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Abstract
Prediabetes continues to be a national and worldwide health concern, affecting 84 million adults in the US. Early identification and intervention have been successful in delaying and/or preventing the progression to type 2 diabetes mellitus (T2DM). To curb the increasing prevalence of T2DM, recognizing the importance of identifying and managing prediabetes is paramount.
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Rariden C. Prediabetes: Early identification and management. Nurse Pract 2018; 43:35-40. [PMID: 30439773 DOI: 10.1097/01.npr.0000547552.94259.6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prediabetes continues to be a national and worldwide health concern, affecting 84 million adults in the US. Early identification and intervention have been successful in delaying and/or preventing the progression to type 2 diabetes mellitus (T2DM). Nonpharmacologic treatment of prediabetes is paramount, although pharmacologic treatment is appropriate in high-risk patients. In an attempt to curb the increasing prevalence of T2DM, recognizing the importance of identifying and managing prediabetes should remain in the national healthcare forefront.
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Affiliation(s)
- Christina Rariden
- Christina Rariden is an assistant professor at Saint Louis University, St. Louis, Mo
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Palaya J, Pearson S, Nash T. Perception of social support in individuals living with a diabetic foot: A qualitative study. Diabetes Res Clin Pract 2018; 146:267-277. [PMID: 30389622 DOI: 10.1016/j.diabres.2018.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/13/2018] [Accepted: 10/23/2018] [Indexed: 12/21/2022]
Abstract
AIM To explore the perception of social support in individuals living with a diabetic foot in order to influence future service delivery in management of similar individuals. METHOD A purposive sample of eight participants with a diabetic foot were recruited from a public podiatry service in Tasmania, Australia. A hermeneutic phenomenology qualitative approach was used with individual semi-structured interviews conducted using an interview guide designed to gain insight into five pre-determined measures of social support. Hybrid thematic analysis was used to produce the final results. RESULTS Five clusters of themes emerged; emotional self-efficacy, isolation and stress; transport needs linked to physical or social functioning; perception of social support from health professionals; reciprocal support including health professionals facilitating support and financial support. CONCLUSION The findings have major implications for three broad areas; recognition and management of psychosocial well-being, the need for patient centred care approaches and inclusion and equity in health care and society. Adopting measures that are informed by these findings in current day management practices will complement the existing body of evidence on addressing factors for developing and treating ulceration.
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Affiliation(s)
- Joshua Palaya
- College of Health and Medicine, University of Tasmania, Private Bag 34, Hobart, Tasmania 7000, Australia; Tasmanian Health Service - South, Podiatry Department, GPO Box 1061, Hobart, Tasmania 7001, Australia.
| | - Sue Pearson
- College of Health and Medicine, University of Tasmania, Private Bag 34, Hobart, Tasmania 7000, Australia.
| | - Toni Nash
- Tasmanian Health Service - South, Podiatry Department, GPO Box 1061, Hobart, Tasmania 7001, Australia.
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Caballero AE. The "A to Z" of Managing Type 2 Diabetes in Culturally Diverse Populations. Front Endocrinol (Lausanne) 2018; 9:479. [PMID: 30233490 PMCID: PMC6127640 DOI: 10.3389/fendo.2018.00479] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022] Open
Abstract
Type 2 diabetes affects racial/ethnic minorities at an alarming rate in the US and in many countries around the world. The quality of health care provided to these groups is often suboptimal, resulting in worse patient-related outcomes when compared to those in mainstream populations. Understanding the complex biological elements that influence the development and course of the disease in high-risk populations is extremely important but often insufficient to implement effective prevention and treatment plans. Multiple factors must be addressed in routine diabetes clinical care. This paper discusses various key factors, organized in alphabetical order. These are acculturation, biology, clinician's cultural awareness, depression and diabetes-specific emotional distress, educational level, fears, group integration, health literacy, intimacy and sexual dysfunction, judging, knowledge of the disease, language, medication adherence, nutritional preferences, other forms of medicine (alternative), perception of body image, quality of life, religion and faith, socio-economic status, technology, unconscious bias, vulnerable groups, asking why?, exercise, "you are in charge" and zip it! Considering these factors in the development of type 2 diabetes prevention and treatment programs will help improve diabetes-related outcomes in culturally diverse populations and reduce health care disparities.
