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Firima E, Gonzalez L, Ursprung F, Robinson E, Huber J, Belus JM, Raeber F, Gupta R, Deen GF, Amstutz A, Leigh B, Weisser M, Labhardt ND. Community-based models of care for management of type 2 diabetes mellitus among non-pregnant adults in sub-Saharan Africa: A scoping review. PLoS One 2023; 18:e0278353. [PMID: 37967126 PMCID: PMC10651052 DOI: 10.1371/journal.pone.0278353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/25/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION The prevalence of type 2 diabetes mellitus (T2DM) and associated morbidity and mortality are increasing in sub-Saharan Africa (SSA). To facilitate access to quality care and improve treatment outcomes, there is a need for innovative community care models and optimized use of non-physician healthcare workers bringing diagnosis and care closer to patients' homes. AIM We aimed to describe with a scoping review different models of community-based care for non-pregnant adults with T2DM in SSA, and to synthesize the outcomes in terms of engagement in care, blood sugar control, acceptability, and end-organ damage. We further aimed to critically appraise the different models of care and compare community-based to facility-based care if data were available. METHODS We searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus, supplemented with backward and forward citation searches. We included cohort studies, randomized trials and case-control studies that reported on non-pregnant individuals diagnosed with T2DM in SSA, who received a substantial part of care in the community. Only studies which reported at least one of our outcomes of interest were included. A narrative analysis was done, and comparisons made between community-based and facility-based models, where within-study comparison was reported. RESULTS We retrieved 5,335 unique studies, four of which met our inclusion criteria. Most studies were excluded because interventions were facility-based; community care interventions described in the studies were only add-on features of a primarily facility-based care; and studies did not report outcomes of interest. The included studies reported on a total of 383 individuals with T2DM. Three different community care models were identified. 1) A community-initiated model where diagnosis, treatment and monitoring occurred primarily in the community. This model reported a higher linkage and engagement in care at 9 months compared to the corresponding facility model, but only slight reductions of average blood glucose levels at six months compared to baseline. 2) A facility-originated community model where after treatment initiation, a substantial part of follow-up was offered at community level. Two studies reported such a model of care, both had as core component home-delivery of medication. Acceptability of this approach was high. But neither study found improved T2DM control when compared to facility care 3) An eHealth model with high acceptability scores for both patients and care providers, and an absolute 1.76% reduction in average HbA1c levels at two months compared to baseline. There were no reported outcomes on end-organ damage. All four studies were rated as being at high risk for bias. CONCLUSION Evidence on models of care for persons with T2DM in SSA where a substantial part of care is shifted to the community is scant. Whereas available literature indicates high acceptability of community-based care, we found no conclusive data on their effectiveness in controlling blood sugar and preventing complications. Evidence from larger scale studies, ideally randomized trials with clinically relevant endpoints is needed before roll-out of community-based T2DM care can be recommended in SSA.
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Affiliation(s)
- Emmanuel Firima
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Clinical Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Lucia Gonzalez
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Clinical Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Fabiola Ursprung
- Faculty of Biomedical Sciences, Universita della Svizzera Italiana, Lugano, Switzerland
| | - Elena Robinson
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jacqueline Huber
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Clinical Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Jennifer M. Belus
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Fabian Raeber
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Ravi Gupta
- SolidarMed, Swiss Organisation for Health in Africa, Maseru, Lesotho
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Department of Internal Medicine, Connaught Hospital, Freetown, Sierra Leone
| | - Alain Amstutz
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Bailah Leigh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Maja Weisser
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Chronic Diseases Clinic, Ifakara Health Institute, Ifakara, Tanzania
| | - Niklaus Daniel Labhardt
