1
|
Gad H, Kalra S, Pinzon R, Garcia RAN, Yotsombut K, Coetzee A, Nafach J, Lim LL, Fletcher PE, Lim V, Malik RA. Earlier diagnosis of peripheral neuropathy in primary care: A call to action. J Peripher Nerv Syst 2024; 29:28-37. [PMID: 38268316 DOI: 10.1111/jns.12613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/26/2024]
Abstract
Peripheral neuropathy (PN) often remains undiagnosed (~80%). Earlier diagnosis of PN may reduce morbidity and enable earlier risk factor reduction to limit disease progression. Diabetic peripheral neuropathy (DPN) is the most common PN and the 10 g monofilament is endorsed as an inexpensive and easily performed test for DPN. However, it only detects patients with advanced neuropathy at high risk of foot ulceration. There are many validated questionnaires to diagnose PN, but they can be time-consuming and have complex scoring systems. Primary care physicians (PCPs) have busy clinics and lack access to a readily available screening method to diagnose PN. They would prefer a short, simple, and accurate tool to screen for PN. Involving the patient in the screening process would not only reduce the time a physician requires to make a diagnosis but would also empower the patient. Following an expert meeting of diabetologists and neurologists from the Middle East, South East Asia and Latin America, a consensus was formulated to help improve the diagnosis of PN in primary care using a simple tool for patients to screen themselves for PN followed by a consultation with the physician to confirm the diagnosis.
Collapse
Affiliation(s)
- Hoda Gad
- Research Department, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - Rizaldy Pinzon
- Neurology Department of the Bethesda, General Hospital Yogyakarta, Yogyakarta, Indonesia
| | - Rey-An Nino Garcia
- College of Medicine, De LA Salle, Health Medical and Science Institute College of Medicine, Manila, Philippines
| | - Kitiyot Yotsombut
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Ankia Coetzee
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jalal Nafach
- Dubai Diabetes Center, Dubai Academic Health Corporation, Dubai, UAE
| | - Lee-Ling Lim
- Department of Medicine, Diabetes Care Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Pablo E Fletcher
- Endocrinology Department, Medical School, University of Panama, Panama, Panama
| | - Vivien Lim
- Endocrinology Department, Gleneagles Hospital, Singapore, Singapore
| | - Rayaz A Malik
- Research Department, Weill Cornell Medicine-Qatar, Doha, Qatar
- Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK
| |
Collapse
|
2
|
Xie LF, Roy-Fleming A, Haag S, Costa DD, Brazeau AS. Development of the Support self-guided, web application for adults living with type 1 diabetes in Canada by a multi-disciplinary team using a people-oriented approach based on the Behaviour Change Wheel. Digit Health 2023; 9:20552076231152760. [PMID: 36762025 PMCID: PMC9903036 DOI: 10.1177/20552076231152760] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/04/2023] [Indexed: 01/26/2023] Open
Abstract
Background Diabetes self-management education and support (DSME/S) are central in type 1 diabetes (T1D) where individuals are responsible for 95% of care. In-person DSME/S programs have been proven clinically effective (e.g. optimizing glycemic management, improving diabetes-related behaviors) but are limited by a lack of accessibility and long-term follow-up. Self-guided digital tools such as web applications (web apps) can be an alternative for delivering DSME/S. Objective This article describes the development of Support, a behavioral theory-based, self-guided, web application for adults living with T1D in the province of Quebec, Canada. Methods A multi-disciplinary team developed Support. Patient partners first proposed its focus, learning topics, and expressed barriers to using digital tools for DSME/S. These barriers were analyzed based on the Behaviour Change Wheel. A group of healthcare professionals (HCPs) drafted the evidence-based learning content which was reviewed by external HCPs and by patient partners. Results Support is a bilingual (English and French) web app accessible at any time via the Internet. It has four learning paths focusing on hypoglycemia and based on the user's method of diabetes treatment. Learning modules are divided into six categories with a maximum of three learning levels. It contains features such as a discussion forum, videos, and quizzes to ensure interactivity, provide social support, and maintain the motivation and long-term engagement of users. Conclusions To the best of the authors' knowledge, Support is the first self-guided evidence-based web app for adults living with T1D. It is currently under study to evaluate its feasibility and clinical impacts.
