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Fukuda T, Aoki Y, Kiyohara H, Yokoyama A, Nakazawa A, Yoshimatsu Y, Sugimoto S, Nanki K, Mikami Y, Fukuhara K, Mizuno S, Sujino T, Mutaguchi M, Takabayashi K, Morohoshi Y, Hosoda Y, Ogata H, Iwao Y, Naganuma M, Kanai T. Efficacy of Dose Escalation of Oral 5-Aminosalicylic Acid for Ulcerative Colitis With a Mayo Endoscopic Subscore of 1: An Open Label Randomized Controlled Trial. Inflamm Bowel Dis 2024:izae088. [PMID: 38655866 DOI: 10.1093/ibd/izae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Indexed: 04/26/2024]
Abstract
BACKGROUND Endoscopic healing is generally defined as Mayo endoscopic subscore (MES) ≤1 in ulcerative colitis (UC). However, patients with an MES of 1 are at higher relapse risk than those with an MES of 0. This study evaluated the therapeutic efficacy of proactive dose escalation of oral 5-aminosalicylic acid (5-ASA) in UC patients with an MES of 1. METHODS An open-label, randomized controlled trial was conducted in 5 hospitals between 2018 and 2022. Ulcerative colitis patients in clinical remission under oral 5-ASA therapy and diagnosed as having an MES of 1 were enrolled. Patients receiving maintenance therapy other than 5-ASA and immunomodulator were excluded. Patients were randomly assigned in a 1:1 ratio to receive either a dose-escalated (intervention) or constant dose (control) of 5-ASA. Concomitant immunomodulator was used as the stratification factor in the randomization. The primary end point was relapse within 1 year. The subgroup analysis was stratified for the use of immunomodulators. RESULTS The full analysis set included 79 patients (39 intervention and 40 control). Immunomodulators were used in 20 (25.3%) patients. Relapse was less in the intervention group (15.4%) than the control group (37.5%; P = .026). In the subgroup with concomitant immunomodulators, relapse was also less in the intervention group (10.0%) than the control group (70.0%; P = .020). In patients without immunomodulators, the difference was not significant between 2 groups (intervention, 17.2%; control, 26.7%; P = .53). CONCLUSIONS Dose escalation of 5-ASA reduced relapse within 1 year in UC patients in clinical remission with an MES of 1.
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Affiliation(s)
- Tomohiro Fukuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Gastroenterology, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan
| | - Yasuhiro Aoki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroki Kiyohara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Ayumi Yokoyama
- Department of Gastroenterology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Atsushi Nakazawa
- Department of Gastroenterology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Yusuke Yoshimatsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shinya Sugimoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kosaku Nanki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yohei Mikami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kayoko Fukuhara
- Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinta Mizuno
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomohisa Sujino
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Mutaguchi
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Yuichi Morohoshi
- Department of Gastroenterology, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan
| | - Yasuo Hosoda
- Department of Gastroenterology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Iwao
- Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Coppola A, Chuquitaype M, Guglielmo S, Pujia R, Ferrulli A, Falcone C, Maurotti S, Montalcini T, Luzi L, Gazzaruso C. Therapeutic patient education and treatment intensification of diabetes and hypertension in subjects with newly diagnosed type 2 diabetes mellitus: a longitudinal study. Endocrine 2024:10.1007/s12020-024-03839-8. [PMID: 38656749 DOI: 10.1007/s12020-024-03839-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE The aim of this study is to prospectively evaluate whether individual and group Therapeutic Patient Education (TPE) can reduce the need to intensify treatment of diabetes and hypertension in newly diagnosed type 2 diabetic patients. METHODS A total of 937 patients were recruited and followed-up for 42.7 ± 21.5 months. TPE was a structured comprehensive education delivered by trained nurses: 322 patients received individual TPE (ITPE), 291 underwent group TPE (GTPE), and 324 were in Usual Care (UC). The primary endpoints were intensification of diabetes treatment and intensification of hypertension treatment. RESULTS The rate of diabetes treatment intensification was 40.1% in patients receiving ITPE, 47.8% in patients undergoing GTPE, and 64.2% in patients in UC (p < 0.001). The rate of hypertension treatment intensification was 24.2% in patients following ITPE, 31.3% in patients receiving GTPE, and 41.0% in patients in UC (p < 0.001). Multivariate analysis showed that both ITPE and GTPE were associated with reduced intensification of diabetes (ITPE: HR:0.51; 95% IC:0.40-0.64; p < 0.001 - GTPE: HR:0.46; 95% IC:0.44-0.70; p < 0.001) and hypertension medication (ITPE: HR:0.45; 95% IC:0.34-0.61; p < 0.001 - GTPE: HR:0.49; 95% IC:0.38-0.65; p < 0.001). The association was independent of age, sex, BMI, HbA1c, and presence of hypertension at baseline. CONCLUSIONS TPE, delivered as both individual and group sessions, represents an effective tool to reduce the need to intensify treatment of both diabetes and hypertension. Therefore, it can ensure better control of diabetes and hypertension with fewer medications. This could reduce adverse effects and costs and improve quality of life and medication taking in patients with type 2 diabetes.
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Affiliation(s)
- Adriana Coppola
- Diabetes and endocrine-metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy.
| | - Maritza Chuquitaype
- Diabetes and endocrine-metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy
| | - Selene Guglielmo
- Diabetes and endocrine-metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy
| | - Roberta Pujia
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Anna Ferrulli
- Department of Endocrinology, IRCCS Multimedica, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Colomba Falcone
- CIRMC, University of Pavia, Pavia, Italy
- Cardiology Unit, Istituto di Cura Città di Pavia, Gruppo Ospedaliero San Donato, Pavia, Italy
| | - Samantha Maurotti
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Tiziana Montalcini
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Livio Luzi
- Department of Endocrinology, IRCCS Multimedica, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Carmine Gazzaruso
- Diabetes and endocrine-metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Bogannam AR, McNicol E, DeLeonardo K, Ranade A, Zaiken K. Impact of American Diabetes Association 2022 Guidelines on Prescribing Rates of Sodium-Glucose Cotransporter-2 Inhibitors in Ambulatory Care Organization Patients With Type 2 Diabetes. J Pharm Pract 2024:8971900241247658. [PMID: 38647229 DOI: 10.1177/08971900241247658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Background: Recent clinical trials and guideline updates have highlighted the efficacy and safety of sodium-glucose cotransporter-2 inhibitor (SGLT2i) use in patients with type 2 diabetes (T2D) and comorbidities including atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), or heart failure (HF). Objective: This study assesses the rates of guideline-based prescribing of SGLT2i in patients with T2D and one or more of the following comorbidities: ASCVD, CKD, or HF, prior to and after the 2022 American Diabetes Association (ADA) guideline publication within the Atrius Health clinical pharmacy, internal medicine, and specialty medicine departments. Methods: This is a retrospective chart review of data from the electronic medical record. Patients with the aforementioned criteria were included if they were managed by either the clinical pharmacy department, internal medicine, or specialty medicine departments. Patients were excluded if they did not have any of the comorbidities listed or a form of diabetes other than T2D. Results: Of the 10,631 patients enrolled, 354 (3.3%) were initiated on an SGLT2i during the study. The average number of SGLT2i initiations prior to the 2022 ADA guideline publication was five prescription starts per week. After the guideline publication initiation increased to seven prescription starts per week. Secondary outcomes showed the majority of SGLT2i prescriptions were started in the internal medicine department, followed by cardiology and nephrology. Conclusion: Overall utilization rates of SGLT2i are low but increased after the 2022 ADA guidelines were published. These results suggest opportunities to optimize the use of SGLT2i in this patient population.
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Affiliation(s)
- Alexis R Bogannam
- Department of Clinical Pharmacy, Beth Israel Lahey Health, Wakefield, MA, USA
| | - Ewan McNicol
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
| | - Kevin DeLeonardo
- Department of Clinical Pharmacy, Atrius Health, Watertown, MA, USA
| | - Ashwini Ranade
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
| | - Kathy Zaiken
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
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Hollander PA, Krause-Steinrauf H, Butera NM, Kazemi EJ, Ahmann AJ, Fattaleh BN, Johnson ML, Killean T, Lagari VS, Larkin ME, Legowski EA, Rasouli N, Willis HJ, Martin CL. The Use of Rescue Insulin in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care 2024; 47:638-645. [PMID: 37756542 PMCID: PMC10973913 DOI: 10.2337/dc23-0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/18/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To describe rescue insulin use and associated factors in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). RESEARCH DESIGN AND METHODS GRADE participants (type 2 diabetes duration <10 years, baseline A1C 6.8%-8.5% on metformin monotherapy, N = 5,047) were randomly assigned to insulin glargine U-100, glimepiride, liraglutide, or sitagliptin and followed quarterly for a mean of 5 years. Rescue insulin (glargine or aspart) was to be started within 6 weeks of A1C >7.5%, confirmed. Reasons for delaying rescue insulin were reported by staff-completed survey. RESULTS Nearly one-half of GRADE participants (N = 2,387 [47.3%]) met the threshold for rescue insulin. Among participants assigned to glimepiride, liraglutide, or sitagliptin, rescue glargine was added by 69% (39% within 6 weeks). Rescue aspart was added by 44% of glargine-assigned participants (19% within 6 weeks) and by 30% of non-glargine-assigned participants (14% within 6 weeks). Higher A1C values were associated with adding rescue insulin. Intention to change health behaviors (diet/lifestyle, adherence to current treatment) and not wanting to take insulin were among the most common reasons reported for not adding rescue insulin within 6 weeks. CONCLUSIONS Proportionately, rescue glargine, when required, was more often used than rescue aspart, and higher A1C values were associated with greater rescue insulin use. Wanting to use noninsulin strategies to improve glycemia was commonly reported, although multiple factors likely contributed to not using rescue insulin. These findings highlight the persistent challenge of intensifying type 2 diabetes treatment with insulin, even in a clinical trial.
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Affiliation(s)
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Nicole M. Butera
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Erin J. Kazemi
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | | | | | - Mary L. Johnson
- International Diabetes Center at Park Nicollet, Minneapolis, MN
| | - Tina Killean
- Southwestern American Indian Center, Phoenix, AZ
| | | | | | - Elizabeth A. Legowski
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Neda Rasouli
- University of Colorado, School of Medicine, and VA Eastern Colorado Health Care System, Aurora, CO
| | - Holly J. Willis
- International Diabetes Center at Park Nicollet, Minneapolis, MN
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Basch CH, Hillyer GC, Basch CE. Wait Times for Scheduling Appointments for Prevention of Macrovascular and Microvascular Complications of Diabetes: Cross-Sectional Descriptive Study. J Med Internet Res 2024; 26:e55351. [PMID: 38530352 PMCID: PMC11005437 DOI: 10.2196/55351] [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: 12/10/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Diabetes is a chronic disease that requires lifelong management and care, affecting around 422 million people worldwide and roughly 37 million in the United States. Patients newly diagnosed with diabetes must work with health care providers to formulate a management plan, including lifestyle modifications and regular office visits, to improve metabolic control, prevent or delay complications, optimize quality of life, and promote well-being. OBJECTIVE Our aim is to investigate one component of system-wide access to timely health care for people with diabetes in New York City (NYC), namely the length of time for someone with newly diagnosed diabetes to obtain an appointment with 3 diabetes care specialists: a cardiologist, an endocrinologist, and an ophthalmologist, respectively. METHODS We contacted the offices of 3 different kinds of specialists: cardiologists, endocrinologists, and ophthalmologists, by telephone, for this descriptive cross-sectional study, to determine the number of days required to schedule an appointment for a new patient with diabetes. The sampling frame included all specialists affiliated with any private or public hospital in NYC. The number of days to obtain an appointment with each specialist was documented, along with "time on hold" when attempting to schedule an appointment and the presence of online booking capabilities. RESULTS Of the 1639 unique physicians affiliated with (private and public) hospitals in the 3 subspecialties, 1032 (cardiologists, endocrinologists, and ophthalmologists) were in active practice and did not require a referral. The mean wait time for scheduling an appointment was 36 (SD 36.4; IQR 12-51.5) days for cardiologists; 82 (SD 47; IQR 56-101) days for endocrinologists; and 50.4 (SD 56; IQR 10-72) days for ophthalmologists. The median wait time was 27 days for cardiologists, 72 days for endocrinologists, and 30 days for ophthalmologists. The mean time on hold while attempting to schedule an appointment with these specialists was 2.6 (SD 5.5) minutes for cardiologists, 5.4 (SD 4.3) minutes for endocrinologists, and 3.2 (SD 4.8) minutes for ophthalmologists, respectively. Over 46% (158/341) of cardiologists enabled patients to schedule an appointment on the web, and over 55% (128/228) of endocrinologists enabled patients to schedule an appointment on the web. In contrast, only approximately 25% (117/463) of ophthalmologists offered web-based appointment scheduling options. CONCLUSIONS The results indicate considerable variation in wait times between and within the 3 specialties examined for a new patient in NYC. Given the paucity of research on wait times for newly diagnosed people with diabetes to obtain an appointment with different specialists, this study provides preliminary estimates that can serve as an initial reference. Additional research is needed to document the extent to which wait times are associated with complications and the demographic and socio-economic characteristics of people served by different providers.
