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Shafiee F, Sarbaz M, Marouzi P, Banaye Yazdipour A, Kimiafar K. Providing a framework for evaluation disease registry and health outcomes Software: Updating the CIPROS checklist. J Biomed Inform 2024; 149:104574. [PMID: 38101688 DOI: 10.1016/j.jbi.2023.104574] [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: 06/08/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND AIMS Properly designed and implemented registry systems play an important role in improving health outcomes and reducing care costs, and can provide a true representation of clinical practice, disease outcomes, safety, and efficacy. Therefore, the aim of this study was to redesign and develop a checklist with items for a patient registry software system (CIPROS) Checklist. METHOD The study is descriptive-cross-sectional. The extraction of the data elements of the checklist was first done through a comprehensive review of the texts in PubMed, Science Direct and Scopus databases and receiving articles related to the evaluation of registry systems. Based on the extracted data, a five-point Likert scale questionnaire was created and 30 experts in this field were asked for their opinions using the two-step Delphi method. RESULTS A total of 100 information items were determined as a registry software evaluation checklist. This checklist included 12 groups of software architecture factors, development, interfaces and interactivity, semantics and standardization, internationality, data management, data quality and usability, data analysis, security, privacy, organizational, education and public factors. CONCLUSION By using the results of this research, it is possible to identify the defects and possible strengths of the registry software and put it at the disposal of the relevant officials to make a decision in this field. In this way, among the designers and developers of these softwares, the best and most appropriate ones are selected with the needs of the registry programs.
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Affiliation(s)
- Fatemeh Shafiee
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Masoume Sarbaz
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Parviz Marouzi
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Alireza Banaye Yazdipour
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Health Information Management and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
| | - Khalil Kimiafar
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
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Lim LL, Lau ES, Kong AP, Fu AW, Lau V, Jia W, Sheu WH, Sobrepena L, Yoon K, Tan AT, Chia YC, Sosale A, Saboo BD, Kesavadev J, Goh SY, Nguyen TK, Thewjitcharoen Y, Suwita R, Ma RC, Chow EY, Luk AO, Chan JC. Gender-associated cardiometabolic risk profiles and health behaviors in patients with type 2 diabetes: a cross-sectional analysis of the Joint Asia Diabetes Evaluation (JADE) program. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 32:100663. [PMID: 36785858 PMCID: PMC9918795 DOI: 10.1016/j.lanwpc.2022.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 10/31/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022]
Abstract
Background In Asia, diabetes-associated death due to cardiorenal diseases were 2-3 times higher in women than men which might be due to gender disparity in quality of care and health habits. Methods Adults with type 2 diabetes (T2D) from 11 Asian countries/areas were assessed using the same protocol (2007-2015). We compared treatment target attainment (HbA1c < 7%, blood pressure [BP] < 130/80 mmHg, risk-based LDL-cholesterol, lack of central obesity [waist circumference <90 cm in men or <80 cm in women), use of cardiorenal-protective drugs (renin-angiotensin system [RAS] inhibitors, statins), and self-reported health habits including self-monitoring blood glucose (SMBG) by gender. Analyses were stratified by countries/areas, age of natural menopause (<50 vs. ≥50 years), and comorbidities (atherosclerotic cardiovascular disease [ASCVD], heart failure, kidney impairment [eGFR < 60 mL/min/1.73 m2]). Findings Among 106,376 patients (53.2% men; median (interquartile range) diabetes duration: 6.0 (2.0-12.0) years; mean ± SD HbA1c 8.0 ± 1.9%; 27% insulin-treated), women were older and less likely to receive college education than men (28.9% vs. 48.8%). Women were less likely to smoke/drink alcohol and were physically less active than men. Women had lower BP (<130/80 mmHg: 29.4% vs. 25.7%), less general obesity (54.8% vs. 57.8%) but more central obesity than men (77.5% vs. 57.3%). Women were less likely to have ASCVD (12.8% vs. 17.0%) or heart failure (1.3% vs. 2.3%), but more likely to have kidney impairment (22.3% vs. 17.6%) and any-site cancer than men (2.5% vs. 1.6%). In most countries/areas, more men attained HbA1c <7% and risk-based LDL-cholesterol level than women. After adjusting for potential confounders including countries and centres, men had 1.63 odds ratio (95% CI 1.51, 1.74) of attaining ≥3 treatment targets than women. Interpretation Asian women with T2D had worse quality of care than men especially in middle-income countries/areas, calling for targeted implementation programs to close these care gaps. Sponsor Asia Diabetes Foundation. Funding Nil.
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Affiliation(s)
- Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China,Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, China
| | - Eric S.H. Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China,Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, China
| | - Alice P.S. Kong
- 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
| | - Amy W.C. Fu
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, China
| | - Vanessa Lau
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, China
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Clinical Centre for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wayne H.H. Sheu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - K.H. Yoon
- Department of Endocrinology and Metabolism, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | | | - Yook-Chin Chia
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore
| | | | | | - Raymond Suwita
- Cerebrocardiovascular Diabetes Group Clinic (CDG), Jakarta, Indonesia
| | - Ronald C.W. Ma
- 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
| | - Elaine Y.K. Chow
- 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
| | - Andrea O.Y. Luk
- 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
| | - 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,Asia Diabetes Foundation, Shatin, 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,Corresponding author. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
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Ma RCW, Xie F, Lim CKP, Lau ESH, Luk AOY, Ozaki R, Cheung GPY, Lee HM, Ng ACW, Li HW, Wong CKM, Wong SYS, So WY, Chan JCN. A randomized clinical trial of genetic testing and personalized risk counselling in patients with type 2 diabetes receiving integrated care -The genetic testing and patient empowerment (GEM) trial. Diabetes Res Clin Pract 2022; 189:109969. [PMID: 35728675 DOI: 10.1016/j.diabres.2022.109969] [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: 04/08/2022] [Revised: 06/05/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
AIMS We evaluated the effect of personalized risk counseling incorporating clinical and genetic risk factors on patient empowerment and risk factor control in diabetes. METHODS Patients with type 2 diabetes (T2D) with suboptimal glycaemic control (HbA1c ≥ 7.5%) were randomized to a genetic counselling (GC) or control group. All patients underwent genetic testing for alleles at three loci associated with diabetic complications. The GC group received additional explanation of the joint associations of genetic and modifiable risk factors on risk of complications. All patients were reassessed at 12 months including validated questionnaires for patient reported outcomes. The primary outcome was proportion of patients reaching ≥ 3 of 5 predefined treatment targets (HbA1c < 7%, BP < 130/80 mmHg, LDL-C < 2.6 mmol/L, Triglyceride < 2.0 mmol/L, use of renin-angiotensin system inhibitors). Secondary outcomes included new-onset chronic kidney disease or microalbuminuria and patient reported outcome measures. RESULTS A total of 435 patients were randomized and 420 patients were included in the modified intention-to-treat analysis. At 12 months, the proportion of patients who attained ≥ 3 targets increased from 41.6% to 52.3% in the GC group (p = 0.007) versus 49.5% to 62.6% in the control group (p = 0.003), without between-group difference. Both groups had similar reduction in HbA1c, LDL-C and increased use of medications. In per protocol analysis, the GC group had higher diabetes empowerment, with reduced diabetes distress. In the GC group, the greatest improvement in positive attitude and self-care activities was observed in the intermediate to high genetic risk score (GRS) groups. CONCLUSIONS In patients with T2D receiving integrated care, additional counselling on genetic risk of complications did not further improve risk factor control, although the improvement in self-efficacy warrants long-term evaluation.
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Affiliation(s)
- Ronald Ching Wan Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China; Chinese University of Hong Kong-Shanghai Jiao Tong University Joint Research Centre in Diabetes Genomics and Precision Medicine, China.
| | - Fangying Xie
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | - Cadmon King Poo Lim
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China; Chinese University of Hong Kong-Shanghai Jiao Tong University Joint Research Centre in Diabetes Genomics and Precision Medicine, China.
| | - Eric Siu Him Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China.
| | - Andrea On Yan Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China; Chinese University of Hong Kong-Shanghai Jiao Tong University Joint Research Centre in Diabetes Genomics and Precision Medicine, China.
| | - Risa Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Grace Pui Yiu Cheung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | - Heung Man Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | - Alex Chi Wai Ng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | - Heung Wing Li
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Carmen Ka Man Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Samuel Yeung Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Wing Yee So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Juliana Chung Ngor Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China; Chinese University of Hong Kong-Shanghai Jiao Tong University Joint Research Centre in Diabetes Genomics and Precision Medicine, China.
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Chan JCN, Thewjitcharoen Y, Nguyen TK, Tan A, Chia YC, Hwu CM, Jian D, Himathongkam T, Wong KL, Choi YM, Mirasol R, Mohamed M, Kong APS, Ma RCW, Chow EYK, Ozaki R, Lau V, Fu AWC, Hong EG, Yoon KH, Tsang CC, Lau ESH, Lim LL, Luk AOY. Effect of a Web-Based Management Guide on Risk Factors in Patients With Type 2 Diabetes and Diabetic Kidney Disease: A JADE Randomized Clinical Trial. JAMA Netw Open 2022; 5:e223862. [PMID: 35333363 PMCID: PMC8956973 DOI: 10.1001/jamanetworkopen.2022.3862] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Diabetic kidney disease (DKD) and its comorbidities can be prevented by treating multiple targets. Technology-assisted team-based care with regular feedback and patient empowerment can improve the attainment of multiple targets and clinical outcomes in patients with type 2 diabetes, but the effects of this intervention on patients with DKD are unclear. OBJECTIVE To evaluate the effect of the Joint Asia Diabetes Evaluation (JADE) web portal, nurse reminders, and team-based care on multiple risk factors in patients with DKD. DESIGN, SETTING, AND PARTICIPANTS This 12-month multinational, open-label randomized clinical trial was conducted between June 27, 2014, and February 19, 2019, at 13 hospital-based diabetes centers in 8 countries or regions in Asia. All patients who participated had DKD. The intention-to-treat data analysis was performed from April 7 to June 30, 2020. INTERVENTIONS Patients were randomized in a 1:1:1 ratio at each site to usual care, empowered care, or team-based empowered care. All patients underwent a JADE web portal-guided structured assessment at baseline and month 12. Patients in the usual care and empowered care groups received a medical follow-up. Patients in the empowered care group also received a personalized JADE report and nurse telephone calls every 3 months. Patients in the team-based empowered care group received additional face-to-face reviews every 3 months from a physician-nurse team. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients who attained multiple treatment targets (defined as ≥3 of 5 targets: HbA1c level <7.0% [53 mmol/mol], blood pressure <130/80 mm Hg, low-density lipoprotein cholesterol level <1.8 mmol/L, triglyceride level <1.7 mmol/L, and/or persistent use of renin-angiotensin-aldosterone system inhibitors). RESULTS A total of 2393 patients (mean [SD] age, 67.7 [9.8] years; 1267 men [52.9%]) were randomized to the usual care group (n = 795), empowered care group (n = 802), and team-based empowered care group (n = 796). At baseline, 34.7% patients (n = 830) were on 3 treatment targets. On intention-to-treat analysis, the team-based empowered care group had the highest proportion of patients who had further increase in attainment of multiple treatment targets (within-group differences: usual care group, 3.9% [95% CI, 0.0%-7.8%]; empowered care group, 1.3% [95% CI, -2.8% to 5.4%]; team-based empowered care group, 9.1% [95% CI, 4.7%-13.5%]). The team-based empowered care group was more likely to attain multiple treatment targets than the usual care group (risk ratio [RR], 1.17; 95% CI, 1.00-1.37) and the empowered care group (RR, 1.25; 95% CI, 1.06-1.48) after adjustment for site. Compared with the group that did not attain multiple treatment targets, the group that attained multiple treatment targets reported a lower incidence of cardiovascular, kidney, and cancer events (8.4% [n = 51] vs 14.5% [n = 134]; P = .004). Analysis of the per-protocol population yielded similar results. CONCLUSIONS AND RELEVANCE This trial found that technology-assisted team-based care for 12 months improved the attainment of multiple treatment targets as well as empowerment in patients with DKD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02176278.
