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Willis VC, Thomas Craig KJ, Jabbarpour Y, Scheufele EL, Arriaga YE, Ajinkya M, Rhee KB, Bazemore A. Digital Health Interventions to Enhance Prevention in Primary Care: Scoping Review. JMIR Med Inform 2022; 10:e33518. [PMID: 35060909 PMCID: PMC8817213 DOI: 10.2196/33518] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Disease prevention is a central aspect of primary care practice and is comprised of primary (eg, vaccinations), secondary (eg, screenings), tertiary (eg, chronic condition monitoring), and quaternary (eg, prevention of overmedicalization) levels. Despite rapid digital transformation of primary care practices, digital health interventions (DHIs) in preventive care have yet to be systematically evaluated. Objective This review aimed to identify and describe the scope and use of current DHIs for preventive care in primary care settings. Methods A scoping review to identify literature published from 2014 to 2020 was conducted across multiple databases using keywords and Medical Subject Headings terms covering primary care professionals, prevention and care management, and digital health. A subgroup analysis identified relevant studies conducted in US primary care settings, excluding DHIs that use the electronic health record (EHR) as a retrospective data capture tool. Technology descriptions, outcomes (eg, health care performance and implementation science), and study quality as per Oxford levels of evidence were abstracted. Results The search yielded 5274 citations, of which 1060 full-text articles were identified. Following a subgroup analysis, 241 articles met the inclusion criteria. Studies primarily examined DHIs among health information technologies, including EHRs (166/241, 68.9%), clinical decision support (88/241, 36.5%), telehealth (88/241, 36.5%), and multiple technologies (154/241, 63.9%). DHIs were predominantly used for tertiary prevention (131/241, 54.4%). Of the core primary care functions, comprehensiveness was addressed most frequently (213/241, 88.4%). DHI users were providers (205/241, 85.1%), patients (111/241, 46.1%), or multiple types (89/241, 36.9%). Reported outcomes were primarily clinical (179/241, 70.1%), and statistically significant improvements were common (192/241, 79.7%). Results were summarized across the following 5 topics for the most novel/distinct DHIs: population-centered, patient-centered, care access expansion, panel-centered (dashboarding), and application-driven DHIs. The quality of the included studies was moderate to low. Conclusions Preventive DHIs in primary care settings demonstrated meaningful improvements in both clinical and nonclinical outcomes, and across user types; however, adoption and implementation in the US were limited primarily to EHR platforms, and users were mainly clinicians receiving alerts regarding care management for their patients. Evaluations of negative results, effects on health disparities, and many other gaps remain to be explored.
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Affiliation(s)
- Van C Willis
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Kelly Jean Thomas Craig
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yalda Jabbarpour
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Elisabeth L Scheufele
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yull E Arriaga
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Monica Ajinkya
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Kyu B Rhee
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Andrew Bazemore
- The American Board of Family Medicine, Lexington, KY, United States
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Bravo JJM. [Importance of adherence to healthy lifestyles in people with diabetes]. Semergen 2021; 47:141-143. [PMID: 33975690 DOI: 10.1016/j.semerg.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
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Powers MA, Bardsley JK, Cypress M, Funnell MM, Harms D, Hess-Fischl A, Hooks B, Isaacs D, Mandel ED, Maryniuk MD, Norton A, Rinker J, Siminerio LM, Uelmen S. Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care and Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. J Acad Nutr Diet 2021; 121:773-788.e9. [DOI: 10.1016/j.jand.2020.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Powers MA, Bardsley JK, Cypress M, Funnell MM, Harms D, Hess-Fischl A, Hooks B, Isaacs D, Mandel ED, Maryniuk MD, Norton A, Rinker J, Siminerio LM, Uelmen S. Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Sci Diabetes Self Manag Care 2021; 47:54-73. [PMID: 34078207 DOI: 10.1177/0145721720987936] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Joan K Bardsley
- Medstar Health Research Institute, MedStar Diabetes Institute and MedStar Health System Nursing, Hyattsville, Maryland
| | | | | | - Dixie Harms
- MercyOne Clive Internal Medicine, Clive, Iowa
| | - Amy Hess-Fischl
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, Illinois
| | | | - Diana Isaacs
- Cleveland Clinic Diabetes Center, Cleveland, Ohio
| | | | | | | | - Joanne Rinker
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
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Wrzal PK, Bunko A, Myageri V, Kukaswadia A, Neish CS, Ivers NM. Strategies to Overcome Therapeutic Inertia in Type 2 Diabetes Mellitus: A Scoping Review. Can J Diabetes 2020; 45:273-281.e13. [PMID: 33160883 DOI: 10.1016/j.jcjd.2020.08.109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022]
