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Yang M, Zhang P, Halladay J, Zou K, Choonara I, Ji X, Zhang S, Yan W, Huang L, Lu X, Wang H, Jiang Y, Liu X, Zeng L, Zhang L, Guyatt GH. Patient-reported outcome measures for medication treatment satisfaction: a systematic review of measure development and measurement properties. BMC Med 2024; 22:347. [PMID: 39218858 PMCID: PMC11367775 DOI: 10.1186/s12916-024-03560-3] [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: 01/13/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Medication Treatment Satisfaction (M-TS) from the patients' perspective is important for comprehensively evaluating the effect of medicines. The extent to which current patient-reported outcome measures (PROMs) for M-TS are valid, reliable, responsive, and interpretable remains unclear. To assess the measurement properties of existing PROMs for M-TS and to highlight research gaps. METHODS Using PubMed, Embase (Ovid), Cochrane library (Ovid), IPA (Ovid), PsycINFO, Patient-Reported Outcome and Quality of Life Questionnaires biomedical databases, and four Chinese databases, we performed a systematic search for studies addressing the development and validation of PROMs for M-TS. Based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guideline, pairs of reviewers independently assessed the measurement properties of the PROMs and rated the quality of evidence on the measurement properties of each PROM. (The Open Science Framework registration: https://doi.org/10.17605/OSF.IO/8S5ZM ). RESULTS This review identified 69 PROMs for M-TS in 114 studies (four generic, 32 disease-specific, and 33 drug-specific) of which 60 were intended for adults. All provided limited or no information regarding interpretability. Most demonstrated appropriate construct validity including convergent validity (39/69) and discriminative or known-groups validity (40/69) (high to moderate quality of evidence). Only a few provided evidence of sufficient content validity (8/69), structural validity (13/69), and internal consistency (11/69). Of 38 PROMs reporting test-retest reliability, results in 24 provided evidence of satisfactory test-retest reliability (18 with high to moderate, 6 with low to very low quality of evidence). Few PROMs reported responsiveness (16/69). Two generic PROMs (Treatment Satisfaction Questionnaire for Medication initial Version 1.4, TSQM-1.4; Treatment Satisfaction with Medicines Questionnaire, SATMED-Q) and one drug-specific PROM (Insulin Treatment Satisfaction Questionnaire, ITSQ) demonstrated both satisfactory validity and reliability. CONCLUSIONS Most existing PROMs for M-TS require further exploration of measurement properties. Reporting guidelines are needed to enhance the reporting quality of the development and validation of PROMs for M-TS.
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Affiliation(s)
- Mengting Yang
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Children's Medicine Key Laboratory of Sichuan Province, Chengdu, China
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Puwen Zhang
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Children's Medicine Key Laboratory of Sichuan Province, Chengdu, China
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jillian Halladay
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Camperdown, NSW, Australia
- Joseph's Healthcare Hamilton (SJHH), Research Institute of St. Joe's Hamilton Mental Health and Addictions Research Program, McMaster University, Hamilton, ON, Canada
| | - Kun Zou
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Children's Medicine Key Laboratory of Sichuan Province, Chengdu, China
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Imti Choonara
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Xiaorui Ji
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Shuya Zhang
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Weiyi Yan
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Liang Huang
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Children's Medicine Key Laboratory of Sichuan Province, Chengdu, China
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xiaoxi Lu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Paediatric Haematology and Oncology, West China Second Hospital, Sichuan University, Chengdu, China
| | - Huiqing Wang
- Medical Simulation Centre, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuxin Jiang
- School of Mathematics, Sichuan University, Chengdu, China
| | - Xinyu Liu
- School of Mathematics, Sichuan University, Chengdu, China
| | - Linan Zeng
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.
- Children's Medicine Key Laboratory of Sichuan Province, Chengdu, China.
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
| | - Lingli Zhang
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.
- Children's Medicine Key Laboratory of Sichuan Province, Chengdu, China.
