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Holland D, Heald AH, Stedman M, Hanna F, Wu P, Duff C, Green L, Robinson S, Halsall I, Gaskell N, Pemberton J, Bloor C, Fryer AA. Assessment of the effect of the COVID-19 pandemic on UK HbA1c testing: implications for diabetes management and diagnosis. J Clin Pathol 2023; 76:177-184. [PMID: 34645702 PMCID: PMC8520598 DOI: 10.1136/jclinpath-2021-207776] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/08/2021] [Indexed: 01/23/2023]
Abstract
AIMS The COVID-19 pandemic, and the focus on mitigating its effects, has disrupted diabetes healthcare services worldwide. We aimed to quantify the effect of the pandemic on diabetes diagnosis/management, using glycated haemoglobin (HbA1c) as surrogate, across six UK centres. METHODS Using routinely collected laboratory data, we estimated the number of missed HbA1c tests for 'diagnostic'/'screening'/'management' purposes during the COVID-19 impact period (CIP; 23 March 2020 to 30 September 2020). We examined potential impact in terms of: (1) diabetes control in people with diabetes and (2) detection of new diabetes and prediabetes cases. RESULTS In April 2020, HbA1c test numbers fell by ~80%. Overall, across six centres, 369 871 tests were missed during the 6.28 months of the CIP, equivalent to >6.6 million tests nationwide. We identified 79 131 missed 'monitoring' tests in people with diabetes. In those 28 564 people with suboptimal control, this delayed monitoring was associated with a 2-3 mmol/mol HbA1c increase. Overall, 149 455 'screening' and 141 285 'diagnostic' tests were also missed. Across the UK, our findings equate to 1.41 million missed/delayed diabetes monitoring tests (including 0.51 million in people with suboptimal control), 2.67 million screening tests in high-risk groups (0.48 million within the prediabetes range) and 2.52 million tests for diagnosis (0.21 million in the pre-diabetes range; ~70 000 in the diabetes range). CONCLUSIONS Our findings illustrate the widespread collateral impact of implementing measures to mitigate the impact of COVID-19 in people with, or being investigated for, diabetes. For people with diabetes, missed tests will result in further deterioration in diabetes control, especially in those whose HbA1c levels are already high.
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Affiliation(s)
| | - Adrian H Heald
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | | | - Fahmy Hanna
- Department of Diabetes and Endocrinology, Univerisity Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- Centre for Health and Development, Staffordshire University Faculty of Health Sciences, Stoke-on-Trent, UK
| | - Pensee Wu
- Academic Department of Obstetrics and Gynaecology, Univerisity Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- School of Medicine, Keele University, Keele, UK
| | - Christopher Duff
- School of Medicine, Keele University, Keele, UK
- Department of Clinical Biochemistry, Univerisity Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Lewis Green
- Department of Clinical Biochemistry, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - Sarah Robinson
- Department of Clinical Biochemistry, Univerisity Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ian Halsall
- Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge, UK
| | - Neil Gaskell
- Department of Pathology, Warrington & Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | | | | | - Anthony A Fryer
- School of Medicine, Keele University, Keele, UK
- Department of Clinical Biochemistry, Univerisity Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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Ansbro É, Masri S, Prieto-Merino D, Willis R, Aoun Bahous S, Molfino L, Boulle P, Perel P. Fixed dose combination drugs for cardiovascular disease in a prolonged humanitarian crisis in Lebanon: an implementation study. BMJ Open 2023; 13:e063668. [PMID: 36697043 PMCID: PMC9884866 DOI: 10.1136/bmjopen-2022-063668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/12/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This pre-post implementation study evaluated the introduction of fixed dose combination (FDC) medications for atherosclerotic cardiovascular disease (ASCVD) secondary prevention into routine care in a humanitarian setting. SETTING Two Médecins sans Frontières (MSF) primary care clinics serving Syrian refugee and host populations in north Lebanon. PARTICIPANTS Consenting patients ≥18 years with existing ASCVD requiring secondary prevention medication were eligible for study enrolment. Those with FDC contraindication(s) or