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Imai C'C, Li L, Hardie RA, Pearce C, Georgiou A. Patient and practice factors associated with HbA1c testing frequency in patients with type 2 diabetes: a retrospective cohort study in Australian general practice. Aust J Prim Health 2023; 29:520-526. [PMID: 36921296 DOI: 10.1071/py22026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/17/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Better adherence to guideline-recommended glycated haemoglobin A1c (HbA1c) testing frequency is associated with better glycaemic control and lower risk of complications such as chronic kidney disease in patients with type 2 diabetes. This study investigates patient and practice factors associated with adherence to guideline-recommended HbA1c testing frequency. METHODS A cohort of type 2 diabetes patients who regularly visited general practices from 2012 to 2018 was identified from 225 Australian general practices. With the goal of ≤53mmol/mol, Australian guidelines recommend HbA1c testing at least 6-monthly. Patient history of HbA1c tests from 2017 to 2018 was used to define adherence to guidelines, and the associations with patient and practice factors were examined by regression models. RESULTS Of the 6881 patients, 2186 patients (31.8%) had 6-monthly HbA1c testing. Patient age and anti-diabetic medications were associated with adherence to 6-monthly testing. When financial incentives are available to practices, a larger practice was associated with better adherence to 6-monthly testing. CONCLUSIONS The identified key factors such as age, practice size, medication, and incentive payments can be used to target initiatives aimed at improving guideline-recommended monitoring care for patients with type 2 diabetes to enhance their health outcomes.
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Affiliation(s)
| | - Ling Li
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Rae-Anne Hardie
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Christopher Pearce
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia; and Aurora Primary Care Research Institute, Blackburn, Vic., Australia
| | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Roth M, Lehmann T, Kloos C, Schmidt S, Kellner C, Wolf G, Müller N. Metabolic Control, Diabetic Complications and Drug Therapy in a Cohort of Patients with Type 1 and Type 2 Diabetes in Secondary and Tertiary Care between 2004 and 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2631. [PMID: 36768000 PMCID: PMC9916122 DOI: 10.3390/ijerph20032631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
This paper studies the features of metabolic parameters, diabetic complications and drug therapy of a single-centre cohort of patients with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) in secondary care and tertiary care over a 15-year period. METHODS Retrospective cross-sectional analysis of four single-centre cohorts between 2004 and 2019. All patients with T1DM or T2DM in secondary care (n = 5571) or tertiary care (n = 2001) were included. Statistical analyses were performed using linear mixed models. RESULTS Diabetes duration increased in both patients with T1DM and T2DM in secondary care and tertiary care (p < 0.001). Patients in secondary care consistently showed good glycaemic control, while patients in tertiary care showed inadequate glycaemic control. All four cross-sectional cohorts showed a significant increase in the prevalence of nephropathy over time and three out of four cohorts (T1DM and T2DM in secondary care and T2DM in tertiary care) showed an increase in the prevalence of neuropathy (all p < 0.001). The incidence of severe hypoglycaemia was consistently low. The use of insulin pumps and insulin analogues in the therapy of T1DM increased significantly. CONCLUSIONS The increased prevalence of complications is likely due to older age and longer diabetes duration. Low rates of hypoglycaemia, lower limb amputations and good glycaemic control in secondary care patients indicate a good structure of patient care.
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Affiliation(s)
- Matthias Roth
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, 07743 Jena, Germany
| | - Christof Kloos
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Sebastian Schmidt
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Christiane Kellner
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Nicolle Müller
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
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García-Pérez L, Ramallo-Fariña Y, Vallejo-Torres L, Rodríguez-Rodríguez L, González-Pacheco H, Santos-Hernández B, García-Bello MA, Wägner AM, Carmona M, Serrano-Aguilar PG. Cost-effectiveness of multicomponent interventions in type 2 diabetes mellitus in a cluster randomised controlled trial: the INDICA study. BMJ Open 2022; 12:e058049. [PMID: 35396305 PMCID: PMC8995956 DOI: 10.1136/bmjopen-2021-058049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To analyse the cost-effectiveness of multicomponent interventions designed to improve outcomes in type 2 diabetes mellitus (T2DM) in primary care in the Canary Islands, Spain, within the INDICA randomised clinical trial, from the public health system perspective. DESIGN An economic evaluation was conducted for the within-trial period (2 years) comparing the four arms of the INDICA study. SETTING Primary care in the Canary Islands, Spain. PARTICIPANTS 2334 patients with T2DM without complications were included. INTERVENTIONS Interventions for patients (PTI), for primary care professionals (PFI), for both (combined intervention arm for patients and professionals, CBI) and usual care (UC) as a control group. OUTCOMES The main outcome was the incremental cost per quality-adjusted life-years (QALY). Only the intervention and the healthcare costs were included. ANALYSIS Multilevel models were used to estimate results, and to measure the size and significance of incremental changes. Missed values were treated by means of multiple imputations procedure. RESULTS There were no differences between arms in terms of costs (p=0.093), while some differences were observed in terms of QALYs after 2 years of follow-up (p=0.028). PFI and CBI arms were dominated by the other two arms, PTI and UC. The differences between the PTI and the UC arms were very small in terms of QALYs, but significant in terms of healthcare costs (p=0.045). The total cost of the PTI arm (€2571, 95% CI €2317 to €2826) was lower than the cost in the UC arm (€2750, 95% CI €2506 to €2995), but this difference did not reach statistical significance. Base case estimates of the incremental cost per QALY indicate that the PTI strategy was the cost-effective option. CONCLUSIONS The INDICA intervention designed for patients with T2DM and families is likely to be cost-effective from the public healthcare perspective. A cost-effectiveness model should explore this in the long term. TRIAL REGISTRATION NUMBER NCT01657227.
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Affiliation(s)
- Lidia García-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Laura Vallejo-Torres
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | - Leticia Rodríguez-Rodríguez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | | | | | | | - Ana María Wägner
- Department of Endocrinology and Nutrition, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
- University Institute for Biomedical and Health Research (iUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Montserrat Carmona
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Health Technology Assessment Agency, Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro G Serrano-Aguilar
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
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Matthys E, Van Bogaert P, Blommaert S, Verdonck L, Remmen R. Evidence-based early stage type 2 diabetes follow-up in Belgian primary care practices: Impact of multi-professional teams and care protocols. Prim Care Diabetes 2021; 15:249-256. [PMID: 33060036 DOI: 10.1016/j.pcd.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
AIM The aim of this research is to explore the current early-stage diabetes mellitus type 2 care in Belgian general practices. This, to find out if the care is provided according to the proposed evidence-based national diabetes care guideline. Additionally, this research aims to detect which person and practice characteristics can be associated with a more evidence-based care provision. METHODS People were included in the study if they were recently diagnosed with type 2 diabetes by the participating practice. Practice and person characteristics, and clinical parameter monitoring and lifestyle monitoring data were collected by using a questionnaire and a topic list. RESULTS A total of 27 general practices participated and a total of 249 people were included through their patient records. People monitored in a practice according to a self-developed protocol were 5.5 times more likely to have a better clinical parameter follow-up. Larger practices (>2000 patients), follow-up by general practitioners and practice nurses together and according to self-developed protocols were associated with a significantly better lifestyle follow-up. CONCLUSION Practices providing multidisciplinary diabetes care, in collaboration with practice nurses, and with diabetes care based on self-developed protocols achieved a more comprehensive follow-up.
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Affiliation(s)
- Evi Matthys
- University of Antwerp, Campus Drie Eiken DR334, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | | | | | | | - Roy Remmen
- University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
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Imai C, Li L, Hardie RA, Georgiou A. Adherence to guideline-recommended HbA1c testing frequency and better outcomes in patients with type 2 diabetes: a 5-year retrospective cohort study in Australian general practice. BMJ Qual Saf 2021; 30:706-714. [PMID: 33542066 PMCID: PMC8380884 DOI: 10.1136/bmjqs-2020-012026] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/12/2022]
Abstract
Background Clinical practice guidelines emphasise the role of regular monitoring of glycated haemoglobin A1c (HbA1c) for patients with type 2 diabetes, with most recommending 6-monthly testing. Nonetheless, there are few in-depth studies evaluating the clinical impact of the recommended testing frequency for patients to underpin the significance of guideline adherence. Objective This study aimed to examine associations between patient outcomes and adherence to HbA1c testing frequencies recommended by Australian guidelines (6-monthly for patients with adequate glycaemic control and 3-monthly for patients with inadequate glycaemic control). The primary and secondary outcomes of interest were longitudinal changes in HbA1c values and development of ischaemic heart disease (IHD) and chronic kidney disease (CKD). Methods This 5-year retrospective cohort study (July 2013–June 2018) evaluated HbA1c testing frequency in a subset of patients with type 2 diabetes identified within data collected from approximately 250 Australian general practices. The study included patients who were aged ≥18 in 2013 and had a record of HbA1c testing in study practices during the study period. Each patient’s adherence rate was defined by the proportion of HbA1c tests performed within the testing intervals recommended by Australian guidelines. Based on the adherence rate, adherence level was categorised into low (≤33%), moderate (34%–66%) and high (>66%). Generalised additive mixed models were used to examine associations between adherence to the recommended HbA1c testing frequency and patient outcomes. Results In the 6424 patients with diabetes, the overall median HbA1c testing frequency was 1.6 tests per year with an adherence rate of 50%. The estimated HbA1c levels among patients with low adherence gradually increased or remained inadequately controlled, while HbA1c values in patients with high adherence remained controlled or improved over time. The risk of developing CKD for patients with high adherence was significantly lower than for patients with low adherence (OR: 0.42, 95% CI 0.18 to 0.99). No association between IHD and adherence to the recommended HbA1c frequency was observed. Conclusion Better adherence to guideline-recommended HbA1c testing frequency was associated with better glycaemic control and lower risk of CKD. These findings may provide valuable evidence to support the use of clinical guidelines for better patient outcomes in patients with type 2 diabetes.
