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Ruissen MM, Steyerberg EW, Huisman SD, de Graaf AA, de Koning EJP, Delgado-Lista J, Sont JK. Critical comments regarding the assessment of quality of life and the clinical impact of the POWER2DM intervention. Reply to Pouwer F, Deschênes SS [letter]. Diabetologia 2024; 67:956-957. [PMID: 38427075 DOI: 10.1007/s00125-024-06119-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Merel M Ruissen
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Sasja D Huisman
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Albert A de Graaf
- Netherlands Organization for Applied Scientific Research (TNO), Utrecht, the Netherlands
| | - Eelco J P de Koning
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Javier Delgado-Lista
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofia University Hospital, Córdoba, Spain
| | - Jacob K Sont
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
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Landstra CP, Ruissen MM, Regeer H, Nijhoff MF, Ballieux BEPB, van der Boog PJM, de Vries APJ, Huisman SD, de Koning EJP. Impact of a Public Health Emergency on Behavior, Stress, Anxiety and Glycemic Control in Patients With Pancreas or Islet Transplantation for Type 1 Diabetes. Transpl Int 2024; 37:12278. [PMID: 38601276 PMCID: PMC11005033 DOI: 10.3389/ti.2024.12278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024]
Abstract
A public health emergency such as the COVID-19 pandemic has behavioral, mental and physical implications in patients with type 1 diabetes (T1D). To what extent the presence of a transplant further increases this burden is not known. Therefore, we compared T1D patients with an islet or pancreas transplant (β-cell Tx; n = 51) to control T1D patients (n = 272). Fear of coronavirus infection was higher in those with β-cell Tx than without (Visual Analogue Scale 5.0 (3.0-7.0) vs. 3.0 (2.0-5.0), p = 0.004) and social isolation behavior was more stringent (45.8% vs. 14.0% reported not leaving the house, p < 0.001). A previous β-cell Tx was the most important predictor of at-home isolation. Glycemic control worsened in patients with β-cell Tx, but improved in control patients (ΔHbA1c +1.67 ± 8.74 vs. -1.72 ± 6.15 mmol/mol, p = 0.006; ΔTime-In-Range during continuous glucose monitoring -4.5% (-6.0%-1.5%) vs. +3.0% (-2.0%-6.0%), p = 0.038). Fewer patients with β-cell Tx reported easier glycemic control during lockdown (10.4% vs. 22.6%, p = 0.015). All T1D patients, regardless of transplantation status, experienced stress (33.4%), anxiety (27.9%), decreased physical activity (42.0%), weight gain (40.5%), and increased insulin requirements (29.7%). In conclusion, T1D patients with β-cell Tx are increasingly affected by a viral pandemic lockdown with higher fear of infection, more stringent social isolation behavior and deterioration of glycemic control. This trial has been registered in the clinicaltrials.gov registry under identifying number NCT05977205 (URL: https://clinicaltrials.gov/study/NCT05977205).
