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Hayanga B, Stafford M, Saunders CL, Bécares L. Ethnic inequalities in age-related patterns of multiple long-term conditions in England: Analysis of primary care and nationally representative survey data. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:582-607. [PMID: 37879907 DOI: 10.1111/1467-9566.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
Little is known about the patterning of multiple long-term conditions (MLTCs) by age, ethnicity and across conceptualisations of MLTCs (e.g. MLTCs with/without mental health conditions [MHCs]). We examined ethnic inequalities in age-related patterns of MLTCs, and combinations of physical and MHCs using the English GP Patient Survey and Clinical Practice Research Datalink. We described the association between MLTCs and age using multilevel regression models adjusting for sex and area-level deprivation with patients nested within GP practices. Similar analyses were repeated for MLTCs that include MHCs. We observed ethnic inequalities from middle-age onwards such as older Pakistani, Indian, Black Caribbean and Other ethnic people had increased risk of MLTCs compared to white British people, even after adjusting for area-level deprivation. Compared to white British people, Gypsy and Irish Travellers had higher levels of MLTCs across the age groups, and Chinese people had lower levels. Pakistani and Bangladeshi people aged 50-74 years were more likely than white people to report MLTCs that included MHCs. We find clear evidence of ethnic inequalities in MLTCs. The lower prevalence of MLTCs that include MHCs among some minoritised ethnic groups may be an underestimation due to underdiagnosis and/or inadequate primary care and requires further scrutiny.
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Affiliation(s)
- Brenda Hayanga
- Department of Global Health and Social Medicine, King's College London, London, UK
| | | | | | - Laia Bécares
- Department of Global Health and Social Medicine, King's College London, London, UK
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Meunier A, Opeifa O, Longworth L, Cox O, Bührer C, Durand-Zaleski I, Kelly SP, Gale RP. An eye on equity: faricimab-driven health equity improvements in diabetic macular oedema using a distributional cost-effectiveness analysis from a UK societal perspective. Eye (Lond) 2024:10.1038/s41433-024-03043-y. [PMID: 38555401 DOI: 10.1038/s41433-024-03043-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/26/2024] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND/OBJECTIVES Diabetic macular oedema (DMO) is a leading cause of blindness in developed countries, with significant disease burden associated with socio-economic deprivation. Distributional cost-effectiveness analysis (DCEA) allows evaluation of health equity impacts of interventions, estimation of how health outcomes and costs are distributed in the population, and assessments of potential trade-offs between health maximisation and equity. We conducted an aggregate DCEA to determine the equity impact of faricimab. METHODS Data on health outcomes and costs were derived from a cost-effectiveness model of faricimab compared with ranibizumab, aflibercept and off-label bevacizumab using a societal perspective in the base case and a healthcare payer perspective in scenario analysis. Health gains and health opportunity costs were distributed across socio-economic subgroups. Health and equity impacts, measured using the Atkinson inequality index, were assessed visually on an equity-efficiency impact plane and combined into a measure of societal welfare. RESULTS At an opportunity cost threshold of £20,000/quality-adjusted life year (QALY), faricimab displayed an increase in net health benefits against all comparators and was found to improve equity. The equity impact increased the greater the concerns for reducing health inequalities over maximising population health. Using a healthcare payer perspective, faricimab was equity improving in most scenarios. CONCLUSIONS Long-acting therapies with fewer injections, such as faricimab, may reduce costs, improve health outcomes and increase health equity. Extended economic evaluation frameworks capturing additional value elements, such as DCEA, enable a more comprehensive valuation of interventions, which is of relevance to decision-makers, healthcare professionals and patients.
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Affiliation(s)
| | | | | | - Oliver Cox
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse, Basel, Switzerland
| | | | | | | | - Richard P Gale
- Hull York Medical School, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
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Backholer K, Ebekozien O, Hofman K, Miranda JJ, Seidu S. Health equity in endocrinology. Nat Rev Endocrinol 2024; 20:130-135. [PMID: 37884738 DOI: 10.1038/s41574-023-00912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA, USA.
- John D Bower School of Population Health, University of Mississippi, Jackson, MS, USA.
| | - Karen Hofman
- SA MRC/Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - J Jaime Miranda
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Samuel Seidu
- Diabetes Research Centre, Centre for Ethnic Health Research, University of Leicester, Leicester General Hospital, Leicester, UK.
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Melson E, Fazil M, Lwin H, Thomas A, Yeo TF, Thottungal K, Tun H, Aftab F, Davitadze M, Gallagher A, Seidu S, Higgins K. Tertiary centre study highlights low inpatient deintensification and risks associated with adverse outcomes in frail people with diabetes. Clin Med (Lond) 2024; 24:100029. [PMID: 38387535 DOI: 10.1016/j.clinme.2024.100029] [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] [Indexed: 02/24/2024]
Abstract
INTRODUCTION The community deintensification rates in older people with diabetes are low and hospital admission presents an opportunity for medication review. We audited the inpatient assessment and deintensification rate in people with diabetes and frailty. We also identified factors associated with adverse inpatient outcomes. METHODS A retrospective review of electronic charts was conducted in all people with diabetes and clinical frailty score ≥6 who were discharged from the medical unit in 2022. Data on demographics, comorbidities and background glucose-lowering medications were collected. RESULTS Six-hundred-and-sixty-five people with diabetes and moderate/severe frailty were included in our analysis. For people with no HbA1c in the last six months preceding admission, only 9.0% had it assessed during inpatient. Deintensification rates were 19.1%. Factors that were associated with adverse inpatient outcomes included inpatient hypoglycaemia, non-White ethnicity, and being overtreated (HbA1c <7.0% [53 mmol/mol] with any glucose-lowering medication). CONCLUSION The assessment and deintensification rate in secondary care for people with diabetes and frailty is low. Inpatient hypoglycaemia, non-White ethnicity, and overtreatment are important factors in determining inpatient outcomes highlighting the importance of deintensification and the need for an evidence-based risk stratification tool.
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Affiliation(s)
- Eka Melson
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom; Leicester Diabetes Centre, University of Leicester, LE5 4PW, United Kingdom.
| | - Mohamed Fazil
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Hnin Lwin
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Anu Thomas
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Ting Fong Yeo
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Kevin Thottungal
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - HayMar Tun
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Faseeha Aftab
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Meri Davitadze
- Clinic NeoLab, Tbilisi, Georgia; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Alison Gallagher
- Leicester General Hospital, University Hospitals of Leicester NHS Foundation Trust, LE5 4PW, United Kingdom
| | - Samuel Seidu
- Leicester Diabetes Centre, University of Leicester, LE5 4PW, United Kingdom
| | - Kath Higgins
- Leicester Diabetes Centre, University of Leicester, LE5 4PW, United Kingdom; Leicester General Hospital, University Hospitals of Leicester NHS Foundation Trust, LE5 4PW, United Kingdom
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Neumiller JJ, St. Peter WL, Shubrook JH. Type 2 Diabetes and Chronic Kidney Disease: An Opportunity for Pharmacists to Improve Outcomes. J Clin Med 2024; 13:1367. [PMID: 38592214 PMCID: PMC10932148 DOI: 10.3390/jcm13051367] [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: 01/11/2024] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024] Open
Abstract
Chronic kidney disease (CKD) is an important contributor to end-stage kidney disease, cardiovascular disease, and death in people with type 2 diabetes (T2D), but current evidence suggests that diagnosis and treatment are often not optimized. This review examines gaps in care for patients with CKD and how pharmacist interventions can mitigate these gaps. We conducted a PubMed search for published articles reporting on real-world CKD management practice and compared the findings with current recommendations. We find that adherence to guidelines on screening for CKD in patients with T2D is poor with particularly low rates of testing for albuminuria. When CKD is diagnosed, the prescription of recommended heart-kidney protective therapies is underutilized, possibly due to issues around treatment complexity and safety concerns. Cost and access are barriers to the prescription of newer therapies and treatment is dependent on racial, ethnic, and socioeconomic factors. Rates of nephrologist referrals for difficult cases are low in part due to limitations of information and communication between specialties. We believe that pharmacists can play a vital role in improving outcomes for patients with CKD and T2D and support the cost-effective use of healthcare resources through the provision of comprehensive medication management as part of a multidisciplinary team. The Advancing Kidney Health through Optimal Medication Management initiative supports the involvement of pharmacists across healthcare systems to ensure that comprehensive medication management can be optimally implemented.
