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Vashist K, Frediani JK, Weber MB, Ali MK, Narayan KMV, Patel SA. Changes in Diabetes Care and Management Practices during the COVID-19 Pandemic. RESEARCH SQUARE 2024:rs.3.rs-3849240. [PMID: 38313263 PMCID: PMC10836114 DOI: 10.21203/rs.3.rs-3849240/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Background Evidence suggests diabetes management was negatively impacted early in the pandemic. However, the impact of the pandemic on key healthcare services for diabetes control and diabetes self-management practices is less known. We examined changes in diabetes care and management practices before and during the COVID-19 pandemic. Methods Population-based data regarding 4 diabetes-related healthcare engagement and 4 self-management indicators were obtained from adults with diabetes surveyed in 19 US States and Washington DC through the Behavioral Risk Factor Surveillance System. Using logistic regression, we estimated changes in the prevalence of each indicator, overall and by sociodemographic subgroups, before (2019; n = 15,307) and during (2021; n = 13,994) the COVID-19 pandemic. Results Between 2019 and 2021, the prevalence of biannual HbA1c tests reduced by 2.6 percentage points (pp, 95% CI :-4.8, -0.4), from 75.4-73.1%, and prevalence of annual eye exams fell by 4.0 pp (-6.2, -2.8), from 72.2-68.7%. The composite indicator of engagement with healthcare for diabetes control fell by 3.5 pp (-5.9, -1.1), from 44.9-41.9%. Reductions in engagement with healthcare were largely seen across sex, age, education, employment status, marital status, insurance status, and urbanicity; and were more pronounced among those aged 18-34 and the uninsured. Reductions in engagement with healthcare were seen in several states, with Delaware and Washington DC reporting the largest decrease. Of self-management behaviors, we only observed change in avoidance of smoking, an increase of 2.0 pp (0.4, 3.6) from 84.7-87.1%. Conclusions The pandemic had mixed impacts on diabetes care and self-management. The findings suggest a deterioration of the uptake of evidence-based, preventive health services requiring laboratory services and clinical examination for diabetes control during the pandemic. On the other hand, smoking rates decreased, suggesting potential positive impacts of the pandemic on health behaviors in people with diabetes.
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Li L, Chattopadhyay K, Li X, Yu J, Xu M, Chen X, Li L, Li J. Factors associated with nonattendance at annual diabetes check-up in Ningbo, China: a case-control study. Front Public Health 2023; 11:1247406. [PMID: 38162612 PMCID: PMC10755863 DOI: 10.3389/fpubh.2023.1247406] [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] [Received: 06/26/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is a grave issue in China. The annual check-up is recommended in clinical guidelines on T2DM. It plays an important role in monitoring and managing the condition and detecting and managing any comorbidities and T2DM-related complications. However, people with T2DM may miss the annual check-up, and the benefits of this check-up are lost. Therefore, this study aimed to determine the factors associated with nonattendance at the annual T2DM check-up in Ningbo, China. Methods A case-control study was conducted using the Ningbo National Metabolic Management Center dataset. Cases were people with T2DM who were alive but did not attend the first annual check-up, scheduled between 1 March 2019 and 28 February 2022 (n = 1,549). Controls were people with T2DM who were alive and attended the first annual check-up during the same period (n = 1,354). The characteristics of cases and controls were compared using logistic regressions. Results The odds of being a female [odds ratio (OR) 1.26, 95% confidence interval (CI) 1.06-1.50], alcohol drinker (1.26, 1.06-1.49), and with glycated hemoglobin A1c (HbA1c) ≥7% (1.67, 1.42-1.97) were higher among case patients than controls. The odds of being a high school graduate (0.77, 0.66-0.89) and on standard treatments in addition to lifestyle modification (oral hypoglycemic drug 0.63, 0.42-0.96; oral hypoglycemic drug and injection therapy 0.48, 0.32-0.73) were lower among case patients than controls. Conclusion The factors associated with nonattendance at the annual T2DM check-up in Ningbo, China were female sex, not a high school graduate, alcohol drinker, HbA1c ≥7%, and only on lifestyle modification. The study findings should be used for improving attendance at the annual check-up among people with T2DM in Ningbo.