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Affiliation(s)
- Cyril P. Landstra
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Merel M. Ruissen
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
| | - Hannah Regeer
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Michiel F. Nijhoff
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
- Transplantation Center, Leiden University Medical Center, Leiden, Netherlands
| | - Bart E. P. B. Ballieux
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Paul J. M. van der Boog
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
- Transplantation Center, Leiden University Medical Center, Leiden, Netherlands
| | - Aiko P. J. de Vries
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
- Transplantation Center, Leiden University Medical Center, Leiden, Netherlands
| | - Sasja D. Huisman
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Eelco J. P. de Koning
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
- Transplantation Center, Leiden University Medical Center, Leiden, Netherlands
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Ruissen MM, Torres-Peña JD, Uitbeijerse BS, Arenas de Larriva AP, Huisman SD, Namli T, Salzsieder E, Vogt L, Ploessnig M, van der Putte B, Merle A, Serra G, Rodríguez G, de Graaf AA, de Koning EJP, Delgado-Lista J, Sont JK. Clinical impact of an integrated e-health system for diabetes self-management support and shared decision making (POWER2DM): a randomised controlled trial. Diabetologia 2023; 66:2213-2225. [PMID: 37775611 PMCID: PMC10627940 DOI: 10.1007/s00125-023-06006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/23/2023] [Accepted: 07/21/2023] [Indexed: 10/01/2023]
Abstract
AIMS/HYPOTHESIS There is a lack of e-health systems that integrate the complex variety of aspects relevant for diabetes self-management. We developed and field-tested an e-health system (POWER2DM) that integrates medical, psychological and behavioural aspects and connected wearables to support patients and healthcare professionals in shared decision making and diabetes self-management. METHODS Participants with type 1 or type 2 diabetes (aged >18 years) from hospital outpatient diabetes clinics in the Netherlands and Spain were randomised using randomisation software to POWER2DM or usual care for 37 weeks. This RCT assessed the change in HbA1c between the POWER2DM and usual care groups at the end of the study (37 weeks) as a primary outcome measure. Participants and clinicians were not blinded to the intervention. Changes in quality of life (QoL) (WHO-5 Well-Being Index [WHO-5]), diabetes self-management (Diabetes Self-Management Questionnaire - Revised [DSMQ-R]), glycaemic profiles from continuous glucose monitoring devices, awareness of hypoglycaemia (Clarke hypoglycaemia unawareness instrument), incidence of hypoglycaemic episodes and technology acceptance were secondary outcome measures. Additionally, sub-analyses were performed for participants with type 1 and type 2 diabetes separately. RESULTS A total of 226 participants participated in the trial (108 with type 1 diabetes; 118 with type 2 diabetes). In the POWER2DM group (n=111), HbA1c decreased from 60.6±14.7 mmol/mol (7.7±1.3%) to 56.7±12.1 mmol/mol (7.3±1.1%) (means ± SD, p<0.001), compared with no change in the usual care group (n=115) (baseline: 61.7±13.7 mmol/mol, 7.8±1.3%; end of study: 61.0±12.4 mmol/mol, 7.7±1.1%; p=0.19) (between-group difference 0.24%, p=0.008). In the sub-analyses in the POWER2DM group, HbA1c in participants with type 2 diabetes decreased from 62.3±17.3 mmol/mol (7.9±1.6%) to 54.3±11.1 mmol/mol (7.1±1.0%) (p<0.001) compared with no change in HbA1c in participants with type 1 diabetes (baseline: 58.8±11.2 mmol/mol [7.5±1.0%]; end of study: 59.2±12.7 mmol/mol [7.6±1.2%]; p=0.84). There was an increase in the time during which interstitial glucose levels were between 3.0 and 3.9 mmol/l in the POWER2DM group, but no increase in clinically relevant hypoglycaemia (interstitial glucose level below 3.0 mmol/l). QoL improved in participants with type 1 diabetes in the POWER2DM group compared with the usual care group (baseline: 15.7±3.8; end of study: 16.3±3.5; p=0.047 for between-group difference). Diabetes self-management improved in both participants with type 1 diabetes (from 7.3±1.2 to 7.7±1.2; p=0.002) and those with type 2 diabetes (from 6.5±1.3 to 6.7±1.3; p=0.003) within the POWER2DM group. The POWER2DM integrated e-health support was well accepted in daily life and no important adverse (or unexpected) effects or side effects were observed. CONCLUSIONS/INTERPRETATION POWER2DM improves HbA1c levels compared with usual care in those with type 2 diabetes, improves QoL in those with type 1 diabetes, improves diabetes self-management in those with type 1 and type 2 diabetes, and is well accepted in daily life. TRIAL REGISTRATION ClinicalTrials.gov NCT03588104. FUNDING This study was funded by the European Union's Horizon 2020 Research and Innovation Programme (grant agreement number 689444).
