2019 Diabetes Atlas: Achievements and challenges in diabetes care in Taiwan

Real-World Effectiveness of the Gla-300 + Cap + App Program in Adult Users Living with Type 2 Diabetes in Taiwan

INTRODUCTION

Health2Sync (H2S) is a digital health technology platform that provides coaching and titration support to patients with diabetes. The Mallya cap converts a conventional insulin pen into a smart connected device that can automatically synchronize dose values and associated timestamps (upon injection) to the H2S platform. This single-arm real-world study evaluated the effectiveness of insulin glargine 300 U/mL (Gla-300) combined with H2S and Mallya cap (Gla-300 + Cap + App program) on clinical outcomes among users with type 2 diabetes (T2D) in Taiwan.

METHODS

Adults (aged ≥ 20 years) with T2D who were registered H2S users and initiated Mallya cap for a new/existing Gla-300 regimen (identification period May 1, 2021-May 31, 2022) were included in this retrospective cohort study. Follow-up data from H2S were collected for 90 days. Glycated hemoglobin (HbA1c) change (baseline to follow-up) and HbA1c goal attainment were primary outcomes. Hypoglycemia incidence and usage metrics of Mallya cap were secondary outcomes.

RESULTS

Of 83 participants, 38.6% were new Gla-300 users. HbA1c was reduced in both new (- 2.4 [2.7] %, - 26.2 [29.5] mmol/mol) and previous Gla-300 users (- 0.5 [1.6] %, - 5.5 [17.5] mmol/mol). Reduction in HbA1c was significant (p < 0.05) in both groups. At follow-up, 43.4% of users had a reduction of > 0.5%. Mean HbA1c reductions increased numerically with higher baseline HbA1c and with longer duration of Mallya cap usage.

CONCLUSIONS

Use of digital technology within a connected ecosystem such as Gla-300 + Cap + App program could help people with type 2 diabetes to improve their glycemic condition.

Soluble tumor necrosis factor receptor type 1 is an alternative marker of urinary albumin-creatinine ratio and estimated glomerular filtration rate for predicting the decline of renal function in subjects with type 2 diabetes mellitus

BACKGROUND

Urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rates (eGFR) help predict worsening diabetic kidney disease (DKD) but have their limitations. Soluble tumor necrosis factor receptor type 1 (sTNFR1) is a biomarker of DKD. The predictive abilities of sTNFR1 and UACR plus eGFR have not been compared.

METHODS

This prospective cohort study included patients with type 2 diabetes (T2D) to identify the risk factors of worsening DKD. Renal events were defined as > 30 % loss in eGFR based on consecutive tests after 6 months. The associations of sTNFR1, UACR, and eGFR levels and the risks of renal events were tested using a Cox regression model and the area under the curve (AUC) was compared between sTNFR1 levels and UACR plus eGFR using receiver-operating characteristic (ROC) analysis. The accuracy of stratification was evaluated using Kaplan-Meier analysis.

RESULTS

Levels of sTNFR1 and UACR were associated with risks of > 30 % decline in eGFR after adjusting for relevant factors. The association between sTNFR1 levels and renal outcomes was independent of UACR and eGFR at baseline. The AUC of sTNFR1 level was comparable with that of combined UACR and eGFR (0.73 vs. 0.71, respectively, p = 0.72) and the results persisted for quartile groups of sTNFR1 and risk categories of Kidney Disease: Improving Global Outcomes (KDIGO) (0.70 vs. 0.71, respectively, p = 0.84). Both stratifications by sTNFR1 levels and KDIGO were accurate.

CONCLUSION

sTNFR1 could be an alternative marker for identifying patients with diabetes at risk of declining renal function.

Bleb-related infection after primary trabeculectomy: medical chart reviews from 1993 to 2021

BACKGROUND

To investigate the incidence of and risk factors for bleb-related infection (BRI) in patients who underwent mitomycin C-augmented primary trabeculectomy.

METHODS

We reviewed the medical charts of consecutive patients who had received primary trabeculectomy in Taipei Veterans General Hospital. We recorded the demographic and clinical characteristics of patients before, during and after surgery. Furthermore, we recorded the time interval between surgery and infection onset, clinical manifestations and visual outcomes of patients with BRI. The cumulative incidence of BRI was estimated using the Kaplan-Meier method. A Cox proportional hazards model was used to explore factors associated with BRI.

