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Ferrin M, Häge A, Swanson J, Wong KHTW, Dittmann RW, Banaschewski T, Coghill D, Santosh PJ, Romanos M, Simonoff E, Buitelaar JK. Medication adherence and persistence in children and adolescents with attention deficit hyperactivity disorder (ADHD): a systematic review and qualitative update. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02538-z. [PMID: 39105823 DOI: 10.1007/s00787-024-02538-z] [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: 02/23/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024]
Abstract
Low medication-adherence and persistence may reduce the effectiveness of ADHD-medication. This preregistered systematic review (PROSPERO CRD42020218654) on medication-adherence and persistence in children and adolescents with ADHD focuses on clinically relevant questions and extends previous reviews by including additional studies. We included a total of n = 66 studies. There was a lack of consistency in the measurement of adherence/persistence between studies. Pooling the medication possession ratios (MPR) and using the most common adherence definition (MPR ≥ 80%) indicated that only 22.9% of participants had good adherence at 12-month follow-up. Treatment persistence on medication measured by treatment duration during a 12-month follow-up averaged 170 days (5.6 months). Our findings indicate that medication-adherence and persistence among youth with ADHD are generally poor and have not changed in recent years. Clinicians need to be aware that various factors may contribute to poor adherence/persistence and that long-acting stimulants and psychoeducational programs may help to improve adherence/persistence. However, the evidence to whether better adherence/persistence contributes to better long-term outcomes is limited and requires further research.
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Affiliation(s)
- Maite Ferrin
- Child and Adolescent Mental Health Service, Barnet Enfield and Haringey NHS Trust, London, UK.
- ReCognition Health, London, UK.
| | - Alexander Häge
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - James Swanson
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Kirstie H T W Wong
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, WC1H 9JP, UK
| | - Ralf W Dittmann
- Paediatric Psychopharmacology, Dept of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Heidelberg, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Paramala J Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Center of Mental Health, University Hospital Wuerzburg, Würzburg, Germany
| | - Emily Simonoff
- Institute of Psychiatry, Psychology and Neuroscience and Maudsley NIHR Biomedical Research Centre, King's College London, London, UK
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
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Oppler SH, Hocum Stone LL, Leishman DJ, Janecek JL, Moore MEG, Rangarajan P, Willenberg BJ, O’Brien TD, Modiano J, Pheil N, Dalton J, Dalton M, Ramachandran S, Graham ML. A bioengineered artificial interstitium supports long-term islet xenograft survival in nonhuman primates without immunosuppression. SCIENCE ADVANCES 2024; 10:eadi4919. [PMID: 38181083 PMCID: PMC10776017 DOI: 10.1126/sciadv.adi4919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 12/02/2023] [Indexed: 01/07/2024]
Abstract
Cell-based therapies hold promise for many chronic conditions; however, the continued need for immunosuppression along with challenges in replacing cells to improve durability or retrieving cells for safety are major obstacles. We subcutaneously implanted a device engineered to exploit the innate transcapillary hydrostatic and colloid osmotic pressure generating ultrafiltrate to mimic interstitium. Long-term stable accumulation of ultrafiltrate was achieved in both rodents and nonhuman primates (NHPs) that was chemically similar to serum and achieved capillary blood oxygen concentration. The majority of adult pig islet grafts transplanted in non-immunosuppressed NHPs resulted in xenograft survival >100 days. Stable cytokine levels, normal neutrophil to lymphocyte ratio, and a lack of immune cell infiltration demonstrated successful immunoprotection and averted typical systemic changes related to xenograft transplant, especially inflammation. This approach eliminates the need for immunosuppression and permits percutaneous access for loading, reloading, biopsy, and recovery to de-risk the use of "unlimited" xenogeneic cell sources to realize widespread clinical translation of cell-based therapies.
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Affiliation(s)
- Scott H. Oppler
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - David J. Leishman
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jody L. Janecek
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Meghan E. G. Moore
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | | | - Bradley J. Willenberg
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Timothy D. O’Brien
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN, USA
| | - Jaime Modiano
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | - Natan Pheil
- Cell-Safe LifeSciences, Skokie, IL, USA
- Medline UNITE Foot and Ankle, Medline Industries LP, 3 Lakes Drive, Northfield, IL, USA
| | | | | | | | - Melanie L. Graham
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN, USA
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Wilson V. Managing type 1 diabetes in children and young people: challenges and solutions. Nurs Child Young People 2023; 35:e1465. [PMID: 37272192 DOI: 10.7748/ncyp.2023.e1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 06/06/2023]
Abstract
Type 1 diabetes is the most common form of diabetes in school-age children. Effective management and self-management at home and during school hours are essential to improve the quality of life of children and young people and reduce their risk of developing complications such as cardiovascular disease and kidney disease. There are, however, multiple barriers to effective management and self-management, notably in adolescence. Interventions, education and support based on clear psychoeducational principles improve the outcomes of children and young people. This article explores type 1 diabetes including its causes and risk factors, presentation and diagnosis, complications and comorbidities, and treatment and management. It focuses in particular on the role of nurses in supporting self-management and on the challenges of type 1 diabetes care in school.
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Kim J, Yang C, Joo HJ, Park RW, Kim GE, Kim D, Choi J, Lee JH, Kim E, Park SC, Kim K, Kim IB. Risks of complicated acute appendicitis in patients with psychiatric disorders. BMC Psychiatry 2022; 22:763. [PMID: 36471298 PMCID: PMC9721022 DOI: 10.1186/s12888-022-04428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/25/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Acute appendicitis often presents with vague abdominal pain, which fosters diagnostic challenges to clinicians regarding early detection and proper intervention. This is even more problematic with individuals with severe psychiatric disorders who have reduced sensitivity to pain due to long-term or excessive medication use or disturbed bodily sensation perceptions. This study aimed to determine whether psychiatric disorder, psychotropic prescription, and treatment compliance increase the risks of complicated acute appendicitis. METHODS The diagnosis records of acute appendicitis from four university hospitals in Korea were investigated from 2002 to 2020. A total of 47,500 acute appendicitis-affected participants were divided into groups with complicated and uncomplicated appendicitis to determine whether any of the groups had more cases of psychiatric disorder diagnoses. Further, the ratio of complicated compared to uncomplicated appendicitis in the mentally ill group was calculated regarding psychotropic dose, prescription duration, and treatment compliance. RESULTS After adjusting for age and sex, presence of psychotic disorder (odds ratio [OR]: 1.951; 95% confidence interval [CI]: 1.218-3.125), and bipolar disorder (OR: 2.323; 95% CI: 1.194-4.520) was associated with a higher risk of having complicated appendicitis compared with absence of psychiatric disorders. Patients who are taking high-daily-dose antipsychotics, regardless of prescription duration, show high complicated appendicitis risks; High-dose antipsychotics for < 1 year (OR: 1.896, 95% CI: 1.077-3.338), high-dose antipsychotics for 1-5 years (OR: 1.930, 95% CI: 1.144-3.256). Poor psychiatric outpatient compliance was associated with a high risk of complicated appendicitis (OR: 1.664, 95% CI: 1.014-2.732). CONCLUSIONS This study revealed a close relationship in the possibility of complicated appendicitis in patients with severe psychiatric disorders, including psychotic and bipolar disorders. The effect on complicated appendicitis was more remarkable by the psychiatric disease entity itself than by psychotropic prescription patterns. Good treatment compliance and regular visit may reduce the morbidity of complicated appendicitis in patients with psychiatric disorders.
