1
|
Findlay-White F, Dornan T, Davies M, Archer A, Kilvert A, Fox C. From fixer to facilitator: an interpretative phenomenological study of diabetes person-centred counselling and empowerment-based education. F1000Res 2023; 11:78. [PMID: 38434003 PMCID: PMC10904953 DOI: 10.12688/f1000research.73596.2] [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] [Accepted: 11/01/2023] [Indexed: 03/05/2024] Open
Abstract
Background The purpose of this study is to explore the professional and personal experiences of multidisciplinary healthcare professionals during and following diabetes counselling and empowerment-based education. Methods Everyone who had participated in a diabetes counselling and empowerment course between 2008-2016 was invited to respond to an online survey and follow-up telephone interview if willing. Interviews were recorded and transcribed verbatim. The research team used interpretative phenomenology to identify core themes from both the survey and telephone interviews and which captured the impact of empowerment-based education. Results 22 doctors, nurses, dieticians, and psychologists completed an online questionnaire. 10 subsequently took part in telephone interviews. Empowerment-based education changed them from fixers to facilitators. Their transformation included a sense of becoming authentic, 'being the way I want to be' in clinical practice and becoming more self-reflective. This affected them personally as well as reinvigorating them professionally. Conclusions The participants described a personal and professional journey of transformation that included discovering their person-centred philosophy. They adopted a consultation structure that empowered people with diabetes to care for themselves. It can be speculated that participants' experience of transformation may also guard against professional burnout.
Collapse
Affiliation(s)
- Florence Findlay-White
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, BT9 7BL, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, BT9 7BL, UK
| | - Mark Davies
- Clinical Psychology Department, Belfast City Hospital, Belfast, Northern Ireland, BT9 7AE, UK
| | - Alan Archer
- Derbyshire Community Health Service, Walton Hospital, Chesterfield, England, S40 3HW, UK
| | - Anne Kilvert
- Northampton Community Diabetes Service, Danetre Hospital, Daventry, England, NN11 4DY, UK
| | - Charles Fox
- Diabetes Research Centre, University of Leicester, Leicester, England, LE5 4PW, UK
| |
Collapse
|
2
|
Matthys E, Van Bogaert P, Blommaert S, Verdonck L, Remmen R. Evidence-based early stage type 2 diabetes follow-up in Belgian primary care practices: Impact of multi-professional teams and care protocols. Prim Care Diabetes 2021; 15:249-256. [PMID: 33060036 DOI: 10.1016/j.pcd.2020.09.003] [Citation(s) in RCA: 1] [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] [Received: 04/08/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
AIM The aim of this research is to explore the current early-stage diabetes mellitus type 2 care in Belgian general practices. This, to find out if the care is provided according to the proposed evidence-based national diabetes care guideline. Additionally, this research aims to detect which person and practice characteristics can be associated with a more evidence-based care provision. METHODS People were included in the study if they were recently diagnosed with type 2 diabetes by the participating practice. Practice and person characteristics, and clinical parameter monitoring and lifestyle monitoring data were collected by using a questionnaire and a topic list. RESULTS A total of 27 general practices participated and a total of 249 people were included through their patient records. People monitored in a practice according to a self-developed protocol were 5.5 times more likely to have a better clinical parameter follow-up. Larger practices (>2000 patients), follow-up by general practitioners and practice nurses together and according to self-developed protocols were associated with a significantly better lifestyle follow-up. CONCLUSION Practices providing multidisciplinary diabetes care, in collaboration with practice nurses, and with diabetes care based on self-developed protocols achieved a more comprehensive follow-up.
