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McKay CD, Gubhaju L, Gibberd AJ, McNamara BJ, Banks E, Azzopardi P, Williams R, Eades S. Cardiometabolic health markers among Aboriginal adolescents from the Next Generation Youth Wellbeing Cohort Study. Aust N Z J Public Health 2024; 48:100139. [PMID: 38447271 DOI: 10.1016/j.anzjph.2024.100139] [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: 04/25/2023] [Revised: 11/28/2023] [Accepted: 02/11/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE The objective of this study was to investigate cardiometabolic health markers among Aboriginal adolescents aged 10-24 years and relationships with age, gender, and body composition. METHODS Baseline data (2018-2020) from the Next Generation Youth Wellbeing Cohort Study (Western Australia, New South Wales, and Central Australia) on clinically assessed body mass index, waist/height ratio, blood pressure, glycated haemoglobin (HbA1c), total and high-density lipoprotein cholesterol, total/high-density lipoprotein cholesterol ratio, and triglycerides were analysed. RESULTS Among 1100 participants, the proportion with individual health markers within the ideal range ranged from 59% for total cholesterol to 91% for HbA1c. Four percent had high blood pressure, which was more common with increasing age and among males; 1% had HbA1c indicative of diabetes. Healthier body composition (body mass index and waist/height ratio) was associated with having individual health markers in the ideal range and with an ideal cardiometabolic profile. CONCLUSIONS Most Aboriginal adolescents in this study had cardiometabolic markers within the ideal range, though markers of high risk were present from early adolescence. Ideal health markers were more prevalent among those with healthy body composition. IMPLICATIONS FOR PUBLIC HEALTH Specific screening and management guidelines for Aboriginal adolescents and population health initiatives that support maintenance of healthy body composition could help improve cardiometabolic health in this population.
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Affiliation(s)
- Christopher D McKay
- Melbourne School of Population and Global Health, The University of Melbourne, Australia.
| | - Lina Gubhaju
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Alison J Gibberd
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Bridgette J McNamara
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Emily Banks
- Centre for Public Health Data and Policy, National Centre for Epidemiology and Population Health, College of Health & Medicine, Australian National University, Australia
| | - Peter Azzopardi
- Murdoch Children's Research Institute, Australia; Telethon Kids Institute, Australia
| | | | - Sandra Eades
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
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Holloway D, James S, Ekinci E, Craft J. Systematic review of the effectiveness of nurse-led care in reducing glycated haemoglobin in adults with Type 1 or 2 diabetes. Int J Nurs Pract 2023; 29:e13135. [PMID: 36733216 DOI: 10.1111/ijn.13135] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Type 1 and 2 diabetes care, especially within primary health-care settings, has traditionally involved doctor-led clinics. However, with increasing chronic disease burden, there is scope for nurses to expand their role in assisting diabetes self-management. AIMS This study aimed to determine the effectiveness of nurse-led care in reducing glycated haemoglobin in adults with Type 1 or 2 diabetes. METHODS Methodology from the Joanna Briggs Institute Method for Systematic Review Research and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, including identifying publications, assessing study quality, summarizing evidence and interpreting findings. The search strategy involved using the Medical Subject Headings and keyword variations when searching MEDLINE (Ovid), Scopus, PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Inclusion criteria were samples with Type 1 or 2 diabetes, mean age of ≥18 years, English language studies and publication date of January 2011-December 2021. RESULTS Overall, 34 articles from 16 countries met inclusion criteria. Though not always clinically significant, results indicated that nurse-led care had beneficial impacts on glycated haemoglobin values, with reductions from 0.03% to 2.0%. This was evident when nurses received formal training, used treatment algorithms, had limited medical support, utilized technology and offered defined culturally sensitive and appropriate diabetes care. CONCLUSIONS Findings support nurse-led Type 1 and 2 diabetes care. Although further research is required, changes may necessitate increased recognition of nurse-led care and funding. Nurse-led care models should differ according to health-care settings.