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Affiliation(s)
- Corey H Basch
- Department of Public Health, William Paterson University, Wayne, NJ, United States
| | - Grace C Hillyer
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Charles E Basch
- Department of Health Studies and Applied Educational Psychology, Teachers College Columbia University, New York, NY, United States
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Yabe D, Matsuhisa M, Takahashi Y, Morimoto Y, Terauchi Y. Impact of Participant Characteristics on Clinical Outcomes with iGlarLixi in Type 2 Diabetes: Post Hoc Analysis of SPARTA Japan. Diabetes Ther 2024; 15:705-723. [PMID: 38363541 PMCID: PMC10942962 DOI: 10.1007/s13300-024-01531-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/11/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The real-world SPARTA Japan study confirmed the effectiveness and safety of the fixed-ratio combination of insulin glargine 100 U/mL plus lixisenatide (iGlarLixi) once daily over 6 months in Japanese people with type 2 diabetes (T2D). This post hoc analysis examined the impact of participant characteristics on the achievement of age-defined glycaemic targets with iGlarLixi therapy. METHODS The retrospective, observational SPARTA Japan study included adults with T2D who initiated iGlarLixi. In this analysis, data from insulin-naïve and insulin-experienced participants were separately assessed to compare glycated haemoglobin (HbA1c), body weight and safety outcomes between those who achieved ('achieved' group) and those who did not achieve ('not-achieved' group) age-defined glycaemic targets after 6 months of iGlarLixi. The not-achieved group was further stratified by whether or not their iGlarLixi dose was increased during treatment. RESULTS In total, 418 participants were included in this analysis (138 insulin naïve and 280 insulin experienced). Among both insulin-naïve and insulin-experienced participants, those in the achieved group were older and had lower baseline HbA1c than those in the not-achieved group. Compared with the not-achieved group, the achieved group showed significantly greater HbA1c reductions from baseline (in both insulin-naïve and insulin-experienced participants) and significantly greater body weight reductions (in insulin-naïve participants), despite some participants in the not-achieved group receiving significantly higher insulin glargine doses than those in the achieved group. In both insulin-naïve and insulin-experienced participants, the incidence of hypoglycaemia and gastrointestinal-related adverse events was similar in the achieved and not-achieved groups. In a multivariate analysis, glycaemic target achievement was significantly more likely in older individuals and those who lost weight during iGlarLixi treatment. CONCLUSIONS Achievement of age-defined glycaemic targets with iGlarLixi treatment for 6 months was significantly affected by increased age and body weight loss, regardless of prior insulin exposure. TRIAL REGISTRATION UMIN-CTR Trials Registry, UMIN000044126; registered 10 May 2021.
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Affiliation(s)
- Daisuke Yabe
- Department of Diabetes, Endocrinology and Metabolism, and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan
- Center for One Medicine Innovative Translational Research, Gifu University, Gifu, Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Yoko Takahashi
- General Medicine Medical, Sanofi K.K., Opera City Tower 3-20-2 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 163-1488, Japan.
| | - Yukiko Morimoto
- Real World Evidence Generation Partnering, Sanofi K.K., Tokyo, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Slade D, Carr K, Karimi M, Stewart MW. Improving care practices of the patient with type 2 diabetes in community health centers. J Am Assoc Nurse Pract 2024; 36:128-135. [PMID: 38011633 DOI: 10.1097/jxx.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/10/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Diabetes ranks seventh in morbidity and mortality in the United States. In addition, more than 25 million Americans living with diabetes depend on community health centers (CHCs) for primary care. LOCAL PROBLEM Preimplementation data in a group of CHCs indicated poor adherence to standards of care practices as recommended by the American Diabetes Association (ADA) with quarterly A1c (33.1%), annual serum laboratory tests (66.6%), and annual urine microalbumin (26.5%). METHODS Using a pre- and postimplementation comparison method, a NP-led practice improvement project was conducted in a group of CHCs, which sought to (1) identify adherence to ADA care standards; (2) determine whether an intervention could affect adherence to ADA standards; and (3) compare pre- and postimplementation occurrences of hemoglobin A1c greater than 7.1% and greater than 9%. INTERVENTION Intervention composed of an educational component, standing orders to facilitate care practice changes, and electronic health record utilization changes. RESULTS Postimplementation data reveal statistically significant improvements in quarterly hemoglobin A1c (93.6%), annual serum laboratory tests (96.5%), and annual urine microalbumin screening (85.5%). CONCLUSIONS Improvements in translation to care for standardized guidelines facilitate improvements in health outcomes for patients. This project demonstrated improvements that can decrease the morbidity and mortality experienced by persons living with diabetes and being seen within a CHC. In addition, this project demonstrated that advanced practice nurses have the training and occupy a unique position within health care to spearhead initiatives for translation of evidence into care practices.
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Affiliation(s)
- Deloris Slade
- University of MS Medical Center, School of Nursing, Jackson, Mississippi
| | - Kayla Carr
- Mississippi State University, Mississippi
| | - Masoumeh Karimi
- University of MS Medical Center, School of Nursing, Jackson, Mississippi
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Horiguchi D, Shin S, Pepino JA, Peterson JT, Kehoe IE, Goldstein JN, Lee J, Kwon BK, Hahn JO, Reisner AT. Hypotension During Vasopressor Infusion Occurs in Predictable Clusters: A Multicenter Analysis. J Intensive Care Med 2024:8850666241226893. [PMID: 38282376 DOI: 10.1177/08850666241226893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Background: Published evidence indicates that mean arterial pressure (MAP) below a goal range (hypotension) is associated with worse outcomes, though MAP management failures are common. We sought to characterize hypotension occurrences in ICUs and consider the implications for MAP management. Methods: Retrospective analysis of 3 hospitals' cohorts of adult ICU patients during continuous vasopressor infusion. Two cohorts were general, mixed ICU patients and one was exclusively acute spinal cord injury patients. "Hypotension-clusters" were defined where there were ≥10 min of cumulative hypotension over a 60-min period and "constant hypotension" was ≥10 continuous minutes. Trend analysis was performed (predicting future MAP using 14 min of preceding MAP data) to understand which hypotension-clusters could likely have been predicted by clinician awareness of MAP trends. Results: In cohorts of 155, 66, and 16 ICU stays, respectively, the majority of hypotension occurred within the hypotension-clusters. Failures to keep MAP above the hypotension threshold were notable in the bottom quartiles of each cohort, with hypotension durations of 436, 167, and 468 min, respectively, occurring within hypotension-clusters per day. Mean arterial pressure trend analysis identified most hypotension-clusters before any constant hypotension occurred (81.2%-93.6% sensitivity, range). The positive predictive value of hypotension predictions ranged from 51.4% to 72.9%. Conclusions: Across 3 cohorts, most hypotension occurred in temporal clusters of hypotension that were usually predictable from extrapolation of MAP trends.
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Affiliation(s)
- Daisuke Horiguchi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Nihon Kohden Innovation Center, LLC, Cambridge, MA, USA
| | - Sungtae Shin
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Jeremy A Pepino
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey T Peterson
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Iain E Kehoe
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jarone Lee
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston MA, USA
| | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Andrew T Reisner
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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9
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Lever CS, Williman JA, Boucsein A, Watson A, Sampson RS, Sergel-Stringer OT, Keesing C, Chepulis L, Wheeler BJ, de Bock MI, Paul RG. Study protocol: glycaemic outcomes in people with type 2 diabetes initiating continuous glucose monitoring: the 2GO-CGM study. J Diabetes Metab Disord 2023; 22:1779-1792. [PMID: 37969919 PMCID: PMC10638210 DOI: 10.1007/s40200-023-01244-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/31/2023] [Indexed: 11/17/2023]
Abstract
Purpose Improving glycaemic control in type 2 diabetes (T2D) is essential to reducing social and health-economic burden of diabetes-related complications. Continuous glucose monitoring (CGM) has been established as beneficial in improving glycaemic control and reducing hypoglycaemia in people with type 1 diabetes, however data in T2D is limited. This study has been designed to assess the effect of initiating real-time CGM (rtCGM) on glycaemic control in a high-risk population of adults with T2D. Secondary objectives are to assess the cost-effectiveness and safety of rtCGM, and the effects of rtCGM on diet/lifestyle and the burden of diabetic complications, including cardiovascular risk. Methods This multicentre randomised controlled trial (RCT) will be conducted at three sites in New Zealand (Waikato, Christchurch and Dunedin). Eighty adults with T2D on insulin with suboptimal glycaemic control (HbA1c > 8.0% or 64 mmol/mol) will be randomised 1:1 to rtCGM or routine care with self-monitoring of blood glucose levels (SMBG) for three months. This intervention phase will be followed by a three-month continuation phase where SMBG group crossover to use rtCGM. Participants will then be invited to join the extension phase with continued use of rtCGM for a further 12 months. During the extension phase, both groups will independently titrate their insulin under the remote supervision of prescribing diabetes nurse specialists following an insulin titration algorithm. The primary outcome of the study is time in target glucose range (3.9-10 mmol/L or 70-180 mg/dL; TIR). Secondary outcomes include CGM metrics as per consensus statement recommendations, and HbA1c. Additional planned analyses include cardiovascular risk profile, incremental cost-effectiveness analyses, dietary patterns, and qualitative analyses. Trial registration number The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000889853) on 8 July 2021 and the World Health Organisation International Clinical Trial Registry Platform (Universal Trial Number U1111-1264-5822).
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Affiliation(s)
- Claire S. Lever
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, Aotearoa New Zealand
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
- Aotearoa Diabetes Collective, Hamilton, Waikato New Zealand
| | | | - Alisa Boucsein
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Antony Watson
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Rachael S. Sampson
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
- Aotearoa Diabetes Collective, Hamilton, Waikato New Zealand
| | - Oscar T. Sergel-Stringer
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Celeste Keesing
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
- Pinnacle Midlands Health Network, New Plymouth, New Zealand
| | - Lynne Chepulis
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, Aotearoa New Zealand
| | - Benjamin J. Wheeler
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Paediatrics, Te Whatu Ora Southern, Dunedin, New Zealand
| | - Martin I. de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Te Whatu Ora Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Ryan G. Paul
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, Aotearoa New Zealand
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
- Aotearoa Diabetes Collective, Hamilton, Waikato New Zealand
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Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, Castillo-Martínez L, de la Torre-Saldaña V, Guzman-Olvera E, Bernal-Ceballos F. Impact of a multicomponent integrated care delivery program on diabetes care goals achievement: a primary care quality improvement initiative. Prim Care Diabetes 2023; 17:568-574. [PMID: 37640623 DOI: 10.1016/j.pcd.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023]
Abstract
AIM To evaluate the impact of multicomponent integrated care (MIC) delivery program in a primary care real-life setting on diabetes care goals. METHODS Patients with T2D and usual primary care from the public health system in Mexico were invited to participate in a five-month ambulatory MIC quality initiative (DIAbetes Empowerment and Improvement of Care program, DIABEMPIC). RESULTS 841 patients who finished the program and with complete data were analyzed. The patients had a mean decrease in hemoglobin A1c, systolic and diastolic pressure, and LDL-cholesterol of 2.4%, 9 mmHg, 3 mmHg, and 22.5 mg/dL, respectively (p < 0.001). The achievement of the optimal triple target goal increased from 1.8% to 26.7% (p < 0.001). In the adjusted analysis, the diabetes knowledge and global self-care behavior score post-intervention, as well as the increment of global self-care behavior score were associated with the optimal composite risk factor control achievement. CONCLUSION The incorporation of diabetes therapeutic education interventions to improve self-care behaviors along with adequate treatment intensification in diabetes care are fundamental to attaining optimal risk factor control and attenuating disease burden.
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Affiliation(s)
- Ruben Silva-Tinoco
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico
| | - Teresa Cuatecontzi-Xochitiotzi
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico
| | - Lilia Castillo-Martínez
- Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Viridiana de la Torre-Saldaña
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico
| | - Eileen Guzman-Olvera
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico
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Deshmukh V, Chaudhury T, Chadha M, Chawla M, Mukherjee S, Pitale S, Basu D, Gadekar A, Menon S, Trivedi C, Salvi V, Ramakrishnan S, Goyal G. LIVE INDIA: Effectiveness of Gla-100 in a Post hoc Pooled Analysis of FINE ASIA and GOAL Registries. Diabetes Ther 2023; 14:2075-2088. [PMID: 37789213 PMCID: PMC10597908 DOI: 10.1007/s13300-023-01469-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Real-world evidence on insulin glargine 100 U/ml (Gla-100) initiation in Indian type 2 diabetes mellitus (T2DM) individuals is limited. The present study aimed to evaluate the effectiveness of Gla-100 in insulin-naïve T2DM participants from India. METHODS This post hoc analysis includes real-world data of insulin-naïve Indian participants with T2DM who started Gla-100 treatment in two Asian registries: FINE ASIA and GOAL. Changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), body weight, insulin dose, and incidence of hypoglycemia from baseline to 6 months were assessed. RESULTS A total of 955 participants with T2DM were identified and analyzed. The mean [standard deviation (SD)] age and duration of diabetes were 54.7 (9.8) years and 9.8 (6.3) years, respectively. Mean HbA1c and FPG were significantly reduced after 6 months of Gla-100 treatment [- 2.07 (1.4) %; - 94.4 (65.2) mg/dl, respectively]. HbA1c targets of < 7.0% and < 7.5% were achieved by 292 (30.6%) and 589 (61.7%) study participants, respectively. The overall incidence of hypoglycemia was low (n = 52; 5.4%); only two participants (0.2%) reported severe hypoglycemia. Insulin was titrated with a mean (SD) increment of 2.5 (5.6) U/day after 6 months, leading to a mean Gla-100 dose of 18.2 (8.9) U/day. Mean body weight remained unchanged from baseline to 6 months (- 0.1 kg). CONCLUSION In routine clinical practice, Gla-100 significantly improved glycemic parameters after 6 months of treatment with a low risk of hypoglycemia and no weight change in participants with T2DM.