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Affiliation(s)
- Joshua J. Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99210, USA
| | - Wendy L. St. Peter
- Department of Pharmaceutical Care & Health Systems, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Jay H. Shubrook
- Department of Clinical Sciences and Community Health, Touro University California, Vallejo, CA 94592, USA;
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Ehrhardt N, Thomas CC, Zou T, Vasconcelos AG, Bouchonville M. Project ECHO for Diabetes Improves Primary Care Providers' Comfort With and Use of Diabetes Medications and Technology. Diabetes Spectr 2024; 37:160-164. [PMID: 38756423 PMCID: PMC11093770 DOI: 10.2337/ds23-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Nicole Ehrhardt
- University of Washington Diabetes Institute, Division of Endocrinology, Diabetes and Metabolism, Seattle, WA
| | - Celeste C. Thomas
- Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, IL
| | - Tracy Zou
- University of Washington Diabetes Institute, Division of Endocrinology, Diabetes and Metabolism, Seattle, WA
| | | | - Matt Bouchonville
- Division of Endocrinology, Diabetes, and Metabolism, University of New Mexico School of Medicine, Albuquerque, NM
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Doran W, Tunnicliffe L, Muzambi R, Rentsch CT, Bhaskaran K, Smeeth L, Brayne C, Williams DM, Chaturvedi N, Eastwood SV, Dunachie SJ, Mathur R, Warren-Gash C. Incident dementia risk among patients with type 2 diabetes receiving metformin versus alternative oral glucose-lowering therapy: an observational cohort study using UK primary healthcare records. BMJ Open Diabetes Res Care 2024; 12:e003548. [PMID: 38272537 PMCID: PMC10823924 DOI: 10.1136/bmjdrc-2023-003548] [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: 05/23/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION 4.2 million individuals in the UK have type 2 diabetes, a known risk factor for dementia and mild cognitive impairment (MCI). Diabetes treatment may modify this association, but existing evidence is conflicting. We therefore aimed to assess the association between metformin therapy and risk of incident all-cause dementia or MCI compared with other oral glucose-lowering therapies (GLTs). RESEARCH DESIGN AND METHODS We conducted an observational cohort study using the Clinical Practice Research Datalink among UK adults diagnosed with diabetes at ≥40 years between 1990 and 2019. We used an active comparator new user design to compare risks of dementia and MCI among individuals initially prescribed metformin versus an alternative oral GLT using Cox proportional hazards regression controlling for sociodemographic, lifestyle and clinical confounders. We assessed for interaction by age and sex. Sensitivity analyses included an as-treated analysis to mitigate potential exposure misclassification. RESULTS We included 211 396 individuals (median age 63 years; 42.8% female), of whom 179 333 (84.8%) initiated on metformin therapy. Over median follow-up of 5.4 years, metformin use was associated with a lower risk of dementia (adjusted HR (aHR) 0.86 (95% CI 0.79 to 0.94)) and MCI (aHR 0.92 (95% CI 0.86 to 0.99)). Metformin users aged under 80 years had a lower dementia risk (aHR 0.77 (95% CI 0.68 to 0.85)), which was not observed for those aged ≥80 years (aHR 0.95 (95% CI 0.87 to 1.05)). There was no interaction with sex. The as-treated analysis showed a reduced effect size compared with the main analysis (aHR 0.90 (95% CI 0.83 to 0.98)). CONCLUSIONS Metformin use was associated with lower risks of incident dementia and MCI compared with alternative GLT among UK adults with diabetes. While our findings are consistent with a neuroprotective effect of metformin against dementia, further research is needed to reduce risks of confounding by indication and assess causality.
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Affiliation(s)
- William Doran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Louis Tunnicliffe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rutendo Muzambi
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Christopher T Rentsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Dylan M Williams
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Sophie V Eastwood
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Susanna J Dunachie
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rohini Mathur
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Toal CM, Fowler AJ, Pearse RM, Puthucheary Z, Prowle JR, Wan YI. Health Resource Utilisation and Disparities: an Ecological Study of Admission Patterns Across Ethnicity in England Between 2017 and 2020. J Racial Ethn Health Disparities 2023; 10:2872-2881. [PMID: 36471147 PMCID: PMC9734479 DOI: 10.1007/s40615-022-01464-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM The COVID-19 pandemic highlighted adverse outcomes in Asian, Black, and ethnic minority groups. More research is required to explore underlying ethnic health inequalities. In this study, we aim to examine pre-COVID ethnic inequalities more generally through healthcare utilisation to contextualise underlying inequalities that were present before the pandemic. DESIGN This was an ecological study exploring all admissions to NHS hospitals in England from 2017 to 2020. METHODS The primary outcomes were admission rates within ethnic groups. Secondary outcomes included age-specific and age-standardised admission rates. Sub-analysis of admission rates across an index of multiple deprivation (IMD) deciles was also performed to contextualise the impact of socioeconomic differences amongst ethnic categories. Results were presented as a relative ratio (RR) with 95% confidence intervals. RESULTS Age-standardised admission rates were higher in Asian (RR 1.40 [1.38-1.41] in 2019) and Black (RR 1.37 [1.37-1.38]) and lower in Mixed groups (RR 0.91 [0.90-0.91]) relative to White. There was significant missingness or misassignment of ethnicity in NHS admissions: with 11.7% of admissions having an unknown/not-stated ethnicity assignment and 'other' ethnicity being significantly over-represented. Admission rates did not mirror the degree of deprivation across all ethnic categories. CONCLUSIONS This study shows Black and Asian ethnic groups have higher admission rates compared to White across all age groups and when standardised for age. There is evidence of incomplete and misidentification of ethnicity assignment in NHS admission records, which may introduce bias to work on these datasets. Differences in admission rates across individual ethnic categories cannot solely be explained by socioeconomic status. Further work is needed to identify ethnicity-specific factors of these inequalities to allow targeted interventions at the local level.
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Affiliation(s)
- C M Toal
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK.
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK.
| | - A J Fowler
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK
| | - R M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK
| | - Z Puthucheary
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK
| | - J R Prowle
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK
| | - Y I Wan
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK
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Isaksen AA, Sandbaek A, Skriver MV, Bjerg L. Glucose-lowering drug use in migrants and native Danes with type 2 diabetes: Disparities in combination therapy and drug types. Diabetes Obes Metab 2023; 25:3307-3316. [PMID: 37550891 DOI: 10.1111/dom.15230] [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: 03/16/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
AIM To examine disparities in glucose-lowering drug (GLD) usage between migrants and native Danes with type 2 diabetes (T2D). MATERIALS AND METHODS In a nationwide, register-based cross-sectional study of 253 364 individuals with prevalent T2D on December 31, 2018, we examined user prevalence during 2019 of (i) GLD combination therapies and (ii) individual GLD types. Migrants were grouped by origin (Middle East, Europe, Turkey, Former Yugoslavia, Pakistan, Sri Lanka, Somalia, Vietnam), and relative risk (RR) versus native Danes was computed using robust Poisson regression to adjust for clinical and socioeconomic characteristics. RESULTS In 2019, 34.7% of native Danes received combination therapy, and prevalence was lower in most migrant groups (RR from 0.78, 95% confidence interval CI 0.71-0.85 [Somalia group] to 1.00, 95% CI 0.97-1.04 [former Yugoslavia group]). Among native Danes, the most widely used oral GLD was metformin (used by 62.1%), followed by dipeptidyl peptidase-4 inhibitors (13.3%), sodium-glucose cotransporter-2 inhibitors (11.9%) and sulphonylureas (5.2%), and user prevalence was higher in most migrant groups (RR for use of any oral GLD: 0.99, 95% CI 0.97-1.01 [Europe group] to 1.09, 95% CI 1.06-1.11 [Sri Lanka group]). Furthermore, 18.7% of native Danes used insulins and 13.3% used glucagon-like peptide-1 receptor agonists (GLP-1RAs), but use was less prevalent in migrants (RR for insulins: 0.66, 95% CI 0.62-0.71 [Sri Lanka group] to 0.94, 95% CI 0.89-0.99 [Europe group]; RR for GLP-1RAs: 0.29, 95% CI 0.22-0.39 [Somalia group] to 0.95, 95% CI 0.89-1.01 [Europe group]). CONCLUSIONS Disparities in GLD types and combination therapy were evident between migrants and native Danes. Migrants were more likely to use oral GLDs and less likely to use injection-based GLDs, particularly GLP-1RAs, which may contribute to complication risk and mortality among this group.