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Olsen MT, Klarskov CK, Pedersen-Bjergaard U, Hansen KB, Kristensen PL. Summary of clinical investigation plan for The DIATEC trial: in-hospital diabetes management by a diabetes team and continuous glucose monitoring or point of care glucose testing - a randomised controlled trial. BMC Endocr Disord 2024; 24:60. [PMID: 38711112 PMCID: PMC11071255 DOI: 10.1186/s12902-024-01595-4] [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: 07/25/2023] [Accepted: 04/30/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Worldwide, up to 20 % of hospitalised patients have diabetes mellitus. In-hospital dysglycaemia increases patient mortality, morbidity, and length of hospital stay. Improved in-hospital diabetes management strategies are needed. The DIATEC trial investigates the effects of an in-hospital diabetes team and operational insulin titration algorithms based on either continuous glucose monitoring (CGM) data or standard point-of-care (POC) glucose testing. METHODS This is a two-armed, two-site, prospective randomised open-label blinded endpoint (PROBE) trial. We recruit non-critically ill hospitalised general medical and orthopaedic patients with type 2 diabetes treated with basal, prandial, and correctional insulin (N = 166). In both arms, patients are monitored by POC glucose testing and diabetes management is done by ward nurses guided by in-hospital diabetes teams. In one of the arms, patients are monitored in addition to POC glucose testing by telemetric CGM viewed by the in-hospital diabetes teams only. The in-hospital diabetes teams have operational algorithms to titrate insulin in both arms. Outcomes are in-hospital glycaemic and clinical outcomes. DISCUSSION The DIATEC trial will show the glycaemic and clinical effects of in-hospital CGM handled by in-hospital diabetes teams with access to operational insulin titration algorithms in non-critically ill patients with type 2 diabetes. The DIATEC trial seeks to identify which hospitalised patients will benefit from CGM and in-hospital diabetes teams compared to POC glucose testing. This is essential information to optimise the use of healthcare resources before broadly implementing in-hospital CGM and diabetes teams. TRIAL REGISTRATION Prospectively registered at ClinicalTrials.gov with identification number NCT05803473 on March 27th 2023.
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Affiliation(s)
- Mikkel Thor Olsen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.
| | - Carina Kirstine Klarskov
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Bagge Hansen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital - Herlev-Gentofte, Herlev, Denmark
| | - Peter Lommer Kristensen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kozlowska O, Tallett A, Bond S, Mansbridge SE, Aveyard H, Jenkinson C, Dudbridge A, McRobert N, Lumb A, Rea R, Tan GD, Walthall H. Developing and exploring the validity of a patient reported experience measure for adult inpatient diabetes care. Diabet Med 2024; 41:e15266. [PMID: 38150334 DOI: 10.1111/dme.15266] [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: 08/15/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
AIM To develop and explore the validity of a Patient Reported Experience Measure (PREM) for adult inpatient diabetes care. METHOD 27 in-depth interviews were conducted to inform the development of the 42-item PREM which was cognitively tested with 10 people. A refined 38-item PREM was piloted with 228 respondents completing a paper (n = 198) or online (n = 30) version. The performance of the PREM was evaluated by exploring (i) uptake/number of responses and (ii) survey validity by investigating whether the PREM data were of adequate quality and delivered useful information. RESULTS The PREM had low drop-out or missing data rates suggesting it was appropriately constructed. Analysis of item frequencies and variances, and problem score calculations concluded that questions provided sufficient score differentiation. CONCLUSIONS This new PREM allows for experiences of inpatient diabetes care to be measured, understood and reported on to help identify priority areas for improving care quality.