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Affiliation(s)
- Juliana C. N. Chan
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region (SAR), China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | | | | | | | - Yook-Chin Chia
- Department of Medical Sciences, Sunway University, Selangor, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chii-Min Hwu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Du Jian
- Department of Endocrinology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | | | - Kim-Leng Wong
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yun-Mi Choi
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Roberto Mirasol
- Section of Endocrinology, Diabetes and Metabolism, St Luke's Medical Center, Quezon City, Philippines
| | - Mafauzy Mohamed
- Department of Medicine, Universiti Sains Malaysia, Kota Bahru, Malaysia
| | - Alice P. S. Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Ronald C. W. Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Elaine Y. K. Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Risa Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Vanessa Lau
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region (SAR), China
| | - Amy W. C. Fu
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region (SAR), China
| | - Eun-Gyoung Hong
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Kun-Ho Yoon
- Department of Endocrinology and Metabolism, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chiu-Chi Tsang
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China
| | - Eric S. H. Lau
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region (SAR), China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Lee-Ling Lim
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region (SAR), China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Andrea O. Y. Luk
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region (SAR), China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Design and Evaluation of Web-Based Dental Implant Registry (DIR) for Better Clinical Outcomes. Int J Biomater 2022; 2022:7162645. [PMID: 35186089 PMCID: PMC8856821 DOI: 10.1155/2022/7162645] [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: 11/12/2021] [Revised: 01/15/2022] [Accepted: 01/21/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction Identification of dental implant system in undocumented patients is a major challenge for dentists due to the vast variety of tools and technologies that are used in dental care. It also takes a long time to identify the type of connection or length and diameter of implant. To obtain accurate and timely information, it is necessary to have a Dental Implant Registry (DIR). In the present study, a DIR was designed, developed, and evaluated at the Dental Implant Research Center of Tehran University of Medical Sciences. Materials and Methods This is an applied, developmental, and cross-sectional study that was conducted between 2018 and 2020. In the present study, after determining the objectives of DIR system, its conceptual model was designed by EDraw Max 7.9 software. Then, the registry was developed in Visual Studio 2018 environment with the C# programming language and, finally, it was evaluated by Nielsen's ten principles of usability assessment. Results After creating the registry, its data entry search and report functions were tested. Also, in the exploratory evaluation, the highest number of problems related to the principles of system clarity and compatibility between the system and real world was identified. Conclusion The web-based DIR created in C# programming language has the ability to gather data, provide report with different access levels, and send text messages to patients for follow-up. This tool enables physicians to quickly identify the components of dental implant. The web-based DIR also provides support for health research, quality assessment, and dental performance assessment.
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Yang A, Wu H, Lau ESH, Ma RCW, Kong APS, So WY, Luk AOY, Chan JCN, Chow E. Trends in Glucose-Lowering Drug Use, Glycemic Control, and Severe Hypoglycemia in Adults With Diabetes in Hong Kong, 2002-2016. Diabetes Care 2020; 43:2967-2974. [PMID: 33046501 DOI: 10.2337/dc20-0260] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There has been a shift toward new classes of glucose-lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs use, glycemic control, and SH rate among patients with diabetes in Hong Kong, which introduced a territory-wide, team-based diabetes care model since 2000. RESEARCH DESIGN AND METHODS Using population-based data from the Hong Kong Diabetes Surveillance Database, we estimated age- and sex-standardized proportion of GLD classes, mean hemoglobin A1c (HbA1c) levels, and SH rates in 763,809 patients with diabetes aged ≥20 years between 2002 and 2016. RESULTS Between 2002 and 2016, use declined for sulfonylureas (62.9% to 35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase 4 inhibitors (DPP-4is) (0.01% in 2007 to 8.3%). The proportion of patients with HbA1c of 6.0-7.0% (42-53 mmol/mol) increased from 28.6% to 43.4%, while the SH rate declined from 4.2/100 person-years to 1.3/100 person-years. The main improvement in HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.6% (1.6) (59.5 [19.0] mmol/mol) to 7.2% (1.7) (54.8 [18.9] mmol/mol) (P < 0.001). The 20-44 years age-group had the highest proportion of HbA1c ≥9% (75 mmol/mol) and rising proportions not on GLDs (from 2.0% to 7.7%). CONCLUSIONS In this 15-year survey, the modest but important improvement in HbA1c since 2007 coincided with diabetes service reforms, increase in metformin, decrease in sulfonylureas, and modest rise in DPP-4i use. Persistently poor glycemic control and underuse of GLDs in the youngest group calls for targeted action.
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Affiliation(s)
- Aimin Yang
- 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
| | - Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Ronald C W Ma
- 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
| | - Alice P S Kong
- 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
| | - Wing Yee So
- Hong Kong Hospital Authority Head Office, Hong Kong Special Administrative Region, China
| | - Andrea O Y Luk
- 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
| | - 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
| | - Elaine Chow
- 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
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7
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Castillo-Carandang NT, Buenaventura RD, Chia YC, Do Van D, Lee C, Duong NL, Ng CH, Robles YR, Santoso A, Sigua HS, Sukonthasarn A, Tan R, Viora E, Zakaria H, Brizuela GE, Ratnasingham P, Thomas M, Majumdar A. Moving Towards Optimized Noncommunicable Disease Management in the ASEAN Region: Recommendations from a Review and Multidisciplinary Expert Panel. Risk Manag Healthc Policy 2020; 13:803-819. [PMID: 32765135 PMCID: PMC7371561 DOI: 10.2147/rmhp.s256165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality in the Association of Southeast Asian Nations (ASEAN) member states. Progress has been slow despite the World Health Organization action plan for the prevention and control of NCDs in the region. This paper presents recommendations focused on practical strategies for optimizing NCD management in the ASEAN region. Methods A multidisciplinary group of experts from six ASEAN member states convened for two face-to-face meetings to discuss barriers and possible recommendations for optimizing NCD management, focused on cardiovascular diseases and mental disorders, in the region. Multiple approaches, ie, analysis of insights from the meetings and a review of existing literature on NCD programs in the ASEAN region were followed. The proposed recommendations were also based on selected successful interventions in ASEAN member states, thus providing actionable strategies. Results The gaps identified in NCD management for cardiovascular diseases and mental disorders in the ASEAN region were classified into gaps relating to policies and to clinical and public health practice. The proposed solutions addressing policy gaps include fostering multisectoral public–private partnerships, employing “whole-of-government” and “whole-of-society” approaches and promoting “health-in-all policies approach” to manage issues with financing, accessibility, efficiency and quality of health services. Whereas proposed solutions to bridge clinical and public health practice gaps entail strengthening primary care services, building the capacity of trained healthcare workers and employing collaborative care for holistic management of patients. Conclusion The scale of premature and preventable deaths from NCDs in the ASEAN region remains a serious public health concern and requires a “whole-of-system approach”. The interventions proposed in this paper build on regional collaborations and knowledge sharing to help develop a concerted and targeted response to NCDs.
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Affiliation(s)
- Nina T Castillo-Carandang
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines; and Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Robert D Buenaventura
- Department of Psychiatry, Manila Theological College - College of Medicine, Manila, Philippines
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Dung Do Van
- The University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Cheng Lee
- National Addictions Management Service, Institute of Mental Health, Singapore
| | - Ngoc Long Duong
- Department of Research, Education and Technology, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Yolanda R Robles
- College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | - Anwar Santoso
- Department of Cardiology, Vascular Medicine, National Cardiovascular Centre - Harapan Kita Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Helen S Sigua
- University of the Philippines Open University, Laguna, Philippines
| | - Apichard Sukonthasarn
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Roger Tan
- Roger Kidney Clinic, Gleneagles Hospital, Singapore
| | - Eka Viora
- Indonesia Psychiatrist Association, Jakarta, Indonesia
| | - Hazli Zakaria
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Grace E Brizuela
- Research, Development and Medical, Pfizer Upjohn, Manila, Philippines
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8
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Wu H, Lau ESH, Yang A, Ma RCW, Kong APS, Chow E, So WY, Chan JCN, Luk AOY. Trends in diabetes-related complications in Hong Kong, 2001-2016: a retrospective cohort study. Cardiovasc Diabetol 2020; 19:60. [PMID: 32398003 PMCID: PMC7218631 DOI: 10.1186/s12933-020-01039-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/09/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Nationwide studies on contemporary trends in incidence of diabetes-related complications in Asia are lacking. We describe trends in incident coronary heart disease (CHD), stroke, heart failure, hyperglycaemic crisis, and lower-extremity amputation (LEA) in people with diabetes in Hong Kong between 2001 and 2016. METHODS The Hong Kong Diabetes Surveillance Database (HKDSD) is a territory-wide diabetes cohort identified from Hong Kong Hospital Authority electronic medical record system. We identified events of CHD, stroke, heart failure and hyperglycaemic crisis using hospital principal diagnosis codes at discharge and that of LEA using inpatient procedure codes. We used Joinpoint regression analysis to describe incidence trends by age and sex. RESULTS Between 2001 and 2016, a total of 390,071 men and 380,007 women aged 20 years or older with diabetes were included in the HKDSD. Event rates of CHD, stroke, heart failure, hyperglycaemic crisis and LEA declined by 69.4% (average annual percent change: - 7.6, 95% CI - 10.2, - 5.0), 70.3% (- 8.7, 95% CI - 9.8, - 7.5), 63.6% (- 6.4, 95% CI - 8.0, - 4.7), 59.1% (- 6.6, 95% CI - 12.4, - 0.44), and 67.5% (- 5.8, 95% CI - 7.2, - 4.4), in men and by 77.5% (- 9.9, 95% CI - 11.8, - 7.9), 74.5% (- 9.0, 95% CI - 9.6, - 8.4), 65.8% (- 7.0, 95% CI - 8.0, - 6.0), 81.7% (- 8.5, 95% CI - 10.5, - 6.5), and 72.7% (- 9.1. 95% CI - 12.2, - 5.8) in women, respectively, over a 16-year period in people with diabetes in Hong Kong. Joinpoint analysis identified greater declines in event rates of the five diabetes-related complications in the earlier one-third of study period and slowed down but remained significant until 2016. Event rates decreased for all age groups above 45 years for both sexes. There was no significant change in event rates in the group aged 20-44 years except for decline in hyperglycaemic crisis. CONCLUSIONS The event rates of diabetes-related complications have declined substantially with no evidence of stabilization or increase in Hong Kong up to 2016. Improvements in outcome were observed for all age subgroups but not in young people with diabetes, calling for urgent action to improve quality of care to prevent complications in young people at risk.
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Affiliation(s)
- Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Hospital Authority, Kowloon, Hong Kong Special Administrative Region, People's Republic of China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China. .,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China. .,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China.
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Jagannathan R, Patel SA, Ali MK, Narayan KMV. Global Updates on Cardiovascular Disease Mortality Trends and Attribution of Traditional Risk Factors. Curr Diab Rep 2019; 19:44. [PMID: 31222515 DOI: 10.1007/s11892-019-1161-2] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW The last 2-3 decades have witnessed a decline in age-standardized cardiovascular mortality rates in high-income regions, whereas this has only slightly decreased or even increased in most of the low- and middle-income countries. A systematic comparison of global CVD mortality by regions attributable to various modifiable risk factors such as diabetes, obesity, hypertension, poor diet, and physical inactivity is not available. RECENT FINDINGS We present a summary of time trends and heterogeneity in the distribution of global CVD mortality and the attribution of risk factors between 1990 and 2017 using the Global Burden of Disease (GBD) 2017 study. Globally, an estimated ~ 17.8 million (233.1 per 100,000) people died of CVD in 2017. The rate of CVD death was decreased in high-income countries (1990: 271.8 (95% UI (uncertainty interval), 270.9-273.5); 2017: 128.5 (95% UI, 126.4-130.7) per 100,000)) whereas it remained the same in lower- and middle-income countries (1990: 368.2 (95% UI, 335.6-383.3); 2017: 316.9 (95% UI, 307.0-325.5) per 100,000). Among the various traditional risk factors, high systolic blood pressure, unhealthy diet, high fasting plasma glucose, and high low-density lipoprotein levels were attributed to most of the CVD death and disability-adjusted life year lost. We also observed gender variations in tobacco and increased alcohol consumption. In addition to the traditional risk factors, poor air quality is associated with increased CVD burden in developing countries. Surveillance, country-specific guidelines, evidence-based policies, reinforcement of multisectoral health systems, and innovative solutions are urgently needed in resource-challenged settings to curb CVD risk factors and overall burden.
