 6.7 days (95%CI:6.4, 6.9). CONCLUSIONS Hospital admissions and inpatient mortality due to hypoglycemia in diabetes patients decreased from 2005 to 2015. This trend was more pronounced in women. Mean length of hospital stay decreased in women.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Alberto Guillen-Mollá
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | | | - Jorge Navarro-Pérez
- Biomedical Research Institute INCLIVA, University of Valencia Clinical Hospital, Valencia, Spain; CIBER, Epidemiology and Public Health (CIBERESP), Health Institute Carlos III, Madrid, Spain
| | - Vicente F Gil-Guillén
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Jose A Quesada
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.
| | | | - Adriana Lopez-Pineda
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Concepción Carratalá-Munuera
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
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Bickett A, Tapp H. Anxiety and diabetes: Innovative approaches to management in primary care. Exp Biol Med (Maywood) 2016; 241:1724-31. [PMID: 27390262 DOI: 10.1177/1535370216657613] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Type 2 diabetes mellitus is a chief concern for patients, healthcare providers, and health care systems in America, and around the globe. Individuals with type 2 diabetes mellitus exhibit clinical and subclinical symptoms of anxiety more frequently than people without diabetes. Anxiety is traditionally associated with poor metabolic outcomes and increased medical complications among those with type 2 diabetes mellitus. Collaborative care models have been utilized in the multidisciplinary treatment of mental health problems and chronic disease, and have demonstrated success in managing the pathology of depression which often accompanies diabetes. However, no specific treatment model has been published that links the treatment of anxiety to the treatment of type 2 diabetes mellitus. Given the success of collaborative care models in treating depression associated with diabetes, and anxiety unrelated to chronic disease, it is possible that the collaborative care treatment of primary care patients who suffer from both anxiety and diabetes could be met with the same success. The key issue is determining how to implement and sustain these models in practice. This review summarizes the proposed link between anxiety and diabetes, and offers an innovative and evidence-based collaborative care model for anxiety and diabetes in primary care.
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Affiliation(s)
- Allison Bickett
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA
| | - Hazel Tapp
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA
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