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Embick R, Jackson M, Stewart R. The impact of stigma on the management of type 1 diabetes: A systematic review. Diabet Med 2024; 41:e15299. [PMID: 38361327 DOI: 10.1111/dme.15299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/17/2024]
Abstract
AIMS To systematically review the literature investigating the links between stigma and the management of type 1 diabetes. METHODS A systematic literature review was conducted in accordance with PRISMA guidelines. Both quantitative and qualitative data were considered. Included papers were subject to quality assessment using the Mixed Methods Appraisal Tool (MMAT), and a narrative synthesis of results was reported. RESULTS Nineteen articles met the inclusion criteria and were included in the final analysis. Amongst these, one study used mixed methods, nine were qualitative, and nine were quantitative. All studies found a negative relationship between stigma and type 1 diabetes management. Qualitative studies provided a further understanding of the effects observed in the quantitative studies and found that stigma can affect self-care activities, disclosure of diabetes, and the uptake of diabetes technology. Systemic causes of stigma and intersectional stigma were also observed. CONCLUSIONS This review highlights that people with type 1 diabetes are negatively affected by stigma, irrespective of their age, gender, culture, or use of diabetes technology. Quantitative studies were limited, in that all studies were cross-sectional, and there was a lack of standardisation across outcome measures. There is a need for interventions to target stigma on both an individual and a systemic level, particularly where people experience multiple intersecting stigmas.
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Affiliation(s)
- Ronda Embick
- North Wales Clinical Psychology Programme, School of Psychology, Bangor University, Bangor, UK
| | - Mike Jackson
- North Wales Clinical Psychology Programme, School of Psychology, Bangor University, Bangor, UK
| | - Rose Stewart
- Gladstone Centre, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Bangor, UK
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Essien SK, Zucker-Levin A. Comorbidity and risk factors of subsequent lower extremity amputation in patients diagnosed with diabetes in Saskatchewan, Canada. Chronic Illn 2023; 19:779-790. [PMID: 36366747 PMCID: PMC10655619 DOI: 10.1177/17423953221137891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Subsequent limb amputation (SLA) may be necessary due to disease progression, infection, or to aid prosthesis fit. SLA in Saskatchewan has increased 3.2% from 2006 to 2019 with minor SLA increasing 9.6% during that period. Diabetes affects a large proportion of patients who require SLA; however, the impact of additional comorbidities is not clear. METHODS First-episode subsequent lower extremity limb amputation (SLEA) cases with the presence/absence of diabetes, other comorbidities, and demographic characteristics from 2006-2019 were retrieved from Saskatchewan's Discharge Abstract Database. Logistic regression was performed to examine the magnitude of the odds of SLEA. RESULTS Among the 956 first-episode SLEA patients investigated, 78.8% were diagnosed with diabetes. Of these, 76.1% were male and 83.0% were aged 50 + years. Three comorbidities: renal failure (AOR = 1.9, 95% Cl 1.1 - 3.0), hypertension (AOR = 3.0, 95% Cl 2.0 - 4.5), and congestive heart failure (AOR = 2.0, 95% CI 1.2 - 3.2), conferred the highest odds of SLEA. The odds of SLEA is greatest for those aged 50-69 years, males, Registered Indians, and associated with a prolonged hospital stay. DISCUSSION These data are important as they may help medical providers identify patients at the highest risk of SLEA and target interventions to optimize outcomes.
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Affiliation(s)
- Samuel Kwaku Essien
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Audrey Zucker-Levin
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
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Ben Chmo M, Matricciani L, Kumar S, Graham K. "I know what I'm supposed to do, but I don't do it": patient-perceived risk factors that lead to their lower extremity amputations. J Foot Ankle Res 2023; 16:79. [PMID: 37957636 PMCID: PMC10642033 DOI: 10.1186/s13047-023-00675-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The purpose of this study is to extend on our previous research by exploring patient-perceived factors that lead to their Lower Extremity Amputations (LEA). LEA are a serious complication of Type 2 Diabetes Mellitus (T2DM), LEA are thought to be preventable with early detection and management of risk factors. Our previous study identified that these factors extend beyond the typical biological and modifiable risk factors and may also extend to patient awareness and competing priorities. Therefore, this research explored these issues in further detail, identifying patient-perceived factors that lead to their LEA. METHODS A qualitative descriptive methodology involving non-probability purposive sampling was used to recruit inpatients at a tertiary metropolitan hospital in South Australia. Semi-structured interviews were conducted, and data were transcribed verbatim. Data from the interviews were analysed using thematic analysis and the constant comparison approach. RESULTS A total of 15 participants shared their perspectives of risk factors for LEA. Two main themes emerged: intrinsic and extrinsic factors. Intrinsic factors identified in this study included identity, ambivalence, denial, inevitability, and helplessness. Extrinsic factors related to resources, rapport with healthcare professionals, and management of care. CONCLUSIONS Through identifying that a combination of perceived personal attributes (intrinsic) and system-level (extrinsic) factors likely contribute to LEA, this study highlights the complexity of factors that contribute to patients' perceptions of what led to their diabetes related LEA. These findings support the importance of a nuanced approach in managing patients with diabetes who are at risk of LEA as it's likely patients' personal circumstances, day-to-day life's requirements and responsibilities, their interaction with healthcare professionals all seemingly contribute to how risks are viewed and managed. Tackling this challenge will require reimagining diabetes care, acknowledgement of risk factors beyond the obvious and addressing persistent access and workforce issues.