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Affiliation(s)
- Merel M Ruissen
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Department of Biomedical Data Sciences, Medical Decision Making Section, Leiden University Medical Center, Leiden, the Netherlands
| | - José D Torres-Peña
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofía University Hospital, Córdoba, Spain
- Department of Medical and Surgical Sciences, University of Córdoba, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Bas S Uitbeijerse
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Antonio P Arenas de Larriva
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofía University Hospital, Córdoba, Spain
- Department of Medical and Surgical Sciences, University of Córdoba, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Sasja D Huisman
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Tuncay Namli
- SRDC Software Research & Development and Consultancy Corp., Ankara, Turkey
| | | | - Lutz Vogt
- Diabetes Service Center GmbH, Karlsburg, Germany
| | | | | | | | | | | | - Albert A de Graaf
- Netherlands Organization for Applied Scientific Research (TNO), Utrecht, the Netherlands
| | - Eelco J P de Koning
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands.
| | - Javier Delgado-Lista
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofía University Hospital, Córdoba, Spain
- Department of Medical and Surgical Sciences, University of Córdoba, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Jacob K Sont
- Department of Biomedical Data Sciences, Medical Decision Making Section, Leiden University Medical Center, Leiden, the Netherlands
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Affiliation(s)
- Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Merel M Ruissen
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Ian G Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
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Ruissen MM, Montori VM, Hargraves IG, Branda ME, León García M, de Koning EJ, Kunneman M. Problem-based shared decision-making in diabetes care: a secondary analysis of video-recorded encounters. BMJ Evid Based Med 2023; 28:157-163. [PMID: 36868578 DOI: 10.1136/bmjebm-2022-112067] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Accepted: 02/12/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVES To describe the range of collaborative approaches to shared decision-making (SDM) observed in clinical encounters of patients with diabetes and their clinicians. DESIGN A secondary analysis of videorecordings obtained in a randomised trial comparing usual diabetes primary care with or without using a within-encounter conversation SDM tool. SETTING Using the purposeful SDM framework, we classified the forms of SDM observed in a random sample of 100 video-recorded clinical encounters of patients with type 2 diabetes in primary care. MAIN OUTCOME MEASURES We assessed the correlation between the extent to which each form of SDM was used and patient involvement (OPTION12-scale). RESULTS We observed at least one instance of SDM in 86 of 100 encounters. In 31 (36%) of these 86 encounters, we found only one form of SDM, in 25 (29%) two forms, and in 30 (35%), we found ≥3 forms of SDM. In these encounters, 196 instances of SDM were identified, with weighing alternatives (n=64 of 196, 33%), negotiating conflicting desires (n=59, 30%) and problemsolving (n=70, 36%) being similarly prevalent and developing existential insight accounting for only 1% (n=3) of instances. Only the form of SDM focused on weighing alternatives was correlated with a higher OPTION12-score. More forms of SDM were used when medications were changed (2.4 SDM forms (SD 1.48) vs 1.8 (SD 1.46); p=0.050). CONCLUSIONS After considering forms of SDM beyond weighing alternatives, SDM was present in most encounters. Clinicians and patients often used different forms of SDM within the same encounter. Recognising a range of SDM forms that clinicians and patients use to respond to problematic situations, as demonstrated in this study, opens new lines of research, education and practice that may advance patient-centred, evidence-based care.
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Affiliation(s)
- Merel M Ruissen
- Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian G Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan E Branda
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Montserrat León García
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Eelco Jp de Koning
- Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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Montori VM, Ruissen MM, Branda ME, Hargraves IG, Kunneman M. Problem-based shared decision making: The role of canonical SDM steps. Health Expect 2022; 26:282-289. [PMID: 36448245 PMCID: PMC9854321 DOI: 10.1111/hex.13654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/07/2022] [Accepted: 10/25/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate the extent to which the canonical steps of shared decision making (SDM) take place in clinical encounters in practice and across SDM forms. METHODS We assessed 100 randomly selected video-recorded primary care encounters, obtained as part of a randomized trial of an SDM intervention in patients with type 2 diabetes. Two coders, working independently, noted each instance of SDM, classified it as one of four problem-based forms to SDM (weighing alternatives, negotiating conflicting issues, solving problems, or developing existential insight), and noted the occurrence and timing of each of the four canonical SDM steps: fostering choice awareness, providing information, stating preferences, and deciding. Descriptive analyses sought to determine the relative frequency of these steps across each of the four SDM forms within each encounter. RESULTS There were 485 SDM steps noted (mean 4.85 steps per encounter), of which providing information and stating preferences were the most common. There were 2.7 (38 steps in 14 encounters) steps per encounter observed in encounters with no discernible SDM form, 3.4 (105 steps in 31 encounters) with one SDM form, 5.2 (129 steps in 25 encounters) with two SDM forms, and 7.1 (213 steps in 30 encounters) when ≥3 SDM forms were observed within the encounter. The prescribed order of the four SDM steps was observed in, at best, 16 of the 100 encounters. Stating preferences was a common step when weighing alternatives (38%) or negotiating conflicts (59.3%) but less common when solving problems (29.2%). The distribution of SDM steps was similar to usual care with or without the SDM intervention. CONCLUSION The normative steps of SDM are infrequently observed in their prescribed order regardless of whether an SDM intervention was used. Some steps are more likely in some SDM forms but no pattern of steps appears to distinguish among SDM forms. CLINICAL TRIAL REGISTRATION ClinicalTrial.gov: NCT01293578.