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Te V, Ma S, Por I, Van Damme W, Wouters E, van Olmen J. Diabetes care components effectively implemented in the ASEAN health systems: an umbrella review of systematic reviews. BMJ Open 2023; 13:e071427. [PMID: 37816569 PMCID: PMC10565207 DOI: 10.1136/bmjopen-2022-071427] [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: 12/27/2022] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES Association of Southeast Asian Nations (ASEAN) is among the hardest hit low-income and middle-income countries by diabetes. Innovative Care for Chronic Conditions (ICCC) framework has been adopted by the WHO for health system transformation towards better care for chronic conditions including diabetes. We conducted an umbrella review of systematic reviews on diabetes care components effectively implemented in the ASEAN health systems and map those effective care components into the ICCC framework. DESIGN An umbrella review of systematic reviews and/or meta-analyses following JBI (Joanna Briggs Institute) guidelines. DATA SOURCES Health System Evidence, Health Evidence, PubMed and Ovid MEDLINE. ELIGIBILITY CRITERIA We included systematic reviews and/or meta-analyses which focused on management of type 2 diabetes, reported improvements in measured outcomes and had at least one ASEAN member state in the study setting. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted the data and mapped the included studies into the ICCC framework. A narrative synthesis method was used to summarise the findings. The included studies were assessed for methodological quality based on the JBI critical appraisal checklist for systematic reviews and research syntheses. RESULTS 479 records were found of which 36 studies were included for the analysis. A multidisciplinary healthcare team including pharmacists and nurses has been reported to effectively support patients in self-management of their conditions. This can be supported by effective use of digital health interventions. Community health workers either peers or lay people with necessary software (knowledge and skills) and hardware (medical equipment and supplies) can provide complementary care to that of the healthcare staff. CONCLUSION To meet challenges of the increased burden of chronic conditions including diabetes, health policy-makers in the ASEAN member states can consider a paradigm shift in human resources for health towards the multidisciplinary, inclusive, collaborative and complementary team.
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Affiliation(s)
- Vannarath Te
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
- Health Policy Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| | - Sokvy Ma
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Ir Por
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
- Management Team, National Institute of Public Health, Phnom Penh, Cambodia
| | - Wim Van Damme
- Health Policy Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Edwin Wouters
- Department of Sociology, Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium
- Center for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
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Karajeanes E, Bila D, Luis M, Tovela M, Anjos C, Ramanlal N, Vaz P, Lapão LV. The Infomóvel-An information system for managing HIV/AIDS patients in rural areas of Mozambique. BMC Med Inform Decis Mak 2023; 23:187. [PMID: 37723450 PMCID: PMC10507969 DOI: 10.1186/s12911-023-02281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/31/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Mobile health is gradually revolutionizing the way medical care is delivered worldwide. In Mozambique, a country with a high human immunodeficiency virus prevalence, where antiretroviral treatment coverage is 77% accompanied by a 67% of retention rate, the use of mobile health technology may boost the antiretroviral treatment, by delivering care beyond health facilities and reaching underrepresented groups. Leveraging new technologies is crucial to reach the 95-95-95 United Nations target by 2030. The design, development, implementation, and evaluation of a mobile health platform called Infomóvel were covered in this article. Its intended use involves collaboration with community health workers and aims to increase human immunodeficiency virus patient access, adherence, and retention to care. METHODS Using the Design Science Research Methodology, Infomóvel was created, as well as this publication. The explanation of various actions includes everything from problem description to observational study and goal-following for a solution, which results in the design and development of a platform proposal. Before the utility assessment of Infomóvel was conducted to make adjustments, a demonstration phase was conducted in one region of Mozambique. RESULTS The initial subjects of the Infomóvel flowchart and physical process design were patients receiving antiretroviral medication who were enrolled in the patients tracking system and who had consented to home visits. The case manager examines the file before importing it into the Infomóvel database stored on a cloud server using the website www.commcarehq.org . The case manager application synchronises with the Infomóvel server database, enabling the import of latest data and access to the lists of new patients and community health workers. The community health worker uses his phone to access his application, which allows him to record the geographic coordinates and sort the list of patients by priority and type of visit. CONCLUSION Results from Infomóvel add to the growing body of data showing that mobile health techniques are beneficial for managing stable individuals with chronic conditions in Mozambique. These approaches can be scaled up and better utilised. However, additional studies should be conducted to quantify the resources needed to implement on a larger scale.
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Affiliation(s)
- E Karajeanes
- Fundação Ariel Glaser Contra O SIDA Pediátrico, Avenida Agostinho Neto N° 620, Maputo, Mozambique.