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Affiliation(s)
- Danielle Holloway
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Steven James
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Petrie, Queensland, Australia
| | - Elif Ekinci
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Judy Craft
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
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Shubrook JH, Patel M, Young CF. Community-Based Diabetes Awareness Strategy With Detection and Intervention: The Mobile Diabetes Education Center. Clin Diabetes 2023; 42:125-134. [PMID: 38230347 PMCID: PMC10788663 DOI: 10.2337/cd23-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
To prevent diabetes and increase equitable access to health care screenings, Touro University California has created and implemented a community outreach program called the Mobile Diabetes Education Center (MOBEC). This program is a joint effort that also involves Sutter Health, the California Department of Public Health, Kaiser Permanente, the Solano County Department of Public Health, and community-based organizations, focusing on advancing health equity in Solano County's at-risk populations. This article reports on the services and initial successes of MOBEC. With its strong community collaboration, MOBEC has helped to raise awareness of diabetes and ensure access to much-needed health screenings and education. This model can potentially be used as a blueprint for similar efforts nationwide to address the health care needs of medically underserved communities.
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Affiliation(s)
- Jay H. Shubrook
- Touro University California College of Osteopathic Medicine, Vallejo, CA
| | - Megha Patel
- Touro University California College of Osteopathic Medicine, Vallejo, CA
| | - Clipper F. Young
- Touro University California College of Osteopathic Medicine, Vallejo, CA
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Tenorio-Mucha J, Busta-Flores P, Lazo-Porras M, Vetter B, Safary E, Moran AE, Gupta R, Bernabé-Ortiz A. Facilitators and barriers of the implementation of point-of-care devices for cardiometabolic diseases: a scoping review. BMC Health Serv Res 2023; 23:412. [PMID: 37118750 PMCID: PMC10144879 DOI: 10.1186/s12913-023-09419-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Point-of-care testing (POCT) devices may facilitate the delivery of rapid and timely results, providing a clinically important advantage in patient management. The challenges and constraints in the implementation process, considering different levels of actors have not been much explored. This scoping review aimed to assess literature pertaining to implementation facilitators and barriers of POCT devices for the diagnosis or monitoring of cardiometabolic diseases. METHODS A scoping review of the literature was conducted. The inclusion criteria were studies on the inception, planning, or implementation of interventions with POCT devices for the diagnosis or monitoring of cardiometabolic diseases defined as dyslipidemia, cardiovascular diseases, type 2 diabetes, and chronic kidney disease. We searched MEDLINE, Embase, and Global Health databases using the OVID searching engine until May 2022. The Consolidated Framework of Implementation Research (CFIR) was used to classify implementation barriers and facilitators in five constructs. Also, patient, healthcare professional (HCP), and organization level was used. RESULTS Twenty studies met the eligibility criteria for data extraction. All studies except two were conducted in high-income countries. Some findings are: 1) Intervention: the most widely recognized facilitator was the quick turnaround time with which results are obtained. 2) Outer setting: at the organizational level, the lack of clear regulatory and accreditation mechanisms has hindered the adoption and sustainability of the use of POCT. 3) Inner setting: for HCP, performing POCT during the consultation was both a facilitator and a barrier in terms of time, personnel, and service delivery. 4) Individuals: the implementation of POCT may generate stress and discomfort in some HCP in terms of training and new responsibilities. 5) Process: for patients, it is highly appreciated that obtaining the sample was simple and more comfortable if venipuncture was not used. CONCLUSION This scoping review has described the facilitators and barriers of implementing a POCT device for cardiometabolic conditions using the CFIR. The information can be used to design better strategies to implement these devices and benefit more populations that have low access to cardiometabolic tests.
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Affiliation(s)
- Janeth Tenorio-Mucha
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445 - Miraflores, Lima, Peru
| | - Patricia Busta-Flores
- CONEVID - Unidad de Conocimiento y Evidencia, Facultad de Medicina "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Lazo-Porras
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445 - Miraflores, Lima, Peru
| | | | | | | | - Reena Gupta
- Resolve to Save Lives, New York, NY, USA
- Department of Medicine of Medicine, University of California, San Francisco, USA
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445 - Miraflores, Lima, Peru.
