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Sankoda A, Nagae Y, Waki K, Sze WT, Oba K, Mieno M, Nangaku M, Yamauchi T, Ohe K. Glycemic Control, Renal Progression, and Use of Telemedicine Phone Consultations Among Japanese Patients With Type 2 Diabetes Mellitus During the COVID-19 Pandemic: Retrospective Cohort Study. JMIR Diabetes 2023; 8:e42607. [PMID: 37315193 DOI: 10.2196/42607] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/07/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Reduced or delayed medical follow-ups have been reported during the COVID-19 pandemic, which may lead to worsening clinical outcomes for patients with diabetes. The Japanese government granted special permission for medical institutions to use telephone consultations and other remote communication modes during the COVID-19 pandemic. OBJECTIVE We aimed to evaluate changes in the frequency of outpatient consultations, glycemic control, and renal function among patients with type 2 diabetes before and during the COVID-19 pandemic. METHODS This is a retrospective single-cohort study conducted in Tokyo, Japan, analyzing results for 3035 patients who visited the hospital regularly. We compared the frequency of outpatient consultations attended (both in person and via telemedicine phone consultation), glycated hemoglobin A1c (HbA1c), and estimated glomerular filtration rate (eGFR) among patients with type 2 diabetes mellitus during the 6 months from April 2020 to September 2020 (ie, during the COVID-19 pandemic) with those during the same period of the previous year, 2019, using Wilcoxon signed rank tests. We conducted a multivariate logistic regression analysis to identify factors related to the changes in glycemic control and eGFR. We also compared the changes in HbA1c and eGFR from 2019 to 2020 among telemedicine users and telemedicine nonusers using difference-in-differences design. RESULTS The overall median number of outpatient consultations attended decreased significantly from 3 (IQR 2-3) in 2019 to 2 (IQR 2-3) in 2020 (P<.001). Median HbA1c levels deteriorated, though not to a clinically significant degree (6.90%, IQR 6.47%-7.39% vs 6.95%, IQR 6.47%-7.40%; P<.001). The decline in median eGFR was greater during the year 2019-2020 compared to the year 2018-2019 (-0.9 vs -0.5 mL/min/1.73 m2; P=.01). Changes in HbA1c and eGFR did not differ between patients who used telemedicine phone consultations and those who did not. Age and HbA1c level before the pandemic were positive predictors of worsening glycemic control during the COVID-19 pandemic, whereas the number of outpatient consultations attended was identified as a negative predictor of worsening glycemic control during the pandemic. CONCLUSIONS The COVID-19 pandemic resulted in reduced attendance of outpatient consultations among patients with type 2 diabetes, and these patients also experienced deterioration in kidney function. Difference in consultation modality (in person or by phone) did not affect glycemic control and renal progression of the patients.
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Affiliation(s)
- Akiko Sankoda
- Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan
| | - Yugo Nagae
- Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan
| | - Kayo Waki
- Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wei Thing Sze
- Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Oba
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makiko Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Shimotsuke, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Ohe
- Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Wang Y, Zheng J, Schneberk T, Ke Y, Chan A, Hu T, Lam J, Gutierrez M, Portillo I, Wu D, Chang CH, Qu Y, Brown L, Nichol MB. What quantifies good primary care in the United States? A review of algorithms and metrics using real-world data. BMC PRIMARY CARE 2023; 24:130. [PMID: 37355573 PMCID: PMC10290298 DOI: 10.1186/s12875-023-02080-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
Primary care physicians (PCPs) play an indispensable role in providing comprehensive care and referring patients for specialty care and other medical services. As the COVID-19 outbreak disrupts patient access to care, understanding the quality of primary care is critical at this unprecedented moment to support patients with complex medical needs in the primary care setting and inform policymakers to redesign our primary care system. The traditional way of collecting information from patient surveys is time-consuming and costly, and novel data collection and analysis methods are needed. In this review paper, we describe the existing algorithms and metrics that use the real-world data to qualify and quantify primary care, including the identification of an individual's likely PCP (identification of plurality provider and major provider), assessment of process quality (for example, appropriate-care-model composite measures), and continuity and regularity of care index (including the interval index, variance index and relative variance index), and highlight the strength and limitation of real world data from electronic health records (EHRs) and claims data in determining the quality of PCP care. The EHR audits facilitate assessing the quality of the workflow process and clinical appropriateness of primary care practices. With extensive and diverse records, administrative claims data can provide reliable information as it assesses primary care quality through coded information from different providers or networks. The use of EHRs and administrative claims data may be a cost-effective analytic strategy for evaluating the quality of primary care.