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Affiliation(s)
- A. Enrique Caballero
- Office for External Education, Harvard Medical School, Boston, MA, United States
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multi-disciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/content/clinical-practice-recommendations.
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Kandula NR, Moran MR, Tang JW, O’Brien MJ. Preventing Diabetes in Primary Care: Providers' Perspectives About Diagnosing and Treating Prediabetes. Clin Diabetes 2018; 36:59-66. [PMID: 29382980 PMCID: PMC5775003 DOI: 10.2337/cd17-0049] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IN BRIEF Offering patient-centered care to prevent diabetes will require collaborative decision-making between patients with prediabetes and their health care providers. From the perspective of primary care providers, prediabetes detection should be targeted to patients who are most likely to benefit from diagnosis and treatment. Improving access to lifestyle intervention programs and educating providers about evidence-based treatments for prediabetes and how to effectively discuss treatment options with patients may improve both providers' and patients' engagement in diabetes prevention.
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Affiliation(s)
- Namratha R. Kandula
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Margaret R. Moran
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joyce W. Tang
- Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL
| | - Matthew J. O’Brien
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Rosenberg-Yunger ZRS, Verweel L, Gionfriddo MR, MacCallum L, Dolovich L. Community pharmacists' perspectives on shared decision-making in diabetes management. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:414-422. [PMID: 29277945 DOI: 10.1111/ijpp.12422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 11/07/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Shared decision-making (SDM) is an approach where patients and clinicians share evidence and patients are supported to deliberate options resulting in preference-based informed decisions. The aim of this study was to describe community pharmacists' perceptions and awareness of SDM within their provision of general diabetes management [including Ontario's MedsCheck for Diabetes (MCD) programme], and potential challenges of implementing SDM within community pharmacy. METHODS This qualitative study used semistructured interviews with a convenience sample of community pharmacists. Data were analysed using thematic analysis. KEY FINDINGS We conducted 16 interviews. Six participants were male, and nine were certified diabetes educators. When providing a MCD, participants used aspects of a patient-centred approach focusing on providing education. Variation was evident in participants' description and use of SDM, as well as in their perceived level of training in SDM. Participants also highlighted challenges surrounding implementing a SDM approach in practice. CONCLUSION Pharmacists are well positioned to apply SDM within community settings; however, implementation barriers exist. Pharmacists will require additional training as well as perceived patient and physician barriers should be addressed to encourage uptake.
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Affiliation(s)
- Zahava R S Rosenberg-Yunger
- Ted Rogers School of Management, Health Services Management, Ryerson University, Toronto, ON, Canada.,Ontario Pharmacists Association, Toronto, ON, Canada
| | - Lee Verweel
- Ontario Pharmacists Association, Toronto, ON, Canada
| | | | - Lori MacCallum
- Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada.,Banting & Best Diabetes Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada.,Departments of Family Medicine, Health Research Methods, Evidence, and Impact and Medicine, McMaster University, Hamilton, Canada.,School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
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Maraka S, Singh Ospina N, Rodriguez-Gutierrez R, Davidge-Pitts CJ, Nippoldt TB, Prokop LJ, Murad MH. Sex Steroids and Cardiovascular Outcomes in Transgender Individuals: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2017; 102:3914-3923. [PMID: 28945852 DOI: 10.1210/jc.2017-01643] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transgender individuals receive cross-sex hormonal therapy to induce desired secondary sexual characteristics despite limited data regarding its effects on cardiovascular health. METHODS A comprehensive search of several databases up to 7 April 2015 was conducted for studies evaluating the effect of sex steroid use on lipids, myocardial infarction, stroke, venous thromboembolism (VTE), and mortality in transgender individuals. Pairs of reviewers selected and appraised the studies. A random-effects model was used to pool weighted mean differences and 95% confidence intervals (CIs). RESULTS We found 29 eligible studies with moderate risk of bias. In female-to-male (FTM) individuals, sex steroid therapy was associated with statistically significant increases in serum triglyceride (TG) levels at 3 to 6 months and at ≥24 months (21.4 mg/dL; 95% CI: 0.14 to 42.6) and in low-density lipoprotein cholesterol (LDL-C) levels at 12 months and ≥24 months (17.8 mg/dL; 95% CI: 3.5 to 32.1). High-density lipoprotein cholesterol (HDL-C) levels decreased significantly across all follow-up periods (highest at ≥24 months, -8.5 mg/dL; 95% CI: -13.0 to -3.9). In male-to-female (MTF) individuals, serum TG levels were significantly higher at ≥24 months (31.9 mg/dL; 95% CI: 3.9 to 59.9) without any changes in other parameters. Few myocardial infarction, stroke, VTE, and death events were reported (more frequently in MTF individuals). CONCLUSIONS Low-quality evidence suggests that sex steroid therapy may increase LDL-C and TG levels and decrease HDL-C level in FTM individuals, whereas oral estrogens may increase TG levels in MTF individuals. Data about important patient outcomes remain sparse.