Collapse
Affiliation(s)
- Li Feng Xie
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Canada
| | - Amélie Roy-Fleming
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Canada
| | - Sarah Haag
- Montreal Clinical Research Institute, Montreal, Quebec, Canada
| | - Deborah Da Costa
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada,Department of Medicine, McGill University, Sainte-Anne-de-Bellevue, Canada
| | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Canada,Montreal Diabetes Research Center, Montreal, Quebec, Canada,Anne-Sophie Brazeau, School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Canada.
| |
Collapse
|
3
|
Cairns SR, Sjöström ES. Dietitians' perspectives on challenges and prospects for group-based education to adults with type 1 diabetes - a qualitative study. BMC Endocr Disord 2022; 22:249. [PMID: 36253850 PMCID: PMC9576129 DOI: 10.1186/s12902-022-01165-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 1 diabetes (T1DM) is an autoimmune disorder which can have short- and long-term adverse effects on health. Dietitians in diabetes offer specialist evidence-based advice to people with T1DM and provide education in either individual or group settings. The purpose of this study was to explore dietitians' perception of, and role in, group-based education as well as prospects for development. METHODS This was a qualitative descriptive study conducted in Sweden using a convenience sampling of dietitians working in adult diabetes care. Semi-structured interviews were conducted with participants and data were analysed using a content analysis approach. RESULTS Ten dietitians with a median experience of 14.5 years in diabetes care were interviewed. The informants were all appreciative of facilitating group-based education and perceived that it was beneficial for people with T1DM to be part of group processes, but the informants did also suggest that there were challenges for their professional role. The main challenges reported was to adjust the level of depth and complexity to the information provided and the lack of ability to individualize the education-sessions in a heterogenous group. None of the dietitians reported performing pre-assessment or follow-up audits on the group-based education. CONCLUSION There was a great engagement from the dietitians, but they identified a lack of framework that address challenges regarding group-based education. The dietitians experienced examples of person-centred care while facilitating group-based education, which may benefit people with T1DM. Based on the results, it would be valuable to explore the pedagogic training level of Swedish dietitians and potential barriers in their ability to facilitate group-based education. We suggest that a framework for group-based education should be explored together with patient representatives to optimize the care given to ensure cost-effectiveness, optimize clinical outcomes, quality of life and equally accessible care for people with T1DM.
Collapse
|
4
|
Rubin-Falcone H, Fox I, Hirschfeld E, Ang L, Pop-Busui R, Lee JM, Wiens J. Association Between Management of Continuous Subcutaneous Basal Insulin Administration and HbA1C. J Diabetes Sci Technol 2022; 16:1120-1127. [PMID: 33853374 PMCID: PMC9445348 DOI: 10.1177/19322968211004171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While we expect that patients who adjust their insulin delivery algorithms between clinic visits to have better glucose control compared to those who do not, this effect has not been quantified. METHOD This is a single-center retrospective cohort study including pediatric and adult patients with type 1 diabetes evaluating insulin pump self-management behaviors. Basal insulin dose information was obtained from the Glooko-Diasend database, and used to quantify the frequency and magnitude of basal insulin daily dose adjustments within the 90-day window preceding HbA1c measurement. We use a linear mixed-effects model to analyze associations between frequency/magnitude of daily basal insulin changes and HbA1c. RESULTS We present data on 114 adult (44 ± 17 years, 60% female) and 212 pediatric (12 ± 4 years, 50% female) patients. Individuals changed their basal insulin dose on 72%-94% (interquartile range [IQR]) of observed days relative to the previous day. These changes varied 0.6%-2.4% IQR from the previous day's value. In pediatric patients, lower HbA1c was associated with more frequent daily profile adjustments, while controlling for rate of hypoglycemia (z = -3.2, P = .001). In adults, there was no relationship between HbA1c and magnitude or frequency of basal profile adjustments. CONCLUSIONS Pediatric patients who frequently modify their basal insulin exhibit somewhat better clinical outcomes, although the magnitude by which their basal amount is changed does not contribute to this effect.
