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Emad-Eldin M, Balata GF, Elshorbagy EA, Hamed MS, Attia MS. Insulin therapy in type 2 diabetes: Insights into clinical efficacy, patient-reported outcomes, and adherence challenges. World J Diabetes 2024; 15:828-852. [PMID: 38766443 PMCID: PMC11099362 DOI: 10.4239/wjd.v15.i5.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/01/2024] [Accepted: 03/20/2024] [Indexed: 05/10/2024] Open
Abstract
Insulin therapy plays a crucial role in the management of type 2 diabetes as the disease progresses. Over the past century, insulin formulations have undergone significant modifications and bioengineering, resulting in a diverse range of available insulin products. These products show distinct pharmacokinetic and pharmacodynamic profiles. Consequently, various insulin regimens have em-erged for the management of type 2 diabetes, including premixed formulations and combinations of basal and bolus insulins. The utilization of different insulin regimens yields disparate clinical outcomes, adverse events, and, notably, patient-reported outcomes (PROs). PROs provide valuable insights from the patient's perspective, serving as a valuable mine of information for enhancing healthcare and informing clinical decisions. Adherence to insulin therapy, a critical patient-reported outcome, significantly affects clinical outcomes and is influenced by multiple factors. This review provides insights into the clinical effectiveness of various insulin preparations, PROs, and factors impacting insulin therapy adherence, with the aim of enhancing healthcare practices and informing clinical decisions for individuals with type 2 diabetes.
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Affiliation(s)
- Mahmoud Emad-Eldin
- Department of Pharmacy Practice, Faculty of Pharmacy, Zagazig University, Zagazig HFQM+872, Al-Sharqia Governorate, Egypt
| | - Gehan F Balata
- Department of Pharmacy Practice, Faculty of Pharmacy, Heliopolis University, Cairo 44519, Egypt
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Eman A Elshorbagy
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Mona S Hamed
- Department of Community at Faculty of Medicine, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Mohamed S Attia
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
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Fu CH, Lee LY, Huang LC, Tsay SL, Chen SC. Psychological insulin resistance and its impact on self-management in type II diabetes mellitus patients treated with insulin therapy. Int J Nurs Pract 2024; 30:e13190. [PMID: 37596927 DOI: 10.1111/ijn.13190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 07/04/2023] [Accepted: 07/28/2023] [Indexed: 08/21/2023]
Abstract
AIMS Psychological insulin resistance is a common barrier to initiation and persistence with insulin therapy that affects approximately 42.7% of people living with type II diabetes mellitus, which may negatively impact self-management. This study aimed to assess patients' levels of psychological insulin resistance and to identify factors associated with self-management in patients with type II diabetes mellitus treated with insulin therapy. METHODS We adopted a cross-sectional design. Subjects from the metabolism and endocrinology outpatient departments of a regional teaching hospital in central Taiwan were recruited by consecutive sampling. Patients were assessed for psychological insulin resistance and self-management using the barriers to insulin treatment questionnaire and the partners in health scale. RESULTS A total of 222 patients with type II diabetes mellitus were recruited. Patients had an average psychological insulin resistance score of 3.14 (maximum of 8). Positive self-management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin-related outcomes, no diabetes-related complications, less fear of injection and self-testing, no hypoglycaemia within the previous year, and younger age. CONCLUSION Insulin therapy injection by patient and no diabetes-related complications were the most common factors associated with overall self-management and with each domain of self-management in patients with type II diabetes mellitus treated with insulin therapy. Insulin therapy education should be offered to improve patients' beliefs about insulin therapy and enhance patients' ability to perform self-management.
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Affiliation(s)
- Chiung-Hui Fu
- Department of Nursing, China Medical University Beigang Hospital, Taiwan
- Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology, Chaiyi, Taiwan
| | - Li-Yun Lee
- Department of Nursing, College of Nursing and Health Sciences, YAYEH University, Changhua, Taiwan
| | - Li-Chuan Huang
- Department of Nursing, China Medical University Beigang Hospital, Taiwan
| | - Shiow-Luan Tsay
- Department of Nursing, College of Nursing and Health Sciences, YAYEH University, Changhua, Taiwan
| | - Shu-Ching Chen
- School of Nursing and Geriatric and Long-Term Care Research Center, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Radiation Oncology and Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Noordman J, Meurs M, Poortvliet R, Rusman T, Orrego-Villagran C, Ballester M, Ninov L, de Guzmán EN, Alonso-Coello P, Groene O, Suñol R, Heijmans M, Wagner C. Contextual factors for the successful implementation of self-management interventions for chronic diseases: A qualitative review of reviews. Chronic Illn 2024; 20:3-22. [PMID: 36744382 DOI: 10.1177/17423953231153337] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To identify and describe the most relevant contextual factors (CFs) from the literature that influence the successful implementation of self-management interventions (SMIs) for patients living with type 2 diabetes mellitus, obesity, COPD and/or heart failure. METHODS We conducted a qualitative review of reviews. Four databases were searched, 929 reviews were identified, 460 screened and 61 reviews met the inclusion criteria. CFs in this paper are categorized according to the Tailored Implementation for Chronic Diseases framework. RESULTS A great variety of CFs was identified on several levels, across all four chronic diseases. Most CFs were on the level of the patient, the professional and the interaction level, while less CFs were obtained on the level of the intervention, organization, setting and national level. No differences in main themes of CFs across all four diseases were found. DISCUSSION For the successful implementation of SMIs, it is crucial to take CFs on several levels into account simultaneously. Person-centered care, by tailoring SMIs to patients' needs and circumstances, may increase the successful uptake, application and implementation of SMIs in real-life practice. The next step will be to identify the most important CFs according to various stakeholders through a group consensus process.
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Affiliation(s)
- Janneke Noordman
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Maaike Meurs
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Rune Poortvliet
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Tamara Rusman
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Carola Orrego-Villagran
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Ballester
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | | | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Rosa Suñol
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Monique Heijmans
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Cordula Wagner
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Kiconco R, Lumumba SA, Bagenda CN, Atwine R, Ndarubweine J, Rugera SP. Insulin therapy among diabetic patients in rural communities of Sub-Saharan Africa: a perspective review. Ther Adv Endocrinol Metab 2024; 15:20420188241232280. [PMID: 38379780 PMCID: PMC10878220 DOI: 10.1177/20420188241232280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/24/2024] [Indexed: 02/22/2024] Open
Abstract
In this perspective review, we describe a brief background on the status quo of diabetes mellitus-related therapies and glycemic control among patients in rural communities in sub-Saharan Africa. The article discusses insulin therapy as well as the difficulties in obtaining insulin and oral hypoglycemic medications for diabetic patients living in sub-Saharan Africa. We wrap up our discussion with suggestions on solutions and opportunities for future research to tackle this health challenge in these impoverished communities. We conducted a literature search from PubMed and Google Scholar up until August 2023. Key words were used to generate search terms used to retrieve the required information. All types of literature with pertinent information on the current topic were included in the study. Diabetes mellitus is on the rise in sub-Saharan Africa. Several studies have reported poor glycemic control, low screening rates for diabetes mellitus, cigarette smoking, high alcohol consumption, prescription of antidiabetic therapy, and associated costs as contributors to the uptake of antidiabetic treatment. Although there is paucity of data on the extent of insulin therapy uptake and its possible modifiable contributors among the diabetic patients in the region, the anticipated increase in the number of people with diabetes on the continent makes it critical for global leaders to address the research gaps in insulin therapy among rural communities of sub-Saharan Africa, thus reducing the burden of diabetes in these populations.
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Affiliation(s)
- Ritah Kiconco
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Mbarara-Kabale Road, Mbarara 1410, Uganda
- Department of Biochemistry, Sororti University, Soroti, Uganda
| | - Sylvia Achieng Lumumba
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medical Laboratory Science, Technical University of Mombasa, Mombasa, Kenya
| | - Charles Nkubi Bagenda
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Raymond Atwine
- Department of Pathology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Ndarubweine
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Simon Peter Rugera
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
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Beltran J, Valli C, Medina-Aedo M, Canelo-Aybar C, Niño de Guzmán E, Song Y, Orrego C, Ballester M, Suñol R, Noordman J, Heijmans M, Seitidis G, Tsokani S, Kontouli KM, Christogiannis C, Mavridis D, Graaf GD, Groene O, Grammatikopoulou MG, Camalleres-Guillem F, Perestelo-Perez L, McGloin H, Winkley K, Mueller BS, Saz-Parkinson Z, Corcoy R, Alonso-Coello P. COMPAR-EU Recommendations on Self-Management Interventions in Type 2 Diabetes Mellitus. Healthcare (Basel) 2024; 12:483. [PMID: 38391858 PMCID: PMC10887949 DOI: 10.3390/healthcare12040483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/24/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Self-management interventions (SMIs) offer a promising approach to actively engage patients in the management of their chronic diseases. Within the scope of the COMPAR-EU project, our goal is to provide evidence-based recommendations for the utilisation and implementation of SMIs in the care of adult individuals with type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, utilising a core outcome set (COS), identified critical outcomes and established effect thresholds for each outcome. The panel formulated recommendations using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, a transparent and rigorous framework for developing and presenting the best available evidence for the formulation of recommendations. All recommendations are based on systematic reviews (SR) of the effects and of values and preferences, a contextual analysis, and a cost-effectiveness analysis. The COMPAR-EU panel is in favour of using SMIs rather than usual care (UC) alone (conditional, very low certainty of the evidence). Furthermore, the panel specifically is in favour of using ten selected SMIs, rather than UC alone (conditional, low certainty of the evidence), mostly encompassing education, self-monitoring, and behavioural techniques. The panel acknowledges that, for most SMIs, moderate resource requirements exist, and cost-effectiveness analyses do not distinctly favour either the SMI or UC. Additionally, it recognises that SMIs are likely to enhance equity, deeming them acceptable and feasible for implementation.
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Affiliation(s)
- Jessica Beltran
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
| | - Claudia Valli
- Avedis DonabedianResearch Institute (FAD), Universitat Autònoma de Barcelona, 008037 Barcelona, Spain
| | - Melixa Medina-Aedo
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
| | - Yang Song
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
| | - Carola Orrego
- Avedis DonabedianResearch Institute (FAD), Universitat Autònoma de Barcelona, 008037 Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 08007 Barcelona, Spain
| | - Marta Ballester
- Avedis DonabedianResearch Institute (FAD), Universitat Autònoma de Barcelona, 008037 Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 08007 Barcelona, Spain
| | - Rosa Suñol
- Avedis DonabedianResearch Institute (FAD), Universitat Autònoma de Barcelona, 008037 Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 08007 Barcelona, Spain
| | - Janneke Noordman
- Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands
| | - Georgios Seitidis
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Sofia Tsokani
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Katerina-Maria Kontouli
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Christos Christogiannis
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Dimitris Mavridis
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Gimon de Graaf
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3062 PA Rotterdam, The Netherlands
| | | | - Maria G Grammatikopoulou
- Immunonutrition and Clinical Nutrition Unit, Department of Rheumatology and Clinical Immunology, Medical School, University of Thessaly, Biopolis Campus, 43100 Larissa, Greece
| | | | - Lilisbeth Perestelo-Perez
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Tenerife, Spain
| | - Helen McGloin
- School of Nursing, Health Science and Disability Studies, ATU St Angelas, F91 C643 Sligo, Ireland
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London SE1 8WA, UK
| | - Beate Sigrid Mueller
- Institute of General Practice, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50923 Cologne, Germany
| | | | - Rosa Corcoy
- CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, 28220 Madrid, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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Wen S, Ruan Y, Shi Z, Dan S, Zhou L. The Barriers to Insulin Therapy Initiation in Type 2 Diabetes Patients: A Study of General Practitioner Perceptions in Huinan Community in South Shanghai. Diabetes Metab Syndr Obes 2024; 17:393-405. [PMID: 38283634 PMCID: PMC10822111 DOI: 10.2147/dmso.s446349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
Background Despite the demonstrated benefits of insulin therapy, many general practitioners (GPs) are hesitant to administer it due to challenges such as a lack of knowledge, time constraints, and patient reluctance. The barriers that prevent a GP from initiating insulin therapy may vary in comparison to those encountered by a diabetic patient; this aspect of clinical research in the South Shanghai metropolitan area has received limited attention so far. Objective This is a 6-months of interventional analytic cohort study. The prime aim is to investigate the barriers general practitioners (GPs) face when initiating insulin therapy for patients with type 2 diabetes (T2D). Materials and Methods As part of a training program, all 189 registered GPs in Nanhui Health Service Center in Shanghai were given a structured online-multi-choice questionnaire before and after a six-month interval, during which the GPs received sessions of training on insulin therapy either on theoretic classes or clinical practices. Results Before and after training, via the methods of multiple-response analyses, the results showed that social, GP's, and patient barriers to initiating insulin therapy were comparable. However, through the crosstabs chi-square test, we found significant changes in the basal insulin initiation following the prescription of the senior endocrinologists, the titration of insulin, and the need for training (p<0.05). The Spearman analyses discovered significant changes associated with the cause of initial insulin refusal and the factors influencing insulin administration. Finally, the binary logistic regression analysis revealed that distinct causes such as social factors, insurance, GP experience, insulin dosage calculation, follow-up, and patients' feelings are related to insulin treatment application before and after training. Conclusion According to this study, training increased general practitioners' confidence in initiating insulin administration, especially basal insulin. General practitioners require additional education on insulin therapy, with a potential need for increased face-to-face training for insulin initiation.