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Affiliation(s)
- Olga Kozlowska
- Oxford Institute of Applied Health Research, Oxford Brookes University, Oxford, UK
| | | | - Samuel Bond
- Oxford Institute of Applied Health Research, Oxford Brookes University, Oxford, UK
| | - Sarah E Mansbridge
- Oxford Institute of Applied Health Research, Oxford Brookes University, Oxford, UK
| | - Helen Aveyard
- Oxford Institute of Applied Health Research, Oxford Brookes University, Oxford, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Nicky McRobert
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alistair Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Garry D Tan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Helen Walthall
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Dunne F, Newman C, Devane D, Smyth A, Alvarez-Iglesias A, Gillespie P, Browne M, O'Donnell M. A randomised placebo-controlled trial of the effectiveness of early metformin in addition to usual care in the reduction of gestational diabetes mellitus effects (EMERGE): study protocol. Trials 2022; 23:795. [PMID: 36131291 PMCID: PMC9494837 DOI: 10.1186/s13063-022-06694-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/26/2022] [Indexed: 11/12/2022] Open
Abstract
Background Pregnancies affected by gestational diabetes mellitus (GDM) are associated with an increased risk of adverse maternal and foetal outcomes. Current treatments for GDM involve initial medical nutritional therapy (MNT) and exercise and pharmacotherapy in those with persistent hyperglycaemia. Insulin is considered first-line pharmacotherapy but is associated with hypoglycaemia, excessive gestational weight gain (GWG) and an increased caesarean delivery rate. Metformin is safe in selected groups of women with GDM but is not first-line therapy in many guidelines due to a lack of long-term data on efficacy. The EMERGE trial will evaluate the effectiveness of early initiation of metformin in GDM. Methods EMERGE is a phase III, superiority, parallel, 1:1 randomised, double-blind, placebo-controlled trial comparing the effectiveness of metformin versus placebo initiated by 28 weeks (+6 days) plus usual care. Women aged 18–50 years will be recruited. Women with established diabetes, multiple pregnancies, known major congenital malformation or small for gestational age (<10th centile), intolerance or contraindication to the use of metformin, shock or sepsis, current gestational hypertension or pre-eclampsia, significant gastrointestinal problems, congestive heart failure, severe mental illness or galactose intolerance are excluded. Intervention Immediate introduction of metformin or placebo in addition to MNT and usual care. Metformin is initiated at 500mg/day and titrated to a maximum dose of 2500mg over 10 days. Women are followed up at 4 and 12 weeks post-partum to assess maternal and neonatal outcomes. The composite primary outcome measure is initiation of insulin or fasting blood glucose ≥ 5.1 mmol/L at gestational weeks 32 or 38. The secondary outcomes are the time to insulin initiation and insulin dose required; maternal morbidity at delivery; mode and time of delivery; postpartum glucose status; insulin resistance; postpartum body mass index (BMI); gestational weight gain; infant birth weight; neonatal height and head circumference at delivery; neonatal morbidities (neonatal care unit admission, respiratory distress, jaundice, congenital anomalies, Apgar score); neonatal hypoglycaemia; cost-effectiveness; treatment acceptability and quality of life determined by the EQ5D-5L scale. Discussion The EMERGE trial will determine the effectiveness and safety of early and routine use of metformin in GDM. Trial registration EudraCT Number 2016-001644-19l; NCT NCT02980276. Registered on 6 June 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06694-y.
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Affiliation(s)
- F Dunne
- Department of Medicine, HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.
| | - C Newman
- Department of Medicine, HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - D Devane
- HRB-Trials Methodology Research Network, National University of Ireland Galway, Galway, Ireland.,School of Nursing and Midwifery, National University of Ireland, Galway, Ireland.,Evidence Synthesis Ireland, National University of Ireland Galway, Galway, Ireland.,Cochrane Ireland, National University of Ireland Galway, Galway, Ireland
| | - A Smyth
- Department of Medicine, HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - A Alvarez-Iglesias
- Department of Medicine, HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - P Gillespie
- Health Economics & Policy Analysis Centre (HEPAC), Institute for Lifecourse and Society (ILAS), National University of Ireland Galway, Galway, Ireland.,CÚRAM, the SFI Research Centre for Medical Devices (12/RC/2073_2), National University of Ireland Galway, Galway, Ireland
| | - M Browne
- Department of Medicine, HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - M O'Donnell
- Department of Medicine, HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
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5
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Akiboye F, Sihre HK, Al Mulhem M, Rayman G, Nirantharakumar K, Adderley NJ. Impact of diabetes specialist nurses on inpatient care: A systematic review. Diabet Med 2021; 38:e14573. [PMID: 33783872 DOI: 10.1111/dme.14573] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/07/2021] [Accepted: 03/27/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND People with diabetes have longer hospital stays and poorer clinical outcomes. Diabetes inpatient specialist nurses have been introduced to improve care. AIMS To assess the evidence for the benefit of diabetes specialist nurses in the inpatient setting. METHODS A systematic search of MEDLINE (ovid), Embase (ovid), CINAHL (EBSCO) and Web of Science core collection from January 1998 to September 2019 was performed using key terms for diabetes specialist nurses and hospital setting. Studies measuring patient care using any standardised or validated outcome measures after introduction of a dedicated diabetes specialist nurse or nursing team were eligible for inclusion and findings reported by narrative synthesis. RESULTS There were 10 studies which met the inclusion criteria. One was a randomised controlled study and the remaining nine studies were before and after studies with three of them using a time series analysis methodology. The majority reported length of stay (LOS) and showed a reduction in median LOS by between 0.5 and 3 days. Reductions in bed occupancy ranged from 39% to 47%. There was a paucity of evidence for outcomes related to patient care with some measures limited to single studies. These included a 52% reduction in total drug errors, improved patient knowledge, higher patient satisfaction and improved glycaemic control post-discharge. There was no reduction of mortality observed. CONCLUSIONS These studies suggest a reduction in LOS and improved clinical care for patients with diabetes after the introduction of diabetes inpatient specialist nurses. Future research should examine a range of benefits associated with diabetes inpatient specialist nurse delivered services, including reduction of inpatient complications such as infections and cardiovascular events.