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Affiliation(s)
- Junmo Kim
- grid.31501.360000 0004 0470 5905Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Chaeyoung Yang
- grid.49606.3d0000 0001 1364 9317Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea ,grid.411986.30000 0004 4671 5423Department of Psychiatry, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Hyung Joon Joo
- grid.411134.20000 0004 0474 0479Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea ,grid.222754.40000 0001 0840 2678Department of Medical Informatics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Rae Woong Park
- grid.251916.80000 0004 0532 3933Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ga Eun Kim
- grid.411076.5Department of Psychiatry, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Daeho Kim
- grid.49606.3d0000 0001 1364 9317Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Joonho Choi
- grid.49606.3d0000 0001 1364 9317Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea ,grid.412145.70000 0004 0647 3212Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Jun Ho Lee
- grid.49606.3d0000 0001 1364 9317Department of Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Eunkyung Kim
- grid.412145.70000 0004 0647 3212Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Seon-Cheol Park
- grid.49606.3d0000 0001 1364 9317Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea ,grid.412145.70000 0004 0647 3212Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
| | - Il Bin Kim
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea. .,Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
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Comprehension and compliance with discharge instructions among pediatric caregivers. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Nakayama I, Goto A, Hayashino Y, Suzuki H, Yamazaki K, Izumi K, Noda M. Employment status and diabetic outpatient appointment non-attendance in middle to senior working generation with type 2 diabetes: the Japan diabetes outcome intervention trial-2 large‑scale trial 005 (J-DOIT2-LT005). Acta Diabetol 2022; 59:793-801. [PMID: 35279754 PMCID: PMC9085697 DOI: 10.1007/s00592-022-01869-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/15/2022] [Indexed: 11/25/2022]
Abstract
AIMS Workplace demands, support, and relationships differ according to employment status (e.g., employment that is full-time, part-time, or self-employed) and may lead to unequal opportunities to keep diabetic appointments. We investigated the association between employment status and outpatient diabetic appointment non-attendance among working-age adults with type 2 diabetes. METHODS This was a secondary analysis of a cluster-randomized trial (the Japan diabetes outcome intervention trial 2 large-scale trial). The analysis included 2010 trial participants (40-65 years old) with type 2 diabetes who were regularly followed by primary care physicians (PCPs). The outcome measure was the first non-attendance (defined as a failure to visit a PCP within 2 months of the original appointment) during the one-year follow-up. The association between baseline employment status and non-attendance was examined using Cox proportional hazard model in men and women. RESULTS During the 1279 and 789 person-year follow-up periods, 90 men and 34 women, respectively, experienced their first appointment non-attendance. Among men, self-employed participants had a higher risk of non-attendance compared with full-time employees (adjusted HR, 1.84; 95% CI, 1.15, 2.95). The trial intervention (attendance promotion) was associated with a significantly reduced risk of non-attendance among self-employed participants (HR, 0.51; 95% CI, 0.26, 0.99). Among women, a significant association between employment status and non-attendance was not observed. CONCLUSIONS Self-employed men with type 2 diabetes had a twofold increased risk of non-attendance than did full-time employees. Our study suggests that self-employed men with type 2 diabetes should be targeted for interventions promoting appointment adherence.
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Affiliation(s)
- Izumi Nakayama
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2, Seto, Kanazawa-ku, Yokohama, Kanagawa, 236-0027, Japan
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2, Seto, Kanazawa-ku, Yokohama, Kanagawa, 236-0027, Japan.
| | - Yasuaki Hayashino
- Department of Endocrinology, Tenri Hospital, 200 Mishimacho, Nara, Tenri, Japan
| | - Hikari Suzuki
- Japan Community Health Care Organization Takaoka Fushiki Hospital, 8-5 Fushiki Kofumotomachi, Takaoka, Toyama, Japan
| | | | - Kazuo Izumi
- Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism and Endocrinology, Ichikawa Hospital, International University of Health and Welfare, Ichikawa, Chiba, Japan
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Butler AM, Hilliard ME, Fegan-Bohm K, Minard C, Anderson BJ. Peer-support intervention for African American and Latino parents to improve the glycemic control trajectory among school-aged children with type 1 diabetes: A pilot and feasibility protocol. Contemp Clin Trials 2022; 116:106739. [PMID: 35341991 DOI: 10.1016/j.cct.2022.106739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 11/03/2022]
Abstract
Background Type 1 diabetes (T1D) is a common, chronic pediatric health condition with complicated management demands. African American and Latino children with T1D have troubling disparities in glycemic outcomes and acute complications. While there are empirically supported behavioral interventions to support disease management in youth with T1D, there are few that specifically aim to reduce health disparities in this population. While collaborative parent involvement with the child with T1D management tasks is important to promote optimal glycemic outcomes during childhood, our formative research identified multiple individual, family, and broader system factors that impede or facilitate collaborative parental involvement among African American and Latino parents of children with T1D. Methods This paper describes the development, design, and study protocol for the Type 1 Diabetes Empowerment And Management (TEAM) pilot trial. The TEAM intervention is a novel, group-based behavioral intervention designed to enhance collaborative involvement in T1D management for African American and Latino parents of children aged 5-10. This randomized pilot trial's primary aim is to evaluate the TEAM intervention's feasibility and acceptability. The secondary aim is to examine preliminary intervention outcomes (i.e., children's HbA1c, treatment adherence, collaborative parent involvement in T1D management, parent/child quality of life, and parent's diabetes-related distress, depressive symptoms, and self-efficacy) compared to usual T1D care. Discussion The trial will provide preliminary information about whether optimizing appropriate parent involvement during the school-age years may increase T1D treatment adherence and stabilize or improve glycemic control in African American and Latino school-aged children.
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Affiliation(s)
- Ashley M Butler
- Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, Houston, TX 77030, USA.
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, Houston, TX 77030, USA
| | - Kelly Fegan-Bohm
- Texas Department of State Health Services, 1100 West 49(th) Street, Austin, TX 78756, USA
| | - Charles Minard
- Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, Houston, TX 77030, USA
| | - Barbara J Anderson
- Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, Houston, TX 77030, USA
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Alawadhi A, Palin V, van Staa T. Investigating the reasons for missing an outpatient appointment in Royal Hospital, Sultanate of Oman: Perspectives of patients and medical staff in a survey. Health Sci Rep 2022; 5:e470. [PMID: 35036575 PMCID: PMC8749310 DOI: 10.1002/hsr2.470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Missed appointments are a major health issue in the healthcare systems globally. They directly impact on the use of hospital resources, patient's health, and can lead to patient's dissatisfaction. This study was conducted to assess the reasons for missing a hospital appointment. Methods A survey was conducted with a randomly selected sample of patients who missed their outpatient appointment in Royal hospital, Sultanate of Oman, from March to April 2021 in six clinics. Patients were interviewed via telephone to answer a structured survey. In addition, a self‐administered survey was distributed to medical staff to explore their perspectives. Results Two hundred eighty patients and 52 medical staff participated in the study. Frequent patient‐reported reasons for missed appointment were transportation difficulties (11.4%), no longer needing (7.5%), or forgetting the appointment (6.8%); staff‐reported reasons were transportation (23.8%), no SMS received (16.9%), and forgetting the appointment (15.4%). Frequencies of reasons varied substantially between clinics. Family obligations were the main theme in obstetrics (odds ratio [OR] 9.48; 95% confidence interval [CI] 2.66‐33.78) and in diabetes clinic (OR 10.55; 95% CI 2.68‐38.58), where transportation issue was the main theme in Oncology clinic (OR 4.83; 95% CI 1.11‐21.02). The recommendations for improvement were mainly around improving the reminder system, the use of telephone reminders, and developing a flexible appointment scheduling system. Conclusion Knowing the reasons for missed appointment from patients and health professionals can help to develop effective interventions. The heterogeneity between clinics in reasons for missed appointment indicates for interventions tailored to clinic and frequent reasons.