planning to move were excluded. Of 521 enrolled patients, 460 (88.3%) were retained at 6 months, and 418 (80.2%) switched to FDC. Of these, 84% remained on FDC (n=351), 8.1% (n=34) discontinued and 7.9% (n=33) were lost to follow-up by month 12. INTERVENTIONS Eligible patients, enrolled February-May 2019, were switched to Trinomia FDC (atorvastatin 20 mg, aspirin 100 mg, ramipril 2.5/5/10 mg) after 6 months' usual care. During the study, the COVID-19 pandemic, an economic crisis and clinic closures occurred. OUTCOME MEASURES Descriptive and regression analyses compared key outcomes at 6 and 12 months: medication adherence, non-high density lipoprotein cholesterol (non-HDL-C) and systolic blood pressure (SBP) control. We performed per-protocol, intention-to-treat and secondary analyses of non-switchers. RESULTS Among 385 switchers remaining at 12 months, total adherence improved 23%, from 63% (95% CI 58 to 68) at month 6, to 86% (95% CI 82 to 90) at month 12; mean non-HDL-C levels dropped 0.28 mmol/L (95% CI -0.38 to -0.18; p<0.0001), from 2.39 (95% CI 2.26 to 2.51) to 2.11 mmol/L (95% CI 2.00 to 2.22); mean SBP dropped 2.89 mm Hg (95% CI -4.49 to -1.28; p=0.0005) from 132.7 (95% CI 130.8 to 134.6) to 129.7 mm Hg (95% CI 127.9 to 131.5). Non-switchers had smaller improvements in adherence and clinical outcomes. CONCLUSION Implementing an ASCVD secondary prevention FDC improved adherence and CVD risk factors in MSF clinics in Lebanon, with potential for wider implementation by humanitarian actors and host health systems.
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Affiliation(s)
- Éimhín Ansbro
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology & Population Health, London, UK
| | | | - David Prieto-Merino
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology & Population Health, London, UK
| | - Ruth Willis
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Sola Aoun Bahous
- Department of Internal Medicine, School of Medicine, Lebanese American University, Beirut, Lebanon
| | | | | | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology & Population Health, London, UK
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Wells JS, El Husseini A, Okoh S, Jaffar A, Neely C, Crilly P, Dolgin K, Kayyali R. SPUR: psychometric properties of a patient-reported outcome measure of medication adherence in type 2 diabetes. BMJ Open 2022; 12:e058467. [PMID: 36691135 PMCID: PMC9454040 DOI: 10.1136/bmjopen-2021-058467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 07/14/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Poor medication adherence is associated with worsening patient health outcomes and increasing healthcare costs. A holistic tool to assess both medication adherence and drivers of adherence behaviour has yet to be developed. This study aimed to examine SPUR, a multifactorial patient-reported outcome measure of medication adherence in patients living with type 2 diabetes, with a view to develop a suitable model for psychometric analysis.Furthermore, the study aimed to explore the relationship between the SPUR model and socio-clinical factors of medication adherence. RESEARCH DESIGN AND METHODS The study recruited 378 adult patients living with type 2 diabetes from a mix of community and secondary-care settings to participate in this non-interventional cross-sectional study. The original SPUR-45 tool was completed by participants with other patient-reported outcome measures for comparison, in addition to the collection of two objective adherence measures; HbA1c and the medication possession ratio (MPR). RESULTS Factor and reliability analysis conducted on SPUR-45 produced a revised and more concise version (27-items) of the tool, SPUR-27, which was psychometrically assessed. SPUR-27 observed strong internal consistency with significant correlations to the other psychometric measures (Beliefs about Medication Questionnaire, Diabetes Treatment Satisfaction Questionnaire, Medicine Adherence Rating Scale) completed by participants. Higher SPUR-27 scores were associated with lower HbA1c values and a higher MPR, as well as other predicted socio-clinical factors such as higher income, increased age and lower body mass index. CONCLUSIONS SPUR-27 demonstrated strong psychometric properties. Further work should look to examine the test-retest reliability of the model as well as examine transferability to other chronic conditions and broader population samples. Overall, the initial findings suggest that SPUR-27 is a reliable model for the multifactorial assessment of medication adherence among patients living with type 2 diabetes.