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Affiliation(s)
- Funke Akiboye
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Harpreet K Sihre
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Munerah Al Mulhem
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Gerry Rayman
- Diabetes Centre and Diabetes Research Unit, Ipswich Hospital, Ipswich, UK
| | | | - Nicola J Adderley
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
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Gerards MC, Venema GE, Patberg KW, Kross M, Potter van Loon BJ, Hageman IMG, Snijders D, Brandjes DP, Hoekstra JBL, Vriesendorp TM, Gerdes VEA. Dapagliflozin for prednisone-induced hyperglycaemia in acute exacerbation of chronic obstructive pulmonary disease. Diabetes Obes Metab 2018; 20:1306-1310. [PMID: 29316157 PMCID: PMC5947126 DOI: 10.1111/dom.13209] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/28/2017] [Accepted: 12/31/2017] [Indexed: 01/13/2023]
Abstract
The aim of the present study was to compare the effectiveness and safety of add-on treatment with dapagliflozin to placebo in patients with prednisone-induced hyperglycaemia during treatment for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We enrolled 46 patients hospitalized for an AECOPD in a multicentre double-blind randomized controlled study in which add-on treatment with dapagliflozin 10 mg was compared with placebo. Glycaemic control and incidence of hypoglycaemia were measured through a blinded subcutaneous continuous glucose monitoring device. Participants in the dapagliflozin group spent 54 ± 27.7% of the time in target range (3.9-10 mmol/L) and participants in the placebo group spent 53.6 ± 23.4% of the time in target range (P = .96). The mean glucose concentration was 10.1 mmol/L in the dapagliflozin group and 10.4 mmol/L in the placebo group (P = .66). One participant using dapagliflozin and 2 participants using placebo experienced symptomatic hypoglycaemia. Treatment with dapagliflozin was safe and there was no difference in risk of hypoglycaemia compared with placebo. Dapagliflozin did not result in better glycaemic control compared with placebo in participants with prednisone-induced hyperglycaemia during AECOPD.
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Affiliation(s)
- Maaike C. Gerards
- Department of Internal MedicineMC SlotervaartAmsterdamThe Netherlands
| | | | | | - Martijn Kross
- Department of PulmonologyMC SlotervaartAmsterdamThe Netherlands
| | | | | | - Dominic Snijders
- Department of PulmonologySpaarne GasthuisHoofddorpThe Netherlands
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Garg R, Schuman B, Hurwitz S, Metzger C, Bhandari S. Safety and efficacy of saxagliptin for glycemic control in non-critically ill hospitalized patients. BMJ Open Diabetes Res Care 2017; 5:e000394. [PMID: 28405346 PMCID: PMC5372055 DOI: 10.1136/bmjdrc-2017-000394] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/02/2017] [Accepted: 03/09/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate whether saxagliptin is non-inferior to basal-bolus insulin therapy for glycemic control in patients with controlled type 2 diabetes mellitus (T2DM) admitted to hospital with non-critical illnesses. RESEARCH DESIGN AND METHODS This was an open-label, randomized controlled clinical trial. Patients received either saxagliptin or basal-bolus insulin, both with correctional insulin doses. The main study outcome was the mean daily blood glucose (BG) after the first day of randomization. RESULTS Of 66 patients completing the study, 33 (age 69±10 years, 40% men) were randomized to saxagliptin and 33 (age 67±10 years, 52% men) to basal-bolus insulin therapy. The mean daily BG was 149.8±22.0 mg/dL in the saxagliptin group and 146.9±30.5 mg/dL in the insulin group (p=0.59). With an observed group difference of 2.9 mg/dL and an a priori margin of 20 mg/dL, inferiority of saxagliptin was rejected in favor of non-inferiority (p=0.007). There was no significant difference in the percentage of high or low BG values. The insulin group received a higher number of insulin injections (2.3±1.7/day vs 1.2±1.9/day; p<0.001) as well as a higher daily insulin dose (13.3±12.9 units/day vs 2.4±3.3 units/day; p<0.001) than did the saxagliptin group. Continuous BG monitoring showed that glycemic variability was lower in the saxagliptin group as compared to the insulin group. Patient satisfaction scores were similar in the two groups. CONCLUSIONS We conclude that saxagliptin use is non-inferior to basal-bolus insulin in non-critically ill hospitalized patients with T2DM controlled on 0-2 oral agents without insulin. Saxagliptin use may decrease glycemic variability in these patients. TRIAL REGISTRATION NUMBER NCT02182895.