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Affiliation(s)
- Anders Aasted Isaksen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | - Annelli Sandbaek
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
- Research Unit for General Practice, Aarhus, Denmark
| | | | - Lasse Bjerg
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
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Eto F, Samuel M, Henkin R, Mahesh M, Ahmad T, Angdembe A, Hamish McAllister-Williams R, Missier P, J. Reynolds N, R. Barnes M, Hull S, Finer S, Mathur R. Ethnic differences in early onset multimorbidity and associations with health service use, long-term prescribing, years of life lost, and mortality: A cross-sectional study using clustering in the UK Clinical Practice Research Datalink. PLoS Med 2023; 20:e1004300. [PMID: 37889900 PMCID: PMC10610074 DOI: 10.1371/journal.pmed.1004300] [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: 03/04/2023] [Accepted: 09/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The population prevalence of multimorbidity (the existence of at least 2 or more long-term conditions [LTCs] in an individual) is increasing among young adults, particularly in minority ethnic groups and individuals living in socioeconomically deprived areas. In this study, we applied a data-driven approach to identify clusters of individuals who had an early onset multimorbidity in an ethnically and socioeconomically diverse population. We identified associations between clusters and a range of health outcomes. METHODS AND FINDINGS Using linked primary and secondary care data from the Clinical Practice Research Datalink GOLD (CPRD GOLD), we conducted a cross-sectional study of 837,869 individuals with early onset multimorbidity (aged between 16 and 39 years old when the second LTC was recorded) registered with an English general practice between 2010 and 2020. The study population included 777,906 people of White ethnicity (93%), 33,915 people of South Asian ethnicity (4%), and 26,048 people of Black African/Caribbean ethnicity (3%). A total of 204 LTCs were considered. Latent class analysis stratified by ethnicity identified 4 clusters of multimorbidity in White groups and 3 clusters in South Asian and Black groups. We found that early onset multimorbidity was more common among South Asian (59%, 33,915) and Black (56% 26,048) groups compared to the White population (42%, 777,906). Latent class analysis revealed physical and mental health conditions that were common across all ethnic groups (i.e., hypertension, depression, and painful conditions). However, each ethnic group also presented exclusive LTCs and different sociodemographic profiles: In White groups, the cluster with the highest rates/odds of the outcomes was predominantly male (54%, 44,150) and more socioeconomically deprived than the cluster with the lowest rates/odds of the outcomes. On the other hand, South Asian and Black groups were more socioeconomically deprived than White groups, with a consistent deprivation gradient across all multimorbidity clusters. At the end of the study, 4% (34,922) of the White early onset multimorbidity population had died compared to 2% of the South Asian and Black early onset multimorbidity populations (535 and 570, respectively); however, the latter groups died younger and lost more years of life. The 3 ethnic groups each displayed a cluster of individuals with increased rates of primary care consultations, hospitalisations, long-term prescribing, and odds of mortality. Study limitations include the exclusion of individuals with missing ethnicity information, the age of diagnosis not reflecting the actual age of onset, and the exclusion of people from Mixed, Chinese, and other ethnic groups due to insufficient power to investigate associations between multimorbidity and health-related outcomes in these groups. CONCLUSIONS These findings emphasise the need to identify, prevent, and manage multimorbidity early in the life course. Our work provides additional insights into the excess burden of early onset multimorbidity in those from socioeconomically deprived and diverse groups who are disproportionately and more severely affected by multimorbidity and highlights the need to ensure healthcare improvements are equitable.
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Affiliation(s)
- Fabiola Eto
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Miriam Samuel
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Rafael Henkin
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Meera Mahesh
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Tahania Ahmad
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Alisha Angdembe
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - R. Hamish McAllister-Williams
- Translational and Clinical Research Institute, Newcastle University, Newcastle, United Kingdom
- Northern Centre for Mood Disorders, Newcastle University, Newcastle, United Kingdom
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, United Kingdom
| | | | | | - Michael R. Barnes
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Sally Hull
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Sarah Finer
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Rohini Mathur
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Thompson A, Youn JH, Guthrie B, Hainsworth R, Donnan P, Rogers G, Morales D, Payne K. Quantifying the impact of taking medicines for primary prevention: a time-trade off study to elicit direct treatment disutility in the UK. BMJ Open 2023; 13:e063800. [PMID: 37734893 PMCID: PMC10514632 DOI: 10.1136/bmjopen-2022-063800] [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: 04/28/2022] [Accepted: 07/03/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Direct treatment disutility (DTD) represents an individual's disutility associated with the inconvenience of taking medicine over a long period of time. OBJECTIVES The main aim of this study was to elicit DTD values for taking a statin or a bisphosphonate for primary prevention. A secondary aim was to understand factors which influence DTD values. METHODS Design: We used a cross-sectional study consisting of time-trade off exercises embedded within online surveys. Respondents were asked to compare a one-off pill ('Medicine A') assumed to have no inconvenience and a daily pill ('Medicine B') over 10 years (statins) or 5 years (bisphosphonates).Setting: Individuals from National Health Service (NHS) primary care and the general population were surveyed using an online panel company.Participants: Two types of participants were recruited. First, a purposive sample of patients with experience of taking a statin (n=260) or bisphosphonate (n=100) were recruited from an NHS sampling frame. Patients needed to be aged over 30, have experience of taking the medicine of interest and have no diagnosis of dementia or of using dementia drugs. Second, a demographically balanced sample of members of the public were recruited for statins (n=376) and bisphosphonates (n=359).Primary and secondary outcome measures: Primary outcome was mean DTD. Regression analysis explored factors which could influence DTD values. RESULTS A total of 879 respondents were included for analysis (514 for statins and 365 for bisphosphonates). The majority of respondents reported a disutility associated with medicine use. Mean DTD for statins was 0.034 and for bisphosphonates 0.067, respectively. Respondent characteristics including age and sex did not influence DTD. Experience of bisphosphonate-use reduced reported disutilities. CONCLUSIONS Statins and bisphosphonates have a quantifiable DTD. The size of estimated disutilities suggest they are likely to be important for cost-effectiveness, particularly in individuals at low-risk when treated for primary prevention.
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Affiliation(s)
- Alexander Thompson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Ji-Hee Youn
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, University of Edinburgh, Edinburgh, UK
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Robert Hainsworth
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Peter Donnan
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, Dundee, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Daniel Morales
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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12
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Ye Y, Acevedo Mendez BA, Izard S, Myers AK. Demographic Variables Associated With Diabetes Technology Awareness or Use in Adults With Type 2 Diabetes. Diabetes Spectr 2023; 37:60-64. [PMID: 38385093 PMCID: PMC10877207 DOI: 10.2337/ds23-0013] [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: 02/23/2024]
Abstract
Background Studies in populations with type 1 diabetes highlight racial/ethnic disparities in the use of diabetes technology; however, little is known about disparities among those with type 2 diabetes. This project investigates the racial/ethnic and socioeconomic disparities in diabetes technology awareness and use in adults with type 2 diabetes in the ambulatory setting. Methods Adults ≥40 years of age with type 2 diabetes in ambulatory care were invited to participate via an e-mail link to a de-identified REDCap (Research Electronic Data Capture) questionnaire. Variables, including awareness and use of continuous glucose monitoring (CGM) and insulin pumps, were summarized descriptively using frequencies and percentages and were compared across racial/ethnic groups, education level, and income using Pearson χ2 or Fisher exact tests. Results The study included 116 participants, most of whom (62%) were White, elderly Medicare recipients. Compared with White participants, those of racially/ethnically minoritized groups were less likely to be aware of CGM (P = 0.013) or insulin pumps (P = 0.001). Participants with a high school education or less were also less likely to be aware of insulin pumps (P = 0.041). Interestingly, neither awareness nor use of CGM or insulin pumps was found to be associated with income. Conclusion This cross-sectional analysis suggests that racially/ethnically minoritized groups and individuals with lower education have less awareness of CGM or insulin pumps.
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Affiliation(s)
- Yuting Ye
- Department of Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Bernardo A. Acevedo Mendez
- Department of Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Stephanie Izard
- Quantitative Intelligence, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY
| | - Alyson K. Myers
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- Division of Endocrinology, Department of Medicine, Montefiore Einstein, Bronx, NY
- Albert Einstein College of Medicine, Bronx, NY
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13
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Galindo RJ, Trujillo JM, Low Wang CC, McCoy RG. Advances in the management of type 2 diabetes in adults. BMJ MEDICINE 2023; 2:e000372. [PMID: 37680340 PMCID: PMC10481754 DOI: 10.1136/bmjmed-2022-000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/27/2023] [Indexed: 09/09/2023]
Abstract
Type 2 diabetes is a chronic and progressive cardiometabolic disorder that affects more than 10% of adults worldwide and is a major cause of morbidity, mortality, disability, and high costs. Over the past decade, the pattern of management of diabetes has shifted from a predominantly glucose centric approach, focused on lowering levels of haemoglobin A1c (HbA1c), to a directed complications centric approach, aimed at preventing short term and long term complications of diabetes, and a pathogenesis centric approach, which looks at the underlying metabolic dysfunction of excess adiposity that both causes and complicates the management of diabetes. In this review, we discuss the latest advances in patient centred care for type 2 diabetes, focusing on drug and non-drug approaches to reducing the risks of complications of diabetes in adults. We also discuss the effects of social determinants of health on the management of diabetes, particularly as they affect the treatment of hyperglycaemia in type 2 diabetes.