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Jamieson EL, Dimeski G, Flatman R, Hickman PE, Ross Dallas Jones G, V Marley J, David McIntyre H, McNeil AR, Nolan CJ, Potter JM, Sweeting A, Ward P, Williams P, Rita Horvath A. Oral glucose tolerance test to diagnose gestational diabetes mellitus: Impact of variations in specimen handling. Clin Biochem 2022; 115:33-48. [PMID: 36244469 DOI: 10.1016/j.clinbiochem.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/10/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2022]
Abstract
To improve birth outcomes, all pregnant women without known diabetes are recommended for an oral glucose tolerance test (OGTT) to screen for hyperglycaemia in pregnancy (diabetes in pregnancy or gestational diabetes mellitus (GDM)). This narrative review presents contemporary approaches to minimise preanalytical glycolysis in OGTT samples with a focus on GDM diagnosis using criteria derived from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. The challenges of implementing each approach across a diverse Australian healthcare setting were explored. Many Australian sites currently collect and transport OGTT samples at ambient temperature in sodium fluoride (NaF) tubes which is likely to lead to missed diagnosis of GDM in a significant proportion of cases. Alternative preanalytical solutions should be pragmatic and tailored to individual settings and as close as possible to the preanalytical conditions of the HAPO study for correct interpretation of OGTT results. Rapid centrifugation of barrier tubes to separate plasma could be suitable in urban settings provided time to centrifugation is strictly controlled. Tubes containing NaF and citrate could be useful for remote or resource poor settings with long delays to analysis but the impact on the interpretation of OGTT results should be carefully considered. Testing venous blood glucose at the point-of-care bypasses the need for glycolytic inhibition but requires careful selection of devices with robust analytical performance. Studies to evaluate the potential error of each solution compared to the HAPO protocol are required to assess the magnitude of misdiagnosis and inform clinicians regarding the potential impact on patient safety and healthcare costs.
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Khadanga S, Singh G, Pakhare AP, Joshi R. Diagnostic Accuracy of Point-of-Care Tests Measuring Glycosylated Haemoglobin (HbA1c) for Glycemic Control: A Field Study in India. Cureus 2021; 13:e17920. [PMID: 34660113 PMCID: PMC8513731 DOI: 10.7759/cureus.17920] [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] [Accepted: 09/12/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives This study was performed to estimate diagnostic accuracy of the two commercially available point-of-care tests to identify poor glycemic control defined by HbA1c levels, with high-performance liquid chromatography (HPLC) as a reference. Settings The study was carried at two locations, general medical outpatient department of a teaching medical college in Bhopal (urban), and a primary health care centre in a rural area in the state of Madhya Pradesh, India. Participants All individuals with diabetes mellitus who presented to the health care facility for assessment of glycemic control. We compared HbA1c estimated from two index tests (Hemocue Hb 501, Sweden; SD Biosensor, South Korea) from capillary blood samples with HPLC performed from venous blood, as a reference standard. Primary and secondary outcome measures Diagnostic properties of index tests such as sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for identifying poor glycemic control were primary outcome measures. Lin’s concordance correlation coefficient (CCC) was secondary outcome measure. Results Out of 114 patients, all received reference standard - 103 patients received Hemocue A1C test and 110 patients received SD Biosensor test. Overall both the index tests had similar diagnostic accuracy estimates. The area under the Receiver Operating Curve for SDA1c device was 0.935 (95% CI 0.886-0.983), and for Hemocue device was 0.938 (95% CI 0.893-0.984). The Hemocue device HbA1c value of above 7.0 (positive) correctly predicted poor glycemic control 92% times (81.58% for SD device). There were 4 vs. 11 device failures and 14 vs. 12 failures with SD and Hemocue, respectively. Ambient air temperatures were no different for the device test failures. Conclusions Commercially available point-of-care tests evaluated in this study are comparable and an acceptable alternative to HPLC-based measurements for the assessment of glycemic control. Tests and device failure rates of both the index tests are similar.