Collapse
Affiliation(s)
- Evi Matthys
- University of Antwerp, Campus Drie Eiken DR334, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | | | | | | | - Roy Remmen
- University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| |
Collapse
|
3
|
J S, T C S, T D, T B, G K, C L, R S, G J. Our language matters: Improving communication with and about people with diabetes. A position statement by Diabetes Australia. Diabetes Res Clin Pract 2021; 173:108655. [PMID: 33422586 DOI: 10.1016/j.diabres.2021.108655] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 11/22/2022]
Abstract
The words used about diabetes affect the physical and emotional health of people living with diabetes. They also affect how individuals and society view people living with, or at risk of, diabetes. People with diabetes, their families, and people at risk of diabetes, need and deserve communications that are clear and accurate, respectful and inclusive, and free from judgement and bias. The aim of this position statement is to help bring about positive change in the language used about diabetes. It is based on 30+ years of research into the experiences of people with diabetes. Changing thelanguage of diabetes can make a powerful and positive difference to the emotional well-being, self-care and health outcomes of people affected by diabetes. It also affects community and government support for funding diabetes care, prevention and research. Diabetes Australia encourages everyone communicating about diabetes, or about people affected by diabetes, to choose and use their words carefully to support all people affected by diabetes. This position statement is intended as a guide for people working in healthcare, the media, government and policy, academia, industry, as well as employers and the community. It may also be helpful for the family and friends of people with diabetes.
Collapse
Affiliation(s)
- Speight J
- Deakin University, School of Psychology, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia.
| | - Skinner T C
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia; La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia; University of Copenhagen, Psychology, Copenhagen, Denmark
| | - Dunning T
- Deakin University, School of Nursing, Geelong, Victoria, Australia
| | - Black T
- Diabetes Australia, Canberra, ACT, Australia
| | - Kilov G
- University of Melbourne, Parkville, Victoria, Australia; Launceston Diabetes Clinic, Launceston, Tasmania, Australia
| | - Lee C
- Diabetes Australia, Canberra, ACT, Australia
| | - Scibilia R
- Diabetes Australia, Canberra, ACT, Australia
| | - Johnson G
- Diabetes Australia, Canberra, ACT, Australia
| |
Collapse
|
4
|
Abstract
The term 'diabetes distress' first entered the psychosocial research vernacular in 1995, and refers to 'the negative emotional or affective experience resulting from the challenge of living with the demands of diabetes'. At first the proponents of the concept were hesitant in advocating that diabetes distress was a major barrier to individuals' self-care and management of diabetes. Since then, a burgeoning body of evidence, now including several systematic reviews of intervention studies, suggests that diabetes distress, in both type 1 and type 2 diabetes, across ages and in all countries and cultures where it has been studied, is common and can be a barrier to optimal emotional well-being, self-care and management of diabetes. As a consequence, monitoring diabetes distress as part of routine clinical care is part of many national guidelines. The present narrative review summarizes this research and related literature, to postulate the aetiology of diabetes distress, and thus how it may be prevented. The current evidence base for the management of diabetes distress is summarized, and the next steps in the prevention and management of diabetes distress identified.
Collapse
Affiliation(s)
- T C Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - L Joensen
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - T Parkin
- School of Health Professions, University of Plymouth, Plymouth, UK
| |
Collapse
|
5
|
Geerling R, Browne JL, Holmes-Truscott E, Furler J, Speight J, Mosely K. Positive reinforcement by general practitioners is associated with greater physical activity in adults with type 2 diabetes. BMJ Open Diabetes Res Care 2019; 7:e000701. [PMID: 31803479 PMCID: PMC6887508 DOI: 10.1136/bmjdrc-2019-000701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 11/03/2022] Open
Abstract
Objective In a sample of adults with type 2 diabetes mellitus (T2DM), the aim of this study was to examine whether self-reported physical activity level is associated with recall of specific physical activity-related interactions used by general practitioners (GP). Research design and methods Adults with T2DM completed an online survey reporting physical activity behaviors and recall of 14 GP-patient interactions about physical activity, mapped onto discrete behavior change techniques (BCT). Stepped logistical regression examined associations between recommended physical activity (≥600 MET-min/week) and GP-patient interactions, controlling for body mass index, diabetes-related comorbidities, depressive symptoms and self-efficacy. Results In total, 381 respondents (55% men, mean±SD age: 62±10 years and T2DM duration 8±8 years) provided complete data. Most (73%) reported receiving 'general advice', while interactions related to goal setting, monitoring, and relapse prevention were least commonly reported (all <20%). Self-reported achievement of the recommended physical activity level was significantly associated with recall of GP interactions involving praise for 'efforts to be active' (OR 2.1; 95% CI 1.24 to 3.53), 'lost weight' (OR 1.81; 95% CI 1.05 to 3.12) or lowering 'glucose levels as a result of being active' (OR 1.75; 95% CI 1.03 to 2.96). Conclusions Findings suggest GPs can be somewhat effective in promoting physical activity with simple, positive, reinforcing messages/interactions. Future research to develop and evaluate very brief primary care BCT-based physical activity interventions is needed.