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Affiliation(s)
- Vaishali Deshmukh
- Deshmukh Clinic and Research Centre, Second Floor, Pinnacle Prestige, Landmark: Next to Durvankur Hotel, Near Cosmos Bank, Tilak Road, Pantancha Gate, Sadashiv Peth, Pune, Maharashtra, 411030, India.
| | | | - Manoj Chadha
- P.D. Hinduja Hospital and Research Centre, Mumbai, India
| | | | | | | | | | | | | | | | | | | | - Ghanshyam Goyal
- S K Diabetes Research and Education Centre, S V S Marwari Hospital Campus, Kolkata, India
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Molló À, Vlacho B, Gratacòs M, Mata-Cases M, Rubinat E, Berenguera Ossó A, Cos FX, Franch-Nadal J, Khunti K, Mauricio D. A multicomponent health care intervention is associated with improved glycaemic control in subjects with poorly controlled type 2 diabetes compared with routine care: The INTEGRA study. Diabetes Obes Metab 2023; 25:3549-3559. [PMID: 37608473 DOI: 10.1111/dom.15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
AIM The INTEGRA study evaluated whether a specially designed multicomponent health care intervention improved glycaemic control in subjects with poorly controlled type 2 diabetes compared with standard of care practice. RESEARCH DESIGN AND METHODS Pragmatic study in subjects from primary care centres with type 2 diabetes and glycated haemoglobin (HbA1c) >9% (75 mmol/mol). The multifaceted intervention (N = 225 subjects) included a diabetes-focused visit encouraging therapeutic intensification by health care professionals. Retrospective data from matched controls (N = 675) were obtained from electronic medical records of a primary care database. The primary outcome was to compare the change in HbA1c values between the groups at 12 months of follow-up. RESULTS The mean HbA1c decreased substantially in both groups after 3 months, and the mean reduction was significantly greater in the intervention group than in the usual care group after 12 months [mean difference -0.66% (-7 mmol/mol), 95% CI -0.4, -1.0; p < .001]. A larger percentage of participants in the intervention group achieved HbA1c <7% and <8% goals (15.5% vs. 5.3% and 29.3% vs. 13.5%, respectively; p < .001). The improvement in HbA1c levels was sustained throughout the study only in the intervention arm. Glucose-lowering therapy was more frequently intensified in patients in the intervention group at the initial and final time points of the study (between 0-3 and 6-12 months; p < .001), with a significant increase in the number of patients prescribed ≥2 antidiabetic therapies (p < .001). CONCLUSIONS A multifaceted intervention oriented at reducing therapeutic inertia by primary care physicians was associated with greater improvement in glycaemic control compared with patients treated as per usual care.
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Affiliation(s)
- Àngels Molló
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Bogdan Vlacho
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Mònica Gratacòs
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Esther Rubinat
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRB Lleida, University of Lleida, Lleida, Spain
- Department of Nursing & Physiotherapy, Serra Hunter Lecture, University of Lleida, Lleida, Spain
- Society, Health, Education and Culture Research Group (GESEC) of the University of Lleida, Lleida, Spain
| | - Anna Berenguera Ossó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Departament d'Infermeria, Universitat de Girona, Girona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Francesc Xavier Cos
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Innovation Office at Institut Català de la Salut, Barcelona, Spain
| | - Josep Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
- Department of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
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Oshman L, Biszewski M, Carlock F, Radz M, Neu R, Billings LK. Effect of a Type 2 Diabetes-Focused Visit Improvement Initiative on Therapeutic Inertia and Glycemic Control in Primary Care. Clin Diabetes 2023; 41:296-300. [PMID: 37092139 PMCID: PMC10115612 DOI: 10.2337/cd22-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a multicomponent quality improvement initiative in the Chicago, IL, area that used a diabetes-focused clinic visit to overcome barriers that lead to clinical inertia for type 2 diabetes.
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Affiliation(s)
| | | | | | | | - Rachel Neu
- Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Liana K. Billings
- NorthShore University HealthSystem and University of Chicago Pritzker School of Medicine, Skokie, IL
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Lubaki JPF, Francis JM, Omole OB. Perspectives for glycaemic control in type 2 diabetes in Kinshasa, Democratic Republic of the Congo. Health Promot Int 2023; 38:daad128. [PMID: 37815062 PMCID: PMC10563016 DOI: 10.1093/heapro/daad128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Glycaemic control is a significant problem in the Democratic Republic of the Congo (DRC), the perspectives associated with glycaemic control are not fully known as previous studies rarely explored patients' perspectives and lived experiences. This qualitative study described the perspectives regarding glycaemic control among persons with type 2 diabetes in Kinshasa, DRC. A total of 23 participants were purposively selected in seven health centres in Kinshasa. In-depth interviews were used for data collection. The study used a phenomenology approach, and deductive, constructionist and thematic analysis. Data analysis was performed using the MAXQDA 2022. Five themes were identified as perspectives for glycaemic control in Kinshasa: financial constraints, limited social and relational support, difficulties with lifestyle changes, beliefs and practices about diabetes and ability to adapt for caring for the illness. Themes were integrated using social cognitive theory. Participants expressed that they were unable to achieve better glycaemic control due to financial constraints, limited social and relational support and difficulty in changing their lifestyle. Their beliefs and practices about diabetes also constituted a barrier. Our results showed that lack of adequate funding is a major determinant of glycaemic control and therefore it is crucial to integrate a consistent and reliable funding system for care of people living with diabetes. Persons with diabetes must be empowered to successfully adapt to the requirements of diabetes care. In this process, support for people living with type 2 diabetes is also essential and should involve their families as well as healthcare providers.
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Affiliation(s)
- Jean-Pierre Fina Lubaki
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Phillip V Tobias Health Sciences Building, 29 Princess of Wales, Parktown, Johannesburg 2193, South Africa
- Department of Family Medicine and Primary Care,Protestant University of Congo, Croisement des Avenues Libération et Triomphale, Commune de Lingwala, Kinshasa, Democratic Republic of the Congo
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care,University of the Witwatersrand, Phillip V Tobias Health Sciences Building, 29 Princess of Wales, Parktown, Johannesburg 2193, South Africa
| | - Olufemi Babatunde Omole
- Department of Family Medicine and Primary Care,University of the Witwatersrand, Phillip V Tobias Health Sciences Building, 29 Princess of Wales, Parktown, Johannesburg 2193, South Africa
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Pereira L, Valado A. Algae-Derived Natural Products in Diabetes and Its Complications-Current Advances and Future Prospects. Life (Basel) 2023; 13:1831. [PMID: 37763235 PMCID: PMC10533039 DOI: 10.3390/life13091831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Diabetes poses a significant global health challenge, necessitating innovative therapeutic strategies. Natural products and their derivatives have emerged as promising candidates for diabetes management due to their diverse compositions and pharmacological effects. Algae, in particular, have garnered attention for their potential as a source of bioactive compounds with anti-diabetic properties. This review offers a comprehensive overview of algae-derived natural products for diabetes management, highlighting recent developments and future prospects. It underscores the pivotal role of natural products in diabetes care and delves into the diversity of algae, their bioactive constituents, and underlying mechanisms of efficacy. Noteworthy algal derivatives with substantial potential are briefly elucidated, along with their specific contributions to addressing distinct aspects of diabetes. The challenges and limitations inherent in utilizing algae for therapeutic interventions are examined, accompanied by strategic recommendations for optimizing their effectiveness. By addressing these considerations, this review aims to chart a course for future research in refining algae-based approaches. Leveraging the multifaceted pharmacological activities and chemical components of algae holds significant promise in the pursuit of novel antidiabetic treatments. Through continued research and the fine-tuning of algae-based interventions, the global diabetes burden could be mitigated, ultimately leading to enhanced patient outcomes.
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Affiliation(s)
- Leonel Pereira
- Department of Life Sciences, University of Coimbra, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal
- MARE-Marine and Environmental Sciences Centre/ARNET-Aquatic Research Network, University of Coimbra, 3000-456 Coimbra, Portugal;
| | - Ana Valado
- MARE-Marine and Environmental Sciences Centre/ARNET-Aquatic Research Network, University of Coimbra, 3000-456 Coimbra, Portugal;
- Biomedical Laboratory Sciences, Polytechnic Institute of Coimbra, Coimbra Health School, Rua 5 de Outubro-SM Bispo, Apartado 7006, 3045-043 Coimbra, Portugal
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Reddy Peddi D, Pallekonda H, Reddy V. Evaluation of the Prevalence and Risk Factors of Drug-Related Problems in Hypertension and Type 2 Diabetes Mellitus Patients at a Tertiary Care Hospital: A Cross-Sectional Study. Cureus 2023; 15:e42775. [PMID: 37663988 PMCID: PMC10469343 DOI: 10.7759/cureus.42775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/05/2023] Open
Abstract
Background Drug-related problems (DRPs) potentially interfere with the desired treatment goals which may lead to increased healthcare costs, morbidity, and mortality. Despite the negative consequences of DRPs, there is a lack of comprehensive research on their prevalence and risk factors, particularly in chronic diseases such as hypertension and type 2 diabetes mellitus (DM). This study aims to evaluate the prevalence and contributing factors of DRPs among hypertension, type 2 DM, and hypertension with type 2 DM in the outpatient general medicine department. Methodology A hospital-based, prospective, observational study was conducted over three months. DRPs were classified using the Helper-Strand classification. The potential risk factors contributing to DRPs were assessed using binary and multinomial logistic regression methods. A p-value <0.05 was considered statistically significant. Results Among the 236 study participants, DRPs were more prevalent in males, and the mean age of the participants was 51.73 ± 9.47 years. DRPs were found in 76% of the study participants, and the mean number of DRPs per patient was 1.16 ± 0.45. Among the identified DRPs, suboptimal therapeutic goals (33%) were the most frequently observed, followed by ineffective drugs (32%), medication non-adherence (23%), and drug-drug interaction (5%). Therapeutic duplication and overdose were less commonly encountered as DRPs. The presence of comorbidity (adjusted odds ratio (AOR) = 5.77), and smoking (AOR = 21.07) were found to be significant risk factors (p < 0.05) contributing to DRPs. Conclusions DRPs are more prevalent in hypertension, type 2 DM, and hypertension with type 2 DM. Age range (40-60 years), comorbidity, and smoking were found to be associated with a higher incidence of DRPs. The implementation of a multidisciplinary team approach involving clinical pharmacists and physicians can effectively identify the prevalence and determine the associated risk factors of DRPs and subsequently may help employ targeted interventions to mitigate the development of DRPs.
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Affiliation(s)
- Divya Reddy Peddi
- Department of Pharmacy Practice, Arya College of Pharmacy, Osmania University, Sangareddy, IND
| | - Hephzibha Pallekonda
- Department of Pharmacy Practice, Arya College of Pharmacy, Osmania University, Sangareddy, IND
| | - Vikas Reddy
- Department of General Medicine, Government District Hospital, Sangareddy, IND
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Haldane C, Neukom J, Lailo JM, Hero K, Vetter B. Diabetes and blood glucose monitoring knowledge and practices among pharmacy professionals in Cambodia and Viet Nam: digital survey and education. BMC MEDICAL EDUCATION 2023; 23:483. [PMID: 37386440 DOI: 10.1186/s12909-023-04449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 06/14/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND In Southeast Asia, pharmacies are critical sources of healthcare advice for under-served communities, including those with/at risk of diabetes. AIM Explore knowledge/practices relating to diabetes and blood glucose monitoring (BGM) among pharmacy professionals in Cambodia and Viet Nam, using digital professional education to address gaps. METHODS An online survey was distributed to pharmacy professionals in Cambodia and Viet Nam registered on SwipeRx mobile application. Eligible participants dispensed medicines and/or were involved in purchasing products, and worked at retail pharmacies stocking ≥ 1 BGM product. An accredited continuing professional development module was then made available to pharmacy professionals and students on SwipeRx in both countries. After completing the 1-2 h module, users were required to correctly answer ≥ 60% (Cambodia) or ≥ 70% (Viet Nam) of knowledge assessment questions to achieve accreditation units from local partners. RESULTS Whereas 33% of survey respondents in Cambodia (N = 386) and 63% in Viet Nam (N = 375) reported performing blood glucose testing at the pharmacy, only 19% and 14% were aware that clients taking multiple daily doses of insulin should check blood glucose levels several times a day. Of 1,137 and 399 pharmacy professionals/students who completed the module and passed the assessment in Cambodia and Viet Nam, 1,124 (99%) and 376 (94%) received accreditation. Knowledge levels improved substantially in 10 of 14 learning areas in Cambodia and 6 of 10 in Viet Nam. CONCLUSIONS Digital education can strengthen pharmacy professional capacity to provide comprehensive and accurate information on diabetes management and the awareness of quality BGM products in Southeast Asia.
