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Radley A, Beer L, Rushdi D, Close H, McBurney S, Mackenzie A, Gourlay A, Barnett A, Grant A, Greig N, Dow E, Sutherland C. Implementation of point-of-care HbA1C instruments into community pharmacies: Initial development of a pathway for robust community testing. Ann Clin Biochem 2024; 61:273-283. [PMID: 37996254 PMCID: PMC11337724 DOI: 10.1177/00045632231219380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Point-of-care (POC) analysers in community settings can provide opportunistic and regular HbA1c monitoring. Community pharmacies in NHS Scotland are utilised by populations at greatest risk of type two diabetes (T2D). This study describes initial development of an HbA1c pathway using a POC analyser in community pharmacies. METHODS The Abbott Afinion analyser was compared in (i) NHS Tayside's Blood Sciences Service and (ii) community pharmacies from four Scottish Health Boards. A side by side comparison with standard operating procedures for HbA1c quantification using 80 T2D patient venous samples. The machine was implemented into 11 community pharmacies and 144 samples obtained from patients for comparison to their recent laboratory HbA1c. Four focus groups examined themes around the intervention and an exit questionnaire was administered. RESULTS Laboratory assessment verified the efficacy of the POC test machine. The value for level 1 quality control was 44 mmol/mol and the mean during testing 42.7 mmol/mol. The greatest percent coefficient of variation (cv) was within-run for both levels of quality control material, at a value of 1.63% and 1.62%, respectively. The analyser performed robustly within the pharmacy assessment, with a mean difference of 1.68 and a standard deviation of 0.71 (CV 0.423). Patients with T2D reported positive experiences of using a pharmacy. The focus groups identified an appreciation of the convenience of pharmacies and of the longitudinal relationships with pharmacy staff. CONCLUSION POC HbA1c analysers can be successfully established in community pharmacies. The target patient group responded positively to the opportunity to use a pharmacy service.
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Affiliation(s)
- Andrew Radley
- School of Medicine, University of Dundee, Dundee, UK
| | | | | | | | | | | | - Anna Gourlay
- School of Medicine, University of Dundee, Dundee, UK
| | - Anna Barnett
- NHS Research Scotland, Diabetes Network and School of Medicine, University of Dundee, Dundee, UK
| | | | | | - Ellie Dow
- Blood Sciences, NHS Tayside, Dundee, UK
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Campbell LE, Gomersall SR, Tsiamis M, Goode AD, Healy GN. Understanding diabetes risk in the Y Community of Greater Brisbane: Findings from a cross-sectional survey. Health Promot J Austr 2024. [PMID: 38866388 DOI: 10.1002/hpja.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND This cross-sectional study aimed to understand the need and desire for a diabetes prevention program within the Y (formerly YMCA: Young Men's Christian Association) of the Greater Brisbane region, Queensland, Australia. METHODS An anonymous online survey was distributed (March-April 2023) by The Y Queensland targeting adults within the Greater Brisbane Y community. Data were collected on Y membership and branch attended, postcode, diabetes risk in the next 5 years (low, medium, or high), and interest in participation in a diabetes prevention program. Data were analysed via descriptives and cross tabulation with statistical significance considered at p < .05. RESULTS Respondents (n = 575) were primarily female (65%), attending a Y branch located in the outer city (51%), and aged under 55 years (68%). Twenty Y sites were represented, with a mix of inner-city, outer-city, and regional areas. Overall, 46% (n = 241/530) of respondents were at high diabetes risk, with those living in relatively socio-economically disadvantaged areas more likely (p < .001) to be at high-risk (57%) than intermediate (26%) or low-risk (18%). Most (68%) respondents were interested/potentially interested in program participation; those at high risk of developing diabetes in the next 5 years were most interested (55%). CONCLUSIONS The Y in Greater Brisbane may provide a suitable setting to host a community-based diabetes prevention program. Locations outside the inner city should be prioritised to target those who are relatively socio-economically disadvantaged to align with higher need and demand. SO WHAT?: Findings inform the implementation and prioritisation of a community-delivered diabetes prevention program.