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Affiliation(s)
- Rodolfo J Galindo
- Division of Endocrinology, Diabetes, and Metabolism, University of Miami Miller School of Medicine, Miami, Florida, USA
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jennifer M Trujillo
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cecilia C Low Wang
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Rozalina G McCoy
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- University of Maryland Institute for Health Computing, Bethesda, Maryland, USA
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14
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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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15
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Şat S, Aydınkoç-Tuzcu K, Berger F, Barakat A, Danquah I, Schindler K, Fasching P. Diabetes and Migration. Exp Clin Endocrinol Diabetes 2023; 131:319-337. [PMID: 37315566 DOI: 10.1055/a-1946-3878] [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: 06/16/2023]
Affiliation(s)
- Sebahat Şat
- MVZ DaVita Rhine-Ruhr, Düsseldorf, Germany
- German Diabetes Association (DDG) Working Group on Diabetes and Migrants
| | - Kadriye Aydınkoç-Tuzcu
- German Diabetes Association (DDG) Working Group on Diabetes and Migrants
- Wilhelminenspital of the City of Vienna, 5th Medical Department of Endocrinology, Rheumatology and Acute Geriatrics, Vienna, Austria
- Austrian Diabetes Association (ÖGD) Working Group on Migration and Diabetes
| | - Faize Berger
- German Diabetes Association (DDG) Working Group on Diabetes and Migrants
| | - Alain Barakat
- German Diabetes Association (DDG) Working Group on Diabetes and Migrants
- Diabetes Center Duisburg-Mitte (DZDM), Duisburg, Germany
| | - Ina Danquah
- German Diabetes Association (DDG) Working Group on Diabetes and Migrants
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Karin Schindler
- Austrian Diabetes Association (ÖGD) Working Group on Migration and Diabetes
- Medical University of Vienna, Department of Internal Medicine III, Clinical Department of Endocrinology and Metabolism, Vienna, Austria
| | - Peter Fasching
- Wilhelminenspital of the City of Vienna, 5th Medical Department of Endocrinology, Rheumatology and Acute Geriatrics, Vienna, Austria
- Austrian Diabetes Association (ÖGD) Working Group on Migration and Diabetes
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16
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Forbes L, Armes J, Shafi S, Mohamed A, Mustafa R, Dar O, Vandrevala T, Amlôt R, Hayward A, Asaria M, Pirani T, Weston D, Shah S, Zumla A, Ala A. Novel intervention to promote COVID-19 protective behaviours among Black and South Asian communities in the UK: protocol for a mixed-methods pilot evaluation. BMJ Open 2023; 13:e061207. [PMID: 37041047 PMCID: PMC10105914 DOI: 10.1136/bmjopen-2022-061207] [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] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION Culturally appropriate interventions to promote COVID-19 health protective measures among Black and South Asian communities in the UK are needed. We aim to carry out a preliminary evaluation of an intervention to reduce risk of COVID-19 comprising a short film and electronic leaflet. METHODS AND ANALYSIS This mixed methods study comprises (1) a focus group to understand how people from the relevant communities interpret and understand the intervention's messages, (2) a before-and-after questionnaire study examining the extent to which the intervention changes intentions and confidence to carry out COVID-19 protective behaviours and (3) a further qualitative study exploring the views of Black and South Asian people of the intervention and the experiences of health professionals offering the intervention. Participants will be recruited through general practices. Data collection will be carried out in the community. ETHICS AND DISSEMINATION The study received Health Research Authority approval in June 2021 (Research Ethics Committee Reference 21/LO/0452). All participants provided informed consent. As well as publishing the findings in peer-reviewed journals, we will disseminate the findings through the UK Health Security Agency, NHS England and the Office for Health Improvement and Disparities and ensure culturally appropriate messaging for participants and other members of the target groups.
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Affiliation(s)
- Lindsay Forbes
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Shuja Shafi
- Mass Gatherings and Global Health Network, Harrow, UK
| | - Amran Mohamed
- Department of Access and Medicine, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Reham Mustafa
- Department of Access and Medicine, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Osman Dar
- Global Public Health Directorate, UK Health Security Agency, London, UK
| | - Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University, London, UK
| | - Richard Amlôt
- Epidemiological and Behavioural Sciences Directorate, UK Health Security Agency, London, UK
| | - Andrew Hayward
- Epidemiology and Public Health, University College London, London, UK
| | - Miqdad Asaria
- Department of Health Policy, London School of Economics, London, UK
| | - Tasneem Pirani
- Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK
- School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Dale Weston
- Epidemiological and Behavioural Sciences Directorate, UK Health Security Agency, London, UK
| | | | - Alimuddin Zumla
- Infection and Immunity, University College London, London, UK
| | - Aftab Ala
- Gastroenterology and Hepatology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Institute of Liver Studies, King's College Hospital, London, UK
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17
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Cechin L, Campbell L, Oliveira A, Goff LM, Post FA. HbA1c screening for diabetes mellitus and to evaluate diabetic control in people of African ancestry with HIV in South London. Int J STD AIDS 2023:9564624231162163. [PMID: 36921326 DOI: 10.1177/09564624231162163] [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: 03/17/2023]
Abstract
We evaluated glycaemic status in 948 Black adults with HIV and report a high prevalence of dysglycaemia (37.2%). HbA1c testing identified 38 (4.0%) individuals not previously known to have diabetes mellitus (DM) and showed suboptimal or poor glycaemic control in more than half of those with a prior DM diagnosis despite high levels of HIV control.
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Affiliation(s)
- Laura Cechin
- 8948King's College Hospital NHS Foundation Trust, London, UK
| | - Lucy Campbell
- 8948King's College Hospital NHS Foundation Trust, London, UK
| | - Amelia Oliveira
- 8948King's College Hospital NHS Foundation Trust, London, UK
| | | | - Frank A Post
- 8948King's College Hospital NHS Foundation Trust, London, UK.,4616King's College London, London, UK
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18
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Gopalan A, Winn AN, Karter AJ, Laiteerapong N. Racial and Ethnic Differences in Medication Initiation Among Adults Newly Diagnosed with Type 2 Diabetes. J Gen Intern Med 2023; 38:994-1000. [PMID: 35927604 PMCID: PMC10039131 DOI: 10.1007/s11606-022-07746-4] [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: 05/31/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Given persistent racial/ethnic differences in type 2 diabetes outcomes and the lasting benefits conferred by early glycemic control, we examined racial/ethnic differences in diabetes medication initiation during the year following diagnosis. METHODS Among adults newly diagnosed with type 2 diabetes (2005-2016), we examined how glucose-lowering medication initiation differed by race/ethnicity during the year following diagnosis. We specified modified Poisson regression models to estimate the association between race/ethnicity and medication initiation in the entire cohort and within subpopulations defined by HbA1c, BMI, age at diagnosis, comorbidity, and neighborhood deprivation index (a census tract-level socioeconomic indicator). RESULTS Among the 77,199 newly diagnosed individuals, 47% started a diabetes medication within 12 months of diagnosis. The prevalence of medication initiation ranged from 32% among Chinese individuals to 58% among individuals of Other/Unknown races/ethnicities. Compared to White individuals, medication initiation was less likely among Chinese (relative risk: 0.78 (95% confidence interval 0.72, 0.84)) and Japanese (0.82 (0.75, 0.90)) individuals, but was more likely among Hispanic/Latinx (1.27 (1.24, 1.30)), African American (1.14 (1.11, 1.17)), other Asian (1.13 (1.08, 1.18)), South Asian (1.10 (1.04, 1.17)), Other/Unknown (1.31 (1.24, 1.39)), American Indian or Alaska Native (1.11 (1.04, 1.18)), and Native Hawaiian/Pacific Islander (1.28 (1.19, 1.37)) individuals. Racial/ethnic differences dissipated among individuals with higher HbA1c values. CONCLUSIONS Initiation of glucose-lowering treatment during the year following type 2 diabetes diagnosis differed markedly by race/ethnicity, particularly for those with lower HbA1c values. Future research should examine how patient preferences, provider implicit bias, and shared decision-making contribute to these early treatment differences.
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Affiliation(s)
- Anjali Gopalan
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Aaron N Winn
- Department of Clinical Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew J Karter
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
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19
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Holman H, Müller F, Bhangu N, Kottutt J, Alshaarawy O. Impact of limited English proficiency on the control of diabetes and associated cardiovascular risk factors. The National Health and Nutrition Examination Survey, 2003-2018. Prev Med 2023; 167:107394. [PMID: 36563970 DOI: 10.1016/j.ypmed.2022.107394] [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: 07/04/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
Language barriers pose a challenge to managing health conditions for various personal, interpersonal, and structural reasons. This study estimates the impact of limited English proficiency (LEP) on diabetes mellitus control and associated cardiovascular risk factors in a large representative sample of United States adults. Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES, 2003-18) was used to estimate the impact of language proficiency on glycemic control (glycated hemoglobin [HbA1c]) and cardiovascular risk status (blood pressure [BP] and low-density lipoprotein [LDL]) in adult participants with known diabetes disease. The analysis included descriptive statistics and generalized linear models to adjust for sociodemographic characteristics. The study sample included 5017 participants with self-reported, physician-diagnosed diabetes mellitus. Most participants completed NHANES interview in English (90.8%), whereas some participants completed the interview in Spanish (LEP-Spanish; 6.6%) or requested an interpreter (LEP-interpreter; 2.6%). Compared to English-speaking participants, LEP-interpreter participants were more likely to have HbA1c ≥ 7% (OR = 1.6, 95% CI = 1.1, 2.4) or a combination of HbA1c ≥ 7%, LDL ≥ 2.6 mmol/L, and BP ≥ 130/80 mmHg (OR = 3.1; 95% CI = 1.2, 8.2). We observed no differences in the odds of diabetes control. between English-speaking and LEP-Spanish participants, whereas LEP-interpreter participants had worse diabetes control, possibly owing to the greater likelihood of patient-provider language discordance for non-English non-Spanish-speaking patients. Given that many patients, yet few providers, speak languages other than English or Spanish, innovative ways are needed to facilitate patient-provider communications (e.g., digital communication assistance tools).
