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Chang R, Piya MK, Ara P, Fernandes B, Simmons D. Use of glucose sensors for post-discharge care triaging of insulin-treated patients with type 2 diabetes: a feasibility study. Intern Med J 2024; 54:1739-1743. [PMID: 39230209 DOI: 10.1111/imj.16494] [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: 04/29/2024] [Accepted: 07/22/2024] [Indexed: 09/05/2024]
Abstract
The use of glucose sensors to triage post-discharge follow-up was investigated among hospital inpatients with type 2 diabetes. Feasibility, utility and patient satisfaction with this model of care were studied. Feasibility was 36.5%, with 90/198 (45.5%) inpatients discharged with glucose sensors but 9.0% unable to use glucose sensors effectively. Follow-up plans were altered in 76.3% of the patients able to use the sensor technology. Patient satisfaction was high and was improved on follow-up after 6 months.
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Affiliation(s)
- Ruby Chang
- Campbelltown Hospital, Macarthur Diabetes and Endocrine Service, Sydney, New South Wales, Australia
| | - Milan K Piya
- Campbelltown Hospital, Macarthur Diabetes and Endocrine Service, Sydney, New South Wales, Australia
- Macarthur Clinical School, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Paige Ara
- Macarthur Clinical School, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Brunelle Fernandes
- Campbelltown Hospital, Macarthur Diabetes and Endocrine Service, Sydney, New South Wales, Australia
| | - David Simmons
- Campbelltown Hospital, Macarthur Diabetes and Endocrine Service, Sydney, New South Wales, Australia
- Macarthur Clinical School, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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Chimoriya R, Mitlehner K, Khoo CL, Osuagwu UL, Thomson R, Si L, Lean M, Simmons D, Piya MK. Translation of a Diabetes Remission Service into Australian Primary Care: Findings from the Evaluation of DiRECT-Australia. J Diabetes Res 2024; 2024:2350551. [PMID: 38361965 PMCID: PMC10869186 DOI: 10.1155/2024/2350551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/02/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
Background The Diabetes Remission Clinical Trial (DiRECT) study demonstrated that an intensive and structured weight management program in UK primary care resulted in high rates of diabetes remission in adults with recent onset type 2 diabetes mellitus (T2DM). This study was aimed at evaluating the translation of the DiRECT intervention into an Australian primary care setting. Methods All patients enrolled in the DiRECT-Australia Type 2 Diabetes Remission Service in a region of Sydney (Macarthur region, South Western Sydney, Australia) were included. Eligible participants were aged 20-70 years, noninsulin treated, with T2DM of ≤6 years' duration, and body mass index (BMI) ≥ 27 kg/m2. Total diet replacement of 825-853 kcal/day using meal replacements was implemented for 12 weeks, followed by an ongoing structured program until 52 weeks, with regular follow-up with a general practitioner, dietitian, and/or practice nurse. Results Of 39 recruited participants, 32 (82.1%) and 27 (69.2%) completed 12 weeks and 52 weeks of the structured program, respectively. Decrease in weight by -12.0 kg (95% CI: -9.6, -14.4; p < 0.001) and -9.1 kg (95% CI: -5.2, -12.9; p < 0.001) and decrease in glycated haemoglobin (HbA1c) by -1.1% (95% CI: -0.6, -1.6; p < 0.001) and -0.6% (95% CI: -0.1, -1.1; p = 0.013) were observed at 12 and 52 weeks, respectively. At the end of 12 and 52 weeks, 93.8% (30/32) and 55.6% (15/27) of those with follow-up data met the criteria for diabetes remission, respectively. Quality of life and wellbeing scores increased over the course of 12 weeks, remaining significantly higher at 52 weeks. Participants reported they would be willing to pay A$92.50 (95% CI: A$75.80, A$109.30) per fortnight for the low-calorie meal replacement shakes. Conclusions These findings support the feasibility of a structured diabetes remission service in an Australian primary care setting to achieve improvements in glycaemia, weight, and quality of life and wellbeing, and suggest a substantial willingness to pay for diet replacement products among participants.
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Affiliation(s)
- Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Kimberly Mitlehner
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Chee L. Khoo
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Healthfocus Family Practice, Ingleburn, NSW, Australia
| | - Uchechukwu Levi Osuagwu
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Bathurst Rural Clinical School (BRCS), Western Sydney University, Bathurst, NSW, Australia
| | - Russell Thomson
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, Australia
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
| | - Michael Lean
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Campbelltown and Camden Hospitals, Campbelltown, NSW, Australia
| | - Milan K. Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Campbelltown and Camden Hospitals, Campbelltown, NSW, Australia
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Khoo CL, Chimoriya R, Simmons D, Piya MK. Partial meal replacement for people with type 2 diabetes: 2-year outcomes from an Australian general practice. Aust J Prim Health 2023; 29:74-80. [PMID: 36318919 DOI: 10.1071/py22180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to determine weight loss and improvement in glycaemia at 12 and 24months in patients with type 2 diabetes mellitus (T2DM), following a 3-month partial meal replacement and subsequent reduced calorie diet. METHODS This was a retrospective cohort study of patients with T2DM attending a solo general practice in Sydney, New South Wales, Australia. Participants were advised to follow a 3-month partial meal replacement plan comprising of two meal replacement shakes plus a healthy meal. Over the subsequent 21months, patients were encouraged to follow a reduced calorie diet with a particular emphasis on lowering carbohydrate intake. RESULTS Of the 153 patients with T2DM, 51 (33.3%) agreed to follow a 3-month partial meal replacement plan, which was completed by 66.7% (n =34/51). Compared to baseline, the average weight loss at 12 and 24months was 7.1±7.0kg (102.2±20.9kg vs 95.1±18.7kg, P <0.001) and 4.2±7.7kg (102.2±20.9kg vs 98.0±18.2kg, P =0.003), respectively. Haemoglobin A1c (HbA1c) was significantly reduced at 12months (6.9±1.5% vs 6.3±0.9%, P =0.003), but not at 24months. The proportion of participants that met the criteria for diabetes remission was similar at baseline (8.8%) and 12months (11.8%), but increased to 32.4% at 24months (P =0.016). CONCLUSIONS Patients with T2DM who were able to follow a partial meal replacement plan for 3months with advice from a general practitioner achieved significant weight loss over 24months. A multicentre randomised controlled trial to confirm these findings is required as this could significantly change the management of T2DM in primary care.
