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Patel PJ, Cheng JCY, Banh X, Gracen L, Radford-Smith D, Hossain F, Horsfall LU, Hayward KL, Williams S, Johnson T, Brown NN, Saad N, Stuart KA, Russell AW, Valery PC, Clouston AD, Irvine KM, Bernard A, Powell EE. Clinically Significant Fibrosis Is Associated With Longitudinal Increases in Fibrosis-4 and Nonalcoholic Fatty Liver Disease Fibrosis Scores. Clin Gastroenterol Hepatol 2020; 18:710-718.e4. [PMID: 31352092 DOI: 10.1016/j.cgh.2019.07.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is limited knowledge regarding the longitudinal utility of biomarkers of fibrosis, such as the nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS) or the fibrosis-4 score (FIB-4) score. We examined longitudinal changes in the NFS and the FIB-4 score in patients with NAFLD, with and without clinically significant fibrosis (CSF). METHODS We performed a retrospective study of 230 patients with NAFLD, collecting clinical and laboratory records to calculate NFS and FIB-4 scores at 6 monthly intervals for 5 years before hepatology assessment of fibrosis. Linear mixed models with random intercept and slope and adjusted for age at baseline were used to assess the progression of NFS and log-transformed FIB-4 scores over time in subjects with and without CSF, determined by liver stiffness measurements of 8.2 kPa or greater. RESULTS Patients had a median of 11 (minimum, 10; maximum, 11) retrospective observations over a median time period of 5 years (minimum, 4.5 y; maximum, 5 y). Of patients with low baseline NFS and FIB-4 scores, 31.11% and 37.76%, respectively, had CSF at the time of hepatology assessment. There was a correlation between NFS and log10 FIB-4 over time (repeated measure r = 0.55; 95% CI, 0.52-0.59). The rate of increase in NFS and log10 FIB-4 was significantly higher in patients with than without CSF (both P < .001). Predicted NFS increased by 0.17 and 0.06 units per year in subjects with and without CSF, respectively. Predicted log10 FIB-4 score increased by 0.032 and 0.0003 units per year in subjects with and without CSF, respectively. CONCLUSIONS Noninvasively measured fibrosis scores increase progressively in patients with NAFLD and CSF. Further studies are needed to determine whether repeated measurements can identify patients at risk for CSF.
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Affiliation(s)
- Preya Janubhai Patel
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Liver Disease Research, University of Queensland, Brisbane, Australia
| | | | - Xuan Banh
- Centre for Liver Disease Research, University of Queensland, Brisbane, Australia
| | - Lucy Gracen
- Centre for Liver Disease Research, University of Queensland, Brisbane, Australia
| | | | | | - Leigh Ula Horsfall
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Liver Disease Research, University of Queensland, Brisbane, Australia
| | - Kelly Lee Hayward
- Centre for Liver Disease Research, University of Queensland, Brisbane, Australia
| | | | | | | | - Nivene Saad
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia
| | - Katherine Anne Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Anthony William Russell
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia
| | | | | | - Katharine Margaret Irvine
- Centre for Liver Disease Research, University of Queensland, Brisbane, Australia; Mater Research, Translational Research Institute, University of Queensland, Brisbane, Australia
| | - Anne Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, Queensland Bioscience Precinct, University of Queensland, Brisbane, Australia
| | - Elizabeth Ellen Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Liver Disease Research, University of Queensland, Brisbane, Australia.