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Affiliation(s)
- Lucy E Campbell
- The University of Queensland, School of Human Movement and Nutrition Sciences, Health and Wellbeing Centre for Research Innovation, Brisbane, Australia
| | - Sjaan R Gomersall
- The University of Queensland, School of Human Movement and Nutrition Sciences, Health and Wellbeing Centre for Research Innovation, Brisbane, Australia
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | | | - Ana D Goode
- The University of Queensland, School of Human Movement and Nutrition Sciences, Health and Wellbeing Centre for Research Innovation, Brisbane, Australia
| | - Genevieve N Healy
- The University of Queensland, School of Human Movement and Nutrition Sciences, Health and Wellbeing Centre for Research Innovation, Brisbane, Australia
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Huque MH, Kootar S, Eramudugolla R, Han SD, Carlson MC, Lopez OL, Bennett DA, Peters R, Anstey KJ. CogDrisk, ANU-ADRI, CAIDE, and LIBRA Risk Scores for Estimating Dementia Risk. JAMA Netw Open 2023; 6:e2331460. [PMID: 37647064 PMCID: PMC10469268 DOI: 10.1001/jamanetworkopen.2023.31460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023] Open
Abstract
Importance While the Australian National University-Alzheimer Disease Risk Index (ANU-ADRI), Cardiovascular Risk Factors, Aging, and Dementia (CAIDE), and Lifestyle for Brain Health (LIBRA) dementia risk tools have been widely used, a large body of new evidence has emerged since their publication. Recently, Cognitive Health and Dementia Risk Index (CogDrisk) and CogDrisk for Alzheimer disease (CogDrisk-AD) risk tools have been developed for the assessment of dementia and AD risk, respectively, using contemporary evidence; comparison of the relative performance of these risk tools is limited. Objective To evaluate the performance of CogDrisk, ANU-ADRI, CAIDE, LIBRA, and modified LIBRA (LIBRA with age and sex estimates from ANU-ADRI) in estimating dementia and AD risks (with CogDrisk-AD and ANU-ADRI). Design, Setting, and Participants This population-based cohort study obtained data from the Rush Memory and Aging Project (MAP), the Cardiovascular Health Study Cognition Study (CHS-CS), and the Health and Retirement Study-Aging, Demographics and Memory Study (HRS-ADAMS). Participants who were free of dementia at baseline were included. The factors were component variables in the risk tools that included self-reported baseline demographics, medical risk factors, and lifestyle habits. The study was conducted between November 2021 and March 2023, and statistical analysis was performed from January to June 2023. Main outcomes and measures Risk scores were calculated based on available factors in each of these cohorts. Area under the receiver operating characteristic curve (AUC) was calculated to measure the performance of each risk score. Multiple imputation was used to assess whether missing data may have affected estimates for dementia risk. Results Among the 6107 participants in 3 validation cohorts included for this study, 2184 participants without dementia at baseline were available from MAP (mean [SD] age, 80.0 [7.6] years; 1606 [73.5%] female), 548 participants without dementia at baseline were available from HRS-ADAMS (mean [SD] age, 79.5 [6.3] years; 288 [52.5%] female), and 3375 participants without dementia at baseline were available from CHS-CS (mean [SD] age, 74.8 [4.9] years; 1994 [59.1%] female). In all 3 cohorts, a similar AUC for dementia was obtained using CogDrisk, ANU-ADRI, and modified LIBRA (MAP cohort: CogDrisk AUC, 0.65 [95% CI, 0.61-0.69]; ANU-ADRI AUC, 0.65 [95% CI, 0.61-0.69]; modified LIBRA AUC, 0.65 [95% CI, 0.61-0.69]; HRS-ADAMS cohort: CogDrisk AUC, 0.75 [95% CI, 0.71-0.79]; ANU-ADRI AUC, 0.74 [95% CI, 0.70-0.78]; modified LIBRA AUC, 0.75 [95% CI, 0.71-0.79]; CHS-CS cohort: CogDrisk AUC, 0.70 [95% CI, 0.67-0.72]; ANU-ADRI AUC, 0.69 [95% CI, 0.66-0.72]; modified LIBRA AUC, 0.70 [95% CI, 0.68-0.73]). The CAIDE and LIBRA also provided similar but lower AUCs than the 3 aforementioned tools (eg, MAP cohort: CAIDE AUC, 0.50 [95% CI, 0.46-0.54]; LIBRA AUC, 0.53 [95% CI, 0.48-0.57]). The performance of CogDrisk-AD and ANU-ADRI in estimating AD risks was also similar. Conclusions and relevance CogDrisk and CogDrisk-AD performed similarly to ANU-ADRI in estimating dementia and AD risks. These results suggest that CogDrisk and CogDrisk-AD, with a greater range of modifiable risk factors compared with other risk tools in this study, may be more informative for risk reduction.
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Affiliation(s)
- Md Hamidul Huque
- School of Psychology, University of New South Wales, Kensington, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- University of New South Wales Ageing Futures Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Scherazad Kootar
- School of Psychology, University of New South Wales, Kensington, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- University of New South Wales Ageing Futures Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Ranmalee Eramudugolla
- School of Psychology, University of New South Wales, Kensington, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- University of New South Wales Ageing Futures Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - S. Duke Han
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Michelle C. Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - Oscar L. Lopez
- Departments of Neurology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Ruth Peters
- The George Institute of Global Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Kaarin J. Anstey
- School of Psychology, University of New South Wales, Kensington, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- University of New South Wales Ageing Futures Institute, University of New South Wales, Kensington, New South Wales, Australia
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Lovell AL, Roy R, Klein A, Cavadino A, Foster M, Krebs JD, Braakhuis A, Merry TL. Habitual Dietary Patterns, Nutrient Intakes, and Adherence to the Mediterranean Diet among New Zealand Adults: The NZ MED Cross-Sectional Study. Nutrients 2023; 15:2663. [PMID: 37375568 DOI: 10.3390/nu15122663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/27/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
There is increasing evidence that adherence to a Mediterranean dietary pattern reduces the incidence of diet-related diseases. To date, the habitual dietary intake of New Zealand (NZ) adults has not been examined in relation to its alignment with a Mediterranean-style dietary pattern. This study aimed to define the habitual dietary patterns, nutrient intakes, and adherence to the Mediterranean Diet in a sample of 1012 NZ adults (86% female, mean age 48 ± 16 years) who had their diabetes risk defined by the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK). Dietary intakes were collected using a validated semi-quantitative NZ food frequency questionnaire, and dietary patterns were identified using principal component analysis. Reported intakes from the FFQ were used in conjunction with the Mediterranean-Style Dietary Pattern Score (MSDPS) to determine adherence to a Mediterranean dietary pattern. Mixed linear models were used to analyze the association between dietary patterns and MSDPS with demographics, health factors, and nutrient intakes. Two distinct dietary patterns were identified: Discretionary (positive loadings on processed meat, meat/poultry, fast food, sweet drinks, and sugar, sweets, and baked good) and Guideline (positive loadings on vegetables, eggs/beans, and fruits). Adherence to dietary patterns and diet quality was associated with age and ethnicity. Dietary patterns were also associated with sex. Adherence to a Mediterranean dietary pattern defined by the MSDPS was low, indicating that a significant shift in food choices will be required if the Mediterranean Diet is to be adopted in the NZ population.