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Affiliation(s)
- Harland Holman
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Spectrum Health Family Medicine Residency Clinic, Grand Rapids, MI 49503, USA
| | - Frank Müller
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Spectrum Health Family Medicine Residency Clinic, Grand Rapids, MI 49503, USA; Department of General Practice, University Medical Center Göttingen, Germany.
| | - Nikita Bhangu
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Jepkoech Kottutt
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Omayma Alshaarawy
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
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20
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Hayanga B, Stafford M, Bécares L. Ethnic inequalities in multiple long-term health conditions in the United Kingdom: a systematic review and narrative synthesis. BMC Public Health 2023; 23:178. [PMID: 36703163 PMCID: PMC9879746 DOI: 10.1186/s12889-022-14940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 12/23/2022] [Indexed: 01/28/2023] Open
Abstract
Indicative evidence suggests that minoritised ethnic groups have higher risk of developing multiple long-term conditions (MLTCs), and do so earlier than the majority white population. While there is evidence on ethnic inequalities in single health conditions and comorbidities, no review has attempted to look across these from a MLTCs perspective. As such, we currently have an incomplete understanding of the extent of ethnic inequalities in the prevalence of MLTCs. Further, concerns have been raised about variations in the way ethnicity is operationalised and how this impedes our understanding of health inequalities. In this systematic review we aimed to 1) describe the literature that provides evidence of ethnicity and prevalence of MLTCs amongst people living in the UK, 2) summarise the prevalence estimates of MLTCs across ethnic groups and 3) to assess the ways in which ethnicity is conceptualised and operationalised. We focus on the state of the evidence prior to, and during the very early stages of the pandemic. We registered the protocol on PROSPERO (CRD42020218061). Between October and December 2020, we searched ASSIA, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, Web of Science, OpenGrey, and reference lists of key studies/reviews. The main outcome was prevalence estimates for MLTCs for at least one minoritised ethnic group, compared to the majority white population. We included studies conducted in the UK reporting on ethnicity and prevalence of MLTCs. To summarise the prevalence estimates of MLTCs across ethnic groups we included only studies of MLTCs that provided estimates adjusted at least for age. Two reviewers screened and extracted data from a random sample of studies (10%). Data were synthesised using narrative synthesis. Of the 7949 studies identified, 84 met criteria for inclusion. Of these, seven contributed to the evidence of ethnic inequalities in MLTCs. Five of the seven studies point to higher prevalence of MLTCs in at least one minoritised ethnic group compared to their white counterparts. Because the number/types of health conditions varied between studies and some ethnic populations were aggregated or omitted, the findings may not accurately reflect the true level of ethnic inequality. Future research should consider key explanatory factors, including those at the macrolevel (e.g. racism, discrimination), as they may play a role in the development and severity of MLTCs in different ethnic groups. Research is also needed to ascertain the extent to which the COVID19 pandemic has exacerbated these inequalities.
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Affiliation(s)
- Brenda Hayanga
- Department of Global Health and Social Medicine, King’s College London, Bush House, North East Wing, 40 Aldwych, London, WC2B 4BG UK
| | - Mai Stafford
- The Health Foundation, 8 Salisbury Square, London, EC4Y 8AP UK
| | - Laia Bécares
- Department of Global Health and Social Medicine, King’s College London, Bush House, North East Wing, 40 Aldwych, London, WC2B 4BG UK
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21
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Dawed AY, Haider E, Pearson ER. Precision Medicine in Diabetes. Handb Exp Pharmacol 2023; 280:107-129. [PMID: 35704097 DOI: 10.1007/164_2022_590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Tailoring treatment or management to groups of individuals based on specific clinical, molecular, and genomic features is the concept of precision medicine. Diabetes is highly heterogenous with respect to clinical manifestations, disease progression, development of complications, and drug response. The current practice for drug treatment is largely based on evidence from clinical trials that report average effects. However, around half of patients with type 2 diabetes do not achieve glycaemic targets despite having a high level of adherence and there are substantial differences in the incidence of adverse outcomes. Therefore, there is a need to identify predictive markers that can inform differential drug responses at the point of prescribing. Recent advances in molecular genetics and increased availability of real-world and randomised trial data have started to increase our understanding of disease heterogeneity and its impact on potential treatments for specific groups. Leveraging information from simple clinical features (age, sex, BMI, ethnicity, and co-prescribed medications) and genomic markers has a potential to identify sub-groups who are likely to benefit from a given drug with minimal adverse effects. In this chapter, we will discuss the state of current evidence in the discovery of clinical and genetic markers that have the potential to optimise drug treatment in type 2 diabetes.
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Affiliation(s)
- Adem Y Dawed
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Eram Haider
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Ewan R Pearson
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK.
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22
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Aydınkoç-Tuzcu K, Şat S, Berger F, Barakat A, Danquah I, Schindler K, Fasching P. [Diabetes and migration (update 2023)]. Wien Klin Wochenschr 2023; 135:286-306. [PMID: 37101050 DOI: 10.1007/s00508-023-02175-7] [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: 02/22/2023] [Indexed: 04/28/2023]
Abstract
The practice recommendation is intended to supplement the existing guidelines on diabetes mellitus and provides practical recommendations for the diagnosis, therapy and care of people with diabetes mellitus who come from different linguistic and cultural back-grounds. The article deals with the demographic datas of migration in Austria and Germany; with therapeutic advice concerning drug therapy and diabetes education for patients with migration background. In this context socio-cultural spezifics are discussed. These suggestions are seen complementary to the general treatment guidelines of the Austrian Diabetes Society and German Diabetes Society. Especially for the fast months Ramadan thera are a lot of informations. The most important point is that the patient care must highly individualized and the management plan may differ for each patient.
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Affiliation(s)
- Kadriye Aydınkoç-Tuzcu
- AG Diabetes und Migranten der DDG, Berlin, Deutschland.
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich.
- AG Migration und Diabetes der ÖDG, Wien, Deutschland.
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Montlearstraße 37, 1160, Wien, Österreich.
| | - Sebahat Şat
- MVZ DaVita Rhein-Ruhr, Düsseldorf, Deutschland
- AG Diabetes und Migranten der DDG, Berlin, Deutschland
- MVZ DaVita Nieren- und Dialysezentrum, Bismarckstraße, Düsseldorf, Deutschland
| | - Faize Berger
- AG Diabetes und Migranten der DDG, Berlin, Deutschland.
- AG Diabetes und Migranten der DDG, Deutsche Diabetes Gesellschaft (DDG), Albrechtstr. 9, 10117, Berlin, Deutschland.
| | - Alain Barakat
- AG Diabetes und Migranten der DDG, Berlin, Deutschland
- Diabetes Zentrum Duisburg-Mitte DZDM, Duisburg, Deutschland
| | - Ina Danquah
- AG Diabetes und Migranten der DDG, Berlin, Deutschland
- Heidelberger Institut für Global Health (HIGH), Medizinische Fakultät und Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - Karin Schindler
- Universitätsklinik für Innere Medizin III, Klinische Abteilung für Endokrinologie und Stoffwechsel, Medizinische Universität Wien, Wien, Österreich
- AG Migration und Diabetes der ÖDG, Wien, Deutschland
| | - Peter Fasching
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
- AG Migration und Diabetes der ÖDG, Wien, Deutschland
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23
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Bidulka P, Mathur R, Lugo-Palacios DG, O'Neill S, Basu A, Silverwood RJ, Charlton P, Briggs A, Smeeth L, Adler AI, Douglas IJ, Khunti K, Grieve R. Ethnic and socioeconomic disparities in initiation of second-line antidiabetic treatment for people with type 2 diabetes in England: A cross-sectional study. Diabetes Obes Metab 2023; 25:282-292. [PMID: 36134467 PMCID: PMC10092566 DOI: 10.1111/dom.14874] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/06/2022] [Accepted: 09/18/2022] [Indexed: 12/14/2022]
Abstract
AIMS To assess any disparities in the initiation of second-line antidiabetic treatments prescribed among people with type 2 diabetes mellitus (T2DM) in England according to ethnicity and social deprivation level. MATERIALS AND METHODS This cross-sectional study used linked primary (Clinical Practice Research Datalink) and secondary care data (Hospital Episode Statistics), and the Index of Multiple Deprivation (IMD). We included people aged 18 years or older with T2DM who intensified to second-line oral antidiabetic medication between 2014 and 2020 to investigate disparities in second-line antidiabetic treatment prescribing (one of sulphonylureas [SUs], dipeptidyl peptidase-4 [DPP-4] inhibitors, or sodium-glucose cotransporter-2 [SGLT2] inhibitors, in combination with metformin) by ethnicity (White, South Asian, Black, mixed/other) and deprivation level (IMD quintiles). We report prescriptions of the alternative treatments by ethnicity and deprivation level according to predicted percentages derived from multivariable, multinomial logistic regression. RESULTS Among 36 023 people, 85% were White, 10% South Asian, 4% Black and 1% mixed/other. After adjustment, the predicted percentages for SGLT2 inhibitor prescribing by ethnicity were 21% (95% confidence interval [CI] 19-23%), 20% (95% CI 18-22%), 19% (95% CI 16-22%) and 17% (95% CI 14-21%) among people with White, South Asian, Black, and mixed/other ethnicity, respectively. After adjustment, the predicted percentages for SGLT2 inhibitor prescribing by deprivation were 22% (95% CI 20-25%) and 19% (95% CI 17-21%) for the least deprived and the most deprived quintile, respectively. When stratifying by prevalent cardiovascular disease (CVD) status, we found lower predicted percentages of people with prevalent CVD prescribed SGLT2 inhibitors compared with people without prevalent CVD across all ethnicity groups and all levels of social deprivation. CONCLUSIONS Among people with T2DM, there were no substantial differences by ethnicity or deprivation level in the percentage prescribed either SGLT2 inhibitors, DPP-4 inhibitors or SUs as second-line antidiabetic treatment.