Collapse
Affiliation(s)
- Harry Rubin-Falcone
- Department of Electrical Engineering and Computer Science, Division of Computer Science and Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Ian Fox
- Department of Electrical Engineering and Computer Science, Division of Computer Science and Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Emily Hirschfeld
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Lynn Ang
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Joyce M. Lee
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA
| | - Jenna Wiens
- Department of Electrical Engineering and Computer Science, Division of Computer Science and Engineering, University of Michigan, Ann Arbor, MI, USA
- Jenna Wiens, PhD, Department of Electrical Engineering and Computer Science, Division of Computer Science and Engineering, University of Michigan, 2260 Hayward Street, Ann Arbor, MI 48109, USA.
| |
Collapse
|
5
|
Liu F, Guan Y, Li X, Xie Y, He J, Zhou ZG, Li L. Different Effects of Structured Education on Glycemic Control and Psychological Outcomes in Adolescent and Adult Patients with Type 1 Diabetes: A Systematic Review and Meta-Analysis. Int J Endocrinol 2020; 2020:9796019. [PMID: 32184823 PMCID: PMC7061135 DOI: 10.1155/2020/9796019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/30/2019] [Indexed: 12/16/2022] Open
Abstract
AIM This systematic review aimed at investigating the effectiveness of structured education (SE) in improving glycemic control and psychological outcomes in adolescent and adult patients with type 1 diabetes. METHODS Electronic databases (EMBASE, Medline, PubMed, and the Cochrane Library) and the reference lists of included studies were searched from the beginning of the database through April 2019. Randomized controlled trials comparing SE with a control condition and reporting a change in glycosylated hemoglobin (HbA1c) level were included. The primary outcome was glycemic control measured by HbA1c. Secondary outcomes were diabetes-related distress, well-being, depression, and quality of life. RESULTS Eighteen studies representing 2759 patients were included. Twelve studies targeted adolescents and six targeted adults. Adolescent patients who were randomized to the intervention group did not show significant improvement of HbA1c in the short (SMD = -0.04; 95% CI: -0.14 to 0.06; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07. CONCLUSIONS Development of more efficient SE programs according to the patients' personal characteristics is needed.
Collapse
Affiliation(s)
- Fang Liu
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
- Department of Metabolism and Endorinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yuzhu Guan
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Xia Li
- Department of Metabolism and Endorinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yuting Xie
- Department of Metabolism and Endorinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jing He
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Zhi-Guang Zhou
- Department of Metabolism and Endorinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- National Clinical Research Center for Metabolic Disease, Changsha, China
| | - Lezhi Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
- Clinic Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| |
Collapse
|
6
|
Alsaeed D, Al-Kandari J, Al-Ozairi E. Fasting in Ramadan with type 1 diabetes: A dose adjustment for normal eating workshop in Kuwait. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1421-1429. [PMID: 31338906 DOI: 10.1111/hsc.12801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 06/10/2023]
Abstract
This pre-Ramadan workshop was aimed at educating and counselling people with type 1 diabetes, who graduated from the Dose Adjustment for Normal Eating (DAFNE) Kuwait programme, on safe fasting practices as well as determining their views on the challenges associated with fasting. The workshop also served as a pilot for a Ramadan-specific module to inform its implementation in all DAFNE programmes with the goal of meeting the needs of Muslim DAFNE graduates wishing to fast safely. A 2-day workshop (5 hours each) was conducted at DAFNE Kuwait 3 days before the start of Ramadan 2018 and all DAFNE graduates were invited to attend. The workshop consisted of group discussions about fasting-related challenges, followed by three interactive lectures and hands-on experience with popular Ramadan dishes. A qualitative approach was employed to determine the experiences of the participants with fasting by conducting three focus group discussions. The discussions were recorded via handwritten notes and analysed thematically. Seventy-two people with type 1 diabetes attended and 47 participated in the group discussions. Participants discussed their past experiences with fasting and the associated challenges, and shared practices adopted over the years. In addition, they confirmed the positive impact of DAFNE on their fasting experiences. The workshop provided a platform for people with type 1 diabetes to share their experiences with fasting and learn how to fast safely. Furthermore, it provided preliminary information that can be further explored to inform recommendations for safer fasting practices and the implementation of a specific fasting curriculum for people with type 1 diabetes.
