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Heald A, Roberts S, Albelda Gimeno L, White A, Gilingham E, Patel R, Bowden Davies K, Saboo A, Gibson M, Abraham J. Enhancing type 2 diabetes treatment through digital plans of care - a randomized controlled trial: evaluation of change in patient reported outcome measures. Expert Rev Endocrinol Metab 2024; 19:385-391. [PMID: 38567714 DOI: 10.1080/17446651.2024.2334220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/22/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND We investigated how a personalized care-planning software and linked mobile-app may aid people to self-manage their type 2 diabetes (T2D) more effectively. RESEARCH DESIGN AND METHODS People with T2D and glycated hemoglobin (HbA1c) greater than 58 mmol/mol (7.5%) were randomized to either an intervention group receiving a personalized care plan, or the control group receiving usual care. Quality of life (QoL) was measured for both groups using validated questionnaires and one-on-one interviews with a subset of 12 participants from each group. RESULTS QoL for the active treatment group increased, by their EQ -5D-5 L score increasing on average by 0.046, whereas it decreased for the control group on average by 0.009. The EQ Visual Analogue Score (VAS) of the intervention group also increased by 8.2%, whereas the control group had a reduction in EQ VAS score of 2.8% (p = 0.008 for difference). CONCLUSION In this prospective RCT, the findings point to how the provision of personalized care plans can result in an improvement in individuals' self-rated QoL. This may lead to longer term health benefits.
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Affiliation(s)
- Adrian Heald
- Department of Diabetes and Endocrinology, Salford Royal Hospitals NHS Trust, Salford, UK
- Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Manchester, UK
| | | | | | - Alison White
- Middlewood NHS Primary Care Network, Cheshire, UK
| | - Erin Gilingham
- Park Lane Surgery, Waters Green Medical Centre, Macclesfield, UK
| | | | | | | | - Martin Gibson
- Department of Diabetes and Endocrinology, Salford Royal Hospitals NHS Trust, Salford, UK
- Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Manchester, UK
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Stedman M, Robinson A, Dunn G, Meza-Torres B, Gibson JM, Reeves ND, Jude EB, Feher M, Rayman G, Whyte MB, Edmonds M, Heald AH. Diabetes foot complications and standardized mortality rate in type 2 diabetes. Diabetes Obes Metab 2023; 25:3662-3670. [PMID: 37722968 DOI: 10.1111/dom.15260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/07/2023] [Accepted: 08/12/2023] [Indexed: 09/20/2023]
Abstract
AIM To quantify the impact of foot complications on mortality outcomes in people with type 2 diabetes (T2D), and how routinely measured factors might modulate that risk. MATERIALS AND METHODS Data for individuals with T2D for 2010-2020, from the Salford Integrated Care Record (Salford, UK), were extracted for laboratory and clinical data, and deaths. Annual expected deaths were taken from Office of National Statistics mortality data. An index of multiple deprivation (IMD) adjusted the standardized mortality ratio (SMR_IMD). Life years lost per death (LYLD) was estimated from the difference between expected and actual deaths. RESULTS A total of 11 806 T2D patients were included, with 5583 new diagnoses and 3921 deaths during 2010-2020. The number of expected deaths was 2135; after IMD adjustment, there were 2595 expected deaths. Therefore, excess deaths numbered 1326 (SMR_IMD 1.51). No foot complications were evident in n = 9857. This group had an SMR_IMD of 1.13 and 2.74 LYLD. In total, 2979 patients had any foot complication recorded. In this group, the SMD_IMR was 2.29; of these, 2555 (75%) had only one foot complication. Patients with a foot complication showed little difference in percentage HbA1c more than 58 mmol/mol. In multivariate analysis, for those with a foot complication and an albumin-to-creatinine ratio of more than 3 mg/mmol, the odds ratio (OR) for death was 1.93, and for an estimated glomerular filtration rate of less than 60 mL/min/1.73m2 , the OR for death was 1.92. CONCLUSIONS Patients with T2D but without a foot complication have an SMR_IMD that is only slightly higher than that of the general population. Those diagnosed with a foot complication have a mortality risk that is double that of those without T2D.