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Affiliation(s)
- Ahmed Alawadhi
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health The University of Manchester Manchester UK
| | - Victoria Palin
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health The University of Manchester Manchester UK
| | - Tjeerd van Staa
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health The University of Manchester Manchester UK
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Edwards S, He X, Wang W, Poon JL, Meadows E, Price D, Johnson J, Wolpert H, Polonsky W. Use of Connected Pen as a Diagnostic Tool to Evaluate Missed Bolus Dosing Behavior in People with Type 1 and Type 2 Diabetes. Diabetes Technol Ther 2022; 24:61-66. [PMID: 34524010 PMCID: PMC8783630 DOI: 10.1089/dia.2021.0239] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study used connected pen to determine missed bolus dose (MBD) frequency during masked and unmasked continuous glucose monitoring (CGM) periods and examined its link with time-in-range (TIR), time-above-range (TAR), time-below-range (TBR), and key participant characteristics in people with diabetes. Methods: This was a 12-week, single-arm, exploratory, two-period study for people with type 1 diabetes (T1D) or type 2 diabetes (T2D). The primary objective was to estimate the average number of MBD during masked and real-time CGM use. The secondary objective was to estimate the average percent TIR and its relationship to MBD. An exploratory objective was to investigate the participant characteristics that were associated with MBD. Data were analyzed for differences in MBD by diabetes type and other participant characteristics, by CGM period, and by hypoglycemic fear scores. Results: Participants (n = 64; T1D, n = 38; T2D, n = 26) were 48 ± 11.9 years old and 44% were female. From the masked to the unmasked period, MBD, %TAR, %TBR, and glycated hemoglobin decreased significantly (0.74 MBD/day to 0.62 MBD/day, P = 0.008; 53.6%-48.1%, P = 0.004; 4.49%-2.93%, P < 0.001; mean 8.8%-8.4%, P < 0.001, respectively), while %TIR increased significantly (41.9%-49.0%, P < 0.001). MBD/day was negatively associated with TIR (P = 0.016) and positively associated with TAR (P = 0.015) for T1D and positively associated with TBR (P = 0.024) for T2D in the masked period only. MBD was significantly associated with fear of hypoglycemia for T2D, but not T1D. Conclusions: MBD is associated with reduced TIR when CGM is masked and tailored therapeutic approaches are needed for T1D and T2D populations.
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Affiliation(s)
| | - Xuanyao He
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Wenjie Wang
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Eric Meadows
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | | | - William Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- Address correspondence to: William Polonsky, Behavioral Diabetes Institute, 5230 Carroll Canyon Road, Suite 208, San Diego, CA 92121, USA
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Holman N, Knighton P, OʼKeefe J, Wild SH, Brewster S, Price H, Patel K, Hanif W, Patel V, Gregg EW, Holt RIG, Gadsby R, Khunti K, Valabhji J, Young B, Sattar N. Completion of annual diabetes care processes and mortality: A cohort study using the National Diabetes Audit for England and Wales. Diabetes Obes Metab 2021; 23:2728-2740. [PMID: 34405512 DOI: 10.1111/dom.14528] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/05/2021] [Accepted: 08/14/2021] [Indexed: 11/30/2022]
Abstract
AIM To conduct an analysis to assess whether the completion of recommended diabetes care processes (glycated haemoglobin [HbA1c], creatinine, cholesterol, blood pressure, body mass index [BMI], smoking habit, urinary albumin, retinal and foot examinations) at least annually is associated with mortality. MATERIALS AND METHODS A cohort from the National Diabetes Audit of England and Wales comprising 179 105 people with type 1 and 1 397 790 people with type 2 diabetes, aged 17 to 99 years on January 1, 2009, diagnosed before January 1, 2009 and alive on April 1, 2013 was followed to December 31, 2019. Cox proportional hazards models adjusting for demographic characteristics, smoking, HbA1c, blood pressure, serum cholesterol, BMI, duration of diagnosis, estimated glomerular filtration rate, prior myocardial infarction, stroke, heart failure, respiratory disease and cancer, were used to investigate whether care processes recorded January 1, 2009 to March 31, 2010 were associated with subsequent mortality. RESULTS Over a mean follow-up of 7.5 and 7.0 years there were 26 915 and 388 093 deaths in people with type 1 and type 2 diabetes, respectively. Completion of five or fewer, compared to eight, care processes (retinal screening not included as data were not reliable) had a mortality hazard ratio (HR) of 1.37 (95% confidence interval [CI] 1.28-1.46) in people with type 1 and 1.32 (95% CI 1.30-1.35) in people with type 2 diabetes. The HR was higher for respiratory disease deaths and lower in South Asian ethnic groups. CONCLUSIONS People with diabetes who have fewer routine care processes have higher mortality. Further research is required into whether different approaches to care might improve outcomes for this high-risk group.
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Affiliation(s)
- Naomi Holman
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Peter Knighton
- Analytical Services - Population Health, Clinical Audit and Specialist Care, NHS Digital, Leeds, UK
| | - Jackie OʼKeefe
- Analytical Services - Population Health, Clinical Audit and Specialist Care, NHS Digital, Leeds, UK
| | - Sarah H Wild
- College of Medicine and Veterinary Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah Brewster
- West Hampshire Community Diabetes Service, Southern Health NHS Foundation Trust, Lyndhurst, UK
| | - Hermione Price
- West Hampshire Community Diabetes Service, Southern Health NHS Foundation Trust, Lyndhurst, UK
| | - Kiran Patel
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Warwick, UK
- Coventry University, Coventry, UK
| | - Wasim Hanif
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Vinod Patel
- Warwick Medical School, University of Warwick, Warwick, UK
- Diabetes and Endocrinology Centre, George Eliot Hospital NHS Trust, Nuneaton, UK
- West Midlands Clinical Networks and Clinical Senate, NHS England and NHS Improvement - Midlands, Birmingham, UK
| | | | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton and Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Roger Gadsby
- Warwick Medical School, University of Warwick, Warwick, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Jonathan Valabhji
- NHS England and NHS Improvement, London, UK
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Altman J, Niarra R, Balkau B, Vincent‐Cassy C. The JUBILE cohort: Quality of life after more than 40 years with type 1 diabetes. Diabet Med 2021; 38:e14460. [PMID: 33197286 PMCID: PMC8451770 DOI: 10.1111/dme.14460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
AIM The incidence of type 1 diabetes is increasing, and more people are going to live many years with the disease. Quality of life might become the most challenging long-term complication. The JUBILE study describes the quality of life of people living with type 1 diabetes for more than 40 years. METHODS Patients were recruited from 35 French regional or university hospitals: patients and physicians completed questionnaires, validated by the Delphi method. From 1200 questionnaires circulated, 808 patients and their physicians returned questionnaires. RESULTS The duration of type 1 diabetes was 49 ± 6 years (mean±SD), age at diagnosis 15 ± 10 years, HbA1c 7.4 ± 0.9% [58 ± 10 mmol/mol] and 52% were men. Macrovascular disease was present in 32%, 46% had no or only mild non proliferative retinopathy. Insulin pumps were used by 25% and insulin pen/syringe users injected 3.9 ± 2.1 times per day. Blood glucose was self monitored at least five times per day by 67% of patients. Men had 1.8 ± 1.2 children, women 1.4 ± 1.0. More than half (55%) of this population was working, 38% had a university degree. Patients still had a busy life, going out (59%), eating out (82%), playing sports (38%) and travelling (66%). No differences appeared based on age, duration of diabetes, demography or social features. CONCLUSIONS Living a long and pleasant life is possible with type 1 diabetes. Diabetes does not prevent people from having children, working at highly qualified jobs, travelling abroad: a message of hope that is comforting for patients, their family, relatives and the medical teams.