Collapse
Affiliation(s)
- Ralph Geerling
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - Jessica L Browne
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Centre for Evidence and Implementation, Melbourne, Victoria, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - John Furler
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - Kylie Mosely
- BodyMatters Australasia, Sydney, New South Wales, Australia
- University of Technology Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Naughton MFA, Maybery DJ, Goodyear M. Prevalence of mental illness within families in a regional child-focussed mental health service. Int J Ment Health Nurs 2018; 27:901-910. [PMID: 28929573 DOI: 10.1111/inm.12386] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
Abstract
Nearly 50% of all mental illnesses begin in childhood before the age of 14 years, and over 20% of parents have a mental illness. Few studies have examined the co-occurrence of mental illnesses in parents and children. In the present study, we examined the extent of mental illness within families of 152 clients attending an Australian regional child and adolescent mental health service (CAMHS). A cross-sectional study design was employed involving a case record review and clinician-completed questionnaire of the children and youth attending a CAMHS. It was found that 79% of these children were living with a parent with mental illness. The predominant diagnosis of both child and parent was an anxiety or mood disorder, and many families had co-occurring risk factors of domestic violence and limited social supports. The findings in this Australian cohort are similar to those of other international research. While novel in nature, the present study has highlighted the extent of both mental illness and scarce supports for both children and parents in the same family. The findings indicate the need for a coordinated multiservice delivery of appropriate and consistent family-focussed interventions, responding to both mental illness and social supports for children and parents. Further research should examine specific components of family need and support, as seen through the eyes of the child and their parent.
Collapse
Affiliation(s)
- Michael F A Naughton
- School of Rural Health, Monash University and Latrobe Regional Hospital, Victoria, Australia
| | | | - Melinda Goodyear
- School of Rural Health, Monash University and the Parenting Research Centre, Clayton, Victoria, Australia
| |
Collapse
|
7
|
Cradock S. Positive behavioural change requires clarity, objectivity and support. Diabet Med 2017; 34:1025-1026. [PMID: 28608579 DOI: 10.1111/dme.13401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2017] [Indexed: 01/26/2023]
Affiliation(s)
- S Cradock
- Leicester Diabetes Centre, University of Leicester Hospitals, Leicester, UK
| |
Collapse
|
8
|
Gerwing J, Indseth T, Gulbrandsen P. A microanalysis of the clarity of information in physicians' and patients' discussions of treatment plans with and without language barriers. PATIENT EDUCATION AND COUNSELING 2016; 99:522-529. [PMID: 26561309 DOI: 10.1016/j.pec.2015.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 09/24/2015] [Accepted: 10/15/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Physicians and patients discuss treatment plans. If tasks within plans are not described adequately, patients cannot adhere. We evaluated task descriptions, testing whether patient engagement and language barriers affected task clarity. METHOD We sampled 12 videotaped hospital interactions from a corpus of 497: two encounters each from six hospital physicians, interacting with one native-speaking and one non-native-speaking patient. We used microanalysis of face-to-face dialogue to assess whether the physicians and patients achieved a complete, clear description of each task's three core information elements (who should do what and when). RESULTS We conducted detailed analysis on 78 of the 90 tasks. Core information elements were complete in 62 (0.79) and clear in 37 (0.47). Language barriers had no effect on task clarity. When native-speaking patients were engaged, tasks were clearer (p<0.05). Although non-native-speaking patients were significantly more engaged (p<0.01), their engagement had no effect. CONCLUSION Physicians may be pursuing patients' agreement, motivation, and commitment at the expense of working with the patient to be clear about what needs to be done. PRACTICE IMPLICATIONS Physicians need to improve how clearly they present basic task information. Previous research demonstrated that even a short course can significantly improve the clarity of instructions.