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Patel P, Hossain F, Horsfall LU, Banh X, Hayward KL, Williams S, Johnson T, Bernard A, Brown NN, Lampe G, Buck L, Saad N, Russell AW, Valery PC, Irvine KM, Clouston AD, Stuart KA, Rosenberg W, Powell EE. A Pragmatic Approach Identifies a High Rate of Nonalcoholic Fatty Liver Disease With Advanced Fibrosis in Diabetes Clinics and At-Risk Populations in Primary Care. Hepatol Commun 2018; 2:893-905. [PMID: 30094401 PMCID: PMC6078214 DOI: 10.1002/hep4.1208] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/11/2018] [Accepted: 05/17/2018] [Indexed: 12/13/2022] Open
Abstract
Noninvasive serum biomarkers (nonalcoholic fatty liver disease fibrosis score [NFS], fibrosis 4 score [FIB‐4], or enhanced liver fibrosis [ELF] test) are recommended as first‐line tools to determine the risk of advanced fibrosis in nonalcoholic fatty liver disease. We aimed to assess the utility of a pragmatic approach to screening for clinically significant fibrosis in primary care and diabetes clinics. We recruited 252 patients from an endocrine clinic or primary care facility. Anthropometric measurements, ELF test, ultrasound, and liver stiffness measurements (LSMs) were performed. Clinically significant fibrosis was defined as LSM ≥8.2 kPa or ELF ≥9.8. A subgroup of patients underwent liver biopsy (n = 48) or had imaging diagnostic of cirrhosis (n = 14). Patients were 57.3 ± 12.3 years old with a high prevalence of metabolic syndrome (84.5%), type 2 diabetes (82.5%), and body mass index (BMI) ≥40 kg/m2 (21.8%). LSM met quality criteria in 230 (91.3%) patients. NFS and FIB‐4 combined had a high negative predictive value (90.0%) for excluding LSM ≥8.2 kPa. However, 84.1% of patients had indeterminate or high NFS or FIB‐4 scores requiring further assessment. LSM ≥8.2 kPa and ELF ≥9.8 were present in 31.3% and 28.6% of patients, respectively. Following adjustment for age, BMI, sex, and presence of advanced fibrosis, older age was independently associated with ELF ≥9.8 (adjusted odds ratio, 1.14; 95% confidence interval, 1.06‐1.24), whereas increasing BMI was independently associated with LSM ≥8.2 kPa (adjusted odds ratio, 1.15; 95% confidence interval, 1.01‐1.30). Concordant LSM <8.2 kPa and ELF <9.8 and concordant LSM ≥8.2 kPa and ELF ≥9.8 had a high negative predictive value (91.7%) and positive predictive value (95.8%) for excluding and identifying clinically significant fibrosis, respectively. Conclusion: Simple scoring tools alone lack accuracy. LSM accuracy is influenced by severe obesity, whereas age impacts the ELF test. Further studies are required to confirm whether combining LSM and ELF may enhance accuracy and confidence in identifying clinically significant fibrosis. (Hepatology Communications 2018; 00:000‐000)
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Affiliation(s)
- PreyaJanubhai Patel
- Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Australia.,Centre for Liver Disease Research, Translational Research Institute, School of Medicine University of Queensland Brisbane Australia
| | | | - Leigh Ula Horsfall
- Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Australia.,Centre for Liver Disease Research, Translational Research Institute, School of Medicine University of Queensland Brisbane Australia
| | - Xuan Banh
- Centre for Liver Disease Research, Translational Research Institute, School of Medicine University of Queensland Brisbane Australia
| | - Kelly Lee Hayward
- Centre for Liver Disease Research, Translational Research Institute, School of Medicine University of Queensland Brisbane Australia
| | | | | | - Anne Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, Queensland Bioscience Precinct University of Queensland Brisbane Australia
| | | | - Guy Lampe
- Pathology Queensland Brisbane Australia
| | | | - Nivene Saad
- Department of Radiology Princess Alexandra Hospital Brisbane Australia.,School of Medicine University of Queensland Brisbane Australia
| | - Anthony William Russell
- School of Medicine University of Queensland Brisbane Australia.,Department of Diabetes and Endocrinology Princess Alexandra Hospital Brisbane Australia
| | | | - Katharine Margaret Irvine
- Centre for Liver Disease Research, Translational Research Institute, School of Medicine University of Queensland Brisbane Australia.,Mater Research, Translational Research Institute University of Queensland Brisbane Australia
| | - Andrew Donald Clouston
- Centre for Liver Disease Research, Translational Research Institute, School of Medicine University of Queensland Brisbane Australia
| | - Katherine Anne Stuart
- Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Australia
| | - William Rosenberg
- UCL Institute for Liver and Digestive Health, Division of Medicine UCL and Royal Free London NHS Foundation Trust London United Kingdom
| | - Elizabeth Ellen Powell
- Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Australia.,Centre for Liver Disease Research, Translational Research Institute, School of Medicine University of Queensland Brisbane Australia