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Affiliation(s)
- Chisato Imai
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Rae-Anne Hardie
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Koc EM, Aksoy H, Ayhan Baser D, Baydar Artantas A, Kahveci R, Cihan FG. Evaluation of clinical practice guideline quality: comparison of two appraisal tools. Int J Qual Health Care 2020; 32:663-670. [DOI: 10.1093/intqhc/mzaa129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/23/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
The tools used for critically appraising the quality of clinical practice guidelines are complex and not suitable for the busy end users. So rapid, effective and simple instruments are more preferred. The aim of this study is to compare two critical appraisal tools: iCAHE as a rapid instrument and AGREE II as a complex instrument on guideline quality assessment.
Material and Methods
The diabetes mellitus guidelines of the Scottish Intercollegiate Guidelines Network (SIGN), the National Institute for Health and Clinical Excellence (NICE), the International Diabetes Federation (IDF) and the Society of Endocrinology and Metabolism of Turkey (SEMT) were assessed separately by four appraisers using the iCAHE and AGREE II instruments. The mean iCAHE criteria scores and the total and domain AGREE II scores given by the four appraisers are presented for each guideline.
Results
No statistically significant difference was detected between the iCAHE scale scores of the guidelines evaluated (P = 0.063). The rank of the guidelines according to their average total iCAHE and AGREE II instrument scores was similar. The iCAHE mean scores of the guidelines were as follows: NICE, 92.85%; SIGN, 92.85%; IDF, 66.07% and SEMT, 73.21%. The AGREE II mean scores of the guidelines were as follows: NICE, 87.13%; SIGN, 78.25%; IDF, 53.44% and SEMT, 53.22%.
Conclusions
In addition to being a quality scale, the iCAHE checklist is easy, practical and short to implement. It also helps the users to understand the quality of the guideline in a shorter time. To increase the use of guidelines, it is important that users with little experience and time use the iCAHE scale as a rapid appraisal tool, but more studies are needed to decide the best appraisal tool.
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Affiliation(s)
- Esra Meltem Koc
- Katip Celebi University Faculty of Medicine, Department of Family Medicine, Izmir, Turkey
| | - Hilal Aksoy
- Hacettepe University Faculty of Medicine, Department of Family Medicine, Ankara, 06230, Turkey
| | - Duygu Ayhan Baser
- Hacettepe University Faculty of Medicine, Department of Family Medicine, Ankara, 06230, Turkey
| | - Aylin Baydar Artantas
- University of Health Sciences Ankara Bilkent City Hospital, Department of Family Medicine, Ankara, Turkey
| | - Rabia Kahveci
- Health Technology Assessment Department, Ukraine Ministry of Health, Kiev Region, Ukraine
| | - Fatma Goksin Cihan
- Necmettin Erbakan University, Faculty of Medicine, Department of Family Medicine, Konya, Turkey
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Göke B. [The treatment of diabetes mellitus: myths and evidence]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:512-520. [PMID: 32211938 DOI: 10.1007/s00103-020-03124-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
For more than 3500 years, metabolic disorders were recognized by symptoms similar to those indicating diabetes mellitus today. Over centuries, explanations remained elusive and shed sparse light on the origin of the disease and any treatments. The poor prognosis triggered myths and misconceptions, some even lasting until today. Two hundred years ago, major advances were made in the understanding of the pathophysiology, which has led to more successful treatments. Presently, useful preventive, diagnostic, and therapeutic procedures exist. However, old myths and misconceptions still influence the treatments. This article reviews ongoing myths dealing with the genesis and treatment of diabetes and the growing evidence for improved therapies.Increasingly more studies focus on cardiovascular endpoints while considering more realistic therapeutic goals. This paves the way to polyvalent treatment concepts reaching beyond the classic glucocentric treatment concept of type 2 diabetes. The introduction of molecular medicine, the current opportunities and future prospects of new drugs, personalized medicine, and technical innovations prompt hopes and expectations for a change of paradigms in therapeutic concepts. It is quite possible that traditional and newly generated myths will accompany this development. This has to be kept in mind when developing new concepts for treatment.
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Affiliation(s)
- Burkhard Göke
- Universitätsklinikum Hamburg-Eppendorf, Haus O 35, Martinistraße 52, 20246, Hamburg, Deutschland.
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Gao Y, Wang J, Luo X, Song X, Liu L, Ke L, Liao Z, Wang D, Mu Y, Chen Y, Estill JAM. Quality appraisal of clinical practice guidelines for diabetes mellitus published in China between 2007 and 2017 using the AGREE II instrument. BMJ Open 2019; 9:e022392. [PMID: 31488461 PMCID: PMC6731825 DOI: 10.1136/bmjopen-2018-022392] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The aim of this study was to systematically evaluate the quality of the clinical practice guidelines (CPGs) for diabetes mellitus published in China over the period of January 2007 to April 2017. METHODS We searched the China National Knowledge Infrastructure, Chinese Biomedical Literature database, VIP database and WanFang databases and guideline websites for CPGs for diabetes mellitus published between January 2007 and April 2017 in China. Two reviewers independently screened the literature according to the inclusion and exclusion criteria and extracted data. We used the the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool (Canadian Institutes of Health Research, Ottawa, Canada) to evaluate the quality of the included guidelines, calculated the scores of each domain and evaluated the consistency among the assessors via use of the intragroup correlation coefficient. And then we compared the results with Chinese CPGs and international CPGs. We conducted a subgroup analysis based on different classification criteria and compared scores of each domain subgroup analyses. RESULTS A total of 98 guidelines were identified. The correlation coefficient within the group was 0.93, suggesting that the consistency between the evaluators was good. The scores of the six domains of AGREE II were described in median (IQR) as follows: scope and purpose 53.7 (50.0-59.7), stakeholder involvement 31.5 (27.3-37.0), rigour of development 19.1 (15.3-22.2), clarity of presentation 59.3 (50.0-64.8), applicability 18.1 (13.9-25.7) and editorial independence 0.0 (0.0-0.0). The mean score in each domain of quality of Chinese diabetes CPGs was lower than that of CPGs published worldwide but higher than the mean score of Chinese guidelines of all topics. A funding source, the updated version, organisation and publishers of the guidelines and target fields are all the factors influencing the quality of CPGs to a certain degree. CONCLUSIONS A large number of Chinese diabetes CPGs have been produced. Their quality remain unsatisfactorily low compared with CPGs worldwide, there is still room for improvement. Chinese guideline developers should pay more attention to the transparency of methodology, and use the AGREE II instrument to develop and report guidelines.
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Affiliation(s)
- Yuting Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- The First Affiliated Hospital of Sun Yat-sen University, Departmentof Endocrinology and Metabolism, Guangzhou, Guangdong, China
| | - Jinjing Wang
- Department of Endocrinology, the Fifth Medical Centre, Chinese PLA General Hospital, 100071 (Former 307th Hospital of PLA), Beijing, China
| | - Xufei Luo
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Xiaoyang Song
- The First Medical School of Lanzhou University, Lanzhou, China
| | - Lian Liu
- The Second Medical School of Lanzhou University, Lanzhou, China
| | - Lixin Ke
- The Second Medical School of Lanzhou University, Lanzhou, China
| | - Zhihong Liao
- The First Affiliated Hospital of Sun Yat-sen University, Departmentof Endocrinology and Metabolism, Guangzhou, Guangdong, China
| | - Dongke Wang
- The First Medical School of Lanzhou University, Lanzhou, China
| | - Yiming Mu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Chinese GRADE Center, Lanzhou University, Lanzhou, China
| | - Janne Anton Markus Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
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Boels AM, Koning E, Vos RC, Khunti K, Rutten GE. Individualised targets for insulin initiation in type 2 diabetes mellitus-the influence of physician and practice: a cross-sectional study in eight European countries. BMJ Open 2019; 9:e032040. [PMID: 31455718 PMCID: PMC6720145 DOI: 10.1136/bmjopen-2019-032040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To determine at what glycated haemoglobin (HbA1c) level physicians from eight European countries would initiate insulin in type 2 diabetes, which physician or practice related factors influenced this level and whether physicians would differentiate between a younger uncomplicated patient and an older patient with comorbidities. DESIGN Cross-sectional study with data from the Guideline Adherence to Enhance Care study. SETTING AND PARTICIPANTS 410 physicians from both primary and secondary care from Belgium, France, Germany, Italy, Ireland, Sweden, the Netherlands and the UK. OUTCOME MEASURES Physicians were asked at which HbA1c level they would initiate insulin for a young, uncomplicated patient (vignette 1) and for an older, complicated patient (vignette 2). We evaluated differences in HbA1c levels between physicians from different countries using analysis of variance. To identify physician and practice related factors associated with HbA1c level at initiation of insulin, we performed multivariable linear regression. Multiple imputation was used to deal with missing data. RESULTS In Germany, Ireland, Sweden, the Netherlands and the UK, the HbA1c levels for initiating insulin in vignette 2 (range: 60.0 to 66.0 mmol/mol; 7.6% to 8.2%) were higher than for vignette 1 (range: 57.2 to 64.2 mmol/mol; 7.4% to 8.0%). In multivariable analysis, the HbA1c level at which insulin was initiated only differed between countries (vignette 1): Dutch physicians initiated insulin at a lower HbA1c level compared with Belgium, France and the UK. No physician or practice factors were independently associated with HbA1c level at insulin initiation. CONCLUSIONS When deciding on individualised HbA1c targets for insulin initiation, physicians from five countries took patient's age and comorbidity into account. The HbA1c level at which physicians would initiate insulin therapy differed between countries.
