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Tuohy CA, Liziewski KE, White PA, Wright WL. Evaluating adherence to American Diabetes Association standards of care in diabetes and impacts of social determinants of health on patients at two nurse practitioner-owned clinics. J Am Assoc Nurse Pract 2024; 36:399-408. [PMID: 38771202 DOI: 10.1097/jxx.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/08/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The COVID-19 pandemic created barriers in the management of type 2 diabetes mellitus (T2DM) and worsened social determinants of health (SDOH). A New Hampshire primary care office worked to adhere to T2DM standards of care and began screening for SDOH. This project assessed adherence to quality metrics, hemoglobin A1C, and SDOH screening as telehealth utilization decreased. LOCAL PROBLEM A1C values have increased at the practice, especially since COVID-19. The practice also began screening for SDOH at every visit, but there was need to assess how needs were being documented and if/how they were addressed. METHODS A retrospective chart review of patients with T2DM was performed. Demographic data and T2DM metrics were collected and compared with previous years and compared new versus established patients. Charts were reviewed to evaluate documentation of SDOH and appropriate referral. INTERVENTIONS The practice transitioned from an increased utliization of telehealth back to prioritizing in-office visits. The practice also began routinely screening for SDOH in 2020; however, this process had not been standardized or evaluated. RESULTS Adherence to nearly all quality metrics improved. Glycemic control improved after a year of nurse practitioner (NP) care, especially in new patients. All patients were screened for SDOH, but documentation varied, and affected patients had higher A1Cs, despite receiving comparable care. CONCLUSION Nurse practitioners at this practice are adhering to American Diabetes Association guidelines, and A1C values improve under their care. Social determinants of health continue to act as unique barriers that keep patients from improving glycemic control, highlighting the need for individualized treatment of SDOH in T2DM care.
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Affiliation(s)
- Christine A Tuohy
- Wright & Associates Family Healthcare, Amherst, New Hampshire
- Wright & Associates Family Healthcare, Concord, New Hampshire
- Tan Chingfen Graduate School of Nursing, University of Massachusetts (UMass) Chan Medical School, Worcester, Massachusetts
| | - Kathryn E Liziewski
- Tan Chingfen Graduate School of Nursing, University of Massachusetts (UMass) Chan Medical School, Worcester, Massachusetts
- Beth Israel Lahey Health Primary Care, Lexington, Massachusetts
| | - Patricia A White
- Tan Chingfen Graduate School of Nursing, University of Massachusetts (UMass) Chan Medical School, Worcester, Massachusetts
| | - Wendy L Wright
- Wright & Associates Family Healthcare, Amherst, New Hampshire
- Wright & Associates Family Healthcare, Concord, New Hampshire
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Ma L, Diaz J, Deconde J, Wong M, Ruo B. Type 2 diabetes-related health measures during the initial COVID-19 surge at an academic internal medicine practice. Prim Care Diabetes 2024; 18:246-247. [PMID: 38278669 DOI: 10.1016/j.pcd.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 12/28/2023] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
The COVID-19 pandemic disrupted chronic disease management in the United States and across the world. This study reports minimal effects of the initial COVID-19 surge on body mass index, blood pressure, cholesterol, and blood glucose control in ambulatory general internal medicine patients with Type 2 diabetes at a single academic center.
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Affiliation(s)
- Lawrence Ma
- University of California, San Diego, School of Medicine, Department of Medicine.