RESULTS

In total, 1663 eyes were postoperatively followed up for 94.57±65.23 months. The cumulative incidence of BRI was 1.86 per 1000 person-years during the 28-year follow-up period: 24 (1.44%) patients developed BRI and 6 (0.36%) patients additionally developed endophthalmitis. A multivariate analysis revealed a significant association of BRI with wound manipulation, high myopia and hyperlipidaemia. Patients younger than 60 years were more likely to receive wound manipulation than their elderly counterparts (<0.001). One year after BRI, the best corrected visual acuity of the eyes with blebitis did not change significantly, whereas that of the eyes with endophthalmitis worsened significantly.

CONCLUSION

Risk factors for BRI after trabeculectomy include wound manipulation, high myopia and hyperlipidaemia. Considering myopia is highly prevalent throughout the world and is a risk factor for glaucoma, the lifelong risk of BRI after trabeculectomy in eyes with high myopia warrants the attention of ophthalmologists.

Lasting effects of a brief, scalable diabetes conversation map psychosocial intervention on health beliefs and health behaviors: A large randomized controlled trial in Taiwan

The current study aimed to examine the effects of a conversation map (CM) psychosocial intervention on diet and exercise health beliefs and health behaviors among people with diabetes (PWD). Based on the Health Belief Model, this large-scale randomized controlled trial (N = 615) investigated whether an added 1-h theory-driven CM intervention (N = 308), compared with usual shared-care service only (N = 307), could significantly better improve PWD's diet and exercise health beliefs and health behaviors at 3-month posttest. Multivariate linear autoregression analysis demonstrated that, controlling for baseline, the CM group had significantly better diet (β = .270) and exercise (β = .280) health behaviors at 3-month posttest than the control group. The intervention effects on health behavior change were primarily mediated through desired changes in targeted health beliefs, as informed by the theory. For example, as regards diet, the CM group had significantly greater increases in perceived susceptibility (β = .121), perceived benefits (β = .174), and cues to action (β = .268), as well as greater decreases in perceived barriers (β = -.156), between pretest and 3-month posttest. In conclusion, future diabetes care may integrate brief theory-driven CM interventions, as in this study, into current shared-care practice to help PWD improve diabetes self-management health behaviors more effectively. Implications for practice, policy, theory, and research are discussed.

Participation and Outcomes among Disabled and Non-Disabled People in the Diabetes Pay-for-Performance Program

OBJECTIVES

This study's objectives were to compare the participation rates of people with and without disabilities who had type 2 diabetes in a diabetes pay-for-performance (DM P4P) program, as well as their care outcomes after participation.

METHODS

This was a retrospective cohort study. The data came from the disability registry file, cause of death file, and national health insurance research database of Taiwan. The subjects included patients newly diagnosed with type 2 diabetes between 2001 and 2013 who were followed up with until 2014 and categorized as disabled and non-disabled patients. The propensity score matching method was used to match the disabled with the non-disabled patients at a 1:1 ratio. Conditional logistic regression analysis was used to determine the odds ratio between the disabled and non-disabled patients who joined the P4P program. The Cox hazard model was used to compare the risk of dialysis and death between the disabled and non-disabled patients participating in the P4P program.

RESULTS

There were 110,645 disabled and 110,645 non-disabled individuals after matching. After controlling for confounding factors, it was found that the disabled individuals were significantly less likely (odds ratio = 0.89) to be enrolled in the P4P program than the non-disabled individuals. The risk of dialysis was 1.08 times higher for people with disabilities than those without, regardless of their participation in the P4P program. After enrollment in the P4P program, the risk of death for people with disabilities decreased from 1.32 to 1.16 times that of persons without disabilities. Among the people with disabilities, the risk of death for those enrolled in the P4P program was 0.41 times higher than that of those not enrolled. The risk of death was reduced to a greater extent for people with disabilities than for those without disabilities upon enrollment in the DM P4P program.

CONCLUSION

People with disabilities are less likely to be enrolled in the P4P program in Taiwan and have unequal access to care. However, the P4P program was more effective at reducing mortality among people with disabilities than among those without.

Prevalence and predictive modeling of undiagnosed diabetes and impaired fasting glucose in Taiwan: a Taiwan Biobank study

INTRODUCTION

We investigated the prevalence of undiagnosed diabetes and impaired fasting glucose (IFG) in individuals without known diabetes in Taiwan and developed a risk prediction model for identifying undiagnosed diabetes and IFG.