- Global Health and Tropical Medicine, Instituto de Higiene E Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, N° 100, 1349-008, Lisboa, Portugal.
| | - D Bila
- Fundação Ariel Glaser Contra O SIDA Pediátrico, Avenida Agostinho Neto N° 620, Maputo, Mozambique
| | - M Luis
- Fundação Ariel Glaser Contra O SIDA Pediátrico, Avenida Agostinho Neto N° 620, Maputo, Mozambique
| | - M Tovela
- Fundação Ariel Glaser Contra O SIDA Pediátrico, Avenida Agostinho Neto N° 620, Maputo, Mozambique
| | - C Anjos
- Fundação Ariel Glaser Contra O SIDA Pediátrico, Avenida Agostinho Neto N° 620, Maputo, Mozambique
| | - N Ramanlal
- Fundação Ariel Glaser Contra O SIDA Pediátrico, Avenida Agostinho Neto N° 620, Maputo, Mozambique
| | - P Vaz
- Fundação Ariel Glaser Contra O SIDA Pediátrico, Avenida Agostinho Neto N° 620, Maputo, Mozambique
| | - L V Lapão
- Global Health and Tropical Medicine, Instituto de Higiene E Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, N° 100, 1349-008, Lisboa, Portugal
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Aguirre-Sosa J, Vargas-Merino JA. Telemedicine Management: Approaches and Perspectives—A Review of the Scientific Literature of the Last 10 Years. Behav Sci (Basel) 2023; 13:bs13030255. [PMID: 36975280 PMCID: PMC10045599 DOI: 10.3390/bs13030255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
This research paper describes the approaches and perspectives of telemedicine worldwide. The objective of this literature review was to analyze the theoretical and empirical studies that address telemedicine management in the last 10 years based on the scientific literature obtained from the Scopus, Scielo, Ebsco, ProQuest, Dialnet, and Redalyc databases, from which 50 articles were selected. The inclusion criteria were the last 10 years, scientific articles, language, variables, and open access. The non-inclusion criteria were repeated articles, not addressing the variable, and not open access. The results show a tendency to manage telemedicine through various approaches and scenarios. These can be grouped into humanistic, socioeconomic, ethical, contingency in the Armed Forces—NASA, and application in the field of medicine with teaching to the entire chain of users, as well as controls and monitoring of patients. In this sense, it is concluded that telemedicine management worldwide faces challenges that must be overcome to reduce still-existing barriers and achieve better access to health systems worldwide.
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Affiliation(s)
- Joaquín Aguirre-Sosa
- Faculty of Business, School of Management, Universidad Privada del Norte, San Juan de Lurigancho, Lima 15434, Peru;
| | - Jorge Alberto Vargas-Merino
- Faculty of Business, Department of Research, Innovation and Social Responsibility, Universidad Privada del Norte, San Juan de Lurigancho, Lima 15434, Peru
- Correspondence:
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Pepera G, Karanasiou E, Blioumpa C, Antoniou V, Kalatzis K, Lanaras L, Batalik L. Tele-Assessment of Functional Capacity through the Six-Minute Walk Test in Patients with Diabetes Mellitus Type 2: Validity and Reliability of Repeated Measurements. SENSORS (BASEL, SWITZERLAND) 2023; 23:1354. [PMID: 36772396 PMCID: PMC9920804 DOI: 10.3390/s23031354] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/05/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
A tele-assessed 6MWT (TL 6MWT) could be an alternative method of evaluating functional capacity in patients with diabetes mellitus type 2 (DM2). This study aimed to assess the validity and reliability of a TL 6MWT. The functional capacity of 28 patients with DM2 (75% men) aged 61 ± 13 years was evaluated twice via an indoor, center-based 6MWT (CB 6MWT) and twice outside each patient's home via a web-based platform TL 6MWT. The study showed a high statistically significant correlation between the CB and TL 6MWT (Pearson's r = 0.76, p < 0.001). Reliability testing showed no statistically significant differences in the distance covered (CB1: 492 ± 84 m and CB2: 506 ± 86 m versus TL1: 534 ± 87 m and TL2: 542 ± 93 m, respectively) and in the best distance of the TL 6MWT (545 ± 93 m) compared to the best CB distance (521 ± 83 m). Strong internal reliability for both the CB (intraclass correlation coefficient (ICC) = 0.93) and the TL 6MWT (ICC = 0.98) was found. The results indicate that a TL 6MWT performed outdoors can be a highly valid and reliable tool to assess functional capacity in patients with DM2. No learning effect between the TL and CB assessment was found, minimizing the need for repetition.