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Affiliation(s)
- Anne Meike Boels
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands
| | - Elwin Koning
- Faculty of Medicine, UMC Utrecht, Utrecht, Netherlands
| | - Rimke C Vos
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands
- Dept Public Health and Primary Care/LUMC-Campus The Hague, LUMC, Leiden, Netherlands
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Guy Ehm Rutten
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands
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Koc EM, Aksoy H, Ayhan Başer D, Baydar Artantaş A, Kahveci R. Quality assessment of clinical practice guidelines for management of type 2 diabetes mellitus: Assessment of type 2 diabetes mellitus guidelines. Diabetes Res Clin Pract 2019; 152:119-124. [PMID: 31121273 DOI: 10.1016/j.diabres.2019.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
AIMS Diabetes mellitus is one of the most significant global health emergencies of the 21st century. Every year, an increasing number of people succumb to the condition and therefore suffer life-changing complications. So management of this disease has an important role to prevent complications. In this study, our objective is to assess the quality of guidelines related to the significant public health problem diabetes that have been developed by international and national organizations using the AGREE II tool. METHODS This observational study assesses the quality of clinical practice guidelines used in the management of diabetes with AGREE II tool. Statistical analysis was performed using the SPSS 20 program package. RESULTS The overall quality score of the guidelines ranges between 3 and 6.25. While NICE's guidelines scored the highest, the guidelines of the National Diabetes Foundation scored the lowest. CONCLUSION More comprehensive studies are needed for assessing the quality of guidelines in every subject.
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Affiliation(s)
- E Meltem Koc
- Katip Celebi University, Faculty of Medicine, Department of Family Medicine, Izmir, Turkey
| | - Hilal Aksoy
- Hacettepe University, Faculty of Medicine, Department of Family Medicine, Ankara, Turkey.
| | - Duygu Ayhan Başer
- Hacettepe University, Faculty of Medicine, Department of Family Medicine, Ankara, Turkey
| | - Aylin Baydar Artantaş
- University of Health Sciences, Atatürk Training and Research Hospital, Department of Family Medicine, Ankara, Turkey
| | - Rabia Kahveci
- University of Health Sciences, Ankara Numune Training and Research Hospital, Department of Family Medicine, Ankara, Turkey
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Ukai T, Ichikawa S, Sekimoto M, Shikata S, Takemura Y. Effectiveness of monthly and bimonthly follow-up of patients with well-controlled type 2 diabetes: a propensity score matched cohort study. BMC Endocr Disord 2019; 19:43. [PMID: 31046742 PMCID: PMC6498692 DOI: 10.1186/s12902-019-0372-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/17/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND On average, patients in Japan with type 2 diabetes mellitus have a clinical consultation every month, although evidence for a favorable follow-up interval is lacking. This study investigated whether the follow-up interval can be extended by comparing the clinical outcomes and cost for monthly versus bimonthly follow-up of patients with well-controlled diabetes mellitus. METHODS We combined administrative claims data from the National Health Insurance and the Health Checkups Program data of Tsu city, Japan between 2011 and 2014 to conduct a retrospective cohort study of patients with well-controlled type 2 diabetes mellitus. Propensity scores were used to assemble a matched-pairs cohort from patients who had monthly and bimonthly follow-up. Equivalence between two groups was assessed by designating the proportion of patients who maintained good control of their diabetes in the subsequent year as a primary outcome. The proportion achieving target blood pressure and lipid levels, favorable lifestyle, and annual cost were compared as secondary outcomes. RESULTS Of 12,145 participants, 693 with monthly follow-up and 693 with bimonthly follow-up were matched using propensity scores. In the monthly follow-up group 654 (94.4%) remained under good diabetic control, versus 658 (95.0%) in the bimonthly group (difference: 0.6%; 95% confidence interval: - 1.8 to 2.9%). All secondary outcomes were equivalent for the monthly and bimonthly follow-up groups except the proportion achieving target blood pressure, the proportion engaging in regular exercise, and annual cost. CONCLUSIONS For patients with well-controlled diabetes mellitus, although frequent follow-up by a physician does not affect the control of blood glucose level in the subsequent year, the annual treatment cost becomes much higher. We suggest that patients with well-controlled diabetes can be followed up less often.
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Affiliation(s)
- Tomohiko Ukai
- Department of Community Medicine, TSU, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
- Division of Public Health, Osaka Institute of Public Health, 1-3-69 Nakamichi, Higashinari, Osaka, 537-0025, Japan.
| | - Shuhei Ichikawa
- Department of Education and Research in Family and Community Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Miho Sekimoto
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, 2-1-2 Hitotsubashi, Chiyodaku, Tokyo, 101-8439, Japan
| | - Satoru Shikata
- Department of Family Medicine, Mie Prefectural Ichishi Hospital, 616 Minamiieki, Hakunsan-cho, Tsu, Mie, 515-3133, Japan
| | - Yousuke Takemura
- Department of Community Medicine, TSU, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
- Department of Education and Research in Family and Community Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
- Department of Family Medicine, MIE, Mie University School of Medicine & Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Radwan M, Akbari Sari A, Rashidian A, Takian A, Elsous A, Abou-Dagga S. Factors hindering the adherence to clinical practice guideline for diabetes mellitus in the Palestinian primary healthcare clinics: a qualitative study. BMJ Open 2018; 8:e021195. [PMID: 30185569 PMCID: PMC6129048 DOI: 10.1136/bmjopen-2017-021195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Despite a high number of the internationally produced and implemented clinical guidelines, the adherence with them is still low in healthcare. This study aimed at exploring the perspectives and experiences of senior doctors and nurses towards the barriers of adherence to diabetes guideline. SETTING The Palestinian Primary Health Care-Ministry of Health (PHC-MoH) and Primary Health Care-United Nations Relief and Works Agency for Palestine Refugees in the Near East (PHC- UNRWA) in Gaza Strip. PARTICIPANTS Individual face-to-face in-depth interviews were conducted with 20 senior doctors and nurses who were purposefully selected. METHODS Qualitative design was employed using the theoretical framework by Cabana et al to develop an interview guide. Semi-structural and audio-recorded interviews were conducted. Data were transcribed verbatim and thematically analysed. RESULTS The key theme barriers identified by participants that emerged from the analysed data were in regard of the PHC-MoH lack reimbursement, lack of resources and lack of the guideline trustworthiness, and in regard of PHC-UNRWA the time constraints and the lack of the guideline trustworthiness. The two key subthemes elicited from the qualitative analysis were the outdated guideline and lack of auditing and feedback. CONCLUSION The analysis identified a wide range of barriers against the adherence to diabetes guideline within the PHC-MoH and PHC-UNRWA. The environmental-related and guideline-related barriers were the most prominent factors influencing the guideline adherence. Our study can inform the policy makers and senior managers to develop a tailored interventions that can target the elicited barriers through a multifaceted implementation strategy.
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Affiliation(s)
- Mahmoud Radwan
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
- International Cooperation Directorate, Palestinian Ministry of Health, Gaza Strip, Palestine
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Aymen Elsous
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
| | - Sanaa Abou-Dagga
- Department of Research Affairs and Graduates Studies, Islamic University of Gaza, Gaza Strip, Palestine
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Khunti K, Ceriello A, Cos X, De Block C. Achievement of guideline targets for blood pressure, lipid, and glycaemic control in type 2 diabetes: A meta-analysis. Diabetes Res Clin Pract 2018; 137:137-148. [PMID: 29325774 DOI: 10.1016/j.diabres.2017.12.004] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/09/2017] [Accepted: 12/12/2017] [Indexed: 01/15/2023]
Abstract
We assessed global achievement of targets recommended by the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and National Institute of Health and Care Excellence (NICE) for type 2 diabetes. We searched Medline, Embase, and The Cochrane Library for observational studies reporting target attainment (2006 to 2017 inclusive) for HbA1c, blood pressure, or lipids (low density lipoprotein cholesterol [LDL-C], high density lipoprotein cholesterol [HDL-C], or triglycerides). Rates were pooled using a random-effects meta-analysis. Study quality and risk of small study of bias was assessed. From 2491 screened records, 24 studies were included reporting on 369,251 people from 20 countries. The pooled target achievement rates were; 42.8% (95% CI 38.1-47.5%) for glycaemic control, 29.0% (22.9-35.9%) for blood pressure, 49.2% (39.0-59.4%) for LDL-C, 58.2% (51.7-64.4%) for HDL-C, and 61.9% (55.2-68.2%) for triglyceride control. A higher proportion of people achieved HbA1c targets within Europe and North America than the rest of the world. A higher proportion of people achieved blood pressure targets in North America than Europe or the rest of the world. Meta regression showed no significant improvement in rates by year for any target. The achievement of evidence-based targets is markedly suboptimal globally and not improving.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
| | - Antonio Ceriello
- Institut d'Investigacions, Biomèdiques August Pi iSunyer (IDIBAPS) and Centro de Investigación, Biomedica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica Sesto San Giovanni (MI), Italy
| | - Xavier Cos
- University Primary Care Research Institute (IDIAP Jordi Gol), Barcelona, Spain; Sant Martí de Provençals Primary Health Care Centres, Institut Català de la Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Christophe De Block
- Antwerp University Hospital and University of Antwerp, Department of Endocrinology-Diabetology-Metabolism, Antwerp, Belgium
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Widyahening IS, Wangge G, van der Graaf Y, van der Heijden GJMG. Adapting clinical guidelines in low-resources countries: a study on the guideline on the management and prevention of type 2 diabetes mellitus in Indonesia. J Eval Clin Pract 2017; 23:121-127. [PMID: 27592587 PMCID: PMC5347874 DOI: 10.1111/jep.12628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 12/13/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Most of the clinical guidelines in low-resource countries are adaptations from preexisting international guidelines. This adaptation can be problematic when those international guidelines are not based on current evidence or original evidence-based international guidelines are not followed. This study aims to evaluate the quality of an Indonesian type 2 diabetes mellitus guideline adapted from selected international guidelines. METHODS The "Consensus on the Management and Prevention of type 2 Diabetes in Indonesia 2011" is a guideline by the Indonesian Society of Endocrinology (Perkeni). Four parent guidelines identified from its list of references were from the International Diabetes Federation (IDF), American Association of Clinical Endocrinologist (AACE), American Diabetes Association (ADA), and one jointly released by ADA and European Association for the Study of Diabetes (EASD). Two reviewers independently assessed its quality using the Appraisal of Guidelines, Research and Evaluation Collaboration (AGREE II) instrument. Six recommendations were compared: (1) screening for diabetes; (2) diagnosis; (3) control of hyperglycemia; (4) target blood glucose; (5) target blood pressure; and (6) treatment of dyslipidemia. RESULTS Perkeni's guideline satisfied 55% of the AGREE II items, while its parent guidelines satisfied 59% to 74%. Perkeni's shows low score on "rigor of development" and "applicability" and the lowest score in the "scope and purpose" domain. Differences were found in 4 recommendations: the screening of diabetes, control of hyperglycemia, target blood glucose, and treatment of dyslipidemia. In 3 of 4, Perkeni followed the ADA's recommendation. CONCLUSION Derivation of recommendations from parent guidelines and their adaptation to the context of Indonesian health care lacks transparency. When guidelines are either derived from other guidelines or adapted for use in different context, evidence-based practice principles should be followed and adhered to.