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Affiliation(s)
| | | | - Sandra Okoh
- Pharmacy, Kingston University, Kingston Upon Thames, UK
| | - Ali Jaffar
- Pharmacy, Kingston University, Kingston Upon Thames, UK
| | - Claire Neely
- Diabetes, Kingston Hospital NHS Foundation Trust, Kingston, UK
| | - Philip Crilly
- Pharmacy, Kingston University, Kingston Upon Thames, UK
| | - Kevin Dolgin
- Department for Behavioural Diagnostics, Observia, Paris, France
| | - Reem Kayyali
- Pharmacy, Kingston University, Kingston Upon Thames, UK
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Koyama AK, Cheng YJ, Brinks R, Xie H, Gregg EW, Hoyer A, Pavkov ME, Imperatore G. Trends in lifetime risk and years of potential life lost from diabetes in the United States, 1997–2018. PLoS One 2022; 17:e0268805. [PMID: 35609056 PMCID: PMC9129010 DOI: 10.1371/journal.pone.0268805] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background Both incidence and mortality of diagnosed diabetes have decreased over the past decade. However, the impact of these changes on key metrics of diabetes burden–lifetime risk (LR), years of potential life lost (YPLL), and years spent with diabetes–is unknown. Methods We used data from 653,811 adults aged ≥18 years from the National Health Interview Survey, a cross-sectional sample of the civilian non-institutionalized population in the United States. LR, YPLL, and years spent with diabetes were estimated from age 18 to 84 by survey period (1997–1999, 2000–2004, 2005–2009, 2010–2014, 2015–2018). The age-specific incidence of diagnosed diabetes and mortality were estimated using Poisson regression. A multistate difference equation accounting for competing risks was used to model each metric. Results LR and years spent with diabetes initially increased then decreased over the most recent time periods. LR for adults at age 20 increased from 31.7% (95% CI: 31.2–32.1%) in 1997–1999 to 40.7% (40.2–41.1%) in 2005–2009, then decreased to 32.8% (32.4–33.2%) in 2015–2018. Both LR and years spent with diabetes were markedly higher among adults of non-Hispanic Black, Hispanic, and other races compared to non-Hispanic Whites. YPLL significantly decreased over the study period, with the estimated YPLL due to diabetes for an adult aged 20 decreasing from 8.9 (8.7–9.1) in 1997–1999 to 6.2 (6.1–6.4) in 2015–2018 (p = 0.02). Conclusion In the United States, diabetes burden is declining, but disparities by race/ethnicity remain. LR remains high with approximately one-third of adults estimated to develop diabetes during their lifetime.