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Affiliation(s)
- Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece
| | - Evmorfia Karanasiou
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece
| | - Christina Blioumpa
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece
| | - Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece
| | | | - Leonidas Lanaras
- Department of Internal Medicine, General Hospital of Lamia, GR-35100 Lamia, Greece
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
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6
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Jaén-Extremera J, Afanador-Restrepo DF, Rivas-Campo Y, Gómez-Rodas A, Aibar-Almazán A, Hita-Contreras F, Carcelén-Fraile MDC, Castellote-Caballero Y, Ortiz-Quesada R. Effectiveness of Telemedicine for Reducing Cardiovascular Risk: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12030841. [PMID: 36769487 PMCID: PMC9917681 DOI: 10.3390/jcm12030841] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death globally. There are six cardiovascular risk factors: diabetes, hypertension, hypercholesterolemia, overweight, sedentary lifestyle and smoking. Due to the low attendance of healthy people in the health system, the use of telemedicine can influence the acquisition of a heart-healthy lifestyle. OBJECTIVE this systematic review and meta-analysis aimed to determine the effectiveness of telemedicine and e-health in reducing cardiovascular risk. METHODS A systematic review and meta-analysis were carried out using the PubMed, Scopus, Cinhal and WOS databases. Randomized controlled studies between 2017 and 2022 in which telemedicine was used to reduce any of the risk factors were included. The methodological quality was assessed using the "PEDro" scale. RESULTS In total, 763 studies were obtained; after the review, 28 target articles were selected and finally grouped as follows: 13 studies on diabetes, six on hypertension, seven on obesity and two on physical activity. For all of the risk factors, a small effect of the intervention was seen. CONCLUSIONS although the current evidence is heterogeneous regarding the statistically significant effects of telemedicine on various cardiovascular risk factors, its clinical relevance is undeniable; therefore, its use is recommended as long as the necessary infrastructure exists.
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Affiliation(s)
- Jesús Jaén-Extremera
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | | | - Yulieth Rivas-Campo
- Faculty of Human and Social Sciences, University of San Buenaventura, Santiago de Cali 760016, Colombia
| | - Alejandro Gómez-Rodas
- Faculty of Health Sciences and Sport, University Foundation of the Área Andina, Pereira 660004, Colombia
| | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
- Correspondence:
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | | | | | - Raúl Ortiz-Quesada
- Department of Anatomy and Embryology, Faculty of Medicine, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18014 Granada, Spain
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Stolz D, Mkorombindo T, Schumann DM, Agusti A, Ash SY, Bafadhel M, Bai C, Chalmers JD, Criner GJ, Dharmage SC, Franssen FME, Frey U, Han M, Hansel NN, Hawkins NM, Kalhan R, Konigshoff M, Ko FW, Parekh TM, Powell P, Rutten-van Mölken M, Simpson J, Sin DD, Song Y, Suki B, Troosters T, Washko GR, Welte T, Dransfield MT. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet 2022; 400:921-972. [PMID: 36075255 DOI: 10.1016/s0140-6736(22)01273-9] [Citation(s) in RCA: 160] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Takudzwa Mkorombindo
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Desiree M Schumann
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Alvar Agusti
- Respiratory Institute-Hospital Clinic, University of Barcelona IDIBAPS, CIBERES, Barcelona, Spain
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chunxue Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, School of Population and Global health, University of Melbourne, Melbourne, VIC, Australia
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Urs Frey
- University Children's Hospital Basel, Basel, Switzerland
| | - MeiLan Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nadia N Hansel
- Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nathaniel M Hawkins
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Ravi Kalhan
- Department of Preventive Medicine and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melanie Konigshoff
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fanny W Ko
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Trisha M Parekh
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jodie Simpson
- Priority Research Centre for Healthy Lungs, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Don D Sin
- Centre for Heart Lung Innovation and Division of Respiratory Medicine, Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Respiratory Research Institute, Shanghai, China; Jinshan Hospital of Fudan University, Shanghai, China
| | - Bela Suki
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Mark T Dransfield
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA.