RESEARCH DESIGN AND METHODS

Using data from a large population-based Taiwan Biobank study linked with the National Health Insurance Research Database, we estimated the standardized prevalence of undiagnosed diabetes and IFG between 2012 and 2020. We used the forward continuation ratio model with the Lasso penalty, modeling undiagnosed diabetes, IFG, and healthy reference group (individuals without diabetes or IFG) as three ordinal outcomes, to identify the risk factors and construct the prediction model. Two models were created: Model 1 predicts undiagnosed diabetes, IFG_110 (ie, fasting glucose between 110 mg/dL and 125 mg/dL), and the healthy reference group, while Model 2 predicts undiagnosed diabetes, IFG_100 (ie, fasting glucose between 100 mg/dL and 125 mg/dL), and the healthy reference group.

RESULTS

The standardized prevalence of undiagnosed diabetes for 2012-2014, 2015-2016, 2017-2018, and 2019-2020 was 1.11%, 0.99%, 1.16%, and 0.99%, respectively. For these periods, the standardized prevalence of IFG_110 and IFG_100 was 4.49%, 3.73%, 4.30%, and 4.66% and 21.0%, 18.26%, 20.16%, and 21.08%, respectively. Significant risk prediction factors were age, body mass index, waist to hip ratio, education level, personal monthly income, betel nut chewing, self-reported hypertension, and family history of diabetes. The area under the curve (AUC) for predicting undiagnosed diabetes in Models 1 and 2 was 80.39% and 77.87%, respectively. The AUC for predicting undiagnosed diabetes or IFG in Models 1 and 2 was 78.25% and 74.39%, respectively.

CONCLUSIONS

Our results showed the changes in the prevalence of undiagnosed diabetes and IFG. The identified risk factors and the prediction models could be helpful in identifying individuals with undiagnosed diabetes or individuals with a high risk of developing diabetes in Taiwan.

Phenome-wide analysis of Taiwan Biobank reveals novel glycemia-related loci and genetic risks for diabetes

To explore the complex genetic architecture of common diseases and traits, we conducted comprehensive PheWAS of ten diseases and 34 quantitative traits in the community-based Taiwan Biobank (TWB). We identified 995 significantly associated loci with 135 novel loci specific to Taiwanese population. Further analyses highlighted the genetic pleiotropy of loci related to complex disease and associated quantitative traits. Extensive analysis on glycaemic phenotypes (T2D, fasting glucose and HbA_1c) was performed and identified 115 significant loci with four novel genetic variants (HACL1, RAD21, ASH1L and GAK). Transcriptomics data also strengthen the relevancy of the findings to metabolic disorders, thus contributing to better understanding of pathogenesis. In addition, genetic risk scores are constructed and validated for absolute risks prediction of T2D in Taiwanese population. In conclusion, our data-driven approach without a priori hypothesis is useful for novel gene discovery and validation on top of disease risk prediction for unique non-European population.

Evaluation of the effects of diabetes self-management education based on 5A model on the quality of life and blood glucose of women with gestational diabetes mellitus: an experimental study in eastern Iran

INTRODUCTION

Gestational diabetes mellitus (GDM) is an important condition during pregnancy. The aim of the current study was to evaluate the effects of self-management education based on 5A model on the quality of life and blood glucose level of women with GDM.

METHODS

This quasi-experimental study was conducted on 54 pregnant women referred to the urban health care centers affiliated to the Gonabad University of Medical Sciences from March 2019 to March 2020 based on purposive sampling method. Participants were randomly allocated into intervention and control groups based on stratified random sampling using permuted block randomization method. The intervention group received self-management education program based on 5A model in five sessions during two months. Demographic data, blood glucose level, and diabetes quality of life (DQOL) questionnaire were collected for each participant. Data analysis was performed using the SPSS software version 16 and the level of statistical significance was set at 0.05.

RESULTS

Mean age of the participants was 33.11 ± 5.35 years old. At the end of the intervention, the mean blood glucose level of the participants in the intervention group was significantly lower compared to the control group (p < 0.001). The quality of life in the intervention group was significantly improved at the end of the intervention compared to the control group (p < 0.001).

CONCLUSIONS

Self-management education based on 5A model can effectively improve quality of life and blood glucose levels in women with GDM.