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Affiliation(s)
- Amy L Lovell
- Department of Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1023, New Zealand
- High-Value Nutrition Ko Ngā Kai Whai Painga National Science Challenge, The Liggins Institute, Auckland 1023, New Zealand
| | - Rajshri Roy
- Department of Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1023, New Zealand
- High-Value Nutrition Ko Ngā Kai Whai Painga National Science Challenge, The Liggins Institute, Auckland 1023, New Zealand
| | - Alana Klein
- Department of Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1023, New Zealand
| | - Alana Cavadino
- Department of Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1023, New Zealand
| | - Meika Foster
- High-Value Nutrition Ko Ngā Kai Whai Painga National Science Challenge, The Liggins Institute, Auckland 1023, New Zealand
- Edible Research Ltd., Canterbury 7692, New Zealand
| | - Jeremy D Krebs
- High-Value Nutrition Ko Ngā Kai Whai Painga National Science Challenge, The Liggins Institute, Auckland 1023, New Zealand
- Department of Medicine, University of Otago, Wellington 6242, New Zealand
| | - Andrea Braakhuis
- Department of Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1023, New Zealand
- High-Value Nutrition Ko Ngā Kai Whai Painga National Science Challenge, The Liggins Institute, Auckland 1023, New Zealand
| | - Troy L Merry
- Department of Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1023, New Zealand
- High-Value Nutrition Ko Ngā Kai Whai Painga National Science Challenge, The Liggins Institute, Auckland 1023, New Zealand
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Farag HFM, Elrewany E, Abdel-Aziz BF, Sultan EA. Prevalence and predictors of undiagnosed type 2 diabetes and pre-diabetes among adult Egyptians: a community-based survey. BMC Public Health 2023; 23:949. [PMID: 37231362 DOI: 10.1186/s12889-023-15819-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The global prevalence of abnormal glycemic level comprising diabetes mellitus (DM) and pre-diabetes (PDM) is rapidly increasing with special concern for the entity silent or undiagnosed diabetes; those unaware of their condition. Identification of people at risk became much easier with the use of risk charts than the traditional methods. The current study aimed to conduct a community-based screening for T2DM to estimate the prevalence of undiagnosed DM and to assess the AUSDRISK Arabic version as a predictive tool in an Egyptian context. METHODS A cross-sectional study was conducted among 719 Adults aging 18 years or more and not known to be diabetics through a population-based household survey. Each participant was interviewed to fill demographic and medical data as well as the AUSDRISK Arabic version risk score and undergo testing for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT). RESULTS The prevalence of DM and PDM were 5% and 21.7% respectively. The multivariate analysis revealed that age, being physically inactive, history of previous abnormal glycemic level and waist circumference were the predictors for having abnormal glycemic level among the studied participants. At cut off points ≥ 13 and ≥ 9, the AUSDRISK respectively discriminated DM [sensitivity (86.11%), specificity (73.35%), and area under the curve (AUC): 0.887, 95% CI: 0.824-0.950] and abnormal glycemic level [sensitivity (80.73%), specificity (58.06%), and AUC: 0.767, 95% CI: 0.727-0.807], p < 0.001. CONCLUSIONS Overt DM just occupies the top of an iceberg, its unseen big population have undiagnosed DM, PDM or been at risk of T2DM because of sustained exposure to the influential risk factors. The AUSDRISK Arabic version was proved to be sensitive and specific tool to be used among Egyptians as a screening tool for the detection of DM or abnormal glycemic level. A prominent association has been demonstrated between AUSDRISK Arabic version score and the diabetic status.
