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Tamsett Z, James S, Brown F, O'Neal DN, Ekinci EI. Modifiable factors to prevent severe hypoglycaemic and diabetic ketoacidosis presentations in people with type 1 diabetes. Diabet Med 2024:e15384. [PMID: 38923618 DOI: 10.1111/dme.15384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 05/03/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024]
Abstract
AIMS In tackling rising diabetes-related emergencies, the need to understand and address emergency service usage by people with type 1 diabetes is vital. This review aimed to quantify current trends in presentations for type 1 diabetes-related emergencies and identify public health strategies that reduce the frequency of diabetes-related emergencies and improve glycaemic management. METHODS Medline (OVID), Cochrane and CINAHL were searched for studies published between 2000 and 2023, focusing on people with type 1 diabetes, severe hypoglycaemia and/or diabetic ketoacidosis, and ambulance and/or emergency department usage. There were 1313 papers identified, with 37 publications meeting review criteria. RESULTS The incidence of type 1 diabetes-related emergencies varied from 2.4 to 14.6% over one year for hypoglycaemic episodes, and between 0.07 and 11.8 events per 100 person-years for hyperglycaemic episodes. Notably, our findings revealed that ongoing diabetes education and the integration of diabetes technology, such as continuous glucose monitoring and insulin pump therapy, significantly reduced the incidence of these emergencies. However, socio-economic disparities posed barriers to accessing these technologies, subsequently shifting the cost to emergency healthcare and highlighting the need for governments to consider subsidising these technologies as part of preventative measures. CONCLUSIONS Improving access to continuous glucose monitoring and insulin pump therapy, in combination with ongoing diabetes education focusing on symptom recognition and early management, will reduce the incidence of diabetes-related emergencies. Concurrent research assessing emergency healthcare usage patterns during the implementation of such measures is essential to ensure these are cost-effective.
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Affiliation(s)
- Zacchary Tamsett
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Steven James
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- School of Health, University of the Sunshine Coast, Petrie, Queensland, Australia
| | - Fran Brown
- Melbourne Diabetes Education and Support, Heidelberg Heights, Victoria, Australia
| | - David N O'Neal
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Fitzroy, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, Parkville, Victoria, Australia
| | - Elif I Ekinci
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, Parkville, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
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Bashar H, Kobo O, Khunti K, Banerjee A, Bullock‐Palmer RP, Curzen N, Mamas MA. Impact of Social Vulnerability on Diabetes-Related Cardiovascular Mortality in the United States. J Am Heart Assoc 2023; 12:e029649. [PMID: 37850448 PMCID: PMC10727374 DOI: 10.1161/jaha.123.029649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023]
Abstract
Background Social vulnerability impacts the natural history of diabetes as well as cardiovascular disease (CVD). However, there are little data regarding the social vulnerability association with diabetes-related CVD mortality. Methods and Results County-level mortality data (where CVD was the underlying cause of death with diabetes among the multiple causes) extracted from the Centers for Disease Control multiple cause of death (2015-2019) and the 2018 Social Vulnerability Index databases were aggregated into quartiles based on their Social Vulnerability Index ranking from the least (first quartile) to the most vulnerable (fourth quartile). Stratified by demographic groups, the data were analyzed for overall CVD, as well as for ischemic heart disease, hypertensive disease, heart failure, and cerebrovascular disease. In the 5-year study period, 387 139 crude diabetes-related cardiovascular mortality records were identified. The age-adjusted mortality rate for CVD was higher in the fourth quartile compared with the first quartile (relative risk [RR], 1.66 [95% CI, 1.64-1.67]) with an estimated 39 328 excess deaths. Among the youngest age group (<55 years), those with the highest social vulnerability had 2 to 4 times the rate of cardiovascular mortality compared with the first quartile: ischemic heart disease (RR, 2.07 [95% CI, 1.97-2.17]; heart failure (RR, 3.03 [95% CI, 2.62-3.52]); hypertensive disease (RR, 3.79 [95% CI, 3.45-4.17]; and cerebrovascular disease (RR, 4.39 [95% CI, 3.75-5.13]). Conclusions Counties with greater social vulnerability had higher diabetes-related CVD mortality, especially among younger adults. Targeted health policies that are designed to reduce these disparities are warranted.