The Effects of Exercise Habit on Albuminuria and Metabolic Indices in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Background and Objectives: Diabetes mellitus (DM) can cause macrovascular and microvascular complications, potentially resulting in further life-threatening complications. In general, the global prevalence of type 2 DM is increasing. To date, the care of DM comprises three aspects: diet, medication and exercise; among them, exercise is the most economical. Albuminuria is associated with renal injury and the progress of chronic kidney disease (CKD). The effects of habitual exercise in patients with new onset of diabetic kidney disease (DKD) have not been generally recognized. Our aim was to conduct an observational study regarding the effects of regular exercise on proteinuria and associated metabolic indices in patients with newly diagnosed type 2 DM. To investigate the effects of an exercise habit on albuminuria and the metabolic indices including renal function, blood glucose, and plasma lipids among patients with newly diagnosed type 2 DM. Materials and Methods: A cross-sectional study was conducted on newly diagnosed DM patients in two teaching hospitals in Taiwan from 1 June to 31 December 2020. The DM patients participated in the Diabetes Shared Care Network. According to the DM care mode, the patients’ blood biochemical results were analysed. Based on exercise duration, the patients were divided into two groups, i.e., the exercise group (≥150 min per week) and the non-exercise group (<150 min per week). Clinical demographic features and laboratory examination including blood and urine biochemistries were determined. Results: A total of 229 patients including 99 males (43.2%) and 130 females (56.8%) participated in the study. The proportion of DM patients with normoalbuminuria was higher (p < 0.05) in the exercise group (69.8%) than in the non-exercise group (53.7%), and the proportion of DM patients with micro or macroalbuminuria was lower in the exercise group (30.2%) than in the non-exercise group (46.3%). Levels of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), triglycerides (TG) and high-density lipoprotein (HDL) were significantly different in both groups. Compared with the non-exercise group, lower HbA1c (6.89 ± 0.69 vs. 7.16 ± 1.05%) (p < 0.05), lower FPG (121.9 ± 25.7 vs. 140.5 ± 42.4 mg/dL) (p < 0.05), lower TG (115.6 ± 53.6 vs. 150.2 ± 15.4 mg/dL) (p < 0.05), and higher HDL (50.3 ± 11.4 vs. 44.1 ± 9.26 mg/dL) (p < 0.05) levels were noted in the exercise group. Conclusions: Regular exercise remains imperative and may bear an impact on albuminuria, blood glucose, and plasma lipids among type 2 DM patients. Therefore, medical staff and healthcare providers should encourage patients to maintain an exercise duration ≥150 min per week for preventing and controlling DM progression.

A Proposed Multi-Criteria Optimization Approach to Enhance Clinical Outcomes Evaluation for Diabetes Care: A Commentary

There are several challenges in diabetes care management including optimizing the currently used therapies, educating patients on selfmanagement, and improving patient lifestyle and systematic healthcare barriers. The purpose of performing a systems approach to implementation science aided by artificial intelligence techniques in diabetes care is two-fold: 1) to explicate the systems approach to formulate predictive analytics that will simultaneously consider multiple input and output variables to generate an ideal decision-making solution for an optimal outcome; and 2) to incorporate contextual and ecological variations in practicing diabetes care coupled with specific health educational interventions as exogenous variables in prediction. A similar taxonomy of modeling approaches proposed by Brennon et al (2006) is formulated to examining the determinants of diabetes care outcomes in program evaluation. The discipline-free methods used in implementation science research, applied to efficiency and quality-of-care analysis are presented. Finally, we illustrate a logically formulated predictive analytics with efficiency and quality criteria included for evaluation of behavioralchange intervention programs, with the time effect included, in diabetes care and research.

The Dynamics and Plasticity of Epigenetics in Diabetic Kidney Disease: Therapeutic Applications Vis-à-Vis

Chronic kidney disease (CKD) refers to the phenomenon of progressive decline in the glomerular filtration rate accompanied by adverse consequences, including fluid retention, electrolyte imbalance, and an increased cardiovascular risk compared to those with normal renal function. The triggers for the irreversible renal function deterioration are multifactorial, and diabetes mellitus serves as a major contributor to the development of CKD, namely diabetic kidney disease (DKD). Recently, epigenetic dysregulation emerged as a pivotal player steering the progression of DKD, partly resulting from hyperglycemia-associated metabolic disturbances, rising oxidative stress, and/or uncontrolled inflammation. In this review, we describe the major epigenetic molecular mechanisms, followed by summarizing current understandings of the epigenetic alterations pertaining to DKD. We highlight the epigenetic regulatory processes involved in several crucial renal cell types: Mesangial cells, podocytes, tubular epithelia, and glomerular endothelial cells. Finally, we highlight epigenetic biomarkers and related therapeutic candidates that hold promising potential for the early detection of DKD and the amelioration of its progression.