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Affiliation(s)
| | - Adam Robinson
- Department of Diabetes and Endocrinology, Salford Royal Foundation Trust, Salford, UK
| | | | - Bernado Meza-Torres
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - J Martin Gibson
- Department of Diabetes and Endocrinology, Salford Royal Foundation Trust, Salford, UK
- Department of Medicine, University of Manchester, Manchester, UK
| | - Neil D Reeves
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Edward B Jude
- Department of Medicine, University of Manchester, Manchester, UK
| | | | - Gerry Rayman
- The Ipswich Diabetes Centre and Research Unit, Ipswich Hospital NHS Trust, Ipswich, UK
| | - Martin B Whyte
- Diabetic Foot Clinic, King's College Hospital Foundation Trust, London, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Michael Edmonds
- Diabetic Foot Clinic, King's College Hospital Foundation Trust, London, UK
| | - Adrian H Heald
- Department of Diabetes and Endocrinology, Salford Royal Foundation Trust, Salford, UK
- Department of Medicine, University of Manchester, Manchester, UK
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Waheed U, Heald AH, Stedman M, Solomon E, Rea R, Eltom S, Gibson JM, Grady K, Nouwen A, Rayman G, Paisley A. Distress and Living with Diabetes: Defining Characteristics Through an Online Survey. Diabetes Ther 2022; 13:1585-1597. [PMID: 35831740 PMCID: PMC9281294 DOI: 10.1007/s13300-022-01291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION There is considerable evidence for diabetes reducing quality of life. The impact of such a diagnosis on mental health is less well understood and was subsequently explored here. METHODS Online PHQ-9 scores (which calculate the severity of depression), Diabetes Distress Screening Scale (DDSS) and EQ-5D-5L (quality-of-life) questionnaires were completed by patients with diabetes, followed by the extraction of data where possible from responders' clinical records. RESULTS A total of 133 people submitted questionnaires. However, not all data items could be completed by each patient; 35% (45/130) had type I diabetes mellitus (T1DM); 55% (64/117) were women. The overall median age of 117 responders was 60 (IQR 50-68 years). The median aggregated response scores were: EQ-5D-5L 0.74 (IQR 0.64-0.85) (lower quality of life than UK population median of 0.83), DDSS 1.9 (IQR1.3-2.7) (≥ 2 indicates moderate distress) and PHQ-9 5 (IQR2-11) (≥ 5 indicates depression). Higher diabetes distress (DDSS)/lower quality of life EQ-5D-5L/higher depressive symptoms (PHQ-9) linked to female sex (DDSS 0.5/25% above median), younger age (< 50 years DDSS 0.7/35% above median), fewer years after diagnosis (< 10 years DDSS 0.8/40% above median), and obesity (BMI > 35 DDSS 0.6/30% above median). Additionally, a HbA1c reading of ≤ 48 mmol/mol was associated with higher DDSS scores, as did a reduction of more than 5 mmol/mol in HbA1c over the last three HbA1c measurements. The 30 individuals with a history of prescribed antidepressant medication also showed higher diabetes distress scores (DDSS 0.9, equating to 45% above the median). The DDSS score elevation came from an increase in emotional burden and regimen-related distress. DDSS scores were not significantly linked to diabetes type, insulin use, absolute level/change in blood glucose HbA1c. Physician-related distress showed a similar pattern. CONCLUSIONS A low level of stress in relation to diabetes management may be associated with lower HbA1c. The larger impact of diabetes on mental health in younger women/people with shorter diabetes duration should be noted when considering psychosocial intervention/behavior change messaging. Physician-related distress is a potentially remediable factor. However, this sample was self-selecting, limiting generalization to other samples.
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Affiliation(s)
- Unaiza Waheed
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK
| | - Adrian H Heald
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK.
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
| | | | - Emma Solomon
- Department of Clinical Psychology, Salford Royal Hospital, Salford, UK
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK
| | - Saydah Eltom
- Pharmacy Department, Salford Royal Hospital, Salford, UK
| | - J Martin Gibson
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Katherine Grady
- Research for the Future, Northern Care Alliance NHS Group, Salford, UK
| | - Arie Nouwen
- Department of Psychology, Middlesex University, London, UK
| | - Gerry Rayman
- The Ipswich Diabetes Centre and Research Unit, Ipswich Hospital NHS Trust, Colchester, Essex, UK
| | - Angela Paisley
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Stedman M, Rea R, Duff CJ, Livingston M, McLoughlin K, Wong L, Brown S, Grady K, Gadsby R, Gibson JM, Paisley A, Fryer AA, Heald AH. The experience of blood glucose monitoring in people with type 2 diabetes mellitus (T2DM). Endocrinol Diabetes Metab 2022; 5:e00302. [PMID: 34921531 PMCID: PMC8917860 DOI: 10.1002/edm2.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Finger prick blood glucose (BG) monitoring remains a mainstay of management in people with type 2 diabetes (T2DM) who take sulphonylurea (SU) drugs or insulin. We recently examined patient experience of BG monitoring in people with type 1 diabetes (T1DM). There has not been any recent comprehensive assessment of the performance of BG monitoring strips or the patient experience of BG strips in people with T2DM in the UK. METHODS An online self-reported questionnaire containing 44 questions, prepared following consultation with clinicians and patients, was circulated to people with T2DM. 186 responders provided completed responses (25.5% return rate). Fixed responses were coded numerically (eg not confident = 0 fairly confident = 1). RESULTS Of responders, 84% were treated with insulin in addition to other agents. 75% reported having had an HbA1c check in the previous 6 months. For those with reported HbA1c ≥ 65 mmol/mol, a majority of people (70%) were concerned or really concerned about the shorter term consequences of running a high HbA1c This contrasted with those who did not know their recent HbA1c, of whom only 33% were concerned/really concerned and those with HbA1c <65 mmol/mol of whom 35% were concerned. Regarding BG monitoring/insulin adjustment, only 25% of responders reported having sufficient information with 13% believing that the accuracy and precision of their BG metre was being independently checked. Only 9% recalled discussing BG metre accuracy when their latest metre was provided and only 7% were aware of the International Standardisation Organisation (ISO) standards for BG metres. 77% did not recall discussing BG metre performance with a healthcare professional. CONCLUSION The group surveyed comprised engaged people with T2DM but even within this group there was significant variation in (a) awareness of shorter term risks, (b) confidence in their ability to implement appropriate insulin dosage (c) awareness of the limitations of BG monitoring technology. There is clearly an area where changes in education/support would benefit many.
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Affiliation(s)
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK
| | - Christopher J Duff
- Department of Clinical Biochemistry, North Midlands and Cheshire Pathology Service, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK.,School of Medicine, Keele University, Keele, UK
| | - Mark Livingston
- Black Country Pathology Services, Walsall Manor Hospital, Walsall, UK
| | | | | | | | | | - Roger Gadsby
- Warwick Medical School, University of Warwick, West Midlands, UK
| | - John M Gibson
- Salford Royal Hospital, Salford, UK.,The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | | | - Anthony A Fryer
- Department of Clinical Biochemistry, North Midlands and Cheshire Pathology Service, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK.,School of Medicine, Keele University, Keele, UK
| | - Adrian H Heald
- Salford Royal Hospital, Salford, UK.,The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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