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Patel PJ, Hossain F, Horsfall LU, Banh X, Hayward KL, Williams S, Johnson T, Brown NN, Saad N, Valery PC, Irvine KM, Clouston AD, Stuart KA, Russell AW, Powell EE. Controlled attenuation parameter in NAFLD identifies risk of suboptimal glycaemic and metabolic control. J Diabetes Complications 2018; 32:799-804. [PMID: 29861312 DOI: 10.1016/j.jdiacomp.2018.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/06/2018] [Accepted: 05/07/2018] [Indexed: 12/14/2022]
Abstract
AIMS To examine the relationship between steatosis quantified by controlled attenuation parameter (CAP) values and glycaemic/metabolic control. METHODS 230 patients, recruited from an Endocrine clinic or primary care underwent routine Hepatology assessment, with liver stiffness measurements and simultaneous CAP. Multivariable logistic regression was performed to identify potential predictors of Metabolic Syndrome (MetS), HbA1c ≥ 7%, use of insulin, hypertriglyceridaemia and CAP ≥ 300 dB/m. RESULTS Patients were 56.7 ± 12.3 years of age with a high prevalence of MetS (83.5%), T2DM (81.3%), and BMI ≥ 40 kg/m2 (18%). Median CAP score was 344 dB/m, ranging from 128 to 400 dB/m. BMI (aOR 1.140 95% CI 1.068-1.216), requirement for insulin (aOR 2.599 95% CI 1.212-5.575), and serum ALT (aOR 1.018 95% CI 1.004-1.033) were independently associated with CAP ≥ 300 dB/m. Patients with CAP interquartile range < 40 (68%) had a higher median serum ALT level (p = 0.029), greater prevalence of BMI ≥ 40 kg/m2 (p = 0.020) and higher median CAP score (p < 0.001). Patients with higher CAP scores were more likely to have MetS (aOR 1.011 95% CI 1.003-1.019), HBA1c ≥ 7 (aOR 1.010 95% CI 1.003-1.016), requirement for insulin (aOR 1.007 95% CI 1.002-1.013) and hypertriglyceridemia (aOR 1.007 95% CI 1.002-1.013). CONCLUSIONS Our data demonstrate that an elevated CAP reflects suboptimal metabolic control. In diabetic patients with NAFLD, CAP may be a useful point-of-care test to identify patients at risk of poorly controlled metabolic comorbidities or advanced diabetes.
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Affiliation(s)
- Preya Janubhai Patel
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Australia
| | | | - Leigh Ula Horsfall
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Australia
| | - Xuan Banh
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Australia
| | - Kelly Lee Hayward
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Australia
| | | | | | | | - Nivene Saad
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | | | - Katharine Margaret Irvine
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Australia; Mater Research, Translational Research Institute, The University of Queensland, Brisbane, Australia
| | - Andrew Donald Clouston
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Australia
| | - Katherine Anne Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Anthony William Russell
- School of Medicine, University of Queensland, Brisbane, Australia; Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia
| | - Elizabeth Ellen Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Australia.
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Patel PJ, Hayward KL, Rudra R, Horsfall LU, Hossain F, Williams S, Johnson T, Brown NN, Saad N, Clouston AD, Stuart KA, Valery PC, Irvine KM, Russell AW, Powell EE. Multimorbidity and polypharmacy in diabetic patients with NAFLD: Implications for disease severity and management. Medicine (Baltimore) 2017; 96:e6761. [PMID: 28658094 PMCID: PMC5500016 DOI: 10.1097/md.0000000000006761] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
An observational study describing the number and type of chronic conditions and medications taken by diabetic patients with NAFLD and identifying characteristics that may impact liver disease severity or clinical management.Adults with type 2 diabetes have a high prevalence of nonalcoholic fatty liver disease (NAFLD) and increased risk of developing advanced liver disease. Appropriate management should consider the characteristics of the diabetic NAFLD population, as comorbid conditions and medications may increase the complexity of treatment strategies.Diabetic patients with NAFLD at risk of clinically significant liver disease (as assessed by the FIB-4 or NAFLD fibrosis scores) were recruited consecutively from the Endocrine clinic or primary care. Medical conditions, medication history, anthropometric measurements, and laboratory tests were obtained during assessment. NAFLD severity was classified by transient elastography and liver ultrasound into "no advanced disease" (LSM < 8.2 kPa) or "clinically significant liver disease" (LSM ≥ 8.2 kPa).The most common coexistent chronic conditions were metabolic syndrome (94%), self-reported "depression" (44%), ischaemic heart disease (32%), and obstructive sleep apnoea (32%). Polypharmacy or hyperpolypharmacy was present in 59% and 31% of patients respectively. Elevated LSM (≥ 8.2 kPa) suggesting significant liver disease was present in 37% of this at-risk cohort. Increasing obesity and abdominal girth were both independently associated with likelihood of having significant liver disease.There is a high burden of multimorbidity and polypharmacy in diabetic NAFLD patients, highlighting the importance of multidisciplinary management to address their complex health care needs and ensure optimal medical treatment.