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Affiliation(s)
- Jean‐Jacques Altman
- Service de Diabétologie‐Nutrition‐EndocrinologieAssistance Publique‐Hôpitaux de ParisHôpital Européen Georges Pompidou et Université Paris‐DescartesParisFrance
| | - Ralph Niarra
- Service d’Epidémiologie CliniqueAssistance Publique‐Hôpitaux de ParisHôpital Européen Georges Pompidou et Université Paris‐DescartesParisFrance
| | - Beverley Balkau
- Clinical EpidemiologyUniversity Paris SaclayUVSQCESPVillejuifInsermFrance
| | - Christophe Vincent‐Cassy
- Service des urgences adultesAssistance Publique‐Hôpitaux de ParisHôpital Kremlin Bicêtre and Université Paris‐SaclayParisFrance
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Hogervorst S, Adriaanse MC, Hugtenburg JG, Bot M, Speight J, Pouwer F, Nefs G. Medication Intake, Perceived Barriers, and Their Correlates Among Adults With Type 1 and Type 2 Diabetes: Results From Diabetes MILES – The Netherlands. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:645609. [PMID: 36994341 PMCID: PMC10012124 DOI: 10.3389/fcdhc.2021.645609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/24/2021] [Indexed: 11/13/2022]
Abstract
PurposeThe purpose of this study is to investigate medication intake, perceived barriers and their correlates in adults with type 1 or type 2 diabetes.MethodsIn this cross-sectional study, 3,383 Dutch adults with diabetes (42% type 1; 58% type 2) completed the 12-item ‘Adherence Starts with Knowledge’ questionnaire (ASK-12; total score range: 12-60) and reported socio-demographics, clinical and psychological characteristics and health behaviors. Univariable and multivariable logistic regression analyses were used.ResultsAdults with type 1 diabetes had a slightly lower mean ASK-12 score (i.e. more optimal medication intake and fewer perceived barriers) than adults with non-insulin-treated type 2 diabetes. After adjustment for covariates, correlates with suboptimal intake and barriers were fewer severe hypoglycemic events and more depressive symptoms and diabetes-specific distress. In type 2 diabetes, correlates were longer diabetes duration, more depressive symptoms and diabetes-specific distress.ConclusionsAdults with type 1 diabetes showed slightly more optimal medication intake and fewer perceived barriers than adults with non-insulin treated type 2 diabetes. Correlates differed only slightly between diabetes types. The strong association with depressive symptoms and diabetes-specific distress in both diabetes types warrants attention, as improving these outcomes in some people with diabetes might indirectly improve medication intake.
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Affiliation(s)
- Stijn Hogervorst
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam University Medical Centre, Amsterdam, Netherlands
- *Correspondence: Stijn Hogervorst, , orcid.org/0000-0001-9276-2675
| | - Marce C. Adriaanse
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Jacqueline G. Hugtenburg
- Amsterdam Public Health Research Institute (APH), Amsterdam University Medical Centre, Amsterdam, Netherlands
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres (UMC), Amsterdam, Netherlands
| | - Mariska Bot
- Department of Psychiatry and the Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Frans Pouwer
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense (SDCO), Odense, Denmark
| | - Giesje Nefs
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults With Type 1 Diabetes, Rotterdam, Netherlands
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Agarwal D, Udeh B, Campbell J, Bena J, Rachitskaya A. Follow-Up Appointment Delay in Diabetic Macular Edema Patients. Ophthalmic Surg Lasers Imaging Retina 2021; 52:200-206. [PMID: 34039185 DOI: 10.3928/23258160-20210330-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate a novel measure of compliance, follow-up appointment delay, and assess its relationship with clinical and sociodemographic factors in patients undergoing treatment for diabetic macular edema (DME). PATIENTS AND METHODS This is a comparative case series of patients treated for DME. The novel measure of compliance - the time in days from the intended day of return and actual day of return, or follow-up appointment delay - was studied and compared to a traditional measure: the percentage of visits missed. These were correlated with clinical and sociodemographic characteristics: best-corrected visual acuity, hemoglobin A1C percent (HbA1c), median household income, smoking status, type of insurance held, marital status, gender, and age. Univariate and multivariable analyses were conducted. RESULTS One hundred fifty-five patients (212 eyes) were included in the study. The median times between recommended and actual appointments was 5.0 days (range: 2.0-14.0 days). The mean percentage of visits missed was 31.7% (± 13.3%). The two measures of compliance were positively associated, but the correlation was moderate (r = 0.44). Non-white race, lack of bilateral injections, and higher baseline HBA1c were significant predictors of a median time greater than 7 days between the intended and actual follow-up dates. CONCLUSIONS The current study identified a novel method of measuring compliance of DME patients seen by retina specialists and has identified non-white race, lack for bilateral treatment, and poorer glycemic control as risk factors for noncompliance. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:200-206.].
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Brewster S, Bartholomew J, Holt RIG, Price H. Non-attendance at diabetes outpatient appointments: a systematic review. Diabet Med 2020; 37:1427-1442. [PMID: 31968127 DOI: 10.1111/dme.14241] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-attendance at diabetes outpatient appointments is a sizeable problem worldwide and has been associated with suboptimal health outcomes. We aimed to describe the characteristics, health outcomes and reasons given for non-attendance at doctor- or nurse-led diabetes appointments, and interventions to improve attendance. METHODS PubMed, EMBASE, CINAHL and PsychInfo were searched from database inception to February 2019. Included articles were peer-reviewed, published in English, related to adults or young people with type 1 or type 2 diabetes, and addressed one of the above aspects of non-attendance. Studies were excluded if reporting on other types of diabetes or reviewing attendance at structured education, retinal screening, paediatric, antenatal, podiatry or dietetic clinics. RESULTS Thirty-four studies of varied designs were identified (15 observational, 1 randomized control trial, 9 qualitative, 5 surveys, 4 service improvements). The definition of non-attendance varied. Younger adults, smokers and those with financial pressures were less likely to attend. Non-attendance was associated with higher HbA1c ; other outcomes were varied but typically worse in non-attenders. Reasons for non-attendance in qualitative studies fell into three categories: balancing the costs and benefits of attendance, coping strategies, and the relationships between the person with diabetes and healthcare professionals. Interventions included appointment management strategies, service improvements, patient navigators and WebCam appointments. CONCLUSIONS Non-attendance is only partially explained by logistical issues. Qualitative studies suggest complex psychosocial factors are involved. Interventions have progressed from simple appointment reminders in an attempt to address some of the psycho-social determinants, but more work is needed to improve attendance.