Associations between gene expression of magnesium transporters and glucose metabolism in pregnancy

BACKGROUND/PURPOSE

To assess the relationship between gene expressions of the magnesium transporters and glucose parameters in pregnant women.

METHODS

A cohort of women without ongoing or prior medical illnesses was recruited at the start of an early singleton pregnancy. Expression levels of the magnesium transporters-SLC41A1, CNNM2, MAGT1, TRPM6, and TRPM7-were assessed in the peripheral leukocytes, while total calcium and magnesium were assessed in the serum between 10 and 13 weeks gestation. Glucose parameters were assessed between 24 and 28 weeks gestation using the 75 g oral glucose tolerance test.

RESULTS

A total of 208 patients were included in the study. The expressions of the magnesium transports were generally unrelated to age, body mass index (BMI), or serum levels of calcium and magnesium. The magnesium transporters were correlated with each other at baseline (correlation coefficients: 0.31 to 0.51). BMI was a strong predictor of fasting glucose levels, while both BMI and age were strong predictors of post-load glucose levels. The expression of TRPM7 was found to be predictive of 1-h post-load blood glucose after accounting for the effects of age and BMI (β = -0.196, p = 0.020).

CONCLUSION

The increased maternal expression of the magnesium transporter TRPM7 may be associated with decreased glucose tolerance in pregnant women. In particular, the association between TRPM7 and 1-h post-load glucose levels was found to be independent of the effects of age and BMI. Future studies are needed to determine whether a mechanistic relationship can be demonstrated between TRPM7 and glucose metabolism.

Is Colectomy Associated with the Risk of Type 2 Diabetes in Patients without Colorectal Cancer? A Population-Based Cohort Study

Type 2 diabetes might be influenced by colonic disease; however, the association between colonic resection and type 2 diabetes has rarely been discussed. This population-based cohort study explored the association between colectomy and type 2 diabetes in patients without colorectal cancer. A total of 642 patients who underwent colectomy for noncancerous diseases at any time between 2000 and 2012 in the National Health Insurance Research Database of Taiwan were enrolled. The enrolled patients were matched with 2568 patients without colectomy at a 1:4 ratio using a propensity score that covered age, sex, and comorbidities. The risk of type 2 diabetes was assessed using a Cox proportional hazards model. The mean (standard deviation) follow-up durations in colectomy cases and non-colectomy controls were 4.9 (4.0) and 5.6 (3.6) years, respectively; 65 (10.1%) colectomy cases and 342 (15.5%) non-colectomy controls developed type 2 diabetes. After adjustment, colectomy cases still exhibited a decreased risk of type 2 diabetes (adjusted HR = 0.80, 95% CI: 0.61–1.04). A stratified analysis for colectomy type indicated that patients who underwent right or transverse colectomy had a significantly lower risk of developing type 2 diabetes (adjusted HR = 0.57, 95% CI: 0.34–0.98). In the present study, colectomy tended to be at a reduced risk of type 2 diabetes in patients without colorectal cancer, and right or transverse colectomies were especially associated with a significantly reduced risk of type 2 diabetes.

Adding Pay-for-Performance Program to Routine Care Was Related to a Lower Risk of Depression Among Type 2 Diabetes Patients in Taiwan

Background: Patients with type 2 diabetes (T2DM) often experience depression during treatment, negatively influencing their treatment compliance and clinical outcomes. Recently, the pay-for-performance (P4P) program for chronic diseases, with high-cost and high-risk feature, such as T2DM, has been implemented and has been operational for several years. Nevertheless, its effect on the risk of developing depression among T2DM cases is unknown. This study aims to explore the association of P4P use with the subsequent risk of developing depression among these patients. Methods: This cohort study used a nationwide health insurance database to identify patients 20-70 years of age newly diagnosed with T2DM who enrolled in the P4P program between 2001 and 2010. From this group, we enrolled 17,022 P4P users and then 17,022 non-P4P users who were randomly selected using propensity-score-matching. Enrolled patients were followed until the end of 2012 to record the occurrence of depression. The Cox proportional hazards regression was utilized to obtain the adjusted hazard ratio (aHR) for P4P use. Results: During the study period, a total of 588 P4P users and 1,075 non-P4P users developed depression at incidence rates of 5.89 and 8.41 per 1,000 person-years, respectively. P4P users had a lower depression risk than did non-P4P users (aHR, 0.73; 95% Confidence Interval, 0.65-0.80). This positive effect was particularly prominent in those receiving high-intensity use of the P4P program. Conclusion: Integrating P4P into routine care for patients with T2DM may have beneficial effects on curtailing the subsequent risk of depression.