| | - Joseph Diaz
- University of California, San Diego, School of Medicine, Department of Medicine
| | - Jennifer Deconde
- University of California, San Diego, School of Medicine, Department of Medicine
| | - Melissa Wong
- University of California, San Diego, School of Medicine, Department of Medicine
| | - Bernice Ruo
- University of California, San Diego, School of Medicine, Department of Medicine
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3
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Ratzki-Leewing A, Black JE, Kahkoska AR, Ryan BL, Zou G, Klar N, Timcevska K, Harris SB. Severe (level 3) hypoglycaemia occurrence in a real-world cohort of adults with type 1 or 2 diabetes mellitus (iNPHORM, United States). Diabetes Obes Metab 2023; 25:3736-3747. [PMID: 37700692 PMCID: PMC10958739 DOI: 10.1111/dom.15268] [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: 02/28/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023]
Abstract
AIMS Among adults with insulin- and/or secretagogue-treated diabetes in the United States, very little is known about the real-world descriptive epidemiology of iatrogenic severe (level 3) hypoglycaemia. Addressing this gap, we collected primary, longitudinal data to quantify the absolute frequency of events as well as incidence rates and proportions. MATERIALS AND METHODS iNPHORM is a US-wide, 12-month ambidirectional panel survey (2020-2021). Adults with type 1 diabetes mellitus (T1DM) or insulin- and/or secretagogue-treated type 2 diabetes mellitus (T2DM) were recruited from a probability-based internet panel. Participants completing ≥1 follow-up questionnaire(s) were analysed. RESULTS Among 978 respondents [T1DM 17%; mean age 51 (SD 14.3) years; male: 49.6%], 63% of level 3 events were treated outside the health care system (e.g. by family/friend/colleague), and <5% required hospitalization. Following the 12-month prospective period, one-third of individuals reported ≥1 event(s) [T1DM 44.2% (95% CI 36.8%-51.8%); T2DM 30.8% (95% CI 28.7%-35.1%), p = .0404, α = 0.0007]; and the incidence rate was 5.01 (95% CI 4.15-6.05) events per person-year (EPPY) [T1DM 3.57 (95% CI 2.49-5.11) EPPY; T2DM 5.29 (95% CI 4.26-6.57) EPPY, p = .1352, α = 0.0007]. Level 3 hypoglycaemia requiring non-transport emergency medical services was more common in T2DM than T1DM (p < .0001, α = 0.0016). In total, >90% of events were experienced by <15% of participants. CONCLUSIONS iNPHORM is one of the first long-term, prospective US-based investigations on level 3 hypoglycaemia epidemiology. Our results underscore the importance of participant-reported data to ascertain its burden. Events were alarmingly frequent, irrespective of diabetes type, and concentrated in a small subsample.
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Affiliation(s)
- Alexandria Ratzki-Leewing
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jason E. Black
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anna R. Kahkoska
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bridget L. Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Neil Klar
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kristina Timcevska
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stewart B. Harris
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Medicine/Division of Endocrinology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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4
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Tang TS, Vesco AT, Fraser EG. Disruptions in Lifestyle Habits and Access to Social Support in the Time of COVID-19: Associations With Diabetes Distress and Depression Among Adults With Type 1 Diabetes Living in British Columbia. Can J Diabetes 2023; 47:497-502. [PMID: 37116655 PMCID: PMC10132832 DOI: 10.1016/j.jcjd.2023.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/30/2023] [Accepted: 04/21/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVES In this study, we examined rates of diabetes distress and depressive symptoms in adults with type 1 diabetes (T1D) during the COVID-19 lockdown and its association with disruptions in lifestyle habits and access to social support. METHODS This cross-sectional investigation included a convenience sample of 60 adults with T1D who completed a survey assessing diabetes distress (Type 1 Diabetes Distress Scale), depressive symptoms (Personal Health Questionnaire-9), and disruptions in lifestyle habits (sleep patterns, dietary patterns, exercise routine) and access to support from family/friends. Linear regression analyses examined COVID-19 disruption variables as predictors of diabetes distress and depressive severity. RESULTS Seventy-three percent and 38% of participants reported elevated diabetes distress and depressive symptoms, respectively. Greater eating disruption predicted higher depressive symptom severity (β=1.33, p=0.045) and eating distress (β=0.28, p=0.045). Greater social support disruption predicted higher eating distress (β=0.36, p=0.019). CONCLUSIONS Findings revealed high rates of diabetes distress and depressive symptoms in this T1D sample during the COVID-19 lockdown. Moreover, disruptions in some lifestyle habits and access to social support were associated with worse mental health outcomes.