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Affiliation(s)
- Hassan Farag Mohamed Farag
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Ehab Elrewany
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Basem Farouk Abdel-Aziz
- Department of Health Administration and Behavioral Sciences, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Eman Anwar Sultan
- Department of Community Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
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Mahmoodzadeh S, Jahani Y, Najafipour H, Sanjari M, Shadkam-Farokhi M, Shahesmaeili A. External Validation of Finnish Diabetes Risk Score and Australian Diabetes Risk Assessment Tool Prediction Models to Identify People with Undiagnosed Type 2 Diabetes: A Cross-sectional Study in Iran. Int J Endocrinol Metab 2022; 20:e127114. [PMID: 36714189 PMCID: PMC9871969 DOI: 10.5812/ijem-127114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Noninvasive risk prediction models have been widely used in various settings to identify individuals with undiagnosed diabetes. OBJECTIVES We aimed to evaluate the discrimination, calibration, and clinical usefulness of the Finnish Diabetes Risk Score (FINDRISC) and Australian Diabetes Risk Assessment (AUSDRISK) to screen undiagnosed diabetes in Kerman, Iran. METHODS We analyzed data from 2014 to 2018 in the second round of the Kerman Coronary Artery Disease Risk Factors Study (KERCADRS), Iran. Participants aged 35 - 65 with no history of confirmed diabetes were eligible. The area under the receiver operating characteristic curve (AUROC) and decision curve analysis were applied to evaluate the discrimination power and clinical usefulness of the models, respectively. The calibration was assessed by the Hosmer-Lemeshow test and the calibration plots. RESULTS Out of 3262 participants, 145 (4.44%) had undiagnosed diabetes. The estimated AUROCs were 0.67 and 0.62 for the AUSDRISK and FINDRISC models, respectively (P < 0.001). The chi-square test results for FINDRISC and AUSDRISC were 7.90 and 16.47 for the original model and 3.69 and 14.61 for the recalibrated model, respectively. Based on the decision curves, useful threshold ranges for the original models of FINDRIS and AUSDRISK were 4% to 10% and 3% to 13%, respectively. Useful thresholds for the recalibrated models of FINDRISC and AUSDRISK were 4% to 8% and 4% to 9%, respectively. CONCLUSIONS The original AUSDRISK model performs better than FINDRISC in identifying patients with undiagnosed diabetes and could be used as a simple and noninvasive tool where access to laboratory facilities is costly or limited.
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Affiliation(s)
- Saeedeh Mahmoodzadeh
- School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Younes Jahani
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Najafipour
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mojgan Sanjari
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mitra Shadkam-Farokhi
- Gastrointestinal and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Corresponding Author: HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Farag HFM, Sultan EA, Elrewany E, Abdel-Aziz BF. Arabic version of the Australian type 2 diabetes risk assessment tool (AUSDRISK): translation and validation. BMC Res Notes 2022; 15:303. [PMID: 36138452 PMCID: PMC9503206 DOI: 10.1186/s13104-022-06200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
Objective The current study aimed to translate the Australian Type 2 Diabetes Risk Assessment tool (AUSDRISK) into the Arabic language and evaluate the reliability and validity of the resultant Arabic version among Egyptians. The AUSDRISK was translated into Arabic language using the World Health Organization (WHO) forward and backward translation protocol. Using the WHO cluster sampling, a sample of 18+ years 719 Egyptians was randomly selected through a population-based household survey. Each participant was interviewed to fill the AUSDRISK Arabic version risk score and undergo confirmatory testing for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT). Test-retest reliability and convergent validity were computed. Results Most of the study participants were physically active (60.5%) and females (69.3%). The Arabic version of the AUSDRISK reflected statistically significant perfect positive correlation (r = 1 and p < 0.01) for test re-test reliability as well as a significant moderate positive correlation with each of FPG (r = 0.48, p < 0.01) and OGTT (r = 0.52, p < 0.01) for the criterion-related (convergent) validity. The recalibrated noninvasive AUSDRISK Arabic version proved to be a simple, reliable, and valid predictive tool, and thereof, its employment for opportunistic mass public screening is strongly recommended. This can reduce diabetes mellitus Type 2disease burden and health expenditure.
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Affiliation(s)
- Hassan Farag Mohamed Farag
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Eman Anwar Sultan
- Department of Community Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ehab Elrewany
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Basem Farouk Abdel-Aziz
- Department of Health Administration and Behavioral Sciences, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
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Mariño R, Priede A, King M, Adams GG, Sicari M, Morgan M. Oral health professionals screening for undiagnosed type-2 diabetes and prediabetes: the iDENTify study. BMC Endocr Disord 2022; 22:183. [PMID: 35850674 PMCID: PMC9294826 DOI: 10.1186/s12902-022-01100-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 07/12/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As part of an evaluation of an oral healthcare practice-based model that identifies patients with prediabetes or type-2 diabetes, this study reports on the proportion of patients identified with clinically confirmed type-2 diabetes (T2D)/prediabetes and barriers of implementation of the model. METHODOLOGY Urban and rural oral healthcare practices were invited to participate. Participating practices invited eligible patients to participate in the screening program using the Australian Type-2 Diabetes Risk Assessment Tool (AUSDRISK). Participants were categorised as low, intermediate, or high-risk for prediabetes/T2D. Patients in the intermediate or high-risk category were referred to their General Medical Practitioner (GP) for further investigation. RESULTS Fifty-one oral healthcare practices and 76 Oral Health Professionals (OHP) participated (60 Dentists, 8 Dental Hygienists, 8 Oral Health Therapists). 797 patients were screened; 102 were low-risk; 331 intermediate-risk; and 364 high-risk for T2D. Of the 695 participants in the intermediate or high-risk groups, 386 (55.5%) were referred to their GP for T2D assessment. Of them, 96 (25.0%) results were returned to OHPs. Of the returned results, six were (6.3%) diagnosed with pre-T2D. CONCLUSION Patients found to have undiagnosed T2D/prediabetes (6.3%) were within the expected range reported in the literature. Findings indicate that identifying individuals at an elevated risk of having or developing T2D is effective, feasible and could be incorporated into oral healthcare settings. However, this integration may require additional OHPs training and education to ensure that patients at elevated risk of T2D are referred for further assessment.