Effectiveness of a Problem-Solving Program in Improving Problem-Solving Ability and Glycemic Control for Diabetics with Hypoglycemia

The purpose of this study was to evaluate the effects of a hypoglycemia problem-solving program (HPSP) on problem-solving ability and glycemic control in diabetics with hypoglycemia. This was a prospective, quasi-experimental study with two groups, using a pre- and post-repeated measures design. A total of 71 diabetic patients with hypoglycemia were purposively assigned to an experimental group (n = 34) and a control group (n = 37). The experimental group participated in an 8-week HPSP, and each weekly session lasted approximately 90 min, while the control group received usual care. Participants were assessed at baseline, 1, 3, and 6 months after intervention care. In the experimental group, 6 months after the HPSP intervention, HbA1c was superior to that before the intervention. In both groups, the score obtained using the hypoglycemia problem-solving scale (HPSS) was low before the intervention. In the experimental group, HPSS tracking improved at all stages after the intervention compared to before the intervention. In the control group, the HPSS score improved slightly in the first month and sixth months after usual care. There were significant differences between and within groups in HbA1c levels and HPSS score over time. The intervention based on the HPSP effectively improves HbA1c level and hypoglycemia problem-solving ability in patients with hypoglycemia.

Electronic dashboard-based remote glycemic management program reduces length of stay and readmission rate among hospitalized adults

AIMS/INTRODUCTION

Currently, the impact of hospital-wide glycemic control interventions on length of hospital stay (LOS) and readmission rates are largely unknown. We investigated the impact of a 4-year hospital-wide remote glycemic management program on LOS and 30-day readmission rates among hospitalized adults who received glucose monitoring.

MATERIALS AND METHODS

In this retrospective study, hospitalized patients who received glucose monitoring were classified into groups 1 (high glucose variability), 2 (hypoglycemia), 3 (hyperglycemia) and 4 (relatively stable). The monthly percentage changes, and average monthly percentage changes of hyperglycemia, hypoglycemia and treat to target were determined using joinpoint regression analysis.

RESULTS

A total of 106,528 hospitalized patients (mean age 60.9 ± 18.5 years, 57% men) were enrolled. We observed a significant reduction in the percentage of inpatients in poor glycemic control groups (groups 1, 2 and 3, all P < 0.001), and a reciprocal increase in the relatively stable group (group 4) from 2016 to 2019. We found a significant reduction in LOS by 11.4% (10.5-9.3 days, P = 0.002, after adjustment for age, sex, and admission department). The 30-day readmission rate decreased from 29.9% to 29.3%, mainly among those in group 4 in 2019 (P < 0.001 after adjustment of sex, age, admission department and LOS).

CONCLUSIONS

Improved glycemic control through a hospital-wide electronic remote glycemic management system reduced LOS and 30-day readmission rates. Findings observed in this study might be associated with the reduction in cost of avoidable hospitalizations.

Association of Tooth Scaling with Acute Myocardial Infarction and Analysis of the Corresponding Medical Expenditure: A Nationwide Population-Based Study

Accumulating evidence has shown a significant correlation between periodontal diseases and systemic diseases. In this study, we investigated the association between the frequency of tooth scaling and acute myocardial infarction (AMI). Here, a group of 7164 participants who underwent tooth scaling was compared with another group of 7164 participants without tooth scaling through propensity score matching to assess AMI risk by Cox’s proportional hazard regression. The results show that the hazard ratio of AMI from the tooth scaling group was 0.543 (0.441, 0.670) and the average expenses of AMI in the follow up period was USD 265.76, while the average expenses of AMI in follow up period for control group was USD 292.47. The tooth scaling group was further divided into two subgroups, namely A and B, to check the influence of tooth scaling frequency on AMI risk. We observed that (1) the incidence rate of AMI in the group without any tooth scaling was 3.5%, which is significantly higher than the incidence of 1.9% in the group with tooth scaling; (2) the tooth scaling group had lower total medical expenditures than those of the other group because of the high medical expenditure associated with AMI; and (3) participants who underwent tooth scaling had a lower AMI risk than those who never underwent tooth scaling had. Therefore, the results of this study demonstrate the importance of preventive medicine.