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Affiliation(s)
- Rajesh Garg
- Division of Endocrinology, Diabetes, and Hypertension , Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts , USA
| | - Brooke Schuman
- Division of Endocrinology, Diabetes, and Hypertension , Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts , USA
| | - Shelley Hurwitz
- Division of Endocrinology, Diabetes, and Hypertension , Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts , USA
| | - Cheyenne Metzger
- Division of Endocrinology, Diabetes, and Hypertension , Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts , USA
| | - Shreya Bhandari
- Division of Endocrinology, Diabetes, and Hypertension , Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts , USA
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Bourion-Bédès S, Schwan R, Di Patrizio P, Vlamynck G, Viennet S, Schvartz M, Gaunard A, Bédès A, Clerc-Urmès I, Baumann C. The effects of patient and physician characteristics on early outpatient satisfaction with substance dependence care: results of the SUBUSQOL study. Patient Prefer Adherence 2017; 11:887-896. [PMID: 28507432 PMCID: PMC5428790 DOI: 10.2147/ppa.s134242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Although patient perceptions of health care have increasingly been explored in the literature, little is known about care satisfaction among individuals with substance dependence. This exploratory study assessed the relationships between patient and physician characteristics and early outpatient satisfaction with care for alcohol and opioid dependence. METHODS Satisfaction was assessed using a multidimensional, self-administered and validated questionnaire during the early care process among a prospective outpatient cohort. In addition to measuring satisfaction and obtaining sociodemographic and clinical data, this study collected data on the self-reported health status and physician characteristics at inclusion. Cross-sectional analysis with multiple linear regression was performed to identify the variables associated with satisfaction level. RESULTS A total of 249 outpatients were included, and 63.8% completed the satisfaction questionnaire. Patients without a history of previous care for substance dependence were more satisfied with the appointment-making process (β=7.2; P=0.029) and with the doctor consultation (β=10.3; P=0.003) than those who had received care previously. Neither sociodemographic characteristics nor self-reported health status was associated with outpatient satisfaction. CONCLUSION The factors that affect patients' ratings of early satisfaction with the care that they receive should be studied further because increased understanding of the factors that negatively affect these ratings might enable caregivers and outpatient management facilities to improve the patient experience during the early stages of care, which might in turn improve treatment adherence, continuity of care, and other health-related outcomes.