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Affiliation(s)
- Patrick Bidulka
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - David G Lugo-Palacios
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen O'Neill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anirban Basu
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle, Washington
| | - Richard J Silverwood
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - Paul Charlton
- Patient Research Champion Team, National Institute for Health Research, Twickenham, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Amanda I Adler
- Diabetes Trials Unit, The Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Headington, UK
| | - Ian J Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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24
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Khunti K, Aroda VR, Aschner P, Chan JCN, Del Prato S, Hambling CE, Harris S, Lamptey R, McKee M, Tandon N, Valabhji J, Seidu S. The impact of the COVID-19 pandemic on diabetes services: planning for a global recovery. Lancet Diabetes Endocrinol 2022; 10:890-900. [PMID: 36356612 PMCID: PMC9640202 DOI: 10.1016/s2213-8587(22)00278-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/01/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022]
Abstract
The COVID-19 pandemic has disproportionately affected certain groups, such as older people (ie, >65 years), minority ethnic populations, and people with specific chronic conditions including diabetes, cardiovascular disease, kidney disease, and some respiratory diseases. There is now evidence of not only direct but also indirect adverse effects of COVID-19 in people with diabetes. Recurrent lockdowns and public health measures throughout the pandemic have restricted access to routine diabetes care, limiting new diagnoses, and affecting self-management, routine follow-ups, and access to medications, as well as affecting lifestyle behaviours and emotional wellbeing globally. Pre-pandemic studies have shown that short-term delays in delivery of routine care, even by 12 months, are associated with adverse effects on risk factor control and worse microvascular, macrovascular, and mortality outcomes in people with diabetes. Disruptions within the short-to-medium term due to natural disasters also result in worse diabetes outcomes. However, the true magnitude of the indirect effects of the COVID-19 pandemic on long-term outcomes and mortality in people with diabetes is still unclear. Disasters tend to exacerbate existing health disparities; as we recover ambulatory diabetes services in the aftermath of the pandemic, there is an opportunity to prioritise those with the greatest need, and to target resources and interventions aimed at improving outcomes and reducing inequality.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK; NIHR Applied Research Collaboration East Midlands, Leicester, UK.
| | | | - Pablo Aschner
- Asociación Colombiana de Diabetes, Bogotá, Colombia; Oficina de Investigaciones, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Stefano Del Prato
- Diabetology Divisions, Pisa University Hospital, University of Pisa, Pisa, Italy
| | | | - Stewart Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Roberta Lamptey
- Department of Family Medicine, Korle Bu Teaching Hospital, Accra, Ghana; Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Jonathan Valabhji
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; NHS England, London, UK; NHS Improvement, London, UK; Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Samuel Seidu
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK; NIHR Applied Research Collaboration East Midlands, Leicester, UK
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25
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Knight R, Walker V, Ip S, Cooper JA, Bolton T, Keene S, Denholm R, Akbari A, Abbasizanjani H, Torabi F, Omigie E, Hollings S, North TL, Toms R, Jiang X, Angelantonio ED, Denaxas S, Thygesen JH, Tomlinson C, Bray B, Smith CJ, Barber M, Khunti K, Davey Smith G, Chaturvedi N, Sudlow C, Whiteley WN, Wood AM, Sterne JA. Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales. Circulation 2022; 146:892-906. [PMID: 36121907 PMCID: PMC9484653 DOI: 10.1161/circulationaha.122.060785] [Citation(s) in RCA: 107] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear. METHODS We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January 1 to December 7, 2020. We estimated adjusted hazard ratios comparing the incidence of arterial thromboses and venous thromboembolic events (VTEs) after diagnosis of COVID-19 with the incidence in people without a COVID-19 diagnosis. We conducted subgroup analyses by COVID-19 severity, demographic characteristics, and previous history. RESULTS Among 48 million adults, 125 985 were hospitalized and 1 319 789 were not hospitalized within 28 days of COVID-19 diagnosis. In England, there were 260 279 first arterial thromboses and 59 421 first VTEs during 41.6 million person-years of follow-up. Adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 (95% CI, 21.0-22.4) in week 1 after COVID-19 diagnosis to 1.34 (95% CI, 1.21-1.48) during weeks 27 to 49. Adjusted hazard ratios for first VTE after COVID-19 diagnosis declined from 33.2 (95% CI, 31.3-35.2) in week 1 to 1.80 (95% CI, 1.50-2.17) during weeks 27 to 49. Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event. The estimated whole-population increases in risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7200 and 3500 additional events, respectively, after 1.4 million COVID-19 diagnoses. CONCLUSIONS High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs. However, incidence remains elevated up to 49 weeks after COVID-19 diagnosis. These results support policies to prevent severe COVID-19 by means of COVID-19 vaccines, early review after discharge, risk factor control, and use of secondary preventive agents in high-risk patients.
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Affiliation(s)
- Rochelle Knight
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- NIHR Bristol Biomedical Research Centre, UK (R.K., J.A.C., R.D., J.A.C.S.)
- NIHR Applied Research Collaboration West, Bristol, UK (R.K.)
- MRC Integrative Epidemiology Unit, Bristol, UK (R.K., V.W., G.D.S.)
| | - Venexia Walker
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- MRC Integrative Epidemiology Unit, Bristol, UK (R.K., V.W., G.D.S.)
| | - Samantha Ip
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Centre for Cancer Genetic Epidemiology (S.I.), University of Cambridge, UK
| | - Jennifer A. Cooper
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- NIHR Bristol Biomedical Research Centre, UK (R.K., J.A.C., R.D., J.A.C.S.)
| | - Thomas Bolton
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics (T.B., S.K., E.D.A., A.M.W.), University of Cambridge, UK
- British Heart Foundation Data Science Centre (T.B., C.S.), London
| | - Spencer Keene
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics (T.B., S.K., E.D.A., A.M.W.), University of Cambridge, UK
| | - Rachel Denholm
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- NIHR Bristol Biomedical Research Centre, UK (R.K., J.A.C., R.D., J.A.C.S.)
- Health Data Research UK South-West, Bristol (R.D., J.A.C.S.)
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, Wales, UK (A.A., H.A., F.T.)
| | - Hoda Abbasizanjani
- Population Data Science, Swansea University Medical School, Swansea University, Wales, UK (A.A., H.A., F.T.)
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea University, Wales, UK (A.A., H.A., F.T.)
| | - Efosa Omigie
- National Health Service Digital, Leeds, UK (E.O., S.H.)
| | - Sam Hollings
- National Health Service Digital, Leeds, UK (E.O., S.H.)
| | - Teri-Louise North
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
| | - Renin Toms
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- School of Health Sciences, Cardiff Metropolitan University, UK (R.T.)
| | - Xiyun Jiang
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics (T.B., S.K., E.D.A., A.M.W.), University of Cambridge, UK
- British Heart Foundation Centre of Research Excellence (E.D.A., A.M.W.), University of Cambridge, UK
- Wellcome Genome Campus, Health Data Research UK Cambridge (E.D.A., A.M.W.)
| | - Spiros Denaxas
- Health Data Research UK (S.D.), London
- Institute of Health Informatics (S.D., J.H.T., C.T.), University College London, UK
- University College London Hospitals Biomedical Research Centre (C.T., S.D.), University College London, UK
- BHF Accelerator, London, UK (S.D.)
| | - Johan H. Thygesen
- Institute of Health Informatics (S.D., J.H.T., C.T.), University College London, UK
| | - Christopher Tomlinson
- Institute of Health Informatics (S.D., J.H.T., C.T.), University College London, UK
- UK Research and Innovation Centre for Doctoral Training in AI-Enabled Healthcare Systems (C.T.), University College London, UK
- University College London Hospitals Biomedical Research Centre (C.T., S.D.), University College London, UK
| | - Ben Bray
- School of Population Health and Environmental Sciences, King’s College London, UK (B.B.)
| | - Craig J. Smith
- Geoffrey Jefferson Brain Research Centre, Manchester Centre for Clinical Neurosciences, Northern Care Alliance National Health Service Foundation Trust, Salford Royal Hospital, UK (C.J.S.)
- Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, UK (C.J.S.)