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Sonmez A, Sabbour H, Echtay A, Rahmah AM, Alhozali AM, al Sabaan FS, Haddad FH, Iraqi H, Elebrashy I, Assaad SN, Bayat Z, Osar Siva Z, Hassanein M. Current gaps in management and timely referral of cardiorenal complications among people with type 2 diabetes mellitus in the Middle East and African countries: Expert recommendations. J Diabetes 2022; 14:315-333. [PMID: 35434900 PMCID: PMC9366572 DOI: 10.1111/1753-0407.13266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 03/05/2022] [Accepted: 03/13/2022] [Indexed: 12/11/2022] Open
Abstract
The upsurge of type 2 diabetes mellitus is a major public health concern in the Middle East and North Africa (MENA) and Africa (AFR) region, with cardiorenal complications (CRCs) being the predominant cause of premature morbidity and mortality. High prevalence of cardiometabolic risk factors, lack of awareness among patients and physicians, deficient infrastructure, and economic constraints lead to a cascade of CRCs at a significantly earlier age in MENA and AFR. In this review, we present consensus recommendations by experts in MENA and AFR, highlighting region-specific challenges and potential solutions for management of CRCs. Health professionals who understand sociocultural barriers can significantly increase patient awareness and encourage health-seeking behavior through simple educational tools. Increasing physician knowledge on early identification of CRCs and personalized treatment based on risk stratification, alongside optimum glycemic control, can mitigate therapeutic inertia. Early diagnosis of high-risk people with regular and systematic monitoring of cardiorenal parameters, development of region-specific care pathways for timely referral to specialists, followed by guideline-recommended care with novel antidiabetics are imperative. Adherence to guideline-recommended care can catalyze utilization of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists with demonstrated cardiorenal benefits-thus paving the way for overcoming care gaps in a cost-effective manner. Leveraging digital technology like electronic medical records can help generate real-world data and provide insights on voids in adoption of newer antidiabetic medications. A patient-centric approach, collaborative care among physicians from different specialties, alongside involvement of policy makers are key for improving patient outcomes and quality of care in MENA and AFR.
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Affiliation(s)
- Alper Sonmez
- Department of Endocrinology and MetabolismGulhane School of Medicine, University of Health SciencesAnkaraTurkey
| | - Hani Sabbour
- Heart & Vascular Institute Cleveland ClinicAbu DhabiUAE
- Brown University Warren Alpert School of MedicineProvidenceRhode IslandUSA
| | - Akram Echtay
- School of MedicineLebanese UniversityHadathLebanon
| | - Abbas Mahdi Rahmah
- National Centre for DiabetesCollege of Medicine, Al‐Mustansriya UniversityBaghdadIraq
| | | | | | - Fares H. Haddad
- Endocrine & Diabetes, Abdali Hospital/Endocrine & Diabetes ClinicAmmanJordan
| | - Hinde Iraqi
- Faculty of Medicine and PharmacyMohammed V UniversityRabatMorocco
| | | | | | - Zaheer Bayat
- Division of Endocrinology and Metabolism, Department of Internal MedicineHelen Joseph HospitalRossmore, JohannesburgSouth Africa
| | | | - Mohamed Hassanein
- Dubai Hospital, DHADubaiUAE
- Gulf Medical UniversityAjmanUAE
- Cardiff UniversityCardiffUK
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Translation and Validation of the Questionnaire on Acceptance to Telemedicine from the Technology Acceptance Model (TAM) for Use in Malaysia. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9123887. [PMID: 35463970 PMCID: PMC9020140 DOI: 10.1155/2022/9123887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/18/2022]
Abstract
The COVID-19 pandemic has accelerated implementation of telemedicine in healthcare facilities for delivery of care. Healthcare providers' acceptance of the telemedicine services is important for successful implementation of this new system. A questionnaire based on the Technology Acceptance Model (TAM) has been used to measure user acceptance of telemedicine service. The aim of this study was to translate and validate the English version of the questionnaire into Malay, to extend the availability and utilization of this questionnaire in Malaysia. A forward and backward translation of the questionnaire was conducted to produce the TAM in the Malay version (Malay-TAM). Panel experts assessed content validity. Internal consistency reliability was determined using Cronbach's alpha. Confirmatory factor analysis based on structural equation modelling was performed to validate the factor structure. The questionnaire was then tested on and completed by 149 healthcare workers from several public health clinics across Malaysia. The Malay-TAM demonstrated good reliability with Cronbach's alphas ranging from 0.823 to 0.912. Factor analysis showed good convergent validity but relatively poor discriminant validity. All five constructs were retained to preserve content validity. The findings suggest that the Malay-TAM can serve as a reliable and valid instrument to measure acceptance to telemedicine.
