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Morales-Rodriguez DP, González-Cantú A, Garza-Silva A, Rivera-Cavazos A, Fernández-Chau IF, Cepeda-Medina AB, Sanz-Sánchez MA, Del Rio-Parra GF, Torres-Fuentes MA, Rodriguez-Puente MA, Romero-Ibarguengoitia ME. Effect of the SARS-CoV-2 pandemic on metabolic control in patients with type 2 diabetes: a 5-year cohort follow-up managed by a dynamic multidisciplinary team in Northeastern Mexico. Diabetol Metab Syndr 2024; 16:94. [PMID: 38664823 PMCID: PMC11044561 DOI: 10.1186/s13098-024-01318-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic brought a radical shift in the healthcare system and suboptimal care for vulnerable patients, such as those with Type 2 Diabetes Mellitus (T2D). Therefore, we compared metabolic control and macro/microvascular complications of patients with T2D before and throughout the three-year SARS-CoV-2 pandemic. RESEARCH DESIGN AND METHODS A retrospective observational cohort of subjects with T2D studied from 2018 to 2022 in Northern Mexico was treated by a dynamic multidisciplinary team. Levels of Glycated hemoglobin (HbA1c), fasting serum glucose (FG), LDL-Cholesterol (LDL-C), blood pressure (BP), albuminuria, triglycerides, Body Mass Index (BMI), and FIB-4 score, micro and macrovascular complications were evaluated. RESULTS A total of 999 patients were studied, 51.7% males with a mean (SD) age of 60.1 (12.7) years. Adequate glycemic control based on HbA1c increased by 15.2% and 42.3% in FSG (p < 0.001) between the beginning 2018 and the end of 2022. LDL-C control decreased by 5.1% between 2018 and 2022 (p < 0.001). Systolic BP control decreased by 2.6% (p < 0.001), whereas diastolic BP control increased by 1.8% (p = 0.01) between 2018 and 2022. Albuminuria control increased by 8.5% (p = 0.002). When comparing the Area Under the Curve (AUC) of metabolic parameters between patients who developed SARS-CoV-2 vs. those who did not, AUC was statistically higher in those who developed SARS-CoV-2 (p < 0.05). Diabetic neuropathy was the most prevalent microvascular complication (n = 35; 3.6%); ischemic heart disease was the most frequent macrovascular complication (n = 11;1.1%). CONCLUSIONS A multidisciplinary dynamic team that adapts to the pandemic SARS-CoV-2 maintains and increases metabolic control in subjects with type 2 diabetes in Mexico. This represents a low percentage of chronic complications. The AUC of metabolic parameters of subjects with SARS-CoV-2 infection is higher, reflecting more variability in metabolic control.
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Affiliation(s)
- Devany Paola Morales-Rodriguez
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Arnulfo González-Cantú
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Arnulfo Garza-Silva
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
| | - Andrea Rivera-Cavazos
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
| | - Iván Francisco Fernández-Chau
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Andrea Belinda Cepeda-Medina
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Miguel Angel Sanz-Sánchez
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | | | - María Angelina Torres-Fuentes
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Miguel Assael Rodriguez-Puente
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Maria Elena Romero-Ibarguengoitia
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico.
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico.
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Zupa MF, Beattie J, Boudreaux-Kelly M, Larson M, Lumley B, Lutz-McCain S, Summerville A, Bandi A. Diabetes Care Network: A Novel Model to Disseminate Team-Based Diabetes Specialty Care in a Rural Population. DIABETES EDUCATOR 2022; 48:483-491. [PMID: 36125114 DOI: 10.1177/26350106221125690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to examine the impact of a novel approach to provide diabetes specialty team care to rural patients with type 2 diabetes (T2DM) on clinical outcomes and processes of care. METHODS Diabetes Care Network (DCN) provides Veterans with T2DM and elevated A1C an initial 6-week period of remote self-management education and support and medication management by a centrally located team of diabetes specialists. Participants are then comanaged by remote liaisons embedded in rural primary care facilities for the remainder of the 12-month intervention. In this pre-post intervention study, 87 Veterans enrolled in DCN from 2 different clinical sites had baseline and 12-month postenrollment A1C, systolic blood pressure, weight, and LDL cholesterol levels collected and compared using paired t tests. RESULTS Participants were mostly male and White with elevated baseline A1C. Participants from both sites had significant improvement in A1C over the 12-month intervention period compared to an increase in the 12 months prior to enrollment. There were also significant improvements in LDL and systolic blood pressure at 1 site, with no significant change in weight at either site. CONCLUSIONS DCN participants had significant improvement in A1C after not meeting similar goals previously in a robust primary care setting. A technology-enabled collaborative partnership between centrally located diabetes care teams and local liaisons is a feasible approach to enhance access to diabetes specialty care for rural populations.