Collapse
Affiliation(s)
- Jennifer Gerwing
- Health Services Research Center (HØKH), Akershus University Hospital, Lørenskog, Norway.
| | - Thor Indseth
- Norwegian Center for Minority Health Research (NAKMI), Oslo Universitetssykehus HF, avd. Ullevål, Oslo, Norway.
| | - Pål Gulbrandsen
- Health Services Research Center (HØKH), Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway.
| |
Collapse
|
9
|
Graumlich JF, Wang H, Madison A, Wolf MS, Kaiser D, Dahal K, Morrow DG. Effects of a Patient-Provider, Collaborative, Medication-Planning Tool: A Randomized, Controlled Trial. J Diabetes Res 2016; 2016:2129838. [PMID: 27699179 PMCID: PMC5028848 DOI: 10.1155/2016/2129838] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022] Open
Abstract
Among patients with various levels of health literacy, the effects of collaborative, patient-provider, medication-planning tools on outcomes relevant to self-management are uncertain. Objective. Among adult patients with type II diabetes mellitus, we tested the effectiveness of a medication-planning tool (Medtable™) implemented via an electronic medical record to improve patients' medication knowledge, adherence, and glycemic control compared to usual care. Design. A multicenter, randomized controlled trial in outpatient primary care clinics. 674 patients received either the Medtable tool or usual care and were followed up for up to 12 months. Results. Patients who received Medtable had greater knowledge about indications for medications in their regimens and were more satisfied with the information about their medications. Patients' knowledge of drug indication improved with Medtable regardless of their literacy status. However, Medtable did not improve patients' demonstrated medication use, regimen adherence, or glycemic control (HbA1c). Conclusion. The Medtable tool supported provider/patient collaboration related to medication use, as reflected in patient satisfaction with communication, but had limited impact on patient medication knowledge, adherence, and HbA1c outcomes. This trial is registered with ClinicalTrials.gov NCT01296633.
Collapse
Affiliation(s)
- James F. Graumlich
- Department of Medicine, University of Illinois College of Medicine at Peoria, 530 Northeast Glen Oak Avenue, Peoria, IL 61637, USA
- *James F. Graumlich:
| | - Huaping Wang
- Department of Medicine, Division of Research Services, University of Illinois College of Medicine at Peoria, One Illini Drive, Peoria, IL 61605, USA
| | - Anna Madison
- Department of Psychology, University of Illinois at Urbana-Champaign, 603 E. Daniel, Champaign, IL 61820, USA
| | - Michael S. Wolf
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA
| | - Darren Kaiser
- Northwestern Medical Faculty Foundation, 675 North Saint Clair Street, Chicago, IL 60611, USA
| | - Kumud Dahal
- Department of Medicine, University of Illinois College of Medicine at Peoria, One Illini Drive, Peoria, IL 61605, USA
| | - Daniel G. Morrow
- Department of Educational Psychology, University of Illinois at Urbana-Champaign, Education Building, 1310 South 6th Street, Champaign, IL 61820, USA
| |
Collapse
|
10
|
Coates VE, McCann A, Posner N, Gunn K, Seers K. ‘Well, who do I phone?’ Preparing for urgent care: a challenge for patients and service providers alike'. J Clin Nurs 2015; 24:2152-63. [DOI: 10.1111/jocn.12814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Vivien E Coates
- Joint Appointment University of Ulster & Western Health and Social Care Trust; Institute of Nursing & Health Research; School of Nursing; University of Ulster; Coleraine UK
| | | | - Natasha Posner
- Warwick Medical School; University of Warwick; Coventry UK