Abstract
The objectives of this review were to: 1) examine recent strategies and component interventions used to overcome therapeutic inertia in type 2 diabetes mellitus (T2DM), 2) map strategies to the causes of therapeutic inertia they target and 3) identify causes of therapeutic inertia in T2DM that have not been targeted by recent strategies. A systematic search of the literature published from January 2014 to December 2019 was conducted to identify strategies targeting therapeutic inertia in T2DM, and key strategy characteristics were extracted and summarized. The search identified 46 articles, employing a total of 50 strategies aimed at overcoming therapeutic inertia. Strategies were composed of an average of 3.3 interventions (range, 1 to 10) aimed at an average of 3.6 causes (range, 1 to 9); most (78%) included a type of educational strategy. Most strategies targeted causes of inertia at the patient (38%) or health-care professional (26%) levels only and 8% targeted health-care-system-level causes, whereas 28% targeted causes at multiple levels. No strategies focused on patients' attitudes toward disease or lack of trust in health-care professionals; none addressed health-care professionals' concerns over costs or lack of information on side effects/fear of causing harm, or the lack of a health-care-system-level disease registry. Strategies to overcome therapeutic inertia in T2DM commonly employed multiple interventions, but novel strategies with interventions that simultaneously target multiple levels warrant further study. Although educational interventions are commonly used to address therapeutic inertia, future strategies may benefit from addressing a wider range of determinants of behaviour change to overcome therapeutic inertia.
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Affiliation(s)
- Paulina K Wrzal
- Medical Affairs, Novo Nordisk Canada, Inc, Mississauga, Ontario, Canada.
| | - Andrean Bunko
- Real World Solutions, IQVIA, Mississauga, Ontario, Canada
| | - Varun Myageri
- Real World Solutions, IQVIA, Mississauga, Ontario, Canada
| | | | - Calum S Neish
- Real World Solutions, IQVIA, Mississauga, Ontario, Canada
| | - Noah M Ivers
- Department of Family Medicine, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
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Powers MA, Bardsley JK, Cypress M, Funnell MM, Harms D, Hess-Fischl A, Hooks B, Isaacs D, Mandel ED, Maryniuk MD, Norton A, Rinker J, Siminerio LM, Uelmen S. Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care 2020; 43:1636-1649. [PMID: 32513817 DOI: 10.2337/dci20-0023] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Joan K Bardsley
- Medstar Health Research Institute, MedStar Diabetes Institute, and MedStar Health System Nursing, Hyattsville, MD
| | | | | | | | - Amy Hess-Fischl
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL
| | | | | | | | | | | | - Joanne Rinker
- Association of Diabetes Care & Education Specialists, Chicago, IL
| | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, IL
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Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. J Am Pharm Assoc (2003) 2020; 60:e1-e18. [PMID: 32527704 DOI: 10.1016/j.japh.2020.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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8
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Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the Association of Diabetes Care and Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. JAAPA 2020; 33:1-20. [PMID: 32516163 DOI: 10.1097/01.jaa.0000668828.47294.2a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Diabetes Self-management Education and Support in Adults with Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care and Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. J Am Assoc Nurse Pract 2020; 33:1314-1331. [PMID: 32530872 DOI: 10.1097/jxx.0000000000000473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/26/2022]
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Powers MA, Bardsley JK, Cypress M, Funnell MM, Harms D, Hess-Fischl A, Hooks B, Isaacs D, Mandel ED, Maryniuk MD, Norton A, Rinker J, Siminerio LM, Uelmen S. Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. DIABETES EDUCATOR 2020; 46:350-369. [PMID: 32510275 DOI: 10.1177/0145721720930959] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Joan K Bardsley
- Medstar Health Research Institute, MedStar Diabetes Institute and MedStar Health System Nursing, Hyattsville, Maryland
| | | | | | - Dixie Harms
- MercyOne Clive Internal Medicine, Clive, Iowa
| | - Amy Hess-Fischl
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, Illinois
| | | | - Diana Isaacs
- Cleveland Clinic Diabetes Center, Cleveland, Ohio
| | | | | | | | - Joanne Rinker
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
| | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