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Affiliation(s)
- Yun Wang
- School of Pharmacy, Chapman University, Irvine, US.
| | | | - Todd Schneberk
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, Los Angeles, US
| | - Yu Ke
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, US
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, US
| | - Tao Hu
- Department of Geography, Oklahoma State University, Stillwater, US
| | - Jerika Lam
- School of Pharmacy, Chapman University, Irvine, US
| | | | | | - Dan Wu
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London, School of Hygiene and Tropical Medicine, London, UK
| | - Chih-Hung Chang
- Program in Occupational Therapy, Department of Medicine, and Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, US
| | - Yang Qu
- School of Pharmacy, Chapman University, Irvine, US
| | | | - Michael B Nichol
- Sol Price School of Public Policy, University of Southern California, Los Angeles, US
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Abd Jamil J, Myers EF, Swee WCS. Defining the Practice of Dietitians in Malaysia Using the Nutrition Care Process in Patients with Type 2 Diabetes Mellitus. DIETETICS 2022; 1:203-215. [DOI: 10.3390/dietetics1030018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
(1) Background: The quality of dietetic care is crucial to improve patient outcomes. The aim of this study was to measure the current practices regarding the provision of nutrition care in type 2 diabetes mellitus (T2DM) among dietitians in Malaysia. (2) Methods: A 49-item online survey was distributed via Malaysian Dietitians’ Association and Ministry of Health Malaysia social media platforms. Self-reported dietetic practices in the management of T2DM were evaluated against practice guidelines. (3) Results: A total of 173 dietitians completed the survey, with a response rate of 62%. Three-quarters of dietitians in the public sector consulted patients within two to three weeks or more than four weeks versus less than two weeks (86.3%) among private dietitians (p-value < 0.001). More than 95% of private dietitians spent 31–60 min or more than 60 min on new cases versus 71% among public dietitians (p-value < 0.001). Group counseling was only practiced among public dietitians (36.0%). Different practice settings led to the current findings. A limited use of behavioral counseling theories and strategies was observed among dietitians from both sectors. Limited adherence to nutrition-related recommendations (62.8%) and lack of readiness for diet/lifestyle changes (45.5%) were the key challenges faced by dietitians when managing T2DM. (4) Conclusions: The survey indicates that there is a need for the development of comprehensive training to increase the utilization of behavioral counselling. Practice setting is an element to consider when designing training.
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Thomas F, Pannier B, Meghiref K, Galtier D, Lamande JP, Raison J, Danchin N. Adapted educational health program among deprived subjects with prediabetes. Prim Care Diabetes 2022; 16:664-669. [PMID: 35781187 DOI: 10.1016/j.pcd.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/06/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
AIMS Assess the feasibility and benefit of a health educational program on global metabolic status in prediabetic deprived subjects. DESIGN Case control study. METHODS 693 subjects (466 men, 227 women), aged 16 to 95 years with prediabetes and low socioeconomic status, consulting at the IPC Center were included between September 2015 and June 2016. Subjects were invited to participate in 4 workshops (2 nutrition, 2 physical activities). One year after their inclusion (visit 1), they were offered a second health check-up (visit 2). Participants were classified into 3 groups: 1) Intervention group (INTG, N=133): complete process 2) Control group (CG, N=415): Only a second health check-up, no workshop participation; 3) Abandoned group (AG, N=145). All groups were compared. RESULTS After considered confounding factors, fasting blood glucose and SBP levels variation between visit 1 and visit 2 differed significantly between the CG and INTG. In the INTG with higher diminution of fasting glucose, 90% reported eating healthy food since nutrition workshop and 51%. reached objectives (The same trend was observed for physical activity. CONCLUSION An educational program among deprived prediabetic tended to limit fasting glucose increment, improve metabolic status and encourage healthy lifestyle despite difficulties in convincing subjects to participate.
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Affiliation(s)
- F Thomas
- Centre d'Investigations Préventives et Cliniques, Paris, France.