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Affiliation(s)
- Preya Janubhai Patel
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital
- Centre for Liver Disease Research, Translational Research Institute, School of Medicine, The University of Queensland
| | - Kelly Lee Hayward
- School of Medicine, The University of Queensland
- Pharmacy Department, Princess Alexandra Hospital
| | - Rathiga Rudra
- Centre for Liver Disease Research, Translational Research Institute, School of Medicine, The University of Queensland
| | - Leigh Ula Horsfall
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital
- Centre for Liver Disease Research, Translational Research Institute, School of Medicine, The University of Queensland
| | | | | | | | | | - Nivene Saad
- Department of Radiology, Princess Alexandra Hospital
| | - Andrew Donald Clouston
- Centre for Liver Disease Research, Translational Research Institute, School of Medicine, The University of Queensland
| | | | | | - Katharine Margaret Irvine
- Centre for Liver Disease Research, Translational Research Institute, School of Medicine, The University of Queensland
| | | | - Elizabeth Ellen Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital
- Centre for Liver Disease Research, Translational Research Institute, School of Medicine, The University of Queensland
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Russell AW, Netherwood GMA, Robinson SA. Photosynthesis In Silico. Overcoming the Challenges of Photosynthesis Education Using a Multimedia CD-ROM. ACTA ACUST UNITED AC 2015. [DOI: 10.3108/beej.2004.03000009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A W Russell
- School of Biological Sciences, University of Wollongong, Wollongong, NSW 2522
| | - G M A Netherwood
- School of Biological Sciences, University of Wollongong, Wollongong, NSW 2522
| | - S A Robinson
- School of Biological Sciences, University of Wollongong, Wollongong, NSW 2522
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Zhang J, Donald M, Baxter KA, Ware RS, Burridge L, Russell AW, Jackson CL. Impact of an integrated model of care on potentially preventable hospitalizations for people with Type 2 diabetes mellitus. Diabet Med 2015; 32:872-80. [PMID: 25615800 DOI: 10.1111/dme.12705] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 01/04/2023]
Abstract
AIMS To evaluate the impact of an integrated model of care for patients with complex Type 2 diabetes mellitus on potentially preventable hospitalizations. METHODS A prospective controlled trial was conducted comparing a multidisciplinary, community-based, integrated primary-secondary care diabetes service with usual care at a hospital diabetes outpatient clinic. Study and hospital admissions data were linked for the period from 12 months before to 24 months after commencement of the trial. The primary outcome was the number of potentially preventable hospitalizations with diabetes-related principal diagnoses. Length of stay once hospitalized was also reported. RESULTS Of 327 adult participants, 206 were hospitalized and accounted for 667 admissions during the study period. Compared with the usual care group, patients in the integrated model of care group were nearly half as likely to be hospitalized for a potentially preventable diabetes-related principal diagnosis in the 24 months after study commencement (incidence rate ratio 0.53, 95% CI 0.29, 0.96; P = 0.04). The magnitude of the result remained similar after adjusting for age, sex, education and baseline HbA1c concentration (incidence rate ratio 0.54, 95% CI 0.29, 1.01; P = 0.05).When hospitalized, patients in the integrated care group had a similar length of stay compared with those in the usual care group (median difference -2 days, 95% CI -6.5, 2.3; P = 0.33). CONCLUSIONS Patients receiving the integrated model of care had a reduction in the number of hospitalizations when the principal diagnosis for admission was a diabetes-related complication. Integrated models of care for people with complex diabetes can reduce hospitalizations and help attempts to curtail increasing demand on finite health services.
