1
|
Gregg EW, Pratt A, Owens A, Barron E, Dunbar-Rees R, Slade ET, Hafezparast N, Bakhai C, Chappell P, Cornelius V, Johnston DG, Mathews J, Pickles J, Bragan Turner E, Wainman G, Roberts K, Khunti K, Valabhji J. The burden of diabetes-associated multiple long-term conditions on years of life spent and lost. Nat Med 2024:10.1038/s41591-024-03123-2. [PMID: 39090411 DOI: 10.1038/s41591-024-03123-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 06/11/2024] [Indexed: 08/04/2024]
Abstract
Diabetes mellitus is a central driver of multiple long-term conditions (MLTCs), but population-based studies have not clearly characterized the burden across the life course. We estimated the age of onset, years of life spent and loss associated with diabetes-related MLTCs among 46 million English adults. We found that morbidity patterns extend beyond classic diabetes complications and accelerate the onset of severe MLTCs by 20 years earlier in life in women and 15 years earlier in men. By the age of 50 years, one-third of those with diabetes have at least three conditions, spend >20 years with them and die 11 years earlier than the general population. Each additional condition at the age of 50 years is associated with four fewer years of life. Hypertension, depression, cancer and coronary heart disease contribute heavily to MLTCs in older age and create the greatest community-level burden on years spent (813 to 3,908 years per 1,000 individuals) and lost (900 to 1,417 years per 1,000 individuals). However, in younger adulthood, depression, severe mental illness, learning disabilities, alcohol dependence and asthma have larger roles, and when they occur, all except alcohol dependence were associated with long periods of life spent (11-14 years) and all except asthma associated with many years of life lost (11-15 years). These findings provide a baseline for population monitoring and underscore the need to prioritize effective prevention and management approaches.
Collapse
Affiliation(s)
- Edward W Gregg
- RCSI University of Medicine and Health Sciences, Dublin, Ireland.
- School of Public Health, Imperial College London, London, UK.
| | - Adrian Pratt
- NHS Arden & GEM Commissioning Support Unit, Leicester, UK
| | - Alex Owens
- NHS Arden & GEM Commissioning Support Unit, Leicester, UK
| | - Emma Barron
- NHS England, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | | | | | | | - Chirag Bakhai
- NHS England, London, UK
- Bedfordshire, Luton and Milton Keynes Integrated Care Board, Luton, UK
| | | | | | - Desmond G Johnston
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Department of Diabetes & Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jacqueline Mathews
- National Institute for Health and Care Research Clinical Research Network National Coordination Centre, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | | | | | - Kate Roberts
- National Institute for Health and Care Research Clinical Research Network National Coordination Centre, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Jonathan Valabhji
- NHS England, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| |
Collapse
|
2
|
Nie Z, Gao S, Chen L, Yang R, Edelman LS, Sward KA, Jiang Y, Demiris G. Social media use and mental health among older adults with multimorbidity: the role of self-care efficacy. J Am Med Inform Assoc 2024:ocae179. [PMID: 38990654 DOI: 10.1093/jamia/ocae179] [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: 12/10/2023] [Revised: 06/16/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVES To describe the prevalence and trends in the use of social media over time and explore whether social media use is related to better self-care efficacy and thus related to better mental health among United States older adults with multimorbidity. MATERIALS AND METHODS Respondents aged 65 years+ and having 2 or more chronic conditions from the 2017-2020 Health Information National Trends Survey were analyzed (N = 3341) using weighted descriptive and logistic regression analyses. RESULTS Overall, 48% (n = 1674) of older adults with multimorbidity used social media and there was a linear trend in use over time, increasing from 41.1% in 2017 to 46.5% in 2018, and then further up to 51.7% in 2019, and 54.0% in 2020. Users were often younger, married/partnered, and non-Hispanic White with high education and income. Social media use was associated with better self-care efficacy that was further related to better mental health, indicating a significant mediation effect of self-care efficacy in the relationship between social media use and mental health. DISCUSSION Although older adults with multimorbidity are a fast-growing population using social media for health, significant demographic disparities exist. While social media use is promising in improving self-care efficacy and thus mental health, relying on social media for the management of multimorbidity might be potentially harmful to those who are not only affected by multimorbidity but also socially disadvantaged (eg, non-White with lower education). CONCLUSION Great effort is needed to address the demographic disparity and ensure health equity when using social media for patient care.
Collapse
Affiliation(s)
- Zuoting Nie
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Shiying Gao
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Long Chen
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Rumei Yang
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Linda S Edelman
- College of Nursing, University of Utah, Salt Lake City, UT 84112, United States
| | - Katherine A Sward
- College of Nursing, University of Utah, Salt Lake City, UT 84112, United States
| | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, United States
| | - George Demiris
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, United States
| |
Collapse
|
3
|
Igland J, Forster R, Jenum AK, Strandberg RB, Berg TJ, Røssberg JI, Iversen MM, Buhl ES. How valid is a prescription-based multimorbidity index (Rx-risk) in predicting mortality in the Outcomes and Multimorbidity In Type 2 diabetes (OMIT) study? A nation-wide registry-based cohort study from Norway. BMJ Open 2024; 14:e077027. [PMID: 38548358 PMCID: PMC10982738 DOI: 10.1136/bmjopen-2023-077027] [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] [Received: 06/23/2023] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE The prescription-based Rx-risk index has previously been developed to measure multimorbidity. We aimed to adapt and evaluate the validity of the Rx-risk index in prediction of mortality among persons with type 2 diabetes. DESIGN Registry-based study. SETTING Adults with type 2 diabetes in Norway identified within the 'Outcomes and Multimorbidity In Type 2 diabetes' cohort, with linkage to prescriptions from the Norwegian Prescription Database and mortality from the Population Registry. PARTICIPANTS We defined a calibration sample of 42 290 adults diagnosed with type 2 diabetes 1950-2013, and a temporal validation sample of 7085 adults diagnosed 2014-2016 to evaluate the index validity over time PRIMARY OUTCOME MEASURE: All-cause mortality METHODS: For the calibration sample, dispensed drug prescriptions in 2013 were used to define 44 morbidity categories. Weights were estimated using regression coefficients from a Cox regression model with 5 year mortality as the outcome and all morbidity categories, age and sex included as covariates. The Rx-risk index was computed as a weighted sum of morbidities. The validity of the index was evaluated using C-statistic and calibration plots. RESULTS In the calibration sample, mean (SD) age at start of follow-up and duration of diabetes was 63.8 (12.4) and 10.1 (7.0) years, respectively. The overall C-statistic was 0.82 and varied from 0.74 to 0.85 when stratifying on age groups, sex, level of education and country of origin. In the validation sample, mean (SD) age and duration of diabetes was 59.7 (13.0) and 2.0 (0.8) years, respectively. Despite younger age, shorter duration of diabetes and later time period, the C-index was high both in the total sample (0.84) and separately for men (0.83) and women (0.84). CONCLUSIONS The Rx-risk index showed good discrimination and calibration in predicting mortality and thus presents a valid tool to assess multimorbidity among persons with type 2 diabetes.
Collapse
Affiliation(s)
- Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
| | - Rachel Forster
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Karen Jenum
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Ragnhild B Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
| | - Tore Julsrud Berg
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Marjolein Memelink Iversen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
| | | |
Collapse
|
4
|
Nguyen TH, De Leo G, Barefield A. Factors Associated with Controlled Glycemic Levels in Type 2 Diabetes Patients: Study from a Large Medical Center and Its Satellite Clinics in Southeast Region in the USA. Healthcare (Basel) 2023; 12:26. [PMID: 38200932 PMCID: PMC10779028 DOI: 10.3390/healthcare12010026] [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: 11/13/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Diabetes, including type 1, type 2, and gestational, is a significant public health issue responsible for various clinical, economic, and societal issues. Most of the consequences, if uncontrolled, can result in serious health problems, such as heart disease, vision loss, and kidney disease. Approximately 37.3 million Americans have diabetes, including 37.1 million adults 18 years or older, with 90-95% type 2 diabetes (T2D). The purpose of this study is (1) to explore the profile of patients with T2D and (2) to identify the associated factors of diabetic status. Examined factors included sociodemographic characteristics, social factors, and comorbidities. The study analyzed a primary dataset from a retrospective chart review of adult patients with T2D who were seen at a large medical center and its satellite clinics in the southeast region of the United States in 2019. Sex, dyslipidemia, and the number of concordant comorbidities were found to be significant associated factors of diabetic status. In the era of intertwined patient-centered approach and public health, the study's findings can guide treatment plans and interventions targeting individuals and communities.