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Affiliation(s)
- Sagar Khadanga
- Internal Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Gyanendra Singh
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Abhijit P Pakhare
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Rajnish Joshi
- Internal Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Walicka M, Jozwiak J, Rzeszotarski J, Zonenberg A, Masierek M, Bijos P, Franek E. Diagnostic Accuracy of Glycated Haemoglobin and Average Glucose Values in Type 2 Diabetes Mellitus Treated with Premixed Insulin. Diabetes Ther 2019; 10:587-596. [PMID: 30734901 PMCID: PMC6437248 DOI: 10.1007/s13300-019-0570-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Studies assessing the relationship between glycated haemoglobin (HbA1c) and average blood glucose (ABG) were conducted in small groups of patients on different treatments and may be biased for these reasons. The aim of the study was to assess the relationship between HbA1c and ABG in a large group of type 2 diabetes patients treated with premix insulin. METHODS In 4257 patients treated with premixed insulin, the parallel point-of-care assessment of HbA1c and ABG from the preceding 90 days (ABG90), calculated automatically from all values measured by the glucometer, was performed twice. The regression formulas and respective values of HbA1c and ABG90 were calculated. RESULTS The mean number of recorded glucose values/patient was 2.37 estimations per day. The regression formula calculated using data from the first assessment was HbA1c = 5.28 + 0.01487 × ABG90 and that using data from the second one was HbA1c = 4.78 + 0.01683 × ABG90. The slopes of the regression lines are lower than that in a similar analysis from the A1c-Derived Average Glucose (ADAG) study. The comparison of ADAG formula and the formula derived from the present study shows that both formulas give similar results at low HbA1c values, but differ at higher HbA1c values. Additionally, the 95% confidence interval is broader in the PROGENS study e.g. a 95% probability of certainty that the actual HbA1c value was greater than 7.0% (53 mmol/mol) was achieved only at an ABG90 value of 220 mg/dL. CONCLUSION The relationship between HbA1c and ABG estimations may be different in various patients; therefore, it seems that the use of one equation in all populations may not be reliable. Broad assessment of ABG as a tool that may replace HbA1c measurements should be recommended only with caution, providing the possible limitations and confidence intervals. FUNDING Bioton S.A.
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Affiliation(s)
- Magdalena Walicka
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Inferior and Administration, Warsaw, Poland
| | - Jacek Jozwiak
- Department of Public Health, Czestochowa University of Technology, Czestochowa, Poland
- Silesian Analytical Laboratories, Katowice, Poland
| | - Jacek Rzeszotarski
- Clinical Department of Internal Diseases and Diabetology, 10th Military Hospital, Bydgoszcz, Poland
| | - Anna Zonenberg
- Medical Institute, Higher School of Computer Science and Business Administration, Lomza, Poland
| | | | | | - Edward Franek
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Inferior and Administration, Warsaw, Poland.
- Department of Human Epigenetics, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland.