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Affiliation(s)
- Margaret F Zupa
- Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Janice Beattie
- Division of Endocrinology, Diabetes & Metabolism, VA Pittsburgh Health System, Pittsburgh, Pennsylvania
| | | | - Meg Larson
- Erie VA Medical Center, Erie, Pennsylvania
| | | | - Stacey Lutz-McCain
- Division of Endocrinology, Diabetes & Metabolism, VA Pittsburgh Health System, Pittsburgh, Pennsylvania
| | | | - Archana Bandi
- Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Endocrinology, Diabetes & Metabolism, VA Pittsburgh Health System, Pittsburgh, Pennsylvania
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Letta S, Aga F, Yadeta TA, Geda B, Dessie Y. Barriers to Diabetes Patients' Self-Care Practices in Eastern Ethiopia: A Qualitative Study from the Health Care Providers Perspective. Diabetes Metab Syndr Obes 2021; 14:4335-4349. [PMID: 34712054 PMCID: PMC8547594 DOI: 10.2147/dmso.s335731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND All types of diabetes can damage the heart, blood vessels, eyes, kidneys, nerves and increase the overall risk of disability and premature death. Diabetes mellitus requires a range of self-care practices, scientifically recommended to control the glycemic level and maintain the patient's health. However, perceived barriers that hinder patients from fully implementing these diabetes self-care practices and obstacles have not been thoroughly explored. Therefore, this study aimed to explore the barriers to diabetes patients' self-care practices from the perspective of health care providers in two public hospitals in Harar City, Eastern Ethiopia. METHODS Researchers conducted an exploratory qualitative study among 26 health care providers working in two public hospitals from March to June 2021. The study participants were recruited from different disciplines working on diabetes care. Interviews were conducted in the Amharic language until the saturation point was reached. The interviews were tape-recorded, transcribed, and translated to English. Each transcript was read, re-read, and then exported to ATLAS.ti 7 software for coding. Field notes were used to supplement verbatim transcriptions. Initial codes were generated. The consistency between the two coders and their alignment with research questions were checked and applied to all subsequent transcripts after reached on consensus. The thematic analysis was employed in line with the primary set research question. RESULTS Researchers identified barriers to diabetes patients' self-care practices such as system, health care providers, and patient-level. These barriers were categorized under three main themes: lack of organized diabetes care services, limited collaborative care practices, and perceived lack of knowledge on self-care practices. In addition, the lack of multidisciplinary team care, lack of training for health care providers on diabetes self-care practices, and availability of laboratory tests and diabetes medication were prominent barriers. CONCLUSION Multi-level barriers to diabetes patients' self-care practices such as system, health care providers, and patients were identified. Therefore, interventions targeting proper service integration, building providers' and patients' capacity on diabetes self-care practices, and ensuring the sustainability of laboratory tests and medication supplies are essential. These interventions need to be accomplished through multi-level stakeholders' engagement and one-to-one or group interventions covering the multi-level challenges.
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Affiliation(s)
- Shiferaw Letta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Correspondence: Shiferaw Letta School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box: 235, Harar, EthiopiaTel +251911771934 Email
| | - Fekadu Aga
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene Campus, Shashamene, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Lal RA, Cuttriss N, Haller MJ, Yabut K, Anez-Zabala C, Hood KK, Sheehan E, Basina M, Bernier A, Baer LG, Filipp SL, Wang CJ, Town MA, Gurka MJ, Maahs DM, Walker AF. Primary Care Providers in California and Florida Report Low Confidence in Providing Type 1 Diabetes Care. Clin Diabetes 2020; 38:159-165. [PMID: 32327888 PMCID: PMC7164993 DOI: 10.2337/cd19-0060] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
People with type 1 diabetes may receive a significant portion of their care from primary care providers (PCPs). To understand the involvement of PCPs in delivering type 1 diabetes care, we performed surveys in California and Florida, two of the most populous and diverse states in the United States. PCPs fill insulin prescriptions but report low confidence in providing type 1 diabetes care and difficulty accessing specialty referrals to endocrinologists.