Collapse
Affiliation(s)
- Tran Ha Nguyen
- Department of Health Management, Economics and Policy, Augusta University, Augusta, GA 30912, USA;
| | - Gianluca De Leo
- Department of Health Management, Economics and Policy, Augusta University, Augusta, GA 30912, USA;
| | - Amanda Barefield
- Department of Undergraduate Health Professions, Augusta University, Augusta, GA 30912, USA;
| |
Collapse
|
5
|
Beverly EA, Love C, Love M, Lammert L, Bowditch J. Cinematic Virtual Reality for Educating Health Care Providers About Type 2 Diabetes, Disability, and Elder Abuse and Neglect: A Pilot Study. J Diabetes Sci Technol 2023; 17:1160-1171. [PMID: 37114917 PMCID: PMC10563529 DOI: 10.1177/19322968231171586] [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: 04/29/2023]
Abstract
BACKGROUND Diabetes care for older adults is complex and must consider geriatric syndromes, disability, and elder abuse and neglect. Health care providers would benefit from professional training programs that emphasize these risks. One new educational approach is cinematic virtual reality (cine-VR). We conducted a pilot study to evaluate a cine-VR training program based on an older patient with type 2 diabetes and multiple geriatric syndromes who is at risk for elder abuse and neglect. METHODS We employed a single-arm, pre-post-test study to assess changes in attitudes to disability and self-efficacy in identifying and managing elder abuse and neglect. RESULTS Thirty health care providers completed the pilot study (83.3% women, 86.7% white, 56.7% physicians, 43.4% practiced in outpatient clinics). We observed change in attitudes toward discrimination (Z = -2.628, P = .009, Cohen's d = .62). In addition, we observed changes in six of the eight self-efficacy items, including how participants would ask questions about abuse (Z = -3.221, P = .001, Cohen's d = .59) and helping an older patient make a report to the police or social services (Z = -2.087, P = .037, Cohen's d = .52). In addition, we observed positive changes in understanding the documentation needed to complete whether a patient reports abuse (Z = -3.598, P < .001) as well as the legal knowledge for how to report elder abuse and neglect (Z = -2.556, P = .011). CONCLUSION Findings from this pilot study suggest that cine-VR training may increase health care providers' awareness of discrimination and improve self-efficacy toward identifying and managing elder abuse and neglect. Research with a proper control condition is needed to confirm its effectiveness.
Collapse
Affiliation(s)
- Elizabeth A. Beverly
- Department of Primary Care, Heritage
College of Osteopathic Medicine, Ohio University, Athens, OH, USA
- Diabetes Institute, Ohio University,
Athens, OH, USA
| | - Carrie Love
- Department of Primary Care, Heritage
College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Matthew Love
- J. Warren McClure School of Emerging
Communication Technologies, Ohio University, Athens, OH, USA
- Game Research and Immersive Design
(GRID) Lab, Ohio University, Athens, OH, USA
| | - Lori Lammert
- Department of Primary Care, Heritage
College of Osteopathic Medicine, Ohio University, Athens, OH, USA
- Diabetes Institute, Ohio University,
Athens, OH, USA
| | - John Bowditch
- J. Warren McClure School of Emerging
Communication Technologies, Ohio University, Athens, OH, USA
- Game Research and Immersive Design
(GRID) Lab, Ohio University, Athens, OH, USA
| |
Collapse
|
6
|
Safieddine B, Sperlich S, Beller J, Lange K, Geyer S. Socioeconomic inequalities in type 2 diabetes comorbidities in different population subgroups: trend analyses using German health insurance data. Sci Rep 2023; 13:10855. [PMID: 37407649 PMCID: PMC10322827 DOI: 10.1038/s41598-023-37951-y] [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: 03/19/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023] Open
Abstract
While socioeconomic inequalities in the prevalence and management of type 2 diabetes (T2D) are well established, little is known about whether inequalities exist in the prevalence and the temporal development of T2D comorbidities. Previous research points towards expansion of morbidity in T2D as depicted mainly by a rising trend of T2D comorbidities. Against this background, and using German claims data, this study aims to examine whether socioeconomic status (SES) inequalities exist in the rates and the temporal development of T2D comorbidities. Since previous research indicates varying risk levels for T2D prevalence in the population subgroups: working individuals, nonworking spouses and pensioners, the analyses are stratified by these three population subgroups. The study is done on a large population of statutory insured individuals with T2D in three time-periods between 2005 and 2017. Predicted probabilities of three comorbidity groups and the number of comorbidities were estimated using logistic and ordinal regression analyses among different income, education and occupation groups. Interaction analyses were applied to examine whether potential SES inequalities changed over time. The study showed that neither the cross-sectional existence, nor the temporal development of T2D comorbidities differed significantly among SES groups, ruling out SES inequalities in the prevalence and the temporal development of T2D comorbidities in Germany. In men and women of all examined population subgroups, predicted probabilities for less severe cardiovascular (CVD) comorbidities, other vascular diseases and the number of comorbidities per individual rose significantly over time regardless of SES, but little if any change took place for more severe CVD comorbidities. Another important finding is that the population subgroup of nonworking spouses had markedly higher predicted probabilities for most of the examined outcomes compared to working individuals. The study indicates that the expansion of morbidity in T2D in Germany does not appear to be SES-dependent, and applies equally to different population subgroups. Yet, the study highlights that nonworking spouses are a susceptible population subgroup that needs to be focused upon when planning and implementing T2D management interventions.
Collapse
Affiliation(s)
| | | | - Johannes Beller
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - Karin Lange
- Medical Psychology Unit, Hannover Medical School, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| |
Collapse
|
7
|
Zeren FG, Canbolat O. The relationship between family support and the level of self care in type 2 diabetes patients. Prim Care Diabetes 2023:S1751-9918(23)00091-8. [PMID: 37149410 DOI: 10.1016/j.pcd.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Abstract
AIMS The purpose of the study was to determine the relationship between family support and self-care in patients with type 2 diabetes in Middle Anatolia Region of Turkey. METHODS This descriptive relation-seeker-type study conducted with 284 patients who met inclusion criteria between February and May 2020 in the internal medicine and endocrinology clinics and polyclinics of a university hospital. Data were collected using, a demographic questionnaire, Hensarling's Diabetes Family Support Scale (HDFSS), and Diabetes Self-Care Scale (DSCS). RESULTS Participants had a mean DSCS and HDFSS score of 83.20 ± 18.63 and 82.44 ± 28.04, respectively. There was a strong correlation between DSCS and HDFSS scores (r:.621) (p < 0.001). Participants' DSCS totals score was strongly correlated with their HDFSS "empathetic support" (p = 0.001, r = 0.625), "encouragement" (p = 0.001, r = 0.558), "facilitative support" (p = 0.001, r = 0.558), and "participative support" scores (p = 0.001, r = 0.555). CONCLUSIONS Patients with more family support have higher levels of self-care. The results underline the significance of focusing on the relationship between self-care and family support in patients with type 2 diabetes.