Self-efficacy remains a vital factor in reducing the risk of dialysis in type 2 diabetes care

Studies have provided promising outcomes of the pay-for-performance (P4P) program or with good continuity of care levels in diabetes control.We investigate the different exposures in continuity of care (COC) with their providers and those who participate in the P4P program and its effects on the risk of diabetes diabetic nephropathy in the future.We obtained COC and P4P information from the annual database, to which we applied a hierarchical linear modeling (HLM) in 3 levels adjusted to account for other covariates as well as the effects of hospital clustering and accumulating time.Newly diagnosed type 2 diabetes in 2003At the individual level, those with a higher Diabetes Complications Severity Index (DCSI) score have a higher likelihood of diabetic nephropathy than those with a lower DCSI (OR, 1.46), whereas contrasting results were obtained for the Charlson Comorbidity Index (CCI) (odds ratio[OR], 0.88). Patients who visited family physicians, endocrinologists, and gastroenterologists showed a lower likelihood of diabetic nephropathy (OR, 0.664, 0.683, and 0.641, respectively), whereas those who continued to visit neurologists showed an increased risk of diabetic nephropathy by 4 folds. At the hospital level, patients with diabetes visiting primary care clinics had a lower risk of diabetic nephropathy with an OR of 0.584 than those visiting hospitals of other higher levels. Regarding the repeat time level, the patients who had a higher COC score and participated in the P4P program had a reduced diabetic nephropathy risk with an OR of 0.339 and 0.775, respectively.Diabetes control necessitates long-term care involving the patients' healthcare providers for the management of their conditions to reduce the risk of diabetic nephropathy. Indeed, most contributing factors are related to patients, but we cannot eliminate the optimal outcomes related to good relationships with healthcare providers and participation in the P4P program.

Life satisfaction and emotional distress in people living with type 2 diabetes mellitus: The mediating effect of cognitive function

AIMS AND OBJECTIVES

To explore the relationships among emotional distress, cognitive function and life satisfaction in people living with type 2 diabetes mellitus (T2DM), and to verify the mediating role of cognitive function.

BACKGROUND

People with T2DM face cognitive decline caused by age and disease complications. Emotional distress will reduce their life satisfaction, and cognitive function will also affect the life satisfaction, but whether cognitive function mediates the effect of emotional distress on life satisfaction has not been verified.

DESIGN

A cross-sectional study.

METHODS

A total of 200 people living with T2DM in the community by convenience sampling were enrolled from November-December 2018. Data collection involved a demographic and disease characteristic questionnaire, Problem Areas in Diabetes Scale, Subjective and Objective Cognitive Function Evaluation and Life Satisfaction Questionnaire. Data analysis included descriptive statistics and structural equation modelling. This report followed the STROBE guideline.

RESULTS

The emotional distress and subjective memory complaints of cognitive function had a significant positive correlation, while both emotional distress and cognitive function showed significant negative correlations with life satisfaction. In addition, cognitive function completely mediated the relationship between emotional distress and life satisfaction.

CONCLUSION

The cognitive function played a mediating role in life satisfaction and explains how emotional distress affects life satisfaction of people with T2DM. Therefore, it is suggested that diabetes nurses should early identify the decline of cognitive function, and to intervene at an early stage.

RELEVANCE TO CLINICAL PRACTICE

This study provides opinions on the mediating factors of cognitive function. Coping strategies and supporting resources to help the T2DM people to improve their life satisfaction are suggested.

Dietary Patterns and the Risk of Prediabetes in Taiwan: A Cross-Sectional Study

Background: prediabetes prevention and management are the main methods used to combat the prevalence of diabetes. Exploratory factor analysis is an upcoming method that is successful in identifying dietary patterns that correlate with healthy or unhealthy outcomes. Aim: this study aims to identify dietary patterns in Taiwan that are associated with the risk of prediabetes. Methods: anthropometric, blood glucose, 3 d/24 h dietary records, and food frequency questionnaire data were collected from subjects recruited at Taipei Tzu-Chi Hospital. The following five dietary patterns were identified using factor analysis: Western, prudent, convenience, Asian traditional, and continental. This cross-sectional study compares tertiles of dietary patterns and analyzes the significance of the characteristics. Results: the Western and the prudent patterns are the major dietary patterns found in other studies. A higher factor loading in the Western pattern is significantly related to a higher risk of prediabetes. A higher factor loading in the continental pattern is significantly related to a lower risk of prediabetes. Conclusion: decreasing meat and seafood consumption while increasing egg, coffee, and milk consumption may be associated with a decreased risk for prediabetes.