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Affiliation(s)
- Stéphanie Bourion-Bédès
- Regional Medical and Psychological Service (SMPR)
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
- EA4360 APEMAC, University of Lorraine, Nancy
- Correspondence: Stéphanie Bourion-Bédès, Service Médico-Psychologique Régional, 1 Rue Seulhotte, 57 073 Metz, France, Tel +33 3 87 38 51 05, Fax +33 3 87 38 51 09, Email
| | - Raymund Schwan
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
| | - Paolo Di Patrizio
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
| | - Guillaume Vlamynck
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
| | - Sarah Viennet
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
| | - Maxime Schvartz
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
| | - Anne Gaunard
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
| | - Alex Bédès
- ANPAA 15-CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), Saint-Flour, Cantal
| | - Isabelle Clerc-Urmès
- Platform of Clinical Research Facility PARC, Unit MDS, University Hospital of Nancy, Nancy, France
| | - Cédric Baumann
- EA4360 APEMAC, University of Lorraine, Nancy
- Platform of Clinical Research Facility PARC, Unit MDS, University Hospital of Nancy, Nancy, France
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Hommel I, van Gurp PJ, Tack CJ, Liefers J, Mulder J, Wollersheim H, Hulscher MEJL. Perioperative diabetes care: room for improving the person centredness. Diabet Med 2015; 32:561-8. [PMID: 25308875 DOI: 10.1111/dme.12600] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/07/2014] [Accepted: 10/06/2014] [Indexed: 01/26/2023]
Abstract
AIMS Person centredness is an important principle for delivering high-quality diabetes care. In this study, we assess the level of person centredness of current perioperative diabetes care. METHODS We conducted a survey in six Dutch hospitals, among 690 participants with diabetes who underwent major abdominal, cardiac or large-joint orthopaedic surgery. The survey included questions regarding seven dimensions of person-centred perioperative diabetes care. RESULTS Complete data were obtained from 298 participants. The survey scores were low for many of the dimensions of person centredness. The dimensions 'information', 'patient involvement' and 'coordination and integration of care' had the lowest scores. Only half the participants had received information about perioperative diabetes treatment, and approximately one-third had received information about the effect of surgery on blood glucose values, target glucose values and glucose measurement times. Similarly, half the participants had an opportunity to ask questions preoperatively, and only one-third of the participants felt involved in the decision-making regarding diabetes treatment. Most participants knew neither the caregiver in charge of perioperative diabetes treatment nor whom to contact in case of diabetes-related problems during their hospital stay. CONCLUSIONS Current perioperative diabetes care is characterized by a lack of patient information and limited patient involvement. These results indicate that there is ample room for improving the person centredness of perioperative diabetes care.
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Affiliation(s)
- I Hommel
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Korytkowski MT, Koerbel GL, Kotagal L, Donihi A, DiNardo MM. Pilot trial of diabetes self-management education in the hospital setting. Prim Care Diabetes 2014; 8:187-194. [PMID: 24387916 DOI: 10.1016/j.pcd.2013.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/26/2013] [Accepted: 11/29/2013] [Indexed: 01/04/2023]
Abstract
AIMS Diabetes self-management education (DSME) is recommended for all patients with diabetes. Current estimates indicate that <50% of patients receive DSME, increasing risk for hospitalization which occurs more frequently with diabetes. Hospitalization presents opportunities to provide DSME, potentially decreasing readmissions. To address this, we investigated the feasibility of providing DSME to inpatients with diabetes. METHODS Patients hospitalized on four medicine units were randomized to receive DSME (Education Group) (n=9) prescribed by a certified diabetes educator and delivered by a registered nurse, or Usual Care (n=12). Participants completed Diabetes Knowledge Tests (DKT), Medical Outcomes Short Form (SF-36), Diabetes Treatment Satisfaction Questionnaire (DTSQ), and the DTSQ-inpatient (DTSQ-IP). Bedside capillary blood glucoses (CBG) on day of admission, randomization and discharge were compared. RESULTS There were no group differences in demographics, diabetes treatment, admission CBG (186±93 mg/dL vs. 219±84 mg/dL, p=0.40), DKT scores (Education vs. Usual Care 48±25 vs. 68±19, p=0.09), SF-36, and DTSQ scores (28±6 vs. 25±7, p=0.41). Patients receiving education reported more satisfaction with inpatient treatment (83±13 vs. 65±19, p=0.03), less hyperglycemia prior to (2.7±4.5 vs. 4.5±1.4, p=0.03) and during hospitalization (3.9±1.9 vs. 5.5±1.2, p=0.04); and had lower mean discharge CBG (159±38 mg/dL vs. 211±67 mg/dL, p=0.02). CONCLUSIONS Inpatient diabetes education has potential to improve treatment satisfaction, and reduce CBG.