Collapse
Affiliation(s)
- Fatma Gul Zeren
- Emergency Unit, Kadinhani Refik Saime Koyuncu Public Hospital, Konya, Turkey
| | | |
Collapse
|
8
|
Andersen JD, Jensen MH, Vestergaard P, Jensen V, Hejlesen O, Hangaard S. The multidisciplinary team in diagnosing and treatment of patients
with diabetes and comorbidities: A scoping review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231165966. [PMID: 36968789 PMCID: PMC10031602 DOI: 10.1177/26335565231165966] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/09/2023] [Indexed: 03/24/2023]
Abstract
Background Multidisciplinary Teams (MDTs) has been suggested as an intervention to
overcome some of the complexities experienced by people with diabetes and
comorbidities in terms of diagnosis and treatment. However, evidence
concerning MDTs within the diabetes field remains sparse. Objective This review aims to identify and map available evidence on key
characteristics of MDTs in the context of diagnosis and treatment in people
with diabetes and comorbidities. Methods This review followed the PRISMA-ScR guidelines. Databases PubMed, EMBASE, and
CINAHL were systematically searched for studies assessing any type of MDT
within the context of diagnosis and treatment in adult people (≥ 18 years)
with diabetes and comorbidities/complications. Data extraction included
details on study characteristics, MDT interventions, digital health
solutions, and key findings. Results Overall, 19 studies were included. Generally, the MDTs were characterized by
high heterogeneity. Four overall components characterized the MDTs: Both
medical specialists and healthcare professionals (HCPs) of different team
sizes were represented; interventions spanned elements of medication,
assessment, nutrition, education, self-monitoring, and treatment adjustment;
digital health solutions were integrated in 58% of the studies; MDTs were
carried out in both primary and secondary healthcare settings with varying
frequencies. Generally, the effectiveness of the MDTs was positive across
different outcomes. Conclusions MDTs are characterized by high diversity in their outline yet seem to be
effective and cost-effective in the context of diagnosis and treatment of
people with diabetes and comorbidities. Future research should investigate
the cross-sectorial collaboration to reduce care fragmentation and enhance
care coordination.
Collapse
Affiliation(s)
- Jonas Dahl Andersen
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
- Jonas Dahl Andersen, Department of Health
Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, DK-9260
Gistrup, Denmark.
| | - Morten Hasselstrøm Jensen
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
- Department of Endocrinology and
Clinical Medicine, Aalborg
University Hospital,
Aalborg, Denmark
| | - Vigga Jensen
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
| | - Stine Hangaard
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
| |
Collapse
|
9
|
Whitehead L, Palamara P, Babatunde-Sowole OO, Boak J, Franklin N, Quinn R, George C, Allen J. Nurses' experience of managing adults living with multimorbidity: A qualitative study. J Adv Nurs 2023. [PMID: 36861787 DOI: 10.1111/jan.15600] [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: 08/17/2022] [Revised: 01/09/2023] [Accepted: 02/05/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND The number of adults living with two or more chronic conditions is increasing worldwide. Adults living with multimorbidity have complex physical, psychosocial and self-management care needs. AIM This study aimed to describe Australian nurses' experience of care provision for adults living with multimorbidity, their perceived education needs and future opportunities for nurses in the management of multimorbidity. DESIGN Qualitative exploratory. METHODS Nurses providing care to adults living with multimorbidity in any setting were invited to take part in a semi-structured interview in August 2020. Twenty-four registered nurses took part in a semi-structured telephone interview. RESULTS Three main themes were developed: (1) The care of adults living with multimorbidity requires skilled collaborative and holistic care; (2) nurses' practice in multimorbidity care is evolving; and (3) nurses value education and training in multimorbidity care. CONCLUSION Nurses recognize the challenge and the need for change in the system to support them to respond to the increasing demands they face. IMPACT The complexity and prevalence of multimorbidity creates challenges for a healthcare system configured to treat individual disease. Nurses are key in providing care for this population, but little is known about nurses' experiences and perceptions of their role. Nurses believe a person-centred approach is important to address the complex needs of adults living with multimorbidity. Nurses described their role as evolving in response to the growing demand for quality care and believed inter-professional approaches achieve the best outcomes for adults living with multimorbidity. The research has relevance for all healthcare providers seeking to provide effective care for adults living with multimorbidity. Understanding how best to equip and support the workforce to meet the issues and demands of managing the care of adults living with multimorbidity has the potential to improve patient outcomes. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution. The study only concerned the providers of the service.
Collapse
Affiliation(s)
- Lisa Whitehead
- Centre for Nursing, Midwifery & Health Services Research, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Australian College of Nursing, Parramatta, New South Wales, Australia
| | - Peter Palamara
- Centre for Nursing, Midwifery & Health Services Research, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Olutoyin Oluwakemi Babatunde-Sowole
- Australian College of Nursing, Parramatta, New South Wales, Australia.,Faculty of Health, School of Nursing and Midwifery, University of Technology, Sydney, New South Wales, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Jennifer Boak
- Australian College of Nursing, Parramatta, New South Wales, Australia.,Bendigo Health, Bendigo, Victoria, Australia
| | - Natasha Franklin
- Australian College of Nursing, Parramatta, New South Wales, Australia.,Australian Catholic University, Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Blacktown, New South Wales, Australia
| | - Robyn Quinn
- Australian College of Nursing, Parramatta, New South Wales, Australia
| | - Cobie George
- Australian College of Nursing, Parramatta, New South Wales, Australia
| | - Jacqueline Allen
- Australian College of Nursing, Parramatta, New South Wales, Australia.,School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
10
|
Deshmane AR, Muley AS. Adherence and Barriers to Medical Nutrition Therapy and the Effect on Glycemic Control Among Individuals With Type 2 Diabetes in India. CURRENT RESEARCH IN NUTRITION AND FOOD SCIENCE JOURNAL 2022. [DOI: 10.12944/crnfsj.10.3.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Medical Nutrition Therapy (MNT) has a remarkable effect on glycemic control among individuals with Type 2 Diabetes. However, the extent of adherence to MNT isn't hundred percent. Therefore, we aim to determine the adherence level towards the MNT advised by a Registered Dietitian (RD); to identify the barriers and associated contributing factors and strategies to improve the compliance towards the MNT among people with Type 2 Diabetes. A cross-sectional study was conducted among people with Type 2 Diabetes visiting the out-patient diabetes clinic from Kolhapur city, India. A structured questionnaire was used to capture the adherence and non-adherence, reasons and barriers to adhering the MNT. Out of 293 participants, 41.6% were adhering to the MNT. There was a significant association between the non working group (p = 0.01), presence of co-morbidities (p = 0.03) and diabetes duration < 10 years (p = 0.05) with the increased adherence level. Similarly, there was a significant reduction of 26.7%, 38.1%, and 30.9% in the fasting, postprandial blood glucose and HbA1c values respectively in adhering group post MNT advice. More than 50% of the participants in the adhering group gave ‘To Improve overall health’ and ‘To control sugar’ as reasons to adhere. ‘Habitual to what they eat’ (64.3%), ‘Does not satisfy hunger’ (42.1%) and ‘Lack of willpower’ (42.1%), were the common barriers identified in our study. Our study shows that the MNT advised by an RD is effective in reducing the socio-cultural barriers to adherence and improves glycemic control. Strategies like making the workplace more diabetes-friendly and adopting behavior changing techniques should be implemented to increase adherence.
Collapse
Affiliation(s)
- Aditi Rajesh Deshmane
- 2Clinical Nutrition and Dietetics, Indian Institute of Food Science and Technology, Aurangabad, India
| | - Arti S Muley
- 1Nutrition and Dietetics Program, Symbiosis Institute of Health Sciences, Symbiosis International (Deemed University), Pune, India
| |
Collapse
|
11
|
Sinclair AJ, Abdelhafiz AH. Multimorbidity, Frailty and Diabetes in Older People-Identifying Interrelationships and Outcomes. J Pers Med 2022; 12:1911. [PMID: 36422087 PMCID: PMC9695437 DOI: 10.3390/jpm12111911] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 08/11/2023] Open
Abstract
Multimorbidity and frailty are highly prevalent in older people with diabetes. This high prevalence is likely due to a combination of ageing and diabetes-related complications and other diabetes-associated comorbidities. Both multimorbidity and frailty are associated with a wide range of adverse outcomes in older people with diabetes, which are proportionally related to the number of morbidities and to the severity of frailty. Although, the multimorbidity pattern or cluster of morbidities that have the most adverse effect are not yet well defined, it appears that mental health disorders enhance the multimorbidity-related adverse outcomes. Therefore, comprehensive diabetes guidelines that incorporate a holistic approach that includes screening and management of mental health disorders such as depression is required. The adverse outcomes predicted by multimorbidity and frailty appear to be similar and include an increased risk of health care utilisation, disability and mortality. The differential effect of one condition on outcomes, independent of the other, still needs future exploration. In addition, prospective clinical trials are required to investigate whether interventions to reduce multimorbidity and frailty both separately and in combination would improve clinical outcomes.