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Affiliation(s)
- Ling Li
- Health Science Center, Ningbo University, Ningbo, China
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Kaushik Chattopadhyay
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Xueyu Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Jingjia Yu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Miao Xu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Xueqin Chen
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Li Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Jialin Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, China
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Nurminen M, Rättö H. Impact of diabetes diagnosis on dental care utilization: evidence from Finland. HEALTH ECONOMICS REVIEW 2023; 13:26. [PMID: 37129732 PMCID: PMC10152714 DOI: 10.1186/s13561-023-00440-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Poor oral health is associated with many chronic diseases, including diabetes. As diabetes can worsen oral health and vice versa, care guidelines recommend that patients with diabetes maintain good oral health and have regular dental checkups. We analyzed the impact of receiving an initial type 2 diabetes diagnosis on dental care utilization. METHODS We used register data on residents aged over 25 in the city of Oulu, Finland, covering the years 2013-2018. We used the difference-in-differences method and individuals with no diabetes diagnosis as control group. As robustness checks, we used propensity score matching and constructed an alternative control group from patients that received the same diagnosis a few years apart. RESULTS Despite the guideline recommendations, we found that receiving a diabetes diagnosis did not increase the probability for dental care visits in a two-year follow-up. The findings remained similar for both high-income and low-income persons. CONCLUSIONS The finding is concerning in terms of diabetes management and oral health. Further research is needed on the reasons behind the lack of response to guidelines.
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Affiliation(s)
- Mikko Nurminen
- Research Department, The Social Insurance Institution of Finland, P.O. Box 450, Helsinki, 00056, Finland.
| | - Hanna Rättö
- Research Department, The Social Insurance Institution of Finland, P.O. Box 450, Helsinki, 00056, Finland
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Kukafka R, Jin X, Li Y, Wang H, Yang D, Zhang Z, He X, Liao J, Chen W, Gong N. Perspective of People With Type 2 Diabetes Toward Self-management: Qualitative Study Based on Web Crawler Data. J Med Internet Res 2023; 25:e39325. [PMID: 36729569 PMCID: PMC9936364 DOI: 10.2196/39325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/17/2022] [Accepted: 12/14/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The diabetes disease burden in China is heavy, and medical standards such as diabetes guidelines are the core reference guidelines for diabetes management for health care providers and patients. However, patients' guideline compliance is too low, which correlates with the gap between guidelines and patients' self-management needs. Incorporating patient needs into the guideline development would reduce this gap. OBJECTIVE We sought to capture the needs of patients with diabetes for self-management in everyday situations and to clarify the contradictions and misalignments between medical standards, such as guidelines, and patient needs. METHODS This study collected crawler-based data from 4 online health communities. We selected 1605 text records collected from Chinese patients with diabetes between March 2020 and July 2020 for analysis. The text analysis applied grounded theory to separate issues that concerned patients into 3 themes, 7 subthemes, and 25 entries. RESULTS Altogether, 69.03% (1108/1605) of texts were related to issues concerning disease treatment (theme B) and mainly inquired about medication use (B2 and B3; 686/1108, 61.91%), including medication choice, change in medication administration, side effects, and postmedication effects. In addition, 222 (N=1605, 13.8%) texts (theme A) concerned the explanation of disease etiology and knowledge of diabetes, and 275 (N=1605, 17.1%) texts (theme C) discussed lifestyle changes and various restrictions on life brought about by the disease. CONCLUSIONS Our findings suggest an urgent need to improve diabetes health education and guideline development strategies and to develop health management strategies from a patient perspective to bridge the misalignment between patient needs and current medical standards.
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Affiliation(s)
| | - Xiaoyuan Jin
- Department of Social Medicine of School of Public Health, Zhejiang University, Hangzhou, China
| | - Yundong Li
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Hongmei Wang
- Department of Social Medicine of School of Public Health, Zhejiang University, Hangzhou, China
| | - Dan Yang
- School of Nursing, Jinan University, Guangzhou, China
| | - Ziqing Zhang
- School of Nursing, Jinan University, Guangzhou, China
| | - Xiaoyu He
- School of Nursing, Jinan University, Guangzhou, China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, Sun Yat-sen Global Health Institute, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weiju Chen
- School of Nursing, Jinan University, Guangzhou, China
| | - Ni Gong
- School of Nursing, Jinan University, Guangzhou, China