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Affiliation(s)
- Song Wen
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yufeng Ruan
- Department of General Practice, Huinan Health Service Center, Shanghai, People’s Republic of China
| | - Zhongyu Shi
- Department of International Medicine, Shanghai Pudong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Shujie Dan
- Department of General Practice, Huinan Health Service Center, Shanghai, People’s Republic of China
| | - Ligang Zhou
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, People’s Republic of China
- Department of General Practice, Huinan Health Service Center, Shanghai, People’s Republic of China
- Department of International Medicine, Shanghai Pudong Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, People’s Republic of China
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Pitak P, Tasai S, Kumpat N, Na Songkla P, Fuangchan A, Krass I, Dhippayom T. The prevalence of glycemic control in patients with type 2 diabetes treated with insulin: a systematic review and meta-analysis. Public Health 2023; 225:218-228. [PMID: 37939463 DOI: 10.1016/j.puhe.2023.10.015] [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: 04/06/2023] [Revised: 07/28/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To estimate the overall prevalence of glycemic control among patients with type 2 diabetes (T2D) treated with insulin. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic search was performed in PubMed, EMBASE, Cochrane CENTRAL, and ProQuest Dissertation and Theses from 2000 to January 2022. Cross-sectional studies were included if they were conducted on more than 292 patients with T2D and reported the number of insulin-treated patients who were justified as achieving glycemic control. The Joanna Briggs Institute critical appraisal checklist was used to assess the quality of the included studies. Pooled estimates of the prevalence of glycemic control were calculated and reported with a 95% confidence interval (95% CI) using a random-effects model. All analyses were conducted using RStudio Version 2022.02.0, Build 443 (meta package). RESULTS A total of 42 studies (234,345 patients) met the inclusion criteria and were classified as having a low risk of bias. The overall estimated prevalence of glycemic control to insulin therapy among patients with T2D was 26.02% (95% CI: 23.17, 29.08). A subgroup of 34 studies that set the target HbA1c <7% showed that 23.75% (95% CI: 21.47, 26.18) of patients with T2D treated with insulin were justified as achieving good glycemic control. CONCLUSIONS This study provided summative evidence that glycemic control among patients with T2D treated with insulin was suboptimal and should be appropriately addressed.
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Affiliation(s)
- P Pitak
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Clinical Department, Nan Hospital, Nan, Thailand; The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Science, Naresuan University, Phitsanulok, Thailand
| | - S Tasai
- Inventory Department, Ramathibodi Hospital, Bangkok, Thailand
| | - N Kumpat
- Clinical Department, Wisetchaichan Hospital, Angthong, Thailand
| | - P Na Songkla
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - A Fuangchan
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - I Krass
- School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - T Dhippayom
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Science, Naresuan University, Phitsanulok, Thailand.
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Liang W, Lo SHS, Chow KM, Zhong J, Ni X. Perception of self-management and glycaemic control in people with type 2 diabetes receiving insulin injection therapy: A qualitative study. Prim Care Diabetes 2023; 17:587-594. [PMID: 37658019 DOI: 10.1016/j.pcd.2023.08.006] [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: 11/09/2022] [Revised: 04/16/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023]
Abstract
AIM The aim of this study was to explore the experience of self-management and glycaemic control in Chinese people with type 2 diabetes receiving insulin injection therapy. METHODS A qualitative descriptive design was adopted with individual, semi-structured interviews. Participants were selected by purposive sampling. All face-to-face interviews were conducted between December 2020 and January 2021. The interviews were audio recorded and transcribed verbatim. Content analysis was used to analyse the interview data. RESULTS A total of 27 participants were recruited and individually interviewed. Three themes were generated: integrating insulin injection therapy into daily self-management; experiencing uncertainty when coping with suboptimal glycaemic control; and self-management programmes for optimal diabetes control. CONCLUSION All of our findings increase the understanding of self-management and glycaemic control in people with T2D receiving insulin injection therapy. Healthcare professionals should recognise the unmet needs of this cohort to promote their diabetes management. Appropriate and effective self-management programmes should be developed and implemented to alleviate the negative impacts of insulin injection therapy on diabetes management with consideration of cultural and personal context.
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Affiliation(s)
- Wei Liang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Ka Ming Chow
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China.
| | - Jie Zhong
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Xiaoying Ni
- Xidu Street Community Health Service Centre, Fengxian District, Shanghai, China
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Maldonado-Valer T, Pareja-Mujica LF, Corcuera-Ciudad R, Terry-Escalante FA, Chevarría-Arriaga MJ, Vasquez-Hassinger T, Yovera-Aldana M. Prevalence of diabetic foot at risk of ulcer development and its components stratification according to the international working group on the diabetic foot (IWGDF): A systematic review with metanalysis. PLoS One 2023; 18:e0284054. [PMID: 38015974 PMCID: PMC10684108 DOI: 10.1371/journal.pone.0284054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/22/2023] [Indexed: 11/30/2023] Open
Abstract
AIMS To determine the overall prevalence of diabetic foot at risk according to the International Working Group on the Diabetic Foot stratification. MATERIALS AND METHODS We searched PubMed/Medline, Scopus, Web of Science, and Embase. We included cross-sectional studies or cohorts from 1999 to March 2022. We performed a meta-analysis of proportions using a random-effects model. We assessed heterogeneity through subgroup analysis by continent and other characteristics. RESULTS We included 36 studies with a total population of 11,850 people from 23 countries. The estimated overall prevalence of diabetic foot at risk was 53.2% (95% CI: 45.1-61.3), I2 = 98.7%, p < 0.001. In the analysis by subgroups, South and Central America had the highest prevalence and Africa the lowest. The factors explaining the heterogeneity were the presence of chronic kidney disease, diagnostic method for peripheral arterial disease, and quality. The estimates presented very low certainty of evidence. CONCLUSIONS The overall prevalence of diabetic foot at risk is high. The high heterogeneity between continents can be explained by methodological aspects and the type of population. However, using the same classification is necessary for standardization of the way of measuring the components, as well as better designed general population-based studies.
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Affiliation(s)
| | | | - Rodrigo Corcuera-Ciudad
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Carrera de Medicina Humana, CHANGE Research Working Group, Lima, Peru
| | - Fernando Andres Terry-Escalante
- Universidad de San Martín de Porres, Facultad de Medicina Humana. Lima, Peru
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
| | | | | | - Marlon Yovera-Aldana
- Grupo de Investigación en Neurociencias, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
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Niño-de-Guzman Quispe E, Bracchiglione J, Ballester M, Groene O, Heijmans M, Martínez García L, Noordman J, Orrego C, Rocha C, Suñol R, Alonso-Coello P. Patients' and informal caregivers' perspectives on self-management interventions for type 2 diabetes mellitus outcomes: a mixed-methods overview of 14 years of reviews. Arch Public Health 2023; 81:140. [PMID: 37537669 PMCID: PMC10401891 DOI: 10.1186/s13690-023-01153-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/15/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Self-management interventions (SMIs) are core components of high-quality care in type 2 diabetes mellitus (T2DM). We aimed to identify and summarise the scientific evidence exploring the perspectives of patients with T2DM and their informal caregivers on outcomes of SMIs, and the key themes to enhance T2DM patient-centred care. METHODS We conducted a mixed-methods overview of reviews. We searched MEDLINE, CINAHL and PsycINFO, up to June 2021 for systematic reviews (SRs) exploring the perspectives of adults with T2DM and their informal caregivers, regarding self-management. Two reviewers conducted independently study selection, data extraction and quality assessment. We estimated the degree of overlap across SRs. We performed a qualitative analysis using a thematic synthesis approach. RESULTS We identified 54 SRs, corresponding to 939 studies, with a slight overlap. Most SRs (47/54, 87%) were considered high quality. We developed summaries for 22 outcomes and identified six overarching themes: (1) diabetic identity; (2) accessing healthcare; (3) experience of care; (4) engagement with self-management; (5) outcomes awareness; and (6) challenges adhering to self-management. We found important variability in how patients with T2DM and their informal caregivers value critical outcomes influenced by the disease progression and several contextual factors. CONCLUSIONS Our findings represent what matters most to patients with T2DM and their informal caregivers regarding outcomes of SMIs. Our results can facilitate the development and evaluation of SMIs, and guide decision-making in diabetes care, including the formulation of decisions and recommendations.
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Affiliation(s)
- Ena Niño-de-Guzman Quispe
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.
- Cancer Screening Unit, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Javier Bracchiglione
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud (CIBERESP), Madrid, Spain
- Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Viña del Mar, Chile
| | - Marta Ballester
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Oliver Groene
- OptiMedis, Hamburg, Germany
- University of Witten/Herdecke, Witten, Germany
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud (CIBERESP), Madrid, Spain
| | - Janneke Noordman
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Carola Orrego
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Claudio Rocha
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Rosa Suñol
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud (CIBERESP), Madrid, Spain
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Madawala S, Warren N, Osadnik C, Barton C. The primary care experience of adults with chronic obstructive pulmonary disease (COPD). An interpretative phenomenological inquiry. PLoS One 2023; 18:e0287518. [PMID: 37352267 PMCID: PMC10289323 DOI: 10.1371/journal.pone.0287518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Studies of the lived experience of chronic obstructive pulmonary disease (COPD) reveal a number of challenges patients face when interacting with healthcare providers that may be exacerbated by unwillingness or inability to quit smoking. However, none have explored, in-depth, primary care experiences among patients with COPD in community healthcare settings. AIMS/ OBJECTIVE The study investigated healthcare experiences of patients living independently in the community with COPD who smoked or had recently quit (at most within the last 5 years), seeking care in primary care settings. METHOD An Interpretative Phenomenological Analysis (IPA) involving thirteen participants purposively recruited from social media posts in COPD and carer support groups, general community groups, community noticeboards and paid adverts on social media. In-depth interviews were held between February and April 2022 by phone or Zoom™ and explored patient experience of primary care, focusing on how smoking patterns, addiction and stigma impact upon and shape these experiences. RESULTS Participants were aged between 45 to 75 years. Nine were female and two thirds were current smokers. Problematic experiences including time-constrained consultations, having to self-advocate for care "…go digging myself and then go and see him and say, can we do this, can we do that type of thing?" and guilt about smoking were common. Positive care experiences described non-judgemental interpersonal interactions with doctors, timely referral, proactive care and trust "I have an actual great trust for my GP… they're awesome, they'll look after you". Participants described how their care experience shifted as primary care adapted care delivery during COVID-19. CONCLUSIONS Pro-active, empathetic care from general practitioners is desired from patients living with COPD. Stigma and fear of judgement was an important underlying driver of negative care experiences contributing to delayed help seeking from general practitioners.