Collapse
Affiliation(s)
- Alan J. Sinclair
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
- Rotherham General Hospital Foundation Trust, Rotherham S60 2UD, UK
| | - Ahmed H. Abdelhafiz
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham S60 2UD, UK
| |
Collapse
|
12
|
Aga F, Dunbar SB, Kebede T, Guteta S, Higgins MK, Gary RA. Foot self-care behaviour in type 2 diabetes adults with and without comorbid heart failure. Nurs Open 2022; 9:2473-2485. [PMID: 35678585 PMCID: PMC9374405 DOI: 10.1002/nop2.1265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/15/2022] [Indexed: 11/08/2022] Open
Abstract
AIMS To compare the correlates of foot self-care behaviours among type 2 diabetes mellitus (T2D) adults with and without comorbid heart failure (HF). DESIGN Cross-sectional, correlational, comparative design. METHODS A 210 T2D adults (105 with HF and 105 without HF) participated from August-December 2020. Foot self-care behaviour was measured using the foot care subscale of the Summary of Diabetes Self-Care Activities (SDSCA) instrument. A stepwise logistic regression analysis was used to explore variables predicting foot self-care behaviour. RESULTS The participants' mean age was 58.7 ± 10.9 years. Poor foot self-care behaviour was reported in T2D adults both with (53.3%) and without (54.3%) HF. Participants with HF-comorbidity were statistically significantly older and had higher total daily medication intake. Household income and the total number of daily medications statistically significantly predicted foot self-care behaviour in HF-comorbid T2D adults. Marital status, social support and body mass index predicted foot self-care behaviour in the non-HF group.
Collapse
Affiliation(s)
- Fekadu Aga
- School of Nursing & Midwifery, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Sandra B. Dunbar
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Tedla Kebede
- Department of Internal Medicine, School of Medicine, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Senbeta Guteta
- Department of Internal Medicine, School of Medicine, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | | | - Rebecca A. Gary
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| |
Collapse
|
13
|
Heikkala E, Hagnäs M, Jokelainen J, Karppinen J, Ferreira P, Ferreira ML, Mikkola I. Association of musculoskeletal pain with the achievement of treatment targets for type 2 diabetes among primary care patients. Prim Care Diabetes 2022; 16:531-536. [PMID: 35523651 DOI: 10.1016/j.pcd.2022.04.006] [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: 11/18/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
AIMS To assess the association of diagnosed musculoskeletal (MS) pain (low back, neck, shoulder, and knee pain; and the number of pain sites) with the achievement of targets for glycosylated haemoglobin A1c (HbA1c), low-density-lipoprotein cholesterol (LDL), and systolic blood pressure (SBP) among primary care patients with type 2 diabetes (T2D). METHODS The cross-sectional study population consisted of 3478 patients with a registry-based T2D diagnosis and available registry-based data on MS pain diagnoses, covariates, and outcomes between 2016 and 2019. Logistic regression analysis was used to evaluate the study aims. RESULTS Overall, 22% had at least one of the four types of MS pain, and 73%, 57%, and 51% achieved the treatment targets of HbA1c, LDL, and SBP, respectively. T2D patients with or without MS pain did not differ in their achievement of T2D treatment goals. Of pain locations, low back pain was associated with higher rates of achievement of the LDL target (OR 1.29, 95% CI 1.01-1.65), but the association was attenuated in the adjusted model. CONCLUSIONS MS pain was relatively prevalent among primary care patients with T2D, but did not influence the achievement of T2D treatment goals.
Collapse
Affiliation(s)
- Eveliina Heikkala
- Rovaniemi Health Center, Rovaniemi, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland.
| | - Maria Hagnäs
- Rovaniemi Health Center, Rovaniemi, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland; Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
| | - Paulo Ferreira
- School of Health Sciences, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Manuela L Ferreira
- Faculty of Medicine and Health, Kolling Institute, School of Health Sciences, University of Sydney, Sydney, Australia
| | | |
Collapse
|
14
|
Tang LH, Harrison A, Skou ST, Doherty P. To what extent are comorbidity profiles associated with referral and uptake to cardiac rehabilitation. Int J Cardiol 2021; 343:85-91. [PMID: 34534605 DOI: 10.1016/j.ijcard.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Given the high proportion of comorbidities in patients with coronary heart disease (CHD) and low participation rates in cardiac rehabilitation (CR), a better understanding of how comorbidity interacts with the CR pathway is needed. We investigated associations between comorbidity profiles and referral and uptake in everyday clinical CR across UK. METHOD Patients (≥18 years) diagnosed with a CHD between 1st of January 2014 and 31st of December 2019 registered in the National Audit of Cardiac Rehabilitation (NACR) database were eligible. Self-reported comorbidities from 15 disease categories were conceptualized into similar or dissimilar based on overall related pathophysiologic profile and care management as CHD. Regression models were conducted with four comorbidity profiles; similar conditions, dissimilar conditions, similar and dissimilar and no comorbidity. RESULTS 399,348 (61.8%) patients were eligible for referral from 198 programmes. The majority were males (70%), mean age of 67 (±12 SD) years. A non-significant association was found between comorbidity profiles and referral. Odds ratios (OR) for CR uptake were higher in patients with dissimilar (OR = 1.38 (95% CI 1.26-1.54)) and dissimilar and similar comorbidities profiles (OR = 1.35 (95% CI 1.21-1.43)) compared to patients with similar comorbidities. No significant differences in uptake were found between patients with similar comorbidities and those without comorbidities (OR = 0.985 (95% CI 0.854-1.125). CONCLUSION Using routine practice data, comorbidity profiles were not significantly associated with CR referral suggesting equality in referral. Dissimilar comorbidity profiles were associated with uptake. To increase the likelihood of starting CR, services should consider developing tailored participation strategies that include comorbidity profiles.
Collapse
Affiliation(s)
- Lars Hermann Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; The Department of Regional Health Research, University of Southern Denmark, Denmark; Department of Health Sciences, University of York, England, United Kingdom.
| | - Alexander Harrison
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; The Department of Regional Health Research, University of Southern Denmark, Denmark; Department of Health Sciences, University of York, England, United Kingdom
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Patrick Doherty
- Department of Health Sciences, University of York, England, United Kingdom
| |
Collapse
|
15
|
Heikkala E, Mikkola I, Jokelainen J, Timonen M, Hagnäs M. Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study. BMC Health Serv Res 2021; 21:964. [PMID: 34521389 PMCID: PMC8442281 DOI: 10.1186/s12913-021-06989-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP). Methods The study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients’ records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets. Results Altogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01–1.70) and belonging to the Concordant (OR 1.45, CI 1.08–1.95) and Concordant and discordant (OR 1.31, CI 1.00–1.72) subgroups was associated with achievement of the HbA1c treatment target. Belonging to the Concordant and discordant subgroup was related to meeting the LDL treatment target (OR 1.31, CI 1.00–1.72). Conclusions Multimorbidity, including cardiovascular risk and the musculoskeletal disease burden, was extremely prevalent among the T2D patients who consulted primary health care. Primary care clinicians should survey the possible co-existence of long-term diseases among T2D patients to help maintain adequate treatment of T2D.