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Affiliation(s)
- Spyridoula Maraka
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
- Central Arkansas Veterans Health Care System, Little Rock, Arkansas 72205
| | - Naykky Singh Ospina
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida 32610
| | - Rene Rodriguez-Gutierrez
- Division of Endocrinology, Department of Internal Medicine, University Hospital "Dr. Jose E. Gonzalez," Autonomous University of Nuevo León, Monterrey, Mexico 64460
| | - Caroline J Davidge-Pitts
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | - Todd B Nippoldt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | - Larry J Prokop
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota 55905
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
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Metformin Use and Vitamin B12 Deficiency: Untangling the Association. Am J Med Sci 2017; 354:165-171. [PMID: 28864375 DOI: 10.1016/j.amjms.2017.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/25/2017] [Accepted: 04/17/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Current evidence linking vitamin B12 deficiency with metformin use is inconsistent. Hence, there is uncertainty regarding the diagnostic approach in this scenario. Furthermore, this possible association has not been studied in the complete spectrum of patients with diabetes. MATERIALS AND METHODS We conducted a cross-sectional, controlled study with the objective of assessing differences in serum vitamin B12 levels among patients with and without diabetes with different metformin-treatment regimens. A total of 150 participants were recruited: patients with diabetes (group 1: metformin alone ≥850mg/day, group 2: patients with type 2 diabetes naive to treatment and group 3: metformin ≥850mg/day, in addition to any other oral glucose lowering agent or insulin, or both) and without diabetes (group 4: polycystic ovary syndrome or group 5: healthy individuals). Serum vitamin B12, folate levels and complete blood counts were obtained for the entire population. Methylmalonic acid and homocysteine were obtained for patients when vitamin B12 levels were found to be borderline or low. RESULTS When patients with or without diabetes were compared, no significant difference was found in relation to their vitamin B12 levels (517.62 versus 433.83; P = 0.072). No difference in vitamin B12 levels was found among participants with metformin use and metformin naive participants (503.4 versus 462.3; P = 0.380). CONCLUSIONS Irrespective of metformin use, no significant difference in the serum levels of vitamin B12 was observed, both in patients with and without diabetes. In the light of the body of evidence and the results of this study, a universal recommendation for vitamin B12 deficiency screening cannot be made.
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Bradley KA, Ludman EJ, Chavez LJ, Bobb JF, Ruedebusch SJ, Achtmeyer CE, Merrill JO, Saxon AJ, Caldeiro RM, Greenberg DM, Lee AK, Richards JE, Thomas RM, Matson TE, Williams EC, Hawkins E, Lapham G, Kivlahan DR. Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial. Addict Sci Clin Pract 2017; 12:15. [PMID: 28514963 PMCID: PMC5436432 DOI: 10.1186/s13722-017-0080-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 04/28/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Most patients with alcohol use disorders (AUDs) never receive alcohol treatment, and experts have recommended management of AUDs in primary care. The Choosing Healthier Drinking Options In primary CarE (CHOICE) trial was a randomized controlled effectiveness trial of a novel intervention for primary care patients at high risk for AUDs. This report describes the conceptual and scientific foundation of the CHOICE model of care, critical elements of the CHOICE trial design consistent with the Template for Intervention Description and Replication (TIDieR), results of recruitment, and baseline characteristics of the enrolled sample. METHODS The CHOICE intervention is a multi-contact, extended counseling intervention, based on the Chronic Care Model, shared decision-making, motivational interviewing, and evidence-based options for managing AUDs, designed to be practical in primary care. Outpatients who received care at 3 Veterans Affairs primary care sites in the Pacific Northwest and reported frequent heavy drinking (≥4 drinks/day for women; ≥5 for men) were recruited (2011-2014) into a trial in which half of the participants would be offered additional alcohol-related care from a nurse. CHOICE nurses offered 12 months of patient-centered care, including proactive outreach and engagement, repeated brief motivational interventions, monitoring with and without alcohol