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Affiliation(s)
- Indah S. Widyahening
- Community Medicine DepartmentFaculty of Medicine Universitas IndonesiaJakartaIndonesia
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Grace Wangge
- Community Medicine DepartmentFaculty of Medicine Universitas IndonesiaJakartaIndonesia
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
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Hale K, Capra S, Bauer J. Are nutrition messages lost in transmission? Assessing the quality and consistency of diabetes guideline recommendations on the delivery of nutrition therapy. PATIENT EDUCATION AND COUNSELING 2016; 99:1940-1946. [PMID: 27473638 DOI: 10.1016/j.pec.2016.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/13/2016] [Accepted: 07/13/2016] [Indexed: 06/06/2023]
Abstract
AIM To provide an overview of (1) the consistency of Type 2 Diabetes Clinical Practice Guidelines recommendations on the delivery of nutrition therapy and (2) Clinical Practice Guideline quality. METHODS Large international clinical practice guideline repositories, diabetes organisation websites, and electronic databases (Pubmed, Scopus), were searched to identify Clinical Practice Guidelines for adults with type 2 diabetes published 2005 to August 2014. Recommendations on the delivery of nutrition therapy were extracted and inductive content analysis was used to analyse consistency. Two researchers independently assessed guideline quality using the AGREE II tool. RESULTS Nine topics were identified from the recommendations. Overall the consistency of the recommendations was related to guideline type. Compared with nutrition-specific guidelines, the broad ones had a broader focus and included more patient-focused recommendations. The ten Clinical Practice Guidelines assessed included six broad guidelines and four nutrition specific guidelines. Based on AGREE II analysis, the broad guidelines were higher quality than nutrition-specific ones. CONCLUSIONS Broad Clinical Practice Guidelines were higher quality and included more patient-focused recommendations than nutrition-specific ones. PRACTICE IMPLICATIONS Our findings suggest a need for nutrition-specific guidelines to be modified to include greater patient-focus, or for practitioners delivering nutrition therapy to adopt broad Clinical Practice Guidelines.
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Affiliation(s)
- Kelli Hale
- Centre for Dietetic Research, University of Queensland, Brisbane, 4007, Australia.
| | - Sandra Capra
- Centre for Dietetic Research, University of Queensland, Brisbane, 4007, Australia
| | - Judy Bauer
- Centre for Dietetic Research, University of Queensland, Brisbane, 4007, Australia
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Rutten GEHM, Tack CJ, Pieber TR, Comlekci A, Ørsted DD, Baeres FMM, Marso SP, Buse JB. LEADER 7: cardiovascular risk profiles of US and European participants in the LEADER diabetes trial differ. Diabetol Metab Syndr 2016; 8:37. [PMID: 27274772 PMCID: PMC4891842 DOI: 10.1186/s13098-016-0153-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/26/2016] [Indexed: 01/18/2023] Open
Abstract
AIMS To determine whether US and European participants in the Liraglutide Effect and Action in Diabetes: Evaluation of cardiovascular outcome Results (LEADER) trial differ regarding risk factors for cardiovascular mortality and morbidity. METHODS Baseline data, stratified for prior cardiovascular disease (CVD), were compared using multivariable logistic regression analysis to establish whether region is an independent determinant of achieved targets for glycated hemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein (LDL)-cholesterol. RESULTS Independent of CVD history, US participants were more often of non-White origin and had a longer history of type 2 diabetes, higher body weight, and higher baseline HbA1c. They had substantially lower systolic and diastolic BP, and a marginally lower LDL-cholesterol level. Fewer US participants were diagnosed with left ventricular dysfunction. In the largest group of patients, those with prior CVD and the highest cardiovascular risk, US participants were more often female, had a higher waist circumference, and had a decreased estimated glomerular filtration rate, but less frequently prior myocardial infarction or angina pectoris. CONCLUSIONS There were baseline differences between US and European participants. These differences may result from variation in regional targets for cardiovascular risk factor management, and should be considered in the analysis and reporting of the trial results. Clinical trial identifier: ClinicalTrials.gov, NCT01179048.
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Affiliation(s)
- Guy E. H. M. Rutten
- />Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Cees J. Tack
- />Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas R. Pieber
- />Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Abdurrahman Comlekci
- />Division of Endocrinology, Dokuz Eylul University Medical School, Inciralti, Izmir, Turkey
| | | | | | - Steven P. Marso
- />Department of Internal Medicine, UT Southwestern, Dallas, TX USA
| | - John B. Buse
- />Department of Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - on behalf of the LEADER Investigators
- />Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
- />Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- />Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
- />Division of Endocrinology, Dokuz Eylul University Medical School, Inciralti, Izmir, Turkey
- />Novo Nordisk, Søborg, Denmark
- />Department of Internal Medicine, UT Southwestern, Dallas, TX USA
- />Department of Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC USA
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Järvinen S, Laine MK, Eriksson JG. Comparison of use of diabetic medication and clinical guidelines in four Nordic countries. Ann Med 2016; 48:162-8. [PMID: 26890317 DOI: 10.3109/07853890.2016.1146825] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical guidelines form one of the cornerstones for providing high-quality care for patients with diabetes. We compare the national guidelines and the use of glucose lowering medication for type 2 diabetes (T2D) in Denmark, Finland, Norway and Sweden. METHODS We compared how guidelines take comprehensive care into consideration, what treatment targets and what antihyperglycemic medication was recommended. The use of glucose-lowering medication was based on the sales of diabetes drugs in these countries. RESULTS All guidelines stress the importance of comprehensive diabetes care. Individualized glycemic targets are emphasized especially in the Danish and Finnish guidelines. In 2013, sulfonylureas were the most common second-line treatment after metformin in Denmark, Norway and Sweden; in Finland, this position was taken by DPP-4 inhibitors. Recommended initial insulin type for patients with T2D differs between the four countries. Danish, Norwegian and Swedish guidelines also take economic aspects into account. CONCLUSIONS All guidelines stress regular and comprehensive diabetes care. Danish and Finnish guidelines strongly underline the importance of individualized glycemic targets. All guidelines recommend metformin as the initial oral antihyperglycemic drug. In relation to recommended second line drug therapy and initial insulin type for patients with T2D, the guidelines vary largely between the four countries.
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Affiliation(s)
- Saara Järvinen
- a Department of General Practice and Primary Health Care , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,b Kotka Health Center , City of Kotka , Finland
| | - Merja K Laine
- a Department of General Practice and Primary Health Care , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,c Vantaa Health Center , City of Vantaa , Finland
| | - Johan G Eriksson
- a Department of General Practice and Primary Health Care , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,d Folkhälsan Research Centre , Helsinki , Finland ;,e National Institute for Health and Welfare , Helsinki , Finland
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Patel NR, Chew-Graham C, Bundy C, Kennedy A, Blickem C, Reeves D. Illness beliefs and the sociocultural context of diabetes self-management in British South Asians: a mixed methods study. BMC FAMILY PRACTICE 2015; 16:58. [PMID: 25958196 PMCID: PMC4438635 DOI: 10.1186/s12875-015-0269-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 04/27/2015] [Indexed: 12/30/2022]
Abstract
Background British South Asians have a higher incidence of diabetes and poorer health outcomes compared to the general UK population. Beliefs about diabetes are known to play an important role in self-management, yet little is known about the sociocultural context in shaping beliefs. This study aimed to explore the influence of sociocultural context on illness beliefs and diabetes self-management in British South Asians. Methods A mixed methods approach was used. 67 participants recruited using random and purposive sampling, completed a questionnaire measuring illness beliefs, fatalism, health outcomes and demographics; 37 participants completed a social network survey interview and semi-structured interviews. Results were analysed using SPSS and thematic analysis. Results Quantitative data found certain social network characteristics (emotional and illness work) were related to perceived concern, emotional distress and health outcomes (p < 0.05). After multivariate analysis, emotional work remained a significant predictor of perceived concern and emotional distress related to diabetes (p < 0.05). Analysis of the qualitative data suggest that fatalistic attitudes and beliefs influences self-management practices and alternative food ‘therapies’ are used which are often recommended by social networks. Conclusions Diabetes-related illness beliefs and self-management appear to be shaped by the sociocultural context. Better understanding of the contextual determinants of behaviour could facilitate the development of culturally appropriate interventions to modify beliefs and support self-management in this population. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0269-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Neesha R Patel
- Centre for Endocrinology and Diabetes and Manchester Centre for Health Psychology, Institute of Human Development, The University of Manchester, Room S42, Second Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PT, UK.
| | - Carolyn Chew-Graham
- Primary Care and Health Sciences, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands, Research Institute, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Christine Bundy
- Institute for Inflammation and Repair, The University of Manchester, 1.530 Stopford Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Anne Kennedy
- NIHR CLAHRC Wessex, Faculty of Health Sciences, Building 67, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK.