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Harindhanavudhi T, Areevut C, Sahakitrungruang T, Tharavanij T, Kietdumrongwong P, Ngimruksa O, Songsiri P, Pitukweerakul S, Tanathornkirati N, Kaewprasert N, Thamcharoen R, Karndumri K, Saetung S, Anthanont P, Kiattisakthavee P, Putkong S, Chotwanvirat P, Nartsupha Phattanasri C, Jinadit S, Korpaisarn S, Chusane M, Samittarucksa R, Lertrit A, Siangruangsang S, Sanpawithayakul K, Sathiravikarn W, Soisuwan S, Chevaisrakul P, Imsakul K, Thuptimtong P, Sakmanarit J, Somwang S, Prasartkaew H, Jerawatana R, Butadej S, Tachanivate P, Jongjaroenprasert W, Sripatong J, Chobtangsilp S, Kamnirdsittiseree P, Savetkairop B, Manosittisak W, Tantivatanasatien J, Hathaidechadusadee A, Reutrakul S. Implementation of Diabetes Care and Educational Program via Telemedicine in Patients with COVID-19 in Home Isolation in Thailand: A Real-World Experience. J Diabetes Investig 2022; 13:1448-1457. [PMID: 35394118 PMCID: PMC9114836 DOI: 10.1111/jdi.13804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 04/05/2022] [Indexed: 01/08/2023] Open
Abstract
Background The coronavirus disease (COVID‐19) outbreak in Bangkok led to a shortage of hospital capacity, and a home isolation system was set up. We described the process of diabetes self‐management education and support (DSMES) and glycemic management via telemedicine, along with outcomes in home‐isolated patients with COVID‐19 infection. Methods A retrospective chart review of glucose values, insulin and corticosteroids use, and outcomes was performed. Results A volunteer group of 21 endocrinologists and 21 diabetes educators/nurses formed the consultation team. Patients with diabetes or at high‐risk of diabetes and receiving corticosteroids were referred by primary volunteer physicians. Glucometers and related supplies, and insulin were donated, and delivered via same‐day delivery services. A chat group of an individual patient/their caregiver, diabetes educator, endocrinologist, and primary physician was formed (majority via LINE® platform) to assess the patient's clinical status and need. Real‐time virtual DSMES sessions were performed and treatments were adjusted via smartphone application or telephone. There were 119 patients (1,398 service days), mean (SD) age 62.0 (13.6) years, 85.7% had a history of type 2 diabetes, and 84.0% received corticosteroids. Insulin was used in 88 patients; 69 of whom were insulin‐naïve. During the first 10 days, there were 2,454 glucose values. The mean glucose level on day 1 was 280.6 (122.3) mg/dL, and declined to 167.7 (43.4) mg/dL on day 10. Hypoglycemia occurred in 1.4% of the values. A majority of patients (79.5%) recovered at home. Conclusion Diabetes care and DSMES delivered via telemedicine to patients on home isolation during COVID‐19 pandemic was safe and effective.