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Affiliation(s)
- Victor M. Montori
- Knowledge and Evaluation Research UnitMayo Clinic RochesterRochesterMinnesotaUSA
| | - Merel M. Ruissen
- Knowledge and Evaluation Research UnitMayo Clinic RochesterRochesterMinnesotaUSA,Department of Medicine, Division of EndocrinologyLeiden University Medical CenterLeidenZuid‐HollandThe Netherlands,Department of Biomedical Data Sciences, Section of Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
| | - Megan E. Branda
- Knowledge and Evaluation Research UnitMayo Clinic RochesterRochesterMinnesotaUSA,Department of Quantitative Health Sciences, Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMinnesotaUSA
| | - Ian G. Hargraves
- Knowledge and Evaluation Research UnitMayo Clinic RochesterRochesterMinnesotaUSA
| | - Marleen Kunneman
- Knowledge and Evaluation Research UnitMayo Clinic RochesterRochesterMinnesotaUSA,Department of Biomedical Data Sciences, Section of Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
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Perez-Corral I, Gomez-Delgado F, Ruissen MM, Torres-Peña JD, Larriva APAD, Sont JK, de Graaf AA, Uitbeijerse BS, de Koning EJP, Delgado-Lista J. Sleep duration and lipid metabolism in patients with diabetes mellitus: from the POWER2DM study. Sleep Biol Rhythms 2022; 20:595-599. [PMID: 38468620 PMCID: PMC10899896 DOI: 10.1007/s41105-022-00403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/04/2022] [Indexed: 10/16/2022]
Abstract
This study assesses the association between sleep duration and plasma lipid profiles in people with diabetes mellitus (DM). Sleep duration data were obtained in 91 patients from the POWER2DM study (NCT03588104). The patients were divided in tertiles, based on their sleep duration, and blood samples were obtained at the beginning and after 9 months. Significant differences were found, specifically, patients in Tertile 3 (≥ 7.51 h) showed lower plasma levels of high-density lipoprotein cholesterol HDL-c (p < 0.05), apolipoprotein A1 (apo-A1; p < 0.05) and low HDL-c/apo-A1 ratio (p < 0.05). This study shows that sleep duration is associated with plasma lipid profiles in people with DM.