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Crowshoe L, Dannenbaum D, Green M, Henderson R, Hayward MN, Toth E. Type 2 Diabetes and Indigenous Peoples. Can J Diabetes 2018; 42 Suppl 1:S296-S306. [DOI: 10.1016/j.jcjd.2017.10.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/16/2022]
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Culliney K, McCowan LM, Okesene‐Gafa K, Murphy R, Rowan J, Taylor RS, Mckinlay CJ. Accuracy of point‐of‐care HbA1c testing in pregnant women. Aust N Z J Obstet Gynaecol 2018; 58:643-647. [DOI: 10.1111/ajo.12786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/17/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Katherine Culliney
- Department of Obstetrics and GynaecologyUniversity of Auckland Auckland New Zealand
- Counties Manukau Health Auckland New Zealand
| | - Lesley M.E. McCowan
- Department of Obstetrics and GynaecologyUniversity of Auckland Auckland New Zealand
- Counties Manukau Health Auckland New Zealand
| | - Karaponi Okesene‐Gafa
- Department of Obstetrics and GynaecologyUniversity of Auckland Auckland New Zealand
- Counties Manukau Health Auckland New Zealand
| | - Rinki Murphy
- Department of MedicineUniversity of Auckland Auckland New Zealand
- Auckland District Health Board Auckland New Zealand
| | - Janet Rowan
- Auckland District Health Board Auckland New Zealand
| | - Rennae S. Taylor
- Department of Obstetrics and GynaecologyUniversity of Auckland Auckland New Zealand
| | - Christopher J.D. Mckinlay
- Counties Manukau Health Auckland New Zealand
- Liggins InstituteUniversity of AucklandAucklandNew Zealand
- Department of Paediatrics: Child Youth HealthUniversity of Auckland Auckland New Zealand
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Hirst JA, McLellan JH, Price CP, English E, Feakins BG, Stevens RJ, Farmer AJ. Performance of point-of-care HbA1c test devices: implications for use in clinical practice - a systematic review and meta-analysis. Clin Chem Lab Med 2017; 55:167-180. [PMID: 27658148 DOI: 10.1515/cclm-2016-0303] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/19/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Point-of-care (POC) devices could be used to measure hemoglobin A1c (HbA1c) in the doctors' office, allowing immediate feedback of results to patients. Reports have raised concerns about the analytical performance of some of these devices. We carried out a systematic review and meta-analysis using a novel approach to compare the accuracy and precision of POC HbA1c devices. METHODS Medline, Embase and Web of Science databases were searched in June 2015 for published reports comparing POC HbA1c devices with laboratory methods. Two reviewers screened articles and extracted data on bias, precision and diagnostic accuracy. Mean bias and variability between the POC and laboratory test were combined in a meta-analysis. Study quality was assessed using the QUADAS2 tool. RESULTS Two researchers independently reviewed 1739 records for eligibility. Sixty-one studies were included in the meta-analysis of mean bias. Devices evaluated were A1cgear, A1cNow, Afinion, B-analyst, Clover, Cobas b101, DCA 2000/Vantage, HemoCue, Innovastar, Nycocard, Quo-Lab, Quo-Test and SDA1cCare. Nine devices had a negative mean bias which was significant for three devices. There was substantial variability in bias within devices. There was no difference in bias between clinical or laboratory operators in two devices. CONCLUSIONS This is the first meta-analysis to directly compare performance of POC HbA1c devices. Use of a device with a mean negative bias compared to a laboratory method may lead to higher levels of glycemia and a lower risk of hypoglycaemia. The implications of this on clinical decision-making and patient outcomes now need to be tested in a randomized trial.
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Diabetes Spatial Care Paths, Leading Edge HbA1c Testing, Facilitation Thresholds, Proactive-Preemptive Strategic Intelligence, and Unmanned Aerial Vehicles in Limited-Resource Countries. ACTA ACUST UNITED AC 2017. [DOI: 10.1097/poc.0000000000000122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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What’s New in Point-of-Care Testing? POINT OF CARE 2016. [DOI: 10.1097/poc.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nguyen HD, Chitturi S, Maple-Brown LJ. Management of diabetes in Indigenous communities: lessons from the Australian Aboriginal population. Intern Med J 2016; 46:1252-1259. [DOI: 10.1111/imj.13123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 03/08/2016] [Accepted: 04/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
- H. D. Nguyen
- Department of Endocrinology, Division of Medicine; Royal Darwin Hospital; Tiwi Northern Territory Australia
| | - S. Chitturi
- Department of Endocrinology, Division of Medicine; Royal Darwin Hospital; Tiwi Northern Territory Australia
| | - L. J. Maple-Brown
- Department of Endocrinology, Division of Medicine; Royal Darwin Hospital; Tiwi Northern Territory Australia
- Menzies School of Health Research; Charles Darwin University; Casuarina Northern Territory Australia
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Gruson D, Ko G. Laboratory medicine and mobile health technologies at crossroads: Perspectives for the management of chronic diseases. Crit Rev Clin Lab Sci 2016; 53:352-7. [PMID: 26983900 DOI: 10.3109/10408363.2016.1167163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Management of chronic diseases represents a leading health and economic issue worldwide. Biomarkers are critical for the diagnosis and management of both communicable and non-communicable chronic diseases, and mobile health (mHealth) technologies are about to change the "game" with regard to the management of patients with such chronic diseases. The development of efficient, accurate and interactive solutions that integrate biomarkers and mHealth opens new perspectives for caregivers for the management of chronic illness.