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Affiliation(s)
- Hussein Bashar
- Faculty of MedicineUniversity of SouthamptonSouthamptonUnited Kingdom
- Department of CardiologyUniversity Hospital Southampton NHS Foundation TrustSouthamptonUnited Kingdom
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchInstitute for Primary Care and Health Sciences, Keele UniversityKeeleUnited Kingdom
| | - Ofer Kobo
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchInstitute for Primary Care and Health Sciences, Keele UniversityKeeleUnited Kingdom
- Department of CardiologyHillel Yaffe Medical CentreHaderaIsrael
| | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUnited Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College LondonLondonUnited Kingdom
| | | | - Nick Curzen
- Faculty of MedicineUniversity of SouthamptonSouthamptonUnited Kingdom
- Department of CardiologyUniversity Hospital Southampton NHS Foundation TrustSouthamptonUnited Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchInstitute for Primary Care and Health Sciences, Keele UniversityKeeleUnited Kingdom
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Violência contra mulheres imigrantes no Brasil na perspectiva de um estado do conhecimento. PSICO 2023. [DOI: 10.15448/1980-8623.2023.1.38048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
A violência de gênero é um preocupante fenômeno mundial. Evidências apontam que uma em cada três mulheres é ou foi submetida a algum tipo de violência, configurando um problema de saúde pública e de violação de direitos humanos que ocorre em todas as comunidades e culturas. Mulheres imigrantes estão entre os grupos desproporcionalmente mais afetados por este problema de saúde pública. Dado este contexto, o objetivo deste trabalho é examinar a produção de conhecimento sobre este tema no Brasil em seus múltiplos contex- tos. É uma pesquisa qualitativa, bibliográfica situada no âmbito de uma revisão sistemática. A abordagem metodológica constitui-se na perspectiva de um Estado do Conhecimento. As categorias analíticas emergiram a partir da análise dos trabalhos encontrados nas bases de dados da Biblioteca Digital Brasileira de Teses e Dissertações (BDTD) – desenvolvida e coordenada pelo IBICT –, a APA PsycNET, o PubMed e o Google Acadêmico entre 2010 e 2019.
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Pontes MA, Robeiro AA, Rover MRM, Leite SN. Rising drug prices in Brazil during COVID-19 pandemic: another threat to people’s health. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Pasciak WE, Berg DN, Cherlin E, Fried T, Lipska KJ. Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes. BMC Geriatr 2021; 21:318. [PMID: 34001014 PMCID: PMC8130109 DOI: 10.1186/s12877-021-02268-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hospital admissions for severe hypoglycemia are associated with significant healthcare costs, decreased quality of life, and increased morbidity and mortality, especially for older adults with diabetes. Understanding the reasons for hypoglycemia hospitalization is essential for the development of effective interventions; yet, the causes and precipitants of hypoglycemia are not well understood. METHODS We conducted a qualitative study of non-nursing home patients aged 65 years or older without cognitive dysfunction admitted to a single tertiary-referral hospital with diabetes-related hypoglycemia. During the hospitalization, we conducted one-on-one, in-depth, semi-structured interviews to explore: (1) experiences with diabetes management among patients hospitalized for severe hypoglycemia; and (2) factors contributing and leading to the hypoglycemic event. Major themes and sub-themes were extracted using the constant comparative method by 3 study authors. RESULTS Among the 17 participants interviewed, the mean age was 78.9 years of age, 76.5% were female, 64.7% African American, 64.7% on insulin, and patients had an average of 13 chronic conditions. Patients reported: (1) surprise at hypoglycemia despite living with diabetes for many years; (2) adequate support, knowledge, and preparedness for hypoglycemia; (3) challenges balancing a diet that minimizes hyperglycemia and prevents hypoglycemia; (4) the belief that hyperglycemia necessitates medical intervention, but hypoglycemia does not; and (5) tension between clinician-prescribed treatment plans and self-management based on patients' experience. Notably, participants did not report the previously cited reasons for hypoglycemia, such as food insecurity, lack of support or knowledge, or treatment errors. CONCLUSIONS Our findings suggest that some hypoglycemic events may not be preventable, but in order to reduce the risk of hypoglycemia in older individuals at risk: (1) healthcare systems need to shift from their general emphasis on the avoidance of hyperglycemia towards the prevention of hypoglycemia; and (2) clinicians and patients need to work together to design treatment regimens that fit within patient capacity and are flexible enough to accommodate life's demands.