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Affiliation(s)
- S Brewster
- Research and Development Tom Rudd Unit, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, UK
| | - J Bartholomew
- CRN Wessex, NIHR Clinical Research Network (CRN), University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - H Price
- Research and Development Tom Rudd Unit, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, UK
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15
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Steyl T. Satisfaction with quality of healthcare at primary healthcare settings: Perspectives of patients with type 2 diabetes mellitus. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1321. [PMID: 32285017 PMCID: PMC7136797 DOI: 10.4102/sajp.v76i1.1321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 10/02/2019] [Indexed: 11/01/2022] Open
Abstract
Background Measuring client satisfaction is part of the quality assurance process and has become an integral part of healthcare management strategies globally. It is essential for improvement of amenities in healthcare facilities. Objectives The aim of this study was to assess patients with type 2 diabetes' satisfaction with healthcare services at primary healthcare settings in the Cape Metropolitan district, Western Cape, South Africa. Methods This cross-sectional study used proportionate stratified random sampling. The Patient Survey for Quality of Care scale was used to assess patients with type 2 diabetes' satisfaction with quality of care received. Descriptive and inferential statistics were employed in the analysis of the quantitative data. The open-ended question was analysed qualitatively. Results The majority of patients were satisfied with the overall quality of care. Dissatisfaction was reported for waiting time to get appointments at the clinic, to see a healthcare professional on the same day and clarity of instructions for managing their diabetes. Conclusion Employing more staff in the multidisciplinary team and improving health information by developing staff through continuous education could foster more positive experiences and provide care that contributes to the well-being of patients. Clinical implications Addressing patients' views regarding quality of healthcare services could assist in overall improvement of healthcare provision through the rectification of the system weaknesses. Satisfaction with quality of care could positively affect adherence to treatment protocols that could lead to better quality of life of patients with type 2 diabetes.
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Affiliation(s)
- Tania Steyl
- Department of Physiotherapy, University of the Western Cape, Cape Town, South Africa
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16
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Khokhar B, Quan H, Kaplan GG, Butalia S, Rabi D. Exploring novel diabetes surveillance methods: a comparison of administrative, laboratory and pharmacy data case definitions using THIN. J Public Health (Oxf) 2019; 40:652-658. [PMID: 28977382 DOI: 10.1093/pubmed/fdx096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Indexed: 01/17/2023] Open
Abstract
Background The objective of this study was to identify patients with diabetes in a comprehensive primary care electronic medical records database using a number of different case definitions (clinical, pharmacy, laboratory definitions and a combination thereof) and understand the differences in patient populations being captured by each definition. Methods Data for this population-based retrospective cohort study was obtained from The Health Information Network (THIN). THIN is a longitudinal, primary care medical records database of over 9 million patients in UK. Primary outcome was a diagnosis of diabetes, defined by the presence of a diabetes read code, or an abnormal laboratory result, or a prescription for an Oral Anti-diabetic drug or insulin. A 2-year washout period was applied prior to the index of diabetes to avoid inclusion of prevalent cases for each case definition. Results This study demonstrated that different case definitions of diabetes identify different sub-populations of patients. When the cohorts were observed based on any measure of central tendency, each of the cohorts were reasonably comparable to each other. However, the distribution of each of the cohorts when grouped by age categories and sex, reveal differences. For example, using pharmacy case definition results in a bimodal distribution among women, one between 1-19 year and 35-39 age categories, and then again between 60-64 and 85 years-however, the histogram becomes more normally distributed when metformin was removed from the case definition. Conclusion Our results suggest that clinical, pharmacy, laboratory case definitions identify different sub-populations and using multiple case definitions is likely required to optimally identify the entire diabetes population within THIN. Our study also suggests that age and sex of patients may affect the indexing of diabetes in THIN and is critical to better understand these variations.
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Affiliation(s)
- Bushra Khokhar
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Sonia Butalia
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,Division of Endocrinology, Department of Medicine, 1820 Richmond Road SW, Calgary, Alberta, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,Division of Endocrinology, Department of Medicine, 1820 Richmond Road SW, Calgary, Alberta, Canada
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17
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Lange-Asschenfeldt C. [Psychiatric pharmacotherapy of older individuals with severe mental illness]. Z Gerontol Geriatr 2018; 51:770-778. [PMID: 30302537 DOI: 10.1007/s00391-018-1455-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chronic schizophrenia, depression, and bipolar disorders, among other chronic psychiatric disorders with onset at youth or early adulthood are often referred to as severe mental illness (SMI). Aging with SMI is associated with various psychosocial, physiological, and medical problems with potential impact on psychiatric pharmacotherapy. OBJECTIVES Determination and discussion of problems and special features of the psychopharmacological treatment of older persons with SMI and presentation of treatment recommendations for the distinct diagnoses. MATERIALS AND METHODS International literature and guidelines were searched. In addition, the basic literature and expert opinions are discussed. RESULTS General problems that influence the psychiatric pharmacotherapy of older persons with SMI include nonadherence, nonresponse, polypharmacy, and distinct pharmacokinetic changes with aging and somatic comorbidity. Psychotropic drugs may exhibit cardiovascular, metabolic, and neuropsychiatric risks, among others. The literature regarding effectiveness of psychotropic drugs, drug groups, or combination of drugs in older patients with SMI is scarce to nonexistent. CONCLUSIONS Drug treatment of older persons with SMI should be part of an overall treatment plan that also has to include social and psychotherapeutic components that address the specific problems of this population. Most importantly, psychiatric pharmacotherapy should consider these risks and the treatment should be tailored to a patient's individual risk profile. Due to a general lack of evidence in this special population, treatment strategies of standard guidelines should be adjusted with special consideration to physiological changes of age.
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Affiliation(s)
- Christian Lange-Asschenfeldt
- Abteilung Gerontopsychiatrie, Klinik und Poliklinik für Psychiatrie und Psychotherapie, LVR-Klinikum, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Deutschland.