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Affiliation(s)
- Alain K. Koyama
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Yiling J. Cheng
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Ralph Brinks
- Institute for Biometry and Epidemiology, German Diabetes Center, Düsseldorf, Germany
- Medical Biometry and Epidemiology, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Hui Xie
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Edward W. Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Meda E. Pavkov
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Ali N, El Hamdaoui S, Nefs G, Tack CJ, De Galan BE. Improved glucometrics in people with type 1 diabetes 1 year into the COVID-19 pandemic. BMJ Open Diabetes Res Care 2022; 10:10/3/e002789. [PMID: 35606020 PMCID: PMC9125382 DOI: 10.1136/bmjdrc-2022-002789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/01/2022] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Various studies have shown a number of glycemic parameters to improve over several weeks in people with type 1 diabetes during the first surge of the COVID-19 pandemic. Whether and to what extent such improvement is sustained during following COVID-19 surges remains unknown. Therefore, the aim of this study was to investigate glycemic parameters during the first year of the COVID-19 pandemic in people with type 1 diabetes and to determine factors associated with glycemic improvement. RESEARCH DESIGN AND METHODS This was an observational cohort study in people with type 1 diabetes, aged ≥16 years. We compared glycated hemoglobin (HbA1c) and flash glucose monitoring (FGM) downloads between the prelockdown period and approximately 1 year thereafter. Using logistic regression analysis, we assessed associations between an HbA1c reduction of at least 0.5% (~5.5 mmol/mol) with baseline clinical characteristics and self-reported changes in psychological well-being and lifestyle behavior related to COVID-19. RESULTS A total of 437 participants were included. As compared with prepandemic data, 1 year after the start of the COVID-19 pandemic and associated lockdowns, HbA1c had decreased from 7.9%±1.1% (63±12 mmol/mol) to 7.5%±1.0% (59±11 mmol/mol) (p<0.001), whereas time in range increased from 55.8%±16.7% to 58.6%±16.7% (p=0.004) and time below (<3.9 mmol/L) and above (>13.9 mmol/L) range and glucose variability all decreased (all p<0.05). FGM use, higher HbA1c at baseline and current smoking were independently associated with an HbA1c decrease of at least 0.5%, whereas self-reported changes in psychological well-being and lifestyle behavior related to the first surge of the COVID-19 pandemic and associated lockdowns were not. CONCLUSIONS The COVID-19 pandemic and related lockdown measures were associated with improvement in glucometrics, including HbA1c and FGM data, in individuals with type 1 diabetes, particularly in FGM users, those with higher HbA1c at baseline or current smokers.
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Affiliation(s)
- Namam Ali
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Soumia El Hamdaoui
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Giesje Nefs
- Department of Medical Psychology, Radboudumc Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Center of Research on Psychological disorders and Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, Netherlands
| | - Cornelis J Tack
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Bastiaan E De Galan
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands
- Internal Medicine/Endocrinology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
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Czeisler MÉ, Barrett CE, Siegel KR, Weaver MD, Czeisler CA, Rajaratnam SM, Howard ME, Bullard KM. Health Care Access and Use Among Adults with Diabetes During the COVID-19 Pandemic - United States, February-March 2021. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1597-1602. [PMID: 34793416 PMCID: PMC8601412 DOI: 10.15585/mmwr.mm7046a2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Czupryniak L, Dicker D, Lehmann R, Prázný M, Schernthaner G. The management of type 2 diabetes before, during and after Covid-19 infection: what is the evidence? Cardiovasc Diabetol 2021; 20:198. [PMID: 34598700 PMCID: PMC8485772 DOI: 10.1186/s12933-021-01389-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with Covid-19 place new challenges on the management of type 2 diabetes, including the questions of whether glucose-lowering therapy should be adjusted during infection and how to manage a return to normal care after resolution of Covid-19 symptoms. Due to the sudden onset of the pandemic, physicians have by necessity made such important clinical decisions in the absence of robust evidence or consistent guidelines. The risk to patients is compounded by the prevalence of cardiovascular disease in this population, which alongside diabetes is a major risk factor for severe disease and mortality in Covid-19. We convened as experts from the Central and Eastern European region to consider what advice we can provide in the setting of type 2 diabetes and Covid-19, considering the evidence before, during and after infection. We review recommendations that have been published to date, and consider the best available—but currently limited—evidence from large observational studies and the DARE-19 randomized control trial. Notably, we find a lack of guidance on restarting patients on optimal antidiabetic therapy after recovering from Covid-19, and suggest that this may provide an opportunity to optimize treatment and counter clinical inertia that predates the pandemic. Furthermore, we emphasize that optimization applies not only to glycaemic control, but other factors such as cardiorenal protection. While we look forward to the emergence of new evidence that we hope will address these gaps, in the interim we provide a perspective, based on our collective clinical experience, on how best to manage glucose-lowering therapy as patients with Covid-19 recover from their disease and return to normal care.
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Affiliation(s)
- Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Dror Dicker
- Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Centre, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roger Lehmann
- Department of Endocrinology, Diabetes and Nutrition, University Hospital Zürich, Zürich, Switzerland
| | - Martin Prázný
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Guntram Schernthaner
- Department of Medicine I, Rudolfstiftung Hospital Vienna, 1030, Vienna, Austria. .,Medical University of Vienna, Vienna, Austria.