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Affiliation(s)
- Sanduni Madawala
- Department of General Practice, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Prahran, Victoria, Australia
| | - Narelle Warren
- Department of Sociology, School of Social Sciences, Faculty of Arts, Monash University, Prahran, Victoria, Australia
| | - Christian Osadnik
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Prahran, Victoria, Australia
| | - Chris Barton
- Department of General Practice, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Prahran, Victoria, Australia
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Winkley K, Sorsa T, Tian Q, Reece I, Fitzgerald C, Chamley M, Ismail K, Forbes A, Upsher R. The diabetes insulin self-management education (DIME) intervention for people with type 2 diabetes starting insulin: a pilot feasibility randomised controlled trial. Pilot Feasibility Stud 2023; 9:89. [PMID: 37237318 DOI: 10.1186/s40814-023-01318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To determine the feasibility and acceptability of a diabetes insulin self-management education (DIME) group intervention for people with type 2 diabetes starting insulin. DESIGN Single-centre parallel randomised pilot trial. SETTING Primary care, South London, UK. SUBJECTS Adults with type 2 diabetes, requiring insulin treatment, on maximum tolerated dose of 2 or more oral antidiabetic drugs with HbA1c > / = 7.5% (58 mmol/mol) on 2 occasions. We excluded people who were non-fluent in English; morbid obesity (BMI > / = 35 kg/m2); in employment that contraindicates insulin treatment; and those with severe depression, anxiety disorders, psychotic disorders, personality disorders, or cognitive impairment. METHODS Participants were randomised using blocks of 2 or 4 to 3, 2-h group, face-to-face, DIME sessions or standard insulin group education sessions (control). We assessed feasibility according to consent to randomisation and attendance at intervention (DIME) and standard group insulin education sessions. Acceptability of the interventions was determined using exit interviews. We additionally measured change in self-reported insulin beliefs, diabetes distress and depressive symptoms between baseline and 6-month post-randomisation. RESULTS There were 28 potentially eligible participants, of which 17 consented to randomisation, 9 were allocated to the DIME group intervention and 8 were allocated to the standard group insulin education. Three people withdrew from the study (1 from DIME and 2 from standard insulin education) before the start of the first session and did not complete baseline questionnaires. Of the remaining participants (n = 14), all DIME participants (n = 8) completed all 3 sessions, and all standard insulin education participants (n = 6) completed at least 1 standard insulin education session. The median group size was 2, the mean age of participants was 57.57 (SD 6.45) years, and 64% were female (n = 9). Exit interviews demonstrated that all participants (n = 7) found the group sessions acceptable, and thematic analysis of interview transcripts indicated social support, the content of group sessions and post-group experiences were positive, especially amongst DIME participants. There was improvement on self-report questionnaires. CONCLUSIONS The DIME intervention was acceptable and feasible to deliver to participants with type 2 diabetes starting insulin in South London, UK. TRIAL REGISTRATION International Study Registration Clinical Trial Network (ISRCTN registration number 13339678).
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Affiliation(s)
- Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, SE1 8WA, London, UK.
| | - Taru Sorsa
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Qingxiu Tian
- Department of Endocrinology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Ilse Reece
- Lambeth Diabetes Intermediate Care Team, London, UK
| | | | - Mark Chamley
- Lambeth Diabetes Intermediate Care Team, London, UK
| | - Khalida Ismail
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, SE1 8WA, London, UK
| | - Rebecca Upsher
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Maxey J, Gupta A, Houchens N. Quality and safety in the literature: April 2023. BMJ Qual Saf 2023; 32:235-240. [PMID: 36931631 DOI: 10.1136/bmjqs-2023-015977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Jordan Maxey
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Pilla SJ, Meza KA, Schoenborn NL, Boyd CM, Maruthur NM, Chander G. A Qualitative Study of Perspectives of Older Adults on Deintensifying Diabetes Medications. J Gen Intern Med 2023; 38:1008-1015. [PMID: 36175758 PMCID: PMC10039184 DOI: 10.1007/s11606-022-07828-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/16/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND While many older adults with type 2 diabetes have tight glycemic control beyond guideline-recommended targets, deintensifying (stopping or dose-reducing) diabetes medications rarely occurs. OBJECTIVE To explore the perspectives of older adults with type 2 diabetes around deintensifying diabetes medications. DESIGN This qualitative study used individual semi-structured interviews, which included three clinical scenarios where deintensification may be indicated. PARTICIPANTS Twenty-four adults aged ≥65 years with medication-treated type 2 diabetes and hemoglobin A1c <7.5% were included (to thematic saturation) using a maximal variation sampling strategy for diabetes treatment and physician specialty. APPROACH Interviews were independently coded by two investigators and analyzed using a grounded theory approach. We identified major themes and subthemes and coded responses to the clinical scenarios as positive (in favor of deintensification), negative, or ambiguous. KEY RESULTS Participants' mean age was 74 years, half were women, and 58% used a sulfonylurea or insulin. The first of four major themes was fear of losing control of diabetes, which participants weighed against the benefits of taking less medication (Theme 2). Few participants viewed glycemic control below target as a reason for deintensification and a majority would restart the medication if their home glucose increased. Some participants were anchored to their current diabetes treatment (Theme 3) driven by unrealistic views of medication benefits. A trusting patient-provider relationship (Theme 4) was a positive influence. In clinical scenarios, 8%, 4%, and 75% of participants viewed deintensification positively in the setting of poor health, limited life expectancy, and high hypoglycemia risk, respectively. CONCLUSIONS Optimizing deintensification requires patient education that describes both individualized glycemic targets and how they will change over the lifespan. Deintensification is an opportunity for shared decision-making, but providers must understand patients' beliefs about their medications and address misconceptions. Hypoglycemia prevention may be a helpful framing for discussing deintensification.
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Affiliation(s)
- Scott J Pilla
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Kayla A Meza
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nancy L Schoenborn
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cynthia M Boyd
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nisa M Maruthur
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Geetanjali Chander
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Mathose TT, Mash R. Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa. S Afr Fam Pract (2004) 2023; 65:e1-e7. [PMID: 36861914 PMCID: PMC9982463 DOI: 10.4102/safp.v65i1.5656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2DM) is a leading cause of mortality in South Africa and resistance to the use of insulin is common. This study aimed to explore factors that influence the initiation of insulin in patients with T2DM in primary care facilities in Cape Town, South Africa. METHODS An exploratory descriptive qualitative study was conducted. Seventeen semi-structured interviews were held with patients eligible for insulin, on insulin and primary care providers. Participants were selected by maximum variation purposive sampling. Data were analysed using the framework method in Atlas-ti. RESULTS Factors related to the health system, service delivery, clinical care and patients. Systemic issues related to the required inputs of workforce, educational materials, and supplies. Service delivery issues related to workload, poor continuity and parallel coordination of care. Clinical issues related to adequate counselling. Patient factors included a lack of trust, concerns about injections, impact on lifestyle and disposal of needles. CONCLUSION Although resource constraints are likely to remain, district and facility managers can improve supplies, educational materials, continuity and coordination. Counselling must be improved and may require innovative alternative approaches to support clinicians who face high number of patients. Alternative approaches using group education, telehealth and digital solutions should be considered.Contribution: This study identified key factors influencing insulin initiation in patients with T2DM in primary care. These can be addressed by those responsible for clinical governance, service delivery and in further research.
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Affiliation(s)
- Tasunungurwa T Mathose
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Negash Z, Mekonen T. Patient perception towards shifting oral antihyperglycemic agents to injectable insulin and associated factors in the diabetes clinic of Tikur Anbessa specialized hospital: Cross-sectional study. Metabol Open 2023; 17:100228. [PMID: 36632175 PMCID: PMC9826942 DOI: 10.1016/j.metop.2022.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/21/2022] [Accepted: 12/31/2022] [Indexed: 01/02/2023] Open
Abstract
Background With the growing understanding of the importance of preserving adequate glycemic control for the prevention of long-term diabetes-related complications, insulin therapy has become increasingly recommended for type 2 diabetes. However, insulin use in various healthcare settings remains low due to patients' low levels of acceptability of insulin therapy, which necessitates evaluating patients' attitudes. Objective To assess patients' perception toward shifting oral antihyperglycemic agents to insulin and associated factors at the ambulatory diabetes clinics of Tikur Anbessa Specialized Hospital (TASH). Method A cross-sectional study design was applied using a pre-tested interviewer-administered questionnaire on adult type 2 diabetes patients on follow-up at the diabetes clinic of TASH, Ethiopia from July to September 2021. The questionnaire tool was adapted from Insulin Treatment Appraisal Scale with modifications to fit the purpose of the study. Data was gathered, cleaned up, entered, and analyzed using Statistical Package for the Social Sciences (SPSS) version 23 for descriptive and logistic regression. For logistic regression data, a p-value of 0.05 was used to determine the statistical significance. Result Of 293 patients, 65.9% were female. Study participants had a mean age of 53.9 ± 10.9 years. About 45% and 75% of the participants have complications and comorbidities, respectively with a mean disease duration of 19.16 ± 8.2 years. Almost 54% of patients on oral antihyperglycemic agents were unwilling to start insulin. A perception score below the median was observed in 56.3% of the respondents. Patients with primary and secondary education were 45% and 42% less likely to have a poor perception of shifting oral antihyperglycemic agents to insulin than those who couldn't read or write (P < 0.05), respectively. The study found that participants who were taking only oral antihyperglycemic agents had a 2.76 times poor perception than those who are on insulin treatment (P < 0.001). Conclusion Poor perception toward shifting oral antihyperglycemic agents to insulin was found to be high among study participants. It was substantially correlated with low educational attainment, financial constraints, exclusively using oral antihyperglycemic agents, duration of disease, and absence of disease complications.
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Gouveia BDLA, de Sousa MM, Almeida TDCF, dos Santos WP, Trevizan DD, Soares MJGO, Oliveira SHDS. Psychosocial factors related to the behavioral intention of people with type 2 diabetes using insulin. Rev Bras Enferm 2022; 76:e20210617. [PMID: 36542050 PMCID: PMC9749767 DOI: 10.1590/0034-7167-2021-0617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/09/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES to analyze the psychosocial factors correlated with the behavioral intention of people with Type 2 Diabetes Mellitus (T2DM) towards insulin use. METHODS a cross-sectional study; a validated instrument based on the Theory of Planned Behavior was used to identify the direct measures (attitude, subjective norm and perceived control), indirect measures (behavioral, normative and control beliefs) and behavioral intention for the use of insulin. Descriptive analysis and Spearman's correlation were performed for data analysis. RESULTS a total of 211 individuals participated in the study, with a positive median of behavioral intention. Attitude, normative and behavioral beliefs were the psychosocial factors that presented a significant correlation (r=0.16, r=-0,15 and r=0.25, respectively; p<0.05) with the intention. CONCLUSIONS there is a positive behavioral intention in the use of insulin by people with T2DM. Attitude, normative beliefs and behavioral beliefs have a low magnitude correlation with the intention of people with T2DM to use insulin.
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Hernández-García F, González-Velázquez VE, Pérez García ER, Lazo Herrera LA, Pedraza-Rodríguez EM, Pupo Pérez A, González Quintana P, Casanovas Figueroa J. Validation and application of the Insulin Treatment Appraisal Scale in Cuban patients with type 2 diabetes mellitus. ENDOCRINOL DIAB NUTR 2022; 69:791-801. [PMID: 36443192 DOI: 10.1016/j.endien.2021.11.036] [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: 08/16/2021] [Accepted: 11/08/2021] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The purpose of this study was to validate the Insulin Treatment Appraisal Scale (ITAS) in the Cuban population with type 2 diabetes mellitus. MATERIAL AND METHODS A cross-sectional, multicentre analytical study was performed in Cuba from February 2020 to April 2021; 199 patients were surveyed in a hospital institution and in primary healthcare. We used the Insulin Treatment Appraisal Scale, consisting of 20 items, with a minimum score of 20 points and a maximum of 100, where the higher the score, the worse the perception of insulin therapy. The validity of the instrument was determined by means of an exploratory factor analysis. The internal consistency and reliability of the scale were calculated by means of Cronbach's alpha coefficient. A K-means cluster analysis was performed to establish a cut-off point for poor perception of insulin therapy. RESULTS The exploratory factor analysis supported the validity of the instrument, with a Cronbach's alpha of 0.747. There were statistically significant differences between patients under insulin and non-insulin treatment in terms of the answers given in all items of the scale. The total mean score obtained was 51.96 ± 10.78, and it was lower in insulin users compared to those who used other drugs (49.79 ± 10.07 vs 55.09 ± 11.12). A score ≥65 was proposed as a cut-off point for poor perception of insulin therapy. A positive relationship was found between the body mass index values and the total score of the scale. Being female and current treatment not involving insulin were factors associated with low perception of insulin therapy. CONCLUSIONS The instrument proved to be valid for the population in which it was applied. Insulin users turned out to be the ones with the best perception about its use. A cut-off point of ≥65 points for poor perception of insulin treatment was proposed for evaluation and comparison in future studies in other patient populations.
