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Bashir M, Thani N, Khalid A, Khalil O, Alamer Z, Hamad M, Karuppasamy G, Abufaeid M, Elbidairi M, Al‐Mohnnadi D, Elhadd T, Zirie M. Insulin Inertia Among People With Type 2 Diabetes Mellitus in Qatar: The INERT-Q Study. Endocrinol Diabetes Metab 2024; 7:e00495. [PMID: 38844642 PMCID: PMC11156521 DOI: 10.1002/edm2.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/23/2024] [Accepted: 05/07/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Achieving and maintaining adequate glycaemic control is critical to reduce diabetes-related complications. Therapeutic inertia is one of the leading causes of suboptimal glycaemic control. AIM To assess the degree of inertia in insulin initiation and intensification in people with Type 2 diabetes mellitus (DM-2). METHODS We performed a retrospective longitudinal cohort study and followed DM-2 2 years before and 2 years after the start of insulin. The primary outcome was the proportion of patients who achieved glycaemic targets (HBA1c ≤ 7.5%) at 6th month, 1st year and 2nd year. RESULTS We included 374 predominantly male subjects (62%). The mean age was 55.3 ± 11.3 years, the mean duration of DM-2 was 12.0 ± 7.3 years, 64.4% were obese, 47.6% had a microvascular disease, and 24.3% had a macrovascular disease. The mean HBA1c at -2nd year and -1st year was 9.2 ± 2.1% and 9.3 ± 2.0%, respectively. The mean HbA1C at the time of insulin initiation was 10.4 ± 2.1%. The mean HBA1c at 6th month, 12th month and 2nd year was 8.5 ± 1.8%, 8.4 ± 1.8% and 8.5 ± 1.7%, respectively. The proportion of subjects who achieved HBA1c targets at 6th month, 12th month and 2nd year was 32.9%, 31.0% and 32.9%, respectively. Multivariate logistic regression analysis showed that achieving HBA1c targets at 6th month and 1st year increases the odds of achieving HBA1c targets at 2nd year (OR 4.87 [2.4-9.6] p < 0.001) and (OR 6.2 [3.2-12.0], p < 0.001), respectively. CONCLUSION In people with DM-2, there was an alarming delay in starting and titrating insulin. The reduction in HBA1c plateaued at 6th month. Earlier initiation and intensification of insulin therapy are critical to achieving glycaemic targets. More studies are needed to examine the causes of therapeutic inertia from physicians', patients' and systems' points of view.
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Affiliation(s)
- Mohammed Bashir
- Endocrine Section, Internal Medicine DepartmentHamad Medical CorporationDohaQatar
- Qatar Metabolic InstitutesHamad Medical CorporationDohaQatar
| | - Noora Al Thani
- Endocrine Section, Internal Medicine DepartmentHamad Medical CorporationDohaQatar
| | - Abeer Khalid
- Endocrine Section, Internal Medicine DepartmentHamad Medical CorporationDohaQatar
| | - Obada Khalil
- Endocrine Section, Internal Medicine DepartmentHamad Medical CorporationDohaQatar
| | - Zaina Alamer
- Endocrine Section, Internal Medicine DepartmentHamad Medical CorporationDohaQatar
| | - Mohammed Khair Hamad
- Endocrine Section, Internal Medicine DepartmentHamad Medical CorporationDohaQatar
| | - Gowri Karuppasamy
- Endocrine Section, Internal Medicine DepartmentHamad Medical CorporationDohaQatar
| | - Mohammed Abufaeid
- Endocrine Section, Internal Medicine DepartmentHamad Medical CorporationDohaQatar
| | | | - Dhabia Al‐Mohnnadi
- Endocrine Section, Internal Medicine DepartmentHamad Medical CorporationDohaQatar
| | - Tarik Elhadd
- Endocrine Section, Internal Medicine DepartmentHamad Medical CorporationDohaQatar
| | - Mahmoud Zirie
- Endocrine Section, Internal Medicine DepartmentHamad Medical CorporationDohaQatar
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Wong SKW, Soon W, Griva K, Smith HE. Diabetes knowledge, self-efficacy and dietary, psychological and physical health barriers: Comparing young and usual-onset type 2 diabetes. Diabet Med 2024; 41:e15207. [PMID: 37597247 DOI: 10.1111/dme.15207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