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18
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Kulzer B, Daenschel W, Daenschel I, Schramm W, Messinger D, Weissmann J, Vesper I, Parkin CG, Heinemann L. Integrated personalized diabetes management improves glycemic control in patients with insulin-treated type 2 diabetes: Results of the PDM-ProValue study program. Diabetes Res Clin Pract 2018; 144:200-212. [PMID: 30205184 DOI: 10.1016/j.diabres.2018.09.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 01/18/2023]
Abstract
AIMS Globally, many patients with insulin-treated type-2 diabetes are suboptimally controlled. The PDM-ProValue study program evaluated whether integrated personalized diabetes management (iPDM) has the potential to improve clinical outcomes. METHODS 101 practices with 907 patients participated in the 12-month, prospective, controlled, cluster-randomized study program. HbA1c levels, therapy changes, frequency of hypoglycemic episodes, patient reported outcomes, and physician satisfaction were assessed. RESULTS iPDM led to a greater reduction in HbA1c after 12 months vs. usual care (-0.5%, p < 0.0001 vs. -0.3%, p < 0.0001), (Diff. 0.2%, p = 0.0324). Most of the HbA1c reduction occurred after 3 months and remained stable thereafter. The percentage of patients with therapy adjustments was higher in the iPDM group at all visits (p < 0.01 at week 3, month 3, month 6). Patient adherence at month 12 was higher in the iPDM group compared to baseline (Odds ratio = 2.39; p = 0.0003); also, patient treatment satisfaction (DTSQc: 12.2 vs. 10.4, δ = 1.78, p = 0.004; DTSQs: 31.0 vs. 30.0, δ = 0.924, p = 0.02), and physician satisfaction was higher in the intervention group. CONCLUSIONS iPDM improved the use of diagnostic data leading to better glycemic control, more timely treatment adjustments (indicating reduced clinical inertia), and increased patient adherence and treatment satisfaction among patients and physicians.
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Affiliation(s)
- Bernhard Kulzer
- Forschungsinstitut Diabetes Akademie Bad Mergentheim, Theodor-Klotzbücher-Straße 12, D-97980 Bad Mergentheim, Germany.
| | - Wilfried Daenschel
- Medizinisches Versorgungszentrum am Küchwald GmbH, Bürgerstr. 2, D-9113 Chemnitz, Germany.
| | - Ingrid Daenschel
- Medizinisches Versorgungszentrum am Küchwald GmbH, Bürgerstr. 2, D-9113 Chemnitz, Germany; Hausarztpraxis, Karl-Marx-Str. 15-17, D-09328 Lunzenau, Germany.
| | - Wendelin Schramm
- GECKO Institute for Medicine, Informatics and Economics, Heilbronn University, Max-Planck Str. 39, D-74081 Heilbronn, Germany.
| | - Diethelm Messinger
- Biometrics Department, Prometris GmbH, Soldnerstrasse 1, D-68219 Mannheim, Germany.
| | - Joerg Weissmann
- Roche Diabetes Care GmbH, Sandhofer Straße 116, D-68305 Mannheim, Germany.
| | - Iris Vesper
- Roche Diabetes Care GmbH, Sandhofer Straße 116, D-68305 Mannheim, Germany.
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Heinemann L, Parkin CG. Rethinking the Viability and Utility of Inhaled Insulin in Clinical Practice. J Diabetes Res 2018; 2018:4568903. [PMID: 29707584 PMCID: PMC5863311 DOI: 10.1155/2018/4568903] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/21/2017] [Accepted: 01/23/2018] [Indexed: 01/01/2023] Open
Abstract
Despite considerable advances in pharmacotherapy and self-monitoring technologies in the last decades, a large percentage of adults with diabetes remain unsuccessful in achieving optimal glucose due to suboptimal medication adherence. Contributors to suboptimal adherence to insulin treatment include pain, inconvenience, and regimen complexity; however, a key driver is hypoglycemia. Improvements in the PK/PD characteristics of today's SC insulins provide more physiologic coverage of basal and prandial insulin requirements than regular human insulin; however, they do not achieve the rapid on/rapid off characteristics of endogenously secreted insulin seen in healthy, nondiabetic individuals. Pulmonary administration of prandial insulin represents an attractive option that overcomes limitations of SC insulin by providing more a rapid onset of action and a faster return of action to baseline levels than SC administration of rapid-acting insulin analogs. This article reviews the unique PK/PD properties of a novel inhaled formulation that support its use in patient populations with T1D or T2D.
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20
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Mora P, Buskirk A, Lyden M, Parkin CG, Borsa L, Petersen B. Use of a Novel, Remotely Connected Diabetes Management System Is Associated with Increased Treatment Satisfaction, Reduced Diabetes Distress, and Improved Glycemic Control in Individuals with Insulin-Treated Diabetes: First Results from the Personal Diabetes Management Study. Diabetes Technol Ther 2017; 19:715-722. [PMID: 29027812 PMCID: PMC5734194 DOI: 10.1089/dia.2017.0206] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND The ability to automatically transfer data to clinicians and receive timely guidance in therapy adjustments through remote and in-office consults can positively impact patients' perceptions about quality of care, which is positively associated with clinical outcomes. We assessed the impact of using the Accu-Chek Connect diabetes management system on treatment satisfaction, diabetes distress, and glycemic control in adults with type 1 diabetes and insulin-treated type 2 diabetes. SUBJECTS AND METHODS This 6-month, prospective, multicenter, single-arm study assessed the impact of using the system on treatment satisfaction and glycemic control among 87 adults with insulin-treated diabetes (multiple daily insulin injections and basal only), with 8.8% ± 1.6% glycated hemoglobin (HbA1c) at baseline. The Diabetes Treatment Satisfaction Questionnaire-status (DTSQs) and Diabetes Distress Scale (DDS) were administered at baseline, and the Diabetes Treatment Satisfaction Questionnaire-change (DTSQc) and DDS at 6 months. Changes in HbA1c, average blood glucose (BG), and other metrics were also assessed. RESULTS Improvements in DTSQc scores were observed at 6 months with a total mean (standard deviation) score of 14.3 ± 5.1. Significant reductions in total mean DDS scores from baseline to 6 months were also observed, from 2.0 ± 0.8 to 1.7 ± 0.7, P < 0.0001. A significant reduction in regimen-related distress was notable, from "moderate distress" (2.4 ± 1.0) to "not distressed" (1.9 ± 0.9), P < 0.0001). Significant reductions in mean HbA1c (-0.9 ± 1.6, P < 0.0001) and mean BG (-24.8 ± 50.8, P < 0.0001) were observed. CONCLUSIONS Use of the Accu-Chek Connect diabetes management system is associated with increased treatment satisfaction and improved glycemic control among individuals with insulin-treated diabetes. NCT02600845 ( www.clinicaltrials.gov ).
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Affiliation(s)
- Pablo Mora
- Dallas Diabetes Research Center, Dallas, Texas
| | | | | | | | - Lena Borsa
- Roche Diabetes Care, Indianapolis, Indiana
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21
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Marshall K, Martin H, Siarkowski Amer K. Exploring Perceptions about Insulin Dependent Diabetes Mellitus in Adolescent Patients and Peers. Compr Child Adolesc Nurs 2017; 41:25-41. [PMID: 29474802 DOI: 10.1080/24694193.2017.1316788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Friends can provide encouragement and support during stressful times. Friends are even more important for children coping with chronic illness such as adolescents managing insulin dependent diabetes mellitus (IDDM). Nurses need to recognize that the knowledge and care of both the children coping with diabetes and friends can be critical. This study explored perceptions of adolescents managing diabetes and their peers. The non-affected peers and adolescents with IDDM ranged in age between 15-18 were studied using an exploratory qualitative method. A sample of 6 subjects, 2 with diabetes and 4 peers, were interviewed. Subjects with IDDM reported manageable stress but frustration with friends' lack of knowledge. The peers reported different views of managing diabetes than those with IDDM. Adolescents with IDDM also reported positive family support. The study revealed that peers need additional education on the illness. In summary, adolescents coping with diabetes had overall positive perceptions and accurate knowledge, but limited support from peers.