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Affiliation(s)
- J Zhang
- Discipline of General Practice, University of Queensland, Herston, Queensland, Australia
| | - M Donald
- Discipline of General Practice, University of Queensland, Herston, Queensland, Australia
| | - K A Baxter
- Discipline of General Practice, University of Queensland, Herston, Queensland, Australia
| | - R S Ware
- School of Population Health, University of Queensland, Herston, Queensland, Australia
| | - L Burridge
- Discipline of General Practice, University of Queensland, Herston, Queensland, Australia
| | - A W Russell
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - C L Jackson
- Discipline of General Practice, University of Queensland, Herston, Queensland, Australia
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Gordon LG, Bird D, Oldenburg B, Friedman RH, Russell AW, Scuffham PA. A cost-effectiveness analysis of a telephone-linked care intervention for individuals with Type 2 diabetes. Diabetes Res Clin Pract 2014; 104:103-11. [PMID: 24503043 DOI: 10.1016/j.diabres.2013.12.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/16/2013] [Accepted: 12/21/2013] [Indexed: 11/28/2022]
Abstract
AIM To assess the cost-effectiveness of an automated telephone-linked care intervention, Australian TLC Diabetes, delivered over 6 months to patients with established Type 2 diabetes mellitus and high glycated haemoglobin level, compared to usual care. METHODS A Markov model was designed to synthesize data from a randomized controlled trial of TLC Diabetes (n=120) and other published evidence. The 5-year model consisted of three health states related to glycaemic control: 'sub-optimal' HbA1c ≥58mmol/mol (7.5%); 'average' ≥48-57mmol/mol (6.5-7.4%) and 'optimal' <48mmol/mol (6.5%) and a fourth state 'all-cause death'. Key outcomes of the model include discounted health system costs and quality-adjusted life years (QALYS) using SF-6D utility weights. Univariate and probabilistic sensitivity analyses were undertaken. RESULTS Annual medication costs for the intervention group were lower than usual care [ INTERVENTION £1076 (95%CI: £947, £1206) versus usual care £1271 (95%CI: £1115, £1428) p=0.052]. The estimated mean cost for intervention group participants over five years, including the intervention cost, was £17,152 versus £17,835 for the usual care group. The corresponding mean QALYs were 3.381 (SD 0.40) for the intervention group and 3.377 (SD 0.41) for the usual care group. Results were sensitive to the model duration, utility values and medication costs. CONCLUSION The Australian TLC Diabetes intervention was a low-cost investment for individuals with established diabetes and may result in medication cost-savings to the health system. Although QALYs were similar between groups, other benefits arising from the intervention should also be considered when determining the overall value of this strategy.
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Affiliation(s)
- L G Gordon
- Centre for Applied Health Economics, Griffith Health Institute, Griffith University, University Dr, Meadowbrook, Queensland, Australia.