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Affiliation(s)
- Ram Jagannathan
- Division of Hospital Medicine, Emory University School of Medicine, 5206 Woodruff Memorial Research Building, 101 Woodruff Circle, Atlanta, GA, 30322, USA.
| | - Shivani A Patel
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mohammed K Ali
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Wu H, Lau ES, Kong AP, Ma RC, Ozaki R, Cheung KK, Chow E, Tsang CC, Lau KP, Hui EM, So WY, Gasevic D, Wild SH, Chan JC, Luk A. Association between educational level and cardiovascular disease and all-cause mortality in patients with type 2 diabetes: a prospective study in the Joint Asia Diabetes Evaluation Program. Clin Epidemiol 2018; 10:1561-1571. [PMID: 30464636 PMCID: PMC6208565 DOI: 10.2147/clep.s177437] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to describe the association between educational level and incident cardiovascular disease (CVD) and all-cause mortality in Hong Kong Chinese patients with type 2 diabetes. Patients and methods We included 12,634 patients with type 2 diabetes who were enrolled into the Joint Asia Diabetes Evaluation Program between June 1, 2007, and June 30, 2017. We classified patients' educational level into the following three groups: ≤6 years, 6-13 years, and >13 years. Incident CVD events were identified using hospital discharge diagnoses. Death was identified from Hong Kong Death Register. We estimated HRs for incident CVD and all-cause mortality using Cox regression models. Results Patients with the highest educational level were younger and had shorter diabetes duration and better glycemic control at enrollment than those with the lowest educational level. During the median follow-up of 6.2 years for CVD and 6.4 years for all-cause mortality, 954 CVD events and 833 deaths were recorded. HRs for CVD and all-cause mortality were 0.73 (95% CI: 0.57, 0.94) and 0.71 (95% CI: 0.54, 0.94) for the highest educational level compared to the lowest educational level, after adjustment for age, sex, diabetes duration, and family history of diabetes. Conclusion Educational level is inversely associated with the risk of CVD and all-cause mortality among Hong Kong Chinese patients with type 2 diabetes. Hong Kong Chinese patients with type 2 diabetes and low educational level should be given special attention for the prevention of key complications of diabetes.
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Affiliation(s)
- Hongjiang Wu
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK, .,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China,
| | - Eric Sh Lau
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
| | - Alice Ps Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China, .,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ronald Cw Ma
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China, .,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Risa Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Kitty Kt Cheung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Chiu Chi Tsang
- Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China
| | - Kam Piu Lau
- Northern District Hospital, Fanling, Hong Kong SAR, China
| | - Eric Mt Hui
- Department of Family Medicine, Prince of Wales Hospital, Hong Kong SAR, China
| | - Wing Yee So
- Hospital Authority Head Office, Hong Kong SAR, China
| | - Danijela Gasevic
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK, .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK,
| | - Juliana Cn Chan
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China, .,Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Andrea Luk
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China, .,Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
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11
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Ayatollahi H, Hasannezhad M, Fard HS, Haghighi MK. Type 1 diabetes self-management: developing a web-based telemedicine application. HEALTH INF MANAG J 2018; 45:16-26. [PMID: 28691565 DOI: 10.1177/1833358316639456] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Self-management skills are essential for patients with diabetes mellitus to minimise the risks of complications from their condition. The aim of this research was to develop a web-based application for self-management of type 1 diabetes, suitable for use by patients, their carers and physicians. METHOD The study was comprised of two phases, the first being analysis of the kind of information and capabilities required by potential users of the system. Based on the results derived from the first phase of the study, the system prototype was designed and then evaluated using the 'think aloud' method and a standard questionnaire. The application was designed for use by patients, their carers and physicians. Patients could enter the level of blood glucose, insulin and activities on a daily basis, and physicians were able to supervise a patient's health status from a distance. RESULTS Users were generally satisfied with the final version of the system. People with a wide range of literacy skills were able to use the system effectively. CONCLUSION Patients or their carers could use the web-based application as a log book by entering the level of blood glucose and insulin doses on a regular basis, and as an educational resource to improve self-management skills. Physicians could use the system at any time convenient to them to support patients by giving medical advice. Further research is needed to report the effectiveness of the system in practice.
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Affiliation(s)
- Haleh Ayatollahi
- 1 Department of Health Information Management, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hasannezhad
- 1 Department of Health Information Management, Iran University of Medical Sciences, Tehran, Iran
| | - Hedieh Saneei Fard
- 2 Paediatric Endocrinology & Metabolism, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehran Kamkar Haghighi
- 1 Department of Health Information Management, Iran University of Medical Sciences, Tehran, Iran
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12
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Gani L, Lau E, Luk A, Sobrepena L, Tran QK, Kesavadev J, Jia W, Yu W, Tsang CC, Mukhopadhyay M, Jha S, Sheu W, Ho YK, Nguyen TK, Ozaki R, So WY, Kwan C, Fu AWC, Mirasol R, Phatak SR, Kumar KMP, Aravind S, Janakiraman H, Chan JCN. Cross-sectional survey of biosimilar insulin utilization in Asia: The Joint Asia Diabetes Evaluation Program. J Diabetes Investig 2018; 9:1312-1322. [PMID: 29575724 PMCID: PMC6215931 DOI: 10.1111/jdi.12843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/26/2018] [Accepted: 03/14/2018] [Indexed: 12/01/2022] Open
Abstract
Aims/Introduction Biosimilar insulin can reduce treatment costs, although the extent of its use is largely unknown. We examined biosimilar insulin use and its associations with the quality of glycemic control using the Joint Asia Diabetes Evaluation register. Materials and Methods We carried out a cross‐sectional analysis in 81,531 patients with type 1 and type 2 diabetes enrolled into the Joint Asia Diabetes Evaluation Program from 2007 to 2014. All insulin related terms are extracted from the Joint Asia Diabetes Evaluation portal, and compared clinical profiles between biosimilar and originator insulin users. Multivariate analysis was performed to assess the association of biosimilar insulin compared with originator insulin with dosage, glycated hemoglobin and hypoglycemia events. Results Amongst 81,531 patients, 20.5% (n = 16,738) were insulin‐treated. In four countries with high use of biosimilar insulin, 4.7% (n = 719) of insulin users (n = 10,197) were treated with biosimilar insulin (India n = 507, 70.3%; the Philippines n = 90, 12.5%; China n = 62, 8.6%; Vietnam n = 60, 8.3%). Biosimilar insulin users were younger and had higher body mass index, glycated hemoglobin, insulin dosage and more frequent hypoglycemia than originator insulin users. These associations were non‐significant after adjustment for confounders. Only age, college education, diabetes education, lipid control, physical activity and history of cardiovascular complications were independently associated with these quality measures. Conclusions Biosimilar insulin use is not uncommon in Asia. Data exclusion due to incomplete capturing of brand names suggests possibly higher use. The multiple determinants of the quality of glycemic control call for establishment of prospective cohorts and diabetes registers to monitor the safety and efficacy of different brands of biosimilar insulin and their impacts on clinical outcomes.
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Affiliation(s)
- Linsey Gani
- Changi General Hospital, Singapore.,Asia Diabetes Foundation, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Eric Lau
- Asia Diabetes Foundation, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Andrea Luk
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | | | | | - Jothydev Kesavadev
- Jothydev's Diabetes and Research Center, Thiruvananthapuram, Kerala, India
| | - Weiping Jia
- Shanghai Sixth People's Hospital, Shanghai, China
| | - Weinan Yu
- Huaian Second People's Hospital, Jiangsu, China
| | | | | | - Sujeet Jha
- Max Super Specialty Hospital, New Delhi, Delhi, India
| | - Wayne Sheu
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yoon Kun Ho
- The Catholic University of Korea, Seoul, Korea
| | | | - Risa Ozaki
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Wing Yee So
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Christine Kwan
- Asia Diabetes Foundation, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Amy W C Fu
- Asia Diabetes Foundation, Prince of Wales Hospital, Sha Tin, Hong Kong
| | | | | | | | | | | | - Juliana C N Chan
- Asia Diabetes Foundation, Prince of Wales Hospital, Sha Tin, Hong Kong.,Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
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13
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Mansmann U, Lindoerfer D. A Comprehensive Assessment Tool for Patient Registry Software Systems: The CIPROS Checklist. Methods Inf Med 2018; 54:447-54. [DOI: 10.3414/me14-02-0026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 07/24/2015] [Indexed: 12/21/2022]
Abstract
SummaryBackground: Patient registries are an important instrument in medical research. Often their structure is complex and their implementation uses composite software systems to meet the wide spectrum of challenges.Objectives: For the implementation of a registry, there is a wide range of commercial, open source, and self-developed systems available and a minimal standard for the critical appraisal of their architecture is needed.Methods: We performed a systematic review of the literature to define a catalogue of relevant criteria to construct a minimal appraisal standard.Results: The CIPROS list is developed based on 64 papers which were found by our systematic review. The list covers twelve sections and contains 72 items.Conclusions: The CIPROS list supports developers to assess requirements on existing systems and strengthens the reporting of patient registry software system descriptions. It can be a first step to create standards for patient registry software system assessments.
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14
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Fisher EB, Boothroyd RI, Elstad EA, Hays L, Henes A, Maslow GR, Velicer C. Peer support of complex health behaviors in prevention and disease management with special reference to diabetes: systematic reviews. Clin Diabetes Endocrinol 2017; 3:4. [PMID: 28702258 PMCID: PMC5471959 DOI: 10.1186/s40842-017-0042-3] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/09/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Examine Peer Support (PS) for complex, sustained health behaviors in prevention or disease management with emphasis on diabetes prevention and management. DATA SOURCES AND ELIGIBILITY PS was defined as emotional, motivational and practical assistance provided by nonprofessionals for complex health behaviors. Initial review examined 65 studies drawn from 1442 abstracts identified through PubMed, published 1/1/2000-7/15/2011. From this search, 24 reviews were also identified. Extension of the search in diabetes identified 30 studies published 1/1/2000-12/31/2015. RESULTS In initial review, 54 of all 65 studies (83.1%) reported significant impacts of PS, 40 (61.5%) reporting between-group differences and another 14 (21.5%) reporting significant within-group changes. Across 19 of 24 reviews providing quantifiable findings, a median of 64.5% of studies reviewed reported significant effects of PS. In extended review of diabetes, 26 of all 30 studies (86.7%) reported significant impacts of PS, 17 (56.7%) reporting between-group differences and another nine (30.0%) reporting significant within-group changes. Among 19 of these 30 reporting HbA1c data, average reduction was 0.76 points. Studies that did not find effects of PS included other sources of support, implementation or methodological problems, lack of acceptance of interventions, poor fit to recipient needs, and possible harm of unmoderated PS. CONCLUSIONS Across diverse settings, including under-resourced countries and health care systems, PS is effective in improving complex health behaviors in disease prevention and management including in diabetes.