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Affiliation(s)
- Rodrigo Mariño
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
| | - Andre Priede
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
| | - Michelle King
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
| | - Geoffrey G. Adams
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
| | - Maria Sicari
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
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Williams SL, To Q, Vandelanotte C. What is the effectiveness of a personalised video story after an online diabetes risk assessment? A Randomised Controlled Trial. PLoS One 2022; 17:e0264749. [PMID: 35239723 PMCID: PMC8893700 DOI: 10.1371/journal.pone.0264749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 02/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Online risk assessment tools for type 2 diabetes communicate risk information to motivate individuals to take actions and reduce their risk if needed. The impact of these tools on follow-up behaviours (e.g., General Practitioner (GP) visits, improvement in health behaviours) is unknown. This study examined effectiveness of a personalised video story and text-based message on GP and health professional visitations and health behaviours, of individuals assessed as ‘high risk’ following completion of the online Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK). Methods A Randomised Controlled Trial (conducted between October 2018 and April 2019) included 477 participants with a high score (≥12). The control group received a text-based message (TM) and the intervention group received both the text-based message and a personalised video story (TM+VS) encouraging them to take follow-up action. Participants reported follow-up actions (one- and three months), and physical activity (PA), dietary behaviours and body weight (baseline, one and three months). Generalized Linear Mixed Models and chi-squared tests were used to test differences in outcomes between groups over time. Results The intervention was not more effective for the TM+VS group compared to the TM only group (p-values>0.05 for all outcomes). More participants in the TM only group (49.8% compared to 40.0% in the VS+TM group) visited either a GP or health professional (p = 0.18). During the 3-month follow-up: 44.9% of all participants visited a GP (36.7%) and/or other health professional (31.0%). Significant improvements were found between baseline and three months, in both groups for weekly physical activity, daily fruit and vegetable intake and weight status. Conclusions Messages provided with online diabetes risk assessment tools to those with high-risk, positively influence GP and health professional visitations and promote short-term improvements in health behaviours that may contribute to an overall reduction in the development of type 2 diabetes. Trial registration Australia New Zealand Clinical Trials Registry; ACTRN12619000809134.
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Affiliation(s)
- Susan L. Williams
- Central Queensland University, School of Health Medical and Applied Sciences, Physical Activity Research Group, Appleton Institute, Queensland, Australia
- * E-mail:
| | - Quyen To
- Central Queensland University, School of Health Medical and Applied Sciences, Physical Activity Research Group, Appleton Institute, Queensland, Australia
| | - Corneel Vandelanotte
- Central Queensland University, School of Health Medical and Applied Sciences, Physical Activity Research Group, Appleton Institute, Queensland, Australia
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Somerville M, Burch E, Ball L, Williams LT. 'I could have made those changes years earlier': experiences and characteristics associated with receiving a prediabetes diagnosis among individuals recently diagnosed with type 2 diabetes. Fam Pract 2020; 37:382-389. [PMID: 31776562 DOI: 10.1093/fampra/cmz081] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Prediabetes increases the risk of developing type 2 diabetes (T2D). Improving diet quality is key in preventing this progression, yet little is known about the characteristics of individuals with prediabetes or the nutrition care they receive. OBJECTIVES This study aims to identify characteristics and experiences associated with receiving a prediabetes diagnosis prior to developing T2D. METHODS A mixed methods study encompassed a quantitative subanalysis of participants with newly diagnosed T2D from The 3D Study, and semi-structured telephone interviews with a subsample of participants who were previously diagnosed with prediabetes. Interviews were thematically analysed and survey data synthesized using SPSS statistical software. RESULTS Of the 225 study participants, 100 individuals were previously diagnosed with prediabetes and 120 participants were not. Those with prediabetes were less likely to be smokers (P = 0.022) and more likely to be satisfied with seeing a dietitian (P = 0.031) than those without a previous prediabetes diagnosis. A total of 20 participants completed semi-structured interviews. Thematic analysis revealed three themes: (i) experiencing a prediabetes diagnosis; (ii) receiving nutrition care during prediabetes and (iii) reflecting on the experience of receiving care for prediabetes versus T2D. CONCLUSIONS There are gaps in the current management of prediabetes in Australia. Low rates of prediabetes diagnosis and an ambiguous experience of receiving this diagnosis suggest an area of health service improvement. With no difference in diet quality between individuals with and without a previous prediabetes diagnosis, the nutrition care during prediabetes may be more important than the diagnosis itself in delaying the onset of T2D.
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Affiliation(s)
- Mari Somerville
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Emily Burch
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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11
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Cardiovascular Disease and Type 2 Diabetes Risk Across Occupational Groups and Industry in a Statewide Study of an Australian Working Population. J Occup Environ Med 2019; 60:286-294. [PMID: 29135835 DOI: 10.1097/jom.0000000000001228] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to investigate prevalence of type 2 diabetes (diabetes) and cardiovascular disease (CVD) risk in occupational and industry groups in a large, diverse working population. METHODS Five hundred thousand Victorian workers undertook health checks, including lifestyle, anthropometric, and biomedical cardiovascular risk factor assessment. Five-year diabetes (AUSDRISK) and absolute CVD risk were estimated. RESULTS High diabetes and CVD risk was increased in many occupational groups and industries relative to managers and Professional/Scientific/Technical Services, respectively. Significantly more blue-collar workers had high diabetes risk [males prevalence ratio (PR) 1.19 (95% confidence interval, 95% CI 1.17 to 1.20); females 1.34 (95% CI 1.30 to 1.38)], high CVD risk [males 1.45 (95% CI 1.37 to 1.53); females 1.48 (95% CI 1.17 to 1.88], and risk factors including smoking [males 2.26 (95% CI 2.22 to 2.30); females 2.20 (95% CI 2.13 to 2.27)], compared with white-collar workers. CONCLUSION Targeting occupational and industry groups within sustainable workplace programs could assist in reducing chronic diseases, lowering sickness absence, and improving productivity.