| | - Christian Blickem
- NIHR CLAHRC Greater Manchester, The University of Manchester, Centre for Primary Care, 5th Floor Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
| | - David Reeves
- Centre for Primary Care, The University of Manchester, 5th Floor Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
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Weymann N, Dirmaier J, von Wolff A, Kriston L, Härter M. Effectiveness of a Web-based tailored interactive health communication application for patients with type 2 diabetes or chronic low back pain: randomized controlled trial. J Med Internet Res 2015; 17:e53. [PMID: 25736340 PMCID: PMC4376097 DOI: 10.2196/jmir.3904] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 11/13/2022] Open
Abstract
Background The prevalence of chronic diseases such as type 2 diabetes and chronic low back pain is rising. Patient empowerment is a key strategy in the management of chronic diseases. Patient empowerment can be fostered by Web-based interactive health communication applications (IHCAs) that combine health information with decision support, social support, and/or behavioral change support. Tailoring the content and tone of IHCAs to the needs of individual patients might improve their effectiveness. Objective The main objective was to test the effectiveness of a Web-based, tailored, fully automated IHCA for patients with type 2 diabetes or chronic low back pain against a standard website with identical content without tailoring (control condition) on patients’ knowledge and empowerment. Methods We performed a blinded randomized trial with a parallel design. In the intervention group, the content was delivered in dialogue form, tailored to relevant patient characteristics. In the control group, the sections of the text were presented in a content tree without any tailoring. Participants were recruited online and offline and were blinded to their group assignments. Measurements were taken at baseline (t0), directly after the first visit (t1), and at 3-month follow-up (t2). The primary hypothesis was that the tailored IHCA would have larger effects on knowledge and patient empowerment (primary outcomes) than the control website. The secondary outcomes were decisional conflict and preparation for decision making. All measurements were conducted by online self-report questionnaires. Intention-to-treat (ITT) and available cases (AC) analyses were performed for all outcomes. Results A total of 561 users agreed to participate in the study. Of these, 179 (31.9%) had type 2 diabetes and 382 (68.1%) had chronic low back pain. Usage was significantly higher in the tailored system (mean 51.2 minutes) than in the control system (mean 37.6 minutes; P<.001). Three months after system use, 52.4% of the sample was retained. There was no significant intervention effect in the ITT analysis. In the AC analysis, participants using the tailored system displayed significantly more knowledge at t1 (P=.02) and more emotional well-being (subscale of empowerment) at t2 (P=.009). The estimated mean difference between the groups was 3.9 (95% CI 0.5-7.3) points for knowledge and 25.4 (95% CI 6.3-44.5) points for emotional well-being on a 0-100 points scale. Conclusions The primary analysis did not support the study hypothesis. However, content tailoring and interactivity may increase knowledge and reduce health-related negative effects in persons who use IHCAs. There were no main effects of the intervention on other dimensions of patient empowerment or decision-related outcomes. This might be due to our tailored IHCA being, at its core, an educational intervention offering health information in a personalized, empathic fashion that merely additionally provides decision support. Tailoring and interactivity may not make a difference with regard to these outcomes. Trial Registration International Clinical Trials Registry: DRKS00003322; http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00003322 (Archived by WebCite at http://www.webcitation.org/6WPO0lJwE).
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Affiliation(s)
- Nina Weymann
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Mulder BC, van Belzen M, Lokhorst AM, van Woerkum CMJ. Quality assessment of practice nurse communication with type 2 diabetes patients. PATIENT EDUCATION AND COUNSELING 2015; 98:156-161. [PMID: 25433968 DOI: 10.1016/j.pec.2014.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/03/2014] [Accepted: 11/08/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Nurse self-management support for type 2 diabetes patients may benefit from applying theory-based behavior change counseling. The 5As model was used to assess if, and how, nurses applied the five key elements of self-management support in standard care. METHODS Seven practice nurses audio-recorded consultations with 66 patients. An existing instrument for assessing counseling quality was used to determine if the 5As were applied. Applied As were compared with quality criteria, to provide an in-depth assessment. RESULTS In almost every consultation, nurses assessed health behaviors, and arranged a follow-up meeting. However, nurses advised behavior change in less than half of the consultations, while setting goals and assisting patients to overcome barriers were used even less. Comparing applied As with quality criteria revealed several issues that could be improved. CONCLUSION Nurses consistently discussed health behaviors with patients, but important elements of self-management support were not applied. PRACTICE IMPLICATIONS Self-management support may benefit from training nurses in performing assessments that form the base for specific advice, setting goals, and addressing barriers to behavior change. Nurses also have to learn how to combine being medical expert and behavioral counselor. Clarifying both roles to patients may facilitate communication and establishing a collaborative relationship.
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Affiliation(s)
- Bob C Mulder
- Strategic Communication, Wageningen University, Wageningen, The Netherlands.
| | - Milou van Belzen
- Strategic Communication, Wageningen University, Wageningen, The Netherlands.
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Campmans-Kuijpers MJ, Baan CA, Lemmens LC, Rutten GE. Change in quality management in diabetes care groups and outpatient clinics after feedback and tailored support. Diabetes Care 2015; 38:285-92. [PMID: 25488914 DOI: 10.2337/dc14-1860] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. RESEARCH DESIGN AND METHODS This before-and-after study with a 1-year follow-up surveyed quality managers on six domains of quality management. Questionnaires measured organization of care, multidisciplinary teamwork, patient centeredness, performance results, quality improvement policy, and management strategies (score range 0-100%). Based on the scores, responders received feedback and a benchmark and were granted access to a toolbox of quality improvement instruments. If requested, additional support in improving quality management was available, consisting of an elucidating phone call or a visit from an experienced consultant. After 1 year, the level of quality management was measured again. RESULTS Of the initially 60 participating care groups, 51 completed the study. The total quality management score improved from 59.8% (95% CI 57.0-62.6%) to 65.1% (62.8-67.5%; P < 0.0001). The same applied to all six domains. The feedback and benchmark improved the total quality management score (P = 0.001). Of the 44 participating outpatient clinics, 28 completed the study. Their total score changed from 65.7% (CI 60.3-71.1%) to 67.3% (CI 62.9-71.7%; P = 0.30). Only the results in the domain multidisciplinary teamwork improved (P = 0.001). CONCLUSIONS Measuring quality management and providing feedback and a benchmark improves the level of quality management in care groups but not in outpatient clinics. The questionnaires might also be a useful asset for other diabetes care groups, such as Accountable Care Organizations.
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Affiliation(s)
- Marjo J Campmans-Kuijpers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Caroline A Baan
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Lidwien C Lemmens
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Guy E Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Wermeling PR, Gorter KJ, Stellato RK, de Wit GA, Beulens JWJ, Rutten GEHM. Effectiveness and cost-effectiveness of 3-monthly versus 6-monthly monitoring of well-controlled type 2 diabetes patients: a pragmatic randomised controlled patient-preference equivalence trial in primary care (EFFIMODI study). Diabetes Obes Metab 2014; 16:841-9. [PMID: 24635880 DOI: 10.1111/dom.12288] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/05/2014] [Accepted: 03/08/2014] [Indexed: 11/28/2022]
Abstract
AIM To investigate effectiveness and cost-effectiveness of 6-monthly monitoring compared with 3-monthly monitoring of well-controlled type 2 diabetes patients in primary care. METHODS A pragmatic randomised controlled patient-preference equivalence trial was performed. From April 2009 to August 2010, 2215 patients from 233 general practitioners across the Netherlands were included. Patients were eligible if between 40- and 80-years-old, diagnosed with type 2 diabetes for more than a year, treated by their general practitioner, not on insulin treatment and well-controlled during the last year (HbA1c ≤ 58 mmol/mol, systolic blood pressure ≤ 145 mmHg and total cholesterol ≤ 5.2 mmol/l). Patients without a strong preference for their monitoring frequency were randomised to 3-monthly or 6-monthly monitoring. Follow-up was 18 months. The primary outcome is the percentage of patients remaining under: HbA1c ≤ 58 mmol/mol, systolic blood pressure ≤ 145 mmHg and total cholesterol ≤ 5.2 mmol/l. Equivalence was assumed if the two-sided 95% confidence interval (CI) was between -5 and 5%. Cost-effectiveness was determined using a cost-minimisation analysis. RESULTS In the 3-monthly group 69.5% remained under good cardiometabolic control, versus 69.8% in the 6-monthly group (difference: 0.3%; 95%CI: -6.2-6.7%). All secondary outcomes were equivalent for 3-monthly and 6-monthly monitoring, except the systolic blood pressure target, physical activity and antihypertensive drug use. Six-monthly monitoring was €387 (£333) cheaper per patient compared to 3-monthly monitoring during the study period. CONCLUSIONS Patients with good cardiometabolic control and without preference for their monitoring frequency can visit the primary care physician less often. The cost-savings can be considerable.
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Affiliation(s)
- P R Wermeling
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Nauck MA, Haastert B, Trautner C, Müller UA, Nauck MA, Heinemann L. A randomised, controlled trial of self-monitoring of blood glucose in patients with type 2 diabetes receiving conventional insulin treatment. Diabetologia 2014; 57:868-77. [PMID: 24445534 DOI: 10.1007/s00125-014-3168-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/17/2013] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS We evaluated whether self-monitoring of blood glucose (SMBG) leads to better glycaemic control (HbA(1c)) in patients with type 2 diabetes on conventional insulin regimens. METHODS Patients with type 2 diabetes on a conventional insulin regimen (basal or premixed insulin with or without additional oral glucose-lowering agents) were recruited at study centres led by members of the German Diabetes Association. In a randomised, prospective, open 2 × 2 factorial design, the once-weekly performance of four-point glucose profiles (SMBG +; n = 151 patients) was compared with no SMBG (SMBG -; n = 149), and the measuring and transmitting of HbA1c results to the study centres (HbA(1c) +; n = 158, of these 82 SMBG - and 76 SMBG +) was compared with HbA1c measurement without disclosure of results (HbA(1c) -; n = 142, of these 67 SMBG - and 75 SMBG +). Randomised allocation was carried out by a central office, using sequentially numbered, sealed envelopes. The primary endpoint was the reduction of HbA(1c) compared with baseline after 12 months. Secondary analyses were of therapy intensification in response to higher blood or urinary glucose or HbA(1c). Participants and caregivers were not blinded as to the allocation of interventions, whereas the laboratory determining HbA(1c) remained blinded. RESULTS Patient characteristics were balanced across groups. A total of 56 patients dropped out. In completers, HbA(1c) was reduced in the SMBG + group from 7.3% to 7.0%, i.e. by 0.3% (0.1%, 0.5%) vs SMBG - from 7.3% to 7.0% and 0.3% (0.2%, 0.5%), respectively, the difference being 0.0% (-0.2%, 0.2%) (p = 0.93). The disclosure of HbA(1c) results had no significant influence, with a difference of 0.1% (-0.1%, 0.4%) (p = 0.28). Values above are mean (95% CI). The ORs for therapy intensification significantly rose as the following increased: proportions of urine samples testing positive for glucose, HbA1c concentrations, and fasting or postprandial glucose concentrations. No important adverse events were associated with the interventions. CONCLUSIONS/INTERPRETATION SMBG profiles once weekly or the disclosure of HbA(1c) results did not improve glycaemic control in patients with type 2 diabetes on conventional insulin treatment, although indicators of hyperglycaemia increased the likelihood of therapy intensification. Greater intensification may be necessary to impact on glycaemic control. TRIAL REGISTRATION www.clinicaltrials.gov (registration code NCT00688363) FUNDING: Deutsche Diabetes-Gesellschaft, Deutsche Diabetes-Stiftung, Bayer Vital GmbH.