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Affiliation(s)
- Edwin B. Fisher
- Peers for Progress, Gillings School of Global Public Health, University of North Carolina, Box 7440, Chapel Hill, NC 27599-7440 USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Box 7440, Chapel Hill, NC 27599-7440 USA
| | - Renée I. Boothroyd
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC USA
| | | | - Laura Hays
- Indiana University School of Nursing, Indianapolis, IN USA
| | - Amy Henes
- RTI International, Research Triangle Park, NC USA
| | - Gary R. Maslow
- Department of Pediatrics, Duke University, Durham, NC USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC USA
| | - Clayton Velicer
- National Public Relations and Communications, Kaiser Permanente, Oakland, CA USA
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15
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Yin J, Luk A, Wong R, Chung H, Kong A, Ozaki R, Ma R, Chow CC, So W, Chan J. Regular mailing of personalized feedback reports improves glycemic control in diabetes: A randomized controlled trial. J Diabetes 2017; 9:536-538. [PMID: 28083979 DOI: 10.1111/1753-0407.12527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 12/02/2016] [Accepted: 01/09/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Junmei Yin
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Department of Clinical Nutrition, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Andrea Luk
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Rebecca Wong
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Harriet Chung
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Alice Kong
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Risa Ozaki
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ronald Ma
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Chun-Chung Chow
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Wingyee So
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Juliana Chan
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
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16
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Tutino GE, Yang WY, Li X, Li WH, Zhang YY, Guo XH, Luk AO, Yeung ROP, Yin JM, Ozaki R, So WY, Ma RCW, Ji LN, Kong APS, Weng JP, Ko GTC, Jia WP, Chan JCN. A multicentre demonstration project to evaluate the effectiveness and acceptability of the web-based Joint Asia Diabetes Evaluation (JADE) programme with or without nurse support in Chinese patients with Type 2 diabetes. Diabet Med 2017; 34:440-450. [PMID: 27278933 PMCID: PMC5324581 DOI: 10.1111/dme.13164] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 02/06/2023]
Abstract
AIMS To test the hypothesis that delivery of integrated care augmented by a web-based disease management programme and nurse coordinator would improve treatment target attainment and health-related behaviour. METHODS The web-based Joint Asia Diabetes Evaluation (JADE) and Diabetes Monitoring Database (DIAMOND) portals contain identical built-in protocols to integrate structured assessment, risk stratification, personalized reporting and decision support. The JADE portal contains an additional module to facilitate structured follow-up visits. Between January 2009 and September 2010, 3586 Chinese patients with Type 2 diabetes from six sites in China were randomized to DIAMOND (n = 1728) or JADE, plus nurse-coordinated follow-up visits (n = 1858) with comprehensive assessments at baseline and 12 months. The primary outcome was proportion of patients achieving ≥ 2 treatment targets (HbA1c < 53 mmol/mol (7%), blood pressure < 130/80 mmHg and LDL cholesterol < 2.6 mmol/l). RESULTS Of 3586 participants enrolled (mean age 57 years, 54% men, median disease duration 5 years), 2559 returned for repeat assessment after a median (interquartile range) follow-up of 12.5 (4.6) months. The proportion of participants attaining ≥ 2 treatment targets increased in both groups (JADE 40.6 to 50.0%; DIAMOND 38.2 to 50.8%) and there were similar absolute reductions in HbA1c [DIAMOND -8 mmol/mol vs JADE -7 mmol/mol (-0.69 vs -0.62%)] and LDL cholesterol (DIAMOND -0.32 mmol/l vs JADE -0.28 mmol/l), with no between-group difference. The JADE group was more likely to self-monitor blood glucose (50.5 vs 44.2%; P = 0.005) and had fewer defaulters (25.6 vs 32.0%; P < 0.001). CONCLUSIONS Integrated care augmented by information technology improved cardiometabolic control, with additional nurse contacts reducing the default rate and enhancing self-care. (Clinical trials registry no.: NCT01274364).
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Affiliation(s)
- G. E. Tutino
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - W. Y. Yang
- China‐Japan Friendship HospitalBeijingChina
| | - X. Li
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Asia Diabetes FoundationPrince of Wales HospitalHong Kong SARChina
| | - W. H. Li
- Peking Union HospitalBeijingChina
| | - Y. Y. Zhang
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Asia Diabetes FoundationPrince of Wales HospitalHong Kong SARChina
| | - X. H. Guo
- First HospitalPeking University HospitalBeijingChina
| | - A. O. Luk
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Asia Diabetes FoundationPrince of Wales HospitalHong Kong SARChina
| | - R. O. P. Yeung
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Asia Diabetes FoundationPrince of Wales HospitalHong Kong SARChina
| | - J. M. Yin
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Asia Diabetes FoundationPrince of Wales HospitalHong Kong SARChina
| | - R. Ozaki
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - W. Y. So
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - R. C. W. Ma
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - L. N. Ji
- Beijing People's HospitalBeijingChina
| | - A. P. S. Kong
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - J. P. Weng
- Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - G. T. C. Ko
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - W. P. Jia
- Shanghai Sixth People's HospitalShanghaiChina
| | - J. C. N. Chan
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
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17
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McFadden N, Daniel B, Hoyt R, Snider D. Development of a Web-Based Registry to Support Diabetes Care in Free Medical Clinics. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2017; 14:1a. [PMID: 28566990 PMCID: PMC5430109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The United States has more than 1,000 free medical clinics. Because these clinics do not bill Medicare or Medicaid, they are not eligible for federal reimbursement for electronic health record (EHR) adoption. As a result, most do not have EHRs or electronic disease registries. A web-based diabetes registry was created with all open-source components for use in an urban free clinic to manage patients with type 2 diabetes and comorbidities. The registry was modeled after the Chronic Disease Electronic Management System and recommendations of the American Diabetes Association. The software was enhanced to include multiple other features, such as progress notes, so that it can function as a simple EHR. The configuration permits other free clinics to join securely, and the software can be shared.
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Affiliation(s)
- Norman McFadden
- Our Lady of the Angel St. Joseph Medical Clinic in Pensacola, FL
| | | | - Robert Hoyt
- College of Health at the University of West Florida in Pensacola, FL
| | - Dallas Snider
- Hal Marcus College of Science and Engineering at the University of West Florida in Pensacola, FL
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18
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Luk AOY, Ho TS, Lau ES, Ko GT, Ozaki R, Tsang CC, Kong AP, Ma RC, So WY, Chow FC, Chan JC. Association of self-reported recurrent mild hypoglycemia with incident cardiovascular disease and all-cause mortality in patients with type 2 diabetes: Prospective analysis of the Joint Asia Diabetes Evaluation Registry. Medicine (Baltimore) 2016; 95:e5183. [PMID: 27828844 PMCID: PMC5106050 DOI: 10.1097/md.0000000000005183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Severe hypoglycemia is an established risk marker for cardiovascular complications of diabetes, but whether mild hypoglycemia confers similar risks is unclear. We examined the association of self-reported recurrent mild hypoglycemic events with cardiovascular disease (CVD) and all-cause mortality in a prospective cohort of Chinese adults with type 2 diabetes.From June 2007 to May 2015, 19,019 patients in Hong Kong underwent comprehensive assessment of metabolic and complication status using the Joint Asia Diabetes Evaluation program. Recurrent mild hypoglycemic event was determined by self-report of mild-to-moderate hypoglycemic symptoms at least once monthly in previous 3 months. Incident cardiovascular events were identified using hospital discharge diagnosis codes and death using Hong Kong Death Registry.Patients reporting recurrent mild hypoglycemia (n = 1501, 8.1%) were younger, had longer disease duration, worse glycemic control, and higher frequencies of vascular complications at baseline. Over 3.9 years of follow-up, respective incidences of CVD and all-cause death were 18.1 and 10.3 per 1000 person-years and 15.4 and 9.9 per 1000 person-years in patients with and without recurrent mild hypoglycemia. Using multivariate Cox regression analysis, recurrent mild hypoglycemia was not associated with CVD or all-cause mortality. In subgroup analysis, mild hypoglycemia was related to CVD in patients with chronic kidney disease (hazard ratio 1.36, 95% confidence interval 1.01-1.84, P = 0.0435) and those on insulin (hazard ratio 1.37, 95% confidence interval 1.01-1.86, P = 0.0402) adjusted for confounders.Mild hypoglycemia by self-report was frequent in patients with type 2 diabetes and was associated with increased risk of CVD in susceptible groups.
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Affiliation(s)
- Andrea On Yan Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital
- Asia Diabetes Foundation
- Correspondence: Andrea On Yan Luk, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, People's Republic of China (e-mail: )
| | | | | | - Gary T.C. Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital
| | - Risa Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital
| | - Chiu-Chi Tsang
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
| | - Alice P.S. Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital
- Li Ka Shing Institute of Health and Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Ronald C.W. Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital
- Li Ka Shing Institute of Health and Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital
| | - Francis C.C. Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital
| | - Juliana C.N. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital
- Asia Diabetes Foundation
- Hong Kong Institute of Diabetes and Obesity
- Li Ka Shing Institute of Health and Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
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19
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Luk AO, Li X, Zhang Y, Guo X, Jia W, Li W, Weng J, Yang W, Chan WB, Ozaki R, Tsang CC, Mukhopadhyay M, Ojha AK, Hong EG, Yoon KH, Sobrepena L, Toledo RM, Duran M, Sheu W, Q Do T, Nguyen TK, Ma RC, Kong AP, Chow CC, Tong PC, So WY, Chan JC. Quality of care in patients with diabetic kidney disease in Asia: The Joint Asia Diabetes Evaluation (JADE) Registry. Diabet Med 2016; 33:1230-9. [PMID: 26511783 DOI: 10.1111/dme.13014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 12/18/2022]
Abstract
AIMS Diabetic kidney disease independently predicts cardiovascular disease and premature death. We examined the burden of chronic kidney disease (CKD, defined as an estimated GFR < 60 ml/min/1.73 m(2) ) and quality of care in a cross-sectional survey of adults (age ≥ 18 years) with Type 2 diabetes across Asia. METHODS The Joint Asia Diabetes Evaluation programme is a disease-management programme implemented using an electronic portal that systematically captures clinical characteristics of all patients enrolled. Between July 2007 and December 2012, data on 28 110 consecutively enrolled patients (China: 3415, Hong Kong: 15 196, India: 3714, Korea: 1651, Philippines: 3364, Vietnam: 692, Taiwan: 78) were analysed. RESULTS In this survey, 15.9% of patients had CKD, 25.0% had microalbuminuria and 12.5% had macroalbuminuria. Patients with CKD were less likely to achieve HbA1c < 53 mmol/mol (7.0%) (36.0% vs. 42.3%) and blood pressure < 130/80 mmHg (20.8% vs. 35.3%), and were more likely to have retinopathy (26.2% vs. 8.7%), sensory neuropathy (29.0% vs. 7.7%), cardiovascular disease (26.6% vs. 8.7%) and self-reported hypoglycaemia (18.9% vs. 8.2%). Despite high frequencies of albuminuria (74.8%) and dyslipidaemia (93.0%) among CKD patients, only 49.0% were using renin-angiotensin system inhibitors and 53.6% were on statins. On logistic regression, old age, male gender, tobacco use, long disease duration, high HbA1c , blood pressure and BMI, and low LDL cholesterol were independently associated with CKD (all P < 0.05). CONCLUSIONS The poor control of risk factors, suboptimal use of organ-protective drugs and high frequencies of hypoglycaemia highlight major treatment gaps in patients with diabetic kidney disease in Asia.