biomarkers, medications for AUDs, and/or specialty alcohol treatment as appropriate and per patient preference. A CHOICE nurse practitioner was available to prescribe medications for AUDs. RESULTS A total of 304 patients consented to participate in the CHOICE trial. Among consenting participants, 90% were men, the mean age was 51 (range 22-75), and most met DSM-IV criteria for alcohol abuse (14%) or dependence (59%). Many participants also screened positive for tobacco use (44%), depression (45%), anxiety disorders (30-41%) and non-tobacco drug use disorders (19%). At baseline, participants had a median AUDIT score of 18 [Interquartile range (IQR) 14-24] and a median readiness to change drinking score of 5 (IQR 2.75-6.25) on a 1-10 Likert scale. CONCLUSION The CHOICE trial tested a patient-centered intervention for AUDs and recruited primary care patients at high risk for AUDs, with a spectrum of severity, co-morbidity, and readiness to change drinking. Trial registration The trial is registered at clinicaltrial.gov (NCT01400581).
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Affiliation(s)
- Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Health Services, University of Washington, Seattle, WA USA
- Department of Medicine, University of Washington, Seattle, WA USA
| | - Evette Joy Ludman
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Laura J. Chavez
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH USA
- Center for Innovation in Pediatric Practice, Nationwide Children’s Hospital, Columbus, OH USA
| | - Jennifer F. Bobb
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Susan J. Ruedebusch
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
| | - Carol E. Achtmeyer
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
| | | | - Andrew J. Saxon
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | - Ryan M. Caldeiro
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Diane M. Greenberg
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
| | - Amy K. Lee
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Julie E. Richards
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Rachel M. Thomas
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
| | - Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Emily C. Williams
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Eric Hawkins
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | - Gwen Lapham
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Daniel R. Kivlahan
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
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Larsson I. Patients' conceptions of their own influence on good treatment response to biological therapy in chronic inflammatory arthritis. Patient Prefer Adherence 2017; 11:1057-1067. [PMID: 28706444 PMCID: PMC5495133 DOI: 10.2147/ppa.s131239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Biological therapies are common in the treatment of patients with chronic inflammatory arthritis (CIA). However, despite the fact that many patients respond well to their biological therapies, there are still a number of nonresponders. In order to design the best care for patients, it is important to understand how they conceive their own role in their treatment response. OBJECTIVE To explore how patients with CIA conceive their own influence on a good treatment response to biological therapy. METHODS This study had an exploratory and descriptive design with a phenomenographic approach. Interviews were conducted with 25 patients (11 women and 14 men) aged 17-79 years, with CIA who were undergoing biological therapy and who had low disease activity or were in remission. RESULTS Patients with CIA undergoing biological therapy conceived their own influence on good treatment response in terms of adherence, physical activity, mental attitude, social support, and self-awareness. Adherence was described as the foundation for the patients' own influence on good treatment response. Physical activity, mental attitude, and social support reflected three essential ways of understanding patients' influence on good treatment response where the patients spoke about physical strength, mental strength, and social strength. Self-awareness reflected a comprehensive way of influencing good treatment response in which patients balanced their physical, mental, and social resources in partnership with health care professionals. CONCLUSION Patients conceived that they had a responsibility for adhering to the treatment as well as achieving balance in life in order to ensure good treatment response. Self-awareness was essential for maintaining a good treatment response, and this reflected the patients' awareness of the complexity of living their lives with a chronic illness.