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Affiliation(s)
- Michael A Nauck
- Diabeteszentrum Bad Lauterberg, Kirchberg 21, 37431, Bad Lauterberg im Harz, Germany,
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Mulder BC, Lokhorst AM, Rutten GEHM, van Woerkum CMJ. Effective Nurse Communication With Type 2 Diabetes Patients. West J Nurs Res 2014; 37:1100-31. [DOI: 10.1177/0193945914531077] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Many type 2 diabetes mellitus patients have difficulties reaching optimal blood glucose control. With patients treated in primary care by nurses, nurse communication plays a pivotal role in supporting patient health. The twofold aim of the present review is to categorize common barriers to nurse–patient communication and to review potentially effective communication methods. Important communication barriers are lack of skills and self-efficacy, possibly because nurses work in a context where they have to perform biomedical examinations and then perform patient-centered counseling from a biopsychosocial approach. Training in patient-centered counseling does not seem helpful in overcoming this paradox. Rather, patient-centeredness should be regarded as a basic condition for counseling, whereby nurses and patients seek to cooperate and share responsibility based on trust. Nurses may be more successful when incorporating behavior change counseling based on psychological principles of self-regulation, for example, goal setting, incremental performance accomplishments, and action planning.
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Tomasik T, Windak A, Seifert B, Kersnik J, Jozwiak J. Treatment targets in patients with type 2 diabetes set by primary care physicians from Central and Eastern Europe. Eur J Gen Pract 2014; 20:253-9. [PMID: 24520868 DOI: 10.3109/13814788.2013.877130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary care physicians have an important role in the care of patients with Type 2 diabetes but little is known about this issue in Central and Eastern European countries. OBJECTIVES To investigate the treatment goals of patients with type 2 diabetes mellitus (type 2 DM) set by primary care physicians in Central and Eastern European countries and illustrate inter-country variation. METHODS A cross-sectional survey of primary care physicians randomly chosen in nine countries. A validated questionnaire was used. Physicians reported treatment goals for patients with type 2 DM. RESULTS A total of 44.1% of physicians, reported the acceptance of HbA1c < 6.5% (48 mmol/mol) as a treatment goal, whilst 40% chose lower levels (< 6.1%; 43 mmol/mol). In all countries, 62% of physicians set FPG at a level of < 6.0 mmol/l. Most respondents set low BP levels as a goal of therapy (47% of physicians in all countries: BP < 130/80 mmHg and 48% < 120/80 mmHg). A TC level < 4.5 mmol/l and a LDL-C level < 2.5 mmol/l were reported as the targets for patients with diabetes by 51% and 69% of all respondents, respectively. The overall differences between all the countries were statistically significant (P < 0.01). CONCLUSION For patients with diabetes approximately half of physicians set treatment goals at levels that were recommended within the international guidelines. Most of them set treatment goals for HbA1c and BP at very low levels. Educational efforts to raise awareness about new treatment goals are needed.
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Affiliation(s)
- Tomasz Tomasik
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College , Krakow , Poland
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Renard LM, Bocquet V, Vidal-Trecan G, Lair ML, Blum-Boisgard C. Adherence to international follow-up guidelines in type 2 diabetes: a longitudinal cohort study in Luxembourg. PLoS One 2013; 8:e80162. [PMID: 24244637 PMCID: PMC3823868 DOI: 10.1371/journal.pone.0080162] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 10/10/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction Type 2 diabetes is associated with severe micro- and macro-vascular complications. Physicians’ and patients’ adherence to follow-up guidelines permits postponing or reducing these complications. The objectives were to assess the level of adherence to fundamental follow-up guidelines and determine patients’ characteristics associated with this level of adherence in the context of Luxembourg, where no guidelines were implemented. Study population The exhaustive residing population treated for type 2 diabetes in Luxembourg during the 2000-2006 period (N = 21,068). Methods Seven fundamental criteria were extracted from international guidelines (consultation with the treating physician, HbA1c tests, electrocardiogram, retinal, dental, lipid and renal check-ups). The factors associated with the level of adherence to those criteria were identified using a partial proportional odds model. Results In 2006, despite 90% of the patients consulted at least 4 times their treating physician, only 0.6% completed all criteria; 55.0% had no HbA1c test (−8.6 points since 2000) and 31.1% had a renal check-up (+21.6 points). The sex (ORmale: 0.87 [95%CI, 0.83−0.92]), the nationality (ORNonEU: 0.64 [0.52−0.78]), the type of antidiabetic treatment (ORoral: 1.48 [1.35−1.63], ORmixed: 1.35 [1.20−1.52]) and the type of treating physician (ORG-ID: 0.47 [0.42−0.53]) were the main factors associated with the level of adherence in 2006 (3 or more criteria). Conclusion A large percentage of patients were not provided with a systematic annual follow-up between 2000 and 2006. This study highlighted the necessity to promote guidelines in Luxembourg, education for physicians and to launch a national discussion on a disease management program for diabetic patients.
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Affiliation(s)
- Laurence M. Renard
- Centre for Health Studies, Public Research Centre for Health, Strassen, Luxembourg
- EA 4069 - Epidemiology, Assessment and Health Policies, University Paris-Descartes, Paris, France
- * E-mail:
| | - Valery Bocquet
- Competence Center for Methodology and Statistics, Public Research Centre for Health, Strassen, Luxembourg
| | - Gwenaelle Vidal-Trecan
- EA 4069 - Epidemiology, Assessment and Health Policies, University Paris-Descartes, Paris, France
- Public Health Department, Faculty of Medicine, University Paris Descartes, Paris, France
- Risk management and quality unit, Cochin-Saint Vincent de Paul Hospital, AP-HP, Paris, France
| | - Marie-Lise Lair
- Centre for Health Studies, Public Research Centre for Health, Strassen, Luxembourg
| | - Claudine Blum-Boisgard
- EA 4069 - Epidemiology, Assessment and Health Policies, University Paris-Descartes, Paris, France
- Public Health Department, Faculty of Medicine, University Paris Descartes, Paris, France
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Wermeling PR, Janssen J, Gorter KJ, Beulens JWJ, Rutten GEHM. Six-monthly diabetes monitoring of well-controlled patients: experiences of primary care providers. Prim Care Diabetes 2013; 7:187-191. [PMID: 23660331 DOI: 10.1016/j.pcd.2013.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/04/2013] [Accepted: 04/09/2013] [Indexed: 11/24/2022]
Abstract
AIMS To examine experiences of primary care providers with six-monthly diabetes monitoring of well-controlled patients. METHODS This study was part of the EFFIMODI study, examining whether six-monthly monitoring of well-controlled (HbA1c ≤58 mmol/mol, systolic blood pressure ≤145 mmHg and total cholesterol ≤5.2 mmol/l) type 2 diabetes patients results in equivalent cardiometabolic control compared to three-monthly monitoring. Primary care providers completed a questionnaire about their experiences with six-monthly diabetes monitoring, whether they want to continue six-monthly monitoring and for which type of patients six-monthly monitoring is sufficient. RESULTS Of 163 questionnaires, 157 (96.3%) were completed and returned. Only 14 (8.9%) primary care providers were negative about the six-monthly monitoring and 102 (65.0%) would like to continue six-monthly monitoring. Primary care providers disagreed about patients' ability to determine their own monitoring frequency and whether six-monthly monitoring was suitable for all well-controlled type 2 diabetes patients. Practical concerns emerged such as the inability to declare healthcare costs and the unsuitability of electronic health record systems. CONCLUSIONS Almost two out of three primary care providers would like to continue six-monthly monitoring of well-controlled type 2 diabetes patients. However, some diabetes care providers should be convinced and some practical concerns should be solved.
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Affiliation(s)
- Paulien R Wermeling
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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Stone MA, Charpentier G, Doggen K, Kuss O, Lindblad U, Kellner C, Nolan J, Pazderska A, Rutten G, Trento M, Khunti K. Quality of care of people with type 2 diabetes in eight European countries: findings from the Guideline Adherence to Enhance Care (GUIDANCE) study. Diabetes Care 2013; 36:2628-38. [PMID: 23628621 PMCID: PMC3747883 DOI: 10.2337/dc12-1759] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 02/08/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to determine levels of adherence in eight European countries to recommendations for the management of type 2 diabetes and to investigate factors associated with key intermediate outcomes. RESEARCH DESIGN AND METHODS GUIDANCE was a cross-sectional study including retrospective data extraction from the medical records of people with type 2 diabetes recruited, using a shared protocol, from primary and specialist care sites in the following eight European countries: Belgium, France, Germany, Italy, Ireland, Sweden, the Netherlands, and the United Kingdom. The dataset for analysis comprised 7,597 cases. Proportions meeting process and outcome criteria were determined, including between-country variations. Logistic regression was used to investigate potential predictors of meeting targets for HbA1c, blood pressure, and LDL cholesterol. RESULTS In the total sample, adherence to process recommendations was high for some measures, for example, HbA1c recorded in past 12 months in 97.6% of cases. Target achievement for intermediate outcome measures was lower, with only 53.6% having HbA1c <7%. Considerable between-country variation was identified for both processes and outcomes. The following characteristics were associated with an increased likelihood of meeting targets for all three measures considered (HbA1c, blood pressure, LDL cholesterol): shorter diagnosis of diabetes; having one or more macrovascular complications; lower BMI; being prescribed lipid-lowering medication; and no current antihypertensive prescribing. CONCLUSIONS Compared with earlier reports, we have suggested some encouraging positive trends in Europe in relation to meeting targets for the management of people with type 2 diabetes, but there is still scope for further improvement and greater between-country consistency.