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Affiliation(s)
| | | | | | - Kol Hero
- Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia
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Gavin JR, Abaniel RM, Virdi NS. Therapeutic Inertia and Delays in Insulin Intensification in Type 2 Diabetes: A Literature Review. Diabetes Spectr 2023; 36:379-384. [PMID: 38024219 PMCID: PMC10654128 DOI: 10.2337/ds22-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background Therapeutic inertia leading to delays in insulin initiation or intensification is a major contributor to lack of optimal diabetes care. This report reviews the literature summarizing data on therapeutic inertia and delays in insulin intensification in the management of type 2 diabetes. Methods A literature search was conducted of the Allied & Complementary Medicine, BIOSIS Previews, Embase, EMCare, International Pharmaceutical Abstracts, MEDLINE, and ToxFile databases for clinical studies, observational research, and meta-analyses from 2012 to 2022 using search terms for type 2 diabetes and delay in initiating/intensifying insulin. Twenty-two studies met inclusion criteria. Results Time until insulin initiation among patients on two to three antihyperglycemic agents was at least 5 years, and mean A1C ranged from 8.7 to 9.8%. Early insulin intensification was linked with reduced A1C by 1.4%, reduction of severe hypoglycemic events from 4 to <1 per 100 person-years, and diminution in risk of heart failure (HF) by 18%, myocardial infarction (MI) by 23%, and stroke by 28%. In contrast, delayed insulin intensification was associated with increased risk of HF (64%), MI (67%), and stroke (51%) and a higher incidence of diabetic retinopathy. In the views of both patients and providers, hypoglycemia was identified as a primary driver of therapeutic inertia; 75.5% of physicians reported that they would treat more aggressively if not for concerns about hypoglycemia. Conclusion Long delays before insulin initiation and intensification in clinically eligible patients are largely driven by concerns over hypoglycemia. New diabetes technology that provides continuous glucose monitoring may reduce occurrences of hypoglycemia and help overcome therapeutic inertia associated with insulin initiation and intensification.
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Russo G, Di Bartolo P, Candido R, Lucisano G, Manicardi V, Giandalia A, Nicolucci A, Rocca A, Rossi MC, Di Cianni G. The AMD ANNALS: A continuous initiative for the improvement of type 2 diabetes care. Diabetes Res Clin Pract 2023; 199:110672. [PMID: 37084893 DOI: 10.1016/j.diabres.2023.110672] [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] [Indexed: 04/23/2023]
Abstract
AIMS Since 2006, the Italian AMD (Associations of Medical Diabetologists) Annals Initiative promoted a continuous monitoring of the quality of diabetes care, that was effective in improving process, treatment and outcome indicators through a periodic assessment of standardized measures. Here, we show the 2022 AMD Annals data on type 2 diabetes (T2D). METHODS A network involving ∼1/3 of diabetes centers in Italy periodically extracts anonymous data from electronic clinical records, by a standardized software. Process, treatment and outcome indicators, and a validated score of overall care, the Q-score, were evaluated. RESULTS 295 centers provided the annual sample of 502,747 T2D patients. Overall, HbA1c value ≤7.0% was documented in 54.6% of patients, blood pressure <130/80 mmHg in 23.0%, and LDL-cholesterol levels <70 mg/dl in 34.3%, but only 5.2% were at- target for all the risk factors. As for innovative drugs, 29.0% of patients were on SGLT2-i, and 27.5% on GLP1-RAs. In particular, 59.7% were treated with either GLP1-RAs or SGLT2-i among those with established cardiovascular disease (CVD), 26.6% and 49.3% with SGLT2-i among those with impaired renal function and heart failure, respectively. Notably, only 3.2% of T2D patients showed a Q score <15, which correlates with a 80% higher risk of incident CVD events compared to scores >25. CONCLUSIONS The 2022 AMD Annals data show an improvement in the use of innovative drugs and in the overall quality of T2D care in everyday clinical practice. However, additional efforts are needed to reach the recommended targets for HbA1c and major CVD risk factors.
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Affiliation(s)
- G Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - P Di Bartolo
- Ravenna Diabetes Center - Romagna Local Health Authority, Ravenna, Italy
| | - R Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, Diabetes Center, ASUGI, Trieste, Italy
| | - G Lucisano
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | | | - A Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - A Rocca
- "G. Segalini" H. Bassini Cinisello Balsamo ASST Nord, Milan, Italy
| | - M C Rossi
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - G Di Cianni
- USL Tuscany Northwest Location Livorno, Diabetes and Metabolic Disease, Livorno, Italy
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20
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Karslioglu French E, Kanter J, Winger ME, Williams K, Grumski T, Schuster J, Beckjord E. A Payer-Provider Partnership for Endocrine Targeted Automatic eConsults: Implementation and Early Impact on Diabetes and Cost Outcomes. Popul Health Manag 2023. [PMID: 37093168 DOI: 10.1089/pop.2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
In the United States, many individuals with diabetes mellitus (DM) do not achieve treatment goals despite the availability of effective interventions. Provider clinical inertia is one cause of these unfavorable outcomes. Targeted automatic eConsults (TACos) are an emerging technology-based intervention with potential to address clinical inertia in primary care (PC). TACos prospectively identify at-risk patients and use unsolicited specialist recommendations to prompt treatment intensification. Through a payer-provider collaboration, a TACos intervention was piloted for adults with uncontrolled DM (HbA1c >8%) to understand impact on DM clinical inertia and outcomes. Clinical inertia was assessed by measuring whether a PC provider implemented recommended therapeutic changes. Six-month changes in HbA1c and health care costs per member per month were evaluated using an observational matched design and intention-to-treat (ITT) analysis. The analysis included 196 individuals who received a TACos between February 2021 and August 2021 (ITT group) matched to 392 controls based on clinical and demographic criteria. TACos recommendations were implemented 65% of the time. Median percent change in HbA1c was significantly greater for the ITT group versus controls (-10.9% vs. -10.2%; P = 0.0359). Median total costs were 7.9% lower in the ITT group (P = 0.0900). A per protocol analysis was done to examine effects between ITT group individuals with an implemented TACos recommendation (n = 126) and controls. Median percent change in HbA1c was significantly greater (-19.5% vs. -10.2%; P < 0.0001), but there was no difference in total costs (-7.9%; P = 0.1753). TACos may feasibly address clinical inertia in PC and improve HbA1c for uncontrolled DM.
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Affiliation(s)
| | - Justin Kanter
- UPMC Center for High-Value Health Care, Pittsburgh, Pennsylvania, USA
| | - Mary E Winger
- UPMC Insurance Services Division, Department of Health Economics, Pittsburgh, Pennsylvania, USA
| | - Kelly Williams
- UPMC Center for High-Value Health Care, Pittsburgh, Pennsylvania, USA
| | - Tammi Grumski
- UPMC Insurance Services Division, Pittsburgh, Pennsylvania, USA
| | - James Schuster
- UPMC Insurance Services Division, Pittsburgh, Pennsylvania, USA
| | - Ellen Beckjord
- UPMC Insurance Services Division, Pittsburgh, Pennsylvania, USA
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21
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Miyoshi H, Matsuhisa M, Yabe D, Takahashi Y, Morimoto Y, Terauchi Y. Use of iGlarLixi for the Management of Type 2 Diabetes in Japanese Clinical Practice: Prior Treatment Subgroup Analysis of the SPARTA Japan Study. Diabetes Ther 2023; 14:671-689. [PMID: 36809494 PMCID: PMC10064399 DOI: 10.1007/s13300-023-01373-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION iGlarLixi, a fixed-ratio combination of insulin glargine 100 U/mL and the glucagon-like peptide 1 receptor agonist (GLP-1 RA) lixisenatide, is one option for treatment intensification in individuals with type 2 diabetes (T2D) who are unable to achieve targeted glycaemic control with their current glucose-lowering agent. Real-world data on the impact of prior treatment on the effectiveness and safety of iGlarLixi may be useful to guide individualised treatment decisions. METHODS This analysis of the 6-month, retrospective, observational SPARTA Japan study compared glycated haemoglobin (HbA1c), body weight and safety for pre-specified subgroups defined by prior treatment: post oral antidiabetic agent (OAD), GLP-1 RA, basal insulin (BI) + OADs (BOT), GLP-1 RA + BI or multiple daily injections (MDI). The post BOT and MDI subgroups were further divided on the basis of prior dipeptidyl peptidase 4 inhibitor (DPP-4i) use, and the post MDI group was divided on the basis of whether participants continued bolus insulin. RESULTS Of the 432 participants in the full analysis set (FAS), 337 were included in this subgroup analysis. Across subgroups, mean baseline HbA1c ranged from 8.49% to 9.18%. iGlarLixi significantly (p < 0.05) reduced mean HbA1c from baseline in all but the post GLP-1 RA + BI group. At 6 months, these significant reductions ranged from 0.47% to 1.27%. Prior DPP-4i exposure had no impact on the HbA1c-lowering effect of iGlarLixi. Mean body weight decreased significantly in the FAS (0.5 kg) and the post BOT (1.2 kg) and MDI (1.5 and 1.9 kg) subgroups but increased in the post GLP-1 RA subgroup (1.3 kg). iGlarLixi treatment was generally well tolerated, with very few participants discontinuing because of hypoglycaemia or gastrointestinal events. CONCLUSION In participants with suboptimal glycaemic control on various regimens, 6 months of iGlarLixi treatment improved HbA1c in all but one prior treatment subgroup (GLP-1 RA + BI), and was generally well tolerated. TRIAL REGISTRATION UMIN-CTR Trials Registry, UMIN000044126; registered 10 May 2021.
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Affiliation(s)
- Hideaki Miyoshi
- Department of Immunology and Metabolism, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Daisuke Yabe
- Department of Diabetes, Endocrinology and Metabolism, and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoko Takahashi
- General Medicine Medical, Sanofi K.K., Opera City Tower 3-20-2, Nishi-Shinjuku, Shinjuku-ku, Tokyo, 163-1488 Japan
| | - Yukiko Morimoto
- Real World Evidence Generation Partnering, Sanofi K.K., Tokyo, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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22
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Clark CN, Eby EL, Lensing CJ, Fultz E, Hart B, Lingcaro L, Hoffner R, Schloot NC, Benneyworth BD. Characterizing Diabetes Empowerment and Motivation for Changing Health Behaviors Among People with Type 2 Diabetes: A Cross-Sectional Survey. Diabetes Ther 2023; 14:869-882. [PMID: 37010793 PMCID: PMC10126189 DOI: 10.1007/s13300-023-01397-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/14/2023] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION Effectively engaging people with type 2 diabetes (T2D) earlier in their health journeys is critical to prevent downstream complications. Digitally based diabetes programs are a growing component of care delivery that have the potential to engage individuals outside of traditional clinic-based settings and use personalized data to pair people to tailored diabetes self-management interventions. Knowing an individuals' diabetes empowerment and health-related motivation can help drive appropriate recommendations for personalized interventions. We aimed to characterize diabetes empowerment and motivation towards changing health behaviors among participants in Level2, a T2D specialty care organization in the USA that combines wearable technology with personalized clinical support. METHODS A cross-sectional online survey was conducted among people enrolled in Level2 (February-March 2021). Distributions of respondent-reported diabetes empowerment and health motivation were analyzed using Motivation and Attitudes Toward Changing Health (MATCH) and Diabetes Empowerment Scale Short Form (DES-SF) scales, respectively. Associations between MATCH and DES-SF scores with Level2 engagement measures and glycemic control were analyzed. RESULTS The final analysis included 1258 respondents with T2D (mean age 55.7 ± 8.4 years). Respondents had high average MATCH (4.19/5) and DES-SF (4.02/5) scores. The average MATCH subscores for willingness (4.43/5) and worthwhileness (4.39/5) were higher than the average ability subscore (3.73/5). Both MATCH and DES-SF scores showed very weak correlations with Level2 engagement measures and glycemic control (ρ = - 0.18-0.19). CONCLUSIONS Level2 survey respondents had high average motivation and diabetes empowerment scores. Further research is needed to validate sensitivity of these scales to detect changes in motivation and empowerment over time and to determine whether differences in scores can be used to pair people to personalized interventions.
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Affiliation(s)
| | - Elizabeth L Eby
- Eli Lilly and Company, 1 Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | | | | | - Brian Hart
- Optum Labs, Eden Prairie, MN, 55344, USA
| | | | | | | | - Brian D Benneyworth
- Eli Lilly and Company, 1 Lilly Corporate Center, Indianapolis, IN, 46285, USA.
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23
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Nee R, Yuan CM, Narva AS, Yan G, Norris KC. Overcoming barriers to implementing new guideline-directed therapies for chronic kidney disease. Nephrol Dial Transplant 2023; 38:532-541. [PMID: 36264305 PMCID: PMC9976771 DOI: 10.1093/ndt/gfac283] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Indexed: 11/13/2022] Open
Abstract
For the first time in many years, guideline-directed drug therapies have emerged that offer substantial cardiorenal benefits, improved quality of life and longevity in patients with chronic kidney disease (CKD) and type 2 diabetes. These treatment options include sodium-glucose cotransporter-2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists and glucagon-like peptide-1 receptor agonists. However, despite compelling evidence from multiple clinical trials, their uptake has been slow in routine clinical practice, reminiscent of the historical evolution of angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use. The delay in implementation of these evidence-based therapies highlights the many challenges to optimal CKD care, including: (i) clinical inertia; (ii) low CKD awareness; (iii) suboptimal kidney disease education among patients and providers; (iv) lack of patient and community engagement; (v) multimorbidity and polypharmacy; (vi) challenges in the primary care setting; (vii) fragmented CKD care; (viii) disparities in underserved populations; (ix) lack of public policy focused on health equity; and (x) high drug prices. These barriers to optimal cardiorenal outcomes can be ameliorated by a multifaceted approach, using the Chronic Care Model framework, to include patient and provider education, patient self-management programs, shared decision making, electronic clinical decision support tools, quality improvement initiatives, clear practice guidelines, multidisciplinary and collaborative care, provider accountability, and robust health information technology. It is incumbent on the global kidney community to take on a multidimensional perspective of CKD care by addressing patient-, community-, provider-, healthcare system- and policy-level barriers.