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Affiliation(s)
- Tricia S Tang
- Faculty of Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Anthony T Vesco
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Ellen G Fraser
- The Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
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5
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Casagrande SS, Lawrence JM. Blood glucose, blood pressure, and cholesterol testing among adults with diabetes before and during the COVID-19 pandemic, USA, 2019 vs 2021. BMJ Open Diabetes Res Care 2023; 11:e003420. [PMID: 37380358 PMCID: PMC10410960 DOI: 10.1136/bmjdrc-2023-003420] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION Regular blood glucose/A1c, blood pressure (BP), and cholesterol (ABC) testing is important for diabetes management. It is unknown whether pandemic-related disruptions in medical care were negatively associated with ABC testing among US adults with diagnosed diabetes. RESEARCH DESIGN AND METHODS A cross-sectional analysis was conducted among adults ≥18 years with diagnosed diabetes who participated in the 2019 or 2021 National Health Interview Survey (n=3355 and n=3127, respectively). Adults with diabetes self-reported sociodemographic and diabetes-related characteristics, ABC testing in the past year, and delays or not getting medical care due to the pandemic (2021 only). Descriptive statistics were used to determine differences in ABC testing in 2019 vs 2021. Logistic regression models were used to assess the association between delays or not getting medical care due to the pandemic and ABC testing, adjusting for sociodemographic characteristics, diabetes duration, and diabetes medication use. RESULTS Overall, the prevalence of having a blood glucose/A1c or a BP test in the past year was high (>90%) but it was significantly lower in 2021 compared with 2019 (A1c: 94.2% vs 96.8%, p<0.001; BP: 96.8% vs 98.4%, p=0.002, respectively). Cholesterol testing remained stable (93.0% in 2021 vs 94.5% in 2019, p=0.053). In logistic regression analysis, after full adjustment, adults who reported delaying or not getting medical care when needed due to the pandemic were 50% less likely to get an ABC test in the past year compared with those who promptly received medical care (A1c: adjusted OR (aOR)=0.44, 95% CI 0.29-0.68; BP: aOR=0.48, 95% CI 0.27-0.85; cholesterol: aOR=0.48, 95% CI 0.31-0.75). CONCLUSIONS Disruptions in medical care during the pandemic were associated with a decrease in ABC testing. Future research is needed to assess whether blood glucose/A1c and BP testing returns to prepandemic levels and if reductions in these tests result in excess diabetes-related complications.
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Affiliation(s)
- Sarah S Casagrande
- Division of Public Health Research, DLH Holdings Corporation, Atlanta, Georgia, USA
| | - Jean M Lawrence
- Division of Diabetes, Endocrinology, and Metabolic Diseases, NIDDK, Bethesda, Maryland, USA
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6
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Hovanesian J, Singh IP, Bauskar A, Vantipalli S, Ozden RG, Goldstein MH. Identifying and addressing common contributors to nonadherence with ophthalmic medical therapy. Curr Opin Ophthalmol 2023; 34:S1-S13. [PMID: 36951648 DOI: 10.1097/icu.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
PURPOSE OF REVIEW To discuss common reasons for nonadherence and review existing and emerging options to reduce nonadherence with ocular medical therapy and optimize therapeutic outcomes. RECENT FINDINGS Nonadherence can arise from patient-related issues (e.g. physical, cognitive) and healthcare-related issues (e.g. cost, access to care). Multiple strategies have been developed and evaluated to overcome these barriers to adherence. Identifying nonadherence and its cause(s) facilitates the development of strategies to overcome it. SUMMARY Many common causes of nonadherence can be mitigated through a variety of strategies presented.