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Affiliation(s)
- A O Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - X Li
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
| | - Y Zhang
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
| | - X Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - W Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - W Li
- Peking Union Medical College Hospital, Beijing, China
| | - J Weng
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, Beijing, China
| | - W Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - W B Chan
- Qualigenics Diabetes Centre, Hong Kong SAR, China
| | - R Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - C C Tsang
- Alice Ho Nethersole Hospital, Hong Kong SAR, China
| | | | | | - E G Hong
- Hallym University College of Medicine, Gangwon-do, Korea
| | - K H Yoon
- The Catholic University of Korea, Seocho-gu, Korea
| | - L Sobrepena
- Heart of Jesus Hospital, San Jose City, Philippines
| | - R M Toledo
- Senor Sto. Nino Hospital, Tarlac, Philippines
| | - M Duran
- New Bilibid Prison Hospital, Bureau of Corrections, Muntinlupa, Philippines
| | - W Sheu
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - T Q Do
- Bach Mai Hospital, Hanoi, Vietnam
| | - T K Nguyen
- HCMC University of Pharmaceutical and Medicine, Ho Chi Minh City, Vietnam
| | - R C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A P Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - C C Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
| | - P C Tong
- Qualigenics Diabetes Centre, Hong Kong SAR, China
| | - W Y So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J C Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
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20
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Goh SY, Ang E, Bajpai S, Deerochanawong C, Hong EG, Hussein Z, Joshi S, Kamaruddin NA, Kho S, Kong APS, Pan CY, Perfetti R, Vichayanrat A, Vlajnic A, Chan JCN. A patient-centric approach to optimise insulin therapy in Asia. J Diabetes Complications 2016; 30:973-80. [PMID: 27288201 DOI: 10.1016/j.jdiacomp.2016.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ernesto Ang
- Cardinal Santos Medical Center, San Juan, Philippines; The Institute for Studies on Diabetes Foundation Inc., Metro Manila, Philippines
| | | | | | - Eun-Gyoung Hong
- Hallym University School of Medicine, Dongtan Sacred Heart Hospital, Gyeonggi-do, South Korea
| | | | | | | | - Sjoberg Kho
- University of Santo Tomas, Manila, Philippines
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21
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Munch L, Arreskov AB, Sperling M, Overgaard D, Knop FK, Vilsbøll T, Røder ME. Risk stratification by endocrinologists of patients with type 2 diabetes in a Danish specialised outpatient clinic: a cross-sectional study. BMC Health Serv Res 2016; 16:124. [PMID: 27061722 PMCID: PMC4826533 DOI: 10.1186/s12913-016-1365-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 03/24/2016] [Indexed: 12/20/2022] Open
Abstract
Background To target optimised medical care the Danish guidelines for diabetes recommend stratification of patients with type 2 diabetes (T2D) into three levels according to risk and complexity of treatment. The aim was to describe the T2D population in an outpatient clinic, measure the compliance of the endocrinologists’ to perform risk stratification, and investigate the level of concordance between stratification performed by the endocrinologists and objective assessments. Methods A cross-sectional study with data collected from medical records and laboratory databases. The Danish risk stratification model contained the following criteria: HbA1c, blood pressure, metabolic complications, microvascular and macrovascular complications. Stratification levels encompassed: level 1 (uncomplicated), level 2 (intermediate risk) and level 3 (high risk). Objective assessments were conducted independently by two health professionals, and compared with the endocrinologists’ assessments. In order to test the degree of concordance, we conducted Cohen's kappa, McNemar’s test for marginal homogeneity, and Bowker’s test for symmetry. Results Of 245 newly referred patients, 209 (85 %) were stratified by the endocrinologists to level 1 (16 %), level 2 (55 %) and level 3 (29 %). By objective assessments, 4 % were stratified to level 1, 51 % to level 2 and 45 % to level 3. Of 419 long-term follow-up patients, 380 (91 %) were stratified by the endocrinologists to level 1 (5 %), level 2 (57 %), level 3 (38 %). By objective assessments, 3 % were stratified to level 1, 58 % to level 2 and 39 % to level 3. The concordance rate between endocrinologists’ and objective assessments was 63 % among newly referred (kappa 0.39; fair agreement) and 67 % for long-term follow-up (kappa 0.45; moderate agreement). Among newly referred patients, the endocrinologists stratified less patients at level 3 compared to objective assessments (p < 0.0001). There were no significant differences in marginal distribution within long-term follow-up patients. Conclusion Type 2 diabetes patients, newly referred to or allocated for long-term follow-up in the out-patient clinic, were mainly intermediate and high-risk, complicated patients (96 % and 95 %, respectively). Compliance of stratification by endocrinologists was high. The concordance between endocrinologists’ and objective assessments was not strong. Our data suggest that clinician-support for stratification level categorisation might be needed.
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Affiliation(s)
- Lene Munch
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark.,Institute of Nursing, University College Metropol, Tagensvej 86, DK-2200, Copenhagen, Denmark
| | - Anne B Arreskov
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark
| | | | - Dorthe Overgaard
- Institute of Nursing, University College Metropol, Tagensvej 86, DK-2200, Copenhagen, Denmark
| | - Filip K Knop
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark.,NNF Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200, Copenhagen, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark
| | - Michael E Røder
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark.
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22
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Yin J, Yeung R, Luk A, Tutino G, Zhang Y, Kong A, Chung H, Wong R, Ozaki R, Ma R, Tsang CC, Tong P, So W, Chan J. Gender, diabetes education, and psychosocial factors are associated with persistent poor glycemic control in patients with type 2 diabetes in the Joint Asia Diabetes Evaluation (JADE) program. J Diabetes 2016; 8:109-19. [PMID: 25564925 DOI: 10.1111/1753-0407.12262] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/28/2014] [Accepted: 12/23/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Factors associated with persistent poor glycemic control were explored in patients with type 2 diabetes under the Joint Asia Diabetes Evaluation (JADE) program. METHODS Chinese adults enrolled in JADE with HbA1c ≥8% at initial comprehensive assessment (CA1) and repeat assessment were analyzed. The improved group was defined as those with a ≥1% absolute reduction in HbA1c, and the unimproved group was those with <1% reduction at the repeat CA (CA2). RESULTS Of 4458 enrolled patients with HbA1c ≥8% at baseline, 1450 underwent repeat CA. After a median interval of 1.7 years (interquartile range[IQR] 1.1-2.2) between CA1 and CA2, the unimproved group (n = 677) had a mean 0.4% (95% confidence interval [CI] 0.3%, 0.5%) increase in HbA1c compared with a mean 2.8% reduction (95% CI -2.9, -2.6%) in the improved group (n = 773). The unimproved group had a female preponderance with lower education level, and was more likely to be insulin treated. Patients in the improved group received more diabetes education between CAs with improved self-care behaviors, whereas the unimproved group had worsening of health-related quality of life at CA2. Apart from female gender, long disease duration, low educational level, obesity, retinopathy, history of hypoglycemia, and insulin use, lack of education from diabetes nurses between CAs had the strongest association for persistent poor glycemic control. CONCLUSIONS These results highlight the multidimensional nature of glycemic control, and the importance of diabetes education and optimizing diabetes care by considering psychosocial factors.
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Affiliation(s)
- Junmei Yin
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Roseanne Yeung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
- Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
| | - Greg Tutino
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuying Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
| | - Alice Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
- Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, Hong Kong SAR, China
| | - Harriet Chung
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, Hong Kong SAR, China
| | - Rebecca Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China
| | - Risa Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ronald Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
- Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, Hong Kong SAR, China
| | - Chiu-Chi Tsang
- Diabetes Center, Alice Ho Nethersole Hospital, Hong Kong SAR, China
| | - Peter Tong
- Qualigenics Diabetes Centre, Hong Kong SAR, China
| | - Wingyee So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China
| | - Juliana Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
- Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, Hong Kong SAR, China
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23
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Zhang Y, Ting RZW, Yang W, Jia W, Li W, Ji L, Guo X, Kong APS, Wing Y, Luk AOY, Sartorius N, Morisky DE, Oldenburg B, Weng J, Chan JCN. Depression in Chinese patients with type 2 diabetes: associations with hyperglycemia, hypoglycemia, and poor treatment adherence. J Diabetes 2015; 7:800-8. [PMID: 25349949 PMCID: PMC4964948 DOI: 10.1111/1753-0407.12238] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/10/2014] [Accepted: 11/10/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND We hypothesize that depression in type 2 diabetes might be associated with poor glycemic control, in part due to suboptimal self-care. We tested this hypothesis by examining the associations of depression with clinical and laboratory findings in a multicenter survey of Chinese type 2 diabetic patients. METHOD 2538 patients aged 18-75 years attending hospital-based clinics in four cities in China underwent detailed clinical-psychological-behavioral assessment during a 12-month period between 2011 and 2012. Depression was diagnosed if Patient Health Questionnaire-9 (PHQ-9) score ≥10. Diabetes self-care and medication adherence were assessed using the Summary of Diabetes Self-care Activities and the 4-item Morisky medication adherence scale respectively. RESULTS In this cross-sectional study (mean age: 56.4 ± 10.5[SD] years, 53% men), 6.1% (n = 155) had depression. After controlling for study sites, patients with depression had higher HbA(1c) (7.9 ± 2.0 vs. 7.7 ± 2.0%, P = 0.008) and were less likely to achieve HbA(1c) goal of <7.0% (36.2% vs 45.6%, P = 0.004) than those without depression. They were more likely to report hypoglycemia and to have fewer days of being adherent to their recommended diet, exercise, foot care and medication. In logistic regression, apart from young age, poor education, long disease duration, tobacco use, high body mass index, use of insulin, depression was independently associated with failure to attain HbA(1c) target (Odds Ratio [OR] = 1.56, 95%CI:1.05-2.32, P = 0.028). The association between depression and glycemic control became non-significant after inclusion of adherence to diet, exercise and medication (OR = 1.48, 95% CI 0.99-2.21, P = 0.058). CONCLUSION Depression in type 2 diabetes was closely associated with hyperglycemia and hypoglycemia, which might be partly mediated through poor treatment adherence.
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Affiliation(s)
- Yuying Zhang
- Department of Medicine and TherapeuticsThe Chinese University of Hong Kong, The Prince of Wales HospitalShatinHong Kong SARChina
- Asia Diabetes FoundationThe Chinese University of Hong Kong, The Prince of Wales HospitalShatinHong Kong SARChina
| | - Rose ZW Ting
- Department of Medicine and TherapeuticsThe Chinese University of Hong Kong, The Prince of Wales HospitalShatinHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong Kong, The Prince of Wales HospitalShatinHong Kong SARChina
| | - Wenying Yang
- Department of Endocrinology and MetabolismChina‐Japan Friendship HospitalBeijingChina
| | - Weiping Jia
- Department of Endocrinology and MetabolismShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Wenhui Li
- Department of Endocrinology and MetabolismPeking Union Medical College HospitalBeijingChina
| | - Linong Ji
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| | - Xiaohui Guo
- Department of Endocrinology and MetabolismPeking University First HospitalBeijingChina
| | - Alice PS Kong
- Department of Medicine and TherapeuticsThe Chinese University of Hong Kong, The Prince of Wales HospitalShatinHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong Kong, The Prince of Wales HospitalShatinHong Kong SARChina
| | - Yun‐Kwok Wing
- Department of PsychiatryThe Chinese University of Hong KongShatin HospitalShatinHong Kong SARChina
| | - Andrea OY Luk
- Department of Medicine and TherapeuticsThe Chinese University of Hong Kong, The Prince of Wales HospitalShatinHong Kong SARChina
- Asia Diabetes FoundationThe Chinese University of Hong Kong, The Prince of Wales HospitalShatinHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong Kong, The Prince of Wales HospitalShatinHong Kong SARChina
| | - Norman Sartorius
- Association for the Improvement of Mental Health ProgrammesGenevaSwitzerland
| | - Donald E Morisky
- University of California Los Angeles Fielding School of Public HealthLos AngelesCAUSA
| | - Brian Oldenburg
- School of Population and Global HealthThe University of MelbourneMelbourneVICAustralia
| | - Jianping Weng
- Department of Endocrinology and MetabolismThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Juliana CN Chan
- Department of Medicine and TherapeuticsThe Chinese University of Hong Kong, The Prince of Wales HospitalShatinHong Kong SARChina
- Asia Diabetes FoundationThe Chinese University of Hong Kong, The Prince of Wales HospitalShatinHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong Kong, The Prince of Wales HospitalShatinHong Kong SARChina
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Yan BP, Zhang Y, Kong APS, Luk AOY, Ozaki R, Yeung R, Tong PCY, Chan WB, Tsang CC, Lau KP, Cheung Y, Wolthers T, Lyubomirsky G, So WY, Ma RCW, Chow FCC, Chan JCN. Borderline ankle-brachial index is associated with increased prevalence of micro- and macrovascular complications in type 2 diabetes: A cross-sectional analysis of 12,772 patients from the Joint Asia Diabetes Evaluation Program. Diab Vasc Dis Res 2015; 12:334-41. [PMID: 26141965 DOI: 10.1177/1479164115590559] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Borderline ankle-brachial index is increasingly recognised as a marker of cardiovascular risk. We evaluated the impact of borderline ankle-brachial index in 12,772 Chinese type 2 diabetes patients from the Joint Asia Diabetes Evaluation Program between 2007 and 2012. Cardiovascular risk factors, complications and health-related quality of life were compared between patients with normal ankle-brachial index (1.0-1.4), borderline ankle-brachial index (0.90-0.99) and peripheral arterial disease (ankle-brachial index < 0.9). The prevalence of peripheral arterial disease and borderline ankle-brachial index was 4.6% and 9.6%, respectively. Borderline ankle-brachial index patients were older, more likely to be smokers and hypertensive, had longer duration of diabetes, poorer kidney function and poorer health-related quality of life than patients with normal ankle-brachial index. After adjustment for traditional cardiovascular risk factors, borderline ankle-brachial index was an independent predictor of diabetes-related micro- and macrovascular complications including retinopathy (odd ratios: 1.19 (95% confidence interval: 1.04-1.37)), macroalbuminuria (1.31 (1.10-1.56)), chronic kidney disease (1.22 (1.00-1.50)) and stroke (1.31 (1.05-1.64)). These findings suggest that patients with diabetes and borderline ankle-brachial index are at increased cardiovascular risk and may benefit from more intensive management.