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Affiliation(s)
- Frank Hernández-García
- Centro Provincial de Atención y Educación al Paciente Diabético, Hospital Provincial General Docente Dr. Antonio Luaces Iraola, Facultad de Ciencias Médicas Dr. José Assef Yara, Universidad de Ciencias Médicas de Ciego de Ávila, Ciego de Ávila, Cuba.
| | | | - Enrique Rolando Pérez García
- Policlínico Universitario Área Norte, Facultad de Ciencias Médicas Dr. José Assef Yara, Universidad de Ciencias Médicas de Ciego de Ávila, Ciego de Ávila, Cuba
| | - Luis Alberto Lazo Herrera
- Facultad de Ciencias Médicas Dr. Ernesto Che Guevara de la Serna, Universidad de Ciencias Médicas de Pinar del Río, Pinar del Río, Cuba
| | | | - Antonio Pupo Pérez
- Facultad de Ciencias Médicas General Calixto García, Universidad de Ciencias Médicas de La Habana, La Habana, Cuba
| | | | - Jany Casanovas Figueroa
- Centro Provincial de Atención y Educación al Paciente Diabético, Hospital Provincial General Docente Dr. Antonio Luaces Iraola, Facultad de Ciencias Médicas Dr. José Assef Yara, Universidad de Ciencias Médicas de Ciego de Ávila, Ciego de Ávila, Cuba
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Pires IGS, Silva e Souza JA, de Melo Bisneto AV, Passos XS, Carneiro CC. Clinical efficacy of stem-cell therapy on diabetes mellitus: A systematic review and meta-analysis. Transpl Immunol 2022; 75:101740. [DOI: 10.1016/j.trim.2022.101740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/12/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022]
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Winkley K. Supporting people with type 2 diabetes who need insulin. PRACTICAL DIABETES 2022. [DOI: 10.1002/pdi.2424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Kirsty Winkley
- PhD, Reader in Diabetes & Primary Care and Diabetes Specialist Nurse for Lambeth Diabetes Intermediate Care Team. King's College London & Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, UK
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Langerman C, Forbes A, Robert G. The experiences of insulin use among older people with Type 2 diabetes mellitus: A thematic synthesis. Prim Care Diabetes 2022; 16:614-626. [PMID: 36089508 DOI: 10.1016/j.pcd.2022.08.008] [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: 02/19/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus is common in older people. Managing diabetes in older people can be challenging due to comorbidities and age-related disabilities, particularly in the context of insulin therapy. The purpose of this review is to explore older people's experiences of insulin use and to consider how these experiences might inform healthcare delivery. REVIEW METHODS A systematic review with thematic synthesis was conducted and reported in accordance with the PRISMA and ENTREQ statements. MEDLINE, Embase, PsycInfo, CINAHL and Web of Science were searched from 1985 to September 2019 with subsequent updates in December 2019 and June 2022. Included studies were quality appraised, findings tabulated, and results used to inform an integrated thematic synthesis. RESULTS Fourteen studies that reported insulin experiences with 274 patients aged 60 years and over were included; nine of the studies were qualitative and five used questionnaires surveys. Seven themes emerged that were grouped into treatment-related factors (physical impact of insulin, physical capacity to administer insulin, insulin self-management behaviours) and person-centred factors (emotional factors, social factors, daily living, and personal knowledge/beliefs). Three analytical themes to guide clinical practice were derived from the data: addressing physical capacity and ability, supporting social and emotional issues and improving interactions with healthcare professionals. CONCLUSION The review indicates issues surrounding the technical aspects of insulin administration, side effects of treatment and reactions to insulin administration are common amongst older people. However, research evidence is limited, and there is an urgent need for empirical, participatory research with older insulin dependent adults with type 2 diabetes. IMPLICATIONS FOR PRACTICE Healthcare professionals need to ensure that older type 2 diabetes people on insulin are actively involved in their own care, to allow their insulin regimens to be personalised and aligned with their goals and expectations. Tailored educational interventions to reduce treatment hazards and promote physical and psychological wellbeing are also needed for this population.
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Affiliation(s)
- Chaya Langerman
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom.
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom
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Wikström K, Lamidi M, Rautiainen P, Tirkkonen H, Laatikainen T. Type 2 diabetes medication and HbA1c levels in North Karelia Finland, 2013-2019. Diabet Med 2022; 39:e14866. [PMID: 35506179 PMCID: PMC9543455 DOI: 10.1111/dme.14866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/30/2022] [Indexed: 12/04/2022]
Abstract
AIMS To analyse the prevalence of prescribed medications among people with type 2 diabetes, their relationship to HbA1c levels and transitions between medications. METHODS The data included all 18- to 85-year-old adults with type 2 diabetes (identified from the electronic health records), who lived in North Karelia, Finland, between 2013 and 2019. Type 2 diabetes medication was defined based on prescriptions. Logistic and linear regressions with generalized estimating equations were used to assess the differences between years. RESULTS Metformin as a monotherapy was the most used medication (33%-35%) with the largest percentage of those in good glycaemic control. After metformin, the most used medications were long-acting and short-acting insulin and gliptin (16%-24% per group). In insulin groups, there were the smallest percentage of people in good glycaemic control. The use of SGLT2-i increased most during the follow-up (from 1.6% to 11%), but at the same time the percentage of those meeting the target HbA1c level decreased the most (from 83% to 53%). The use of GLP-1 RA and other medications were under 3.5%. SGLT2-i and insulin were the most stable medication groups. The most common transitions were from SGLT2-i to long-acting insulin and between insulin groups. CONCLUSIONS The sequencing of prescribing additional type 2 diabetes medication or replacing current medication with new ones seems to occur according to guidelines. However, more attention should be paid to the intensification of treatment and the possibilities for new treatment choices in the management of T2D taking into account the persons' characteristics.
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Affiliation(s)
- Katja Wikström
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
- Department of Public Health and WelfareFinnish Institute for Health and WelfareHelsinkiFinland
| | - Marja‐Leena Lamidi
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
| | - Päivi Rautiainen
- Joint Municipal Authority for North Karelia Social and Health ServicesJoensuuFinland
| | - Hilkka Tirkkonen
- Joint Municipal Authority for North Karelia Social and Health ServicesJoensuuFinland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
- Department of Public Health and WelfareFinnish Institute for Health and WelfareHelsinkiFinland
- Joint Municipal Authority for North Karelia Social and Health ServicesJoensuuFinland
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Validación y aplicación de la escala de percepción del tratamiento con insulina en pacientes cubanos con diabetes mellitus tipo 2. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Liu C, De Roza J, Ooi CW, Mathew BK, Elya, Tang WE. Impact of patients' beliefs about insulin on acceptance and adherence to insulin therapy: a qualitative study in primary care. BMC PRIMARY CARE 2022; 23:15. [PMID: 35172774 PMCID: PMC8776322 DOI: 10.1186/s12875-022-01627-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/14/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Insulin therapy forms a cornerstone of pharmacological management of diabetes mellitus (DM). However, there remains a lack of acceptance and adherence to insulin, thereby contributing to poor DM control. This study aimed to determine the impact of patients' beliefs about insulin on acceptance and adherence to insulin therapy. METHOD This was a qualitative study using grounded theory approach. The study took place from September 2019 to January 2021 at a cluster of primary healthcare clinics in Singapore. Maximum variation sampling was used to recruit adult patients with type 2 DM on basal or premixed insulin for at least 6 months. Semistructured in-depth interviews were conducted using a topic guide and audio recorded. Data collection continued until saturation. Data analysis utilised a constant comparison procedure and a synthesis approach. RESULTS Twenty-one participants (mean age 61 years) were interviewed for this study. Data analyses showed that there were 6 main themes that emerged. Four themes influenced both insulin acceptance and adherence. These were concerns about insulin being a lifelong treatment, physical fear of insulin injection, erroneous beliefs about insulin, and perceived fear of DM complications. Two additional themes influenced adherence to insulin therapy. These were socioeconomic concerns, and concerns about side effects of insulin. CONCLUSIONS Patients' beliefs about insulin impact on the acceptance and adherence to insulin therapy. Health care providers need to elicit and address these beliefs during counselling to improve acceptance and adherence to insulin therapy.
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Affiliation(s)
- Changwei Liu
- National Healthcare Group Polyclinics, 21 Geylang East Central, Singapore, 389707, Singapore.
| | - Jacqueline De Roza
- National Healthcare Group Polyclinics, 21 Geylang East Central, Singapore, 389707, Singapore
| | - Chai Wah Ooi
- National Healthcare Group Polyclinics, 21 Geylang East Central, Singapore, 389707, Singapore
| | | | - Elya
- National Healthcare Group Polyclinics, 21 Geylang East Central, Singapore, 389707, Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics, 21 Geylang East Central, Singapore, 389707, Singapore
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25
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Azri N, Norsa'adah B, Hassan NB, Naing NN. Insulin Adherence and Associated Factors in Patients with Type 2 Diabetes Mellitus Treated in Klang Primary Health Care Centres. Malays J Med Sci 2022; 28:76-87. [PMID: 35002492 PMCID: PMC8715880 DOI: 10.21315/mjms2021.28.6.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/10/2021] [Indexed: 11/05/2022] Open
Abstract
Background Insulin therapy is necessary for patients with type 2 diabetes mellitus (T2DM) to reach the targeted glycaemic level and prevent complications. This study aimed to determine the proportion of adherence to insulin therapy and the associated factors in patients with T2DM. Methods A cross-sectional study was conducted among 249 patients with T2DM who had been on insulin therapy for at least 2 months in primary care centres of the Ministry of Health in Klang, Malaysia. A validated insulin adherence questionnaire for diabetes mellitus (DM) was used to assess insulin adherence. Data on the sociodemographic characteristics, disease-related factors, treatment-related factors and clinical parameters were extracted from medical records and interviews with patients. Results The adherence to insulin therapy was 8.43%. The factors associated with insulin adherence were self-monitoring of blood glucose (SMBG) (adjusted odds ratio [AOR]: 5.39; 95% confidence interval (CI): 1.20, 24.13; P = 0.028), exercise (AOR: 3.38; 95% CI: 1.37, 10.03; P = 0.029) and the number of daily insulin injections (AOR: 1.63; 95% CI: 1.09, 2.44; P = 0.017). Conclusion The adherence to insulin therapy in primary health care centres in Malaysia was very poor. Patients who practiced SMBG, exercised and frequent daily insulin injections were significantly more adherent to insulin therapy.
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Affiliation(s)
- Nasruddin Azri
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,National Pharmaceutical Regulatory Division, Ministry of Health Malaysia, Petaling Jaya, Selangor, Malaysia
| | - Bachok Norsa'adah
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Norul Badriah Hassan
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nyi Nyi Naing
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Medical Campus, Kuala Terengganu, Terengganu, Malaysia
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Mathew BK, De Roza JG, Liu C, Goh LJ, Ooi CW, Chen E, Poon S, Tang WE. Which Aspect of Patient-Provider Relationship Affects Acceptance and Adherence of Insulin Therapy in Type 2 Diabetes Mellitus? A Qualitative Study in Primary Care. Diabetes Metab Syndr Obes 2022; 15:235-246. [PMID: 35153494 PMCID: PMC8828446 DOI: 10.2147/dmso.s344607] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/31/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE In type 2 diabetes mellitus (T2DM), insulin therapy is often recommended to achieve the optimal control of disease, thereby preventing the onset and progression of diabetes-related complications. Despite knowing about the benefits, it has been reported that 71% of patients refuse insulin and the adherence rate ranges from 30 to 80%. Patient-provider relationship (PPR) may affect such insulin-related behaviours, but little is known about which aspect of PPR affects this. This study aimed to explore the key aspect of the patient-provider relationship that affects the initial insulin acceptance and continued adherence. PATIENTS AND METHODS We used the grounded theory approach in this qualitative research. The study was conducted at two primary care clinics between September 2019 and January 2021. Patients with T2DM on basal or premixed insulin were recruited using maximum variation sampling. Data were collected using semi-structured in-depth interviews and transcribed verbatim for analysis using constant comparison and synthesis. RESULTS Twenty-one participants with different levels of diabetes control and adherence were recruited. Four themes that emerged were 1) patient-provider interaction, 2) addressing the psychological fears, 3) gaining confidence in handling insulin equipment and 4) follow-up after insulin initiation. Among the subthemes, trust in doctors, provider's communication skills, patient-centred decision-making and continuity of care positively influenced insulin acceptance and adherence. Conversely, fear of being judged by the provider hindered open communication around non-adherence. Various aspects of interaction with nurses helped in alleviating patient's fear of injection and gaining confidence with the insulin equipment. CONCLUSION Many aspects of PPR affect insulin acceptance and adherence. Among these, gaining patients' trust, effective patient-provider communication, patient-centred decision-making, and ensuring continuity of care improve both insulin acceptance and treatment adherence. Various interactions with nurses help in addressing fears surrounding injection and gaining acceptance towards insulin therapy. Patients' fear of being blamed or judged by the provider negatively affects open communication around non-adherence.