Collapse
Affiliation(s)
- Dalal Alsaeed
- Dasman Diabetes Institute, Dasman, Kuwait
- Ministry of Health, Sulaibkhat, Kuwait
| | - Jumana Al-Kandari
- Dasman Diabetes Institute, Dasman, Kuwait
- Ministry of Health, Sulaibkhat, Kuwait
| | - Ebaa Al-Ozairi
- Dasman Diabetes Institute, Dasman, Kuwait
- Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| |
Collapse
|
7
|
Alsaeed D, Al-Kandari J, Al-Ozairi E. Experiences of people with type 1 diabetes fasting Ramadan following structured education: A qualitative study. Diabetes Res Clin Pract 2019; 153:157-165. [PMID: 31150719 DOI: 10.1016/j.diabres.2019.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/16/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Although people with type 1 diabetes are exempt from fasting the month of Ramadan due to the risk to their health, many wish to fast nonetheless. Little is known about the impact of structured education on the fasting experiences of people with type 1 diabetes. This study aimed to explore how the Dose Adjustment for Normal Eating (DAFNE) course affected people with type 1 diabetes' fasting experiences to provide insight into the benefits of structured education for people wishing to fast while managing their diabetes. METHODS Semi-structured interviews were conducted with 40 DAFNE graduates who fasted Ramadan. The purposive sample was selected from the DAFNE registry at Dasman Diabetes Institute in Kuwait. The interviews were transcribed verbatim and analysed thematically in an iterative process. Topics discussed included fasting experiences prior to attending the DAFNE course, fasting experiences this year, and how DAFNE affected their fasting. RESULTS Five themes emerged; (1) Reduction in fluctuations and complications, (2) Improvement in confidence and self-reliance, (3) Tailored support for dose and pump programming adjustments, (4) Positive effect on wellbeing, and (5) Encouraging informed-decision making about fasting. CONCLUSIONS The findings have provided insight into the impact of DAFNE structured education on the fasting experiences of people with type 1 diabetes and has shown how overall, DAFNE had enhanced the quality of fasting. In addition, by assisting them in fulfilling their fasting wishes, DAFNE has had a positive effect on their wellbeing.
Collapse
Affiliation(s)
- Dalal Alsaeed
- Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait; Ministry of Health, Sulaibkhat, Jamal Abdel Nasser Street, PO Box 5, Zip Code 13001, Kuwait.
| | - Jumana Al-Kandari
- Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait; Ministry of Health, Sulaibkhat, Jamal Abdel Nasser Street, PO Box 5, Zip Code 13001, Kuwait.
| | - Ebaa Al-Ozairi
- Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait; Faculty of Medicine, Kuwait University, Jabriya, PO 13110, Kuwait.
| |
Collapse
|
8
|
Gagliardino JJ, Chantelot JM, Domenger C, Ramachandran A, Kaddaha G, Mbanya JC, Shestakova M, Chan J. Impact of diabetes education and self-management on the quality of care for people with type 1 diabetes mellitus in the Middle East (the International Diabetes Mellitus Practices Study, IDMPS). Diabetes Res Clin Pract 2019; 147:29-36. [PMID: 30218744 DOI: 10.1016/j.diabres.2018.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/10/2018] [Indexed: 11/27/2022]
Abstract
AIMS Self-management (self-monitoring of blood glucose, plus self-adjustment of insulin dose) is important in diabetes care, but its complexity presents a barrier to wider implementation, which hinders attainment and maintenance of glycemic targets. More evidence on self-management is needed to increase its implementation and improve metabolic outcomes. METHODS Data from 1316 participants with type 1 diabetes mellitus who were enrolled from Middle East countries into the International Diabetes Management Practices Study (IDMPS), a multinational observational survey, were analyzed to assess the impact of education on disease management and outcomes. RESULTS A majority (78%) of participants failed to achieve glycemic target (HbA1c < 7.0% [<53 mmol/mol]). Participants who had received diabetes education (59%) were more likely to practice self-management than those who had not (odds ratio [OR]: 2.51; 95% confidence interval [CI]: 1.7-3.69; p < 0.001), and those who practiced self-management were more likely to attain target HbA1c than those who did not (OR: 1.49; 95% CI: 1.06-2.09; p = 0.023). CONCLUSIONS These relationships between diabetes education, self-management and glycemic control suggest that diabetes education provides knowledge and skills to optimize self-management, favoring HbA1c target attainment. Middle East health authorities should search for ways to facilitate access to diabetes education to optimize treatment outcomes.