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12
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Javaeed A, Lone UM, Sadiq S, Ghauri SK, Wajid Z. Diabetes Risk Assessment Among the City Population in Azad Kashmir: A Cross-sectional Study. Cureus 2019; 11:e4580. [PMID: 31293840 PMCID: PMC6605959 DOI: 10.7759/cureus.4580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the frequency of people at risk of developing diabetes mellitus type 2 (DMT2) and their risk of developing the disease over the next five years, using the Australian type 2 diabetes risk assessment (AUSDRISK) tool. Methods A cross-sectional study was done involving 152 adults; both males and females were randomly selected from city populations in Rawalakot and Muzaffarabad of the Azad Kashmir, irrespective of weight, family history and dietary habits. Patients with the apparent clinical features of DMT2 were excluded from the study. Data were collected over a nine-month period from April 2017 using an interviewer-administered questionnaire based on the AUSDRISK tool. Results Statistical analysis was done using SPSS version 23.0 (IBM, Armonk, NY, USA). Descriptive statistics were used to calculate the frequencies and percentages. Fifty-four (35.5%) participants had a low risk, 88 (57.9%) had an intermediate risk, and 10 (6.6%) had a high risk of developing DMT2 over the next five years. Conclusion Most of the city occupants had an intermediate-to-high risk of developing DMT2 (64.5%) over the next five years.
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Affiliation(s)
| | | | - Saima Sadiq
- Pathology, Poonch Medical College, Rawalakot, PAK
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13
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Owolabi MO, Yaria JO, Daivadanam M, Makanjuola AI, Parker G, Oldenburg B, Vedanthan R, Norris S, Oguntoye AR, Osundina MA, Herasme O, Lakoh S, Ogunjimi LO, Abraham SE, Olowoyo P, Jenkins C, Feng W, Bayona H, Mohan S, Joshi R, Webster R, Kengne AP, Trofor A, Lotrean LM, Praveen D, Zafra-Tanaka JH, Lazo-Porras M, Bobrow K, Riddell MA, Makrilakis K, Manios Y, Ovbiagele B. Gaps in Guidelines for the Management of Diabetes in Low- and Middle-Income Versus High-Income Countries-A Systematic Review. Diabetes Care 2018; 41:1097-1105. [PMID: 29678866 PMCID: PMC5911785 DOI: 10.2337/dc17-1795] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/17/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The extent to which diabetes (DM) practice guidelines, often based on evidence from high-income countries (HIC), can be implemented to improve outcomes in low- and middle-income countries (LMIC) is a critical challenge. We carried out a systematic review to compare type 2 DM guidelines in individual LMIC versus HIC over the past decade to identify aspects that could be improved to facilitate implementation. RESEARCH DESIGN AND METHODS Eligible guidelines were sought from online databases and websites of diabetes associations and ministries of health. Type 2 DM guidelines published between 2006 and 2016 with accessible full publications were included. Each of the 54 eligible guidelines was assessed for compliance with the Institute of Medicine (IOM) standards, coverage of the cardiovascular quadrangle (epidemiologic surveillance, prevention, acute care, and rehabilitation), translatability, and its target audiences. RESULTS Most LMIC guidelines were inadequate in terms of applicability, clarity, and dissemination plan as well as socioeconomic and ethical-legal contextualization. LMIC guidelines targeted mainly health care providers, with only a few including patients (7%), payers (11%), and policy makers (18%) as their target audiences. Compared with HIC guidelines, the spectrum of DM clinical care addressed by LMIC guidelines was narrow. Most guidelines from the LMIC complied with less than half of the IOM standards, with 12% of the LMIC guidelines satisfying at least four IOM criteria as opposed to 60% of the HIC guidelines (P < 0.001). CONCLUSIONS A new approach to the contextualization, content development, and delivery of LMIC guidelines is needed to improve outcomes.
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Affiliation(s)
| | | | - Meena Daivadanam
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | | | | | | | | | - Shane Norris
- University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | | | | | | | - Wuwei Feng
- Medical University of South Carolina, Charleston, SC
| | - Hernán Bayona
- Fundación Santa Fe de Bogotá Hospital, University of the Andes, Bogota, Colombia
| | | | - Rohina Joshi
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Ruth Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Andre P Kengne
- South African Medical Research Council, Cape Town, South Africa
| | - Antigona Trofor
- Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
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14
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Lee CMY, Versace VL, Malo JA, Shaw JE, Dunbar JA, Colagiuri S. Screening for diabetes prevention with diabetes risk scores - A balancing act. Diabetes Res Clin Pract 2018; 135:120-127. [PMID: 29155122 DOI: 10.1016/j.diabres.2017.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022]
Abstract
AIMS To compare the diabetes prevention impact and cost of several screening scenarios for diabetes prevention programs with the scenario which included an oral glucose tolerance test (OGTT). METHODS We included 4864 participants of the Australian Diabetes, Obesity and Lifestyle study who were aged ≥40 years, did not have known diabetes at baseline, and attended the five year follow-up. The proportions of participants eligible or ineligible for diabetes prevention program were estimated for each scenario. The costs of screening and diabetes prevention programs were also estimated. RESULTS Screening with OGTT alone identified 21% of participants as eligible for diabetes prevention. While 3.1% of the cohort were identified as high risk and developed diabetes after five years, 1.0% of the cohort were identified as low risk and developed diabetes. The population prevention potential (i.e. sensitivity) for OGTT alone was 76.5%. Screening all Australian adults aged ≥40 years in 2015 by OGTT would have cost a total of AU$2025 million (AU$1031 million on screening and AU$994 million on prevention programs). The total costs of screening and prevention were substantially lower when AUSDRISK was used alone or in combination with a blood test. However, the population prevention potentials were also lower (ranged from 20.1% to 50.7%). CONCLUSIONS A blood test post non-invasive risk assessment is a worthwhile step in the process of enrolling participants in a diabetes prevention program. Nevertheless, there will be ineligible individuals who proceed to diabetes.