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Affiliation(s)
- Bryan P Yan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Institute of Vascular Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yuying Zhang
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Asia Diabetes Foundation, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Asia Diabetes Foundation, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Risa Ozaki
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Roseanne Yeung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Asia Diabetes Foundation, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter C Y Tong
- Qualigenics Diabetes Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Ban Chan
- Qualigenics Diabetes Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Chiu-Chi Tsang
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Kam-Piu Lau
- Department of Medicine, Northern District Hospital, Hong Kong, China
| | - Yu Cheung
- Ma On Shan General Out-Patient Clinic, Hong Kong, China
| | - Troels Wolthers
- Asia Diabetes Foundation, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Greg Lyubomirsky
- Asia Diabetes Foundation, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Francis C C Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Asia Diabetes Foundation, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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25
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Zhang Y, Ting RZW, Lam MHB, Lam SP, Yeung RO, Nan H, Ozaki R, Luk AOY, Kong APS, Wing YK, Sartorius N, Chan JCN. Measuring depression with CES-D in Chinese patients with type 2 diabetes: the validity and its comparison to PHQ-9. BMC Psychiatry 2015; 15:198. [PMID: 26281832 PMCID: PMC4538746 DOI: 10.1186/s12888-015-0580-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The validity of the 20-item Center for Epidemiological Studies Depression (CES-D) scale for depression screening in Hong Kong Chinese patients with type 2 diabetes remains unknown. We aimed to validate CES-D, compare its psychometric properties with the 9-item Patient Health Questionnaire (PHQ-9), and explore whether one of the two is more suitable for depression screening in Chinese patients with type 2 diabetes. METHODS Between June 2010 and July 2011, 545 consecutive Chinese patients with type 2 diabetes who underwent structured comprehensive assessments completed the CES-D and PHQ-9. Forty patients were retested within 2-4 weeks by telephone interview and 97 patients were randomly selected to undergo the Mini International Neuropsychiatric Interview (MINI) by psychiatrists for clinical diagnosis of depression. RESULTS The internal consistency (Cronbach's α) of CES-D was 0.85, with a test-retest correlation coefficient of 0.64. The area under the curve for CES-D compared to the clinical diagnosis of major depression was 0.85. A cut-off score of ≥21 for CES-D provided the optimal balance between sensitivity (78.3 %) and specificity (74.3 %) and identified 17.8 % (n = 97) of patients with depression. CES-D and PHQ-9 showed moderate agreement in depression screening (Cohen's Kappa: 0.45). Compared to non-depressed patients, those who screened positive by PHQ-9 had a higher HbA1c whereas the glycemic differences were not significant when using CES-D. CONCLUSION The CES-D is a valid screening tool for depression in Chinese type 2 diabetic patients although the PHQ-9 was more discriminative in identifying those with suboptimal glycemic control.
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Affiliation(s)
- Yuying Zhang
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Asia Diabetes Foundation, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Rose Z W Ting
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Marco H B Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Siu-Ping Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Roseanne O. Yeung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China ,Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China ,Asia Diabetes Foundation, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hairong Nan
- Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China.
| | - Risa Ozaki
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China.
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China. .,Asia Diabetes Foundation, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Alice P S Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China. .,Asia Diabetes Foundation, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Yun-Kwok Wing
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Norman Sartorius
- The Association for the Improvement of Mental Health Programmes, Geneva, Switzerland.
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China. .,Asia Diabetes Foundation, The Chinese University of Hong Kong, Hong Kong SAR, China.
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26
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Luk AOY, Fu WC, Li X, Ozaki R, Chung HHY, Wong RYM, So WY, Chow FCC, Chan JCN. The Clinical Utility of SUDOSCAN in Chronic Kidney Disease in Chinese Patients with Type 2 Diabetes. PLoS One 2015; 10:e0134981. [PMID: 26270544 PMCID: PMC4535976 DOI: 10.1371/journal.pone.0134981] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/15/2015] [Indexed: 01/13/2023] Open
Abstract
There are gaps between recommendations on regular screening for diabetic kidney disease (DKD) and clinical practice especially in busy and low resource settings. SUDOSCAN (Impeto Medical, Paris, France) is a non-invasive technology for assessing sudomotor function using reverse iontophoresis and chronoamperometry which detects abnormal sweat gland function. Vasculopathy and neuropathy share common risk factors and we hypothesized that SUDOSCAN may be used to detect chronic kidney disease (CKD). Between 2012 and 2013, SUDOSCAN was performed in a consecutive cohort of 2833 Hong Kong Chinese adults with type 2 diabetes. Chronic kidney disease was defined as estimated glomerular filtration rate <60 ml/min/1.73m2. In this cross-sectional cohort (mean age 58.6±9.5 years, 55.7% male, median disease duration 8 [interquartile range 3–14] years), 5.8% had CKD. At a cut-off SUDOSCAN-DKD score of 53, the test had sensitivity of 76.7%, specificity of 63.4% and positive likelihood ratio of 2.1 to detect CKD. The area under receiver operating characteristic curve for CKD was 0.75 (95% confidence interval 0.72–0.79). Patients without CKD but low score had worse risk factors and complications than those with high score. We conclude that SUDOSCAN may be used to detect patients at risk of impaired renal function as part of a screening program in Chinese population, especially in outreach or low resource settings.
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Affiliation(s)
- Andrea O. Y. Luk
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong, SAR
- Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, Hong Kong, SAR
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR
- International Diabetes Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR
- * E-mail:
| | - Wai-Chi Fu
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong, SAR
| | - Xue Li
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong, SAR
| | - Risa Ozaki
- Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, Hong Kong, SAR
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR
- International Diabetes Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR
| | - Harriet H. Y. Chung
- Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, Hong Kong, SAR
| | - Rebecca Y. M. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR
- International Diabetes Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR
| | - Wing-Yee So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR
- International Diabetes Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR
| | - Francis C. C. Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR
- International Diabetes Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR
| | - Juliana C. N. Chan
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong, SAR
- Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, Hong Kong, SAR
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR
- International Diabetes Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR
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Harris S, Aschner P, Mequanint S, Esler J. Use of Diabetes Registry Data for Comparing Indices of Diabetes Management: A Comparison of 2 Urban Sites in Canada and Colombia. Can J Diabetes 2015; 39:496-501. [PMID: 26255579 DOI: 10.1016/j.jcjd.2015.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/12/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To demonstrate the use of a multinational diabetes registry for comparing indices of diabetes management among countries with differing levels of income, healthcare systems and ethnic backgrounds. METHODS A cross-sectional study was conducted among 1742 people with type 2 diabetes attending diabetes clinics in London, Ontario, Canada, and Bogota, Colombia. The data were extracted from the Global Registry and Surveillance System for Diabetes (GRAND). RESULTS Canadian patients were diagnosed with diabetes at significantly younger ages than Colombian patients (49 years and 53 years, respectively) and were heavier (body mass indices of 33 and 28, respectively). The Colombian patient population had significantly higher mean glycated hemoglobin (A1C) levels (9.4% vs. 8.6%) and fewer patients (22% vs. 26%) at the glycemic target (A1C <7.0%) than Canadian patients. In Colombia, 1 or more diabetes-related complications were present in 51% of the study population compared with 37% in Canada. Newly diagnosed Colombians had higher mean A1C levels (9.1% vs. 8.7%) and low-density lipoprotein-C levels (3.3 mmol/L vs. 2.5 mmol/L) than did newly diagnosed Canadians. CONCLUSIONS A multination diabetes registry collecting standardized data facilitates transnational comparison of diabetes clinical parameters for the purpose of identifying potential gaps in care.
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Affiliation(s)
- Stewart Harris
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Pablo Aschner
- Department of Internal Medicine, Javeriana University School of Medicine, San Ignacio University Hospital, and Colombian Diabetes Association, Bogotá, Colombia
| | - Selam Mequanint
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jim Esler
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Pokharel DR, Khadka D, Sigdel M, Yadav NK, Sapkota LB, Kafle R, Nepal S, Sapkota RM, Choudhary N. Estimation of 10-Year Risk of Coronary Heart Disease in Nepalese Patients with Type 2 Diabetes: Framingham Versus United Kingdom Prospective Diabetes Study. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:347-55. [PMID: 26417557 PMCID: PMC4561440 DOI: 10.4103/1947-2714.163642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Predicting future coronary heart disease (CHD) risk with the help of a validated risk prediction function helps clinicians identify diabetic patients at high risk and provide them with appropriate preventive medicine. AIM The aim of this study is to estimate and compare 10-year CHD risks of Nepalese diabetic patients using two most common risk prediction functions: The Framingham risk equation and United Kingdom Prospective Diabetes Study (UKPDS) risk engine that are yet to be validated for Nepalese population. PATIENTS AND METHODS We conducted a hospital-based, cross-sectional study on 524 patients with type 2 diabetes. Baseline and biochemical variables of individual patients were recorded and CHD risks were estimated by the Framingham and UKPDS risk prediction functions. Estimated risks were categorized as low, medium, and high. The estimated CHD risks were compared using kappa statistics, Pearson's bivariate correlation, Bland-Altman plots, and multiple regression analysis. RESULTS The mean 10-year CHD risks estimated by the Framingham and UKPDS risk functions were 17.7 ± 12.1 and 16.8 ± 15 (bias: 0.88, P > 0.05), respectively, and were always higher in males and older age groups (P < 0.001). The two risk functions showed moderate convergent validity in predicting CHD risks, but differed in stratifying them and explaining the patients' risk profile. The Framingham equation predicted higher risk for patients usually below 70 years and showed better association with their current risk profile than the UKPDS risk engine. CONCLUSIONS Based on the predicted risk, Nepalese diabetic patients, particularly those associated with increased numbers of risk factors, bear higher risk of future CHDs. Since this study is a cross-sectional one and uses externally validated risk functions, Nepalese clinicians should use them with caution, and preferably in combination with other guidelines, while making important medical decisions in preventive therapy of CHD.
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Affiliation(s)
- Daya Ram Pokharel
- Department of Biochemistry, Manipal College of Medical Sciences, Pokhara, Kaski, Nepal
| | - Dipendra Khadka
- Department of Laboratory Science, School of Health and Allied Sciences, Pokhara University, Lekhnath, Kaski, Nepal
| | - Manoj Sigdel
- Department of Biochemistry, Manipal College of Medical Sciences, Pokhara, Kaski, Nepal
| | - Naval Kishor Yadav
- Department of Biochemistry, Manipal College of Medical Sciences, Pokhara, Kaski, Nepal
| | | | - Ramchandra Kafle
- Department of Internal Medicine, Manipal College of Medical Sciences and Teaching Hospital, Phoolbari, Pokhara, Kaski, Nepal
| | - Sarthak Nepal
- Department of Internal Medicine, Manipal College of Medical Sciences and Teaching Hospital, Phoolbari, Pokhara, Kaski, Nepal
| | - Ravindra Mohan Sapkota
- Institute of Microbiology, Immunology and Hygiene, Technical University Munich, Trogerstrasse, Munich, Germany
| | - Niraj Choudhary
- Department of Laboratory Science, School of Health and Allied Sciences, Pokhara University, Lekhnath, Kaski, Nepal
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Fisher EB, Ayala GX, Ibarra L, Cherrington AL, Elder JP, Tang TS, Heisler M, Safford MM, Simmons D. Contributions of Peer Support to Health, Health Care, and Prevention: Papers from Peers for Progress. Ann Fam Med 2015; 13 Suppl 1:S2-8. [PMID: 26304968 PMCID: PMC4648132 DOI: 10.1370/afm.1852] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
SUBSTANTIAL: evidence documents the benefits of peer support provided by community health workers, lay health advisors, promotores de salud, and others. The papers in this supplement, all supported by the Peers for Progress program of the American Academy of Family Physicians Foundation, contribute to the growing body of literature addressing the efficacy, effectiveness, feasibility, reach, sustainability, and adoption of peer support for diabetes self-management. They and additional papers supported by Peers for Progress contribute to understanding how peer support can be implemented in real world settings. Topics include examination of the peers who provide peer support, reaching the hardly reached, success factors in peer support interventions, proactive approaches, attention to emotions, peer support in behavioral health, dissemination models and their application in China, peer support in the patient-centered medical home, research challenges, and policy implications.