Collapse
Affiliation(s)
- Juan José Gagliardino
- CENEXA Center of Experimental and Applied Endocrinology (La Plata National University - La Plata National Scientific and Technical Research Council), La Plata, Argentina.
| | | | | | - Ambady Ramachandran
- India Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
| | - Ghaida Kaddaha
- Diabetology Unit, Government of Dubai, Dubai Health Authority, Dubai, United Arab Emirates
| | - Jean Claude Mbanya
- Biotechnology Center, Doctoral School of Life Sciences, Health and Environment, and Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Marina Shestakova
- Endocrinology Research Center, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Juliana Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
| |
Collapse
|
9
|
Walker GS, Chen JY, Hopkinson H, Sainsbury CAR, Jones GC. Structured education using Dose Adjustment for Normal Eating (DAFNE) reduces long-term HbA 1c and HbA 1c variability. Diabet Med 2018; 35:745-749. [PMID: 29573459 DOI: 10.1111/dme.13621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/30/2022]
Abstract
AIMS Previous evidence has demonstrated that participation in the Dose Adjustment for Normal Eating (DAFNE) education programme can reduce HbA1c and severe hypoglycaemia in people with Type 1 diabetes. In a number of studies, increased HbA1c variability has been associated with higher diabetic morbidity and mortality. No studies have examined the impact of structured education on HbA1c variability in Type 1 diabetes. METHODS People with Type 1 diabetes who had attended DAFNE were identified for inclusion from the Scottish Care Information-Diabetes dataset. HbA1c median and variability, expressed as coefficient of variation (CV) before and after DAFNE was calculated. RESULTS Some 1061 individuals participated in DAFNE education and 687 met the inclusion criteria. A significant median reduction in HbA1c [-3.5 mmol/mol (-0.3%)] was seen at 12 months with a significant reduction [-1.5 mmol/mol (-0.1%)] still seen at 60 months of follow-up. HbA1c variability as measured by CV was significantly lower during the post-DAFNE period: 0.08 (IQR 0.05-0.12) reduced to 0.07 (IQR 0.05-0.10); P = 0.002. CONCLUSION The data confirm that DAFNE participation improves glycaemic control in Type 1 diabetes with benefits being sustained for 5 years. This study is the first to demonstrate reduced HbA1c variability after completion of structured education. This is new evidence of the beneficial impact of DAFNE on glycaemic profile.
Collapse
Affiliation(s)
- G S Walker
- Diabetes Centre, Gartnavel General Hospital, Glasgow, UK
| | - J Y Chen
- Diabetes Centre, Gartnavel General Hospital, Glasgow, UK
| | - H Hopkinson
- Diabetes Centre, New Victoria Hospital, Glasgow, UK
| | | | - G C Jones
- Diabetes Centre, Gartnavel General Hospital, Glasgow, UK
| |
Collapse
|
10
|
McGuire HC, Ji L, Kissimova-Skarbek K, Whiting D, Aguirre F, Zhang P, Lin S, Gong C, Zhao W, Lu J, Guo X, Ji Y, Seuring T, Hong T, Chen L, Weng J, Zhou Z. Type 1 diabetes mellitus care and education in China: The 3C study of coverage, cost, and care in Beijing and Shantou. Diabetes Res Clin Pract 2017; 129:32-42. [PMID: 28500868 DOI: 10.1016/j.diabres.2017.02.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/16/2017] [Accepted: 02/22/2017] [Indexed: 02/05/2023]
Abstract
AIMS The paucity of data on Type 1 diabetes in China hinders progress in care and policy-making. This study compares Type 1 diabetes care and clinical outcomes in Beijing and Shantou with current clinical guidelines. METHODS The 3C Study was a cross-sectional study of the clinical practices and outcomes of people with Type 1 diabetes. The study sequentially enrolled 849 participants from hospital records, inpatient wards, and outpatient clinics. Data were collected via face-to-face interviews with patients and health professionals, the Summary of Diabetes Self-Care Activities, medical records, and venous blood samples. Care was audited using ISPAD/IDF indicators. Data underwent descriptive analysis and tests for association. RESULTS The median age was 22years (IQR=13-34years), and 48.4% of the sample had diabetes less than six years. The median HbA1c was 8.5% (69mmol/mol) (IQR 7.2-10.5%), with significant regional variance (p=0.002). Insulin treatment was predominantly two injections/day (45% of patients). The highest incidence of diabetic ketoacidosis was 14.4 events/100 patient years among adolescents. Of the 57.3% of patients with LDL-C>2.6mmol/L, only 11.2% received treatment. Of the 10.6% considered hypertensive, 47.1% received treatment. Rates of documented screening for retinopathy, nephropathy, and peripheral neuropathy were 35.2%, 42.3%, and 25.0%, respectively. The median number of days of self-monitoring/week was 3.0 (IQR=1.0-7.0). There were significant differences in care practices across regions. CONCLUSIONS The study documented an overall deficit in care with significant regional differences noted compared to practice guidelines. Modifications to treatment modalities and the structure of care may improve outcomes.