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Affiliation(s)
- Rayhan A. Lal
- Department of Pediatrics, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA
- Stanford Diabetes Research Center, Stanford, CA
| | - Nicolas Cuttriss
- Department of Pediatrics, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA
| | - Michael J. Haller
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL
| | - Katarina Yabut
- Department of Pediatrics, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA
| | - Claudia Anez-Zabala
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL
| | - Korey K. Hood
- Department of Pediatrics, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA
- Stanford Diabetes Research Center, Stanford, CA
| | - Eleni Sheehan
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL
| | - Marina Basina
- Department of Medicine, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA
- Stanford Diabetes Research Center, Stanford, CA
| | - Angelina Bernier
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL
| | - Linda G. Baer
- Department of Pediatrics, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA
| | - Stephanie L. Filipp
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL
| | - C. Jason Wang
- Stanford Diabetes Research Center, Stanford, CA
- Center for Policy, Outcomes and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Marissa A. Town
- Department of Pediatrics, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA
- Stanford Diabetes Research Center, Stanford, CA
| | - Matthew J. Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL
| | - David M. Maahs
- Department of Pediatrics, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA
- Stanford Diabetes Research Center, Stanford, CA
| | - Ashby F. Walker
- University of Florida Diabetes Institute, Gainesville, FL
- Department of Health Service Research, Management, and Policy, University of Florida, Gainesville, FL
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Daly BM, Arroll B, Honey M, Scragg RKR. Trends in the primary health care nursing workforce providing diabetes care in Auckland, New Zealand: A cross-sectional survey. Prim Care Diabetes 2018; 12:491-500. [PMID: 30145189 DOI: 10.1016/j.pcd.2018.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
AIMS To describe trends from 2006-8 to 2016 in demographic, education and work settings of the primary health care nursing workforce who provide diabetes care in the Auckland region. METHODS A total of 1416 practice, Accident and Medical, district and diabetes specialist nurses were identified who provide community-based care. Of those, 459 were randomly selected and 336 were interviewed in 2016, and were compared with 287 nurses interviewed in 2006-8. RESULTS A 73% response rate was attained in 2016. Compared with nurses in 2006-8, primary health care nurses in 2016 were younger, less experienced, more likely to be Asian, undertook more post-graduate education, worked more in Accident and Medical Clinics and worked in larger practices with ≥4 doctors. However, less worked with a dietitian or received visits from specialist nurses compared with nurses in 2006-8. Significantly more nurses in 2016 had their own room for administrative work and the ability to email patients suggesting greater autonomy. CONCLUSIONS Major demographic, educational and workplace changes have occurred in the Auckland primary health care nursing workforce from 2006-8 to 2016. A significant increase in practice nurses and a large decrease in the number of diabetes specialist nurses were evident, in the Auckland region.
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Affiliation(s)
- Barbara M Daly
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
| | - Bruce Arroll
- School of Population Health, University of Auckland , New Zealand
| | - Michelle Honey
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
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Harlan DM, Hirsch IB. The upside down world of diabetes care medical economics and what we might do to improve it. Curr Opin Endocrinol Diabetes Obes 2017; 24:112-118. [PMID: 28099208 DOI: 10.1097/med.0000000000000325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Increasingly over the past generation, the American healthcare delivery system has received consistently poor marks with regard to public health outcomes and costs. This review by two seasoned diabetes care providers is intended to shed light on the fundamental flaws we believe to underlie that poor performance, and suggest options for better outcomes and cost efficiencies. RECENT FINDINGS Despite major advances in diabetes management medications and tools, overall public health with regard to diabetes outcomes remains poor. Efforts focused on controlling costs appear to be exacerbating the problem. SUMMARY For chronic diseases like diabetes, fee-for-service care models are fundamentally flawed and predictably fail. We suggest that a major overhaul of the medical economics underlying diabetes care can improve patient outcomes and decrease costs.
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Affiliation(s)
- David M Harlan
- aDepartment of Medicine, Diabetes Center of Excellence, University of Massachusetts Medical School, Worcester, Massachusetts bDepartment of Medicine, Division of Metabolism, Endocrinology, and Nutrition at the University of Washington Medical School, Seattle, Washington, USA
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