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Affiliation(s)
- Marcelle Ben Chmo
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.
| | - Lisa Matricciani
- Clinical and Health Sciences, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Saravana Kumar
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
- Innovation, IMPlementation and Clinical Translation (IIMPACT in Health), The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Kristin Graham
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
- Innovation, IMPlementation and Clinical Translation (IIMPACT in Health), The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
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Zhu X, Lee ES, Lim PX, Chen YC, Chan FHF, Griva K. Exploring barriers and enablers of self-management behaviours in patients with diabetic foot ulcers: A qualitative study from the perceptions of patients, caregivers, and healthcare professionals in primary care. Int Wound J 2023; 20:2764-2779. [PMID: 36970982 PMCID: PMC10410341 DOI: 10.1111/iwj.14153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Xiaoli Zhu
- Nursing ServicesNational Healthcare Group PolyclinicsSingaporeSingapore
- Population/Global Health, Lee Kong Chian School of Medicine, NanyangTechnological UniversitySingaporeSingapore
| | - Eng Sing Lee
- Clinical Research UnitNational Healthcare Group PolyclinicsSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Phoebe X.H. Lim
- Population/Global Health, Lee Kong Chian School of Medicine, NanyangTechnological UniversitySingaporeSingapore
| | - Yee Chui Chen
- Nursing ServicesNational Healthcare Group PolyclinicsSingaporeSingapore
| | - Frederick H. F. Chan
- Population/Global Health, Lee Kong Chian School of Medicine, NanyangTechnological UniversitySingaporeSingapore
| | - Konstadina Griva
- Population/Global Health, Lee Kong Chian School of Medicine, NanyangTechnological UniversitySingaporeSingapore
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Roldan Munoz S, Postmus D, de Vries ST, Gross-Martirosyan L, Bahri P, Hillege H, Mol PGM. What Factors Make EU Regulators Want to Communicate Drug Safety Issues Related to SGLT2 Inhibitors? An Online Survey Study. Drug Saf 2023; 46:243-255. [PMID: 36790560 PMCID: PMC9988744 DOI: 10.1007/s40264-022-01270-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Previous studies have found differences in the communication of safety issues among medicines regulatory agencies. OBJECTIVES To explore (1) to what extent regulators' opinions regarding the need to communicate safety issues related to sodium-glucose cotransporter-2 (SGLT2) inhibitors might be influenced by their concern about the safety issue, and (2) whether regulators' concerns might be influenced by certain characteristics of the safety issue or by the demographic and professional characteristics and attitudes of the regulators. METHODS An online cross-sectional survey study with a rating-based conjoint analysis among clinical and pharmacovigilance assessors from the EU regulatory network was performed between April and June 2021. Regulators were invited by email, and participants were asked about their level of concern and their opinion regarding the need to communicate about 12 scenarios defined by four characteristics: adverse drug reaction, source of information, causality, and frequency. The outcomes for the first objective were to update the summary of product characteristics (SmPC; yes/no) and to send direct healthcare professional communications (DHPC; yes/no). The determinant was regulators' level of concern (range 0-100%). The outcome of the second objective was regulators' level of concern, and the determinants were the characteristics of the safety issue, demographic and professional characteristics, and attitudes of the regulators (beliefs about medicines and risk perception). RESULTS A total of 222 regulators completed the survey (64% women; mean age 46 ± 10 years). Depending on the scenario, 54-94% and 25-74% of the participants would update the SmPC or send a DHPC, respectively. The participants' level of concern influenced their opinions regarding the need to update the SmPC and send a DHPC (odds ratio (OR) 13.0; 95% confidence interval (CI) 7.8-21.7 and OR 13.6; 95% CI 9.5-19.2, respectively, for every 10% increase in the level of concern). All characteristics of the safety issue influenced the level of concern. Younger participants, women, and those working for Eastern European agencies had a higher level of concern than older participants, men, and those working in other regions. Beliefs about medicines and general risk perception also influenced their concern. CONCLUSIONS The opinion regarding the need to communicate safety issues was influenced by the concern of regulators. Regulators' concern was influenced by the characteristics of the safety issue, demographic characteristics, and attitudes. Diverse groups of experts regarding such factors would ensure that various views are incorporated in risk communication decisions.