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Affiliation(s)
- Damien Gruson
- a Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain , Brussels , Belgium .,b Department of Laboratory Medicine , Cliniques Universitaires St-Luc and Université Catholique de Louvain , Brussels , Belgium , and
| | - Gabriel Ko
- c GKo and Co Consulting , Paris , France
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Gomez-Peralta F, Abreu C, Andreu-Urioste L, Antolí AC, Rico-Fontsaré C, Martín-Fernández D, Resina-Rufes R, Pérez-García JJ, Negrete-Muñoz Á, Muñoz-Álvarez D, Umpierrez GE. Point-of-care capillary HbA1c measurement in the emergency department: a useful tool to detect unrecognized and uncontrolled diabetes. Int J Emerg Med 2016; 9:7. [PMID: 26894895 PMCID: PMC4760960 DOI: 10.1186/s12245-016-0107-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/11/2016] [Indexed: 11/13/2022] Open
Abstract
Background Inpatient hyperglycaemia and diabetes mellitus (DM) are common and are associated with an increased risk of complications and mortality. The severity of hyperglycaemia determines the rate of complications in patients treated in the emergency department (ED). Our aim was to examine whether determination of the capillary haemoglobin A1c (HbA1c) is a reliable method for detecting unknown diabetes and poor glycaemic control in the ED. Methods A prospective observational study was conducted in adult (>18 years) patients treated in a single-centre ED. We compared the results of HbA1c levels measured by Bio-Rad in2it point-of-care device on a capillary blood sample and by the hospital laboratory. Results A total of 187 ED patients with an average age of 57.1 ± 19.2 years were studied. The mean HbA1c value was 5.78 ± 1.26 % by capillary POC testing and 6.10 ± 1.12 % by the hospital laboratory (correlation = 0.712, P < 0.001). A total of 17.1 % of cases had a prior diagnosis of DM. The diagnosis of DM (plasma glucose > 126 mg/dL and/or HbA1c > 6.5 %) was made in ten (5.4 %) additional cases (prior undiagnosed DM) for a total prior DM prevalence of 22.5 % (95 % CI 16.4–28.5 %). Capillary HbA1c detected 11 additional cases of unknown DM (5.9 %). A capillary HbA1c value greater than 6 % has a sensitivity of 85.7 % and specificity of 85.3 % for the screening of DM. Conclusions Determination of the capillary HbA1c in the ED is a reliable, fast, and simple system for the screening of unknown or uncontrolled DM.
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Affiliation(s)
- Fernando Gomez-Peralta
- Endocrinology and Nutrition Unit, Hospital General de Segovia, c/ Miguel Servet S.N., 40003, Segovia, Spain.
| | - Cristina Abreu
- Endocrinology and Nutrition Unit, Hospital General de Segovia, c/ Miguel Servet S.N., 40003, Segovia, Spain.
| | - Leonor Andreu-Urioste
- Department of Internal Medicine, Hospital Nuestra Señora de Sonsoles, C/ Avda. Juan Carlos I, s/n, 05004, Ávila, Spain.
| | - Ana Cristina Antolí
- Department of Internal Medicine, Hospital Nuestra Señora de Sonsoles, C/ Avda. Juan Carlos I, s/n, 05004, Ávila, Spain.
| | - Carmen Rico-Fontsaré
- Emergency Department, Hospital Nuestra Señora de Sonsoles, C/ Avda. Juan Carlos I, s/n, 05004, Ávila, Spain.