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Affiliation(s)
| | | | - Kris Doggen
- Scientific Institute of Public Health, Brussels, Belgium
| | - Oliver Kuss
- University of Halle-Wittenberg, Halle, Germany
| | | | | | | | | | - Guy Rutten
- University Medical Centre, Utrecht, the Netherlands
| | | | | | - On behalf of the GUIDANCE Study Group*
- University of Leicester, Leicester, United Kingdom
- Corbeil-Essonnes Hospital, Corbeil-Essonnes, France
- Scientific Institute of Public Health, Brussels, Belgium
- University of Halle-Wittenberg, Halle, Germany
- University of Gothenburg, Gothenburg, Sweden
- University Hospital, Jena, Germany
- St. James’s Hospital, Dublin, Ireland
- Trinity College, Dublin, Ireland
- University Medical Centre, Utrecht, the Netherlands
- University of Turin, Turin, Italy
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Wermeling PR, Janssen J, Gorter KJ, Beulens JWJ, Rutten GEHM. Satisfaction of well-controlled type 2 diabetes patients with three-monthly and six-monthly monitoring. BMC FAMILY PRACTICE 2013; 14:107. [PMID: 23899039 PMCID: PMC3737049 DOI: 10.1186/1471-2296-14-107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/22/2013] [Indexed: 01/10/2023]
Abstract
Background Patient’s satisfaction with monitoring frequency is of interest when implementing six-monthly monitoring for well-controlled type 2 diabetes patients. Here we want to determine the satisfaction of well-controlled type 2 diabetes patients with either three-monthly or six-monthly diabetes monitoring and their future preference. Methods Survey among 2215 well-controlled type 2 diabetes patients (not using insulin, HbA1c ≤58 mmol/mol, systolic blood pressure ≤145 mmHg and total cholesterol ≤5.2 mmol/l) who participated in the EFFIMODI study, a randomised controlled patient-preference equivalence trial. At baseline, participants were asked whether they had a strong preference for three-monthly or six-monthly monitoring or not. If not, they were randomised to either three-monthly or six-monthly monitoring, while the others were monitored according to their preference. After eighteen months, all participants were asked whether they were satisfied with the monitoring frequency and about their future preference. Patient characteristics associated with satisfaction were also examined. Results Most patients (70.8%) would like to continue their monitoring frequency. Patients from the preference groups were more often satisfied than randomised patients (92.7% and 88.1%, respectively) and patients monitored three-monthly were more often satisfied than patients monitored six-monthly (93.5% and 88.5%, respectively). Higher age, better physical health, less diabetes-related distress, higher diabetes treatment satisfaction and less perceived hyper- and hypoglycaemias were associated with a higher monitoring satisfaction. Conclusions Most well-controlled type 2 diabetes patients were satisfied with their monitoring frequency and would like to continue it. Although the satisfaction for three-monthly monitoring was slightly higher, the satisfaction with six-monthly monitoring was still rather high (88.5%). Trial registration Current controlled trials ISRCTN93201802.
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Affiliation(s)
- Paulien R Wermeling
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands.
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Holmer HK, Ogden LA, Burda BU, Norris SL. Quality of clinical practice guidelines for glycemic control in type 2 diabetes mellitus. PLoS One 2013; 8:e58625. [PMID: 23577058 PMCID: PMC3618153 DOI: 10.1371/journal.pone.0058625] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 02/06/2013] [Indexed: 01/08/2023] Open
Abstract
Background Several studies have reported that clinical practice guidelines (CPGs) in a variety of clinical areas are of modest or variable quality. The objective of this study was to evaluate the quality of an international cohort of CPGs that provide recommendations on pharmaceutical management of glycemic control in patients with type 2 diabetes mellitus (DM2). Methods and Findings We searched the National Guideline Clearinghouse (NGC) on February 15th and June 4th, 2012 for CPGs meeting inclusion criteria. Two independent assessors rated the quality of each CPG using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Twenty-four guidelines were evaluated, and most had high scores for clarity and presentation. However, scope and purpose, stakeholder involvement, rigor of development, and applicability domains varied considerably. The majority of guidelines scored low on editorial independence, and only seven CPGs were based on an underlying systematic review of the evidence. Conclusions The overall quality of CPGs for glycemic control in DM2 is moderate, but there is substantial variability among quality domains within and across guidelines. Guideline users need to be aware of this variability and carefully appraise and select the guidelines that they apply to patient care.
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Affiliation(s)
- Haley K. Holmer
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Lauren A. Ogden
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Brittany U. Burda
- Kaiser Permanente Center for Health Research, Portland, Oregon, United States of America
| | - Susan L. Norris
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States of America
- * E-mail:
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Jo MW, Lee JY, Kim NS, Kim SY, Sheen S, Kim SH, Lee SI. Assessment of the quality of clinical practice guidelines in Korea using the AGREE Instrument. J Korean Med Sci 2013; 28:357-65. [PMID: 23487579 PMCID: PMC3594597 DOI: 10.3346/jkms.2013.28.3.357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 01/04/2013] [Indexed: 11/23/2022] Open
Abstract
The objective of this study was to conduct the systematic evaluation of methodological quality of clinical practice guidelines (CPGs) in Korea. The authors conducted a very comprehensive literature search to identify potential CPGs for evaluation. CPGs were selected which were consistent with a predetermined criteria. Four reviewers evaluated the quality of the CPGs using the Appraisal of Guidelines, Research and Evaluation (AGREE) Instrument. AGREE item scores and standardized domain scores were calculated. The inter-rater reliability of each domain was evaluated using the intra-class correlation coefficient (ICC). Consequently, 66 CPGs were selected and their quality evaluated. ICCs for CPG appraisal using the AGREE Instrument ranged from 0.626 to 0.877. Except for the "Scope and Purpose" and "Clarity and Presentation domains", 80% of CPGs scored less than 40 in all other domains. This review shows that many Korean research groups and academic societies have made considerable efforts to develop CPGs, and the number of CPGs has increased over time. However, the quality of CPGs in Korea were not good according to the AGREE Instrument evaluation. Therefore, we should make more of an effort to ensure the high quality of CPGs.
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Affiliation(s)
- Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Yong Lee
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Nam-Soon Kim
- Health Policy Research Division, Korea Institute for Health and Social Affairs, Seoul, Korea
| | - Soo-Young Kim
- Department of Family Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Seungsoo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Seon Ha Kim
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-il Lee
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
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Weymann N, Härter M, Dirmaier J. A tailored, interactive health communication application for patients with type 2 diabetes: study protocol of a randomised controlled trial. BMC Med Inform Decis Mak 2013; 13:24. [PMID: 23406466 PMCID: PMC3626867 DOI: 10.1186/1472-6947-13-24] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 02/06/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Type 2 diabetes is an increasingly common chronic condition whose prognosis can be improved by patient involvement and self-management. Patient involvement can be fostered by web-based Interactive Health Communication Applications (IHCAs) combining health information with decision support, social support and/or behaviour change support. They reach great numbers of patients at low cost and provide high-quality information and support at the time, place and learning speed patients prefer. Still, online tools often suffer from high attrition. Tailoring content and tone of IHCAs to the individual patient´s needs might improve their effectiveness. This study aims to test the effectiveness and usage of a tailored IHCA combining health information with decision support and behaviour change support for patients with type 2 diabetes. METHODS/DESIGN The effectiveness and usage of the tailored IHCA will be tested against a standard website with identical content in a single-blinded randomized trial with a parallel design. The content covers information on type 2 diabetes, its complications and sequelae, and its treatment options including health behaviour. In the intervention group the content is delivered in dialogue form, tailored to relevant patient characteristics (health literacy, attitudes towards self-care, and barriers to insulin treatment). In the control group the different sections are presented in a content tree, without any tailoring. Participants are blinded to group assignment. Eligibility criteria are age ≥ 18 years, self-reported type 2 diabetes, and Internet access. The study aims to include 414 participants in order to detect the expected small effect (Cohen's d=0.2), with measurements at baseline, directly after the first visit, and at 3-month follow-up. The primary hypothesis is that the tailored IHCA has larger effects on diabetes knowledge and patient empowerment (primary outcomes) than the standard website. Secondary outcomes are website usage as well as decisional conflict and preparation for decision making. All measurements are online self-report questionnaires. DISCUSSION IHCAs are a promising way to foster diabetes knowledge and self-management competencies. The present trial tries to increase the knowledge on how to develop more effective IHCAs for patients with type 2 diabetes. TRIAL REGISTRATION International Clinical Trials Registry DRKS00003322.