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Affiliation(s)
- Tasma Harindhanavudhi
- University of Minnesota, 420 Delaware St S.E., MMC 101, Minneapolis, Minnesota, 55455-2020, USA
| | - Chatvara Areevut
- Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok, Thailand
| | | | - Thipaporn Tharavanij
- Thammasat University hospital, 99/209 Moo 18, Paholyothin Rd, Pathum Thani, Thailand
| | - Pongtorn Kietdumrongwong
- BDMS Health Research Center, Bangkok, Dusit Medical Services, Plc., Huai Khwang, Bangkok, Thailand
| | | | - Patitta Songsiri
- Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Siwadon Pitukweerakul
- Endocrinology Department, Marshfield Medical Center, Marshfield, Wisconsin, 54449-5703, USA
| | | | | | | | | | - Sunee Saetung
- Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok, Thailand
| | - Pimjai Anthanont
- Thammasat University Hospital, 99/209 Moo 18, Paholyothin Rd, Pathum Thani, Thailand
| | | | - Sarapee Putkong
- Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok, Thailand
| | | | | | - Srikorn Jinadit
- Ramkhamhaeng Hospital, 436 Ramkhamhaeng Road, Hua Mak, Bangkok, Thailand
| | - Sira Korpaisarn
- Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok, Thailand
| | | | | | - Amornpan Lertrit
- Bhumirajanagarindra Kidney Institute Hospital, 8/99 Phayathai Rd, Ratchathewi, Bangkok, Thailand
| | | | | | - Waraporn Sathiravikarn
- Royal Medical Division, Bureau of the Royal Household, Chitralada Villa Royal Residence, Dusit Palace., Bangkok, Thailand
| | | | | | - Kanokporn Imsakul
- Faculty of Medicine Vajira Hospital., 681 Samsen Road, Bangkok, Thailand
| | | | | | - Supaporn Somwang
- Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok, Thailand
| | | | | | - Siriwan Butadej
- Research Center, Theptarin Hospital, 3850 Rama IV road, Bangkok, Thailand
| | | | | | | | | | | | | | - Warot Manosittisak
- Warot Clinic, 1383/5 Phaholyothin R. Samsennet Phayathai, Bangkok, Thailand
| | | | | | - Sirimon Reutrakul
- University of Illinois at Chicago, 835 S. Wolcott, suite E625, Chicago, Illinois, 60612, USA
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Faleh AlMutairi M, Tourkmani AM, Alrasheedy AA, ALHarbi TJ, Bin Rsheed AM, ALjehani M, AlRuthia Y. Cost-effectiveness of telemedicine care for patients with uncontrolled type 2 diabetes mellitus during the COVID-19 pandemic in Saudi Arabia. Ther Adv Chronic Dis 2021; 12:20406223211042542. [PMID: 34729144 PMCID: PMC8442482 DOI: 10.1177/20406223211042542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/05/2021] [Indexed: 01/08/2023] Open
Abstract
Background and aim: Telemedicine could be used to provide diabetes care with positive clinical
outcomes. Consequently, this study evaluated the cost-effectiveness of
telemedicine for patients with uncontrolled type 2 diabetes mellitus (i.e.
HbA1c >9). Patients and methods: This was a retrospective chart review of patients with uncontrolled type 2
diabetes attending an outpatient integrated care clinic. The study consisted
of two arms, namely a telemedicine care model and a traditional care model
with 100 patients in each. The clinical effectiveness (i.e. reduction in
HbA1c) and the total cost in both arms were determined, and the incremental
cost-effectiveness ratio was calculated. This study adopted propensity score
matching. Results: The patients in the telemedicine care model had a mean reduction in their
HbA1c level of 1.82 (95% CI = 1.56–2.09, p < 0.001),
while those in the traditional care model had a mean reduction of 1.54 (95%
CI = 1.23–1.85, p < 0.001). Consequently, the
incremental effect was 0.28 (95% CI = −0.194 to 0.546). The mean total costs
were SAR 4819.76 (US$1285.27) and SAR 4150.69 (US$1106.85) for patients in
the telemedicine and traditional care models, respectively. Consequently,
the incremental cost was SAR 669.07 (US$178.42) [95% CI = SAR 593.7
(US$158.32)–SAR 1013.64 (US$270.30)]. The ICER was estimated to be SAR
2372.52 (US$632.67) per 1% reduction in the level of HbA1c. Moreover, the
telemedicine care model resulted in a higher cost and better outcome (i.e.
reduction in the HbA1c level) with an 81.80% confidence level. Conclusion: Telemedicine care is cost-effective in managing type 2 patients with poorly
controlled diabetes. Consequently, we believe that telemedicine care can be
further expanded and incorporated into routine diabetes care.