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Affiliation(s)
- Blessy Koottappal Mathew
- National Healthcare Group Polyclinics, Toa Payoh Polyclinic, National Healthcare Group, Singapore
- Correspondence: Blessy Koottappal Mathew, National Healthcare Group Polyclinic, 2003 Toa Payoh Polyclinic, Lorong 8, Toa Payoh, 319260, Singapore, Email
| | | | - Changwei Liu
- National Healthcare Group Polyclinics, Geylang Polyclinic, National Healthcare Group, Singapore
| | - Ling Jia Goh
- National Healthcare Group Polyclinics, Hougang Polyclinic, National Healthcare Group, Singapore
| | - Chai Wah Ooi
- National Healthcare Group Polyclinics, Geylang Polyclinic, National Healthcare Group, Singapore
| | - Elya Chen
- National Healthcare Group Polyclinics, Clinical Research Unit, National Healthcare Group, Singapore
| | - Shixuan Poon
- National Healthcare Group Polyclinics, Toa Payoh Polyclinic, National Healthcare Group, Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics, Clinical Research Unit, National Healthcare Group, Singapore
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Davidson MB. A Conversation on an Effective, Straightforward, Quantitative Approach to the Outpatient Use of Insulin. Diabetes Spectr 2022; 35:179-189. [PMID: 35668885 PMCID: PMC9160535 DOI: 10.2337/ds21-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
For primary care providers, using insulin can present challenges that can be met by a straightforward approach using the following principles. Depending on when it is injected, each component of the insulin regimen has a maximal effect on a specific period of the 24-hour cycle (e.g., overnight, morning, afternoon, or evening). The glucose pattern in that period determines whether the dose of that component of the insulin regimen requires adjusting. Regarding which insulin types and insulin regimens to use, human insulin (NPH and regular) is as effective as analog insulins, and a two-injection intensified insulin regimen is as effective as a four-injection regimen.
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Robinson S, Newson RS, Liao B, Kennedy-Martin T, Battelino T. Missed and Mistimed Insulin Doses in People with Diabetes: A Systematic Literature Review. Diabetes Technol Ther 2021; 23:844-856. [PMID: 34270324 DOI: 10.1089/dia.2021.0164] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Development of coordinated management approaches is important to facilitate self-care in people with diabetes (PwD). Gaining a better understanding of suboptimal insulin use is key in this endeavor. This review aimed, for the first time, to systematically identify and narratively summarize real-world evidence on the extent of suboptimal insulin use (missed and mistimed insulin) in PwD. Methods: A systematic literature search of MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews identified studies reporting on missed and mistimed insulin dosing. Results: From 3305 studies, 37 publications reporting on 30 unique studies that involved 58,617 PwD were included. Studies were conducted across 12 different countries and most employed cross-sectional surveys. Observations regarding missed and mistimed insulin doses were reported in 25 and 10 studies, respectively. PwD reported missing insulin doses, but rates varied due to differences in reporting methods, participant populations, and insulin regimens. The association between missed dosing and glycemic control was evaluated in ten studies in which the authors reported lower glycated hemoglobin (HbA1c) levels in PwD who did not omit insulin. The proportion of PwD reporting mistiming of insulin was in the range of 20-45%, depending on the study; this was associated with higher rates of hypoglycemia and higher HbA1c as reported by study authors. Reasons for suboptimal insulin use were multifactorial, occurring due to disrupted daily routines, social situations, and hypoglycemia avoidance. Conclusions: This review suggests that suboptimal insulin use is widespread and that PwD using insulin may still be struggling with disease management. There is an unmet need for better integrated support in managing the complexities of insulin therapy and for the development of systems (e.g. digital solutions) that empower people to take control of insulin-treated diabetes.
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Affiliation(s)
- Susan Robinson
- Kennedy-Martin Health Outcomes Limited, Brighton, United Kingdom
| | - Rachel S Newson
- Global Patient Outcomes and Real-World Evidence, Eli Lilly, Sydney, Australia
| | - Birong Liao
- Medical Affairs, Eli Lilly, Indianapolis, IN, USA
| | | | - Tadej Battelino
- University Medical Center Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Niño de Guzmán Quispe E, Martínez García L, Orrego Villagrán C, Heijmans M, Sunol R, Fraile-Navarro D, Pérez-Bracchiglione J, Ninov L, Salas-Gama K, Viteri García A, Alonso-Coello P. The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions: A Scoping Review of Reviews. THE PATIENT 2021; 14:719-740. [PMID: 33871808 PMCID: PMC8563562 DOI: 10.1007/s40271-021-00514-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Self-management (SM) interventions are supportive interventions systematically provided by healthcare professionals, peers, or laypersons to increase the skills and confidence of patients in their ability to manage chronic diseases. We had two objectives: (1) to summarise the preferences and experiences of patients and their caregivers (informal caregivers and healthcare professionals) with SM in four chronic diseases and (2) to identify and describe the relevant outcomes for SM interventions from these perspectives. METHODS We conducted a mixed-methods scoping review of reviews. We searched three databases until December 2020 for quantitative, qualitative, or mixed-methods reviews exploring patients' and caregivers' preferences or experiences with SM in type 2 diabetes mellitus (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart failure (HF). Quantitative data were narratively synthesised, and qualitative data followed a three-step descriptive thematic synthesis. Identified themes were categorised into outcomes or modifiable factors of SM interventions. RESULTS We included 148 reviews covering T2DM (n = 53 [35.8%]), obesity (n = 20 [13.5%]), COPD (n = 32 [21.6%]), HF (n = 38 [25.7%]), and those with more than one disease (n = 5 [3.4%]). We identified 12 main themes. Eight described the process of SM (disease progression, SM behaviours, social support, interaction with healthcare professionals, access to healthcare, costs for patients, culturally defined roles and perceptions, and health knowledge), and four described their experiences with SM interventions (the perceived benefit of the intervention, individualised care, sense of community with peers, and usability of equipment). Most themes and subthemes were categorised as outcomes of SM interventions. CONCLUSION The process of SM shaped the perspectives of patients and their caregivers on SM interventions. Their perspectives were influenced by the perceived benefit of the intervention, the sense of community with peers, the intervention's usability, and the level of individualised care. Our findings can inform the selection of patient-important outcomes, decision-making processes, including the formulation of recommendations, and the design and implementation of SM interventions.
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Affiliation(s)
- Ena Niño de Guzmán Quispe
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain.
| | - Laura Martínez García
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carola Orrego Villagrán
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Fraile-Navarro
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Madrid Primary Health Care Service, Madrid, Spain
| | | | | | - Karla Salas-Gama
- Health Services Research Group, Institut de Recerca Vall d'Hebron Hospital, Barcelona, Spain
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrés Viteri García
- Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Universidad UTE, Quito, Ecuador
- Centro Asociado Cochrane de Ecuador, Universidad UTE, Quito, Ecuador
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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30
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Huang W, Wei W, Wang J, Lyu Y, Li L. Effectiveness of a nurse-led online educational programme based on basic insulin therapy in patients with diabetes mellitus: A quasi-experimental trial. J Clin Nurs 2021; 31:2227-2239. [PMID: 34558147 DOI: 10.1111/jocn.16041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/14/2021] [Accepted: 08/26/2021] [Indexed: 01/19/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of a nurse-led online educational programme based on patients with diabetes mellitus treated with initial basal insulin therapy. BACKGROUND Patients with type 2 diabetes mellitus (T2DM) need to be treated with insulin to control hyperglycaemia and reduce the risk of diabetic complications when oral hypoglycaemic drugs are not effective or contraindicated. Current practices emphasise the leading role of nurses in patients treated with initial basal insulin therapy after discharge. The introduction of nurse-led online education within this area is a relatively new programme. DESIGN This study was a quasi-experimental, nonequivalent, two-group, comparison group design. METHODS The study selected 800 patients with T2DM hospitalised in the Department of Endocrinology at a Chinese hospital from July 2018 to June 2020 who were initially treated with insulin. According to the time sequence, 400 patients from July 2018 to June 2019 were divided into the control group and 400 patients from July 2019 to June 2020 into the intervention group. The control group received routine health education and doctor-led follow-up based on routine health education. The intervention group received systematic health education and online insulin injection activities led by nurses. The effects were evaluated after 3 and 6 months of intervention. The TREND checklist was followed to ensure rigour in the study. RESULTS In total, 339 patients were enrolled in the intervention group and 333 patients within the control group. According to the analysis, 3 months after the intervention, the compliance rate of fasting blood glucose (FBG) (rate difference: 0.078, 95% CI: 0.006-1.150, p < .05) and HbA1c (%) (rate difference: 0.070, 95% CI: 0.001-0.137, p < .05) between the intervention and control groups were statistically significant; 6 months after the intervention, the compliance rate of FBG (rate difference: 0.077, 95% CI: 0.007-0.14, p < .05) and HbA1c (%) (rate difference: 0.106, 95% CI: 0.324-0.180, p < .01) between the intervention and the control groups were statistically significant. The total score of the 'My Opinion on Insulin' scale in the intervention group was (80.18 ± 6.68), and in the control group was (71.15 ± 8.17), there was a significant difference in the scale between the two groups (mean difference: 9.03, 95% CI: 7.900-10.160, p < .01). Through a multivariable regression model, in order to correct the important baseline characteristics, the daily insulin dosage, and the total score of the 'My Opinion on Insulin' scale after 6 months of intervention were independent risk factors for the two intervention methods in diabetic patients treated with initial basal insulin therapy (p < .05). CONCLUSIONS A nurse-led online programme was feasible and effective for patients with diabetes mellitus treated with initial basal insulin therapy. This programme could effectively be used to reduce the patient's daily insulin dose, as well as improve the patients' compliance using insulin therapy. RELEVANCE TO CLINICAL PRACTICE Nurse-led online education has a role in implementing a safe, standardised, and sustained approach to patients with diabetes mellitus treated with initial basal insulin therapy during follow-up after discharge.
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Affiliation(s)
- Wenzhen Huang
- Department of Endocrinology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No.7 Weiwu Street, Zhengzhou, 450000, China
| | - Wei Wei
- Department of Endocrinology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No.7 Weiwu Street, Zhengzhou, 450000, China
| | - Jie Wang
- Department of Endocrinology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No.7 Weiwu Street, Zhengzhou, 450000, China
| | - Yinghua Lyu
- Department of Endocrinology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No.7 Weiwu Street, Zhengzhou, 450000, China
| | - Li Li
- Department of Endocrinology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No.7 Weiwu Street, Zhengzhou, 450000, China
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Mohan V, Mukherjee JJ, Das AK, Seshadri K, Dasgupta A. Initiation and intensification of insulin therapy in type 2 diabetes mellitus: Physician barriers and solutions – An Indian perspective. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Forst T, Choudhary P, Schneider D, Linetzky B, Pozzilli P. A practical approach to the clinical challenges in initiation of basal insulin therapy in people with type 2 diabetes. Diabetes Metab Res Rev 2021; 37:e3418. [PMID: 33098260 PMCID: PMC8519070 DOI: 10.1002/dmrr.3418] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/17/2020] [Accepted: 08/09/2020] [Indexed: 12/18/2022]
Abstract
Initiating insulin therapy with a basal insulin analogue has become a standard of care in the treatment of type 2 diabetes mellitus (T2DM). Despite increasing choices in pharmacological approaches, intensified glucose monitoring and improvements in quality of care, many patients do not achieve the desired level of glycaemic control. Although insulin therapy, when optimized, can help patients reach their glycaemic goals, there are barriers to treatment initiation on both the side of the patient and provider. Providers experience barriers based on their perceptions of patients' capabilities and concerns. They may lack the confidence to solve the practical problems of insulin therapy and avoid decisions they perceive as risky for their patients. In this study, we review recommendations for basal insulin initiation, focussing on glycaemic targets, titration, monitoring, and combination therapy with non-insulin anti-hyperglycaemic medications. We provide practical advice on how to address some of the key problems encountered in everyday clinical practice and give recommendations where there are gaps in knowledge or guidelines. We also discuss common challenges faced by people with T2DM, such as weight gain and hypoglycaemia, and how providers can address and overcome them.