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Ali MK, Wharam F, Kenrik Duru O, Schmittdiel J, Ackermann RT, Albu J, Ross-Degnan D, Hunter CM, Mangione C, Gregg EW. Advancing Health Policy and Program Research in Diabetes: Findings from the Natural Experiments for Translation in Diabetes (NEXT-D) Network. Curr Diab Rep 2018; 18:146. [PMID: 30456479 PMCID: PMC6640642 DOI: 10.1007/s11892-018-1112-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW To advance our understanding of the impacts of policies and programs aimed at improving detection, engagement, prevention, and clinical diabetes management in the USA, we synthesized findings from a network of studies that used natural experiments to evaluate diabetes health policies and programs. FINDINGS Studies from the Natural EXperiments for Translation in Diabetes (NEXT-D) network used rigorous longitudinal quasi-experimental study designs (e.g., interrupted time series) and analytical methods (e.g., difference-in-differences) to augment causal inference. Investigators partnered with health system stakeholders to evaluate whether glucose testing rates changed from before-to-after clinic interventions (e.g., integrating electronic screening decision prompts in New York City) or employer programs (e.g., targeted messaging and waiving copayments for at-risk employees). Other studies examined participation and behavior change in low- (e.g., wellness coaching) or high-intensity lifestyle modification programs (e.g., diabetes prevention program-like interventions) offered by payers or employers. Lastly, studies assessed how employer health insurance benefits impacted healthcare utilization, adherence, and outcomes among people with diabetes. NEXT-D demonstrated that low-intensity interventions to facilitate glucose testing and enhance engagement in lifestyle modification were associated with small improvements in weight but large improvements in screening and testing when supported by electronic health record-based decision-support. Regarding high-intensity diabetes prevention program-like lifestyle programs offered by payers or employers, enrollment was modest and led to weight loss and marginally lower short-term health expenditures. Health plans that incentivize patient behaviors were associated with increases in medication adherence. Meanwhile, shifting patients to high-deductible health plans was associated with no change in medication use and preventive screenings, but patients with diabetes delayed accessing healthcare for acute complications (e.g., cellulitis). Findings were more pronounced among lower-income patients, who experienced increased rates and acuity of emergency department visits for diabetes complications and other high-severity conditions. Findings from NEXT-D studies provide informative data that can guide programs and policies to facilitate detection, prevention, and treatment of diabetes in practice.
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Affiliation(s)
- Mohammed K Ali
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K10, 4770 Buford Highway, Atlanta, GA, 30341, USA.
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Ste 7041 CNR Building, Atlanta, GA, 30322, USA.
| | - Frank Wharam
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - O Kenrik Duru
- Division of General Internal Medicine, University of California Los Angeles, 911 Broxton Ave., Los Angeles, CA, 90024, USA
| | - Julie Schmittdiel
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Ronald T Ackermann
- Department of Medicine, General Medicine Division, Northwestern University, Rubloff Building 10th Floor 750 N Lake Shore, Chicago, IL, 60611, USA
| | - Jeanine Albu
- Division of Endocrinology, Diabetes and Bone Diseases, Icahn School of Medicine at Mount Sinai, 1111 Amsterdam Avenue Babcock Building - 10th Floor, New York, NY, 10025, USA
| | - Dennis Ross-Degnan
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health, 31 Center Drive, Bethesda, MD, 20892, USA
| | - Carol Mangione
- Division of General Internal Medicine, University of California Los Angeles, UCLA Med-GIM & HSR BOX 957394, 10940 Wilshire Blvd, Los Angeles, CA, 90095, USA
| | - Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K10, 4770 Buford Highway, Atlanta, GA, 30341, USA
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Abstract
The current epidemic of type 2 diabetes (T2D) represents a significant global and national health concern. Globally, the prevalence of diabetes has doubled between 1980 and 2014. In 2014 the World Health Organization estimated that there were 422 million adults living with diabetes worldwide. In the USA, the number of people diagnosed with T2D is estimated to increase to over 70 million by 2050, putting an immense strain on the US healthcare system. Achieving glycemic control is widely acknowledged as the key goal of treatment in T2D and is critical for reducing the onset and progression of diabetes-related complications such as cardiovascular diseases, neuropathies, retinopathies, and nephropathies. Despite the increase in the availability of antihyperglycemic medications and evidence-based treatment guidelines, the proportion of people with T2D who fail to achieve glycemic goals continues to rise. One major contributor is a delay in treatment intensification despite suboptimal glycemic control, referred to as clinical or therapeutic inertia. Clinical inertia prolongs the duration of patients' hyperglycemia which subsequently puts them at increased risk of diabetes-associated complications and reduced life expectancy. Clinical inertia results from a complex interaction between patient, healthcare providers, and healthcare system barriers that need to be addressed together, rather than as separate entities. In this article we provide an overview of clinical inertia in the clinical management of T2D and provide suggestions for overcoming aspects that may have a negative impact on patient care.Funding: Sanofi US, Inc.