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Affiliation(s)
- Chee L Khoo
- Healthfocus Family Practice, Ingleburn, NSW 2565, Australia; and School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; and Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia
| | - Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; and Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia
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Kodsi R, Chimoriya R, Medveczky D, Grudzinskas K, Atlantis E, Tahrani AA, Kormas N, Piya MK. Clinical Use of the Edmonton Obesity Staging System for the Assessment of Weight Management Outcomes in People with Class 3 Obesity. Nutrients 2022; 14:967. [PMID: 35267942 PMCID: PMC8912843 DOI: 10.3390/nu14050967] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to assess weight loss and metabolic outcomes by severity of weight-related complications following an intensive non-surgical weight management program (WMP) in an Australian public hospital. A retrospective cohort study of all patients aged ≥18 years with body mass index (BMI) ≥ 40 enrolled in the WMP during March 2018−March 2019 with 12-month follow-up information were stratified using the Edmonton Obesity Staging System (EOSS). Of 178 patients enrolled in the WMP, 112 (62.9%) completed at least 12 months’ treatment. Most patients (96.6%) met EOSS-2 (56.7%) or EOSS-3 (39.9%) criteria for analysis. Both groups lost significant weight from baseline to 12 months; EOSS-2: 139.4 ± 31.8 kg vs. 131.8 ± 31.8 kg (p < 0.001) and EOSS-3: 141.4 ± 24.2 kg vs. 129.8 ± 24.3 kg (p < 0.001). After adjusting for baseline age, sex and employment status, mean weight loss was similar but a greater proportion of EOSS-3 achieved >10% weight loss compared to EOSS-2, (40% vs. 15.9%, p = 0.024). Changes in metabolic parameters including HbA1c, BP and lipids did not differ between EOSS-2 and 3. Despite increased clinical severity, adult patients with class 3 obesity achieved clinically meaningful weight loss and similar improvements in metabolic parameters compared to patients with less severe complications after 12 months in an intensive non-surgical WMP.
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Affiliation(s)
- Raymond Kodsi
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
| | - Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (D.M.)
| | - David Medveczky
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (D.M.)
| | - Kathy Grudzinskas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia;
- Discipline of Medicine, Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Nepean, NSW 2747, Australia
| | - Abd A. Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK;
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham B15 2TT, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Trust, Birmingham B15 2TT, UK
| | - Nic Kormas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
| | - Milan K. Piya
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (D.M.)
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Disparities in diabetes-related avoidable hospitalization among diabetes patients with disability using a nationwide cohort study. Sci Rep 2022; 12:1794. [PMID: 35110602 PMCID: PMC8810810 DOI: 10.1038/s41598-022-05557-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
Diabetes is an ambulatory care sensitive condition that quality of care can prevent complications development and hospitalization needs. However, diabetes patients with disability face greater challenges with receiving quality diabetes care than those without disabilities. This study examined diabetes-related avoidable hospitalizations (DRAH) focusing on the association with disability. We used nationally representative health insurance cohort data from 2002 to 2013. The study population is people who were newly diagnosed with type 2 diabetes. We measured the cumulated number of DRAH using the Prevention Quality Indicators (PQIs). The variables of interest were disability severity and type. We performed a recurrent events analysis using Cox proportional hazard regression model. Among 49,410 type 2 diabetes patients, 12,231 (24.8%) experienced DRAHs at least once during the follow-up period. Among the total population, 5924 (12.0%) diabetes patients were registered as disabled. The findings report that disability severity was significantly associated with higher risks for DRAH, where severely disabled diabetes patients showed the highest hazard ratio of 2.24 (95% CI 1.80-2.79). Among three DRAH indicators, severely disabled diabetes patients showed increased risks for long-term (AHR 2.21, 95% CI 1.89-2.60) and uncontrolled (AHR 2.28, 95% CI 1.80-2.88) DRAH. In addition, intellectual (AHR 5.52, 95% CI 3.78-8.05) and mental (AHR 3.97, 95% CI 2.29-6.89) disability showed higher risks than other types of disability. In conclusion, diabetes patients with disability are at higher risk for DRAH compared to those without disabilities, and those with intellectual and mental disabilities were more likely to experience DRAH compared to those with physical or other types of disability. These findings call for action to find the more appropriate interventions to improve targeted diabetes primary care for patients with disability. Further research is needed to better understand determinants of increasing risks of DRAH.
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