| | - B Pannier
- Centre d'Investigations Préventives et Cliniques, Paris, France
| | - K Meghiref
- Centre d'Investigations Préventives et Cliniques, Paris, France
| | | | | | | | - N Danchin
- Centre d'Investigations Préventives et Cliniques, Paris, France; Université Paris-Descartes, Paris, France
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Onishi Y, Ichihashi R, Yoshida Y, Tahara T, Kikuchi T, Kobori T, Kubota T, Iwamoto M, Hamano S, Kasuga M. Substitution of telemedicine for clinic visit during the COVID-19 pandemic of 2020-comparison of telemedicine and clinic visit. J Diabetes Investig 2022; 13:1617-1625. [PMID: 35524476 PMCID: PMC9348048 DOI: 10.1111/jdi.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/23/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
Aims/Introduction The purpose of this retrospective observational cohort study was to compare outpatient diabetes care and glycated hemoglobin (HbA1c) level during the coronavirus disease 2019 pandemic in 2020 with 2019, and to compare the glucose‐lowering effect of telemedicine and clinic visits during the state of emergency in Japan declared from 7 April to 25 May (inter‐period) 2020. Materials and Methods A total of 13 weeks before and after the inter‐period were designated as the pre‐period and post‐period, respectively. The number of study participants who had clinic visits during the pre‐period and the post‐period were 3,333 in 2020 and 3,608 in 2019. Propensity score matching was carried out to compare the effect of telemedicine and clinic visits on diabetes control in 2020 among diabetes patients with insufficient glucose control (HbA1c ≥7%). The primary outcome was post‐period HbA1c. Results The major difference between 2020 and 2019 was the use of telemedicine in 2020. After adjustment for age, sex, diabetes type, pre‐period HbA1c and pre‐period body mass index, glycemic control evaluated by HbA1c was significantly worse in the post‐period of 2020 than 2019. In the propensity score‐matched 618 pairs, the clinic visit group had significantly better post‐period HbA1c than the telemedicine group (7.5% vs 7.4%, P = 0.023). Conclusions Glycemic control was slightly, but significantly, worse in 2020 than 2019. Although telemedicine significantly improved glycemic control during the coronavirus disease 2019 pandemic in 2020, clinic visits improved HbA1c significantly more. The substitution of telemedicine for clinic visits appears to be a viable option under emergency conditions, but clinic visits might be a better option when possible.
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Affiliation(s)
- Yukiko Onishi
- The Institute of Medical Science, Asahi Life Foundation, 2-2-6, Nihonbashi-Bakurocho, Chuo-ku, Tokyo, Japan
| | - Rieko Ichihashi
- The Institute of Medical Science, Asahi Life Foundation, 2-2-6, Nihonbashi-Bakurocho, Chuo-ku, Tokyo, Japan
| | - Yoko Yoshida
- The Institute of Medical Science, Asahi Life Foundation, 2-2-6, Nihonbashi-Bakurocho, Chuo-ku, Tokyo, Japan
| | - Tazu Tahara
- The Institute of Medical Science, Asahi Life Foundation, 2-2-6, Nihonbashi-Bakurocho, Chuo-ku, Tokyo, Japan
| | - Takako Kikuchi
- The Institute of Medical Science, Asahi Life Foundation, 2-2-6, Nihonbashi-Bakurocho, Chuo-ku, Tokyo, Japan
| | - Toshiko Kobori
- The Institute of Medical Science, Asahi Life Foundation, 2-2-6, Nihonbashi-Bakurocho, Chuo-ku, Tokyo, Japan
| | - Tetsuya Kubota
- The Institute of Medical Science, Asahi Life Foundation, 2-2-6, Nihonbashi-Bakurocho, Chuo-ku, Tokyo, Japan
| | - Masahiko Iwamoto
- The Institute of Medical Science, Asahi Life Foundation, 2-2-6, Nihonbashi-Bakurocho, Chuo-ku, Tokyo, Japan
| | - Shoko Hamano
- The Institute of Medical Science, Asahi Life Foundation, 2-2-6, Nihonbashi-Bakurocho, Chuo-ku, Tokyo, Japan
| | - Masato Kasuga
- The Institute of Medical Science, Asahi Life Foundation, 2-2-6, Nihonbashi-Bakurocho, Chuo-ku, Tokyo, Japan
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Padda J, Khalid K, Zubair U, Al Hennawi H, Khedr A, Patel V, Cooper AC, Jean-Charles G. Significance of Educational Literature and Diabetes Log Sheet on Hemoglobin A1c. Cureus 2022; 14:e21667. [PMID: 35233335 PMCID: PMC8882019 DOI: 10.7759/cureus.21667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/09/2022] Open
Abstract
Diabetes mellitus (DM) is a major cause of morbidity worldwide. The prevalence of DM has doubled over the last 35 years and is escalating. Various complications and manifestations of diabetes have caused numerous deaths worldwide, with numbers increasing every year. There have been many advances and breakthroughs over the past decade in the management of DM. The major focus of many research studies has been to evaluate effective medication combinations, preventative measures, and the way to control such morbid conditions. Our focus in this review is to discuss specific secondary prevention techniques with the diabetes log sheet and educational literature on its effectiveness in controlling diabetes. Hemoglobin A1c (HbA1c) has been accepted as a diabetes control measure in many resources worldwide. Here, we have assessed articles on the effectiveness of the diabetes log sheet and educational literature on HbA1c levels. We will begin with a few key points to acknowledge diabetes initially, followed by discussing the effectiveness of the diabetes log sheet and literature on HbA1c.