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Affiliation(s)
- Ingrid Larsson
- School of Health and Welfare, Halmstad University
- Spenshult Research and Development Center, Halmstad, Sweden
- Correspondence: Ingrid Larsson, School of Health and Welfare, Halmstad University, Box 823, S-30118 Halmstad, Sweden, Tel +46 35 16 7965, Email
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Agarwal S, Raymond JK, Schutta MH, Cardillo S, Miller VA, Long JA. An Adult Health Care–Based Pediatric to Adult Transition Program for Emerging Adults With Type 1 Diabetes. DIABETES EDUCATOR 2016; 43:87-96. [DOI: 10.1177/0145721716677098] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of the study was to evaluate an adult health care program model for emerging adults with type 1 diabetes transitioning from pediatric to adult care. Methods Evaluation of the Pediatric to Adult Diabetes Transition Clinic at the University of Pennsylvania included a cohort of 72 emerging adults with type 1 diabetes, ages 18 to 25 years. Data were extracted from transfer summaries and the electronic medical record, including sociodemographic, clinical, and follow-up characteristics. Pre- and postprogram assessment at 6 months included mean daily blood glucose monitoring frequency (BGMF) and glycemic control (A1C). Paired t tests were used to examine change in outcomes from baseline to 6 months, and multiple linear regression was utilized to adjust outcomes for baseline A1C or BGMF, sex, diabetes duration, race, and insulin regimen. Open-ended survey responses were used to assess acceptability amongst participants. Results From baseline to 6 months, mean A1C decreased by 0.7% (8 mmol/mol), and BGMF increased by 1 check per day. Eighty-eight percent of participants attended ≥2 visits in 6 months, and the program was rated highly by participants and providers (pediatric and adult). Conclusions This study highlights the promise of an adult health care program model for pediatric to adult diabetes transition.
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Affiliation(s)
- Shivani Agarwal
- Rodebaugh Diabetes Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (Dr Agarwal, Dr Schutta, Dr Cardillo)
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Agarwal, Dr Schutta, Dr Cardillo, Dr Miller, Dr Long)
- Division of Pediatric Endocrinology, Children’s Hospital of Los Angeles, Los Angeles, California (Dr Raymond)
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Miller)
- Corporal Michael J. Crescenz VA Center for Health Equity Research and Promotion. Philadelphia, Pennsylvania (Dr Long)
| | - Jennifer K. Raymond
- Rodebaugh Diabetes Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (Dr Agarwal, Dr Schutta, Dr Cardillo)
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Agarwal, Dr Schutta, Dr Cardillo, Dr Miller, Dr Long)
- Division of Pediatric Endocrinology, Children’s Hospital of Los Angeles, Los Angeles, California (Dr Raymond)
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Miller)
- Corporal Michael J. Crescenz VA Center for Health Equity Research and Promotion. Philadelphia, Pennsylvania (Dr Long)
| | - Mark H. Schutta
- Rodebaugh Diabetes Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (Dr Agarwal, Dr Schutta, Dr Cardillo)
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Agarwal, Dr Schutta, Dr Cardillo, Dr Miller, Dr Long)
- Division of Pediatric Endocrinology, Children’s Hospital of Los Angeles, Los Angeles, California (Dr Raymond)
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Miller)
- Corporal Michael J. Crescenz VA Center for Health Equity Research and Promotion. Philadelphia, Pennsylvania (Dr Long)
| | - Serena Cardillo
- Rodebaugh Diabetes Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (Dr Agarwal, Dr Schutta, Dr Cardillo)
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Agarwal, Dr Schutta, Dr Cardillo, Dr Miller, Dr Long)
- Division of Pediatric Endocrinology, Children’s Hospital of Los Angeles, Los Angeles, California (Dr Raymond)
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Miller)
- Corporal Michael J. Crescenz VA Center for Health Equity Research and Promotion. Philadelphia, Pennsylvania (Dr Long)
| | - Victoria A. Miller
- Rodebaugh Diabetes Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (Dr Agarwal, Dr Schutta, Dr Cardillo)
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Agarwal, Dr Schutta, Dr Cardillo, Dr Miller, Dr Long)
- Division of Pediatric Endocrinology, Children’s Hospital of Los Angeles, Los Angeles, California (Dr Raymond)
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Miller)
- Corporal Michael J. Crescenz VA Center for Health Equity Research and Promotion. Philadelphia, Pennsylvania (Dr Long)
| | - Judith A. Long
- Rodebaugh Diabetes Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (Dr Agarwal, Dr Schutta, Dr Cardillo)
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Agarwal, Dr Schutta, Dr Cardillo, Dr Miller, Dr Long)
- Division of Pediatric Endocrinology, Children’s Hospital of Los Angeles, Los Angeles, California (Dr Raymond)
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Miller)
- Corporal Michael J. Crescenz VA Center for Health Equity Research and Promotion. Philadelphia, Pennsylvania (Dr Long)