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Affiliation(s)
- Edwin B Fisher
- Peers for Progress, American Academy of Family Physicians Foundation, Leawood, Kansas Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Guadalupe X Ayala
- San Diego State University College of Health and Human Services and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | | | - Andrea L Cherrington
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - John P Elder
- San Diego State University College of Health and Human Services and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | - Tricia S Tang
- University of British Columbia Department of Medicine, Vancouver, British Columbia
| | - Michele Heisler
- University of Michigan Department of Internal Medicine, Ann Arbor, Michigan
| | - Monika M Safford
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David Simmons
- School of Medicine, University of Western Sydney, Australia Institute of Metabolic Science, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, England
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30
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Chan JCN, Ozaki R, Luk A, Kong APS, Ma RCW, Chow FCC, Wong P, Wong R, Chung H, Chiu C, Wolthers T, Tong PCY, Ko GTC, So WY, Lyubomirsky G. Delivery of integrated diabetes care using logistics and information technology--the Joint Asia Diabetes Evaluation (JADE) program. Diabetes Res Clin Pract 2014; 106 Suppl 2:S295-304. [PMID: 25550057 DOI: 10.1016/s0168-8227(14)70733-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Diabetes is a global epidemic, and many affected individuals are undiagnosed, untreated, or uncontrolled. The silent and multi-system nature of diabetes and its complications, with complex care protocols, are often associated with omission of periodic assessments, clinical inertia, poor treatment compliance, and care fragmentation. These barriers at the system, patient, and care-provider levels have resulted in poor control of risk factors and under-usage of potentially life-saving medications such as statins and renin-angiotensin system inhibitors. However, in the clinical trial setting, use of nurses and protocol with frequent contact and regular monitoring have resulted in marked differences in event rates compared to epidemiological data collected in the real-world setting. The phenotypic heterogeneity and cognitive-psychological-behavioral needs of people with diabetes call for regular risk stratification to personalize care. Quality improvement initiatives targeted at patient education, task delegation, case management, and self-care promotion had the largest effect size in improving cardio-metabolic risk factors. The Joint Asia Diabetes Evaluation (JADE) program is an innovative care prototype that advocates a change in clinic setting and workflow, coordinated by a doctor-nurse team and augmented by a web-based portal, which incorporates care protocols and a validated risk engine to provide decision support and regular feedback. By using logistics and information technology, supported by a network of health-care professionals to provide integrated, holistic, and evidence-based care, the JADE Program aims to establish a high-quality regional diabetes database to reflect the status of diabetes care in real-world practice, confirm efficacy data, and identify unmet needs. Through collaborative efforts, we shall evaluate the feasibility, acceptability, and cost-effectiveness of this "high tech, soft touch" model to make diabetes and chronic disease care more accessible, affordable, and sustainable.
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Affiliation(s)
- Juliana C N Chan
- Department of Medicine and Therapeutics, China; Hong Kong Institute of Diabetes and Obesity, China; Li Ka Shing Institute of Health Sciences, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China; Asia Diabetes Foundation, Prince of Wales Hospital, Shatin, China.
| | - Risa Ozaki
- Department of Medicine and Therapeutics, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Andrea Luk
- Department of Medicine and Therapeutics, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, China; Hong Kong Institute of Diabetes and Obesity, China; Li Ka Shing Institute of Health Sciences, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, China; Hong Kong Institute of Diabetes and Obesity, China; Li Ka Shing Institute of Health Sciences, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Francis C C Chow
- Department of Medicine and Therapeutics, China; Hong Kong Institute of Diabetes and Obesity, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China; Asia Diabetes Foundation, Prince of Wales Hospital, Shatin, China
| | - Patrick Wong
- Asia Diabetes Foundation, Prince of Wales Hospital, Shatin, China
| | - Rebecca Wong
- Department of Medicine and Therapeutics, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Harriet Chung
- Hong Kong Institute of Diabetes and Obesity, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Cherry Chiu
- Department of Medicine and Therapeutics, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Troels Wolthers
- Asia Diabetes Foundation, Prince of Wales Hospital, Shatin, China
| | - Peter C Y Tong
- Department of Medicine and Therapeutics, China; Qualigenics Diabetes Centre, Central, Hong Kong SAR, China
| | - Gary T C Ko
- Department of Medicine and Therapeutics, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Greg Lyubomirsky
- Asia Diabetes Foundation, Prince of Wales Hospital, Shatin, China
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Jiao FF, Lam CLK, Fung C, McGhee SM. Comparison of four cardiovascular risk prediction functions among Chinese patients with diabetes mellitus in the primary care setting. J Diabetes Investig 2014; 5:606-14. [PMID: 25411630 PMCID: PMC4188120 DOI: 10.1111/jdi.12188] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/01/2013] [Accepted: 11/10/2013] [Indexed: 11/26/2022] Open
Abstract
AIMS/INTRODUCTION To assess the feasibility, convergent validity and sensitivity of four cardiovascular risk prediction functions in Chinese diabetic patients in the primary care setting. MATERIALS AND METHODS A cross-sectional study of 1,140 diabetic patients was carried out to compare four cardiovascular risk functions, which were respectively developed from the Framingham heart study, the USA-People's Republic of China Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology cohort (PRC), the United Kingdom Prospective Diabetes Study (UKPDS) and the Joint Asia Diabetes Evaluation program (JADE). Feasibility was assessed by the percentage of patients with complete data for risk prediction. Convergent validity was measured by Spearman's rank correlation, paired Wilcoxon signed-rank sum test and Bland-Altman plots. Effect size differences between clinical risk groups were used to assess the sensitivity. RESULTS Risk prediction was feasible by the Framingham, UKPDS and PRC risk functions in more than 98% patients, whereas just 74% of patients had complete data for the JADE function. The annual total coronary heart disease (CHD) risk predicted by the JADE and the UKPDS functions showed excellent agreement with no significant difference, and a correlation of 0.8048. The Framingham and the PRC functions predicted significantly lower CHD risk than those by the UKPDS and the JADE functions. The UKPDS and the Framingham functions were more sensitive in differentiating clinical risk groups. CONCLUSIONS The UKPDS risk engine showed good feasibility, convergent validity and sensitivity in predicting CHD risk in Chinese diabetic patients. The JADE function showed excellent agreement with the UKPDS risk engine, but it was less feasible in the primary care setting.
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Affiliation(s)
- Fang Fang Jiao
- Department of Family Medicine and Primary CareLi Ka Shing Faculty of MedicineThe University of Hong KongPokfulamHong Kong
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary CareLi Ka Shing Faculty of MedicineThe University of Hong KongPokfulamHong Kong
| | - Colman Fung
- Department of Family Medicine and Primary CareLi Ka Shing Faculty of MedicineThe University of Hong KongPokfulamHong Kong
| | - Sarah Morag McGhee
- School of Public HealthLi Ka Shing Faculty of MedicineThe University of Hong KongPokfulamHong Kong
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Schweitzer M, Lasierra N, Oberbichler S, Toma I, Fensel A, Hoerbst A. Structuring clinical workflows for diabetes care: an overview of the OntoHealth approach. Appl Clin Inform 2014; 5:512-26. [PMID: 25024765 PMCID: PMC4081752 DOI: 10.4338/aci-2014-04-ra-0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/30/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) play an important role in the treatment of chronic diseases such as diabetes mellitus. Although the interoperability and selected functionality of EHRs are already addressed by a number of standards and best practices, such as IHE or HL7, the majority of these systems are still monolithic from a user-functionality perspective. The purpose of the OntoHealth project is to foster a functionally flexible, standards-based use of EHRs to support clinical routine task execution by means of workflow patterns and to shift the present EHR usage to a more comprehensive integration concerning complete clinical workflows. OBJECTIVES The goal of this paper is, first, to introduce the basic architecture of the proposed OntoHealth project and, second, to present selected functional needs and a functional categorization regarding workflow-based interactions with EHRs in the domain of diabetes. METHODS A systematic literature review regarding attributes of workflows in the domain of diabetes was conducted. Eligible references were gathered and analyzed using a qualitative content analysis. Subsequently, a functional workflow categorization was derived from diabetes-specific raw data together with existing general workflow patterns. RESULTS This paper presents the design of the architecture as well as a categorization model which makes it possible to describe the components or building blocks within clinical workflows. The results of our study lead us to identify basic building blocks, named as actions, decisions, and data elements, which allow the composition of clinical workflows within five identified contexts. CONCLUSIONS The categorization model allows for a description of the components or building blocks of clinical workflows from a functional view.
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Affiliation(s)
- M. Schweitzer
- UMIT – University for Health Sciences, Medical Informatics and Technology, Research Division for eHealth and Telemedicine, Hall in Tirol, Austria
| | - N. Lasierra
- University of Innsbruck, STI – Semantic Technology Institute, Innsbruck, Austria
| | - S. Oberbichler
- UMIT – University for Health Sciences, Medical Informatics and Technology, Research Division for eHealth and Telemedicine, Hall in Tirol, Austria
| | - I. Toma
- University of Innsbruck, STI – Semantic Technology Institute, Innsbruck, Austria
| | - A. Fensel
- University of Innsbruck, STI – Semantic Technology Institute, Innsbruck, Austria
| | - A. Hoerbst
- UMIT – University for Health Sciences, Medical Informatics and Technology, Research Division for eHealth and Telemedicine, Hall in Tirol, Austria
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Abstract
In the 2013 issue of the International Diabetes Federation (IDF) Diabetes Atlas, the prevalence of diabetes in the Western Pacific (WP) Region was reported to be 8.6% in 2013, or 138 million adults, and estimated to rise to 11.1%, or 201 million adults, in 2035. The prevalence estimates of impaired glucose tolerance in 2013 and 2035 were 6.8% and 9.0%, respectively. Over 50% of people with diabetes were undiagnosed. In 2013, 187 million deaths were attributable to diabetes, 44% of which occurred in the under the age of 60. The WP Region is home to one quarter of the world's population, and includes China with the largest number of people with diabetes as well as Pacific Islands countries with the highest prevalence rates. There is a rapid increase in diabetes prevalence in the young-to-middle aged adults, possibly driven by high rates of childhood obesity and gestational diabetes as well as rapid demographic and sociocultural transitions. Differences in genetics, ethnicity, cultures and socioeconomic development have led to complex host-environment-lifestyle interactions with marked disease heterogeneity, further influenced by access to care and treatment. Despite these challenges, the WP Region has provided notable examples to prevent and control diabetes.
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Affiliation(s)
- Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | - Nam H Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Naoko Tajima
- Jikei University School of Medicine, Tokyo, Japan
| | - Jonathan Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Measuring depressive symptoms using the Patient Health Questionnaire-9 in Hong Kong Chinese subjects with type 2 diabetes. J Affect Disord 2013; 151:660-666. [PMID: 23938133 DOI: 10.1016/j.jad.2013.07.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/23/2013] [Accepted: 07/23/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Depression is common in type 2 diabetes although the prevalence in Chinese patients remains unclear. We validated the Patient Health Questionnaire(PHQ-9), a popular depression screening tool, in Chinese with type 2 diabetes, and documented the prevalence, demographic,and clinical characteristics associated with depression. METHODS A consecutive cohort of 586 Hong Kong Chinese outpatients completed the PHQ-9 during comprehensive diabetes complication assessment. Within 2-4 weeks, 40 patients were retested via telephone survey. Ninety-nine randomly selected patients were interviewed by psychiatrists using the Mini International Neuropsychiatric Interview as a golden standard. Receiver operating characteristic curve was used to assess performance of the PHQ-9. RESULTS The internal consistency of the PHQ-9 was 0.86 and test-retest reliability was 0.70. The 3 somatic items explained 53.6% of the PHQ-9 score. The optimal cutoff value was 7 with 82.6% sensitivity and 73.7% specificity, giving a depression prevalence of 18.3% (n=107). Of these, 18.7% had been previously diagnosed with depression. Depression was more prevalent in women than men. After controlling for confounders, patients with depression had higher HbA1c (7.80 ± 1.86% versus 7.43 ± 1.29%, [61.7 ± 20.4 versus 57.8 ± 14.1 mmol/mol], P<0.05), reduced likelihood of achieving HbA1c target of <7.0% (33.6% versus 41.8%, P<0.05), and were more likely to have self-reported hypoglycemia in the previous 3 months (18.7% versus 6.7%, P<0.01). LIMITATION A small sample was used in the criterion validation and the cross-sectional design precludes causal inference. CONCLUSIONS PHQ-9 is a validated tool for screening for depression, which is common and frequently undiagnosed in Chinese type 2 diabetic patients and is associated with suboptimal glycemic control, hypoglycemia, and somatization.