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Quigley M, Earnest A, Andrikopoulos S, Wischer N, Green S, Zoungas S. ANDA-Evaluating Facilitated Feedback Enhancement - a Cluster randomised Trial (ANDA-EFFECT): protocol for a cluster randomised trial of audit feedback augmented with education and support, compared to feedback alone, on acceptability, utility and health outcomes in diabetes centres in Australia. Trials 2022; 23:976. [PMID: 36471424 PMCID: PMC9720980 DOI: 10.1186/s13063-022-06910-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People living with diabetes must manage a range of factors for optimal control of glycaemia and to minimise the risk of diabetes-related complications. Diabetes practitioners are expected to follow guidelines for the key process of care and clinical outcomes, to help people living with diabetes achieve clinical targets. In Australia, the performance of diabetes centres against guidelines is evaluated by the Australian National Diabetes Audit, an annual clinical audit and feedback activity. Previous work has identified areas for improvement in the feedback provided to participating diabetes centres and suggested additional educational and support resources to assist in using audit feedback for the development of quality improvement activities. This cluster randomised trial will test the acceptability, utility and impact on selected clinical outcomes of the developed study intervention (audit feedback and a tailored educational and peer support cointervention). METHODS Two-armed cluster randomised trial with Australian Diabetes Centres that participated in the Australian National Diabetes Audit in 2021 as the clusters, stratified by location and type of centre. We aim to recruit 35 diabetes centres in each arm. Both the intervention and control arms will receive an augmented feedback report, accompanied by a partially pre-populated slide deck. In addition, the intervention arm will receive a tailored theory-based intervention designed to address identified, modifiable barriers to utilising and implementing the recommendations from diabetes audit feedback. The co-primary outcomes are (1) HbA1c at the patient level, measured at 6 months after delivery of the intervention, and (2) the acceptability and utility of the augmented feedback and cointerventions at the practitioner level, measured at 3 months after delivery of the intervention. DISCUSSION This trial aims to test the effects of systematic development and implementation of theory and evidence-informed changes to the audit feedback delivered to diabetes centres participating in an established national clinical diabetes audit. Potential benefits of improved audit feedback include more optimal engagement with the feedback by end clinical users which, ultimately, may lead to improvements in care for people living with diabetes. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12621000765820. Prospectively registered on June 21, 2021.
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Affiliation(s)
- Matthew Quigley
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Arul Earnest
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Sofianos Andrikopoulos
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia ,grid.470804.f0000 0004 5898 9456Australian Diabetes Society, Sydney, NSW 2000 Australia
| | - Natalie Wischer
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia ,National Association of Diabetes Centres, Sydney, NSW 2000 Australia
| | - Sally Green
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Sophia Zoungas
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia ,grid.419789.a0000 0000 9295 3933Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC 3168 Australia
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Rubens M, Ramamoorthy V, Saxena A, McGranaghan P, McCormack-Granja E. Recent Trends in Diabetes-Associated Hospitalizations in the United States. J Clin Med 2022; 11:jcm11226636. [PMID: 36431114 PMCID: PMC9698503 DOI: 10.3390/jcm11226636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study was to examine trends in diabetes-related hospitalizations over the period 2010 to 2019 using Nationwide Inpatient Sample (NIS) to facilitate informed policies regarding diabetes-related prevention and management. Between 2010 and 2019, there were 304 million hospitalizations above 18 years of age, of which 78 million were diabetes-associated hospitalizations. The overall population-adjusted diabetes hospitalizations significantly increased from 3079.0 to 3280.8 per 100,000 US population (relative increase, 6.6%, Ptrend < 0.028). Age-stratified analysis showed that hospitalizations significantly increased for 18−29 years (relative increase, 7.8%, Ptrend < 0.001) while age- and gender-stratified analysis showed that diabetes hospitalization significantly increased for 18−29-year males (relative increase, 18.1%, Ptrend < 0.001). Total hospitalization charge increased from 97.5 billion USD in 2010 to 132.0 billion USD in 2019 (relative increase, 35.4%, Ptrend < 0.001). Our study’s findings suggest that diabetes-associated hospitalizations will continue to increase in the future because recent evidence indicates a reappearance of diabetes complications. It is important to screen, prevent, and control diabetes at a younger age based on the trends observed in our study.
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Affiliation(s)
- Muni Rubens
- Primary Care, Baptist Health South Florida, Miami, FL 33176, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | | | - Anshul Saxena
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL 33143, USA
| | - Peter McGranaghan
- Primary Care, Baptist Health South Florida, Miami, FL 33176, USA
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
- Correspondence: (P.M.); (E.M.-G.); Tel.: +49-30-450-50 (P.M.); +1-786-596-5007 (E.M.-G.)
| | - Elise McCormack-Granja
- Primary Care, Baptist Health South Florida, Miami, FL 33176, USA
- Correspondence: (P.M.); (E.M.-G.); Tel.: +49-30-450-50 (P.M.); +1-786-596-5007 (E.M.-G.)