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Karagiannis T, Liakos A, Branda ME, Athanasiadou E, Mainou M, Boura P, Goulis DG, LeBlanc A, Montori VM, Tsapas A. Use of the Diabetes Medication Choice Decision Aid in patients with type 2 diabetes in Greece: a cluster randomised trial. BMJ Open 2016; 6:e012185. [PMID: 28186933 PMCID: PMC5129072 DOI: 10.1136/bmjopen-2016-012185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/15/2016] [Accepted: 09/29/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To assess the efficacy of the Diabetes Medication Choice Decision Aid among patients with type 2 diabetes in Greece. DESIGN Open-label cluster randomised controlled trial. SETTING Primary and secondary care practices across Greece. PARTICIPANTS 5 sites allocated to the decision aid (n=101 patients) and 4 sites to control (n=103 patients). INTERVENTION Clinicians and patients in the intervention arm used a decision aid, based on outcomes that both consider important when choosing among antihyperglycaemic medications. Patients in the control arm received usual care. OUTCOME MEASURES The primary outcome was patient's level of decisional comfort after the initial clinical encounter. Secondary outcomes included patient's knowledge about type 2 diabetes and medications, and patient's and clinician's satisfaction. Adherence to prescribed antihyperglycaemic medication and change in glycated haemoglobin were assessed at 24 weeks. RESULTS Patients in both arms had similar scores in overall decisional comfort (mean difference between the usual care and decision aid arms -6.9, 95% CI -21.5 to 7.7) and its subscales. Patients' knowledge was high in both arms (mean difference 2.3%, 95% CI -15.7% to 20.4%). Patients and clinicians in both groups were equally satisfied with the decision-making. No significant difference in medication adherence and glycaemic control was found across arms. Clinicians found the decision aid useful and reported that its integration in their daily routine was easy. CONCLUSIONS The decision aid was implemented and positively received in the clinical setting in Greece, in line with the patient-centred approach endorsed by current guidelines. However, this trial yielded imprecise results in terms of patient outcomes. Further research is needed to investigate the interaction between the patient and the clinician in order to clarify the association between the use of decision aids and implementation of shared decision-making. TRIAL REGISTRATION NUMBER NCT01861756. Pre-results.
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Affiliation(s)
- Thomas Karagiannis
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University Thessaloniki, Thessaloniki, Greece
- Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Aris Liakos
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University Thessaloniki, Thessaloniki, Greece
- Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Megan E Branda
- Knowledge and Evaluation Research Unit, Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Eleni Athanasiadou
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Maria Mainou
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University Thessaloniki, Thessaloniki, Greece
- Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Panagiota Boura
- Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynaecology, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Annie LeBlanc
- Knowledge and Evaluation Research Unit, Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University Thessaloniki, Thessaloniki, Greece
- Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
- Harris Manchester College, University of Oxford, Oxford, UK
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Wang Y, Li PF, Tian Y, Ren JJ, Li JS. A Shared Decision-Making System for Diabetes Medication Choice Utilizing Electronic Health Record Data. IEEE J Biomed Health Inform 2016; 21:1280-1287. [PMID: 28113528 DOI: 10.1109/jbhi.2016.2614991] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The use of a shared decision-making (SDM) process in antihyperglycemic medication strategy decisions is necessary due to the complexity of the conditions of diabetes patients. Knowledge of guidelines is used as decision aids in clinical situations, and during this process, no patient health conditions are considered. In this paper, we propose an SDM system framework for type-2 diabetes mellitus (T2DM) patients that not only contains knowledge abstracted from guidelines but also employs a multilabel classification model that uses class-imbalanced electronic health record (EHR) data and that aims to provide a recommended list of available antihyperglycemic medications to help physicians and patients have an SDM conversation. The use of EHR data to serve as a decision-support component in decision aids helps physicians and patients to reach a more intuitive understanding of current health conditions and allows the tailoring of the available knowledge to each patient, leading to a more effective SDM. Real-world data from 2542 T2DM inpatient EHRs were substituted by 77 features and eight output labels, i.e., eight antihyperglycemic medications, and these data were utilized to build and validate the recommendation model. The multilabel recommendation model exhibited stable performance in every single-label classification and showed the ability to predict minority positive cases in which the average recall value of the eight classes was 0.9898. As a whole multilabel classifier, the recommendation model demonstrated outstanding performance, with scores of 0.0941 for Hamming Loss, 0.7611 for Accuracyexam, 0.9664 for Recallexam, and 0.8269 for Fexam.