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Affiliation(s)
- Thomas Forst
- Department of Endocrinology and Metabolic DiseasesUniversitatsmedizin der Johannes GutenbergMainzGermany
- Clinical Research ServicesManhheimGermany
| | - Pratik Choudhary
- Department of Diabetes and Nutritional SciencesKing's CollegeLondonUK
| | | | | | - Paolo Pozzilli
- Department of Endocrinology and Metabolic DiseasesUniversità Campus Bio‐MedicoRomeItaly
- Centre of ImmunobiologyBarts and the London School of MedicineQueen Mary University of LondonUK
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Oliveira REMD, Franco LJ. Glycemic control in elderly people with type 2 diabetes mellitus attending primary health care units. Prim Care Diabetes 2021; 15:733-736. [PMID: 33903088 DOI: 10.1016/j.pcd.2021.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
AIM To assess the glycemic control in elderly people with type 2 diabetes mellitus who attend the primary health care units in the city of Ribeirão Preto, State of São Paulo, Brazil. METHODS This is a cross-sectional study with elderly people registered at the family health care system. Glycemic control was the dependent variable, which was measured by means of glycated hemoglobin test, whereas sociodemographic and clinical data were independent variables. RESULTS 243 elderly people participated in the study, with the majority being females (67.1%), Caucasian (58.4%), within the age group of 60-69 years old (53.9%) and less than four years of study (74.9%). The mean glycated hemoglobin test was 7.2% (SD = 1.7). It was observed that 74.1% of the subjects had glycated hemoglobin test lower than 8.0%. A positive association between glycemic control and combined use of oral anti-diabetic drugs plus insulin was evidenced, whereas presence of cardiovascular disease, ulcer and amputation of lower extremities were the negative associations. CONCLUSION The combined use of oral anti-diabetic drugs plus insulin was associated with adequate glycemic control in this elderly population. Among those who reported having a diabetic chronic complication, that is those who needed a stricter diabetes control, was observed a higher frequency of poor glycemic control. These findings are relevant in the primary care context to guide health care and interventions to achieve success in diabetes control.
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Affiliation(s)
| | - Laercio Joel Franco
- Ribeirão Preto Medical School, University of São Paulo, 3900 Bandeirantes Avenue, Ribeirão Preto, SP, 14049-900, Brazil.
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Sudlow AC, Pournaras DJ, Heneghan H, Bodnar Z, le Roux CW, McGillicuddy D. An Exploration of the Patient Lived Experience of Remission and Relapse of Type 2 Diabetes Following Bariatric Surgery. Obes Surg 2021; 31:3919-3925. [PMID: 34120310 PMCID: PMC8197677 DOI: 10.1007/s11695-021-05514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 12/02/2022]
Abstract
Background Bariatric surgery is the most effective treatment for patients with obesity and type 2 diabetes (T2DM), inducing profound metabolic changes associated with improvements in glycaemic control. In spite of the recognition of the physiological changes associated with bariatric surgery, what remains underappreciated is the patient experience of surgery to treat T2DM. Objectives This study explored the patient experience with regard to motivations, expectations and outcomes, including remission and relapse of diabetes. Methods An in-depth qualitative approach was adopted, encompassing semi-structured interviews with patients (n=17) living with obesity and T2DM both pre- and postsurgery. Interpretive thematic analysis identified emergent themes using a grounded approach. Results Analysis revealed a number of themes throughout the interviews which included motivations and perceived benefits of surgery, obesity stigma and its impact on self-worth as well as perceptions of remission or relapse and the implications for sense of control. Conclusions The motivation for undergoing bariatric surgery was driven by health concerns, namely T2DM and the desire to reduce the risk of developing diabetes-related complications. Patients highlighted social and self-stigmatisation associated with obesity and T2DM, leading to feelings of shame and an inability to seek support from family or healthcare professionals. Stigmatisation created a sense of failure and feeling of guilt for having T2DM. As a result, patients felt responsible for maintaining disease remission postoperatively and regarded the need for medication as a sign of treatment failure.
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Affiliation(s)
- Alexis C Sudlow
- Department of Upper GI Surgery, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
| | - Dimitri J Pournaras
- Department of Upper GI Surgery, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
| | - Helen Heneghan
- Department of Surgery, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin, Ireland
| | - Zsolt Bodnar
- Department of Surgery, Letterkenny University Hospital, Donegal, Ireland
| | - Carel W le Roux
- Department of Experimental Pathology, University College Dublin, Belfield, Dublin, Ireland.
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Alexandre K, Campbell J, Bugnon M, Henry C, Schaub C, Serex M, Elmers J, Desrichard O, Peytremann-Bridevaux I. Factors influencing diabetes self-management in adults: an umbrella review of systematic reviews. JBI Evid Synth 2021; 19:1003-1118. [PMID: 33741836 DOI: 10.11124/jbies-20-00020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this review was to identify and describe the factors influencing diabetes self-management in adults by summarizing the available evidence concerning their types, categories, and relative importance. INTRODUCTION A wide range of factors, acting simultaneously, influence diabetes self-management and interfere with its actual application by patients. There is a variety of systematic reviews of these factors; however, a more thorough examination of their influences was lacking. INCLUSION CRITERIA Systematic reviews of qualitative or quantitative literature focusing on factors influencing adult diabetes self-management in general or on individual behaviors (ie, management of oral antidiabetic medication and insulin injections, self-monitoring of blood glucose, foot care, healthy eating, regular exercise, and smoking cessation) will be included. METHODS We performed an extensive search of 11 bibliographic databases, including gray literature, up to June 2019. Quantitative and qualitative findings were summarized separately and labeled according to their types (eg, facilitator/barrier, strength and direction of association), categories (eg, demographic, social), and frequency of occurrence. RESULTS We identified 51 types of factors within 114 systematic reviews, which mostly addressed medication-taking behavior. Thirty-two (62.7%) factors were reported in both qualitative and quantitative literature. The predominant influences were psychological factors and behavioral attributes/skills factors. The most frequently reported facilitators of diabetes self-management were motivation to diabetes self-management, a favorable attitude to diabetes self-management, knowledge about the disease, medication and behaviors associated with diabetes self-management, skills, and self-efficacy/perceived behavioral control. The predominant barriers were the presence of depression, and polypharmacy or drug regimen complexity. The demographic factor of female sex was frequently reported for its negative influence on diabetes self-management, whereas older age was a positive factor. The social/cultural and physical environment were the least-studied categories. Other factors such as social support from family, friends, or networks; interventions led by health professionals; and a strong community environment with good social services favoring diabetes self-management were reported as major facilitators of diabetes self-management. CONCLUSIONS Essential components of interventions to promote effective diabetes self-management should aim to help adults manage the effects of specific factors related to their psychological and practical self-management experience. Screening for depression, in particular, should become an integral part of the support for adult diabetes self-management, as depression is a particular obstacle to the effectiveness of diabetes self-management. Future studies should more deeply examine the influence of factors identified in the sociocultural and physical environment categories. Research should properly consider and invest efforts in strengthening social support and innovative community care approaches, including pharmacist- and nurse-led care models for encouraging and improving adult diabetes self-management. Finally, researchers should examine non-modifiable factors - age, sex, or socioeconomic status - in the light of factors from other categories in order to deepen understanding of their real-world patterns of action on adult diabetes self-management. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018084665.
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Affiliation(s)
- Ketia Alexandre
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Joan Campbell
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Marie Bugnon
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
| | - Cristina Henry
- Association Vaudoise d'Aide et de Soins À Domicile (AVASAD), Lausanne, Switzerland
| | - Corinne Schaub
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Magali Serex
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Jolanda Elmers
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Olivier Desrichard
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
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Ribeiro RT, Andrade R, Nascimento do Ó D, Lopes AF, Raposo JF. Impact of blinded retrospective continuous glucose monitoring on clinical decision making and glycemic control in persons with type 2 diabetes on insulin therapy. Nutr Metab Cardiovasc Dis 2021; 31:1267-1275. [PMID: 33612381 DOI: 10.1016/j.numecd.2020.12.024] [Citation(s) in RCA: 5] [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] [Received: 05/06/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Blinded retrospective continuous glucose monitoring (rCGM) provides detailed information about real-life glycaemic profile. In persons with type 2 diabetes without adequate glycaemic control, the structured introduction of rCGM may be beneficial to sustain improvements in diabetes management. METHODS AND RESULTS 102 individuals with insulin-treated type 2 diabetes, age less than 66 years old and HbA1c >7.5%, were recruited. Participants performed a 7-day blinded rCGM (iPro2) every four months for one year. Biochemical, anthropometric, and rCGM data was collected. Participants' and healthcare professionals' perceptions were assessed. 90 participants completed the protocol. HbA1c was 9.1 ± 0.1% one year prior to enrolment and 9.4 ± 0.1% at enrolment (p < 0.01). With the rCGM-based intervention, a decrease in HbA1c was achieved at 4 months (8.4 ± 0.1%, p < 0.0001), and 12 months (8.1 ± 0.1%, p < 0.0001). A significant increase in time-in-range was observed (50.8 ± 2.4 at baseline vs 61.5 ± 2.2% at 12 months, for 70-180 mg/dL, p < 0.001), with no difference in exposure time to hypoglycaemia. After 12 months, there was an increase in self-reported diabetes treatment satisfaction (p < 0.05). CONCLUSION In persons with type 2 diabetes and poor metabolic control, specific data from blinded rCGM informed therapeutic changes and referral to targeted education consultations on nutrition and insulin administration technique. Therapeutic changes were made more frequently and targeted to changes in medication dose, timing, and/or type, as well as to lifestyle. Together, these brought significant improvements in clinical outcomes, effective shared decision-making, and satisfaction with treatment. REGISTRATION NUMBER NCT04141111.
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Affiliation(s)
- Rogério Tavares Ribeiro
- APDP - Diabetes Portugal, Lisbon, Portugal; iBiMED, Dep of Medical Sciences, University of Aveiro, Portugal; CEDOC, NOVA University of Lisbon, Portugal.
| | | | | | | | - João Filipe Raposo
- APDP - Diabetes Portugal, Lisbon, Portugal; CEDOC, NOVA University of Lisbon, Portugal; Dep of Public Health, NOVA Medical School, NOVA University of Lisbon, Portugal
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Davidson MB, Davidson SJ. Effective use of computerized insulin dose adjustment algorithms on continuous glucose monitoring results by a clinical pharmacist - Proof-of-concept. J Diabetes 2021; 13:439-441. [PMID: 33399259 DOI: 10.1111/1753-0407.13154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/15/2020] [Accepted: 01/03/2021] [Indexed: 01/18/2023] Open
Abstract
Highlights A clinical pharmacist using recommendations of Food and Drug Administration-cleared computerized insulin dose adjustment algorithms based on analyses of glucose readings from continuous glucose monitoring (Abbot Free Style Pro) in 13 poorly controlled insulin-requiring diabetic patients increased time in target range of 3.9 to 10.0 mmol/L from 29% to 51% and decreased time in range of >13.9 mmol/L from 43% to 23% (both P = 0.01) after 3 months. Glycated hemoglobin (HbA1c) levels (±SD) fell from 102 (±15) to 67 (±10) mmol/mol (P < 10-6 ).
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Affiliation(s)
- Mayer B Davidson
- Charles R. Drew University, Los Angeles, California, USA
- Mellitus Health, Inc, Los Angeles, California, USA
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Arda Sürücü H, Okur Arslan H, Çetik S. Self-care, A1C and stigmatization as predictors of a negative perception of insulin among adults with type 2 diabetes: a hospital-based study in Turkey. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-12-2019-0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeThe purpose of this study was to investigate diabetes self-care behaviors, stigmatization and A1C as predictors of a negative perception of insulin treatment in insulin-treated type 2 diabetic patients.Design/methodology/approachA descriptive cross-sectional and relational design was used. The study was carried out in the Diabetes Training Centre and Endocrine and Metabolism Clinic of a university hospital in the southeast of Turkey between May and October 2017. The research sample consisted of 100 type 2 diabetic patients determined by using a convenience sampling method. An introductory information form for type 2 diabetic patients, the Insulin Treatment Appraisal Scale (ITAS), Diabetes Self-Care Activities Survey (DSCAS) and Barriers to Insulin Treatment Scale (BIT) were used to collect the research data. The data were analyzed using descriptive statistics, correlations and step wise multi-linear regression.FindingsThe number of daily insulin injections, training received about insulin and stigmatization was significant predictors of a negative perception of insulin treatment.Originality/valueStrategies to decrease diabetic individuals' fear of stigmatization should be utilized to minimize their negative insulin treatment perception (giving diabetic individuals training about diabetes, planning public training to inform society and using mass media tools). Diabetes educators should know that diabetic individuals' perception of the severity of the illness could influence the daily number of injections applied and decrease the negative perception regarding insulin.