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Powers B, Bucher A. An Economic Impact Model for Estimating the Value to Health Systems of a Digital Intervention for Diabetes Primary Care: Development and Usefulness Study. JMIR Form Res 2022; 6:e37745. [PMID: 36155985 PMCID: PMC9555334 DOI: 10.2196/37745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/26/2022] [Accepted: 09/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Diabetes is associated with significant long-term costs for both patients and health systems. Regular primary care visits aligned with American Diabetes Association guidelines could help mitigate those costs while generating near-term revenue for health systems. Digital interventions prompting primary care visits among unengaged patients could provide significant economic value back to the health system as well as individual patients, but only few economic models have been put forth to understand this value. Objective Our objective is to establish a data-based method to estimate the economic impact to a health system of interventions promoting primary care visits for people with diabetes who have been historically unengaged with their care. The model was built with a focus on a specific digital health intervention, Precision Nudging, but can be used to quantify the value of other interventions driving primary care usage among patients with diabetes. Methods We developed an economic model to estimate the financial value of a primary care visit of a patient with diabetes to the health system. This model requires segmenting patients with diabetes according to their level of blood sugar control as measured by their most recent hemoglobin A1c value to understand how frequently they should be visiting a primary care provider. The model also accounts for the payer mix among the population with diabetes, documenting the percentage of insurance coverage through a commercial plan, Medicare, or Medicaid, as these influence the reimbursement rates for the services. Then, the model takes into consideration the population base rates of comorbid conditions for patients with diabetes and the associated current procedural terminology codes to understand what a provider can bill as well as the expected inpatient revenue from a subset of patients likely to require hospitalization based on the national hospitalization rates for people with diabetes. Physician reimbursement is subtracted from the total. Finally, the model also accounts for the level of patient engagement with the intervention to ensure a realistic estimate of the impact. Results We present a model to prospectively estimate the economic impact of a digital health intervention to encourage patients with documented diabetes diagnoses to attend primary care visits. The model leverages both publicly available and health system data to calculate the per appointment value (revenue) to the health system. The model offers a method to understand and test the financial impact of Precision Nudging or other primary care–focused diabetes interventions inclusive of costs driven by comorbid conditions. Conclusions The proposed economic model can help health systems understand and evaluate the estimated economic benefits of interventions focused on primary care and prevention for patients with diabetes as well as help intervention developers determine pricing for their product.
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Lewing B, Sansgiry S, Abughosh SM, Lal LS, Essien EJ, Sansgiry SS. Effect of inadequate care on diabetes complications and healthcare resource utilization during management of type 2 diabetes in the United States. Postgrad Med 2022; 134:494-506. [PMID: 35379062 DOI: 10.1080/00325481.2022.2061260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To estimate the effects of inadequate type 2 diabetes mellitus (T2D) care on health outcomes, utilizing a model that incorporates patient, physician, and health-system factors. METHODS The most recently available (years 2016 - 2018) Medical Expenditure panel survey longitudinal data was used to identify adults with type 2 diabetes who had received inadequate diabetes care. American Diabetes Association Standards of Diabetes guidelines were used to define inadequate care, resulting in five categories: lifestyle management, immunization, pharmacologic therapy, physical examination, and laboratory evaluation. For each of the five categories, propensity score 1:1 matching was used to match individuals who received inadequate care to similar individuals who did not. After matching, cohorts were followed for one year. The cohorts were compared by total healthcare expenditure change from baseline, total emergency healthcare visits change from baseline, total newly developed diabetes related complications, and total days absent from school or work change from baseline. RESULTS 1,619 adults with T2D, representing 15,781,346 individuals met study inclusion criteria, of which 22.60%, 22.80%, 49.21%, 23,93%, and 23,45% received inadequate lifestyle management, immunizations, pharmacologic therapies, physical examinations, and laboratory tests, respectively. After propensity score matching, those who had received inadequate care had increased healthcare expenditure change from baseline and more new diabetes related complications in the following year. After adjusting for residual covariate imbalance, those that had received inadequate pharmacologic therapies had approximately 0.20 increased instances of emergency healthcare utilization and 0.10 increase in new diabetes related complications. Those that had received inadequate laboratory tests had 0.26 additional increased instances emergency healthcare utilization. CONCLUSION Inadequate T2D care is an extensive issue that may have substantial economic burden and may lead to increased diabetes related complications. Those who did not receive medications or laboratory tests that were consistent with ADA guidelines had significantly increased emergency healthcare utilization in the following year. These findings highlight the importance of careful monitoring of T2D.
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Affiliation(s)
| | - Shubhada Sansgiry
- Center for Innovations in Quality, Effectiveness and Safety; Michael E. DeBakey Veterans Affairs Medical Center; Baylor College of Medicine, Houston, TX, USA
| | | | - Lincy S Lal
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ekere J Essien
- University of Houston, College of Pharmacy Houston, TX, USA
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