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, UK (K.K.)
| | - George Davey Smith
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- MRC Integrative Epidemiology Unit, Bristol, UK (R.K., V.W., G.D.S.)
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science (N.C.), University College London, UK
| | - Cathie Sudlow
- British Heart Foundation Data Science Centre (T.B., C.S.), London
| | - William N. Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, UK (W.N.W.)
- Nuffield Department of Population Health, University of Oxford, UK (W.N.W.)
| | - Angela M. Wood
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics (T.B., S.K., E.D.A., A.M.W.), University of Cambridge, UK
- British Heart Foundation Centre of Research Excellence (E.D.A., A.M.W.), University of Cambridge, UK
- Wellcome Genome Campus, Health Data Research UK Cambridge (E.D.A., A.M.W.)
- NIHR Cambridge Biomedical Research Centre, UK (A.M.W.)
- Cambridge Centre for AI in Medicine, UK (A.M.W.)
| | - Jonathan A.C. Sterne
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- NIHR Bristol Biomedical Research Centre, UK (R.K., J.A.C., R.D., J.A.C.S.)
- Health Data Research UK South-West, Bristol (R.D., J.A.C.S.)
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26
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Associations between multiple long-term conditions and mortality in diverse ethnic groups. PLoS One 2022; 17:e0266418. [PMID: 35363804 PMCID: PMC8974956 DOI: 10.1371/journal.pone.0266418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Multiple conditions are more prevalent in some minoritised ethnic groups and are associated with higher mortality rate but studies examining differential mortality once conditions are established is US-based. Our study tested whether the association between multiple conditions and mortality varies across ethnic groups in England. Methods and findings A random sample of primary care patients from Clinical Practice Research Datalink (CPRD) was followed from 1st January 2015 until 31st December 2019. Ethnicity, usually self-ascribed, was obtained from primary care records if present or from hospital records. Long-term conditions were counted from a list of 32 that have previously been associated with greater primary care, hospital admissions, or mortality risk. Cox regression models were used to estimate mortality by count of conditions, ethnicity and their interaction, with adjustment for age and sex for 532,059 patients with complete data. During five years of follow-up, 5.9% of patients died. Each additional condition at baseline was associated with increased mortality. The direction of the interaction of number of conditions with ethnicity showed a statistically higher mortality rate associated with long-term conditions in Pakistani, Black African, Black Caribbean and Other Black ethnic groups. In ethnicity-stratified models, the mortality rate per additional condition at age 50 was 1.33 (95% CI 1.31,1.35) for White ethnicity, 1.43 (95% CI 1.26,1.61) for Black Caribbean ethnicity and 1.78 (95% CI 1.41,2.24) for Other Black ethnicity. Conclusions The higher mortality rate associated with having multiple conditions is greater in minoritised compared with White ethnic groups. Research is now needed to identify factors that contribute to these inequalities. Within the health care setting, there may be opportunities to target clinical and self-management support for people with multiple conditions from minoritised ethnic groups.
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27
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Diabetes und Migration. DIABETOLOGE 2022. [DOI: 10.1007/s11428-022-00865-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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28
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Yan X, Stewart WF, Husby H, Delatorre-Reimer J, Mudiganti S, Refai F, Hudnut A, Knobel K, MacDonald K, Sifakis F, Jones JB. Persistent Cardiometabolic Health Gaps: Can Therapeutic Care Gaps Be Precisely Identified from Electronic Health Records. Healthcare (Basel) 2021; 10:70. [PMID: 35052233 PMCID: PMC8775887 DOI: 10.3390/healthcare10010070] [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] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to determine the strengths and limitations of using structured electronic health records (EHR) to identify and manage cardiometabolic (CM) health gaps. We used medication adherence measures derived from dispense data to attribute related therapeutic care gaps (i.e., no action to close health gaps) to patient- (i.e., failure to retrieve medication or low adherence) or clinician-related (i.e., failure to initiate/titrate medication) behavior. We illustrated how such data can be used to manage health and care gaps for blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), and HbA1c for 240,582 Sutter Health primary care patients. Prevalence of health gaps was 44% for patients with hypertension, 33% with hyperlipidemia, and 57% with diabetes. Failure to retrieve medication was common; this patient-related care gap was highly associated with health gaps (odds ratios (OR): 1.23-1.76). Clinician-related therapeutic care gaps were common (16% for hypertension, and 40% and 27% for hyperlipidemia and diabetes, respectively), and strongly related to health gaps for hyperlipidemia (OR = 5.8; 95% CI: 5.6-6.0) and diabetes (OR = 5.7; 95% CI: 5.4-6.0). Additionally, a substantial minority of care gaps (9% to 21%) were uncertain, meaning we lacked evidence to attribute the gap to either patients or clinicians, hindering efforts to close the gaps.
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Affiliation(s)
- Xiaowei Yan
- Sutter Center for Health System Research, 2121 N. California Blvd, Suite 310, Walnut Creek, CA 94596, USA; (H.H.); (S.M.); (J.B.J.)
| | | | - Hannah Husby
- Sutter Center for Health System Research, 2121 N. California Blvd, Suite 310, Walnut Creek, CA 94596, USA; (H.H.); (S.M.); (J.B.J.)
| | - Jake Delatorre-Reimer
- Formerly Sutter Health Research, 2121 N. California Blvd, Suite 310, Walnut Creek, CA 94596, USA; (J.D.-R.); (F.R.)
| | - Satish Mudiganti
- Sutter Center for Health System Research, 2121 N. California Blvd, Suite 310, Walnut Creek, CA 94596, USA; (H.H.); (S.M.); (J.B.J.)
| | - Farah Refai
- Formerly Sutter Health Research, 2121 N. California Blvd, Suite 310, Walnut Creek, CA 94596, USA; (J.D.-R.); (F.R.)
| | | | - Kevin Knobel
- Sutter Gould Medical Foundation, Modesto, CA 95355, USA;
| | - Karen MacDonald
- Formerly AstraZeneca, Wilmington, DE 19897, USA; (K.M.); (F.S.)
| | | | - James B. Jones
- Sutter Center for Health System Research, 2121 N. California Blvd, Suite 310, Walnut Creek, CA 94596, USA; (H.H.); (S.M.); (J.B.J.)
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29
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Catherine JP, Russell MV, Peter CH. The impact of race and socioeconomic factors on paediatric diabetes. EClinicalMedicine 2021; 42:101186. [PMID: 34805811 PMCID: PMC8585622 DOI: 10.1016/j.eclinm.2021.101186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/12/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022] Open
Abstract
There are over 29,000 children and young people (CYP) with Type 1 diabetes mellitus (T1DM) in England and Wales and another 726 with Type 2 diabetes mellitus (T2DM). There is little effect of deprivation on the prevalence of T1DM whereas the association of deprivation on the percentage of CYP with T2DM is striking with 45% of cases drawn from the most deprived backgrounds. A number that has not changed over the last 4 years. Data from the UK and USA as well as other countries demonstrate the impact of deprivation on outcomes in diabetes mellitus with clear effects on measures of long-term control and complications. In the UK black CYP had higher glycosylated haemoglobin (HbA1c) values compared to other groups. Within the black group, CYP from a Caribbean background had a higher mean HbA1c (77.0 mmol/mol (9.2%)) than those from Africa (70.4 mmol/mol (8.6%)). Treatment regimen (multiple daily injections or insulin pump therapy) explained the largest proportion of the variability in HbA1c followed by deprivation. Those in the least deprived areas had an average HbA1c 5.88 mmol/mol (0.5%) lower than those living in the most deprived areas. The picture is complex as UK data also show that deprivation and ethnicity is associated with less use of technology that is likely to improve diabetes control. Increased usage of pump therapy and continuous glucose monitoring was associated with a younger age of patient (less than 10 years of age), living in the least deprived areas and white ethnicity. This gap between pump usage amongst CYP with T1DM living in the most and least deprived areas has widened with time. In 2014/15 the gap was 7.9% and by 2018/19 had increased to 13.5%. To attain an equitable service for CYP with diabetes mellitus we need to consider interventions at the patient, health care professional, community, and health care system levels.