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Affiliation(s)
- Nina Weymann
- Department of Medical Psychology (W 26), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany
| | - Martin Härter
- Department of Medical Psychology (W 26), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology (W 26), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany
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Lee YK, Shin ES, Shim JY, Min KJ, Kim JM, Lee SH. Developing a scoring guide for the Appraisal of Guidelines for Research and Evaluation II instrument in Korea: a modified Delphi consensus process. J Korean Med Sci 2013; 28:190-4. [PMID: 23400114 PMCID: PMC3565128 DOI: 10.3346/jkms.2013.28.2.190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 12/07/2012] [Indexed: 11/20/2022] Open
Abstract
Korea has a relatively short history in the development and use of clinical practice guidelines (CPGs). Additionally, it has been difficult to employ the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument due to the lack of consensus and the presence of differences in Korean medical settings and in the Korean socio-cultural environment. An AGREE II scoring guide was therefore developed to reduce differences among evaluators using the same tool. In consideration of the importance of using a quantitative measure of satisfaction with the elements described in the AGREE II manual, a final draft was developed through a Delphi consensus process. Ninety-two draft scoring guides for anchor points 1, 3, 5, and 7 (full score) in 23 items were developed. Consensus was defined as agreement among at least 70% of the raters. Agreement on 88 draft scoring guidelines was reached in the first Delphi round, and agreement for the remaining four was achieved in the second round. The development of an AGREE II scoring guide in this study is expected to contribute to improving the CPG environment.
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Affiliation(s)
- You Kyoung Lee
- Department of Laboratory Medicine and Genetics, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ein Soon Shin
- Department of Preventive Medicine & Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Yong Shim
- Department of Family Medicine, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Kyung Joon Min
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jun-Mo Kim
- Department of Urology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sun Hee Lee
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Weymann N, Härter M, Petrak F, Dirmaier J. Health information, behavior change, and decision support for patients with type 2 diabetes: development of a tailored, preference-sensitive health communication application. Patient Prefer Adherence 2013; 7:1091-9. [PMID: 24174871 PMCID: PMC3808151 DOI: 10.2147/ppa.s46924] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patient involvement in diabetes treatment such as shared decision-making and patient self-management has significant effects on clinical parameters. As a prerequisite for active involvement, patients need to be informed in an adequate and preference-sensitive way. Interactive Health Communication Applications (IHCAs) that combine web-based health information for patients with additional support offer the opportunity to reach great numbers of patients at low cost and provide them with high-quality information and support at the time, place, and learning speed they prefer. Still, web-based interventions often suffer from high attrition. Tailoring the intervention to patients' needs and preferences might reduce attrition and should thereby increase effectiveness. The purpose of this study was to develop a tailored IHCA offering evidence-based, preference-sensitive content and treatment decision support to patients with type 2 diabetes. The content was developed based on a needs assessment and two evidence-based treatment guidelines. The delivery format is a dialogue-based, tunneled design tailoring the content and tone of the dialogue to relevant patient characteristics (health literacy, attitudes toward self-care, and psychological barriers to insulin treatment). Both content and tailoring were revised by an interdisciplinary advisory committee. CONCLUSION The World Wide Web holds great potential for patient information and self-management interventions. With the development and evaluation of a tailored IHCA, we complement face-to-face consultations of patients with their health care practitioners and make them more efficient and satisfying for both sides. Effects of the application are currently being tested within a randomized controlled trial.
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Affiliation(s)
- Nina Weymann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Correspondence: Nina Weymann, University Medical Center Hamburg-Eppendorf, Department of Medical Psychology (W 26), Martinistraße 52, 20246 Hamburg, Germany, Tel +49 0 40 7410 57134, Fax +49 0 40 7410 54965, Email
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Petrak
- Clinic of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Systematic review of the methodological quality of clinical guideline development for the management of chronic disease in Europe. Health Policy 2012; 107:157-67. [DOI: 10.1016/j.healthpol.2012.06.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 06/06/2012] [Accepted: 06/07/2012] [Indexed: 11/19/2022]
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Umegaki H, Iimuro S, Shinozaki T, Araki A, Sakurai T, Iijima K, Ohashi Y, Ito H. Risk factors associated with cognitive decline in the elderly with type 2 diabetes: Pooled logistic analysis of a 6-year observation in the Japanese elderly diabetes intervention trial. Geriatr Gerontol Int 2012; 12 Suppl 1:110-6. [DOI: 10.1111/j.1447-0594.2011.00818.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Bancos I, Cheng T, Prokop LJ, Montori VM, Murad MH. Endocrine clinical practice guidelines in North America. A systematic assessment of quality. J Clin Epidemiol 2012; 65:520-5. [PMID: 22280992 DOI: 10.1016/j.jclinepi.2011.07.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 06/26/2011] [Accepted: 07/02/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the quality of endocrine guidelines developed in North America. STUDY DESIGN AND SETTING A systematic review of the literature was conducted to identify all endocrine clinical practice guidelines developed in North America and published between January 1, 2007 and January 13, 2010. Two independent reviewers used the Appraisal of Guidelines, Research and Evaluation instrument to evaluate the quality of the guidelines in six domains: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. RESULTS One hundred eligible endocrine guidelines had high scores in the scope-and-purpose (mean pooled standardized score [MPSD] of 82±14) and clarity domains (MPSD=64±17) and low scores in the stakeholder-involvement (MPSD of 36±12) and editorial independence domains (MPSD=36±36). Only 29% of guidelines scored above 60% for more than three domains. Rigor-of-development domain score was significantly higher in guidelines using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach, nondiabetes guidelines, and in published in-print vs. online publications. CONCLUSIONS The quality of endocrine guidelines published in 2007-2009 is moderate and can be improved by (1) using methodologically sound development frameworks, (2) increasing stakeholder involvement, and (3) paying more attention to resource implications of guideline implementation.
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Affiliation(s)
- Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, USA.
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Mar Seguí MD, Ronda E, Wimpenny P. Inconsistencies in guidelines for visual health surveillance of VDT workers. J Occup Health 2011; 54:16-24. [PMID: 22156323 DOI: 10.1539/joh.11-0186-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES In Europe, 25% of workers use video display terminals (VDTs). Occupational health surveillance has been considered a key element in the protection of these workers. Nevertheless, it is unclear if guidelines available for this purpose, based on EU standards and available evidence, meet currently accepted quality criteria. The aim of this study was to appraise three sets of European VDT guidelines (UK, France, Spain) in which regulatory and evidence-based approaches for visual health have been formulated and recommendations for practice made. METHODS Three independent appraisers used an adapted AGREE instrument with seven domains to appraise the guidelines. A modified nominal group technique approach was used in two consecutive phases: first, individual evaluation of the three guidelines simultaneously, and second, a face-to-face meeting of appraisers to discuss scoring. Analysis of ratings obtained in each domain and variability among appraisers was undertaken (correlation and kappa coefficients). RESULTS All guidelines had low domain scores. The domain evaluated most highly was Scope and purpose, while Applicability was scored minimally. The UK guidelines had the highest overall score, and the Spanish ones had the lowest. The analysis of reliability and differences between scores in each domain showed a high level of agreement. CONCLUSIONS These results suggest current guidelines used in these countries need an update. The formulation of evidence-base European guidelines on VDT could help to reduce the significant variation of national guidelines, which may have an impact on practical application.
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Affiliation(s)
- María Del Mar Seguí
- Optic, Pharmacology and Anatomy Department, Public Health Research Group, University of Alicante.
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De Hert M, Vancampfort D, Correll CU, Mercken V, Peuskens J, Sweers K, van Winkel R, Mitchell AJ. Guidelines for screening and monitoring of cardiometabolic risk in schizophrenia: systematic evaluation. Br J Psychiatry 2011; 199:99-105. [PMID: 21804146 DOI: 10.1192/bjp.bp.110.084665] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Metabolic and cardiovascular health problems have become a major focus for clinical care and research in schizophrenia. AIMS To evaluate the content and quality of screening guidelines for cardiovascular risk in schizophrenia. METHOD Systematic review and quality assessment of guidelines/recommendations for cardiovascular risk in people with schizophrenia published between 2000 and 2010, using the Appraisal of Guidelines for Research and Evaluation (AGREE). RESULTS The AGREE domain scores varied between the 18 identified guidelines. Most guidelines scored best on the domains 'scope and purpose' and 'clarity of presentation'. The domain 'rigour of development' was problematic in most guidelines, and the domains 'stakeholder involvement' and 'editorial independence' scored the lowest. The following measurements were recommended (in order of frequency): fasting glucose, body mass index, fasting triglycerides, fasting cholesterol, waist, high-density lipoprotein/low-density lipoprotein, blood pressure and symptoms of diabetes. In terms of interventions, most guidelines recommended advice on physical activity, diet, psychoeducation of the patient, treatment of lipid abnormalities, treatment of diabetes, referral for advice and treatment, psychoeducation of the family and smoking cessation advice. Compared across all domains and content, four European guidelines could be recommended. CONCLUSIONS Four of the evaluated guidelines are of good quality and should guide clinicians' screening and monitoring practices. Future guideline development could be improved by increasing its rigour and assuring user and patient involvement.
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Affiliation(s)
- M De Hert
- University Psychiatric Centre, KU Leuven, campus Kortenberg Leuvensesteenweg 517, 3070 Kortenberg, Belgium.
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Berrigan L, Marshall S, McCullagh S, Velikonja D, Bayley M. Quality of clinical practice guidelines for persons who have sustained mild traumatic brain injury. Brain Inj 2011; 25:742-51. [DOI: 10.3109/02699052.2011.580317] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
This review considers the therapeutic choices currently faced by people with type 2 diabetes and those caring for them when glucose levels initially controlled with lifestyle management and metformin start to rise. While sulphonylureas are familiar agents and cheaper than other alternatives, they cause hypoglycaemia and modest weight gain, and robust outcome data are still lacking. Dipeptidyl peptidase 4 inhibitors ('gliptins') have an attractive pharmacological and adverse effect profile, but their effects on the cardiovascular system are also uncertain. Thiazolidinediones ('glitazones') are effective glucose-lowering agents, but cause weight gain and increase the risk of fracture, while the cardiovascular benefits hoped for in association with 'insulin-sensitization' have not been as expected. Glucagon-like peptide-1 agonists will not be acceptable as initial second-line agents for many people as they are injectable rather than oral. Well-powered 'head-to-head' clinical trials of adequate duration are therefore required to allow evidence-based decisions on second-line therapy.
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Affiliation(s)
- J R Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, UK.
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Affiliation(s)
- Richard Kahn
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA.
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