Collapse
Affiliation(s)
- Eveliina Heikkala
- Rovaniemi Health Center, Koskikatu 25, 96200, Rovaniemi, Finland. .,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland. .,Center for Life Course Health Research, University of Oulu, PO Box 5000, 90015, Oulu, Finland.
| | - Ilona Mikkola
- Rovaniemi Health Center, Koskikatu 25, 96200, Rovaniemi, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, PO Box 5000, 90015, Oulu, Finland
| | - Markku Timonen
- Center for Life Course Health Research, University of Oulu, PO Box 5000, 90015, Oulu, Finland
| | - Maria Hagnäs
- Rovaniemi Health Center, Koskikatu 25, 96200, Rovaniemi, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, PO Box 5000, 90015, Oulu, Finland
| |
Collapse
|
16
|
Aalaa M, Amini M, Yarmohammadi H, Aghaei Meybodi HR, Qorbani M, Adibi H, Razi F, Mehrdad N, Sanjari M. Diabetic foot self-care practice in women with diabetes in Iran. Diabetes Metab Syndr 2021; 15:102225. [PMID: 34340049 DOI: 10.1016/j.dsx.2021.102225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/28/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS The present study was conducted to determine the situation of foot self-care practice among Iranian women with diabetes. METHODS In this cross-sectional study, 475 women completed the Diabetic Foot Self-Care Questionnaire (DFSQ) along with other questions. The overall and three components scores including personal care, podiatric care, and foot wearing, were calculated and their relationship with other factors was analyzed. RESULTS The average total DFSQ score was 60.38 ± 9.9, and 16.98 ± 7, 5.95 ± 2.11, and 12.26 ± 3.95 for personal care, podiatric care, and footwear respectively. Education level, self-reported health status, and life satisfaction had a significant relationship with footwear score, and smoking and life satisfaction were related to personal care and podiatric care respectively. In Pearson regression, DM self-care was correlated with all three components and total DFSQ score. Also, depression and SCS (Social Capital Status) correlated with DFSQ scores except with personal self-care and footwear respectively. Body Mass Index (BMI) and Quality of Life (QoL) were significantly correlated with footwear and podiatric care scores. CONCLUSION In this study, the DFSQ result was almost acceptable, however, it highlights the importance of suitable interventions to establish better self-care practice among Iranian diabetic women.
Collapse
Affiliation(s)
- Maryam Aalaa
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammadreza Amini
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hossein Yarmohammadi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Medical Students Research Committee, Shahed University, Tehran, Iran.
| | - Hamid Reza Aghaei Meybodi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mostafa Qorbani
- Non Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| | - Hossien Adibi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Faride Razi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Neda Mehrdad
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Mahnaz Sanjari
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
17
|
Pearson-Stuttard J, Buckley J, Cicek M, Gregg EW. The Changing Nature of Mortality and Morbidity in Patients with Diabetes. Endocrinol Metab Clin North Am 2021; 50:357-368. [PMID: 34399950 DOI: 10.1016/j.ecl.2021.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The number of adults living with diabetes has increased substantially globally over the past 40 years, driven by a combination of increased age-standardized prevalence, population growth, aging, and increases in obesity prevalence. Patients with diabetes in high-income countries are living longer, with large declines in vascular disease mortality rates. This appears to be resulting in a diversification of cause of death, complications, and comorbidities that those with diabetes live with. This has large implications for prevention and management approaches, which should be reviewed to update the breadth of conditions that patients with diabetes are at excess risk of throughout their life. These trends have not yet been seen in low- and middle-income countries, where evidence is also more scarce.
Collapse
Affiliation(s)
- Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK; MRC Centre for Environment and Health, Imperial College London, Norfolk Place, London W2 1PG, UK; Health Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street, London W1U 1DQ, UK; Northumbria Healthcare NHS Foundation Trust, North Shields NE27 0QJ, UK.
| | - James Buckley
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK; MRC Centre for Environment and Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Meryem Cicek
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, St Dunstan's Road, London W6 8RP, UK
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK; MRC Centre for Environment and Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| |
Collapse
|
18
|
Cicek M, Buckley J, Pearson-Stuttard J, Gregg EW. Characterizing Multimorbidity from Type 2 Diabetes: Insights from Clustering Approaches. Endocrinol Metab Clin North Am 2021; 50:531-558. [PMID: 34399960 PMCID: PMC8383848 DOI: 10.1016/j.ecl.2021.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patients with type 2 diabetes mellitus (T2DM) often live with and develop multiple co-occurring conditions, namely multimorbidity, with diffuse impacts on clinical care and patient quality of life. However, literature characterizing T2DM-related multimorbidity patterns is limited. This review summarizes the findings from the emerging literature characterizing and quantifying the association of T2DM with multimorbidity clusters. The authors' findings reveal 3 dominant cluster types appearing in patients with T2DM-related multimorbidity, such as cardiometabolic precursor conditions, vascular conditions, and mental health conditions. The authors recommend that holistic patient care centers around early detection of other comorbidities and consideration of wider risk factors.
Collapse
Affiliation(s)
- Meryem Cicek
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Charing Cross Campus, Reynolds Building, St Dunstan's Road, London W6 8RP, UK.
| | - James Buckley
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| |
Collapse
|
19
|
Romagnoli A, Santoleri F, Costantini A. Drug utilisation pattern over 3 years in the real-world treatment of type II diabetes. Int J Clin Pract 2021; 75:e14120. [PMID: 33655579 DOI: 10.1111/ijcp.14120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/26/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Non-adherence to therapy is very common in patients with type II diabetes, leading to an increase in morbidity and mortality. The development of new oral therapies following metformin has increased the possibilities of treatment but little has been done in terms of improving medication adherence. The goal of the following study is to evaluate adherence and persistence over a period of 3 years in real-world diabetic patients and describe the comorbidities found in the group of patients studied. MATERIAL AND METHODOLOGY A non-interventional pharmacological observational study was conducted by examining all therapies from 2011 to 2019 at a local health centre in Pescara (ASL). The medication adherence and persistence over a 3-year period were calculated using the pharmacy-refill method. The identification of the comorbidities was carried out in accordance with the Anatomical Therapeutic Chemical (ATC) Classification system at the fourth level. RESULTS A total of 19 600 patients undergoing treatment for type II diabetes from January 2011 to December 2019 were analysed. The absolute adherence value at 3 years was 0.68 ± 0.23. The 3-year persistence curves showed a statistically significant difference (P < .0001). The ATCs with highest figures in the entire study group were: A02BC, B01AC and C10AA with 14 220, 13 934 and 10 858 patients, respectively. CONCLUSIONS Adherence to therapy was suboptimal, while persistence curves showed a statistically significant difference, with patients treated with metformin showing better results. Comorbidities analysed showed a greater relevance of heart disease.
Collapse
|
20
|
Safieddine B, Sperlich S, Epping J, Lange K, Geyer S. Development of comorbidities in type 2 diabetes between 2005 and 2017 using German claims data. Sci Rep 2021; 11:11149. [PMID: 34045564 PMCID: PMC8159920 DOI: 10.1038/s41598-021-90611-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023] Open
Abstract
Against the background of increasing life expectancy over time, several hypotheses have been proposed on the way morbidity has been developing. In type 2 diabetes (T2D), previous research suggests that morbidity compression could be ruled out due to increasing prevalence and life expectancy with T2D over time. Understanding how the health state in individuals with T2D is developing would help identify whether morbidity expansion or a dynamic equilibrium pattern applies for this disease. This study aims to answer the following questions: (1) How do the number and the prevalence of T2D concordant comorbidities develop over time? (2) What does this imply in terms of morbidity development in T2D in Germany? The study used claims data from a statutory health insurance provider in Lower Saxony, Germany. Period prevalence of T2D concordant comorbidities was examined for the periods 2005–2007, 2010–2012 and 2015–2017 in 240,241, 295,868 and 308,134 individuals with T2D respectively. The effect of time period on the number and prevalence of comorbidities was examined by means of (ordered) logistic regression. The age-adjusted predicted probabilities of more severe cardiovascular diseases (CVDs) decreased over the three periods while those of less severe CVDs and other vascular diseases increased significantly in men and women and among all examined age-groups. Predicted probability of having at least one more comorbidity over time also increased significantly among all examined groups. While less and more severe CVDs exhibited different developmental patterns, the results of the study point towards morbidity expansion in T2D. Future studies should focus on mechanisms that contribute to these trends.
Collapse
Affiliation(s)
- Batoul Safieddine
- Medical Sociology Unit OE 5420, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Stefanie Sperlich
- Medical Sociology Unit OE 5420, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jelena Epping
- Medical Sociology Unit OE 5420, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Karin Lange
- Medical Psychology Unit OE 5430, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit OE 5420, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| |
Collapse
|
21
|
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.