| | - D Bird
- School of Public Health and Preventive Medicine, Monash University, Queensland, Australia; School of Nursing, Queensland University of Technology, Australia
| | - B Oldenburg
- School of Public Health and Preventive Medicine, Monash University, Queensland, Australia
| | - R H Friedman
- Medical Information Systems Unit, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - A W Russell
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woollongabba, Queensland, Australia; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - P A Scuffham
- Centre for Applied Health Economics, Griffith Health Institute, Griffith University, University Dr, Meadowbrook, Queensland, Australia
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Russell AW, Baxter KA, Askew DA, Tsai J, Ware RS, Jackson CL. Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial. Diabet Med 2013; 30:1112-21. [PMID: 23758279 DOI: 10.1111/dme.12251] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/28/2013] [Accepted: 06/06/2013] [Indexed: 12/23/2022]
Abstract
AIMS To evaluate patient outcomes for a novel integrated primary/specialist model of community care for complex Type 2 diabetes mellitus management compared with outcomes for usual care at a tertiary hospital for diabetes outpatients. METHODS This was a prospective open controlled trial performed in a primary and tertiary care setting in Australia. A total of 330 patients with Type 2 diabetes aged >18 years were allocated to an intervention (n=185) or usual care group (n=145). The intervention arm was a community-based model of care led by a general practitioner with advanced skills and an endocrinologist partnership. Usual care was provided via the hospital diabetes outpatient department. The primary end point was HbA(1c) concentration at 12 months. Secondary end points included serum lipids and blood pressure. RESULTS The mean change in HbA1c concentration in the intervention group was -9 mmol/mol (-0.8%) at 12 months and in the usual care group it was -2 mmol/mol (-0.2%) (95% CI -5,1). The percentage of patients in the intervention group achieving the HbA(1c) target of ≤53 mmol/mol (7%) increased from 21 to 42% (P<0.001); for the usual care group there was a 1% increase to 39% of patients attaining this target (P=0.99). Patients in the intervention group experienced significant improvements in blood pressure and total cholesterol compared with those in the usual care group. The percentage of patients achieving clinical targets was greater in the intervention group for the combined target of HbA(1c) concentration, blood pressure and LDL cholesterol. CONCLUSIONS A community-based, integrated model of complex diabetes care, delivered by general practitioners with advanced skills, produced clinical and process benefits compared with a tertiary diabetes outpatient clinic.
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Affiliation(s)
- A W Russell
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Qld, Australia.
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Abstract
AIMS To investigate the relationship between retinal nerve fibre layer thickness and peripheral neuropathy in patients with Type 2 diabetes, particularly in those who are at higher risk of foot ulceration. METHODS Global and sectoral retinal nerve fibre layer thicknesses were measured at 3.45 mm diameter around the optic nerve head using optical coherence tomography (OCT). The level of neuropathy was assessed in 106 participants (82 with Type 2 diabetes and 24 healthy controls) using the 0-10 neuropathy disability score. Participants were stratified into four neuropathy groups: none (0-2), mild (3-5), moderate (6-8), and severe (9-10). A neuropathy disability score ≥ 6 was used to define those at higher risk of foot ulceration. Multivariable regression analysis was performed to assess the effect of neuropathy disability scores, age, disease duration and retinopathy on RNFL thickness. RESULTS Inferior (but not global or other sectoral) retinal nerve fibre layer thinning was associated with higher neuropathy disability scores (P = 0.03). The retinal nerve fibre layer was significantly thinner for the group with neuropathy disability scores ≥ 6 in the inferior quadrant (P < 0.005). Age, duration of disease and retinopathy levels did not significantly influence retinal nerve fibre layer thickness. Control participants did not show any significant differences in thickness measurements from the group with diabetes and no neuropathy (P > 0.24 for global and all sectors). CONCLUSIONS Inferior quadrant retinal nerve fibre layer thinning is associated with peripheral neuropathy in patients with Type 2 diabetes, and is more pronounced in those at higher risk of foot ulceration.
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Affiliation(s)
- A M Shahidi
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Sampson GP, Shahidi AM, Vagenas D, Pritchard N, Edwards K, Russell AW, Malik RA, Efron N. Visual sensitivity loss in the central 30° of visual field is associated with diabetic peripheral neuropathy. Diabetologia 2012; 55:1179-85. [PMID: 22258430 DOI: 10.1007/s00125-012-2457-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 12/20/2011] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS Impaired central vision has been shown to predict diabetic peripheral neuropathy (DPN). Several studies have demonstrated diffuse retinal neurodegenerative changes in diabetic patients prior to retinopathy development, raising the prospect that non-central vision may also be compromised by primary neural damage. We hypothesise that type 2 diabetic patients with DPN exhibit visual sensitivity loss in a distinctive pattern across the visual field, compared with a control group of type 2 diabetic patients without DPN. METHODS Increment light sensitivity was measured by standard perimetry in the central 30° of visual field for two age-matched groups of type 2 diabetic patients, with and without neuropathy (n = 40/30). Neuropathy status was assigned using the neuropathy disability score. Mean visual sensitivity values were calculated globally, for each quadrant and for three eccentricities (0-10°, 11-20° and 21-30°). Data were analysed using a generalised additive mixed model (GAMM). RESULTS Global and quadrant between-group visual sensitivity mean differences were marginally but consistently lower (by about 1 dB) in the neuropathy cohort compared with controls. Between-group mean differences increased from 0.36 to 1.81 dB with increasing eccentricity. GAMM analysis, after adjustment for age, showed these differences to be significant beyond 15° eccentricity and monotonically increasing. Retinopathy levels and disease duration were not significant factors within the model (p = 0.90). CONCLUSIONS/INTERPRETATION Visual sensitivity reduces disproportionately with increasing eccentricity in type 2 diabetic patients with peripheral neuropathy. This sensitivity reduction within the central 30° of visual field may be indicative of more consequential loss in the far periphery.