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Abstract
Fetal programming associated with in utero exposure to maternal stress is thought to alter gene expression, resulting in phenotypes that promote survival in a pathogen-rich and nutrient-poor environment but substantially increase the risk of cardiovascular, metabolic and renal disorders (such as diabetes mellitus) in adults with obesity. These (epi)genetic phenomena are modified by environmental and socioeconomic factors, resulting in multiple subphenotypes and clinical consequences. In individuals from areas undergoing rapid economic development, which is associated with a transition from communicable to noncommunicable diseases, an efficient innate immune response can exaggerate obesity-associated inflammation. By contrast, in individuals with a genetic predisposition to autoimmune or monogenic diabetes mellitus, obesity can lead to atypical presentation of diabetes mellitus, termed 'double diabetes mellitus'. The increasingly young age at diagnosis of diabetes mellitus in developing countries results in prolonged exposure to glucolipotoxicity, low-grade inflammation and increased oxidative stress, which put enormous strain on pancreatic β cells and renal function. These conditions create a metabolic milieu conducive to cancer growth. This Review discusses how rapid changes in technology and human behaviour have brought on the global epidemic of metabolic diseases, and suggests that solutions will be based on using system change, technology and behavioural strategies to combat this societal-turned-medical problem.
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Affiliation(s)
- Alice P S Kong
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT Hong Kong Special Administrative Region, China
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Xie F, Zhang D, Wu J, Zhang Y, Yang Q, Sun X, Cheng J, Chen X. Design and implementation of the first nationwide, web-based Chinese Renal Data System (CNRDS). BMC Med Inform Decis Mak 2012; 12:11. [PMID: 22369692 PMCID: PMC3309940 DOI: 10.1186/1472-6947-12-11] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 02/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In April 2010, with an endorsement from the Ministry of Health of the People's Republic of China, the Chinese Society of Nephrology launched the first nationwide, web-based prospective renal data registration platform, the Chinese Renal Data System (CNRDS), to collect structured demographic, clinical, and laboratory data for dialysis cases, as well as to establish a kidney disease database for researchers and policy makers. METHODS The CNRDS program uses information technology to facilitate healthcare professionals to create a blood purification registry and to deliver an evidence-based care and education protocol tailored to chronic kidney disease, as well as online forum for communication between nephrologists. The online portal https://www.cnrds.net is implemented as a Java web application using an Apache Tomcat web server and a MySQL database. All data are stored in a central databank to establish a Chinese renal database for research and publication purposes. RESULTS Currently, over 270,000 clinical cases, including general patient information, diagnostics, therapies, medications, and laboratory tests, have been registered in CNRDS by 3,669 healthcare institutions qualified for hemodialysis therapy. At the 2011 annual blood purification forum of the Chinese Society of Nephrology, the CNRDS 2010 annual report was reviewed and accepted by the society members and government representatives. CONCLUSIONS CNRDS is the first national, web-based application for collecting and managing electronic medical records of patients with dialysis in China. It provides both an easily accessible platform for nephrologists to store and organize their patient data and acts as a communication platform among participating doctors. Moreover, it is the largest database for treatment and patient care of end-stage renal disease (ESRD) patients in China, which will be beneficial for scientific research and epidemiological investigations aimed at improving the quality of life of such patients. Furthermore, it is a model nationwide disease registry, which could potentially be used for other diseases.
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Affiliation(s)
- Fengbo Xie
- Medical Systems Biology Research Center, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing 100084, China.
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Tshiananga JKT, Kocher S, Weber C, Erny-Albrecht K, Berndt K, Neeser K. The effect of nurse-led diabetes self-management education on glycosylated hemoglobin and cardiovascular risk factors: a meta-analysis. DIABETES EDUCATOR 2011; 38:108-23. [PMID: 22116473 DOI: 10.1177/0145721711423978] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this meta-analysis was to determine the effect of nurse-led diabetes self-management education (DSME) on blood glucose control and cardiovascular risk factors. METHODS The electronic databases PubMed and ISIS Knowledge were searched for relevant randomized controlled studies published between 1999 and 2009. Effect size was calculated for change in A1C, blood pressure, and lipid levels using both fixed- and random-effects models. Subgroup analyses were performed on patient age, gender, diabetes type, baseline A1C, length of follow-up, and study setting. RESULTS A total of 34 randomized controlled trials with a combined cohort size of 5993 patients was identified. Mean patient age was 52.8 years, 47% were male, and mean A1C at baseline was 8.5%. Mean change in A1C was a reduction by -0.70% for nurse-led DSME versus -0.21% with usual care (UC). This corresponded to an effect size of 0.506, using a random-effects model for nurse-led DSME versus UC. Effect size was significantly associated with patient age older than 65 years and with duration of follow-up. Nurse-led DSME was also associated with improvements in cardiovascular risk factors, particularly among male patients, among those with good glycemic control, and in studies conducted in the United States. CONCLUSIONS Nurse-led DSME is associated with improved glycemic control, demonstrating that programs are most effective among seniors and with follow-up periods of 1 to 6 months. Future programs tailored to the needs of patients younger than 65 years may improve the impact of DSME on blood glucose.
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Affiliation(s)
| | - Serge Kocher
- The Institute for Medical Informatics and Biostatistics, Basel, Switzerland (Mr. Tshiananga, Dr Kocher, Dr Weber, Dr Neeser)
| | - Christian Weber
- The Institute for Medical Informatics and Biostatistics, Basel, Switzerland (Mr. Tshiananga, Dr Kocher, Dr Weber, Dr Neeser)
| | | | | | - Kurt Neeser
- The Institute for Medical Informatics and Biostatistics, Basel, Switzerland (Mr. Tshiananga, Dr Kocher, Dr Weber, Dr Neeser)
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Chan JCN, So W, Ma RCW, Tong PCY, Wong R, Yang X. The Complexity of Vascular and Non-Vascular Complications of Diabetes: The Hong Kong Diabetes Registry. CURRENT CARDIOVASCULAR RISK REPORTS 2011; 5:230-239. [PMID: 21654912 PMCID: PMC3085116 DOI: 10.1007/s12170-011-0172-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Diabetes is a complex disease characterized by chronic hyperglycemia and multiple phenotypes. In 1995, we used a doctor-nurse-clerk team and structured protocol to establish the Hong Kong Diabetes Registry in a quality improvement program. By 2009, we had accrued 2616 clinical events in 9588 Chinese type 2 diabetic patients with a follow-up duration of 6 years. The detailed phenotypes at enrollment and follow-up medications have allowed us to develop a series of risk equations to predict multiple endpoints with high sensitivity and specificity. In this prospective database, we were able to validate findings from clinical trials in real practice, confirm close links between cardiovascular and renal disease, and demonstrate the emerging importance of cancer as a leading cause of death. In addition to serving as a tool for risk stratification and quality assurance, ongoing data analysis of the registry also reveals secular changes in disease patterns and identifies unmet needs.
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Affiliation(s)
- Juliana C. N. Chan
- Hong Kong Institute of Diabetes and Obesity, Shatin, NT Hongkong SAR
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT Hongkong SAR
- Qualigenics Diabetes Centre, Hong Kong SAR, China
| | - Wingyee So
- Hong Kong Institute of Diabetes and Obesity, Shatin, NT Hongkong SAR
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT Hongkong SAR
| | - Ronald C. W. Ma
- Hong Kong Institute of Diabetes and Obesity, Shatin, NT Hongkong SAR
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT Hongkong SAR
| | - Peter C. Y. Tong
- Hong Kong Institute of Diabetes and Obesity, Shatin, NT Hongkong SAR
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT Hongkong SAR
- Qualigenics Diabetes Centre, Hong Kong SAR, China
| | - Rebecca Wong
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT Hongkong SAR
| | - Xilin Yang
- Hong Kong Institute of Diabetes and Obesity, Shatin, NT Hongkong SAR
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT Hongkong SAR
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So WY, Raboca J, Sobrepena L, Yoon KH, Deerochanawong C, Ho LT, Himathongkam T, Tong P, Lyubomirsky G, Ko G, Nan H, Chan J. Comprehensive risk assessments of diabetic patients from seven Asian countries: The Joint Asia Diabetes Evaluation (JADE) program. J Diabetes 2011; 3:109-18. [PMID: 21599865 DOI: 10.1111/j.1753-0407.2011.00115.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The aim of the web-based Joint Asia Diabetes Evaluation (JADE) program is to establish a registry for quality assurance, monitoring, and evaluation. METHODS The JADE electronic portal provides templates for data collection, supplemented by risk stratification, care protocols, and decision support. Herein, data from 3687 patients with Type 2 diabetes, enrolled over 15 months in 2007-2009 from seven Asian countries, are reported. RESULTS Of the patients, 46.1% were men, the median (range) age was 58 (15-93 years), and median disease duration was 6.5 (0-71) years; 16.2% had at least one cardiovascular-renal complication (10.0% coronary heart disease, 3.3% stroke, 3.1% peripheral vascular disease, 0.4% end-stage renal disease), 20.4% had diabetic retinopathy, 15.0% had sensory neuropathy, 7.5% had chronic kidney disease, and 20.7% of men had erectile dysfunction. Hypertension, dyslipidemia, and central obesity affected 84.6%, 76.8%, and 53.5% of patients, respectively. Treatment targets were HbA1c <7% in 35.3%, blood pressure <130/80 mmHg in 32.3%, and low-density lipoprotein-cholesterol <2.6 mmol/L in 34.0%. The rate of attaining one, two, and three targets was 38.7%, 23.4%, and 5.4%, respectively. Using the JADE Risk Engine, 60% of patients with clinical complications and 20% of those with multiple risk parameters were predicted to have a major event within 5 years. Older age, short disease duration, adherence to diet, control of other risk factors, and not smoking were independently associated with HbA1c <7% (all P < 0.05). CONCLUSIONS It is possible to use a web-based protocol to establish a registry for risk stratification and facilitate early intervention.
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Affiliation(s)
- Wing-Yee So
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
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Abstract
In the past two decades, we have acquired an enormous amount of knowledge regarding the epidemiology, diagnosis, pathophysiology and treatment of type 2 diabetes and its comorbidities. In addition to the earlier landmark blood lipid and blood pressure lowering trials, the latest blood glucose lowering megatrials represent the zenith of this global effort to prevent and control diabetes, and its devastating consequences. Although many of these latter trials have yielded negative results and have shown the narrow risk-benefit ratio of intensive treatment in patients with advanced disease, the exceedingly low event rates in these high-risk patients who were carefully monitored and intensively managed made possible in these clinical trial settings have not been emphasized enough. The heterogeneity of the clinical outcomes in these studies further highlight the complexity of diabetes, which is more than managing a disease, but the multiple needs of a patient with multisystem dysfunction. In the final analysis, what transpires from these megatrials is the need to translate the key components of these studies, namely, protocol, team, documentation and monitoring, into our daily clinical practice to enable the care team to stratify risk, define needs, individualize therapy, monitor progress and reinforce compliance in order to achieve positive outcomes. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00063.x, 2010).
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Affiliation(s)
- Juliana CN Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong, China
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