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Affiliation(s)
- Robert Nee
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Christina M Yuan
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Andrew S Narva
- College of Agriculture, Urban Sustainability and Environmental Studies, University of the District of Columbia, Washington, DC, USA
| | - Guofen Yan
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Keith C Norris
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
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24
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Effectiveness of Telemedicine in Diabetes Management: A Retrospective Study in an Urban Medically Underserved Population Area (UMUPA). INFORMATICS 2023. [DOI: 10.3390/informatics10010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
This paper examines the efficacy of telemedicine (TM) technology compared to traditional face-to-face (F2F) visits as an alternative healthcare delivery service for managing diabetes in populations residing in urban medically underserved areas (UMUPAs). Retrospective electronic patient health records (ePHR) with type 2 diabetes mellitus (T2DM) were examined from 1 January 2019 to 30 June 2021. Multiple linear regression models indicated that T2DM patients with uncontrolled diabetes utilizing TM were similar to traditional visits in lowering hemoglobin (HbA1c) levels. The healthcare service type significantly predicted HbA1c % values, as the regression coefficient for TM (vs. F2F) showed a significant negative association (B = −0.339, p < 0.001), suggesting that patients using TM were likely to have 0.34 lower HbA1c % values on average when compared with F2F visits. The regression coefficient for female (vs. male) gender showed a positive association (B = 0.190, p < 0.034), with HbA1c % levels showing that female patients had 0.19 higher HbA1c levels than males. Age (B = −0.026, p < 0.001) was a significant predictor of HbA1c % levels, with 0.026 lower HbA1c % levels for each year’s increase in age. Black adults (B = 0.888, p < 0.001), on average, were more likely to have 0.888 higher HbA1c % levels when compared with White adults.
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25
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Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010182. [PMID: 36676805 PMCID: PMC9866102 DOI: 10.3390/medicina59010182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
This review seeks to establish, through the recent available literature, the prevalence of therapeutic intensification delay and its sequences in poorly controlled Type 2 Diabetes Mellitus (T2DM) patients. The strategy identified studies exploring the clinical inertia and its associated factors in the treatment of patients with T2DM. A total of 25 studies meeting the pre-established quality criteria were included in this review. These studies were conducted between 2004 and 2021 and represented 575,067 patients diagnosed with T2DM. Trusted electronic bibliographic databases, including Medline, Embase, and the Cochrane Central Register of Controlled Trials, were used to collect studies by utilizing a comprehensive set of search terms to identify Medical Subject Headings (MeSH) terms. Most o the studies included in this review showed clinical inertia rates over 50% of T2DM patients. In the USA, clinical inertia ranged from 35.4% to 85.8%. In the UK, clinical inertia ranged from 22.1% to 69.1%. In Spain, clinical inertia ranged from 18.1% to 60%. In Canada, Brazil, and Thailand, clinical inertia was reported as 65.8%, 68%, and 68.4%, respectively. The highest clinical inertia was reported in the USA (85.8%). A significant number of patients with T2DM suffered from poor glycemic control for quite a long time before treatment intensification with oral antidiabetic drugs (OADs) or insulin. Barriers to treatment intensification exist at the provider, patient, and system levels. There are deficiencies pointed out by this review at specialized centers in terms of clinical inertia in the management of T2DM including in developed countries. This review shows that the earlier intensification in the T2DM treatment is appropriate to address issues around therapeutic inertia.
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26
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Wong R, Kitto S. Rethinking Context in Continuing Professional Development: From Identifying Barriers to Understanding Social Dynamics. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:S9-S17. [PMID: 38054488 DOI: 10.1097/ceh.0000000000000543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
INTRODUCTION For continuing professional development (CPD) to reach its potential to improve outcomes requires an understanding of the role of context and the influencing conditions that enable interventions to succeed. We argue that the heuristic use of frameworks to design and implement interventions tends to conceptualize context as defined lists of barriers, which may obscure consideration of how different contextual factors interact with and intersect with each other. METHODS We suggest a framework approach that would benefit from postmodernist theory that explores how ideologies, meanings, and social structures in health care settings shape social practices. As an illustrative example, we conducted a Foucauldian discourse analysis of diabetes care to make visible how the social, historical, and political conditions in which clinicians experience, practice, and shape possibilities for behavior change. RESULTS The discursive construction of continuing education as a knowledge translation mechanism assumes and is contingent on family physicians to implement guidelines. However, they enact other discursively constituted roles that may run in opposition. This paradoxical position creates a tension that must be navigated by family physicians, who may perceive it possible to provide good care without necessarily implementing guidelines. DISCUSSION We suggest marrying "framework" thinking with postmodernist theory that explores how ideologies, meanings, and social structures shape practice behavior change. Such a proposed reconceptualization of context in the design of continuing professional development interventions could provide a more robust and nuanced understanding of how the dynamic relationships and interactions between clinicians, patients, and their work environments shape educational effectiveness.
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Affiliation(s)
- René Wong
- Dr. Wong: Associate Professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Dr. Kitto: Professor, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
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Ghannam N, Alahmed S, Aldahash R, Aljohani N, Alshammary A, Amir A, Kamal A, Khader S, Salah M, Shalabi H, Abdallah A, Elboghdady A. Addressing the Continuum of Dysglycaemia and Vascular Complications in Prediabetes and Type 2 Diabetes: Need for Early and Intensive Treatment. Diabetes Metab Syndr Obes 2023; 16:105-115. [PMID: 36760588 PMCID: PMC9844108 DOI: 10.2147/dmso.s396621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
The onset of type 2 diabetes increases the risk of vascular complications and death. We know now that that this risk begins long before the diabetes diagnosis. Prediabetes and type 2 diabetes are not separate entities in practice and exist within a continuum of dysglycaemia and vascular risk that increases in severity over time. This excess risk requires early intervention with lifestyle therapy supported with pharmacologic antidiabetic therapy, intensified promptly where necessary throughout the duration of the diabetes continuum. Metformin is an evidence-based treatment for preventing prediabetes and improves cardiovascular outcomes in people with type 2 diabetes from diagnosis onwards. Newer agents (SGLT2 inhibitors and GLP-1 agonists) are appropriate for people presenting with type 2 diabetes and significant cardiovascular comorbidity. Additional therapies should be used without delay to achieve patients' individualised HbA1c goals and to minimise cardiovascular risk.
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Affiliation(s)
- Nadia Ghannam
- Ghannam Clinic, Jeddah, Saudi Arabia
- Correspondence: Nadia Ghannam, Ghannam Clinic, King Abdulaziz Road, Jeddah, 21411, Saudi Arabia, Email
| | | | - Raed Aldahash
- Ministry of National Guard (Health Affairs) and King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Afaf Alshammary
- Ministry of National Guard (Health Affairs), King Abdulaziz Medical City, Riyadh and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ashraf Amir
- Family Medicine International Medical Center, Jeddah, Saudi Arabia
| | | | - Said Khader
- Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Mohammed Salah
- Cairo University, Cairo, Egypt and GNP Hospital, Jeddah, Saudi Arabia
| | - Hani Shalabi
- University of Jeddah, Jeddah, Saudi Arabia
- Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
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28
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Lewinski AA, Jazowski SA, Goldstein KM, Whitney C, Bosworth HB, Zullig LL. Intensifying approaches to address clinical inertia among cardiovascular disease risk factors: A narrative review. PATIENT EDUCATION AND COUNSELING 2022; 105:3381-3388. [PMID: 36002348 PMCID: PMC9675717 DOI: 10.1016/j.pec.2022.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Clinical inertia, the absence of treatment initiation or intensification for patients not achieving evidence-based therapeutic goals, is a primary contributor to poor clinical outcomes. Effectively combating clinical inertia requires coordinated action on the part of multiple representatives including patients, clinicians, health systems, and the pharmaceutical industry. Despite intervention attempts by these representatives, barriers to overcoming clinical inertia in cardiovascular disease (CVD) risk factor control remain. METHODS We conducted a narrative literature review to identify individual-level and multifactorial interventions that have been successful in addressing clinical inertia. RESULTS Effective interventions included dynamic forms of patient and clinician education, monitoring of real-time patient data to facilitate shared decision-making, or a combination of these approaches. Based on findings, we describe three possible multi-level approaches to counter clinical inertia - a collaborative approach to clinician training, use of a population health manager, and use of electronic monitoring and reminder devices. CONCLUSION To reduce clinical inertia and achieve optimal CVD risk factor control, interventions should consider the role of multiple representatives, be feasible for implementation in healthcare systems, and be flexible for an individual patient's adherence needs. PRACTICE IMPLICATIONS Representatives (e.g., patients, clinicians, health systems, and the pharmaceutical industry) could consider approaches to identify and monitor non-adherence to address clinical inertia.
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Affiliation(s)
- Allison A Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Attn: HSR&D COIN (558/152), 508 Fulton Street, Durham, NC 27705, USA; Duke University School of Nursing, Box 3322 DUMC, Durham, NC 27710, USA.
| | - Shelley A Jazowski
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC 27599‑7400, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701, USA; Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 1200, Nashville, TN 37203, USA.
| | - Karen M Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Attn: HSR&D COIN (558/152), 508 Fulton Street, Durham, NC 27705, USA; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 200 Morris Street, Durham, NC 27701, USA.
| | - Colette Whitney
- Cascades East Family Medicine Residency, Oregon Health & Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098, USA.
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Attn: HSR&D COIN (558/152), 508 Fulton Street, Durham, NC 27705, USA; Duke University School of Nursing, Box 3322 DUMC, Durham, NC 27710, USA; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC 27599‑7400, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, P.O. Box 102508, Durham, NC 27710, USA.
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Attn: HSR&D COIN (558/152), 508 Fulton Street, Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701, USA.
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Medication non-adherence and therapeutic inertia independently contribute to poor disease control for cardiometabolic diseases. Sci Rep 2022; 12:18936. [PMID: 36344613 PMCID: PMC9640683 DOI: 10.1038/s41598-022-21916-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022] Open
Abstract
Poorly controlled cardiometabolic biometric health gap measures [e.g.,uncontrolled blood pressure (BP), HbA1c, and low-density lipoprotein cholesterol (LDL-C)] are mediated by medication adherence and clinician-level therapeutic inertia (TI). The study of comparing relative contribution of these two factors to disease control is lacking. We conducted a retrospective cohort study using 7 years of longitudinal electronic health records (EHR) from primary care cardiometabolic patients who were 35 years or older. Cox-regression modeling was applied to estimate how baseline proportion of days covered (PDC) and TI were associated with cardiometabolic related health gap closure. 92,766 patients were included in the analysis, among which 89.9%, 85.8%, and 73.3% closed a BP, HbA1c, or LDL-C gap, respectively, with median days to gap closure ranging from 223 to 408 days. Patients who did not retrieve a medication were the least likely to achieve biometric control, particularly for LDL-C (HR = 0.58, 95% CI: 0.55-0.60). TI or uncertainty of TI was associated with a high risk of health gap persistence, particularly for LDL-C (HR ranges 0.46-0.48). Both poor medication adherence and TI are independently associated with persistent health gaps, and TI has a much higher impact on disease control compared to medication adherence, implying disease management strategies should prioritize reducing TI.
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30
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Ware J, Hovorka R. Closed-loop insulin delivery: update on the state of the field and emerging technologies. Expert Rev Med Devices 2022; 19:859-875. [PMID: 36331211 PMCID: PMC9780196 DOI: 10.1080/17434440.2022.2142556] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Over the last five years, closed-loop insulin delivery systems have transitioned from research-only to real-life use. A number of systems have been commercialized and are increasingly used in clinical practice. Given the rapidity of new developments in the field, understanding the capabilities and key similarities and differences of current systems can be challenging. This review aims to provide an update on the state of the field of closed-loop insulin delivery systems, including emerging technologies. AREAS COVERED We summarize key clinical safety and efficacy evidence of commercial and emerging insulin-only hybrid closed-loop systems for type 1 diabetes. A literature search was conducted and clinical trials using closed-loop systems during free-living conditions were identified to report on safety and efficacy data. We comment on emerging technologies and adjuncts for closed-loop systems, as well as non-technological priorities in closed-loop insulin delivery. EXPERT OPINION Commercial hybrid closed-loop insulin delivery systems are efficacious, consistently improving glycemic control when compared to standard therapy. Challenges remain in widespread adoption due to clinical inertia and the lack of resources to embrace technological developments by health care professionals.