AIMS Young-onset (21-39 years old) type 2 diabetes (YOD) is associated with high complication rates and glycaemic levels, and poor self-management plays a significant role. Knowledge, skills and barriers influence self-management behaviours considerably. Therefore, this study assessed diabetes knowledge, self-efficacy and barriers (situational dietary barriers, physical health, mental health and diabetes-related distress) between participants with young and usual-onset (40-59 years old) (UOD) diabetes. METHODOLOGY A cross-sectional survey was conducted. Differences between YOD and UOD were analysed using bivariate analysis and effect sizes were estimated with Cohen's d. Differences were further adjusted by demographic factors (gender, ethnicity, marital status, educational level, income level) and diabetes duration. RESULTS A total of 409 (97 YOD, 312 UOD) participants were recruited. Participants with YOD had lower self-efficacy levels (adjusted B = -0.19, CI -0.35 to -0.03) and higher dietary barriers (adjusted B = 3.6, CI 2.1-5.1), lower mental health scores (adjusted B = -3.5, CI -5.7 to -1.4) and higher diabetes-related distress levels (adjusted B = 0.2, CI 0.2-0.4). CONCLUSIONS Our study found that participants with YOD faced more challenges with adapting to life with diabetes when compared with UOD. More effective self-management programmes are needed to support the multifaceted needs of adults with YOD.
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Affiliation(s)
- Sabrina K W Wong
- National Healthcare Group Polyclinics, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Winnie Soon
- National Healthcare Group Polyclinics, Singapore, Singapore
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Kar P. Partha Kar: The time to tackle rising type 2 diabetes is T2DaY. BMJ 2023; 383:2490. [PMID: 37907219 DOI: 10.1136/bmj.p2490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
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Misra S, Ke C, Srinivasan S, Goyal A, Nyriyenda MJ, Florez JC, Khunti K, Magliano DJ, Luk A. Current insights and emerging trends in early-onset type 2 diabetes. Lancet Diabetes Endocrinol 2023; 11:768-782. [PMID: 37708901 DOI: 10.1016/s2213-8587(23)00225-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/01/2023] [Accepted: 07/19/2023] [Indexed: 09/16/2023]
Abstract
Type 2 diabetes diagnosed in childhood or early adulthood is termed early-onset type 2 diabetes. Cases of early-onset type 2 diabetes are increasing rapidly globally, alongside rising obesity. Compared with a diagnosis later in life, an earlier-onset diagnosis carries an unexplained excess risk of microvascular complications, adverse cardiovascular outcomes, and earlier death. Women with early-onset type 2 diabetes also have a higher risk of adverse pregnancy outcomes. The high burden of complications renders individuals with early-onset type 2 diabetes at future risk of multimorbidity and interventions to reverse these concerning trends should be a priority. Within the early-onset cohort, disease pathophysiology and interventions have been better studied in paediatric-onset (<19 years) type 2 diabetes compared to adults; however, young adults aged 19-39 years (a larger number proportionally) are not well characterised and are also invisible in the current evidence base supporting management, which is derived from trials in later-onset type 2 diabetes. Young adults with type 2 diabetes face challenges in self-management that older individuals are less likely to experience (being in education or of working age, higher diabetes distress, and possible obesity-related stigma and diabetes-related stigma). There is a major research gap as to the optimal strategies to deploy in managing type 2 diabetes in adolescents and young adults, given that current models of care appear to not work as well in this age group. In the face of manifold risk factors (obesity, female sex, social deprivation, non-White European ethnicity, and genetic risk factors) prevention strategies with tailored lifestyle interventions, where needed, are likely to have greater success, but more evidence is needed. In this Review, we draw on evidence from both adolescents and young adults to provide a contemporary update on the current insights and emerging trends in early-onset type 2 diabetes.