Team-based care improves quality of diabetes care -Family Practice Integrated Care Project in Taiwan

BACKGROUND

The Family Practice Integrated Care Project (FPICP) is a team-based program in Taiwan initiated in 2003. This study investigates the influence of FPICP on the quality of diabetes care.

METHODS

This population-based cohort study used Taiwan's National Health Insurance Administration data on FPICP (fiscal year 2015-2016, with follow-up duration of one year). Participants included diabetic patients aged ≥30 in primary care clinics. We used conditional logistic regression modeling of patient characteristics and annual diabetes examinations and compared FPICP participants with non-participating candidates. Main outcome measures included completion of annual diabetes examinations, including glycated hemoglobin (A1c), low-density lipoprotein (LDL), urine microalbumin (MAU), routine urinalysis (UR), and fundus examination (FE).

RESULTS

The sample included 298,208 FPICP participants and 478,778 non-participating candidates. After 1:1 propensity score matching, the examination completion rates for FPICP participants and non-participants, respectively, were 94.4% versus 93.6% in A1c, 84.2% versus 83.8% in LDL, 61.9% versus 60.1% in MAU, 59.2% versus 58.0% in UR, and 30.1% versus 32.4% in FE.

CONCLUSION

Our findings indicate that a program like FPICP helps improve the quality of diabetes care through regular examinations of Alc, LDL, MAU, and UR.

The factors associated with insulin nonpersistence in persons with type 2 diabetes

AIMS

Implementation of insulin therapy among those with diabetes is often suboptimal as a result of non-adherence or non-persistence. Studies regarding factors leading to insulin nonpersistence are limited. Therefore, we conducted this retrospective cohort study to determine the factors affecting insulin nonpersistence.

METHODS

A total of 274,852 persons with type 2 diabetes mellitus under insulin therapy during the period 2000-2014 were enrolled. Persons who stopped insulin therapy for >90 days were defined as having insulin nonpersistence. We searched for factors associated with insulin nonpersistence during the long-term follow-up period.

RESULTS

According to the multiple Cox regression model with a mean follow-up of 13.9 years, the factors associated with higher risk of insulin nonpersistence were age <40 years, men, residing in a rural area, Charlson comorbidity index score = 4, use of two or more oral antidiabetic drugs, and hypoglycemia during follow-up. The Kaplan-Meier graph showed that patients aged <40 years had significantly less insulin persistence.

CONCLUSIONS

This nationwide cohort study indicated that persons with young-onset type 2 diabetes, less medical resources, and more comorbidities are at risk of insulin nonpersistence. Healthcare providers should regularly assess insulin persistence and help patients who are having difficulty with insulin-taking.

Trend of Neovascular Glaucoma in Taiwan: A 15-year Nationwide Population-based Cohort Study

PURPOSE

To determine the trends in epidemiological data in patients with neovascular glaucoma (NVG) in Taiwan.

METHODS

The data were obtained from the 2016 version of the Longitudinal Health Insurance Database, which contains data on two million randomly sampled patients. Patients with NVG diagnostic codes were enrolled in this study, after which we separated the study population according to different time periods. The demographic data, systemic and ocular comorbidities and treatments that were applied to manage NVG were collected from the database.

RESULTS

The overall age-standardized prevalence was 52.48 per 100,000 individuals, and the age-standardized incidence was 4.33 per 100,000 person-years in patients with NVG. In general, men had a higher prevalence and incidence, and the incidence was observed to fluctuate. The patients with the highest educational levels accounted for less than 5% of the NVG patients, and the patients with the highest income levels accounted for less than 15% of the NVG patients. Systemic comorbidities in NVG patients, especially metabolic syndrome, were observed to increase. The percentage of the patients receiving anti-vascular endothelial growth factor treatments increased by more than two-fold after 2008, whereas reductions in trabeculectomy and cyclodestruction procedures were observed.

CONCLUSION

The prevalence of NVG was observed to increase in men, and the incidence fluctuated during the study period. Furthermore, the systemic comorbidities, and the use of anti-vascular endothelial growth factor treatment increased; the latter may be associated with a decrease in the use of incisional glaucoma surgery for NVG in recent years.