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Affiliation(s)
- Jennifer Okemah
- Western Washington Medical Group, Diabetes and Nutrition Education, Bothell, WA, USA.
| | - John Peng
- Virginia Mason Medical Center, Lynnwood, WA, USA
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Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, Maryniuk MD, Siminerio L, Vivian E. Diabetes Self-management Education and Support in Type 2 Diabetes. DIABETES EDUCATOR 2017; 43:40-53. [DOI: 10.1177/0145721716689694] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Margaret A. Powers
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Joan Bardsley
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Marjorie Cypress
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Paulina Duker
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Martha M. Funnell
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Amy Hess Fischl
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Melinda D. Maryniuk
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Linda Siminerio
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Eva Vivian
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
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Makuc J, Ravber K, Keber T. Glycemia management in a Slovenian general hospital. Wien Klin Wochenschr 2016; 129:16-20. [PMID: 27848073 DOI: 10.1007/s00508-016-1119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 10/19/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND In-hospital hyperglycemia is common and associated with an increased risk of in-hospital mortality and extensive length of stay but there are only few studies on real-life hyperglycemia and diabetes management. METHODS In this cross-sectional, non-interventional, prospective study we analyzed medical charts on glycemia status at our internal medicine department for 5 consecutive months. Patients were grouped by departments and divided into subgroups by diabetes type, etiology and duration. Physicians answered a questionnaire regarding knowledge on national guidelines and personal opinions on the subject. RESULTS A total of 7080 capillary blood glucose measurements from 308 patients were included in the study. Patients were of Caucasian origin with a mean age 72.7 ± 10.7 years and 50.3% were male. Of the measurements 63.3% were within glycemia goals, 2.7% in the range of hypoglycemia and 0.3% of hyperglycemic syndromes. The mean value was 8.88 ± 3.5 mmol/l (159.84 ± 63 mg/dl). There were no differences in mean glucose measurements but significant differences in reaching glycemia target goals and frequency of acute complications between intensive care, general ward and palliative care patients. Subgroup analysis confirmed the association between glycemia management and newly discovered diabetes, type 1 diabetes, steroid use and disrupted food intake (p < 0.05 for all). CONCLUSIONS Our results on in-hospital glycemia management seem comparable to previously published data. Patients with newly discovered diabetes, type 1 diabetes, treated with steroids and those eating improperly should be closely monitored. Additional education on guidelines and steroid-induced hyperglycemia accompanied by updated medical charts represent possible improvements. Quality standards for in-hospital glycemia management should be established.
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Affiliation(s)
- Jana Makuc
- General Hospital Slovenj Gradec, Gosposvetska cesta 1, 2380, Slovenj Gradec, Slovenia.
| | - Katja Ravber
- General Hospital Slovenj Gradec, Gosposvetska cesta 1, 2380, Slovenj Gradec, Slovenia
| | - Tajda Keber
- General Hospital Slovenj Gradec, Gosposvetska cesta 1, 2380, Slovenj Gradec, Slovenia
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Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, Maryniuk MD, Siminerio L, Vivian E. Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Clin Diabetes 2016; 34:70-80. [PMID: 27092016 PMCID: PMC4833481 DOI: 10.2337/diaclin.34.2.70] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Joan Bardsley
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, MD
| | | | - Paulina Duker
- Lifescan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates
| | | | | | | | - Linda Siminerio
- School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Eva Vivian
- University of Wisconsin–Madison, Madison, WI
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Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Hess Fischl A, Maryniuk MD, Siminerio L, Vivian E. Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Care 2015; 38:1372-82. [PMID: 26048904 DOI: 10.2337/dc15-0730] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Joan Bardsley
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, MD
| | | | - Paulina Duker
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates
| | | | | | | | - Linda Siminerio
- School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Eva Vivian
- University of Wisconsin-Madison, Madison, WI
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Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, Maryniuk MD, Siminerio L, Vivian E. Diabetes Self-management Education and Support in Type 2 Diabetes. DIABETES EDUCATOR 2015; 41:417-30. [DOI: 10.1177/0145721715588904] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Margaret A. Powers
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Joan Bardsley
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Marjorie Cypress
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Paulina Duker
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Martha M. Funnell
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Amy Hess Fischl
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Melinda D. Maryniuk
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Linda Siminerio
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Eva Vivian
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
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18
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Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, Maryniuk MD, Siminerio L, Vivian E. Diabetes Self-Management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. J Acad Nutr Diet 2015; 115:1323-34. [PMID: 26054423 DOI: 10.1016/j.jand.2015.05.012] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Indexed: 01/15/2023]
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