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Yong SY, Goh GM, Loh HH. Insulin adherence and the associated factors among patients with type 2 diabetes mellitus at the Hospital Queen Elizabeth II, Sabah. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-020-01409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Matthews DR, Wysham C, Davies M, Slee A, Alba M, Lee M, Perkovic V, Mahaffey KW, Neal B. Effects of canagliflozin on initiation of insulin and other antihyperglycaemic agents in the CANVAS Program. Diabetes Obes Metab 2020; 22:2199-2203. [PMID: 32691499 PMCID: PMC7693248 DOI: 10.1111/dom.14143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 01/14/2023]
Abstract
This study compared initiation of insulin and other antihyperglycaemic agents (AHAs) with canagliflozin versus placebo for participants with type 2 diabetes and a history/high risk of cardiovascular disease in the CANagliflozin cardioVascular Assessment Study (CANVAS) Program. After 1 year, fewer participants treated with canagliflozin versus placebo initiated any AHA (7% vs. 16%), insulin (3% vs. 9%) or any non-insulin AHA (5% vs. 12%) (P < .001 for all); overall AHA initiation rates increased over time but were consistently lower with canagliflozin compared with placebo. During the study, the likelihood of initiating insulin was 2.7 times lower for participants treated with canagliflozin compared with placebo (hazard ratio, 0.37; 95% CI: 0.31, 0.43; P < .001). The time difference between 10% of patients in the canagliflozin and placebo groups being initiated on insulin from the beginning of the trial was about 2 years. Time to initiation of other AHAs, including metformin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists and sulphonylureas, was also delayed for canagliflozin versus placebo (P < .001 for each). Compared with placebo, canagliflozin delayed the need for initiation of other AHAs and delayed time to insulin therapy, an outcome that is important to many people with diabetes.
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Affiliation(s)
- David R. Matthews
- Oxford Centre for Diabetes, Endocrinology and Metabolism and Harris Manchester CollegeUniversity of OxfordOxfordUK
| | | | - Melanie Davies
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | | | - Maria Alba
- Janssen Research & Development, LLCRaritanNew JerseyUSA
| | - Mary Lee
- Janssen Research & Development, LLCRaritanNew JerseyUSA
| | - Vlado Perkovic
- The George Institute for Global Health, UNSW SydneySydneyNew South WalesAustralia
| | - Kenneth W. Mahaffey
- Stanford Center for Clinical Research, Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Bruce Neal
- The George Institute for Global Health, UNSW SydneySydneyNew South WalesAustralia
- The Charles Perkins CentreUniversity of SydneySydneyNew South WalesAustralia
- Imperial College LondonLondonUK
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Hertroijs DFL, Elissen AMJ, Brouwers MCGJ, Hiligsmann M, Schaper NC, Ruwaard D. Preferences of people with Type 2 diabetes for diabetes care: a discrete choice experiment. Diabet Med 2020; 37:1807-1815. [PMID: 31001855 PMCID: PMC7586937 DOI: 10.1111/dme.13969] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 01/05/2023]
Abstract
AIMS Limited knowledge exists on the preferences of people with Type 2 diabetes towards diabetes care. Consequently, these care preferences cannot yet be considered in the development of tailored diabetes care approaches. Therefore, this study aimed to assess care preferences and their determinants in people with Type 2 diabetes. METHODS A discrete choice experiment was conducted to elicit people's preferences. People with Type 2 diabetes, treated in 30 Dutch primary care practices, were asked to choose repeatedly between two hypothetical diabetes care packages, which differed in six attributes: role division in daily diabetes care planning, lifestyle education method, type of medication management support, consultation frequency, emotional support and time spend on self-management. A mixed-logit model was used to estimate the relative importance of the included attributes. Preference heterogeneity among people with different person- and disease-related characteristics was investigated. RESULTS In total, 288 participants completed the experiment. They preferred to plan their daily diabetes care together with a healthcare provider, to receive individual lifestyle education, medication and emotional support from a healthcare provider, one consultation visit every 3 months and to spend less time on self-management. Participants did not prefer to receive emotional support from a psychologist. Heterogeneity in preferences could partly be explained by differences in sex, education level and glucose-lowering drug use. CONCLUSION People with Type 2 diabetes show a preference for traditional care models. Emotional support was identified by participants as the most important attribute. It is therefore important to adequately guide them when changes in diabetes care organization are implemented.
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Affiliation(s)
- D. F. L. Hertroijs
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - A. M. J. Elissen
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - M. C. G. J. Brouwers
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
| | - M. Hiligsmann
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - N. C. Schaper
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
| | - D. Ruwaard
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
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Netere AK, Ashete E, Gebreyohannes EA, Belachew SA. Evaluations of knowledge, skills and practices of insulin storage and injection handling techniques of diabetic patients in Ethiopian primary hospitals. BMC Public Health 2020; 20:1537. [PMID: 33046046 PMCID: PMC7552567 DOI: 10.1186/s12889-020-09622-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Insulin is an effective therapeutic agent in the management of diabetes, but also sensitive to the external environment. Consequently, diabetic patients' adherence to insulin delivery recommendations is critical for better effectiveness. Patients' lack of knowledge, skill and irrational practices towards appropriate insulin delivery techniques may end up in therapeutic failure and increase costs of therapy. The aim of this study was to evaluate patients' knowledge, skills and practices of insulin storage and injection techniques. METHODS An interview-based cross-sectional study was conducted through purposive selection of participants in Northwest Ethiopian primary hospitals from March 1 to May 30, 2019. Levels of knowledge were assessed with right or wrong responses, while practice was measured by using a 4-point Likert scale structured questionnaire collected via face-to-face interviews. Likewise, a five-point observational (demonstration) techniques checklist employed to assess patients' skills. RESULTS Among 194 patients approached, 166 participants completed the survey giving a response rate of 85.6%. More than half of the respondents (54.8%) were males and the mean age (±SD) was 38.5 ± 13.8 years. The overall patients' median knowledge and practice levels on insulin storage and handling techniques were moderately adequate (64.3%) and fair (55.4%), respectively. In patients' skill assessments, 94.6% correctly showed injection sites, 70% indicated injection site rotations, and 60.75% practiced injection site rotations. Education (P < 0.001), duration of insulin therapy (P = 0.008), and duration of diabetes (P = 0.014) had significant impact on knowledge level. Education (P < 0.001), occupation (P < 0.001), duration of insulin therapy (P = 0.001), duration of diabetes (P = 0.036) and patients' knowledge level (P < 0.001) were found to have a significant effects on the patients' practice levels. A Mann-Whitney U test also disclosed that residency, ways to get insulin and mocked injection technique during the first training had significant effects on patients' knowledge levels. CONCLUSION The current study revealed that patients had moderately adequate knowledge and fair practice levels on insulin storage and handling techniques. However, patients missed important insulin administration skills. This study highlights the need of regular public health education so as to enhance the patients' knowledge, skill and practice levels on insulin handling techniques.
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Affiliation(s)
- Adeladlew Kassie Netere
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Lideta Sub City Kebele 16, Gondar, Ethiopia.
| | - Eyayaw Ashete
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Lideta Sub City Kebele 16, Gondar, Ethiopia
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Lideta Sub City Kebele 16, Gondar, Ethiopia
| | - Sewunet Admasu Belachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Lideta Sub City Kebele 16, Gondar, Ethiopia
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Ngassa Piotie P, Wood P, Webb EM, Marcus TS, Rheeder P. Willingness of people with Type 2 diabetes to start insulin therapy: Evidence from the South African Tshwane Insulin Project (TIP). Diabetes Res Clin Pract 2020; 168:108366. [PMID: 32791159 DOI: 10.1016/j.diabres.2020.108366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/22/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
AIMS To determine factors associated with 'hypothetical willingness' to start insulin among people with Type 2 diabetes (T2DM). METHODS A quantitative cross-sectional study with insulin-naïve T2DM patients at 23 primary care facilities in the Tshwane Metropolitan Municipality. Data collected included demographic and clinical data, willingness to start insulin, attitudes and barriers to insulin therapy. Factors associated with unwillingness to start insulin therapy were explored using a multivariable logistic regression model. RESULTS Of 468 T2DM study patients (mean age 57.2, SD = 11.3 years), more than half (51.9%) expressed unwillingness to starting insulin therapy. Unwillingness was associated with negative attitudes (OR = 1.32, 95% CI = 1.12-1.55, p = 0.001) and reluctance (OR = 1.41, 95% CI = 1.27-1.57, p < 0.001) rather than age, sex, education or diabetes duration. The strongest reasons for patient unwillingness were injection anxieties, fear of needles, insufficient knowledge of insulin, feeling unable to cope with insulin and concerns about out-of-pocket costs. CONCLUSIONS The prospect of insulin therapy disturbs patients' sense of self and their psychological wellbeing. The high prevalence of psychological insulin resistance among these T2DM patients needs to be addressed for effective diabetes management.
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Affiliation(s)
- Patrick Ngassa Piotie
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
| | - Paola Wood
- Division of Biokinetics, Department of Physiology, Faculty of Health Sciences, University of Pretoria, P/Bag 14760, Hatfield 0001, City of Tshwane, South Africa.
| | - Elizabeth M Webb
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
| | - Tessa S Marcus
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
| | - Paul Rheeder
- Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
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Blasco-Blasco M, Puig-García M, Piay N, Lumbreras B, Hernández-Aguado I, Parker LA. Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review. PLoS One 2020; 15:e0237542. [PMID: 32886663 PMCID: PMC7473520 DOI: 10.1371/journal.pone.0237542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Given that most evidence-based recommendations for managing type 2 diabetes mellitus (T2DM) are generated in high-income settings, significant challenges for their implementation exist in Latin America and the Caribbean region (LAC), where the rates of T2DM and related mortality are increasing. The aim of this study is to identify the facilitators and barriers to successful management of T2DM in LAC, from the perspectives of patients, their families or caregivers, healthcare professionals, and/or other stakeholders. METHODS We conducted a systematic review in MEDLINE, Web of Science, SciELO, and LILACS. We included studies of disease management, prevention of complications and risk factor management. We qualitatively synthesized the verbatim text referring to barriers and/or facilitators of diabetes management according to the Theoretical Domain Framework and described their relative frequencies. FINDINGS We included 60 studies from 1,595 records identified. 54 studies (90%) identified factors related to the environmental context and resources, highlighting the importance of questions related to health care access or lack of resources in the health system, and the environmental context and living conditions of the patients. Issues related to "social influences" (40 studies) and "social/professional role and identity" (37 studies) were also frequently addressed, indicating the negative impact of lack of support from family and friends and clinicians' paternalistic attitude. 25 studies identified patients beliefs as important barriers, identifying issues such as a lack of patients' trust in the effectiveness of the medication and/or the doctor's advice, or preferences for alternative therapies. CONCLUSIONS Successful diabetes management in LAC is highly dependent on factors that are beyond the control of the individual patients. Successful disease control will require emphasis on public policies to reinforce health care access and resources, the promotion of a patient-centred care approach, and health promoting infrastructures at environmental level.
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Affiliation(s)
- Mar Blasco-Blasco
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Marta Puig-García
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Nora Piay
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Blanca Lumbreras
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lucy Anne Parker
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Bakke Å, Dalen I, Thue G, Cooper J, Skeie S, Berg TJ, Jenum AK, Claudi T, Fjeld Løvaas K, Sandberg S. Variation in the achievement of HbA 1c , blood pressure and LDL cholesterol targets in type 2 diabetes in general practice and characteristics associated with risk factor control. Diabet Med 2020; 37:1471-1481. [PMID: 31651045 DOI: 10.1111/dme.14159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2019] [Indexed: 12/21/2022]
Abstract
AIMS To identify population, general practitioner, and practice characteristics associated with the achievement of HbA1c , blood pressure and LDL cholesterol targets, and to describe variation in the achievement of risk factor control. METHODS We conducted a cross-sectional survey of 9342 people with type 2 diabetes, 281 general practitioners and 77 general practices in Norway. Missing values (7.4%) were imputed using multiple imputation by chained equations. We used three-level logistic regression with the achievement of HbA1c , blood pressure and LDL cholesterol targets as dependent variables, and factors related to population, general practitioners, and practices as independent variables. RESULTS Treatment targets were achieved for HbA1c in 64%, blood pressure in 50%, and LDL cholesterol in 52% of people with type 2 diabetes, and 17% met all three targets. There was substantial heterogeneity in target achievement among general practitioners and among practices; the estimated proportion of a GPs diabetes population at target was 55-73% (10-90 percentiles) for HbA1c , 36-63% for blood pressure, and 47-57% for LDL cholesterol targets. The models explained 11%, 5% and 14%, respectively, of the total variation in the achievement of HbA1c , blood pressure and LDL cholesterol targets. Use among general practitioners of a structured diabetes form was associated with 23% higher odds of achieving the HbA1c target (odds ratio 1.23, 95% confidence interval (CI) 1.02-1.47) and 17% higher odds of achieving the LDL cholesterol target (odds ratio 1.17, 95% CI 1.01-1.35). CONCLUSIONS Clinical diabetes management is difficult, and few people meet all three risk factor control targets. The proportion of people reaching target varied among general practitioners and practices. Several population, general practitioner and practice characteristics only explained a small part of the total variation. The use of a structured diabetes form is recommended.