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Affiliation(s)
- Isabel Perez-Corral
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Avda. Menendez Pidal, S/N., 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, 14004 Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia de La Obesidad Y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Francisco Gomez-Delgado
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Avda. Menendez Pidal, S/N., 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, 14004 Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia de La Obesidad Y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Merel M. Ruissen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland The Netherlands
| | - Jose D. Torres-Peña
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Avda. Menendez Pidal, S/N., 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, 14004 Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia de La Obesidad Y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Antonio P. Arenas-de Larriva
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Avda. Menendez Pidal, S/N., 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, 14004 Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia de La Obesidad Y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jacob K. Sont
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert A. de Graaf
- Department Risk Analysis for Products in Development, The Netherlands Organization for Applied Scientific Research (TNO), 3508 TA Utrecht, The Netherlands
| | - Bas S. Uitbeijerse
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland The Netherlands
| | - Eelco J. P. de Koning
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland The Netherlands
| | - Javier Delgado-Lista
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Avda. Menendez Pidal, S/N., 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, 14004 Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia de La Obesidad Y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Ruissen MM, Sont JK, van Vugt HA, Kunneman M, Rutten GEHM, de Koning EJP. Key Factors Relevant for Healthcare Decisions of Patients with Type 1 and Type 2 Diabetes in Secondary Care According to Healthcare Professionals. Patient Prefer Adherence 2022; 16:809-819. [PMID: 35370405 PMCID: PMC8974434 DOI: 10.2147/ppa.s354686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Understanding which factors are important for healthcare decisions of patients with diabetes in clinical practice is important to personalise diabetes care strategies and tailor care plans to the individual. The main drivers for these healthcare decisions remain unclear. This study assessed which key factors are relevant for healthcare decisions during clinical consultations for patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM), according to healthcare professionals. MATERIALS AND METHODS Annual diabetes reviews were performed as part of a trial assessing the impact of a consultation model facilitating person-centred diabetes care in six hospital outpatient clinics. After each consultation, we asked healthcare professionals to choose a maximum of three out of 20 factors that were most relevant for healthcare decisions about treatment goals and the professional support needed during the upcoming year. Factors were characterised as either person or disease-related. Percentages reflect the number of annual diabetes reviews in which the key factor was reported. RESULTS Seventeen physicians and eight diabetes specialist nurses reported the key factors relevant for healthcare decisions in 285 annual diabetes reviews (T1DM n = 119, T2DM n = 166). Healthcare professionals most often reported quality of life (31.9%), motivation (27.0%) and diabetes self-management (25.6%), and to a lesser extent glycaemic control (24.2%), to be important for decisions about treatment goals. For decisions about the professional support needed during the upcoming year patient's preferences (33.7%), diabetes self-management (33.3%), quality of life (27.0%) and motivation (25.6%) were most often considered relevant by healthcare professionals. CONCLUSION According to healthcare professionals, person-related factors such as quality of life, diabetes self-management and motivation are predominantly relevant for healthcare decisions about treatment goals and the professional support needed during the upcoming year.
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Affiliation(s)
- Merel M Ruissen
- Department of Medicine, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Jacob K Sont
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Heidi A van Vugt
- Julius Centre for Health Sciences and Primary Care, Department of General Practice, University Medical Centre Utrecht, Utrecht, the Netherlands
- Dutch Diabetes Federation, Amersfoort, the Netherlands
| | - Marleen Kunneman
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Guy E H M Rutten
- Julius Centre for Health Sciences and Primary Care, Department of General Practice, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Eelco J P de Koning
- Department of Medicine, Leiden University Medical Centre, Leiden, the Netherlands
- Correspondence: Eelco JP de Koning, Department of Medicine, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands, Tel +31 71 52 62085, Fax +31 71 52 66881, Email
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Ruissen MM, Rodriguez-Gutierrez R, Montori VM, Kunneman M. Making Diabetes Care Fit—Are We Making Progress? Front Clin Diabetes Healthc 2021; 2:658817. [PMID: 36994329 PMCID: PMC10012071 DOI: 10.3389/fcdhc.2021.658817] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/22/2021] [Indexed: 02/04/2023]
Abstract
The care of patients with diabetes requires plans of care that make intellectual, practical, and emotional sense to patients. For these plans to fit well, patients and clinicians must work together to develop a common understanding of the patient’s problematic human situation and co-create a plan of care that responds well to it. This process, which starts at the point of care, needs to continue at the point of life. There, patients work to fit the demands of their care plan along with the demands placed by their lives and loves. Thought in this way, diabetes care goes beyond the control of metabolic parameters and the achievement of glycemic control targets. Instead, it is a highly individualized endeavor that must arrive at a care plan that reflects the biology and biography of the patient, the best available research evidence, and the priorities and values of the patient and her community. It must also be feasible within the life of the patient, minimally disrupting those aspects of the patient life that are treasured and justify the pursuit of care in the first place. Patient-centered methods such as shared decision making and minimally disruptive medicine have joined technological advances, patient empowerment, self-management support, and expert patient communities to advance the fit of diabetes care both at the point of care and at the point of life.