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Affiliation(s)
- Julia Ware
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
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Lee N, Kim DJ. The Degree of Glycemic Control for the First Three Months Determines the Next Seven Years. J Korean Med Sci 2022; 37:e301. [PMID: 36193642 PMCID: PMC9530312 DOI: 10.3346/jkms.2022.37.e301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nami Lee
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
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Benning TJ, Heien HC, McCoy RG. Evolution of Clinical Complexity, Treatment Burden, Health Care Use, and Diabetes-Related Outcomes Among Commercial and Medicare Advantage Plan Beneficiaries With Diabetes in the U.S., 2006-2018. Diabetes Care 2022; 45:2299-2308. [PMID: 35926104 PMCID: PMC9643151 DOI: 10.2337/dc21-2623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/18/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To characterize trends in clinical complexity, treatment burden, health care use, and diabetes-related outcomes among adults with diabetes. RESEARCH DESIGN AND METHODS We used a nationwide claims database to identify enrollees in commercial and Medicare Advantage plans who met claims criteria for diabetes between 1 January 2006 and 31 March 2019 and to quantify annual trends in clinical complexity (e.g., active health conditions), treatment burden (e.g., medications), health care use (e.g., ambulatory, emergency department [ED], and hospital visits), and diabetes-related outcomes (e.g., hemoglobin A1c [HbA1c] levels) between 2006 and 2018. RESULTS Among 1,470,799 commercially insured patients, the proportion with ≥10 active health conditions increased from 33.3% (95% CI 33.1-33.4) in 2006 to 38.9% (38.8-39.1) in 2018 (P = 0.001) and the proportion taking three or more glucose-lowering medications increased from 11.6% (11.5-11.7) to 23.1% (22.9-23.2) (P = 0.007). The proportion with HbA1c ≥8.0% (≥64 mmol/mol) increased from 28.0% (27.7-28.3) in 2006 to 30.5% (30.2-30.7) in 2015, decreasing to 27.8% (27.5-28.0) in 2018 (overall trend P = 0.04). Number of ambulatory visits per patient per year decreased from 6.86 (6.84-6.88) to 6.19 (6.17-6.21), (P = 0.001) while ED visits increased from 0.26 (0.257-0.263) to 0.29 (0.287-0.293) (P = 0.001). Among 1,311,903 Medicare Advantage enrollees, the proportion with ≥10 active conditions increased from 51.6% (51.2-52.0) to 65.1% (65.0-65.2) (P < 0.001); the proportion taking three or more glucose-lowering medications was stable at 16.6% (16.3-16.9) and 18.1% (18.0-18.2) (P = 0.98), and the proportion with HbA1c ≥8.0% increased from 17.4% (16.7-18.1) to 18.6% (18.4-18.7) (P = 0.008). Ambulatory visits per patient per year remained stable at 8.01 (7.96-8.06) and 8.17 (8.16-8.19) (P = 0.23), but ED visits increased from 0.41 (0.40-0.42) to 0.66 (0.66-0.66) (P < 0.001). CONCLUSIONS Among patients with diabetes, clinical complexity and treatment burden have increased over time. ED utilization has also increased, and patients may be using ED services for low-acuity conditions.
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Affiliation(s)
- Tyler J. Benning
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Rochester, MN
| | - Herbert C. Heien
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Rozalina G. McCoy
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN
- OptumLabs, Eden Prairie, MN
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Fadini GP, Buzzetti R, Nicolucci A, Larosa M, Rossi MC, Cucinotta D. Comparative effectiveness and safety of glargine 300 U/mL versus degludec 100 U/mL in insulin-naïve patients with type 2 diabetes. A multicenter retrospective real-world study (RESTORE-2 NAIVE STUDY). Acta Diabetol 2022; 59:1317-1330. [PMID: 35864262 PMCID: PMC9402723 DOI: 10.1007/s00592-022-01925-9] [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: 03/22/2022] [Accepted: 06/15/2022] [Indexed: 11/01/2022]
Abstract
AIMS This study assessed comparative effectiveness of glargine 300 U/mL (Gla-300) versus degludec 100 U/mL (Deg-100) in insulin-naïve patients with T2D. METHODS This is a retrospective, multicenter, non-inferiority study based on electronic medical records. All patients initiating Gla-300 or Deg-100 were 1:1 propensity score-matched (PSM). Linear mixed models were used to assess the changes in continuous endpoints. Incidence rates (IR) of hypoglycemia were compared using Poisson's regression models. RESULTS Nineteen centers provided data on 357 patients in each PSM cohort. HbA1c after 6 months (primary endpoint) decreased by - 1.70% (95%CI - 1.90; - 1.50) in Gla-300 group and - 169% (95%CI - 1.89; - 1.49) in Deg-100 group, confirming non-inferiority of Gla-300 versus Deg-100. Fasting blood glucose (BG) decreased by ~60 mg/dl in both groups; body weight remained unchanged. In both groups, the mean starting dose was 12U (0.15U/kg) and it was slightly titrated to 16U (0.20U/kg). IR (episodes per patient-months) of BG ≤70 mg/dl was 0.13 in Gla-300 group and 0.14 in Deg-100 group (p=0.87). IR of BG <54 mg/dL was 0.02 in both groups (p=0.49). No severe hypoglycemia occurred. CONCLUSION Initiating Gla-300 or Deg-100 was associated with similar improvements in glycemic control, no weight gain and low hypoglycemia rates, without severe episodes during 6 months of treatment.
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Affiliation(s)
| | | | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
| | | | - Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Domenico Cucinotta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Hidalgo Rodríguez A, Martín Enguix D, Aguirre Rodríguez JC, Sánchez Cambronero M. Role of therapeutic inertia in glycemic control according to individualized objectives in a cohort of patients with type 2 diabetes. Results from CONCARDIA2. ENDOCRINOL DIAB NUTR 2022; 69:458-465. [PMID: 36038497 DOI: 10.1016/j.endien.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 09/06/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Therapeutic inertia (TI) is the lack of initiation or intensification of treatment when indicated. It contributes to the fact that more than a third of people with type 2 diabetes mellitus (T2D) do not have adequate metabolic control. We set out to analyze the impact of TI during 4 years of follow-up in a cohort of T2D and its possible variables. MATERIALS AND METHODS Prospective cohort study of a cohort of 297 TD2 patients. We considered TI when treatment was not modified during the 4 years, despite poor control. We contemplate uncontrolled those that did not meet their individualized HbA1c target. RESULTS Uncontrolled patients: 87; age: 62.2 ± 9.2; 58.7% men. We consider TI in 41.6% of the patients. Average HbA1c 8.22% in patients with treatment intensification of which 43.1% achieved their HbA1c goal, 29.8% were on monotherapy at the beginning, 29.8% double, 36.2% triple and 2,1% in quadruple therapy. There was more change in treatment in people with obesity (67.6 vs. 34.6%; P < 0.01) and the 6 of the study patients with cardiovascular events (P < 0.05). Metformin was part of the treatment in 97.1% of IT cases (vs. 76.6%; P < 0.01). Achievement of the HbA1c target was higher in patients receiving iSGLT2 (0 vs. 68.4%; P < 0.001). CONCLUSIONS In 2 out of 5 uncontrolled T2D patients, the treatment was not changed; this was more evident in those patients treated with metformin. Patients with obesity and presence of cardiovascular events seem to protect against IT. Those who were on iSGLT2 have an advantage in meeting their HbA1c target.
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Affiliation(s)
| | - David Martín Enguix
- Distrito Sanitario Granada Metropolitano, Centro de Salud La Zubia, La Zubia (Granada), Spain.
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Hidalgo Rodríguez A, Martín Enguix D, Aguirre Rodríguez JC, Sánchez Cambronero M. Inercia terapéutica en el control glucémico según objetivos individualizados en una cohorte de pacientes con diabetes tipo 2: resultados del estudio CONCARDIA2. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Benson G, Hayes J, Bunkers-Lawson T, Sidebottom A, Boucher J. Leveraging Registered Dietitian Nutritionists and Registered Nurses in Medication Management to Reduce Therapeutic Inertia. Diabetes Spectr 2022; 35:491-503. [PMID: 36561653 PMCID: PMC9668720 DOI: 10.2337/ds21-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective To conduct a systematic review of studies that used registered dietitian nutritionists (RDNs) or registered nurses (RNs) to deliver pharmacological therapy using protocols for diabetes, dyslipidemia, or hypertension. Research Design and Methods A database search of PubMed, the Cochrane Central Register of Controlled Trials, Ovid, and the Cumulative Index to Nursing and Allied Health Literature was conducted of literature published from 1 January 2000 to 31 December 2019. Results Twenty studies met the inclusion criteria, representing randomized controlled trials (12), retrospective (1) and prospective cohort design studies (6), and time series (1). In all, the studies include 7,280 participants with a median study duration of 12 months (range 6-25 months). Fifteen studies were led by RNs alone, two by RDNs, and three by a combination of RDNs and RNs. All demonstrated improvements in A1C, blood pressure, or lipids. Thirteen studies provided a lifestyle behavior change component in addition to medication protocols. Conclusion This systematic review provides evidence that RDN- and RN-led medication management using physician-approved protocols or treatment algorithms can lead to clinically significant improvements in diabetes, dyslipidemia, and hypertension management and is as good or better than usual care.
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Affiliation(s)
| | - Joy Hayes
- Minneapolis Heart Institute Foundation, Minneapolis, MN
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Cigiloglu A, Efendioglu EM, Ozturk ZA. A retrospective study of diabetes treatment in older adults: what should we AIM for? Postgrad Med 2022; 134:693-697. [PMID: 35697060 DOI: 10.1080/00325481.2022.2090175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Management of diabetes in elderly individuals requires a complex approach, considering the negative consequences. Glycemic overtreatment and undertreatment are relatively common conditions among this population. This study aimed to determine the potential overtreatment and undertreatment frequencies in older adults and the factors associated with these conditions. METHODS This retrospective study included 405 diabetic older adults aged >65 years. Sociodemographic characteristics, additional comorbidities, medications, HbA1c and fasting glucose levels of the patients have been recorded. RESULTS The median age of the patients was 71 years. The frequency of potential overtreatment and undertreatment has been found to be 20.2% and 17.8%, respectively. Insulin and sulfonylureas were found to be associated with increased risk of potential overtreatment (p = 0.000, OR = 14.91 and p = 0.000, OR = 8.48, respectively) and reduced risk of potential undertreatment (p = 0.001, OR = 0.16 and p = 0.000, OR = 0.05, respectively), while DPP-4 inhibitors were found to be associated with reduced risk of potential undertreatment (p = 0.000, OR = 0.12). CONCLUSION Our study has shown that potential glycemic overtreatment and undertreatment are common problems in diabetic older adults. It was found that agents with a high risk of hypoglycemia, such as insulin and sulfonylureas, were more closely associated with potential overtreatment. In the management of diabetes in the elderly, it should be aimed to choose treatment agents that lead to less negative consequences and to follow up the patients more closely.
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Affiliation(s)
- Ahmet Cigiloglu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, Turkey
| | - Eyyup Murat Efendioglu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, Turkey
| | - Zeynel Abidin Ozturk
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, Turkey
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Takeuchi M, Ogura M, Inagaki N, Kawakami K. Initiating SGLT2 inhibitor therapy to improve renal outcomes for persons with diabetes eligible for an intensified glucose-lowering regimen: hypothetical intervention using parametric g-formula modeling. BMJ Open Diabetes Res Care 2022; 10:10/3/e002636. [PMID: 35675951 PMCID: PMC9185419 DOI: 10.1136/bmjdrc-2021-002636] [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: 10/12/2021] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Sodium-glucose cotransporter 2 (SGLT2) inhibitors are now recommended in guidelines for persons with type 2 diabetes mellitus (T2DM) and at risk of advanced kidney disease as part of the glucose-lowering regimen. RESEARCH DESIGN AND METHODS To explore the optimal threshold at which to initiate SGLT2 inhibitor therapy, we conducted an observational study analyzed under a counterfactual framework. This study used the electronic healthcare database in Japan, comprising data from approximately 20 million patients at approximately 160 medical institutions. Persons with T2DM with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 in April 2014 were eligible. The primary end point was the composite of renal deterioration (>40% decline in eGFR) and the development of eGFR<30 mL/min/1.73 m2. We estimated the risk of the composite end point occurring over 77 months in different scenarios, such as early or delayed intervention with SGLT2 inhibitors for uncontrolled diabetes at different hemoglobin A1c (HbA1c) thresholds. The parametric g-formula was used to estimate the risk of the composite end point, adjusting for time-fixed and time-varying confounders. RESULTS We analyzed data from 36 237 persons (149 346 person-years observation), of whom 4679 started SGLT2 inhibitor therapy (9470 person-years observation). Overall, initiating SGLT2 inhibitor therapy was associated with a 77-month risk reduction in the end point by 1.3-3.7%. The largest risk reduction was observed within 3 months of initiation once the HbA1c level exceeded 6.5% (risk reduction of 3.7% (95% CI 1.6% to 6.7%)) compared with a threshold of 7.0% or higher. CONCLUSIONS Our analyses favored early intervention with SGLT2 inhibitors to reduce the renal end point, even for persons with moderately controlled HbA1c levels. Our findings also suggest caution against clinical inertia in the care of diabetes.
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Affiliation(s)
- Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masahito Ogura
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Ambrož M, de Vries ST, Hoogenberg K, Denig P. Less Timely Initiation of Glucose-Lowering Medication Among Younger and Male Patients With Diabetes and Similar Initiation of Blood Pressure-Lowering Medication Across Age and Sex: Trends Between 2015 and 2020. Front Pharmacol 2022; 13:883103. [PMID: 35645811 PMCID: PMC9133603 DOI: 10.3389/fphar.2022.883103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/13/2022] [Indexed: 11/15/2022] Open
Abstract
Aims: We aimed to assess trends in glycosylated hemoglobin A1c (HbA1c) and systolic blood pressure (SBP) thresholds at initiation of glucose- and blood pressure-lowering medication among patients with type 2 diabetes and assess the influence of age and sex on these trends. Materials and Methods: We used the Groningen Initiative to ANalyze Type 2 diabetes Treatment (GIANTT) primary care database. Patients initiating a first non-insulin glucose-lowering or any blood pressure-lowering medication between 2015 and 2020 with an HbA1c or SBP measurement in the 120 days before initiation were included. We used multilevel regression analyses adjusted for potential confounders to assess the influence of calendar year, age or sex, and the interaction between calendar year and age or sex on trends in HbA1c and SBP thresholds at initiation of medication. Results: We included 2,671 and 2,128 patients in the analyses of HbA1c and SBP thresholds, respectively. The overall mean HbA1c threshold at initiation of glucose-lowering medication significantly increased from 7.4% in 2015 to 8.0% in 2020 (p < 0.001), and particularly in the younger age groups. Compared to patients ≥80 years, patients aged 60–69 years initiated medication at lower levels mainly in the early years. Patients <60 years and between 70–79 years initiated medication at similar levels as patients ≥80 years. Females initiated medication at lower levels than males throughout the study period (p < 0.001). The mean SBP threshold at initiation of blood pressure-lowering medication varied from 145 to 149 mmHg without a clear trend (p = 0.676). There were no differences in SBP thresholds between patients of different ages or sex. Conclusion: The rising trend in the HbA1c threshold for initiating glucose-lowering medication in the lower age groups was unexpected and requires further investigation. Males appear to receive less timely initiation of glucose-lowering medication than females. The lack of higher thresholds for the oldest age group or lower thresholds for the youngest age group in recent years is not in line with the age-related recommendations for personalized diabetes care and calls for health systems interventions.