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Affiliation(s)
- Å Bakke
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - I Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - G Thue
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - J Cooper
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - S Skeie
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - T J Berg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - A K Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - T Claudi
- Nordland Hospital, Department of Medicine, Bodø, Norway
| | - K Fjeld Løvaas
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - S Sandberg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
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Chauhan PS, Yadav D, Tayal S, Jin JO. Therapeutic Advancements in the Management of Diabetes Mellitus with Special Reference to Nanotechnology. Curr Pharm Des 2020; 26:4909-4916. [PMID: 32851952 DOI: 10.2174/1381612826666200826135401] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/25/2020] [Indexed: 12/11/2022]
Abstract
For improvisation of diabetic's quality of life, nanotechnology is facilitating the development of advanced glucose sensors as well as efficient insulin delivery systems. Our prime focus of the review is to highlight the advancement in diabetic research with special reference to nanotechnology at its interface. Recent studies are more focused on enhancing sensitivity, accuracy, and response by employing metal as well as nanoparticles based glucose sensors. Moreover, the review focuses on nanoscale based approaches i.e. closed-loop insulin delivery systems, which detect any fluctuation in blood glucose levels and allow controlled release of a drug, thus are also called self-regulating insulin release system. Additionally, this review summarizes the role of nanotechnology in the diagnosis and treatment of diabetic complications through little advancement in the existing techniques. To improve health, as well as the quality of life in diabetic's new sensing systems for blood glucose level evaluation and controlled administration of drugs through efficient drug delivery systems should be explored.
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Affiliation(s)
- Pallavi Singh Chauhan
- Amity Institute of Biotechnology, Amity University Madhya Pradesh, Gwalior (M.P.), India
| | - Dhananjay Yadav
- Department of Medical Biotechnology, Yeungnam University, Gyeongsan, 712-749, South Korea
| | - Shivam Tayal
- School of Pharmacy, ITM University, Gwalior, Madhya Pradesh, India
| | - Jun-O Jin
- Research Institute of Cell Culture, Yeungnam University, Gyeongsan 38541, South Korea
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Lambrinou E, Kyriakou M, Lakatamitou I, Angus N, Khatib R, Vellone E, Barrowcliff A, Hansen TB, Lee GA. An integrative review on facilitators and barriers in delivering and managing injectable therapies in chronic conditions: A part of the ACNAP project 'injectable medicines among patients with cardiovascular conditions'. Eur J Cardiovasc Nurs 2020; 19:663-680. [PMID: 32672477 DOI: 10.1177/1474515120939007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Although preventive health and therapeutics have benefited from advances in drug development and device innovation, translating these evidence-based treatments into real-world practice remains challenging. AIM The current integrative review aims to identify facilitators and barriers and perceptions in delivering and managing injectable therapies from patient perspectives. METHODS An integrative review was conducted in the databases of PubMed, CINAHL, PsycINFO and Cochrane. Keywords were used "Injectable therapy", "IV therapy", "SC therapy", "long term injectable therapies", "self-administered injectable therapy", "patients", "caregivers", "family", "carers", "facilitators", "barriers", "perspectives", "needs", "expectations", "chronic disease", "cardiovascular disease" linked with the words "OR" and "AND". The search was limited from January 2000 to July 2019. Inclusion and exclusion criteria were used. RESULTS Twenty studies were identified from the literature search. Studies followed qualitative, quantitative methodology and mixed methods. Facilitators included: health improvement, prevention of disease complications, taking control of their disease, effectiveness of the medication and convenience in management. Barriers included: fear of needles, insulin will cause harm, poor perception of the benefits of injectable therapies on their quality of life, inconvenience in self-management, social stigma, impact on daily living, financial barriers, lack of education. Perceptions included: 'treatment of last resort', 'life becomes less flexible', 'injectables were punishment/restriction', 'personal failure of self-management'. CONCLUSION Evidence shows how to create effective communication and shared decision-making relationships to provide best possible care to patients who need injectable therapy and support for self-management. Future research might help guide response to the fears and barriers of the patients using patients' perspectives.
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Affiliation(s)
- Ekaterini Lambrinou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Cyprus
| | | | - Ioanna Lakatamitou
- Intensive Care Unit, American Medical Center/American Heart Institute, Cyprus
| | - Neil Angus
- Department of Nursing & Midwifery, University of the Highlands and Islands, UK
| | - Rani Khatib
- Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, UK.,Cardiology Department, Leeds Teaching Hospitals NHS, UK.,Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, UK
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Abigail Barrowcliff
- Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, UK
| | - Tina Birgitte Hansen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.,University of Southern Denmark, Department of Regional Health Research, Odense, Denmark
| | - Geraldine A Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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McGloin H, O'Connell D, Glacken M, Mc Sharry P, Healy D, Winters-O'Donnell L, Crerand K, Gavaghan A, Doherty L. Patient Empowerment Using Electronic Telemonitoring With Telephone Support in the Transition to Insulin Therapy in Adults With Type 2 Diabetes: Observational, Pre-Post, Mixed Methods Study. J Med Internet Res 2020; 22:e16161. [PMID: 32406854 PMCID: PMC7256748 DOI: 10.2196/16161] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/23/2019] [Accepted: 01/24/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Initiation of insulin therapy for the management of type 2 diabetes can be an unwelcome and distressful development for patients. Current evidence suggests that telemonitoring can help improve glycemic control in type 2 diabetes and can support empowerment to self-manage diabetes. This telemonitoring intervention was underpinned by an empowerment approach. OBJECTIVE This study aimed to evaluate the clinical effectiveness and feasibility and the patients' and health care providers' experiences of a 12-week telemonitoring intervention with telephone support for patients commencing insulin therapy. This paper focuses on the impact on patient empowerment. METHODS An observational, pre-post, multimethod, and triangulation design was employed to study a 12-week automated electronic telemonitoring intervention with telephone support from a diabetes clinical nurse specialist (CNS). Forty patients were recruited from the clinic as they were about to commence insulin therapy. In the quantitative arm, biometric data (hemoglobin A1c [HbA1c] and weight) and psychosocial data (diabetes empowerment scale [DES] scores and diabetes distress scale [DDS] scores) were gathered by the research team at baseline (T1), the end of the intervention (T2), and 3 months postintervention (T3). Data on hospital admission and general practitioner (GP) visits were collected for the duration of the study. In the qualitative arm, separate focus group interviews were conducted with the CNS team supporting the intervention (n=2) and patients (n=16). RESULTS Of 39 patients who completed the intervention, 23 (59%) were male. The mean age of the sample was 62.4 years (range 37-80 years). The mean HbA1c (mmol/mol) decreased significantly between T1 and T2 (mean difference [MD] -17.13; P<.001) and T1 and T3 (MD -18.16; P<.001), with no significant impact on weight. In the focus groups, patients reported an increased awareness to self-manage diabetes and feelings of safety and comfort. There were 13% (5/39) of patients who had hypoglycemia on two or more occasions. A significant increase in the mean DES score occurred between T1 and T2 (MD 0.62; P=.001) and T1 and T3 (MD 0.72; P<.001). The mean DDS score decreased between T1 and T2 (MD -0.64; P=.002) and T1 and T3 (MD -0.6; P=.002). The mean patient satisfaction with the intervention was above 4 out of possible 5 on all items on the Telemedicine Satisfaction and Usefulness Questionnaire. We observed a reduction in diabetes clinic attendances and GP visits. A significant increase in workload was reported by the CNS team. CONCLUSIONS This intervention had an empowering effect for patients in the self-management of type 2 diabetes and has the potential to meet the need for safer and more effective care in insulin initiation in the community setting. We observed a significant increase in workload for health care staff. Telemonitoring needs to be streamlined with health care delivery and accompanied by adequate support services.
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Affiliation(s)
- Helen McGloin
- Department of Nursing, Health Science and Disability Studies, St Angela's College, Sligo, Ireland
| | - Dympna O'Connell
- Department of Nursing, Health Science and Disability Studies, St Angela's College, Sligo, Ireland
| | | | - Patsy Mc Sharry
- Department of Nursing, Health Science and Disability Studies, St Angela's College, Sligo, Ireland
| | - Denise Healy
- Department of Nursing, Health Science and Disability Studies, St Angela's College, Sligo, Ireland
| | - Lisa Winters-O'Donnell
- Department of Nursing, Health Science and Disability Studies, St Angela's College, Sligo, Ireland
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49
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Ishii H, Shuichi S, Williams P, Demiya S, Aranishi T, Treuer T. Cross-sectional survey in patients with type 1 and type 2 diabetes to understand mealtime insulin unmet needs in Japan: The MINUTES-J study. Diabetes Res Clin Pract 2020; 162:108076. [PMID: 32061818 DOI: 10.1016/j.diabres.2020.108076] [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: 10/10/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
AIMS This study was conducted to evaluate existing burden and unmet needs related to mealtime insulin (MTI) injection timing among adult Japanese patients with type 1 (T1D) and type 2 (T2D) diabetes. It also aimed to evaluate if a novel MTI could reduce this burden. METHODS This study comprised of a qualitative pilot study facilitating development of an online survey; followed by an online quantitative survey involving T1D, young T2D (yT2D) and elderly T2D (eT2D) patients to assess burden of current MTI timings in Japan. RESULTS Overall, 38% patients (amongst T1D, yT2D and eT2D groups) reported injecting MTI just before start or during meal in the past month. Experiencing lower glucose level/hypoglycemic condition before the meal and forgetting were the main reasons for injecting during/after meal in T1D and T2D patients respectively. Patients reported moderate-to-severe burden in multiple aspects of their lives, associated with current MTI timing. Most patients perceived that this burden would remain the same if a faster acting MTI was available. CONCLUSIONS Substantial burden reported by Japanese patients regarding the current MTI timings suggests the need for new MTI products that could achieve optimal post-prandial glucose control at different timings to meet patients' needs in Japan.
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Affiliation(s)
- Hitoshi Ishii
- Department of Diabetology, Nara Medical University, Nara, Japan
| | | | - Paul Williams
- RWE Patient-Centered Endpoints Center of Excellence, IQVIA, Paris, France.
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50
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Ceriello A, deValk HW, Guerci B, Haak T, Owens D, Canobbio M, Fritzen K, Stautner C, Schnell O. The burden of type 2 diabetes in Europe: Current and future aspects of insulin treatment from patient and healthcare spending perspectives. Diabetes Res Clin Pract 2020; 161:108053. [PMID: 32035117 DOI: 10.1016/j.diabres.2020.108053] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 02/08/2023]
Abstract
Due to the progressive nature of type 2 diabetes (T2DM), initiation of insulin therapy is very likely in the disease continuum. This article aims at highlighting the current situation with regard to insulin therapy in people with T2DM in Europe and at presenting the associated unmet need. Challenges for both people with T2DM and healthcare professionals include clinical inertia also derived from fear of hypoglycaemia, weight gain and injections as well as increased need for a comprehensive diabetes management. We compare national and international guidelines and recommendations for the initiation and intensification of insulin therapy with the real-world situation in six European countries, demonstrating that glycaemic targets are only met in a minority of people with T2DM on insulin therapy. Furthermore, this work evaluates currently recorded numbers of people with T2DM treated with insulin in Europe, the proportion not achieving the stated glycaemic targets and thus in need to enhance insulin therapy e.g. by a change in means of insulin delivery including, but not limited to, insulin pens, wearable mealtime insulin delivery patches, patch pumps, and conventional insulin pumps with continuous subcutaneous insulin infusion.
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Affiliation(s)
| | - Harold W deValk
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bruno Guerci
- Endocrinology, Diabetology & Nutrition Clinical Unit, Brabois Hospital & Center of Clinical Investigation ILCV, Centre Hospitalier Universitaire of Nancy, University of Lorraine Vandoeuvre-lès-Nancy, France
| | - Thomas Haak
- Diabetes Klinik Bad Mergentheim, Bad Mergentheim, Germany
| | - David Owens
- Diabetes Research Unit Cymru, Swansea University, Swansea, Wales, UK
| | | | | | | | - Oliver Schnell
- Sciarc GmbH, Baierbrunn, Germany; Forschergruppe Diabetes e.V., Muenchen-Neuherberg, Germany.
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