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Affiliation(s)
- Sonia Roldan Munoz
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Douwe Postmus
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sieta T de Vries
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | | | - Priya Bahri
- European Medicines Agency, Amsterdam, The Netherlands
| | - Hans Hillege
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Peter G M Mol
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands.
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Zhu X, Olsson MM, Bajpai R, Lim VH, Goh LJ. Factors Associated with Healing Outcomes in Primary Care Patients with Diabetic Foot Ulcers: A Retrospective Study in a Multiethnic Sample. Adv Skin Wound Care 2022; 35:22-29. [PMID: 34935718 DOI: 10.1097/01.asw.0000801524.42349.4d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To identify and determine patient- and ulcer-related factors associated with healing outcomes within 3 months for patients with diabetic foot ulcer (DFU) in a multiethnic primary care sample. METHODS Retrospective data were collected over 3 months from 520 primary care patients with a DFU between April 1, 2016 and March 31, 2017. Multivariable prevalence ratios (PRs) were calculated using Poisson regression to find associations between patient- and ulcer-related factors and healing outcomes. RESULTS Most patients were male (66%) and Chinese (49.8%) and had a diabetes mellitus duration longer than 5 years (81.8%). Toe ulcers (64%) were most common. Healing occurred for 33.9% of participants; 19.1% and 1.5% underwent minor and major amputation, respectively. Wound sizes between 1 and 10 cm2 (PR, 0.61; 95% confidence interval [CI], 0.46-0.76; P < .001) and over 10 cm2 (PR, 0.55; 95% CI, 0.33-0.76; P = .003), ulcer duration 6 months or longer (PR, 0.36; 95% CI, 0.19-0.53; P < .001), ischemic ulcers (PR, 0.54; 95% CI, 0.22-0.86; P = .044), and neuroischemic ulcers (PR, 0.73; 95% CI, 0.53-0.93; P = .027) were negatively associated with healing outcomes. Women were more likely to experience healing (PR, 1.18; 95% CI, 0.91-1.45; P = .157). CONCLUSIONS Ulcer healing varied by sex and was affected by wound size, wound duration, and ischemic etiology, regardless of ethnicity. Prompt attention to these risk factors may reduce healing time. Further studies are warranted to elucidate the mechanism underlying sex differences in association with DFU healing.
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Affiliation(s)
- Xiaoli Zhu
- Xiaoli Zhu, MN, BSN, RN, is a wound care nurse clinician, National Healthcare Group Polyclinics, and a PhD student, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. Maja M. Olsson, MMSPH, BSN, RN, is a PhD student, Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia. Ram Bajpai, PhD, is Research Fellow in Epidemiology & Applied Statistics, School of Medicine, Keele University, United Kingdom. Voon Hooi Lim, MHS, BSN, RN, is Chief Nurse, National Healthcare Group Polyclinics. Ling Jia Goh, MClinRes, BSN, RN, is Assistant Nurse Clinician, National Healthcare Group Polyclinics. Acknowledgments: The authors thank Professor Doris Young and Dr Dong Lijuan for their guidance in study design; the wound care nurses of the National Healthcare Group Polyclinics for their assistance in data collection; and the National Healthcare Group Polyclinics Nursing Services and Clinical Research Unit for their support. Funding for this study was received from National Healthcare Group Polyclinics, Singapore. The authors have disclosed no other financial relationships related to this article. Submitted December 16, 2020; accepted in revised form February 18, 2021
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Roșca AC, Baciu CC, Burtăverde V, Mateizer A. Psychological Consequences in Patients With Amputation of a Limb. An Interpretative-Phenomenological Analysis. Front Psychol 2021; 12:537493. [PMID: 34122200 PMCID: PMC8189153 DOI: 10.3389/fpsyg.2021.537493] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/31/2021] [Indexed: 11/30/2022] Open
Abstract
The study aimed to identify the psychological changes that result from the amputation of a limb and the ways in which patients coordinate their daily lives. The study uses an interpretative phenomenological analysis (IPA) aimed at understanding individual experiences in seven patients who have suffered limb amputation. The method used consisted of individual, semi-structured interviews, conducted approximately 4 months after surgery, to patients at home or in hospital, at the time of their regular checkup. The interviews were audio recorded, transcribed and, following the qualitative analysis performed, six common themes were identified: emotional impact, negative affects, tendency toward isolation, role constraints and limitations, phantom limb, and emotional balancing. A specific theme for patients who have suffered amputations is phantom limb pain, which has received special attention from researchers. The last topic relates to the tendency toward emotional balancing and psychological calibration to return to normal life.
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Affiliation(s)
- Andra Cătălina Roșca
- Department of Orthopedics and Traumatology, National University of Political Sciences and Public Administration, Bucharest, Romania
| | - Cosmin Constantin Baciu
- Department of Sociology-Psychology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Vlad Burtăverde
- Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
| | - Alexandru Mateizer
- Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
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