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Affiliation(s)
- Merel M. Ruissen
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
| | - René Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
- Plataforma INVEST Medicina-UANL—KER Unit, KER Unit México, Universidad Autónoma de Nuevo León, Monterrey, Mexico
- Endocrinology Division, University Hospital “Dr José E González,”Monterrey, Mexico
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, United States
| | - Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
- Division of Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Marleen Kunneman,
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10
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Ruissen MM, Regeer H, Landstra CP, Schroijen M, Jazet I, Nijhoff MF, Pijl H, Ballieux BEPB, Dekkers O, Huisman SD, de Koning EJP. Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic. BMJ Open Diabetes Res Care 2021; 9:9/1/e002035. [PMID: 33431602 PMCID: PMC7802391 DOI: 10.1136/bmjdrc-2020-002035] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [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] [Received: 11/23/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Lockdown measures have a profound effect on many aspects of daily life relevant for diabetes self-management. We assessed whether lockdown measures, in the context of the COVID-19 pandemic, differentially affect perceived stress, body weight, exercise and related this to glycemic control in people with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS We performed a short-term observational cohort study at the Leiden University Medical Center. People with type 1 and type 2 diabetes ≥18 years were eligible to participate. Participants filled out online questionnaires, sent in blood for hemoglobin A1c (HbA1c) analysis and shared data of their flash or continuous glucose sensors. HbA1c during the lockdown was compared with the last known HbA1c before the lockdown. RESULTS In total, 435 people were included (type 1 diabetes n=280, type 2 diabetes n=155). An increase in perceived stress and anxiety, weight gain and less exercise was observed in both groups. There was improvement in glycemic control in the group with the highest HbA1c tertile (type 1 diabetes: -0.39% (-4.3 mmol/mol) (p<0.0001 and type 2 diabetes: -0.62% (-6.8 mmol/mol) (p=0.0036). Perceived stress was associated with difficulty with glycemic control (p<0.0001). CONCLUSIONS An increase in perceived stress and anxiety, weight gain and less exercise but no deterioration of glycemic control occurs in both people with relatively well-controlled type 1 and type 2 diabetes during short-term lockdown measures. As perceived stress showed to be associated with glycemic control, this provides opportunities for healthcare professionals to put more emphasis on psychological aspects during diabetes care consultations.
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Affiliation(s)
- Merel M Ruissen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Hannah Regeer
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Cyril P Landstra
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Marielle Schroijen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Ingrid Jazet
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Michiel F Nijhoff
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Hanno Pijl
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Bart E P B Ballieux
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Olaf Dekkers
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
- Department of Epidemiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Sasja D Huisman
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Eelco J P de Koning
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
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11
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Ruissen MM, Mak AL, Beuers U, Tushuizen ME, Holleboom AG. Non-alcoholic fatty liver disease: a multidisciplinary approach towards a cardiometabolic liver disease. Eur J Endocrinol 2020; 183:R57-R73. [PMID: 32508312 DOI: 10.1530/eje-20-0065] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 01/22/2020] [Accepted: 06/04/2020] [Indexed: 11/08/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a growing health problem with a global prevalence of over 25% and prevalence rates of over 60% in high-risk populations. It is considered the hepatic component of the metabolic syndrome and is associated with an increased risk of the development of various liver-associated and cardiometabolic complications. Given the complexity of NAFLD and associated comorbidities and complications, treatment requires interventions from a variety of different healthcare specialties. However, many clinicians are currently insufficiently aware of the potential harm and severity of NAFLD and associated comorbidities, complications and the steps that should be taken when NAFLD is suspected. Recognizing which patients suffer from non-progressive simple steatosis, metabolically active NASH with high risk of developing cardiovascular disease and which patients have a high risk of developing cirrhosis and hepatocellular carcinoma is important. Unfortunately, this can be difficult and guidelines towards the optimal diagnostic and therapeutic approach are ambivalent. Here we review the pathogenesis, diagnostics and treatment of NAFLD and discuss how multidisciplinary care path development could move forward.
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Affiliation(s)
- Merel M Ruissen
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne Linde Mak
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Adriaan G Holleboom
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
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