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Affiliation(s)
| | - Halley Martin
- a School of Nursing, DePaul University , Chicago , Illinois , USA
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Mendel A, Chow S. Impact of health portal enrolment with email reminders at an academic rheumatology clinic. BMJ QUALITY IMPROVEMENT REPORTS 2017; 6:bmjquality_uu214811.w5926. [PMID: 28321302 PMCID: PMC5348589 DOI: 10.1136/bmjquality.u214811.w5926] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/23/2016] [Indexed: 11/12/2022]
Abstract
Missed appointments reduce the quality, safety and efficiency of healthcare delivery. ‘No-Shows’ (NS) have been identified as a problem within the rheumatology clinic at Sunnybrook Health Sciences Center in Toronto, Ontario. NS were studied through a prospective chart review and telephone interviews. Over 6 months, 110 NS took place (rate 2.5-6.8%). From interviews, 85% of NS were attributed to forgetting, being unaware of the appointment, having the wrong date, or another miscommunication. Fifty-seven percent of patients were interested in an appointment reminder, including electronic reminders (46%). Patients were encouraged to enroll in the hospital's electronic patient portal, MyChart, and email reminders were implemented at one clinic for portal users. A detailed follow-up card was also given to patients. Process measures included portal enrolment, email reminder receipt, and call volumes. Outcome measures were NS and patient and staff satisfaction. During the intervention, 120/274 (44%) surveyed patients had MyChart accounts. Of these, 73 (61%) received the e-mail reminder and 72 (99%) found the e-mail helpful. Twenty-two patients knew about their appointment from the e-mail reminder alone. Improvement in attendance was seen after 3.5 months, but it was not sustained thereafter. Prior to this intervention there was no appointment reminder system at this clinic, and the email reminder demonstrated high patient satisfaction. Low portal enrolment, technical difficulties, and the inability of the intervention to reach new patients were possible reasons why the intervention was unsuccessful at reducing NS.
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Affiliation(s)
- Arielle Mendel
- Division of rheumatology, Sunnybrook Health Sciences Center, Canada
| | - Shirley Chow
- Division of rheumatology, Sunnybrook Health Sciences Center, Canada
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23
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Association between copayment, medication adherence and outcomes in the management of patients with diabetes and heart failure. Health Policy 2017; 121:363-377. [PMID: 28314467 DOI: 10.1016/j.healthpol.2017.02.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine the association between copayment, medication adherence and outcomes in patients with Heart failure (HF) and Diabetes Mellitus (DM). METHODS PubMed, Scopus and Cochrane databases were searched using combinations of four sets of key words for: drug cost sharing; resource use, health and economic outcomes; medication adherence; and chronic disease. RESULTS Thirty eight studies were included in the review. Concerning the direct effect of copayment changes on outcomes, the scarcity and diversity of data, does not allow us to reach a clear conclusion, although there is some evidence indicating that higher copayments may result in poorer health and economic outcomes. Seven and one studies evaluating the relationship between copayment and medication adherence in DM and HF population, respectively, demonstrated an inverse statistically significant association. All studies (29) examining the relationship between medication adherence and outcomes, revealed that increased adherence is associated with health benefits in both DM and HF patients. Finally, the majority of studies in both populations, showed that medication adherence was related to lower resource utilization which in turn may lead to lower total healthcare cost. CONCLUSION The results of our systematic review imply that lower copayments may result in higher medication adherence, which in turn may lead to better health outcomes and lower total healthcare expenses. Future studies are recommended to reinforce these findings.
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Liguori Y, Murase K, Hamamura M. Differences between patient and physician opinions on adherence to medication for hypertension and diabetes mellitus. Curr Med Res Opin 2016; 32:1539-45. [PMID: 27167015 DOI: 10.1080/03007995.2016.1189408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Non-adherence to prescribed medication presents a barrier to effective treatment. In order to find improved ways of tackling non-adherence, it is important to understand the perspective of both patients and physicians. METHOD A web-based survey study was performed to obtain the views and opinions of patients receiving medical treatment for hypertension or diabetes mellitus in Japan, and physicians treating such patients, on adherence to medication. RESULTS Forty-four percent of both physicians and patients placed great importance on medication adherence, but 11% of patients considered it of low importance. Overall, 85% of patients reported taking their medication correctly. Patients missed a mean of 4.8 or 5.4 daily doses per 30 day prescription based on patient and physician estimates, respectively. Both patients (64%) and physicians (23%) considered the main reason patients forgot to take their medication was that they "inadvertently forgot". Only 1% of physicians said they do not specifically check for residual drugs, but 46% of patients said they do not report missed doses to their doctor. Measures taken by physicians to reduce residual drugs included use of single packs (64%) and reductions in administration frequency (55%); 63% adjusted prescriptions to take account of any remaining drugs. Only 4% of physicians were satisfied with the effectiveness of measures to reduce non-adherence, whereas 59% of patients felt they managed to successfully perform measures to avoid forgetting to take drugs. LIMITATION The study questionnaires were newly developed and did not incorporate validated instruments to assess adherence. CONCLUSION Similar proportions of physicians and patients consider medication adherence to be important, but their opinions about measures used to improve adherence differ to some extent. Importantly, almost half of patients do not tell their doctor about missed doses.
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Affiliation(s)
- Yuji Liguori
- a Japan Strategy & Business Development , Takeda Pharmaceutical Company Limited , Tokyo , Japan
| | - Katsuhito Murase
- a Japan Strategy & Business Development , Takeda Pharmaceutical Company Limited , Tokyo , Japan
| | - Misako Hamamura
- a Japan Strategy & Business Development , Takeda Pharmaceutical Company Limited , Tokyo , Japan
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25
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Weber DR, Haynes K, Leonard MB, Willi SM, Denburg MR. Type 1 diabetes is associated with an increased risk of fracture across the life span: a population-based cohort study using The Health Improvement Network (THIN). Diabetes Care 2015; 38. [PMID: 26216874 PMCID: PMC4580610 DOI: 10.2337/dc15-0783] [Citation(s) in RCA: 174] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study was conducted to determine if type 1 diabetes is associated with an increased risk of fracture across the life span. RESEARCH DESIGN AND METHODS This population-based cohort study used data from The Health Improvement Network (THIN) in the U.K. (data from 1994 to 2012), in which 30,394 participants aged 0-89 years with type 1 diabetes were compared with 303,872 randomly selected age-, sex-, and practice-matched participants without diabetes. Cox regression analysis was used to determine hazard ratios (HRs) for incident fracture in participants with type 1 diabetes. RESULTS A total of 334,266 participants, median age 34 years, were monitored for 1.9 million person-years. HR were lowest in males and females age <20 years, with HR 1.14 (95% CI 1.01-1.29) and 1.35 (95% CI 1.12-1.63), respectively. Risk was highest in men 60-69 years (HR 2.18 [95% CI 1.79-2.65]), and in women 40-49 years (HR 2.03 [95% CI 1.73-2.39]). Lower extremity fractures comprised a higher proportion of incident fractures in participants with versus those without type 1 diabetes (31.1% vs. 25.1% in males, 39.3% vs. 32% in females; P < 0.001). Secondary analyses for incident hip fractures identified the highest HR of 5.64 (95% CI 3.55-8.97) in men 60-69 years and the highest HR of 5.63 (95% CI 2.25-14.11) in women 30-39 years. CONCLUSIONS Type 1 diabetes was associated with increased risk of incident fracture that began in childhood and extended across the life span. Participants with type 1 diabetes sustained a disproportionately greater number of lower extremity fractures. These findings have important public health implications, given the increasing prevalence of type 1 diabetes and the morbidity and mortality associated with hip fractures.