| | - Kathleen Gunn
- Warwick Medical School; University of Warwick; Coventry UK
| | - Kate Seers
- RCN Research Institute; Division of Health Sciences; Warwick Medical School; University of Warwick; Coventry UK
| |
Collapse
|
11
|
Das AK, Malik A, Haddad PM. A qualitative study of the attitudes of patients in an early intervention service towards antipsychotic long-acting injections. Ther Adv Psychopharmacol 2014; 4:179-85. [PMID: 25360242 PMCID: PMC4212491 DOI: 10.1177/2045125314542098] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The objective of this study was to investigate attitudinal themes to antipsychotic long-acting injections (LAIs) in patients in an early intervention team (EIT). METHODS Interviews were carried out with outpatients purposively sampled from an EIT to represent patients currently prescribed antipsychotic LAIs, oral antipsychotics and those not prescribed antipsychotic medication. Interviews were conducted and analysed according to grounded theory. Recruitment stopped when saturation of themes was reached. RESULTS Interviews from 11 patients were analysed (median age 24 years). Attitudes to LAIs were condensed into three key categories: therapeutic alliance and the psychiatrists' recommendation of antipsychotic medication; patients' knowledge and beliefs about LAIs; and patients' views regarding the appropriateness of LAIs. Participants valued their psychiatrist's recommendation as to the most appropriate antipsychotic. Attitudes to LAIs varied but were most positive among those currently receiving a LAI. Among those not prescribed LAIs, some were open to considering a LAI if their clinician recommended it but others were opposed to such treatment and preferred tables. There was a lack of awareness of LAIs as a treatment option among those not prescribed a LAI. Delay in being offered a LAI was reported in the group currently prescribed a LAI. Several participants associated oral antipsychotics, LAIs and mental illness with stigma. Some not prescribed a LAI had misperceptions about the nature of this treatment. Participants regarded the advantages of LAIs as convenience and avoiding forgetting to take tablets, while disadvantages included injection pain, fear of needles and coercion. CONCLUSION Lack of knowledge, misperceptions and stigma related to LAIs and other treatment options should be addressed by providing patients with accurate information. This will facilitate patients being involved in choices about treatment, and should they decide to accept medication, which drug and formulation is most appropriate for their needs. Clinicians should avoid making assumptions about patients' attitudes to LAIs; attitudes vary but some early intervention patients not prescribed LAIs are open to considering this treatment. Antipsychotic prescribing should result from a shared decision-making process in which clinicians and patients openly discuss the pros and cons of different formulations and drugs. The themes identified in this qualitative study require further exploration using quantitative methodology.
Collapse
Affiliation(s)
- Amlan K Das
- PTSR Program, Homewood Health Centre, Guelph, and McMaster University, Hamilton, Ontario, Canada
| | - Abid Malik
- Greater Manchester West Mental Health NHS Foundation Trust, University of Manchester, Salford, UK
| | - Peter M Haddad
- Consultant Psychiatrist, Greater Manchester West Mental Health NHS Foundation Trust, UK Honorary Reader, University of Manchester, Cromwell Road, Eccles, Salford M30 0GT, UK
| |
Collapse
|
12
|
Affiliation(s)
- Aus Alzaid
- Prince Sultan Military Medical City , Riyadh, Saudi Arabia