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O'Brien MJ, Moran MR, Tang JW, Vargas MC, Talen M, Zimmermann LJ, Ackermann RT, Kandula NR. Patient Perceptions About Prediabetes and Preferences for Diabetes Prevention. DIABETES EDUCATOR 2016; 42:667-677. [PMID: 27621093 DOI: 10.1177/0145721716666678] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to explore how adults with prediabetes perceive their risk of developing diabetes and examine their preferences for evidence-based treatment options to prevent diabetes. METHODS A qualitative study was conducted in 2 large Midwest primary care practices, involving in-depth semistructured interviews with 35 adult patients with prediabetes. RESULTS This ethnically diverse (77% nonwhite) sample of middle-aged primary care patients exhibited multiple diabetes risk factors. Knowledge gaps about prediabetes and its medical management were pervasive. Most patients overestimated the risk of developing diabetes and were not familiar with evidence-based treatment options for prediabetes. They suggested that receiving brief, yet specific information about these topics during the study interview motivated them to act. The majority of participants considered both intensive lifestyle intervention and metformin acceptable treatment options. Many preferred initial treatment with intensive lifestyle intervention but would take metformin if their efforts at lifestyle change failed and their primary care physician recommended it. Some participants expressed wanting to combine both treatments. CONCLUSIONS This qualitative study highlights potential opportunities to promote patient-centered dialogue about prediabetes in primary care settings. Providing patients specific information about the risk of developing diabetes and evidence-based treatment options to prevent or delay its onset may encourage action. Physicians' prediabetes counseling efforts should be informed by the finding that most patients consider both intensive lifestyle intervention and metformin acceptable treatment options.
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Affiliation(s)
- Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Vargas, Dr Zimmermann, Dr Ackermann, Dr Kandula),Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Moran, Ms Vargas, Dr Ackermann, Dr Kandula)
| | - Margaret R Moran
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Moran, Ms Vargas, Dr Ackermann, Dr Kandula)
| | - Joyce W Tang
- Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA (Dr Tang)
| | - Maria C Vargas
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Moran, Ms Vargas, Dr Ackermann, Dr Kandula)
| | - Mary Talen
- Northwestern Family Medicine Residency Program, Erie Family Health Center, Chicago, Illinois, USA (Dr Talen)
| | - Laura J Zimmermann
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Vargas, Dr Zimmermann, Dr Ackermann, Dr Kandula),Erie Family Health Center, Chicago, Illinois, USA (Dr Zimmermann)
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Vargas, Dr Zimmermann, Dr Ackermann, Dr Kandula),Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Moran, Ms Vargas, Dr Ackermann, Dr Kandula)
| | - Namratha R Kandula
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Vargas, Dr Zimmermann, Dr Ackermann, Dr Kandula),Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Moran, Ms Vargas, Dr Ackermann, Dr Kandula),Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr Kandula)
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Rodriguez-Gutierrez R, Lipska KJ, McCoy RG. Intensive Glycemic Control in Type 2 Diabetes Mellitus -- A Balancing Act of Latent Benefit and Avoidable Harm: A Teachable Moment. JAMA Intern Med 2016; 176:300-1. [PMID: 26882223 PMCID: PMC5050553 DOI: 10.1001/jamainternmed.2015.8320] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota2Endocrinology Division, Department of Internal Medicine, University Hospital "Dr Jose E. Gonza
| | - Kasia J Lipska
- Section of Endocrinology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rozalina G McCoy
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota5Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Kim JH, Borden WB. Within-the-Clinic Shared Decision for an Over-the-Counter Medication. J Am Heart Assoc 2015; 4:JAHA.115.002927. [PMID: 26702080 PMCID: PMC4845293 DOI: 10.1161/jaha.115.002927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ju H Kim
- Division of Cardiology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC (J.H.K., W.B.B.)
| | - William B Borden
- Division of Cardiology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC (J.H.K., W.B.B.)
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