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Affiliation(s)
| | - I Paul Singh
- The Eye Centers of Racine and Kenosha, Racine, Wisconsin
| | - Aditi Bauskar
- Ocular Therapeutix, Inc., Bedford, Massachusetts USA
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Troncone A, Cascella C, Chianese A, Zanfardino A, Pizzini B, Iafusco D. Psychological consequences of the COVID-19 pandemic in people with type 1 diabetes: A systematic literature review. J Psychosom Res 2023; 168:111206. [PMID: 36913765 PMCID: PMC9972771 DOI: 10.1016/j.jpsychores.2023.111206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/13/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE A comprehensive picture of the data on the impact of COVID-19 on the mental health of individuals with type 1 diabetes (T1D) is currently lacking. The purpose of this systematic review was to synthesize extant literature reporting on the effects of COVID-19 on psychological outcomes in individuals with T1D and to identify associated factors. METHODS A systematic search was conducted with PubMed, Scopus, PychInfo, PsycArticles, ProQuest, and WoS using a selection procedure according to the PRISMA methodology. Study quality was assessed using a modified Newcastle-Ottawa Scale. In all, 44 studies fulfilling the eligibility criteria were included. RESULTS Findings suggest that during the COVID-19 pandemic, people with T1D had impaired mental health, with relatively high rates of symptoms of depression (11.5-60.7%, n = 13 studies), anxiety (7-27.5%, n = 16 studies), and distress (14-86.6%, n = 21 studies). Factors associated with psychological problems include female gender, lower income, poorer diabetes control, difficulties in diabetes self-care behaviors, and complications. Of the 44 studies, 22 were of low methodological quality. CONCLUSIONS Taking appropriate measures to improve medical and psychological services is needed to support individuals with T1D in appropriately coping with the burden and difficulties caused by the COVID-19 pandemic and to prevent mental health problems from enduring, worsening, or having a long-term impact on physical health outcomes. Heterogeneity in measurement methods, lack of longitudinal data, the fact that most included studies did not aim to make a specific diagnosis of mental disorders limit the generalizability of the findings and have implications for practice.
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Affiliation(s)
- Alda Troncone
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Crescenzo Cascella
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Antonietta Chianese
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Angela Zanfardino
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 2, 80138 Naples, Italy.
| | - Barbara Pizzini
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Dario Iafusco
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 2, 80138 Naples, Italy
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8
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Cusi K, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S49-S67. [PMID: 36507651 PMCID: PMC9810472 DOI: 10.2337/dc23-s004] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Halushko OA, Protsiuk OV, Pogorila OI, Synytsyn MM. HYPOGLYCEMIA IN PATIENTS WITH COVID-19: A COINCIDENCE OR A TREND? WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1075-1082. [PMID: 37326092 DOI: 10.36740/wlek202305128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim: The purpose of this work is to analyze the available scientific information on causes and risk factors of hypoglycemia during treatment of patients with COVID-19. PATIENTS AND METHODS Materials and methods: A search and analysis of full-text articles was carried out in the PubMed, Web of Science, Google Scholar, and Scopus databases. The search was conducted using the keywords: «hypoglycemia in COVID-19 patients», «treatment of COVID-19 and hypoglycemia» and «COVID-19 vaccination and hypoglycemia» from the beginning of the pandemic in December 2019 to July 1, 2022. CONCLUSION Conclusions: Hypoglycemia can be an incidental clinical finding. But it can also be a natural consequence of treatment if it is carried out without taking into account the possible hypoglycemic effects of drugs and without careful monitoring of the patient's condition. In the case of determining the program of treatment and vaccination against COVID-19 in patients with DM, the known and possible hypoglycemic effects of drugs and vaccines should be taken into account, the level of glycemia should be carefully controlled, and sudden changes in the type and dose of drugs, polypharmacy and the use of dangerous combinations of drugs should be avoided.