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Affiliation(s)
| | - David N Berg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Emily Cherlin
- Yale School of Public Health and Yale Global Health Leadership Initiative, New Haven, CT, USA
| | - Terri Fried
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Division of Geriatrics, Yale School of Medicine, New Haven, CT, USA
| | - Kasia J Lipska
- Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA
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Azap RA, Paredes AZ, Diaz A, Hyer JM, Pawlik TM. The association of neighborhood social vulnerability with surgical textbook outcomes among patients undergoing hepatopancreatic surgery. Surgery 2020; 168:868-875. [DOI: 10.1016/j.surg.2020.06.032] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
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Sayyed Kassem L, Aron DC. The assessment and management of quality of life of older adults with diabetes mellitus. Expert Rev Endocrinol Metab 2020; 15:71-81. [PMID: 32176560 DOI: 10.1080/17446651.2020.1737520] [Citation(s) in RCA: 3] [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: 06/24/2019] [Accepted: 02/28/2020] [Indexed: 12/11/2022]
Abstract
Introduction: As the population ages, the number of older adults with diabetes mellitus will continue to rise. The burden of diabetes on older adults is significant due to the disease itself, its complications, and its treatments. This is compounded by geriatric syndromes such as frailty and cognitive dysfunction. Consequently, health and diabetes-related quality of life (QoL) are diminished.Areas covered: This article reviews the value of assessing QoL in providing patient-centered care and the associations between QoL measures and health outcomes. The determinants of QoL particular to diabetes and the older population are reviewed, including psychosocial, physical, and cognitive burdens of diabetes and aging and the impact of hypoglycemia on QoL. Strategies are described to alleviate these burdens and improve QoL, and barriers to multidisciplinary patient-centered care are discussed. QoL measurement instruments are reviewed.Expert opinion: The goals of treating diabetes and its complications should be considered carefully along with each patient's capacity to withstand the burdens of treatment. This capacity is reduced by socioeconomic, psychological, cognitive, and physical factors reduces this capacity. Incorporating measurement of HRQoL into clinical practices is possible, but deficiencies in the systems of health-care delivery need to be addressed to facilitate their use.
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Affiliation(s)
- Laure Sayyed Kassem
- Endocrinology Section, Northeast Ohio Veterans Healthcare System, Cleveland, OH, USA
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David C Aron
- Endocrinology Section, Northeast Ohio Veterans Healthcare System, Cleveland, OH, USA
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Social vulnerability assessment of dog intake location data as a planning tool for community health program development: A case study in Athens-Clarke County, GA, 2014-2016. PLoS One 2019; 14:e0225282. [PMID: 31790438 PMCID: PMC6886854 DOI: 10.1371/journal.pone.0225282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/31/2019] [Indexed: 11/19/2022] Open
Abstract
A retrospective spatial analysis of dog intake data from an open admission animal shelter in Georgia was conducted to explore patterns within dog demographics and outcomes by pickup location or by the home address of the person who transferred ownership rights of the dog to Athens-Clarke County Animal Control during the period 2014-2016. Spatial analysis found the relationship between these intake locations and the final disposition of the dogs to be non-random, suggesting social and environmental influences on distribution. Statistically significant clusters were identified using the Getis-Ord Gi* statistic. This study found statistically significant hot spots (i.e., areas with higher than expected values) and cold spots (i.e., areas with lower than expected values) for the intake of dogs with known health issues, physically neglected dogs, juveniles, and adults. Only statistically significant hot spots were found for socially neglected dogs and dogs whose final disposition was euthanasia due to severe health or behavioral issues. Given the close relationship between humans and dogs, this study explores the association of impounded dog clusters and a previously developed social vulnerability index. Social vulnerability is the product of social inequalities and inequalities related to the human-built environment. The social vulnerability index provides one tool for understanding the differences in characteristics of dogs from different intake locations. Results of this study indicate the utility of non-animal focused data as a planning tool for community programs and to allow for efficient allocation of limited resources for veterinary and other community outreach programs.