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Affiliation(s)
- G P Sampson
- Queensland University of Technology, Kelvin Grove, Australia
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Dimeski G, Jones BW, Tilley V, Greenslade MN, Russell AW. Glucose meters: evaluation of the new formulation measuring strips from Roche (Accu-Chek) and Abbott (MediSense). Ann Clin Biochem 2010; 47:358-65. [DOI: 10.1258/acb.2010.009291] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Both Roche and Abbott have released new glucose meter strips. They supply the entire Australian hospital market. The present study compared the performance of the new strips utilizing various specimen types (capillary, venous lithium heparin whole blood, venous lithium heparin plasma and serum) and evaluated how well they comply with the International Standards Organization (ISO) 15197 criteria. Methods The study included imprecision, patient comparison and interference studies. Participants with and without diabetes were recruited to evaluate the performance of various specimen types against the Beckman DxC800 glucose method. The strips were tested for different interferences: galactose, maltose, lactose, Icodextrin, Intragam, paracetamol, sodium, ascorbic acid, variable strip storage temperature, haematocrit, haemolysis and lipaemia. Results The imprecision of the two strips was ∼5% or less, except for the Abbott strip at very low values (1.4 mmol/L), ∼7%. In total, 78% and 84%, respectively, of the results from the finger prick capillary specimens with the Roche (Accu-Chek Performa meter) and Abbott (Optium Xceed meter) strips, not 95% or greater as recommended by the ISO guideline, were within the recommended limits compared with reference plasma estimation on laboratory analysers. Galactose, ascorbic acid, haematocrit and sodium on the Roche and ascorbic acid and haematocrit on the Abbott strip continue to interfere to a variable degree with the glucose measurement. Conclusion Analytically small differences exist between the glucose meter strips. The most significant analytical difference with the strips was at low glucose levels when compared with laboratory analyses and this may be of clinical importance. The impact of some of the interferences is variable between the two strips. Individuals, health-care professionals and health-care institutions should consider these data when selecting glucose meters for the management of people with diabetes mellitus.
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Affiliation(s)
- G Dimeski
- Department of Chemical Pathology, Pathology Queensland, Princess Alexandra Hospital, Brisbane 4102
| | - B W Jones
- Department of Chemical Pathology, Pathology Queensland, Princess Alexandra Hospital, Brisbane 4102
| | - V Tilley
- Department of Chemical Pathology, Pathology Queensland, Princess Alexandra Hospital, Brisbane 4102
| | - M N Greenslade
- Department of Chemical Pathology, Pathology Queensland, Princess Alexandra Hospital, Brisbane 4102
| | - A W Russell
- Diabetes and Endocrinology, Princess Alexandra Hospital, and Diamantina Institute for Cancer, Immunology and Metabolic Medicine, University of Queensland, Brisbane, Australia
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Abstract
AIMS To determine the effects of acute hyperglycaemia on appetite and food intake in Type 1 diabetes mellitus. METHODS Two separate studies, each involving eight adults with uncomplicated Type 1 diabetes, were performed: one in the fasted state (A) and the other after a nutrient preload (B). In both studies, perceptions of appetite (hunger and fullness) and food intake at a buffet meal were evaluated during euglycaemia (blood glucose, approximately 6 mmol/l) and hyperglycaemia (blood glucose, approximately 14 mmol/l). Both experiments were randomized and single-blind. In study A, appetite was assessed in the fasted state for 90 min before the buffet meal. In study B, a nutrient 'preload' of Ensure and milk containing 13C-octanoic acid was consumed 90 min before the meal. Gastric emptying of the preload was quantified with a radioisotopic breath test technique. RESULTS There was no significant difference in plasma insulin concentrations between euglycaemia and hyperglycaemia in either study. In study A, there were no differences in hunger, fullness or energy intake between the two treatment days. In study B, subjects were slightly less hungry between the preload and buffet meal during hyperglycaemia than euglycaemia (P = 0.04), and tended to have slower gastric emptying during hyperglycaemia (emptying coefficient, 3.89 +/- 0.16 vs. 3.57 +/- 0.21; P = 0.052), but there was no difference in food intake between hyperglycaemia and euglycaemia. CONCLUSIONS Acute hyperglycaemia suppresses hunger after a nutrient preload, but not in the fasted state, in patients with uncomplicated Type 1 diabetes. This effect is small and not associated with changes in food intake.