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Affiliation(s)
- Shivani Misra
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK.
| | - Calvin Ke
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Shylaja Srinivasan
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of California at San Francisco, San Francisco, CA, USA
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Moffat J Nyriyenda
- Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine, Uganda Research Unit, Entebbe, Uganda; London School of Hygiene and Tropical Medicine, London, UK
| | - Jose C Florez
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Programs in Metabolism and Medical and Population Genetics, Broad Institute, Cambridge, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Australia; School of Public Health and Prevention, Monash University Melbourne, Melbourne, Australia
| | - Andrea Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Misra S, Holman N, Barron E, Knighton P, Warner J, Kar P, Young B, Valabhji J. Characteristics and care of young people with type 2 diabetes included in the national diabetes audit datasets for England. Diabet Med 2023; 40:e14940. [PMID: 36054265 PMCID: PMC10087129 DOI: 10.1111/dme.14940] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We report contemporary age-related prevalence, characteristics and care of children and young people with type 2 diabetes in England. METHODS Individuals with a recorded diagnosis of type 2 diabetes between January 2019 and March 2020 were identified from a whole population register. Age, sex, ethnicity, deprivation quintile, weight, HbA1c and receipt of the nine National Institute for Health & Care Excellence (NICE) recommended annual care processes were extracted from electronic clinical records and analysed by pre-specified age bands. RESULTS In total, 122,780 (4.6%) of 2,642,435 individuals in England with type 2 diabetes were aged under 40 years, comprising; 650 (0.5%) under 16 years, 910 (0.7%) aged 16-18 years, 8245 (6.7%) aged 19-25 and 112,975 (92%) aged 26-39 years. Compared to people with type 2 diabetes aged above 40 years, young people were significantly more likely to be from minority ethnic groups: 51% under 16 years, 41% 16-18 years, 38% 19-25 years, 38% 26-39 years, 27% 40-59 years and 15% 60-79 years were of Black or Asian ethnicity. In addition, those aged under 40 years were more likely to be obese, women, to live in the most-deprived socioeconomic areas and less likely to receive the NICE recommended annual care processes or achieve target HbA1c . INTERPRETATION The substantial number of people under 40 years of age with type 2 diabetes, are more likely to have characteristics associated with inequalities and are less likely to achieve HbA1c targets and receive recommended care processes. These findings highlight the need to consider novel approaches to service provision for this high-risk group.
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Affiliation(s)
- Shivani Misra
- National Diabetes Audit Programme, NHS England & Improvement, London, UK
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Clinical Biochemistry, Blood Sciences, Northwest London Pathology, London, UK
| | - Naomi Holman
- National Diabetes Audit Programme, NHS England & Improvement, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Emma Barron
- National Diabetes Audit Programme, NHS England & Improvement, London, UK
- NHS England and NHS Improvement, London, UK
| | - Peter Knighton
- National Diabetes Audit Programme, NHS England & Improvement, London, UK
- Analytical services, Population health, Clinical audit and Specialist Care, NHS Digital, Leeds, UK
| | - Justin Warner
- Dept of Paediatric Endocrinology and Diabetes, Noah's Ark Children's Hospital for Wales, Cardiff, UK
- National Paediatric Diabetes Audit ProgrammeRoyal College of Paediatrics and Child Health (RCPCH), London, UK
| | - Partha Kar
- National Diabetes Audit Programme, NHS England & Improvement, London, UK
- NHS England and NHS Improvement, London, UK
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Bob Young
- National Diabetes Audit Programme, NHS England & Improvement, London, UK
| | - Jonathan Valabhji
- National Diabetes Audit Programme, NHS England & Improvement, London, UK
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- NHS England and NHS Improvement, London, UK
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Oliver N. Fuelling inequality. Diabet Med 2022; 39:e14955. [PMID: 36097327 DOI: 10.1111/dme.14955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
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