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Affiliation(s)
- Martina Ambrož
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sieta T. de Vries
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Klaas Hoogenberg
- Department of Internal Medicine, Martini Hospital, Groningen, Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- *Correspondence: Petra Denig,
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Kompala T, Neinstein AB. Smart Insulin Pens: Advancing Digital Transformation and a Connected Diabetes Care Ecosystem. J Diabetes Sci Technol 2022; 16:596-604. [PMID: 33435704 PMCID: PMC9294591 DOI: 10.1177/1932296820984490] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the first commercially available smart insulin pens, the predominant insulin delivery device for millions of people living with diabetes is now coming into the digital age. Smart insulin pens (SIPs) have the potential to reshape a connected diabetes care ecosystem for patients, providers, and health systems. Existing SIPs are enhanced with real-time wireless connectivity, digital dose capture, and integration with personalized dosing decision support. Automatic dose capture can promote effective retrospective review of insulin dose data, particularly when paired with glucose data. Patients, providers, and diabetes care teams will be able to make increasingly data-driven decisions and recommendations, in real time, during scheduled visits, and in a more continuous, asynchronous care model. As SIPs continue to progress along the path of digital transformation, we can expect additional benefits: iteratively improving software, machine learning, and advanced decision support. Both these technological advances, and future care delivery models with asynchronous interactions, will depend on easy, open, and continuous data exchange between the growing number of diabetes devices. SIPs have a key role in modernizing diabetes care for a large population of people living with diabetes.
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Affiliation(s)
- Tejaswi Kompala
- Department of Medicine, University of
California, San Francisco, San Francisco, CA, USA
- Tejaswi Kompala, MD, University of
California, San Francisco, 1700 Owens Street, Suite 541, San Francisco, CA
94158, USA.
| | - Aaron B. Neinstein
- Department of Medicine, University of
California, San Francisco, San Francisco, CA, USA
- Center for Digital Health Innovation,
University of California, San Francisco, San Francisco, CA, USA
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Sonmez A, Sabbour H, Echtay A, Rahmah AM, Alhozali AM, al Sabaan FS, Haddad FH, Iraqi H, Elebrashy I, Assaad SN, Bayat Z, Osar Siva Z, Hassanein M. Current gaps in management and timely referral of cardiorenal complications among people with type 2 diabetes mellitus in the Middle East and African countries: Expert recommendations. J Diabetes 2022; 14:315-333. [PMID: 35434900 PMCID: PMC9366572 DOI: 10.1111/1753-0407.13266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 03/05/2022] [Accepted: 03/13/2022] [Indexed: 12/11/2022] Open
Abstract
The upsurge of type 2 diabetes mellitus is a major public health concern in the Middle East and North Africa (MENA) and Africa (AFR) region, with cardiorenal complications (CRCs) being the predominant cause of premature morbidity and mortality. High prevalence of cardiometabolic risk factors, lack of awareness among patients and physicians, deficient infrastructure, and economic constraints lead to a cascade of CRCs at a significantly earlier age in MENA and AFR. In this review, we present consensus recommendations by experts in MENA and AFR, highlighting region-specific challenges and potential solutions for management of CRCs. Health professionals who understand sociocultural barriers can significantly increase patient awareness and encourage health-seeking behavior through simple educational tools. Increasing physician knowledge on early identification of CRCs and personalized treatment based on risk stratification, alongside optimum glycemic control, can mitigate therapeutic inertia. Early diagnosis of high-risk people with regular and systematic monitoring of cardiorenal parameters, development of region-specific care pathways for timely referral to specialists, followed by guideline-recommended care with novel antidiabetics are imperative. Adherence to guideline-recommended care can catalyze utilization of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists with demonstrated cardiorenal benefits-thus paving the way for overcoming care gaps in a cost-effective manner. Leveraging digital technology like electronic medical records can help generate real-world data and provide insights on voids in adoption of newer antidiabetic medications. A patient-centric approach, collaborative care among physicians from different specialties, alongside involvement of policy makers are key for improving patient outcomes and quality of care in MENA and AFR.
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Affiliation(s)
- Alper Sonmez
- Department of Endocrinology and MetabolismGulhane School of Medicine, University of Health SciencesAnkaraTurkey
| | - Hani Sabbour
- Heart & Vascular Institute Cleveland ClinicAbu DhabiUAE
- Brown University Warren Alpert School of MedicineProvidenceRhode IslandUSA
| | - Akram Echtay
- School of MedicineLebanese UniversityHadathLebanon
| | - Abbas Mahdi Rahmah
- National Centre for DiabetesCollege of Medicine, Al‐Mustansriya UniversityBaghdadIraq
| | | | | | - Fares H. Haddad
- Endocrine & Diabetes, Abdali Hospital/Endocrine & Diabetes ClinicAmmanJordan
| | - Hinde Iraqi
- Faculty of Medicine and PharmacyMohammed V UniversityRabatMorocco
| | | | | | - Zaheer Bayat
- Division of Endocrinology and Metabolism, Department of Internal MedicineHelen Joseph HospitalRossmore, JohannesburgSouth Africa
| | | | - Mohamed Hassanein
- Dubai Hospital, DHADubaiUAE
- Gulf Medical UniversityAjmanUAE
- Cardiff UniversityCardiffUK
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Ramírez-Rincón A, Builes-Montaño CE, Hincapié-García JA, Blanco VM, Botero-Arango JF. Short-Term Effectiveness and Reduction in Insulin Requirements in Patients With Type 2 Diabetes Treated With IdegLira in a Real-World Setting. Front Endocrinol (Lausanne) 2022; 13:828607. [PMID: 35573995 PMCID: PMC9097264 DOI: 10.3389/fendo.2022.828607] [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: 12/03/2021] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a chronic, highly prevalent disease with a significant impact on health. Appropriate treatment requires effective and timely escalation to achieve metabolic control. To evaluate the effectiveness and safety of IDegLira on adults with T2DM previously treated with oral antidiabetics and/or insulin in a real-life setting. METHODS An observational study in a real-world setting was conducted. Patients were selected from the outpatient clinic of two centers dedicated to specialized diabetes care. Main outcomes were HbA1c, body weight, insulin dose changes, hypoglycemia, and other adverse events. RESULTS 67 T2DM patients treated with IDegLira were monitored between 3 and 7 months. At the end of foll ow-up, the median change in HbA1c was -1.05% (CI95% -1.45, -0.65), and a decrease in insulin requirement was also observed (mean difference -10 TDD units (CI95% - 17 to -2.5). No treatment discontinuation was reported, hypoglycemia events were reported in 3 patients at the end of follow-up versus 8 patients at baseline. CONCLUSIONS This real-life study shows the effectiveness in glycemic control of IDegLira use in T2DM patients who do not achieve goals with other therapies, with an adequate safety profile. The findings need to be confirmed with evaluation of therapeutic results in larger cohorts.
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Affiliation(s)
- Alex Ramírez-Rincón
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
- Endocrinology Department, Clínica Integral de Diabetes, Medellín, Colombia
- *Correspondence: Alex Ramírez-Rincón,
| | - Carlos E. Builes-Montaño
- School of Medicine, Universidad de Antioquia, Medellín, Colombia
- Endocrinology Department, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Jaime A. Hincapié-García
- Clinical Pharmacology, Pharmaceutical Promotion and Prevention Group, Faculty of Pharmaceutical and Food Sciences, Universidad de Antioquia, Medellín, Colombia
| | - Victor M. Blanco
- School Medicine, Pontificia Universidad Bolivariana, Medellín, Colombia
| | - José F. Botero-Arango
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
- Endocrinology Department, Clínica Integral de Diabetes, Medellín, Colombia
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Leto G, Barchetta I, De Candia L, Magotti MG, Cianciullo M, Manti R, Negri C, Cimino V, Dodesini AR, Zerella F, Baratta R. Identification of the Inappropriate Clinical Actions (DON'T) to Improve the Management of Patients with Type 2 Diabetes Failing Basal Insulin Supported Oral Treatment: Results of Survey for a Panel of Diabetes Specialists in Italy. Diabetes Ther 2021; 12:2645-2661. [PMID: 34415563 PMCID: PMC8478995 DOI: 10.1007/s13300-021-01137-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/02/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Despite the development of several recommendations, glycemic control in a large proportion of patients with type 2 diabetes, including those treated with insulin, remains suboptimal. This study is aimed to identify a set of actions to promote the reduction of inappropriate clinical practices in type 2 diabetes failing basal insulin supported oral therapy (BOT). METHODS A panel of diabetes specialists was assembled to identify a list of ten corrective actions, "things not to do," for the management of type 2 diabetes: five concerning treatments, procedures and diagnostic tests and five about relationship, communication and information. The Choosing Wisely methodology and approach were the inspiration. RESULTS A total of 73/73 (100%) panelists responded to the survey. Twenty-four actions were proposed. The final list of inappropriate actions deemed most important to improve the management of patients with type 2 diabetes failing BOT were: (1) do not use secretagogues-do not neglect the use of innovative glucose-lowering agents; (2) do not underestimate the risk of lack of hypoglycemia awareness; (3) do not underestimate the benefit of personalization of therapy; (4) do not delay insulin intensification; (5) do not delay modification of the therapeutic regimen. In the area of patient communication, the following actions were identified: (1) do not fail to train in the management of hypoglycemia; (2) do not underestimate whether the patient has understood the modification of therapy; (3) do not prescribe injection therapy without adequately instructing the patient to titrate it; (4) do not ignore the patient's adherence; (5) do not stop listening to the patient and verify learning. CONCLUSION A set of corrective experience-based actions to enact in a timely manner, which can assist physicians in improving clinical outcomes and patients' needs in terms of communications and interaction, is proposed. The list is intended to promote discussions among diabetes specialists to provide high-value diabetes care.
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Affiliation(s)
- Gaetano Leto
- Diabetology Unit, Sapienza University of Rome, Polo Pontino, Santa Maria Goretti Hospital, Latina, Italy.
| | - Ilaria Barchetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Maria Grazia Magotti
- Department of Intensive Treatment of Diabetes and its Complications, University Hospital of Parma, Parma, Italy
| | - Marco Cianciullo
- Department of Medicine, Nocera Inferiore Hospital, Salerno, Italy
| | - Roberta Manti
- Diabetology Unit, Santa Croce Hospital of Moncalieri, Turin, Italy
| | - Carlo Negri
- Department of Diabetology and Metabolic Diseases, Hospital of Verona, Verona, Italy
| | - Vincenzo Cimino
- Department of Biomedical and Clinical Sciences L. Sacco Endocrinology and Diabetology, Pio Albergo Trivulzio, Milan, Italy
| | - Alessandro R Dodesini
- Diabetology and Endocrine Diseases Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Zerella
- Diabetology, Metabolic Diseases and Clinical Nutrition, San Pio Rummo Hospital of Benevento, Benevento, Italy
| | - Roberto Baratta
- Endocrinology and Diabetology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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44
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Kruger DF, Anderson JE. Continuous Glucose Monitoring (CGM) Is a Tool, Not a Reward: Unjustified Insurance Coverage Criteria Limit Access to CGM. Diabetes Technol Ther 2021; 23:S45-S55. [PMID: 34160300 DOI: 10.1089/dia.2021.0193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Recent studies have demonstrated the clinical utility of continuous glucose monitoring (CGM) use in type 2 diabetes (T2D) patients who are treated with intensive insulin management. Large retrospective database analyses of T2D patients treated with less-intensive therapies have also shown that CGM use was associated with significant reductions in hemoglobin A1c levels and health resource utilization, including diabetes-related hospitalizations and emergency room care. Despite the growing body of evidence supporting CGM use in the broader T2D population, current eligibility criteria required by public and many private insurers are denying millions of individuals with T2D access to this valuable technology. In this article, we discuss an evidence-based rationale for modifying current eligibility requirements for CGM coverage.