| |
Collapse
|
13
|
Cherubini V, Pintaudi B, Rossi MC, Lucisano G, Pellegrini F, Chiumello G, Frongia AP, Monciotti C, Patera IP, Toni S, Zucchini S, Nicolucci A. Severe hypoglycemia and ketoacidosis over one year in Italian pediatric population with type 1 diabetes mellitus: a multicenter retrospective observational study. Nutr Metab Cardiovasc Dis 2014; 24:538-546. [PMID: 24418381 DOI: 10.1016/j.numecd.2013.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 11/07/2013] [Accepted: 11/10/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Evaluation of incidence and correlates of severe hypoglycemia (SH) and diabetes ketoacidosis (DKA) in children and adolescents with T1DM. METHODS AND RESULTS Retrospective study conducted in 29 diabetes centers from November 2011 to April 2012. The incidence of SH and DKA episodes and their correlates were assessed through a questionnaire administered to parents of patients aged 0-18 years. Incidence rates and incident rate ratios (IRRs) were estimated through multivariate Poisson regression analysis and multilevel analysis. Overall, 2025 patients were included (age 12.4 ± 3.8 years; 53% males; diabetes duration 5.6 ± 3.5 years; HbA1c 7.9 ± 1.1%). The incidence of SH and DKA were of 7.7 and 2.4 events/100 py, respectively. The risk of SH was higher in females (IRR = 1.44; 95%CI 1.04-1.99), in patients using rapid acting analogues as compared to regular insulin (IRR = 1.48; 95%CI 0.97-2.26) and lower for patients using long acting analogues as compared to NPH insulin (IRR = 0.40; 95%CI 0.19-0.85). No correlations were found between SH and HbA1c levels. The risk of DKA was higher in patients using rapid acting analogues (IRR = 4.25; 95%CI 1.01-17.86) and increased with insulin units needed (IRR = 7.66; 95%CI 2.83-20.74) and HbA1c levels (IRR = 1.63; 95%CI 1.36-1.95). Mother's age was inversely associated with the risk of both SH (IRR = 0.95; 95%CI 0.92-0.98) and DKA (IRR = 0.94; 95%CI 0.88-0.99). When accounting for center effect, the risk of SH associated with the use of rapid acting insulin analogues was attenuated (IRR = 1.48; 95%CI 0.97-2.26); 33% and 16% of the residual variance in SH and DKA risk was explained by center effect. CONCLUSION The risk of SH and DKA is mainly associated with treatment modalities and strongly depends on the practice of specialist centers.
Collapse
Affiliation(s)
- V Cherubini
- Division of Paediatric Diabetes in Children and Adolescents, Maternal-Infantile Department, Salesi Hospital, Ancona, Italy
| | - B Pintaudi
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Via Nazionale, S. Maria Imbaro 66030, CH, Italy
| | - M C Rossi
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Via Nazionale, S. Maria Imbaro 66030, CH, Italy
| | - G Lucisano
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Via Nazionale, S. Maria Imbaro 66030, CH, Italy
| | - F Pellegrini
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Via Nazionale, S. Maria Imbaro 66030, CH, Italy
| | - G Chiumello
- Endocrine Unit, Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - A P Frongia
- Pediatric Division, Brotzu Hospital, Cagliari, Italy
| | - C Monciotti
- Women & Children's Health Department, University of Padova, Padova, Italy
| | - I P Patera
- Department of Pediatrics, Bambino Gesù Hospital, Passoscuro (RM), Roma, Italy
| | - S Toni
- Diabetes Unit, Meyer Children Hospital, Firenze, Italy
| | - S Zucchini
- Department of Pediatrics, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - A Nicolucci
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Via Nazionale, S. Maria Imbaro 66030, CH, Italy.