Collapse
Affiliation(s)
- Helen C McGuire
- International Diabetes Federation, Chausée de la Hulpe 166, Watermael Boitsfort, 1170 Brussels, Belgium; PATH, 455 Massachusetts Ave NW, Washington DC, 20001, USA.
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, No. 11, Xizhimen Nan Da Jie, Xicheng District, Beijing 100044, PR China.
| | - Katarzyna Kissimova-Skarbek
- International Diabetes Federation, Chausée de la Hulpe 166, Watermael Boitsfort, 1170 Brussels, Belgium; Jagiellonian University Medical College, Faculty of Health Sciences, Department of Health Economics and Social Security, Poland
| | - David Whiting
- International Diabetes Federation, Chausée de la Hulpe 166, Watermael Boitsfort, 1170 Brussels, Belgium
| | - Florencia Aguirre
- International Diabetes Federation, Chausée de la Hulpe 166, Watermael Boitsfort, 1170 Brussels, Belgium
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, 6, Zhichun Road, Haidian District, Beijing 100088, China
| | - Shaoda Lin
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Shantou 515041, Guangdong Province, China
| | - Chunxiu Gong
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, No. 56 South Lishi Road, Xicheng District, Beijing, 100045, China
| | - Weigang Zhao
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Juming Lu
- Department of Endocrinology, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, 7 Xishiku St, Xicheng District, Beijing 100034, China
| | - Ying Ji
- Department of Social Medicine and Health Education, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Till Seuring
- International Diabetes Federation, Chausée de la Hulpe 166, Watermael Boitsfort, 1170 Brussels, Belgium
| | - Tianpei Hong
- Department of Endocrinology and Metabolism, Peking University Third Hospital, No.49, Huayuan North Road, Haidian District, Beijing 100191, China
| | - Lishu Chen
- Department of Endocrinology, The Second Affiliated Hospital of Shantou University Medical College, No. 69, Dongxia North Road, Shantou 515000, Guangdong Province, China
| | - Jianping Weng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China
| | - Zhiguang Zhou
- Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Key Laboratory of Diabetes Immunology, Ministry of Education, Central South University, National Clinical Research Center for Metabolic Diseases, No. 139, Renmin Middle Road, Furong District, Changsha 410011, Hunan Province, China
| |
Collapse
|
11
|
Charalampopoulos D, Hesketh KR, Amin R, Paes VM, Viner RM, Stephenson T. Psycho-educational interventions for children and young people with Type 1 Diabetes in the UK: How effective are they? A systematic review and meta-analysis. PLoS One 2017; 12:e0179685. [PMID: 28665946 PMCID: PMC5493302 DOI: 10.1371/journal.pone.0179685] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/02/2017] [Indexed: 11/29/2022] Open
Abstract
Aims To synthesise evidence from UK-based randomised trials of psycho-educational interventions in children and young people (CYP) with Type 1 Diabetes (T1D) to inform the evidence-base for adoption of such interventions into the NHS. Methods We searched Medline, Embase, Cochrane, PsycINFO, CINAHL, and Web of Science up to March 2016. Two reviewers independently selected UK-based randomised trials comparing psycho-educational interventions for improving management of T1D for CYP with a control group of usual care or attention control. The main outcome was glycaemic control measured by percentage of glycated haemoglobin (HbA1c); secondary outcomes included psychosocial functioning, diabetes knowledge, adverse and other clinical outcomes. A narrative synthesis and meta-analysis were conducted. Pooled effect sizes of standardised mean difference (SMD) were calculated. Results Ten eligible trials of three educational and seven psycho-educational interventions were identified. Most interventions were delivered by non-psychologists and targeted adolescents with more than one year duration of diabetes. Meta-analysis of nine of these trials (N = 1,838 participants) showed a non-significant reduction in HbA1c attributable to the intervention (pooled SMD = -0.06, 95% CI: -0.21 to 0.09). Psycho-educational interventions aiming to increase children’s self-efficacy had a moderate, beneficial effect (SMD = 0.50, 95% CI: 0.13 to 0.87). No benefits on diabetes knowledge and other indicators of psychosocial functioning were identified. Conclusions There is insufficient evidence to recommend the use of particular psycho-educational programme for CYP with T1D in the UK. Further trials with sufficient power and reporting standards are needed. Future trials could consider active involvement of psychological specialists in the delivery of psychologically informed interventions and implementation of psycho-educational interventions earlier in the course of the disease. Systematic review registration PROSPERO CRD42015010701