Collapse
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
| | | |
Collapse
|
22
|
Ukhanova M, Markwardt S, Furuno JP, Davis L, Noble BN, Quiñones AR. Are there sex differences in potentially inappropriate prescribing in adults with multimorbidity? J Am Geriatr Soc 2021; 69:2163-2175. [PMID: 33959939 DOI: 10.1111/jgs.17194] [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: 12/03/2020] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Limited knowledge exists regarding sex differences in prescribing potentially inappropriate medications (PIMs) for various multimorbidity patterns. This study sought to determine sex differences in PIM prescribing in older adults with cardiovascular-metabolic patterns. DESIGN Retrospective cohort study. SETTING Health and Retirement Study (HRS) 2004-2014 interview data, linked to HRS-Medicare claims data annualized for 2005-2014. STUDY SAMPLE Six thousand three-hundred and forty-one HRS participants aged 65 and older with two and more chronic conditions. MEASUREMENTS PIM events were calculated using 2015 American Geriatrics Society Beers Criteria. Multimorbidity patterns included: "cardiovascular-metabolic only," "cardiovascular-metabolic plus other physical conditions," "cardiovascular-metabolic plus mental conditions," and "no cardiovascular-metabolic disease" patterns. Logistic regression models were used to determine the association between PIM and sex, including interaction between sex and multimorbidity categories in the model, for PIM overall and for each PIM drug class. RESULTS Women were prescribed PIMs more often than men (39.4% vs 32.8%). Overall, women had increased odds of PIM (Adj. odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.16-1.46). Women had higher odds of PIM than men with cardiovascular-metabolic plus physical patterns (Adj. OR = 1.25, 95% CI: 1.07-1.45) and cardiovascular-metabolic plus mental patterns (Adj. OR = 1.25, 95% CI: 1.06-1.48), and there were no sex differences in adults with a cardiovascular-metabolic only patterns (Adj. OR = 1.13, 95% CI: 0.79-1.62). Women had greater odds of being prescribed the following PIMs: anticholinergics, antidepressants, antispasmodics, benzodiazepines, skeletal muscle relaxants, and had lower odds of being prescribed pain drugs and sulfonylureas compared with men. CONCLUSION This study evaluated sex differences in PIM prescribing among adults with complex cardiovascular-metabolic multimorbidity patterns. The effect of sex varied across multimorbidity patterns and by different PIM drug classes. This study identified important opportunities for future interventions to improve medication prescribing among older adults at risk for PIM.
Collapse
Affiliation(s)
- Maria Ukhanova
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Sheila Markwardt
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Jon P Furuno
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA
| | - Laura Davis
- Neighborhood Health Center, Hillsboro, Oregon, USA
| | - Brie N Noble
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA.,School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
23
|
Sluijs T, Lokkers L, Özsezen S, Veldhuis GA, Wortelboer HM. An Innovative Approach for Decision-Making on Designing Lifestyle Programs to Reduce Type 2 Diabetes on Dutch Population Level Using Dynamic Simulations. Front Public Health 2021; 9:652694. [PMID: 33996729 PMCID: PMC8116515 DOI: 10.3389/fpubh.2021.652694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/22/2021] [Indexed: 12/12/2022] Open
Abstract
The number of individuals suffering from type 2 diabetes is dramatically increasing worldwide, resulting in an increasing burden on society and rising healthcare costs. With increasing evidence supporting lifestyle intervention programs to reduce type 2 diabetes, and the use of scenario simulations for policy support, there is an opportunity to improve population interventions based upon cost–benefit analysis of especially complex lifestyle intervention programs through dynamic simulations. In this article, we used the System Dynamics (SD) modeling methodology aiming to develop a simulation model for policy makers and health professionals to gain a clear understanding of the patient journey of type 2 diabetes mellitus and to assess the impact of lifestyle intervention programs on total cost for society associated with prevention and lifestyle treatment of pre-diabetes and type 2 diabetes in The Netherlands. System dynamics describes underlying structure in the form of causal relationships, stocks, flows, and delays to explore behavior and simulate scenarios, in order to prescribe intervention programs. The methodology has the opportunity to estimate and simulate the consequences of unforeseen interactions in order to prescribe intervention programs based on scenarios tested through “what-if” experiments. First, the extensive knowledge of diabetes, current available data on the type 2 diabetes population, lifestyle intervention programs, and associated cost in The Netherlands were captured in one simulation model. Next, the relationships between leverage points on the growth of type 2 diabetes population were based upon available data. Subsequently, the cost and benefits of future lifestyle intervention programs on reducing diabetes were simulated, identifying the need for an integrated adaptive design of lifestyle programs while collecting the appropriate data over time. The strengths and limitations of scenario simulations of complex lifestyle intervention programs to improve the (cost)effectiveness of these programs to reduce diabetes in a more sustainable way compared to usual care are discussed.
Collapse
Affiliation(s)
- Teun Sluijs
- Department of Microbiology and Systems Biology, Netherlands Organisation for Applied Scientific Research (TNO), Zeist, Netherlands
| | - Lotte Lokkers
- Methodology Department, School of Management, Radboud University, Nijmegen, Netherlands
| | - Serdar Özsezen
- Department of Microbiology and Systems Biology, Netherlands Organisation for Applied Scientific Research (TNO), Zeist, Netherlands
| | - Guido A Veldhuis
- Department Military Operations, Netherlands Organisation for Applied Scientific Research (TNO), The Hague, Netherlands
| | - Heleen M Wortelboer
- Department of Microbiology and Systems Biology, Netherlands Organisation for Applied Scientific Research (TNO), Zeist, Netherlands
| |
Collapse
|
24
|
Jaarsma T, Strömberg A, Dunbar SB, Fitzsimons D, Lee C, Middleton S, Vellone E, Freedland KE, Riegel B. Self-care research: How to grow the evidence base? (reprint). Int J Nurs Stud 2021; 116:103903. [PMID: 33637295 DOI: 10.1016/j.ijnurstu.2021.103903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE The number of studies in the area of self-care is growing and international researchers are increasingly developing self-care interventions to improve outcomes of individual patients and communities. However, growth of the evidence is still slow due to challenges with designing and testing self-care interventions. In this article we address major methodological challenges with regard to the definition of self-care, use of theory, and research design, intended to provide guidance to researchers in this field. METHOD During the inaugural conference of the International Center for Self-Care Research held in Rome, Italy in June 2019 we identified important issues in existing self-care research. Discussion and literature review lead to eight recommendation for future self-care research. RESULTS In preparation, begin with a theoretically sound definition of self-care. In planning the intervention, build on and extend previous studies. Use theory to develop self-care interventions and consider translational models to guide development, evaluation and implementation of complex self-care interventions. Employ a study design that fits the current phase and objectives of the research and measure self-care and related factors carefully. In reporting, describe the sample and setting sufficiently so that others can draw conclusions about generalizability and applicability to their practice and patient population. In interpretation, describe how the intervention is assumed to work (causal assumptions) and its key components. CONCLUSION Our review of existing self-care research clearly illustrates that the recommendations we provide are needed if we are to substantially grow the evidence base supporting self-care. Embracing a core set of principles will allow us to build on each other's work. Tweetable abstract: A core set of methodological principles is needed to substantially grow the evidence base supporting self-care.