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Affiliation(s)
- Davida F Kruger
- Division of Endocrinology, Diabetes and Bone and Mineral, Henry Ford Health System, Detroit, Michigan, USA
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45
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Hannan A, Sinha SR, Ganiyani MA, Pustake M. Drug Utilization Study of Antidiabetic Drugs in Patients Attending Geriatric Outpatient Department at a Tertiary Care Hospital. Cureus 2021; 13:e17555. [PMID: 34646612 PMCID: PMC8480078 DOI: 10.7759/cureus.17555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Diabetes has increased in prevalence from 108 million individuals in 1980 to 463 million individuals in 2021. As people's life expectancies have risen, it's become increasingly necessary to be worried about diseases that affect the elderly. To focus and manage these diseases effectively, the illumination of current knowledge about the pattern of anti-diabetic drug utilization in the elderly is important. As a result, it is necessary to evaluate the pattern of anti-diabetic medication use among diabetes patients of the geriatric age group and determine if there is room for improvement in light of current knowledge. With this information, we intend to provide feedback and suggestions for the health care providers. This research aimed to study and analyze the drug utilization of antidiabetic medications in patients attending the geriatric outpatient department. Methods The data of 600 patients visiting the geriatric outpatient department from January 1, 2016 to September 30, 2017 were collected from the electronic medical record (EMR) database. The protocol was designed using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Subjects were grouped according to gender, age, drug combination use, and underlying co-morbidities. Indicators of drug usage and the total number of drugs prescribed and prescription patterns were analyzed. Then, the recorded data were classified according to the anatomical therapeutic chemical (ATC) - daily defined dose (DDD) classification. Prescribed daily dose (PDD) values and PDD/DDD ratio of antidiabetic drugs prescribed to a sample of patients (n=600) were calculated. Cost analysis of the prescribed drugs was analyzed and the cost index for each drug is described. Results A total of 600 diabetic patients (286 males) were recruited in the study. In the study, the average age of participants was 69.30±11.34 years. The most common comorbidity associated with diabetes mellitus (DM) was hypertension followed by hypertension along with chronic heart disease. Glibenclamide and pioglitazone (thiazolidenediones) had PDD/DDD ratio equal to 1. The ratios for glimepiride (sulfonylurea), metformin (biguanides), sitagliptin (sodium-glucose cotransporter 2 inhibitor), insulin glargine, insulin lispro, insulin aspart, were 1.85, 1.29, 1.66, 1.63, 1.42, and 1.21, respectively, whereas the premixed insulin had a ratio of 0.83. The average cost per prescription was USD 3.36 and around 87.72% of the cost per prescription was due to the prescribed antidiabetics. Metformin + glibenclamide was the most commonly prescribed combination followed by metformin + glimepiride. Conclusion On the whole, the principles of rational prescription were followed in accordance with the different WHO drug usage indicators. Many of the drugs prescribed by generic name were supplied from hospital pharmacy thus reducing the burden to some extent.
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Affiliation(s)
- Abdul Hannan
- Department of Pharmacology, Grant Government Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, IND
| | - Shyamal R Sinha
- Department of Pharmacology, Grant Government Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, IND
| | - Mohammad Arfat Ganiyani
- Department of Pharmacology, Grant Government Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, IND
- Department of Internal Medicine, Grant Government Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, IND
| | - Manas Pustake
- Department of Internal Medicine, Grant Government Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, IND
- Department of Pharmacology, Grant Government Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, IND
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46
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Boye KS, Lage MJ, Kiljański J. Time to Failure on Oral Glucose-Lowering Agents for Patients with Type 2 Diabetes: A Retrospective Cohort Study. Diabetes Ther 2021; 12:1463-1474. [PMID: 33837921 PMCID: PMC8099964 DOI: 10.1007/s13300-021-01051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Research has shown that glycemic control is associated with lower rates of microvascular and long-term cardiovascular complications. In the analyses reported here, we examined treatment failure on oral glucose-lowering agents (GLAs), defined as having sustained hemoglobin A1c (HbA1c) ≥ 7%. METHODS This study utilized the IBM® MarketScan® Claims and Laboratory Data from 1 January 2012 through 30 June 2018. Adults with type 2 diabetes (T2D) were classified based upon the maximum number of classes of GLAs prescribed per day during the time period from 1 July 2012 through 31 December 2012. Patients were followed for 5.5 years in order to examine time to failure on oral GLAs, defined based upon receipt of ≥ 2 consecutive HbA1c results ≥ 7%. Multivariable analyses employing a Cox proportional hazards model were used to examine time to failure overall and based upon the number of index classes of oral GLAs prescribed. For patients who had sustained HbA1c above the threshold, multivariable analyses examined the duration of time that HbA1c remained above the threshold (i.e, glycemic burden) and whether or not an additional oral or injectable class of GLA was added to the patient treatment regimen (i.e., clinical inertia). RESULTS A total of 4156 patients were included in the study, of whom 16% were identified with sustained HbA1c ≥ 7% after 365 days (1 year) and 36% after 730 days (2 years), with half of all patients having sustained HbA1c above target after 1102 days (3 years). There was a statistically significant difference in time to having sustained HbA1c above target based upon index classes of therapy, with patients treated with more GLAs being quicker to have HbA1c above target (P < 0.0001). Among those patients who were found to have sustained HbA1c ≥ 7%, the average number of days in the post-period that HbA1c remained above target was 1026 (2.8 years). Only 36% of patients with sustained HbA1c above target added a GLA to their treatment regimen and, for patients who did add such a therapy, the average duration from identification of HbA1c above target until treatment intensification was 401 days (1.1 years). Multivariable analyses revealed that, among those with sustained HbA1c ≥ 7%, treatment with more classes of oral GLAs was associated with a significantly higher glycemic burden and significantly lower odds of clinical inertia. CONCLUSION These results indicate that for many patients treated with oral GLAs, glycemic control is not consistently achieved. For patients with above-target HbA1c , the results indicate a relatively large glycemic burden and clinical inertia towards treatment intensification. The findings illustrate some limitations associated with treatment of T2D with oral GLAs.
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Affiliation(s)
- Kristina S. Boye
- Eli Lilly and Company, 893 Delaware Street, Indianapolis, IN 46225 USA
| | - Maureen J. Lage
- HealthMetrics Outcomes Research, 27576 River Reach Drive, Bonita Springs, FL 34134 USA
| | - Jacek Kiljański
- Eli Lilly Polska Sp. z o.o (Eli Lilly and Company), u.l. Żwirki I Wigury 18a, 02-092 Warsaw, Poland
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Scalzo P. From the Association of Diabetes Care & Education Specialists: The Role of the Diabetes Care and Education Specialist as a Champion of Technology Integration. Sci Diabetes Self Manag Care 2021; 47:120-123. [DOI: 10.1177/0145721721995478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
It is the position of the Association of Diabetes Care & Education Specialists that diabetes care and education specialists should play a central role in establishing and maintaining technology-enabled care in a variety of practice settings to optimize outcomes for people with diabetes and cardiometabolic conditions. The objectives of this position statement are to outline the role of diabetes care and education specialists as leaders in technology integration and to describe the resources and guidance the Association has developed to facilitate success in this role.
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Affiliation(s)
- Patty Scalzo
- From the Association of Diabetes Care & Education Specialists, Chicago, Illinois
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48
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An LW, Li XL, Chen LH, Tang H, Yuan Q, Liu YJ, Ji Y, Lu JM. Clinical Inertia and 2-Year Glycaemic Trajectories in Patients with Non-Newly Diagnosed Type 2 Diabetes Mellitus in Primary Care: A Retrospective Cohort Study. Patient Prefer Adherence 2021; 15:2497-2508. [PMID: 34795477 PMCID: PMC8593594 DOI: 10.2147/ppa.s328165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/27/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To analyse diabetes treatment, treatment change and self-management behaviours in association with 2-year glycaemic trajectories in patients with non-newly diagnosed type 2 diabetes mellitus in Chinese primary care. METHODS This was an observational, multi-centre, longitudinal, retrospective cohort study. Clinical data of 4690 subjects were extracted from electronic medical records, including serial glycated haemoglobin A1c (HbA1c) measurements, antidiabetic medication records and compliance to exercise, diet, medications and self-monitoring of blood glucose (SMBG). Patterns of longitudinal HbA1c trajectories were identified using the percentage of HbA1c measurements <7.5% from the second available HbA1c measurement. Clinical relevance of the clusters was assessed through multivariable analysis. RESULTS Approximately half of the participants demonstrated good glycaemic control; of these, 34.5% demonstrated stable, good control, and 13.7% demonstrated relatively good control. About 16.2% demonstrated moderate control, and 35.6% demonstrated poor control. From the good to poor control groups, the percentage of subjects treated with insulin at baseline and during the follow-up period increased gradually, while the percentage of subjects adhering to exercise, diet, medications and SMBG decreased gradually. Compared with baseline, the adherence to exercise, diet, medications and SMBG improved significantly. Approximately 50% and 26% of subjects in the two poorest control groups, respectively, experienced treatment changes. After multivariable adjustments, baseline HbA1c ≥7.5%, HbA1c change ≥-0.5% from baseline to visit 1, insulin treatment, treatment change, poor adherence to diet, exercise, SMBG during the follow-up period and HbA1c measurements <3 per year were significantly associated with poorer glycaemic control. CONCLUSION We identified four longitudinal HbA1c trajectories in patients with non-newly diagnosed type 2 diabetes. Even if baseline HbA1c is suboptimal, aggressive treatment changes, good adherence during the follow-up period, ≥3 HbA1c measurements per year and reducing HbA1c levels to a certain extent by the first follow-up visit were important for good, stable, long-term glycaemic control.
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Affiliation(s)
- Ling-Wang An
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Xiang-Lan Li
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Lin-Hui Chen
- Department of Endocrinology, Taiyuan Diabetes Hospital, Taiyuan, 030013, People’s Republic of China
| | - Hong Tang
- Department of Share-Care Center, Chengdu Ruien Diabetes Hospital, Chengdu, 610000, People’s Republic of China
| | - Qun Yuan
- Department of Endocrinology, Heilongjiang Ruijing Diabetes Hospital, Harbin, 150009, People’s Republic of China
| | - Yan-Jun Liu
- Department of Endocrinology, Lanzhou Ruijing Diabetes Hospital, Lanzhou, 730000, People’s Republic of China
| | - Yu Ji
- Department of Endocrinology, Beijing Aerospace General Hospital, Beijing, 100076, People’s Republic of China
| | - Ju-Ming Lu
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
- Department of Endocrinology, The General Hospital of the People’s Liberation Army, Beijing, 100853, People’s Republic of China
- Correspondence: Ju-Ming Lu Department of Endocrinology, The General Hospital of the People’s Liberation Army, No. 28 of Fuxing Road, Haidian District, Beijing, 100853, People’s Republic of ChinaTel +86 10 8822 9999 Email
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Demidova TY, Titova VV. [Insulin therapy is a personalized approach to glycemic management in diabetes]. TERAPEVT ARKH 2020; 92:201-206. [PMID: 33720595 DOI: 10.26442/00403660.2020.12.200449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 11/22/2022]
Abstract
Type 2 diabetes is characterized by chronic hyperglycemia and varying degrees of insulin resistance and insulinopenia. Achieving targeted glycemic control in diabetic patients is important to reduce the risk of late complications, and many patients with type 2 diabetes ultimately require insulin therapy to maintain adequate glycemic control. Timely administration of insulin can prevent the progression of diabetes, reduce the development of complications, and have fewer side effects. Basal insulin is the preferred option in most cases when glycemic control is not achieved. However, there is considerable therapeutic inertia in clinical practice, both with respect to initiation of insulin therapy and titration of the basal insulin dose. The longer duration of action, reduced glucose variability and a lower risk of hypoglycemia seen with the latest generation of basal insulin analogs compared to the previous generation simplify titration and may increase patient compliance.
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Affiliation(s)
- T Y Demidova
- Pirogov Russian National Research Medical University
| | - V V Titova
- Pirogov Russian National Research Medical University
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50
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Belice T, Ubay M, Gozubuyuk FO, Yilmaz RS, Yuksel A. An example of clinical inertia in geriatrics. J Family Med Prim Care 2020; 9:5695-5698. [PMID: 33532416 PMCID: PMC7842489 DOI: 10.4103/jfmpc.jfmpc_1427_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/17/2020] [Accepted: 09/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background As we know that close contact is the main reason of the contagious diseases, caregivers are at higher risk for diseases that we can prevent by vaccines. In present study, we aim at revealing an example of clinical inertia in geriatrics, which shows us the status of vaccination both in a group of older patients and their caregivers. Materials and Methods Both the caregivers and their dependent geriatric patients were included, and the selection of the participants was designed on a random and volunteer basis. We performed the study with a phenomenological design and asked the participants their vaccination status. For the participants that were not vaccinated, the reasons were questioned with a demographic form. Correlations between parameters were analyzed with an independent t-test and analysis of variance. SPSS (IBM SPSS for Windows, ver.24) was used to analyze the data, which were saved in excel files. Results A total of 144 caregivers with 21 men (14.6%) and 123 female (85.4%) were included in the study. A total of 111(77.1%) caregivers had never been vaccinated before, while 21 (14.6%) caregivers were vaccinated occasionally, and finally, 12 (8.3%) caregivers were vaccinated on a regular base. The vaccination status of the older adults was as follows: 42 patients (29.2%) had never been vaccinated before, 60 (41.7%) had been vaccinated occasionally, and 42 (29.2%) patients had been vaccinated regularly. Conclusion The vaccination rates of caregivers and older patients were lower than we expected, so primary-care providers need to plan more vaccination awareness studies in social media and communities. Clinical inertia might be an essential reason in the lower vaccination rates of the caregivers and older adults' population.
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Affiliation(s)
- Tahir Belice
- Department of Internal Diseases, İzmir Bozyaka Training and Research Hospital, University of Health Sciences, İzmir-Turkey
| | - Mustafa Ubay
- Department of Internal Diseases, İzmir Bozyaka Training and Research Hospital, University of Health Sciences, İzmir-Turkey
| | - Fatma O Gozubuyuk
- Department of Internal Diseases, İzmir Bozyaka Training and Research Hospital, University of Health Sciences, İzmir-Turkey
| | - Rasim S Yilmaz
- Department of Internal Diseases, İzmir Bozyaka Training and Research Hospital, University of Health Sciences, İzmir-Turkey
| | - Arif Yuksel
- Department of Internal Diseases, İzmir Bozyaka Training and Research Hospital, University of Health Sciences, İzmir-Turkey
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