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Affiliation(s)
- Crystal Man Ying Lee
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Level 2 Charles Perkins Centre D17, University of Sydney, NSW 2006, Australia; School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Vincent L Versace
- School of Medicine, Deakin Rural Health, Deakin University, PO Box 423, VIC 3280, Australia
| | - Jonathan A Malo
- Communicable Diseases Branch, Queensland Health, Level 3, 15 Butterfield St, Herston, QLD 4005, Australia; National Centre for Epidemiology and Public Health, Australian National University, Acton, ACT 2601, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC 3004, Australia
| | - James A Dunbar
- Centre for Population Health Research, Deakin University, Melbourne, VIC 3125, Australia
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Level 2 Charles Perkins Centre D17, University of Sydney, NSW 2006, Australia.
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15
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Krass I, Carter R, Mitchell B, Mohebbi M, Shih STF, Trinder P, Versace VL, Wilson F, Namara KM. Pharmacy Diabetes Screening Trial: protocol for a pragmatic cluster-randomised controlled trial to compare three screening methods for undiagnosed type 2 diabetes in Australian community pharmacy. BMJ Open 2017; 7:e017725. [PMID: 29284715 PMCID: PMC5770957 DOI: 10.1136/bmjopen-2017-017725] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/19/2017] [Accepted: 09/28/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION With the rising prevalence of type 2 diabetes in Australia, screening and earlier diagnosis is needed to provide opportunities to intervene with evidence-based lifestyle and treatment options to reduce the individual, social and economic impact of the disease. The objectives of the Pharmacy Diabetes Screening Trial are to compare the clinical effectiveness and cost-effectiveness of three screening models for type 2 diabetes in a previously undiagnosed population. METHODS AND ANALYSIS The Pharmacy Diabetes Screening Trial is a pragmatic cluster randomised controlled trial to be conducted in 363 community pharmacies across metropolitan, regional and remote areas of Australia, randomly allocated by geographical clusters to one of three groups, each with 121 pharmacies and 10 304 screening participants. The three groups are: group A: risk assessment using a validated tool (AUSDRISK); group B: AUSDRISK assessment followed by point-of-care glycated haemoglobin testing; and group C: AUSDRISK assessment followed by point-of-care blood glucose testing. The primary clinical outcome measure is the proportion of newly diagnosed cases of type 2 diabetes. Primary outcome comparisons will be conducted using the Cochran-Mantel-Haenszel test to account for clustering. The secondary clinical outcomes measures are the proportion of those who (1) are referred to the general practitioner (GP), (2) take up referral to the GP, (3) are diagnosed with pre-diabetes, that is, impaired glucose tolerance or impaired fasting glucose and (4) are newly diagnosed with either diabetes or pre-diabetes. The economic outcome measure is the average cost (direct and indirect) per confirmed new case of diagnosed type 2 diabetes based on the incremental net trial-based costs of service delivery and the associated incremental longer term health benefits from a health funder perspective. ETHICS AND DISSEMINATION The protocol has been approved by the Human Research Ethics Committees at University of Sydney and Deakin University. Results will be available on the Sixth Community Pharmacy Agreement website and will be published in peer reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12616001240437; Pre-results.