Collapse
Affiliation(s)
- T Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, 58381 Linköping, Sweden; Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Julius Center, University Medical Center Utrecht, the Netherlands.
| | - A Strömberg
- Department of Health, Medicine and Caring Sciences, Linkoping University, 58381 Linköping, Sweden; Department of Cardiology, Linkoping University, Sweden
| | - S B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, USA
| | - D Fitzsimons
- School of Nursing & Midwifery, Queen's University Belfast, UK
| | - C Lee
- William F. Connell, School of Nursing, Boston College, USA
| | - S Middleton
- Nursing Research Institute, St Vincent's Health Australia & Australian Catholic University, Australia
| | - E Vellone
- University of Rome "Tor Vergata", Italy
| | - K E Freedland
- Department of Psychiatry, Washington University School of Medicine, USA
| | - B Riegel
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; School of Nursing, University of Pennsylvania, USA
| |
Collapse
|
25
|
Ejeta A, Abdosh T, Hawulte B, Lamessa A, Belete Fite M, Fekadu G. Diabetes Concordant Comorbidities and Associated Factors Among Adult Diabetic Out-Patients at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: a Cross-Sectional Study. Diabetes Metab Syndr Obes 2021; 14:2281-2289. [PMID: 34045877 PMCID: PMC8149283 DOI: 10.2147/dmso.s308553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/19/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Nowadays diabetic comorbidities constitute a major public health problem in Ethiopian context. However, there is a dearth in epidemiology and risk factors of diabetic comorbidity in Ethiopia, particularly in the study setting. Therefore, this study was conducted to determine the prevalence and identify factors associated with concordant diabetic comorbidities among diabetic out-patients at Hiwot Fana Specialized University Hospital (HFSUH), EasternEthiopia. METHODOLOGY A hospital-based cross-sectional study was conducted by reviewing medical record charts of adult diabetic outpatients. Bivariable and multivariable logistic regression analysis was carried out by using STATA version 16.0. To measure the strength of association an Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used. Moreover, variables with p-value ≤ 0.05 were considered as statistically significant with the outcome variable. RESULTS In this study, it is found that the overall prevalence of concordant comorbidity among adult diabetic out-patients was 55.8% (95% CI: 50.3-61.3). Moreover, more than two-third of patients, 72.73% were diagnosed for type two diabetic mellitus (T2DM). Among specified comorbidities about 42.3% were hypertension, 21.63% were obesity, and 13% were multi-morbidity. Age ≥ 55 years (AOR: 7.52, 95% CI: 1.24, 45.75), T2DM (AOR: 9.01, 95% CI: 1.50, 54.04), 2-5 years duration of treatments (AOR: 0.23, 95 CI: 0.078, 0.691), and poor glycemic control (AOR: 4.4 1, 95% CI: 2.34, 8.32) were factors significantly associated with concordant diabetic comorbidity. CONCLUSION From the study conducted, the higher prevalence of concordant comorbidity among diabetic patients was investigated. Furthermore, older in age, T2DM, prolonged duration of treatment, and poor glycemic control were factors associated with diabetic comorbidities. Early detection and appropriate treatment of diabetic comorbidities are very important for better patient's quality of life and functionality.
Collapse
Affiliation(s)
- Abdisa Ejeta
- School of Medicine, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Tekabe Abdosh
- School of Medicine, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Behailu Hawulte
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Adugna Lamessa
- School of Medicine, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Meseret Belete Fite
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Gelana Fekadu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
- Correspondence: Gelana Fekadu School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, EthiopiaTel +251933316505 Email
| |
Collapse
|
26
|
Guerrero-Fernández de Alba I, Orlando V, Monetti VM, Mucherino S, Gimeno-Miguel A, Vaccaro O, Forjaz MJ, Poblador Plou B, Prados-Torres A, Riccardi G, Menditto E. Comorbidity in an Older Population with Type-2 Diabetes Mellitus: Identification of the Characteristics and Healthcare Utilization of High-Cost Patients. Front Pharmacol 2020; 11:586187. [PMID: 33746740 PMCID: PMC7970761 DOI: 10.3389/fphar.2020.586187] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/29/2020] [Indexed: 01/11/2023] Open
Abstract
Objectives: Little is known about the specific comorbidities contributing to higher costs in patients with type-2 diabetes mellitus (T2DM), particularly in older cases. We aimed to evaluate the prevalence, type, and cost of comorbidities occurring in older T2DM patients versus older non-T2DM patients, and the factors associated with high cost (HC) T2DM patients. Methods: Retrospective cohort study using information from the Campania Region healthcare database. People aged ≥65 years who received ≥2 prescriptions for antidiabetic drugs were identified as "T2DM patients." Comorbidities among T2DM and non-T2DM groups were assessed through the RxRiskV Index (modified version). T2DM individuals were classified according to the total cost distribution as HC or "non-high cost." Two sub-cohorts of HC T2DM patients were assessed: above 90th and 80th percentile of the total cost. Age- and sex-adjusted logistic regression models were created. Results: Among the T2DM cohort, concordant and discordant comorbidities occurred significantly more frequently than in the non-T2DM cohort. Total mean annual cost per T2DM patient due to comorbidities was €7,627 versus €4,401 per non-T2DM patient. Among T2DM patients identified as being above 90th and 80th percentiles of cost distribution, the total annual costs were >€19,577 and >€2,563, respectively. The hospitalization cost was higher for T2DM cases. Strongest predictors of being a HC T2DM patient were having ≥5 comorbidities and renal impairment. Conclusion: HC patients accrued >80% of the total comorbidities cost in older T2DM patients. Integrated care models, with holistic and patient-tailored foci, could achieve more effective T2DM care.
Collapse
Affiliation(s)
- Inmaculada Guerrero-Fernández de Alba
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
| | - Valentina Orlando
- CIRFF, Center of Pharmacoeconomics and Drug utilization Research, Department of Pharmacy, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Valeria M. Monetti
- CIRFF, Center of Pharmacoeconomics and Drug utilization Research, Department of Pharmacy, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Sara Mucherino
- CIRFF, Center of Pharmacoeconomics and Drug utilization Research, Department of Pharmacy, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
| | - Olga Vaccaro
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria João Forjaz
- National Centre of Epidemiology, Institute of Health Carlos III and REDISSEC, Madrid, Spain
| | - Beatriz Poblador Plou
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics and Drug utilization Research, Department of Pharmacy, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| |
Collapse
|
27
|
Pantalone KM, Misra-Hebert AD, Hobbs TM, Kong SX, Ji X, Ganguly R, Milinovich A, Weng W, Bauman JM, Petraro P, Burguera B, Zimmerman RS, Kattan MW. The Probability of A1C Goal Attainment in Patients With Uncontrolled Type 2 Diabetes in a Large Integrated Delivery System: A Prediction Model. Diabetes Care 2020; 43:1910-1919. [PMID: 32527797 PMCID: PMC7372043 DOI: 10.2337/dc19-0968] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 04/26/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess patient characteristics and treatment factors associated with uncontrolled type 2 diabetes (T2D) and the probability of hemoglobin A1c (A1C) goal attainment. RESEARCH DESIGN AND METHODS This was a retrospective cohort study using the electronic health record at Cleveland Clinic. Patients with uncontrolled T2D (A1C >9%) were identified on the index date of 31 December 2016 (n = 6,973) and grouped by attainment (n = 1,653 [23.7%]) or nonattainment (n = 5,320 [76.3%]) of A1C <8% by 31 December 2017, and subgroups were compared on a number of demographic and clinical variables. On the basis of these variables, a nomogram was created for predicting probability of A1C goal attainment. RESULTS For the entire population, median age at index date was 57.7 years (53.3% male), and the majority were white (67.2%). Median A1C was 10.2%. Obesity (50.6%), cardiovascular disease (46.9%), and psychiatric disease (61.1%) were the most common comorbidities. Metformin (62.7%) and sulfonylureas (38.7%) were the most common antidiabetes medications. Only 1,653 (23.7%) patients achieved an A1C <8%. Predictors of increased probability of A1C goal attainment were older age, white/non-Hispanic race/ethnicity, Medicare health insurance, lower baseline A1C, higher frequency of endocrinology/primary care visits, dipeptidyl peptidase 4 inhibitor use, thiazolidinedione use, metformin use, glucagon-like peptide 1 receptor agonist use, and fewer classes of antidiabetes drugs. Factors associated with lower probability included insulin use and longer time in the T2D database (both presumed as likely surrogates for duration of T2D). CONCLUSIONS A minority of patients with an A1C >9% achieved an A1C <8% at 1 year. While most identified predictive factors are nonmodifiable by the clinician, pursuit of frequent patient engagement and tailored drug regimens may help to improve A1C goal attainment.