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Affiliation(s)
- Mary T Korytkowski
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Glory L Koerbel
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lindsey Kotagal
- School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amy Donihi
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, United States
| | - Monica M DiNardo
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
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Dungan KM, Sagrilla C, Abdel-Rasoul M, Osei K. Prandial insulin dosing using the carbohydrate counting technique in hospitalized patients with type 2 diabetes. Diabetes Care 2013; 36:3476-82. [PMID: 24062326 PMCID: PMC3816892 DOI: 10.2337/dc13-0121] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare a modified fixed meal dosing strategy to flexible meal dosing in hospitalized patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Patients (N = 126) with refractory hyperglycemia or requiring at least 20 units of insulin per day were randomly assigned to fixed meal dosing (including withholding the dose if less than half of the meal tray was consumed) or flexible meal dosing based upon carbohydrate intake. The inpatient diabetes management team made all treatment adjustments. Outcomes included day 3 mean glucose, 72-h glucose trend analysis, hypoglycemia (<3.9 mmol/L), and inpatient diabetes treatment satisfaction. RESULTS The mean glucose on day 3 was 9.5 and 8.8 mmol/L in the fixed and flexible meal groups, respectively (P = 0.26). The frequency of hypoglycemia was 23 and 39% overall in the fixed and flexible meal groups (P = 0.08), with half of events occurring in the morning. There was a wide range of carbohydrate intake (median 51 g/meal, 10-90% range 26-72 g on day 3). The fixed dose group required significantly more prandial insulin overall and more correction insulin over time. There was no difference in composite treatment satisfaction or dosing miscalculations between groups. CONCLUSIONS A fixed meal dosing strategy provided similar glucose control as flexible meal dosing, when managed by an inpatient diabetes treatment team. However, a larger sample size would be needed to definitively evaluate a treatment effect of flexible meal dosing in the hospital. Further study is needed to improve the delivery of bolus insulin in hospitalized patients.
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Rutter CL, Jones C, Dhatariya KK, James J, Irvine L, Wilson ECF, Singh H, Walden E, Holland R, Harvey I, Bradley C, Sampson MJ. Determining in-patient diabetes treatment satisfaction in the UK--the DIPSat study. Diabet Med 2013; 30:731-8. [PMID: 23350704 DOI: 10.1111/dme.12095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/07/2012] [Accepted: 12/04/2012] [Indexed: 01/26/2023]
Abstract
AIMS To measure in-patient diabetes treatment satisfaction and its relationship to in-patient diabetes care. METHODS In a cross-sectional study, diabetes in-patient specialist nurses at 58 UK hospitals asked insulin-treated in-patients with diabetes to complete the recently updated Diabetes Treatment Satisfaction Questionnaire for In-patients and a general questionnaire; 1319 in-patients completed these questionnaires. RESULTS Satisfaction with the general diabetes treatment items in the Diabetes Treatment Satisfaction Questionnaire for In-patients was high, but there were high levels of extreme dissatisfaction with meal choices, meal quality and lack of similarity of hospital meals to normal domestic choices--23% would never or rarely have made similar meal choices at home. Hyperglycaemia or hypoglycaemia was reported for much of the in-patient stay (20% and 7%, respectively) and 26% reported at least one severe hypoglycaemic episode; these groups had lower satisfaction with the timing of medication in relation to meals (P < 0.003). More frequent in-patient hyperglycaemia or hypoglycaemia were associated with significantly poorer overall satisfaction scores and negative well-being scores (both P < 0.0001). Previous experience of a multiple daily insulin injection regimen was associated with more dissatisfaction than other regimens (P < 0.01). Multiple regression models explained 36% of variability in overall treatment satisfaction, with most (22.4%) accounted for by satisfaction with time spent with a diabetes in-patient specialist nurse (P < 0.0001). Self-administration of insulin was independently associated with higher treatment satisfaction (P < 0.006) in this model. CONCLUSIONS The DIPSat programme describes the complex relationships between diabetes in-patient treatment satisfaction and in-patient diabetes care.