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Affiliation(s)
- Manal Faleh AlMutairi
- Chronic Illness Center, Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ayla M Tourkmani
- Chronic Illness Center, Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia
| | - Alian A Alrasheedy
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah 51452, Saudi Arabia
| | - Turki J ALHarbi
- Chronic Illness Center, Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz M Bin Rsheed
- Chronic Illness Center, Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed ALjehani
- Chronic Illness Center, Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia. Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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12
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Ng SW, Hwong WY, Husin M, Ab Rahman N, Nasir NH, Juval K, Sivasampu S. Assessing the availability of teleconsultation and the extent of its use in Malaysian public primary care clinics: a cross-sectional study (Preprint). JMIR Form Res 2021; 6:e34485. [PMID: 35532973 PMCID: PMC9127641 DOI: 10.2196/34485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 01/27/2023] Open
Abstract
Background The integration of teleconsultation into health care systems as a complement to existing approaches to care is growing rapidly. There is, however, limited information on the extent of its implementation across low- and middle-income countries. Objective The aim of this study was to determine the availability and the extent of teleconsultation in Malaysian primary care clinics. Methods A cross-sectional study of public primary care clinics in Malaysia was conducted between November 2020 and December 2020. All clinics in Malaysia that see more than 300 daily patients were recruited. A web-based, self-administered questionnaire including questions on availability of the service, whether it uses video or telephone, and the types of services it provides was distributed to the medical officer in charge of each clinic. Results In total, 97.6% (249/255) of the clinics responded. Out of these clinics, 45.8% (114/249) provided teleconsultation. A majority of the clinics providing consultation (69/114, 60.5%) provided only telephone consultation, while 24.6% (28/114) of the clinics offered video and telephone consultation, and 14.9% (17/114) offered only video consultation. Eighty percent (92/114) of the clinics were located in urban areas. A breakdown by state showed that 17.5% (20/114) and 16.7% (19/114) of the clinics were from two larger states; other states comprised less than 10% each (range 7-9/114). For the clinics providing video consultation, funding for the service came mostly (42/45, 93%) from the Ministry of Health. Conversely, nearly 1 out of 4 (23/97) clinics that provided telephone consultation funded the service either from donations or through self-funding. Most of the clinics provided teleconsultation for diabetes and hypertension. Less than 50% of the clinics with teleconsultation used it for follow up with allied health care providers or pharmacists (video consultation, 20/45; telephone consultation, 36/97). Conclusions Our findings show that telephone consultation is more widely used than video consultation, despite a quarter of its funding being self-subsidized or obtained through donations. Also, teleconsultation was less utilized by allied health care providers and pharmacists. Plans for the expansion of teleconsultation in Malaysian primary health care should take into consideration these findings to ensure a better and more cost-effective implementation of the service.
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Affiliation(s)
- Sock Wen Ng
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Wen Yea Hwong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Kawselyah Juval
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
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13
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Seiglie JA, Serván-Mori E, Manne-Goehler J, Meigs JB, Miranda JJ, Sosa-Rubí SG, Silverman-Retana O, Wexler DJ, Wirtz VJ. Diabetes mellitus as a risk factor for SARS-CoV-2 test positivity in Mexico: A propensity score matched study. Diabetes Res Clin Pract 2021; 178:108953. [PMID: 34298043 PMCID: PMC8331361 DOI: 10.1016/j.diabres.2021.108953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/13/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
AIMS We sought to investigate whether individuals with diabetes have a higher likelihood of testing positive for SARS-CoV-2, as a proxy for infection risk, than individuals without diabetes. METHODS We conducted a cross-sectional study of publicly available data among a Mexican population, totaling 2,314,022 adults ≥ 18 years who underwent SARS-CoV-2 testing between March 1 and December 20, 2020. We used 1:1 nearest neighborhood propensity score matching by diabetes status to account for confounding among those with and without diabetes. RESULTS In the overall study population, 1,057,779 (45.7%) individuals tested positive for SARS-CoV-2 and 270,486 (11.7%) self-reported diabetes. After propensity score matching, patient characteristics were well-balanced, with 150,487 patients in the diabetes group (mean [SD] age 55.9 [12.7] years; 51.3% women) and 150,487 patients in the no diabetes group (55.5 [13.3] years; 50.3% women). The strictest matching algorithm (1:1 nearest neighbor) showed that compared to individuals without diabetes, having diabetes was associated with 9.0% higher odds of having a positive SARS-CoV-2 test (OR 1.09 [95% CI: 1.08-1.10]). CONCLUSIONS Presence of diabetes was associated with higher odds of testing positive for SARS-CoV-2, which could have important implications for risk mitigation efforts for people with diabetes at risk of SARS-CoV-2 infection.
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Affiliation(s)
- Jacqueline A Seiglie
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico.
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James B Meigs
- Department of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; The George Institute for Global Health, Sydney, Australia
| | - Sandra G Sosa-Rubí
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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