| | - David Martín-Fernández
- Emergency Department, Hospital Nuestra Señora de Sonsoles, C/ Avda. Juan Carlos I, s/n, 05004, Ávila, Spain.
| | - Rosa Resina-Rufes
- Emergency Department, Hospital Nuestra Señora de Sonsoles, C/ Avda. Juan Carlos I, s/n, 05004, Ávila, Spain.
| | - Juan Jesús Pérez-García
- Emergency Department, Hospital Nuestra Señora de Sonsoles, C/ Avda. Juan Carlos I, s/n, 05004, Ávila, Spain.
| | - Ángela Negrete-Muñoz
- Emergency Department, Hospital Nuestra Señora de Sonsoles, C/ Avda. Juan Carlos I, s/n, 05004, Ávila, Spain.
| | - Daniel Muñoz-Álvarez
- Emergency Department, Hospital Nuestra Señora de Sonsoles, C/ Avda. Juan Carlos I, s/n, 05004, Ávila, Spain.
| | - Guillermo E Umpierrez
- General Clinical Research Center, Emory University, 49 Jesse Hill Jr. Dr., Atlanta, GA, 30303, USA.
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16
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Arnold LW, Hoy WE, Sharma SK, Wang Z. The Association between HbA1c and Cardiovascular Disease Markers in a Remote Indigenous Australian Community with and without Diagnosed Diabetes. J Diabetes Res 2016; 2016:5342304. [PMID: 26989697 PMCID: PMC4773550 DOI: 10.1155/2016/5342304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/19/2016] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES This study investigates the burden of cardiovascular risk markers in people with and without diabetes in a remote Indigenous Australian community, based on their HbA1c concentration. METHODS This study included health screening exams of 1187 remote Indigenous residents over 15 years old who represented 70% of the age-eligible community. The participants were stratified by HbA1c into 5 groups using cut-off points recommended by international organisations. The associations of traditional cardiovascular risk markers with HbA1c groups were assessed using logistic and linear regressions and ANOVA models. RESULTS Of the 1187 participants, 158 (13%) had a previous diabetes diagnosis, up to 568 (48%) were at high risk (5.7-6.4% (39-46 mmol/mol) HbA1c), and 67 (6%) potential new cases of diabetes (≥6.5% (48 mmol/mol)) were identified. Individuals with higher HbA1c levels were more likely to have albuminuria (OR 3.14, 95% CI 1.26-7.82) and dyslipidaemia (OR 2.37, 95% CI 1.29-4.34) and visited the clinic more often (OR 2.52, 95% CI 1.26-4.99). Almost all traditional CVD risk factors showed a positive association with HbA1c. CONCLUSIONS Screening in this remote Indigenous Australian community highlights the high proportion of individuals who are at high risk of diabetes as indicated by HbA1c and who also had an accentuated cardiovascular risk profile.
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Affiliation(s)
- Luke W. Arnold
- Centre for Chronic Disease, The University of Queensland School of Medicine, Royal Brisbane & Women's Hospital, Health Sciences Building Level 8, Herston, QLD 4029, Australia
- *Luke W. Arnold:
| | - Wendy E. Hoy
- Centre for Chronic Disease, The University of Queensland School of Medicine, Royal Brisbane & Women's Hospital, Health Sciences Building Level 8, Herston, QLD 4029, Australia
| | - Suresh K. Sharma
- Division of Medicine, Royal Darwin Hospital, Top End Health Network, Northern Territory Government, Tiwi, NT 0810, Australia
| | - Zhiqiang Wang
- Centre for Chronic Disease, The University of Queensland School of Medicine, Royal Brisbane & Women's Hospital, Health Sciences Building Level 8, Herston, QLD 4029, Australia
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17