| |
Collapse
|
14
|
Tambascia MA, Nery M, Gross JL, Ermetice MN, de Oliveira CP. Evidence-based clinical use of insulin premixtures. Diabetol Metab Syndr 2013; 5:50. [PMID: 24011173 PMCID: PMC4016222 DOI: 10.1186/1758-5996-5-50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 05/17/2013] [Indexed: 01/04/2023] Open
Abstract
Brazil is expected to have 19.6 million patients with diabetes by the year 2030. A key concept in the treatment of type 2 diabetes mellitus (T2DM) is establishing individualized glycemic goals based on each patient's clinical characteristics, which impact the choice of antihyperglycemic therapy. Targets for glycemic control, including fasting blood glucose, postprandial blood glucose, and glycated hemoglobin (A1C), are often not reached solely with antihyperglycemic therapy, and insulin therapy is often required. Basal insulin is considered an initial strategy; however, premixed insulins are convenient and are equally or more effective, especially for patients who require both basal and prandial control but desire a more simplified strategy involving fewer daily injections than a basal-bolus regimen. Most physicians are reluctant to transition patients to insulin treatment due to inappropriate assumptions and insufficient information. We conducted a nonsystematic review in PubMed and identified the most relevant and recently published articles that compared the use of premixed insulin versus basal insulin analogues used alone or in combination with rapid-acting insulin analogues before meals in patients with T2DM. These studies suggest that premixed insulin analogues are equally or more effective in reducing A1C compared to basal insulin analogues alone in spite of the small increase in the risk of nonsevere hypoglycemic events and nonclinically significant weight gain. Premixed insulin analogues can be used in insulin-naïve patients, in patients already on basal insulin therapy, and those using basal-bolus therapy who are noncompliant with blood glucose self-monitoring and titration of multiple insulin doses. We additionally provide practical aspects related to titration for the specific premixed insulin analogue formulations commercially available in Brazil.
Collapse
Affiliation(s)
- Marcos Antônio Tambascia
- Faculty of Medical Sciences, State University of Campinas, Brazil Rua Frei Manoel da Ressurreição 965, Campinas, SP, Brazil
| | - Márcia Nery
- Diabetes Unit - Endocrinology and Metabolism Service, Clinical Hospital of Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jorge Luiz Gross
- Department of Internal Medicine, Faculty of Medicine of Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Mariana Narbot Ermetice
- Diabetes Group, Eli Lilly do Brazil São Paulo, São Paulo, Brazil
- Currently at Novo Nordisk Brazil, São Paulo, Brazil
| | | |
Collapse
|
15
|
Affiliation(s)
- K D Barnard
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, UK
| | | | | |
Collapse
|
16
|
Dillon PJ. Assessing the influence of patient participation in primary care medical interviews on recall of treatment recommendations. HEALTH COMMUNICATION 2011; 27:58-65. [PMID: 21707391 DOI: 10.1080/10410236.2011.569000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study examined the relationship between patient participation and recall of treatment recommendations among a sample of 96 patients at two primary care medical clinics. Using multilevel modeling analysis, the results of this study indicated a significant positive correlation (t(81)= 8.84, p < .0001) between patients' participation and their ability to recall treatment recommendations discussed with their physicians. The results presented here suggest that patients who take a more active role in medical interviews may have an increased ability to recall important information discussed during these interactions. This is of utmost importance because the ability to recall treatment recommendations is an important predictor of health outcomes.
Collapse
Affiliation(s)
- Patrick J Dillon
- Department of Communication, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620-7800, USA.
| |
Collapse
|
17
|
Arden-Close E, Absolom K, Greenfield DM, Hancock BW, Coleman RE, Eiser C. Gender differences in self-reported late effects, quality of life and satisfaction with clinic in survivors of lymphoma. Psychooncology 2010; 20:1202-10. [DOI: 10.1002/pon.1835] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 07/13/2010] [Accepted: 07/15/2010] [Indexed: 12/21/2022]
|
18
|
Abstract
In paediatric diabetes, the concept of intensive therapy in the post-Diabetes Control and Complications Trial period has become subverted by a pharmaco-technological paradigm at the expense of other aspects of care such as goal-setting and psychosocial support. This review examines which patients benefit most from intensive therapy in terms of glycaemic control (HbA1c). It also reviews published controlled trial and observational data relating to the impact of various insulin types and delivery systems on glycaemic control and canvasses the literature dealing with the impact of patient support, philosophy of care, goal setting and treating team dynamic on HbA1c. Taking into account the characteristics of those patients who benefit most from intensive therapy, the quantum of HbA1c change and the persistence of changes that have been reported in selected and non-selected patient groups, it appears that there is a clear hierarchy in aspects of therapy that improve glycaemic control for children and adolescents with Type 1 diabetes. Prime issues appear to be patient support, team cohesion and goal setting. The reported glycaemic benefits achieved by an isolated emphasis upon a pharmaco-technological paradigm are limited in children and adolescents. It appears that only after the prime issues have been first considered will the potential benefits of the insulin types and regimens then be realized.