Collapse
Affiliation(s)
- Kevin M Pantalone
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Anita D Misra-Hebert
- Internal Medicine, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH.,Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | | | - Sheldon X Kong
- Health Economics and Outcomes Research, Novo Nordisk Inc., Plainsboro, NJ
| | - Xinge Ji
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Rahul Ganguly
- Health Economics and Outcomes Research, Novo Nordisk Inc., Plainsboro, NJ
| | - Alex Milinovich
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Wayne Weng
- Health Economics and Outcomes Research, Novo Nordisk Inc., Plainsboro, NJ
| | - Janine M Bauman
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Paul Petraro
- Health Economics and Outcomes Research, Novo Nordisk Inc., Plainsboro, NJ
| | | | | | | |
Collapse
|
28
|
Alshehri MM, Alenazi AM, Hoover JC, Alothman SA, Phadnis MA, Miles JM, Kluding PM, Siengsukon CF. A comparison of diabetes self-care behavior in people with type 2 diabetes with and without insomnia symptoms. Acta Diabetol 2020; 57:651-659. [PMID: 31909434 DOI: 10.1007/s00592-019-01470-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 12/27/2022]
Abstract
AIMS Individuals with type 2 diabetes (T2DM) are advised to undertake diabetes self-care behavior (DSCB) in order to avoid complications of T2DM. However, comorbidities, such as insomnia symptoms which are commonly reported in people with T2DM, may limit the ability to engage in DSCB. Insomnia and the common sequelae accompanying insomnia such as pain, depression, and anxiety may negatively influence the performance of DSCB. Therefore, this study aimed to compare the DSCB of people with T2DM with and without insomnia symptoms. METHODS Sixty participants with T2DM were divided into two groups based on the presence of insomnia symptoms: T2DM-only group and T2DM+ insomnia group. Insomnia symptoms were identified using the Insomnia Severity Index (ISI). DSCB was assessed using the Diabetic Care Profile (DCP). A standardized composite score was established to account for all of the DCP domains. Chi-square and independent sample t tests were used to assess between-group differences in categorical and continuous variables, respectively. Stepwise linear regression analysis used the ISI score to predict standardized DCP composite score, while controlling for covariates. RESULTS Significant between-group differences were found in age, symptoms of pain, depression, and anxiety. The total DCP composite score was significantly lower in the T2DM+ insomnia group compared to the T2DM-only group (- 0.30 ± 0.46 vs. 0.36 ± 0.48, respectively, p < 0.001) with large effect size (g = 1.40). Stepwise linear regression results showed that a 1-point increase in ISI score significantly predicted a .03-point decrease in standardized DCP composite score, after controlling for age, symptoms of pain, depression, and anxiety (β = - 0.03, p = 0.04). CONCLUSIONS The data suggest that people with T2DM and insomnia symptoms had worse scores on the majority of the DSCB domains and a worse DCP composite score compared to people with T2DM only. The data suggest a negative association between insomnia severity and DSCB among people with T2DM. Further research using a larger sample size and more rigorous research design is required to examine the causal relationship between insomnia symptoms and DSCB.
Collapse
Affiliation(s)
- Mohammed M Alshehri
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS, 66160, USA.
- Physical Therapy Department, Jazan University, Jazan, Southern Region, Saudi Arabia.
| | - Aqeel M Alenazi
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS, 66160, USA
- Physical Therapy Department, Prince Sattam Bin Abdulaziz University, Alkharj, Central Region, Saudi Arabia
| | - Jeffrey C Hoover
- Psychology and Educational Research Department, University of Kansas, Lawrence, KS, USA
| | - Shaima A Alothman
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS, 66160, USA
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - John M Miles
- Endocrinology Department, University of Kansas Medical Center, Kansas City, KS, USA
| | - Patricia M Kluding
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS, 66160, USA
| | - Catherine F Siengsukon
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS, 66160, USA
| |
Collapse
|
29
|
Initial Therapy, Regimen Change, and Persistence in a Spanish Cohort of Newly Treated Type 2 Diabetes Patients: A Retrospective, Observational Study Using Real-World Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103742. [PMID: 32466267 PMCID: PMC7277774 DOI: 10.3390/ijerph17103742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
The World Health Organization considers the non-adherence to medication a significant issue with global impact, especially in chronic conditions such as type 2 diabetes. We aim to study antidiabetic treatment initiation, add-on, treatment switching, and medication persistence. We conducted an observational study on 4247 individuals initiating antidiabetic treatment between 2013 and 2014 in the EpiChron Cohort (Spain). We used Cox regression models to estimate the likelihood of non-persistence after a one-year follow-up, expressed as hazard ratios (HRs). Metformin was the most frequently used first-line antidiabetic (80% of cases); combination treatment was the second most common treatment in adults aged 40–79 years, while dipeptidyl peptidase-4 inhibitors were the second most common in individuals in their 80s and over, and in patients with renal disease. Individuals initiated on metformin were less likely to present addition and switching events compared with any other antidiabetic. Almost 70% of individuals initiated on monotherapy were persistent. Subjects aged 40 and over (HR 0.53–0.63), living in rural (HR 0.79) or more deprived areas (HR 0.77–0.82), or receiving polypharmacy (HR 0.84), were less likely to show discontinuation. Our findings could help identify the population at risk of discontinuation, and offer them closer monitoring for proper integrated management to improve prognosis and health outcomes.
Collapse
|
30
|
Self-care research: How to grow the evidence base? Int J Nurs Stud 2020; 105:103555. [DOI: 10.1016/j.ijnurstu.2020.103555] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
|
31
|
Shah R, McKay SV, Levitt Katz LE, El Ghormli L, Anderson BJ, Casey TL, Higgins L, Izquierdo R, Wauters AD, Chang N. Adherence to multiple medications in the TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) cohort: effect of additional medications on adherence to primary diabetes medication. J Pediatr Endocrinol Metab 2020; 33:191-198. [PMID: 31809265 PMCID: PMC8201598 DOI: 10.1515/jpem-2019-0315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/03/2019] [Indexed: 11/15/2022]
Abstract
Background Non-adherence to diabetes medication leads to poor outcomes and increased healthcare costs. Multiple factors affecting adherence in adults with type 2 diabetes (T2D) have been identified, but pediatric data is sparse. We aimed to determine whether initiation of additional oral medications or insulin affects adherence to primary study medication (PSM) in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. Methods Six hundred and ninety-nine youth (aged 10-17 years) with recent-onset T2D were randomized in the TODAY study. Participants were categorized as adherent (≥80% taken by pill count) or non-adherent (<80%), and adherence was compared between those on additional medications or not. Subgroup analyses to assess influence of race/ethnicity, gender, medication type, or depression were performed. Results At 36 months, 46.3% of participants were taking additional oral medications and 31.9% were on insulin. There was no difference in study medication adherence with additional oral medications (55.1%, 67.1%, and 56.7% at month 36 in those prescribed 0, 1, or 2+ additional medications; p = 0.16). Girls on oral contraceptives (OC) had higher adherence (65.2% vs. 55.8% at month 36; p = 0.0054). Participants on insulin had lower adherence (39.7% vs. 59.3% at 36 months; p < 0.0001). There was decreased adherence in participants with baseline depression (p = 0.008). Conclusions Additional oral medications did not influence adherence to diabetes medications in TODAY. Addition of insulin led to reduced adherence. In subgroup analyses, OC use was associated with higher adherence in girls, while baseline depression was associated with lower adherence overall. Further studies examining potentially modifiable risk factors of adherence in pediatric T2D are needed.
Collapse
Affiliation(s)
- Rachana Shah
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Siripoom V McKay
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Lorraine E Levitt Katz
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laure El Ghormli
- The George Washington University Biostatistics Center, 6110 Executive Boulevard, Suite 750, Rockville, MD 20852, USA, Office: +301-881-9260, Fax: +301-881-3767
| | - Barbara J Anderson
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Terri L Casey
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Laurie Higgins
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA
| | - Roberto Izquierdo
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Aimee D Wauters
- University of Texas Health Science Center, San Antonio, TX, USA
| | - Nancy Chang
- Diabetes and Obesity Program, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | |
Collapse
|
32
|
Bradley R. CTIM special issue on type 2 diabetes mellitus. Complement Ther Med 2019; 45:A1-A2. [PMID: 31331590 DOI: 10.1016/j.ctim.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Ryan Bradley
- National University of Natural Medicine, Portland, United States; Division of Preventive Medicine, University of California, San Diego, La Jolla, CA, United States; Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Faculty of Health, Ultimo, Australia.
| |
Collapse
|