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Affiliation(s)
| | - Olga V Protsiuk
- SHUPYK NATIONAL UNIVERSITY OF HEALTH CARE OF UKRAINE, KYIV, UKRAINE
| | | | - Maksym M Synytsyn
- "FEOFANIYA" CLINICAL HOSPITAL OF STATE MANAGEMENT OF AFFAIRS OF UKRAINE, KYIV, UKRAINE
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Khunti K, Aroda VR, Aschner P, Chan JCN, Del Prato S, Hambling CE, Harris S, Lamptey R, McKee M, Tandon N, Valabhji J, Seidu S. The impact of the COVID-19 pandemic on diabetes services: planning for a global recovery. Lancet Diabetes Endocrinol 2022; 10:890-900. [PMID: 36356612 PMCID: PMC9640202 DOI: 10.1016/s2213-8587(22)00278-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/01/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022]
Abstract
The COVID-19 pandemic has disproportionately affected certain groups, such as older people (ie, >65 years), minority ethnic populations, and people with specific chronic conditions including diabetes, cardiovascular disease, kidney disease, and some respiratory diseases. There is now evidence of not only direct but also indirect adverse effects of COVID-19 in people with diabetes. Recurrent lockdowns and public health measures throughout the pandemic have restricted access to routine diabetes care, limiting new diagnoses, and affecting self-management, routine follow-ups, and access to medications, as well as affecting lifestyle behaviours and emotional wellbeing globally. Pre-pandemic studies have shown that short-term delays in delivery of routine care, even by 12 months, are associated with adverse effects on risk factor control and worse microvascular, macrovascular, and mortality outcomes in people with diabetes. Disruptions within the short-to-medium term due to natural disasters also result in worse diabetes outcomes. However, the true magnitude of the indirect effects of the COVID-19 pandemic on long-term outcomes and mortality in people with diabetes is still unclear. Disasters tend to exacerbate existing health disparities; as we recover ambulatory diabetes services in the aftermath of the pandemic, there is an opportunity to prioritise those with the greatest need, and to target resources and interventions aimed at improving outcomes and reducing inequality.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK; NIHR Applied Research Collaboration East Midlands, Leicester, UK.
| | | | - Pablo Aschner
- Asociación Colombiana de Diabetes, Bogotá, Colombia; Oficina de Investigaciones, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Stefano Del Prato
- Diabetology Divisions, Pisa University Hospital, University of Pisa, Pisa, Italy
| | | | - Stewart Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Roberta Lamptey
- Department of Family Medicine, Korle Bu Teaching Hospital, Accra, Ghana; Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Jonathan Valabhji
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; NHS England, London, UK; NHS Improvement, London, UK; Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Samuel Seidu
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK; NIHR Applied Research Collaboration East Midlands, Leicester, UK
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11
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Ratzki‐Leewing A, Black JE, Ryan BL, Harris S. Real‐world risk factors of confirmed or probable
COVID
‐19 in Americans with diabetes: A prospective, community‐based study (
iNPHORM
). Endocrinol Diabetes Metab 2022; 5:e342. [PMID: 35644866 PMCID: PMC9258990 DOI: 10.1002/edm2.342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Americans with diabetes are clinically vulnerable to worse COVID‐19 outcomes; thus, insight into how to prevent infection is imperative. Using longitudinal, prospective data from the real‐world iNPHORM study, we identify the intrinsic and extrinsic risk factors of confirmed or probable COVID‐19 in people with type 1 or 2 diabetes. Methods The iNPHORM study recruited 1206 Americans (18–90 years) with insulin‐ and/or secretagogue‐treated type 1 or 2 diabetes from a probability‐based internet panel. Online questionnaires (screener, baseline and 12 monthly follow‐ups) assessed COVID‐19 incidence and various plausible intrinsic and extrinsic factors. Multivariable Cox regression was used to model the rate of COVID‐19 (confirmed or probable). Risk factors were selected using a repeated backwards‐selection ‘voting’ procedure. Results A sub‐sample of 817 iNPHORM participants (type 1 diabetes: 16.9%; age: 52.1 [SD: 14.2] years; female: 50.2%) was analysed between May 2020 and March 2021. During this period, 13.7% reported confirmed or probable COVID‐19. Age, body mass index, number of chronic comorbidities, most recent A1C, past severe hypoglycaemia, and employment status were selected in our final model. Body mass index ≥30 kg/m2 versus <30 kg/m2 (HR 1.63 [1.05; 2.52]95% CI), and increased number of comorbidities (HR 1.16 [1.05; 1.27]95% CI) independently predicted COVID‐19 incidence. Marginally significant effects were observed for overall A1C (p = .06) and employment status (p = .07). Conclusions This is the first US‐based epidemiologic investigation to characterize community‐based COVID‐19 susceptibility in diabetes. Our results reveal specific and promising avenues to prevent COVID‐19 in this at‐risk population. ClinicalTrials.gov Identifier: NCT04219514.