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30
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Chudasama YV, Zaccardi F, Coles B, Gillies CL, Hvid C, Seidu S, Davies MJ, Khunti K. Ethnic, social and multimorbidity disparities in therapeutic inertia: A UK primary care observational study in patients newly diagnosed with type 2 diabetes. Diabetes Obes Metab 2021; 23:2437-2445. [PMID: 34189827 DOI: 10.1111/dom.14482] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 01/16/2023]
Abstract
AIM To investigate factors associated with delays in receiving glucose-lowering therapy in patients newly diagnosed with type 2 diabetes mellitus (T2DM), and explore the preferential order and time of intensifications. MATERIALS AND METHODS Retrospective cohort study including 120 409 adults with T2DM initiating first- to fourth-line glucose-lowering therapy in primary care between 2000 and 2018, using the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics, Office of National Statistics death registration, and 2007 Index of Multiple Deprivation data. Associations were investigated using time-to-event analysis. RESULTS The longest delays to prescription of first-line therapy were observed in older patients, of black or other ethnicities, and with multimorbidity. People from the most deprived areas received earlier first-line treatment than those from the least deprived areas. The majority were treated with metformin (82.4%) as the first-line prescription, sulphonylurea (50.4%) as second-line, dipeptidyl peptidase-4 inhibitor (27.7%) as third-line, and insulin (28.0%) as fourth-line. In the past 5 years, there was an increase in prescriptions of dipeptidyl peptidase-4-inhibitor and sodium-glucose transport protein-2 inhibitor. The median time was 0.5 years for first-line prescription, 4.1 for second-line, 4.6 for third-line and 4.7 for fourth-line. After T2DM diagnosis, 25% of patients developed cardiovascular disease and non-cardiovascular disease complications within a median time of 12-14 years, and received intensification 5-6 years later. CONCLUSIONS Within the complex challenges of managing blood glucose levels and risk of additional comorbidities, future health care research and guidelines should focus on overcoming therapeutic inertia particularly at an earlier stage for older patients, from ethnic minorities and with multimorbidities.
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Affiliation(s)
- Yogini V Chudasama
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Briana Coles
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Clare L Gillies
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Christian Hvid
- Novo Nordisk Region Europe Pharmaceuticals A/S, Københav, Denmark
| | - Samuel Seidu
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre, Leicester Diabetes Centre, Leicester, UK
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
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Şat S, Aydınkoç-Tuzcu K, Berger F, Barakat A, Schindler K, Fasching P. Diabetes und Migration. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1507-2545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sebahat Şat
- MVZ DaVita Rhein-Ruhr, Düsseldorf
- AG Diabetes und Migranten der DDG
| | - Kadriye Aydınkoç-Tuzcu
- AG Diabetes und Migranten der DDG
- Wilhelminenspital der Stadt Wien, 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wien
- AG Migration und Diabetes der ÖDG
| | | | - Alain Barakat
- AG Diabetes und Migranten der DDG
- Diabetes Zentrum Duisburg-Mitte DZDM
| | - Karin Schindler
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Endokrinologie und Stoffwechsel, Wien
- AG Migration und Diabetes der ÖDG
| | - Peter Fasching
- Wilhelminenspital der Stadt Wien, 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wien
- AG Migration und Diabetes der ÖDG
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Tran AT, Berg TJ, Mdala I, Gjelsvik B, Cooper JG, Sandberg S, Claudi T, Jenum AK. Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA 1c in type 2 diabetes in norwegian general practice. Diabet Med 2021; 38:e14500. [PMID: 33354827 PMCID: PMC8359382 DOI: 10.1111/dme.14500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/11/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022]
Abstract
AIMS To identify individual and general practitioner (GP) characteristics associated with potential over- and undertreatment of hyperglycaemia in type 2 diabetes and with HbA1c not being measured. METHODS A cross-sectional study that included 10233 individuals with type 2 diabetes attending 282 GPs. Individuals with an HbA1c measurement during the last 15 months were categorized as potentially overtreated if they were prescribed a sulphonylurea and/or insulin when the HbA1c was less than 53 mmol/mol (7%) when aged over 75 years or less than 48 mmol/mol (6.5%) when aged between 65 and 75 years. Potential undertreatment was defined as age less than 60 years and HbA1c > 64 mmol/mol (8.0%) or HbA1c > 69 mmol/mol (8.5%) and treated with lifestyle modification and/or monotherapy. We used multilevel binary and multinominal logistic regression models to examine associations. RESULTS Overall, 4.1% were potentially overtreated, 7.8% were potentially undertreated and 11% did not have HbA1c measured. Characteristics associated with potential overtreatment were as follows: long diabetes duration, prescribed antihypertensive medication, cardiovascular disease and renal failure. Potential undertreatment was associated with male gender, non-western origin and low educational level. Characteristics associated with not having an HbA1c measurement performed were male gender, age < 50 years and cardiovascular diseases. GP specialist status and GPs' use of a Noklus diabetes application reduced the risk of not having an HbA1c measurement performed. CONCLUSION Potential overtreatment in elderly individuals with type 2 diabetes was relatively low. Nevertheless, appropriate de-intensification or intensification of treatment and regular HbA1c measurement in identified subgroups is warranted.
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Affiliation(s)
- Anh T. Tran
- Department of General PracticeInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Tore J. Berg
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
| | - Ibrahimu Mdala
- Department of General PracticeInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Bjørn Gjelsvik
- Department of General PracticeInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - John G. Cooper
- Norwegian Quality Improvement of Laboratory ExaminationsHaraldsplass Deaconess HospitalBergenNorway
- Department of MedicineStavanger University HospitalStavangerNorway
| | - Sverre Sandberg
- Norwegian Quality Improvement of Laboratory ExaminationsHaraldsplass Deaconess HospitalBergenNorway
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
- Department of Clinical Biochemistry and PharmacologyHaukeland University HospitalBergenNorway
| | - Tor Claudi
- Department of MedicineNordland HospitalBodøNorway
| | - Anne K. Jenum
- Department of General PracticeInstitute of Health and SocietyUniversity of OsloOsloNorway
- General Practice Research Unit (AFE)Department of General PracticeInstitute of Health and Society, University of OsloOsloNorway
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Alloh F, Hemingway A, Turner-Wilson A. The Role of Finding Out in Type 2 Diabetes Management among West-African Immigrants Living in the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6037. [PMID: 34199708 PMCID: PMC8199992 DOI: 10.3390/ijerph18116037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 01/29/2023]
Abstract
Type 2 diabetes (T2DM) prevalence is three times higher among West African Immigrants compared to the general population in the UK. The challenges of managing T2DM among this group have resulted in complications. Reports have highlighted the impact of migration on the health of the immigrant population, and this has contributed to the need to understand the influence of living in West Africa, and getting diagnosed with T2DM, in the management of their condition in the UK. Using a qualitative constructivist grounded theory approach, thirty-four West African immigrants living in the UK were recruited for this study. All participants were interviewed using Semi-structured interviews. After coding transcripts, concepts emerged including noticing symptoms, delayed diagnosis, affordability of health services, beliefs about health, feelings at diagnosis, and emotions experienced at diagnosis all contribute to finding out about diagnosis T2DM. These factors were linked to living in West Africa, among participants, and played significant roles in managing T2DM in the UK. These concepts were discussed under finding out as the overarching concept. Findings from this study highlight important aspects of T2DM diagnosis and how lived experiences, of living in West Africa and the UK, contribute to managing T2DM among West African immigrants. The findings of this study can be valuable for healthcare services supporting West African immigrants living in the UK.
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Affiliation(s)
- Folashade Alloh
- Department of Allied and Public Health Professions, School of Health, Sport and Bioscience, University of East London, London E15 4LZ, UK
| | - Ann Hemingway
- Department of Public Health and Human Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK; (A.H.); (A.T.-W.)
| | - Angela Turner-Wilson
- Department of Public Health and Human Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK; (A.H.); (A.T.-W.)
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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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35
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Kamel Boulos MN, Koh K. Smart city lifestyle sensing, big data, geo-analytics and intelligence for smarter public health decision-making in overweight, obesity and type 2 diabetes prevention: the research we should be doing. Int J Health Geogr 2021; 20:12. [PMID: 33658039 PMCID: PMC7926080 DOI: 10.1186/s12942-021-00266-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The public health burden caused by overweight, obesity (OO) and type-2 diabetes (T2D) is very significant and continues to rise worldwide. The causation of OO and T2D is complex and highly multifactorial rather than a mere energy intake (food) and expenditure (exercise) imbalance. But previous research into food and physical activity (PA) neighbourhood environments has mainly focused on associating body mass index (BMI) with proximity to stores selling fresh fruits and vegetables or fast food restaurants and takeaways, or with neighbourhood walkability factors and access to green spaces or public gym facilities, making largely naive, crude and inconsistent assumptions and conclusions that are far from the spirit of 'precision and accuracy public health'. Different people and population groups respond differently to the same food and PA environments, due to a myriad of unique individual and population group factors (genetic/epigenetic, metabolic, dietary and lifestyle habits, health literacy profiles, screen viewing times, stress levels, sleep patterns, environmental air and noise pollution levels, etc.) and their complex interplays with each other and with local food and PA settings. Furthermore, the same food store or fast food outlet can often sell or serve both healthy and non-healthy options/portions, so a simple binary classification into 'good' or 'bad' store/outlet should be avoided. Moreover, appropriate physical exercise, whilst essential for good health and disease prevention, is not very effective for weight maintenance or loss (especially when solely relied upon), and cannot offset the effects of a bad diet. The research we should be doing in the third decade of the twenty-first century should use a systems thinking approach, helped by recent advances in sensors, big data and related technologies, to investigate and consider all these factors in our quest to design better targeted and more effective public health interventions for OO and T2D control and prevention.
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Affiliation(s)
- Maged N. Kamel Boulos
- School of Information Management, Sun Yat-Sen University, East Campus, Guangzhou, 510006 Guangdong China
| | - Keumseok Koh
- Department of Geography, The University of Hong Kong, Pokfulam RD, Hong Kong, China
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