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Affiliation(s)
- Ines Krass
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Rob Carter
- Deakin Health Economics, Centre for Population Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Bernadette Mitchell
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Mohammadreza Mohebbi
- Biostatistics unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Sophy T F Shih
- Deakin Health Economics, Centre for Population Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Peta Trinder
- School of Medicine, Faculty of Health, Centre for Population Health Research, Deakin University, Burwood, Melbourne, Victoria, Australia
| | - Vincent L Versace
- Deakin University School of MedicineWarrnambool Campus, Deakin University, Warnambool, Victoria, Australia
| | - Frances Wilson
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Kevin Mc Namara
- School of Medicine, Faculty of Health, Centre for Population Health Research, Deakin University, Burwood, Melbourne, Victoria, Australia
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16
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Soo DHE, Pendharkar SA, Jivanji CJ, Gillies NA, Windsor JA, Petrov MS. Derivation and validation of the prediabetes self-assessment screening score after acute pancreatitis (PERSEUS). Dig Liver Dis 2017; 49:1146-1154. [PMID: 28666861 DOI: 10.1016/j.dld.2017.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/21/2017] [Accepted: 05/22/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Approximately 40% of patients develop abnormal glucose metabolism after a single episode of acute pancreatitis. This study aimed to develop and validate a prediabetes self-assessment screening score for patients after acute pancreatitis. METHODS Data from non-overlapping training (n=82) and validation (n=80) cohorts were analysed. Univariate logistic and linear regression identified variables associated with prediabetes after acute pancreatitis. Multivariate logistic regression developed the score, ranging from 0 to 215. The area under the receiver-operating characteristic curve (AUROC), Hosmer-Lemeshow χ2 statistic, and calibration plots were used to assess model discrimination and calibration. The developed score was validated using data from the validation cohort. RESULTS The score had an AUROC of 0.88 (95% CI, 0.80-0.97) and Hosmer-Lemeshow χ2 statistic of 5.75 (p=0.676). Patients with a score of ≥75 had a 94.1% probability of having prediabetes, and were 29 times more likely to have prediabetes than those with a score of <75. The AUROC in the validation cohort was 0.81 (95% CI, 0.70-0.92) and the Hosmer-Lemeshow χ2 statistic was 5.50 (p=0.599). Model calibration of the score showed good calibration in both cohorts. CONCLUSION The developed and validated score, called PERSEUS, is the first instrument to identify individuals who are at high risk of developing abnormal glucose metabolism following an episode of acute pancreatitis.
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Affiliation(s)
- Danielle H E Soo
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Chirag J Jivanji
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nicola A Gillies
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - John A Windsor
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Maxim S Petrov
- Department of Surgery, University of Auckland, Auckland, New Zealand.
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17
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Damschroder LJ, Reardon CM, AuYoung M, Moin T, Datta SK, Sparks JB, Maciejewski ML, Steinle NI, Weinreb JE, Hughes M, Pinault LF, Xiang XM, Billington C, Richardson CR. Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA). Implement Sci 2017; 12:94. [PMID: 28747191 PMCID: PMC5530572 DOI: 10.1186/s13012-017-0619-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background The Diabetes Prevention Program (DPP) is an effective lifestyle intervention to reduce incidence of type 2 diabetes. However, there are gaps in knowledge about how to implement DPP. The aim of this study was to evaluate implementation of DPP via assessment of a clinical demonstration in the Veterans Health Administration (VHA). Methods A 12-month pragmatic clinical trial compared weight outcomes between the Veterans Affairs Diabetes Prevention Program (VA-DPP) and the usual care MOVE!® weight management program (MOVE!). Eligible participants had a body mass index (BMI) ≥30 kg/m2 (or BMI ≥ 25 kg/m2 with one obesity-related condition), prediabetes (glycosylated hemoglobin (HbA1c) 5.7–6.5% or fasting plasma glucose (FPG) 100–125 mg/dL), lived within 60 min of their VA site, and had not participated in a weight management program within the last year. Established evaluation and implementation frameworks were used to guide the implementation evaluation. Implementation barriers and facilitators, delivery fidelity, participant satisfaction, and implementation costs were assessed. Using micro-costing methods, costs for assessment of eligibility and scheduling and maintaining adherence per participant, as well as cost of delivery per session, were also assessed. Results Several barriers and facilitators to Reach, Adoption, Implementation, Effectiveness and Maintenance were identified; barriers related to Reach were the largest challenge encountered by site teams. Fidelity was higher for VA-DPP delivery compared to MOVE! for five of seven domains assessed. Participant satisfaction was high in both programs, but higher in VA-DPP for most items. Based on micro-costing methods, cost of assessment for eligibility was $68/individual assessed, cost of scheduling and maintaining adherence was $328/participant, and cost of delivery was $101/session. Conclusions Multi-faceted strategies are needed to reach targeted participants and successfully implement DPP. Costs for assessing patients for eligibility need to be carefully considered while still maximizing reach to the targeted population.
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Affiliation(s)
- Laura J Damschroder
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA. .,VA Diabetes QUERI, Ann Arbor, MI, USA.
| | - Caitlin M Reardon
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA
| | - Mona AuYoung
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.,Scripps Translational Science Institute/The Scripps Research Institute, 10550 North Torrey Pines Road, Mail Drop: TRY-30, La Jolla, CA, 92037, USA
| | - Tannaz Moin
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd 3, Los Angeles, CA, 90073, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Greater Los Angeles VA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
| | - Santanu K Datta
- Durham VA Medical Center HSR&D, 411 W Chapel Hill St, Suite 600, Durham, NC, 27701, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Jordan B Sparks
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA
| | - Matthew L Maciejewski
- Durham VA Medical Center HSR&D, 411 W Chapel Hill St, Suite 600, Durham, NC, 27701, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Nanette I Steinle
- VA Maryland Healthcare System, 10 North Greene St, Baltimore, MD, 21201, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jane E Weinreb
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd 3, Los Angeles, CA, 90073, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Maria Hughes
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA
| | - Lillian F Pinault
- VA Maryland Healthcare System, 10 North Greene St, Baltimore, MD, 21201, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Xinran M Xiang
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.,Louisiana State University Pediatric Neurology Program, 1542 Tulane Ave Rm 763, New Orleans, LA, 70112, USA
| | - Charles Billington
- Minneapolis VA Healthcare System, 1 Veterans Drive, Minneapolis, MN, 55417, USA.,University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Caroline R Richardson
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.,VA Diabetes QUERI, Ann Arbor, MI, USA.,Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.,University of Michigan Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI, 48104, USA
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