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Affiliation(s)
- C L Rutter
- Health Psychology Research Unit, Royal Holloway, University of London, Egham, UK
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Davies M, Speight J. Patient-reported outcomes in trials of incretin-based therapies in patients with type 2 diabetes mellitus. Diabetes Obes Metab 2012; 14:882-92. [PMID: 22420869 DOI: 10.1111/j.1463-1326.2012.01595.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Incretin-based therapies have a glucose-dependent mode of action that results in excellent glucose-lowering efficacy with very low risk of hypoglycaemia, and weight neutrality [dipeptidyl peptidase-4 (DPP-4) inhibitors] or weight loss [glucagon-like peptide-1 (GLP-1) receptor agonists], in people with type 2 diabetes mellitus (T2DM). Patient-reported outcomes (PROs) complement physician evaluations of efficacy and tolerability and offer insights into the subjective experience of using modern diabetes treatments. We conducted a systematic search of clinical trials of the GLP-1 receptor agonists liraglutide, exenatide and long-acting exenatide, one of which included the oral DPP-4 inhibitor sitagliptin as a comparator. No other PRO data for DPP-4 inhibitors were identified. This review summarizes PRO data from eight clinical trials, the majority of which used the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and/or Impact of Weight on Quality of Life-Lite (IWQOL-Lite) to evaluate patient experience. People with T2DM were highly satisfied with modern incretin-based therapies compared with traditional therapies. Treatment satisfaction (including perceptions of convenience and flexibility) was high and generally higher with GLP-1 agonists in association with their greater glucose-lowering efficacy and tendency to facilitate weight loss. Weight-related quality of life (QoL) also improved in people using incretin therapies. The glycaemic improvements achieved with GLP-1 receptor agonists, coupled with the low incidence of hypoglycaemia and ability to cause weight loss, seemed to offset potential concern about injections. It is plausible that superior patient-reported benefits found in clinical trials may translate into improved, clinically meaningful, long-term outcomes through increased treatment acceptability. Long-term, prospective data are needed to ascertain whether this is the case in practice.
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Affiliation(s)
- M Davies
- Department of Cardiovascular Sciences, University of Leicester, UK.
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Ishii H, Oda E. Reproducibility and validity of a satisfaction questionnaire on hypoglycemic agents: the Oral Hypoglycemic Agent Questionnaire (OHA-Q). Diabetol Int 2012. [DOI: 10.1007/s13340-012-0074-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
PURPOSE/OBJECTIVES The purpose of this integrative review is to examine the effectiveness of case management for improving health outcomes in patients with diabetes mellitus as found in the literature from 2000 to 2010. PRIMARY PRACTICE SETTING Diabetes case management in health care settings. FINDINGS/CONCLUSIONS Case management is an effective intervention for glycemic control and is cost-effective. Evidence is building for its use in primary care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Case management can be an important intervention for diabetes care in primary care and community settings. With evidence at the level of rigor of randomized controlled trials, case management significantly improved biophysiological, psychosocial, preventive, and adherence outcomes. Thus, case management can be an important aspect of effectiveness in health care services delivery within a reconfigured delivery system.
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Dhatariya K. Enteral feeding and keeping glucose levels at target. PRACTICAL DIABETES 2012. [DOI: 10.1002/pdi.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Daultrey H, Gooday C, Dhatariya K. Increased length of inpatient stay and poor clinical coding: audit of patients with diabetes. JRSM SHORT REPORTS 2011; 2:83. [PMID: 22140609 PMCID: PMC3227384 DOI: 10.1258/shorts.2011.011100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives People with diabetes stay in hospital for longer than those without diabetes for similar conditions. Clinical coding is poor across all specialties. Inpatients with diabetes often have unrecognized foot problems. We wanted to look at the relationships between these factors. Design A single day audit, looking at the prevalence of diabetes in all adult inpatients. Also looking at their feet to find out how many were high-risk or had existing problems. Setting A 998-bed university teaching hospital. Participants All adult inpatients. Main outcome measures (a) To see if patients with diabetes and foot problems were in hospital for longer than the national average length of stay compared with national data; (b) to see if there were people in hospital with acute foot problems who were not known to the specialist diabetic foot team; and (c) to assess the accuracy of clinical coding. Results We identified 110 people with diabetes. However, discharge coding data for inpatients on that day showed 119 people with diabetes. Length of stay (LOS) was substantially higher for those with diabetes compared to those without (± SD) at 22.39 (22.26) days, vs. 11.68 (6.46) (P < 0.001). Finally, clinical coding was poor with some people who had been identified as having diabetes on the audit, who were not coded as such on discharge. Conclusion Clinical coding – which is dependent on discharge summaries – poorly reflects diagnoses. Additionally, length of stay is significantly longer than previous estimates. The discrepancy between coding and diagnosis needs addressing by increasing the levels of awareness and education of coders and physicians. We suggest that our data be used by healthcare planners when deciding on future tariffs.
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Affiliation(s)
- Harriet Daultrey
- Norwich Medical School, University of East Anglia , Norwich, Norfolk , UK
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