Collapse
Affiliation(s)
- T C Skinner
- Combined Universities Centre for Rural Health, Geraldton, Western Australia, Australia
| | | |
Collapse
|
19
|
Jaeger M, Rossler W. Attitudes towards long-acting depot antipsychotics: a survey of patients, relatives and psychiatrists. Psychiatry Res 2010; 175:58-62. [PMID: 20004980 DOI: 10.1016/j.psychres.2008.11.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 11/03/2008] [Accepted: 11/11/2008] [Indexed: 11/26/2022]
Abstract
In many countries fewer than 20% of individuals with schizophrenia receive depot antipsychotic medication. Frequently stated reasons are psychiatrist's, patient's and relative's objections to depot treatment. This is the first study that directly compares the attitudes to depot antipsychotics of psychiatrists, patients and relatives. A semi-structured questionnaire about their attitudes towards depot antipsychotics was completed by 255 participants (83 patients diagnosed with schizophrenic disorder, 81 psychiatrists in private practice and 91 relatives, not directly related to the patients). Patients were more negative towards depot injections than psychiatrists and relatives. They particularly fear to be constricted in their autonomy when treated with depot antipsychotics and that injections might be painful. About 67% of all patients in our sample did not receive information about depot antipsychotics from their psychiatrist. Less than 10% of psychiatrists offer depot treatment after a first psychotic episode. Psychiatrists use depot antipsychotics in a conservative way, although they attribute positive traits to the method. Patients' negative attitudes might relate to the low level of information. To enhance the use of depot antipsychotics, information practices of psychiatrists should be improved. Patients should be informed about different forms of treatment during early stages of the illness.
Collapse
Affiliation(s)
- Matthias Jaeger
- Department of General and Social Psychiatry, Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | | |
Collapse
|
20
|
Skinner TC, Carey ME, Cradock S, Dallosso HM, Daly H, Davies MJ, Doherty Y, Heller S, Khunti K, Oliver L. 'Educator talk' and patient change: some insights from the DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) randomized controlled trial. Diabet Med 2008; 25:1117-20. [PMID: 19183318 DOI: 10.1111/j.1464-5491.2008.02492.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To determine whether differences in the amount of time educators talk during a self-management education programme relate to the degree of change in participants' reported beliefs about diabetes. METHOD Educators trained to be facilitative and non-didactic in their approach were observed delivering the DESMOND self-management programme for individuals newly diagnosed with Type 2 diabetes. Observers used 10-s event coding to estimate the amount of time educators spoke during different sessions in the programme. Facilitative as opposed to didactic delivery was indicated by targets for levels of educator talk set for each session. Targets were based on earlier pilot work. Using the revised Illness Perceptions Questionnaire (IPQ-R) and the Diabetes Illness Representations Questionnaire (DIRQ), participants completed measures of: perceived duration of diabetes (timeline IPQ-R), understanding of diabetes (coherence IPQ-R), personal responsibility for influencing diabetes (personal responsibility IPQ-R), seriousness of diabetes (seriousness DIRQ) and impact on daily life (impact DIRQ), before and after the education programme. RESULTS Where data from the event coding indicated educators were talking less and meeting targets for being less didactic, a greater change in reported illness beliefs of participants was seen. However, educators struggled to meet targets for most sessions of the programme. CONCLUSION The amount of time educators talk in a self-management programme may provide a practical marker for the effectiveness of the education process, with less educator talk denoting a more facilitative/less didactic approach. This finding has informed subsequent improvements to a comprehensive quality development framework, acknowledging that educators need ongoing support to facilitate change to their normal educational style.
Collapse
Affiliation(s)
- T C Skinner
- School of Psychology, University of Western Australia, Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|