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Affiliation(s)
- Alexandria Ratzki‐Leewing
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry Western University London Ontario Canada
| | - Jason E. Black
- Department of Family Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
| | - Bridget L. Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
| | - Stewart B. Harris
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Department of Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
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12
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Ratzki-Leewing A, Ryan BL, Zou G, Webster-Bogaert S, Black JE, Stirling K, Timcevska K, Khan N, Buchenberger JD, Harris SB. Predicting Real-world Hypoglycemia Risk in American Adults With Type 1 or 2 Diabetes Mellitus Prescribed Insulin and/or Secretagogues: Protocol for a Prospective, 12-Wave Internet-Based Panel Survey With Email Support (the iNPHORM [Investigating Novel Predictions of Hypoglycemia Occurrence Using Real-world Models] Study). JMIR Res Protoc 2022; 11:e33726. [PMID: 35025756 PMCID: PMC8881777 DOI: 10.2196/33726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/16/2021] [Accepted: 01/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hypoglycemia prognostic models contingent on prospective, self-reported survey data offer a powerful avenue for determining real-world event susceptibility and interventional targets. OBJECTIVE This protocol describes the design and implementation of the 1-year iNPHORM (Investigating Novel Predictions of Hypoglycemia Occurrence Using Real-world Models) study, which aims to measure real-world self-reported severe and nonsevere hypoglycemia incidence (daytime and nocturnal) in American adults with type 1 or 2 diabetes mellitus prescribed insulin and/or secretagogues, and develop and internally validate prognostic models for severe, nonsevere daytime, and nonsevere nocturnal hypoglycemia. As a secondary objective, iNPHORM aims to quantify the effects of different antihyperglycemics on hypoglycemia rates. METHODS iNPHORM is a prospective, 12-wave internet-based panel survey that was conducted across the United States. Americans (aged 18-90 years) with self-reported type 1 or 2 diabetes mellitus prescribed insulin and/or secretagogues were conveniently sampled via the web from a pre-existing, closed, probability-based internet panel (sample frame). A sample size of 521 baseline responders was calculated for this study. Prospective data on hypoglycemia and potential prognostic factors were self-assessed across 14 closed, fully automated questionnaires (screening, baseline, and 12 monthly follow-ups) that were piloted using semistructured interviews (n=3) before fielding; no face-to-face contact was required as part of the data collection. Participant responses will be analyzed using multivariable count regression and machine learning techniques to develop and internally validate prognostic models for 1-year severe and 30-day nonsevere daytime and nocturnal hypoglycemia. The causal effects of different antihyperglycemics on hypoglycemia rates will also be investigated. RESULTS Recruitment and data collection occurred between February 2020 and March 2021 (ethics approval was obtained on December 17, 2019). A total of 1694 participants completed the baseline questionnaire, of whom 1206 (71.19%) were followed up for 12 months. Most follow-up waves (10,470/14,472, 72.35%) were completed, translating to a participation rate of 179% relative to our target sample size. Over 70.98% (856/1206) completed wave 12. Analyses of sample characteristics, quality metrics, and hypoglycemia incidence and prognostication are currently underway with published results anticipated by fall 2022. CONCLUSIONS iNPHORM is the first hypoglycemia prognostic study in the United States to leverage prospective, longitudinal self-reports. The results will contribute to improved real-world hypoglycemia risk estimation and potentially safer, more effective clinical diabetes management. TRIAL REGISTRATION ClinicalTrials.gov NCT04219514; https://clinicaltrials.gov/ct2/show/NCT04219514. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33726.
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Affiliation(s)
- Alexandria Ratzki-Leewing
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Robarts Research Institute, Western University, London, ON, Canada
| | - Susan Webster-Bogaert
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jason E Black
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kathryn Stirling
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kristina Timcevska
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Nadia Khan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Stewart B Harris
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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