Collapse
Affiliation(s)
- Dimitrios Charalampopoulos
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- * E-mail:
| | - Kathryn R. Hesketh
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Rakesh Amin
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Veena Mazarello Paes
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Russell M. Viner
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Terence Stephenson
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| |
Collapse
|
12
|
Christie D, Thompson R, Sawtell M, Allen E, Cairns J, Smith F, Jamieson E, Hargreaves K, Ingold A, Brooks L, Wiggins M, Oliver S, Jones R, Elbourne D, Santos A, Wong ICK, O'Neil S, Strange V, Hindmarsh P, Annan F, Viner RM. Effectiveness of a structured educational intervention using psychological delivery methods in children and adolescents with poorly controlled type 1 diabetes: a cluster-randomized controlled trial of the CASCADE intervention. BMJ Open Diabetes Res Care 2016; 4:e000165. [PMID: 27284455 PMCID: PMC4893872 DOI: 10.1136/bmjdrc-2015-000165] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/04/2016] [Accepted: 01/13/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Type 1 diabetes (T1D) in children and adolescents is increasing worldwide with a particular increase in children <5 years. Fewer than 1 in 6 children and adolescents achieve recommended glycated hemoglobin (HbA1c) values. METHODS A pragmatic, cluster-randomized controlled trial assessed the efficacy of a clinic-based structured educational group incorporating psychological approaches to improve long-term glycemic control, quality of life and psychosocial functioning in children and adolescents with T1D. 28 pediatric diabetes services were randomized to deliver the intervention or standard care. 362 children (8-16 years) with HbA1c≥8.5% were recruited. Outcomes were HbA1c at 12 and 24 months, hypoglycemia, admissions, self-management skills, intervention compliance, emotional and behavioral adjustment, and quality of life. A process evaluation collected data from key stakeholder groups in order to evaluate the feasibility of delivering the intervention. RESULTS 298/362 patients (82.3%) provided HbA1c at 12 months and 284/362 (78.5%) at 24 months. The intervention did not improve HbA1c at 12 months (intervention effect 0.11, 95% CI -0.28 to 0.50, p=0.584), or 24 months (intervention effect 0.03, 95% CI -0.36 to 0.41, p=0.891). There were no significant changes in remaining outcomes. 96/180 (53%) families in the intervention arm attended at least 1 module. The number of modules attended did not affect outcome. Reasons for low uptake included difficulties organizing groups and work and school commitments. Those with highest HbA1cs were less likely to attend. Mean cost of the intervention was £683 per child. CONCLUSIONS Significant challenges in the delivery of a structured education intervention using psychological techniques to enhance engagement and behavior change delivered by diabetes nurses and dietitians in routine clinical practice were found. The intervention did not improve HbA1c in children and adolescents with poor control. TRIAL REGISTRATION NUMBER ISRCTN52537669, results.
Collapse
Affiliation(s)
- Deborah Christie
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Rebecca Thompson
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary Sawtell
- Social Sciences Research Unit, Institute of Education, London, UK
| | | | - John Cairns
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Anne Ingold
- Social Sciences Research Unit, Institute of Education, London, UK
| | - Lucy Brooks
- London School of Hygiene and Tropical Medicine, London, UK
| | - Meg Wiggins
- Social Sciences Research Unit, Institute of Education, London, UK
| | - Sandy Oliver
- Social Sciences Research Unit, Institute of Education, London, UK
| | - Rebecca Jones
- London School of Hygiene and Tropical Medicine, London, UK
| | - Diana Elbourne
- London School of Hygiene and Tropical Medicine, London, UK
| | - Andreia Santos
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Vicki Strange
- Social Sciences Research Unit, Institute of Education, London, UK
| | - Peter Hindmarsh
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Francesca Annan
- Royal Liverpool Children's Hospital NHS Trust, Liverpool, UK
| | | |
Collapse
|