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Affiliation(s)
- David R Weber
- Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Kevin Haynes
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Steven M Willi
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Michelle R Denburg
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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26
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Balkhi AM, Reid AM, Westen SC, Olsen B, Janicke DM, Geffken GR. Telehealth interventions to reduce management complications in type 1 diabetes: A review. World J Diabetes 2015; 6:371-379. [PMID: 25897348 PMCID: PMC4398894 DOI: 10.4239/wjd.v6.i3.371] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/20/2014] [Accepted: 01/20/2015] [Indexed: 02/05/2023] Open
Abstract
Type 1 diabetes is a chronic illness with a high burden of care. While effective interventions and recommendations for diabetes care exist, the intensive nature of diabetes management makes compliance difficult. This is especially true in children and adolescents as they have unique psychosocial and diabetes needs. Despite the development of effective in-person interventions targeting improving self-management and ameliorating psychosocial difficulties there are still a number of barriers to implementing these interventions, namely time, cost, and access. Telehealth interventions allow for the dissemination of these interventions to a broader audience. Self-management and psychosocial telehealth interventions are reviewed with a special emphasis on mobile phone and internet based technology use. While efficacy has been demonstrated in a number of telehealth interventions with improved cost effectiveness over in-person interventions, many challenges remain including high participant attrition and difficulties with receiving reimbursement for services rendered. These and other challenges are discussed with recommendations for researchers and telehealth providers provided.
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27
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Anderson A, Davis J. Electrochemical Actuators: Controlled Drug Release Strategies for use in Micro Devices. ELECTROANAL 2015. [DOI: 10.1002/elan.201400643] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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28
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Casey R, O'Hara MC, Cunningham A, Wall D, Geoghegan R, Hynes L, McGuire B, Gately M, Bell M, Dinneen SF. Young adult type 1 diabetes care in the West of Ireland: an audit of hospital practice. QJM 2014; 107:903-8. [PMID: 24925824 DOI: 10.1093/qjmed/hcu103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is well recognised that management of young adults with type 1 diabetes (T1DM) poses difficult challenges for physicians and health care organisations as a whole. In Ireland and in particular the west of Ireland there has been little audit or research on young adults with T1DM and the services available to them. DESIGN In 2011 a retrospective review of this patient population in our territory referral centre was carried out. RESULTS The average glycaemic control in this population was poor at 81mmols/mol and diabetes related complications were present in 32%. Engagement by this population with services was poor with an average of 3 missed clinic appointments over a 24 month period. CONCLUSION These results have prompted a re think of how health care professionals can deliver a service that better suits the needs of this challenging patient group.
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Affiliation(s)
- R Casey
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - M C O'Hara
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - A Cunningham
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - D Wall
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - R Geoghegan
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - L Hynes
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - B McGuire
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - M Gately
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - M Bell
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - S F Dinneen
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
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Abstract
Cardiovascular disease (CVD) remains the leading cause of death among adults with diabetes, and CVD prevention remains a major challenge. Coronary artery calcium (CAC) score measured by electron beam tomography (EBT) or multi-slice detector computed tomography correlates closely with plaque burden and coronary angiography, and predicts coronary events independently of other risk factors. Further, progression of CAC over several years has been shown to predict increased mortality. Coronary calcification is an active process strongly associated with atherosclerotic plaque evolution and is an accepted surrogate endpoint in studies of patients with diabetes older than 30. In this review, recent findings regarding the mechanisms and implications of vascular calcification in diabetes will be discussed.
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Affiliation(s)
- Janet K Snell-Bergeon
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, Mail Stop A140, Aurora, CO 80045, USA.
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30
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Jansà M, Vidal M, Giménez M, Conget I, Galindo M, Roca D, Colungo C, Esmatjes E, Salamero M. Psychometric analysis of the Spanish and Catalan versions of the Diabetes Self-Care inventory-revised version questionnaire. Patient Prefer Adherence 2013; 7:997-1005. [PMID: 24124352 PMCID: PMC3794847 DOI: 10.2147/ppa.s50271] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this study was to validate the Spanish and Catalan versions of the Diabetes Self-Care Inventory-Revised Version (SCI-R) questionnaire to assess the degree of adherence to self-care among adults with diabetes. METHODS We validated the Spanish and Catalan translation from, and back translation to, English and cultural adaptation of the SCI-R in type 1 diabetes patients on multiple insulin doses or continuous subcutaneous insulin infusion and in type 2 diabetes patients on oral agents and/or insulin. Internal reliability, structural validity, and external validity (correlation with glycated hemoglobin) were evaluated. Responsiveness to change was assessed in patients 1 year after onset of type 1 diabetes and following a structured education program. RESULTS The SCI-R presented good internal reliability Cronbach's α: 0.75, test-retest reliability (r = 0.82) and structural validity (r > 0.40). The external validity was also good; the SCI-R correlated with HbA1c in patients with type 1 diabetes on multiple insulin doses (r = -0.50) or continuous subcutaneous insulin infusion (r = -0.66) and in patients with type 2 diabetes on multiple insulin doses (r = -0.62). However, it was not satisfactory in patients on oral agents (r = -0.20) and/or bedtime insulin (r = -0.35). Responsiveness to change was analyzed in 54 patients (age 27.3±7.4 years, 26% men, HbA1c 6.8% ±1.1%); the SCI-R score was 72.3% ±13.7% and correlated negatively with glycated hemoglobin (r = -0.42) and 3 scales of the Diabetes Quality of Life questionnaire (lower score indicating better perception): Impact (r = -0.37), Social Worry (r = -0.36) and Diabetes Worry (r = -0.38), all at P < 0.05. CONCLUSION The Spanish and Catalan versions of the SCI-R questionnaire show good psychometric properties and both could be considered as useful tools for evaluating self-care behavior in patients with type 1 or type 2 diabetes. However, there are still some subgroups of patients with type 2 diabetes in which the validity of this questionnaire needs further evaluation.
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Affiliation(s)
- Margarida Jansà
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
- Correspondence: Margarida Jansà, Diabetes Unit, Endocrinology and nutrition, Institut Clinic de Malalties Digestives i Metabòliques Hospital Clinic, 170 Villarroel St, 08036 Barcelona, Spain, Tel +34 93 227 9846, Fax +34 93 451 6638, Email
| | - Mercè Vidal
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | - Mercedes Galindo
- Endocrinology and nutrition Department, Hospital Clinico, Madrid, Spain
| | - Daria Roca
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | | | - Enric Esmatjes
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | - Manel Salamero
- Psychology Department, Hospital Clinic, Barcelona, Spain
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