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Affiliation(s)
- A W Russell
- University of Adelaide Department of Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
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Russell AW. Inadvertent epidural overdose. Anaesth Intensive Care 1994; 22:501-2. [PMID: 7978225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Russell AW, Owen H, Ilsley AH, Kluger MT, Plummer JL. Background infusion with patient-controlled analgesia: effect on postoperative oxyhaemoglobin saturation and pain control. Anaesth Intensive Care 1993; 21:174-9. [PMID: 8517508 DOI: 10.1177/0310057x9302100207] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The aim of this study was to determine whether the addition of a background infusion (BI) to patient-controlled analgesia (PCA) would lead to significantly improved pain control or poorer oxyhaemoglobin saturation (SpO2) after gynaecological surgery. Sixty-two patients were studied for 24 hours postoperatively; pain scores and morphine dose were recorded hourly, SpO2 was recorded every 10 seconds. Administration of the BI resulted in a significant increase in total morphine dose received although there was no difference in the severity of postoperative desaturation between the therapies. Despite the increased morphine dose pain scores also were similar in the two groups. Addition of a BI at 1 mg/hr did not confer any advantage over PCA alone and is not recommended when PCA is used in this patient group.
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Affiliation(s)
- A W Russell
- Department of Anaesthesia and Intensive Care, Flinders Medical Centre, Bedford Park, South Australia
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Russell AW. Empirical calibration of light blockage sensors. J Parenter Sci Technol 1992; 46:9-11. [PMID: 1625110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The intent of this note is to describe in more detail the calibration process for these sensors with particular emphasis on the method of obtaining the best calibration curve from the raw data. A new method of assessing the accuracy of the calibration curve is also described.
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Russell AW. Ye cow-pock, Gillray and social medicine--a note on Gillray's caricature of Jenner and the 'New inoculation'. Soc Soc Hist Med Bull (Lond) 1977:17-22. [PMID: 11610118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
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17
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Russell AW. Dispensaries in the nineteenth-century: a short bibliography. Soc Soc Hist Med Bull (Lond) 1977:29-30. [PMID: 11610119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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18
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Baker RC, Russell AW. Environmental monitoring summary for the Paducah Plant for 1964. KY-484. KY Rep 1965:1-10. [PMID: 5853614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Russell AW. A Discussion on Amenorrhœal Insanity. Proc R Soc Med 1912; 5:106-7. [PMID: 19976088 PMCID: PMC2006263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Russell AW. Extraperitoneal Cæsarean Section. Proc R Soc Med 1912; 5:306-12. [PMID: 19976135 PMCID: PMC2006311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Russell AW. A Discussion on Amenorrhœal Insanity. Proc R Soc Med 1912; 5:106-107. [PMID: 20900485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Russell AW. Extraperitoneal Cæsarean Section. Proc R Soc Med 1912; 5:306-312. [PMID: 20900532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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23
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Russell AW. Discussion on the Indications for, and Technique of, Cæsarean Section and its Alternatives, in Women with Contracted Pelves, who have been long in Labour and exposed to Septic Infection. Proc R Soc Med 1911; 4:204-206. [PMID: 20899680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Russell AW. Discussion on the Indications for, and Technique of, Cæsarean Section and its Alternatives, in Women with Contracted Pelves, who have been long in Labour and exposed to Septic Infection. Proc R Soc Med 1911; 4:204-6. [PMID: 19975283 PMCID: PMC2005081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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