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Senteio C, Adler-Milstein J, Richardson C, Veinot T. Psychosocial information use for clinical decisions in diabetes care. J Am Med Inform Assoc 2019; 26:813-824. [PMID: 31329894 PMCID: PMC7647218 DOI: 10.1093/jamia/ocz053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/26/2019] [Accepted: 03/31/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE There are increasing efforts to capture psychosocial information in outpatient care in order to enhance health equity. To advance clinical decision support systems (CDSS), this study investigated which psychosocial information clinicians value, who values it, and when and how clinicians use this information for clinical decision-making in outpatient type 2 diabetes care. MATERIALS AND METHODS This mixed methods study involved physician interviews (n = 17) and a survey of physicians, nurse practitioners (NPs), and diabetes educators (n = 198). We used the grounded theory approach to analyze interview data and descriptive statistics and tests of difference by clinician type for survey data. RESULTS Participants viewed financial strain, mental health status, and life stressors as most important. NPs and diabetes educators perceived psychosocial information to be more important, and used it significantly more often for 1 decision, than did physicians. While some clinicians always used psychosocial information, others did so when patients were not doing well. Physicians used psychosocial information to judge patient capabilities, understanding, and needs; this informed assessment of the risks and the feasibility of options and patient needs. These assessments influenced 4 key clinical decisions. DISCUSSION Triggers for psychosocially informed CDSS should include psychosocial screening results, new or newly diagnosed patients, and changes in patient status. CDSS should support cost-sensitive medication prescribing, and psychosocially based assessment of hypoglycemia risk. Electronic health records should capture rationales for care that do not conform to guidelines for panel management. NPs and diabetes educators are key stakeholders in psychosocially informed CDSS. CONCLUSION Findings highlight opportunities for psychosocially informed CDSS-a vital next step for improving health equity.
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Affiliation(s)
- Charles Senteio
- Department of Library and Information Science, Rutgers School of Communication and Information, New Brunswick, New Jersey, USA
| | - Julia Adler-Milstein
- Department of Medicine, University of California San Francisco, San Francisco, California USA
| | - Caroline Richardson
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan USA
| | - Tiffany Veinot
- School of Information, School of Public Health, University of Michigan, Ann Arbor, Michigan USA
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Mirghani HO. The association between hypoglycemia and hospital use, food insufficiency, and unstable housing conditions: a cross-sectional study among patients with type 2 diabetes in Sudan. BMC Res Notes 2019; 12:108. [PMID: 30819208 PMCID: PMC6394060 DOI: 10.1186/s13104-019-4145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
Objectives Hypoglycemia is associated with mortality and healthcare utilization. We aimed to assess hypoglycemia risk and Hospital use among Sudanese patients with type 2 diabetes. Results One hundred and fifty-nine patients with type 2 diabetes attending a diabetes center in Omdurman, Sudan during the period from June to September 2018were approached. A structured questionnaire based on hypoglycemia risk and Hospital use, Fasting plasma glucose (FPG) and the glycated hemoglobin (HbA1c) was used to interview the patients. Participants (age 58.13 ± 9.96 years), 4.4%, 14.5%, and 81.1% were at high, moderate, and low hypoglycemia respectively, 66% reported food insufficiency, while 15.1% had unstable housing conditions. No relationship was evident between the hypoglycemia risk, gender, unstable housing conditions, food insufficiency, fasting plasma glucose,HbA1c, and the duration since the diagnosis of diabetes. A considerable number (18.9%) of Sudanese patients with diabetes were at moderate/high risk of hypoglycemia and Hospital use, including hypoglycemia risk and hospital use assessment in the holistic care of diabetes are recommended.
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Affiliation(s)
- Hyder Osman Mirghani
- Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia. .,Faculty of Medicine, University of Tabuk, PO Box 3378, Tabuk, 51941, Saudi Arabia.
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