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Antonio-Arques V, Franch-Nadal J, Caylà JA. Diabetes and tuberculosis: A syndemic complicated by COVID-19. ACTA ACUST UNITED AC 2021; 157:288-293. [PMID: 34541325 PMCID: PMC8433042 DOI: 10.1016/j.medcle.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
Tuberculosis (TB) is the leading cause of infectious mortality in the world, affecting mainly developing countries (DC), while diabetes (DM) is one of the most prevalent chronic diseases. This review analyzes the fact that diabetes is currently an important risk factor for developing TB, also presenting more complicated TB, more relapses and higher mortality. The DCs and the fourth world of the large cities are those with the highest incidence of TB and an increase in DM, which will make it difficult to control tuberculosis disease. At the same time, the COVID-19 pandemic is complicating the management of both diseases due to the difficulty of access to control and treatment and the worsening of socioeconomic inequalities. It is necessary to establish a bidirectional screening for TB and DM and promote recommendations for the joint management of both diseases.
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Affiliation(s)
- Violeta Antonio-Arques
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain.,Equip d'Atenció Primària (EAP) Bordeta Magòria, Institut Català de la Salut, Barcelona, Spain
| | - Josep Franch-Nadal
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain.,Equip d'Atenció Primària (EAP) Raval Sud - Drassanes, Institut Català de la Salut, Barcelona, Spain
| | - Joan A Caylà
- Fundación de la Unidad de Investigación en Tuberculosis de Barcelona, Barcelona, Spain
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Stedman M, Rea R, Livingston M, McLoughlin K, Wong L, Brown S, Grady K, Gadsby R, Paisley A, Heald A. People with Type 2 Diabetes Mellitus (T2DM) Self-Reported Views on Their Own Condition Management Reveal a High Level of Insight into the Challenges Faced. J Diabetes Sci Technol 2021; 15:972-973. [PMID: 33998847 PMCID: PMC8252150 DOI: 10.1177/19322968211009261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS FT, Oxford
| | - Mark Livingston
- Department of Clinical Biochemistry, Black Country Pathology Services, Walsall Manor Hospital, Walsall
- School of Medicine and Clinical Practice, Faculty of Science & Engineering, The University of Wolverhampton
| | | | | | | | | | - Roger Gadsby
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Adrian Heald
- Salford Royal Hospital, Salford, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, UK
- Adrian Heald, DM, Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK.
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Antonio-Arques V, Franch-Nadal J, Caylà JA. Diabetes and tuberculosis: a syndemic complicated by COVID-19. Med Clin (Barc) 2021; 157:288-293. [PMID: 34049681 PMCID: PMC8101986 DOI: 10.1016/j.medcli.2021.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 01/16/2023]
Abstract
Tuberculosis (TB) is the leading cause of infectious mortality in the world, affecting mainly developing countries (DC), while diabetes (DM) is one of the most prevalent chronic diseases. This review analyzes the fact that diabetes is currently an important risk factor for developing TB, also presenting more complicated TB, more relapses and higher mortality. The DCs and the fourth world of the large cities are those with the highest incidence of TB and an increase in DM, which will make it difficult to control tuberculosis disease. At the same time, the COVID-19 pandemic is complicating the management of both diseases due to the difficulty of access to control and treatment and the worsening of socioeconomic inequalities. It is necessary to establish a bidirectional screening for TB and DM and promote recommendations for the joint management of both diseases.
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Affiliation(s)
- Violeta Antonio-Arques
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España; Equip d'Atenció Primària (EAP) Bordeta Magòria, Institut Català de la Salut, Barcelona, España
| | - Josep Franch-Nadal
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España; Equip d'Atenció Primària (EAP) Raval Sud - Drassanes, Institut Català de la Salut, Barcelona, España.
| | - Joan A Caylà
- Fundación de la Unidad de Investigación en Tuberculosis de Barcelona, Barcelona, España
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