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Kumar S, Shewade HD, Vasudevan K, Durairaju K, Santhi VS, Sunderamurthy B, Krishnakumari V, Panigrahi KC. Effect of mobile reminders on screening yield during opportunistic screening for type 2 diabetes mellitus in a primary health care setting: A randomized trial. Prev Med Rep 2015; 2:640-4. [PMID: 26844130 PMCID: PMC4721301 DOI: 10.1016/j.pmedr.2015.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective. We wanted to study whether mobile reminders increased follow-up for definitive tests resulting in higher screening yield during opportunistic screening for diabetes. Methods. This was a facility-based parallel randomized controlled trial during routine outpatient department hours in a primary health care setting in Puducherry, India (2014). We offered random blood glucose testing to non-pregnant non-diabetes adults with age >30 years (667 total, 390 consented); eligible outpatients (random blood glucose ≥ 6.1 mmol/l, n = 268) were requested to follow-up for definitive tests (fasting and postprandial blood glucose). Eligible outpatients either received (intervention arm, n = 133) or did not receive mobile reminder (control arm, n = 135) to follow-up for definitive tests. We measured capillary blood glucose using a glucometer to make epidemiological diagnosis of diabetes. The trial was registered with Clinical Trial Registry of India (CTRI/2014/10/005138). Results. 85.7% of outpatients in intervention arm returned for definitive test when compared to 53.3% in control arm [Relative Risk = 1.61, (0.95 Confidence Interval — 1.35, 1.91)]. Screening yield in intervention and control arm was 18.6% and 10.2% respectively. Etiologic fraction was 45.2% and number needed to screen was 11.9. Conclusion. In countries like India, which is emerging as the diabetes capital of the world, considering the wide prevalent use of mobile phones, and real life resource limited settings in which this study was carried out, mobile reminders during opportunistic screening in primary health care setting improve screening yield of diabetes. First RCT to determine the effect of mobile reminders on screening yield for diabetes mellitus. Operational research conducted in real world primary health care setting. Outpatients with random blood glucose ≥ 6.1 mmol/l among adults >30y were eligible for definitive tests. Mobile reminders for eligible outpatients was introduced as a reminder system.
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Key Words
- CI, confidence interval
- CTRI, Clinical Trial Registry of India
- Diabetes mellitus, type 2
- FBG, fasting blood glucose
- HbA1C, glycosylated hemoglobin
- India
- Loss to follow-up
- NNS, number needed to screen
- NPCDCS, National Programme for Prevention and Control of Diabetes, Cardiovascular diseases and Stroke
- OPD, Out Patient Department
- Operational research
- Opportunistic screening
- Outpatients
- PHC, Primary Health Centre
- PPBG, postprandial blood glucose
- Primary Health Centre
- Primary health care
- RBG, random blood glucose
- RCT, randomized controlled trial
- Randomized controlled trial
- Reminder system
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Affiliation(s)
- Sathish Kumar
- Indira Gandhi Medical College and Research Institute (IGMCRI), Puducherry, India
| | | | - Kavita Vasudevan
- Indira Gandhi Medical College and Research Institute (IGMCRI), Puducherry, India
| | - Kathamuthu Durairaju
- Primary Health Centre, Lawspet, Department of Health and Family Welfare, Puducherry, India
| | - V S Santhi
- Primary Health Centre, Lawspet, Department of Health and Family Welfare, Puducherry, India
| | | | - Velavane Krishnakumari
- Primary Health Centre, Lawspet, Department of Health and Family Welfare, Puducherry, India
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18
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Marley JV, Oh MS, Hadgraft NT, Singleton SL, Isaacs K, Atkinson DN. Using glycated haemoglobin testing to simplify diabetes screening in remote Aboriginal Australian health care settings. Med J Aust 2015; 203:28-32. [DOI: 10.5694/mja14.01575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/21/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Julia V Marley
- Rural Clinical School of Australia, University of Western Australia, Broome, WA
- Kimberley Aboriginal Medical Services, Broome, WA
| | - May Sian Oh
- Kimberley Aboriginal Medical Services, Broome, WA
| | | | | | - Kim Isaacs
- Kimberley Aboriginal Medical Services, Broome, WA
| | - David N Atkinson
- Rural Clinical School of Australia, University of Western Australia, Broome, WA
- Kimberley Aboriginal Medical Services, Broome, WA
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