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Kim S, Tong B, Lee J, Borodge D, Kooner K. Lifestyle Counseling for Medication Adherence in Glaucoma. Clin Ophthalmol 2021; 15:3521-3529. [PMID: 34429583 PMCID: PMC8380305 DOI: 10.2147/opth.s321351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background Medication adherence in glaucoma patients remains sub-par despite proven benefits of regular administration. The objective was to analyze medication adherence before and after lifestyle counseling in patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG) (mild, moderate, severe). Methods Prospective cohort study from May to July 2018 at a single academic center. From 391 consecutive records, 247 were excluded based on exclusion criteria with 28 patients not meeting inclusion criteria resulting in the final sample of 116 patients (33 had OHT, 83 had POAG – 28 mild, 39 moderate, 16 severe). Scripted lifestyle counseling focusing on diet, exercise, vitamin intake, stress management, and medication adherence was administered by a team of trained medical students. Primary outcome measure was self-reported medication adherence, defined as not missing an eye drop administration in the past month. A 2–3 week follow-up with scripted telephone survey assessing medication adherence, diet, and exercise was collected. Results At baseline, in 116 patients, 59.5% were adherent to their medication with a breakdown of 42.4% OHT, 64.3% mild, 66.7% moderate, and 68.7% severe and an increasing trend in medication adherence was found across increasing disease severity (p=0.055). Of the 76 (65.5%) patients reached for follow-up, 17 (22.4%) became adherent following lifestyle counseling (p=0.02) increasing overall adherence to 78.9% from 62.5%. Conclusion In our study, comprehensive lifestyle counseling succeeded in increasing medication adherence in patients with OHT and POAG.
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Affiliation(s)
- Sandy Kim
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Betty Tong
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jessica Lee
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Darara Borodge
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karanjit Kooner
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Ophthalmology, Veterans Affairs North Texas Health Care System, Dallas, TX, USA
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Ghisi GLDM, Aultman C, Konidis R, Foster E, Sandison N, Alavinia M, Sarin M, Oh P. Development and Validation of the DiAbeTes Education Questionnaire (DATE-Q) to Measure Knowledge Among Diabetes and Prediabetes Patients Attending Cardiac Rehabilitation Programs. J Cardiopulm Rehabil Prev 2021; 41:224-229. [PMID: 33512977 DOI: 10.1097/hcr.0000000000000546] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE Knowledge assessment tools are highly useful in clinical practice, as they help health care teams to customize education and clinical care plans based on the needs of patients. The objective of this study was to develop and validate the DiAbeTes Education Questionnaire (DATE-Q) to measure knowledge among diabetes and prediabetes patients attending cardiac rehabilitation (CR). METHODS Based on patient information needs, other validated tools and diabetes education standards and current practices, experts developed 20 items to comprise the first version of the DATE-Q. To establish content validity, they were reviewed by an expert panel (n = 12) and patients. Refined items were psychometrically tested in 84 diabetes and prediabetes patients attending CR. The internal consistency was assessed via regularized factor analysis and Cronbach α, and criterion validity with regard to patient education and family income. For interpretability analysis, the minimal clinically important difference (MCID) was estimated using distribution- and anchor-based methods. RESULTS All items were appropriate for administration in this population according to experts and patients. Three factors were extracted and were generally internally consistent and well defined by the items. Criterion validity was supported by significant differences in mean scores by family income (P < .05). Results showed that increases in knowledge can moderately increase mean steps/d and peak oxygen uptake, with an MCID of 2.13. CONCLUSIONS This study demonstrated preliminary validity of the DATE-Q. Future research is needed to assess other measurement properties to confirm the applicability of this tool in clinical and research settings.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Turchin A, Florez Builes LF. Using Natural Language Processing to Measure and Improve Quality of Diabetes Care: A Systematic Review. J Diabetes Sci Technol 2021; 15:553-560. [PMID: 33736486 PMCID: PMC8120048 DOI: 10.1177/19322968211000831] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Real-world evidence research plays an increasingly important role in diabetes care. However, a large fraction of real-world data are "locked" in narrative format. Natural language processing (NLP) technology offers a solution for analysis of narrative electronic data. METHODS We conducted a systematic review of studies of NLP technology focused on diabetes. Articles published prior to June 2020 were included. RESULTS We included 38 studies in the analysis. The majority (24; 63.2%) described only development of NLP tools; the remainder used NLP tools to conduct clinical research. A large fraction (17; 44.7%) of studies focused on identification of patients with diabetes; the rest covered a broad range of subjects that included hypoglycemia, lifestyle counseling, diabetic kidney disease, insulin therapy and others. The mean F1 score for all studies where it was available was 0.882. It tended to be lower (0.817) in studies of more linguistically complex concepts. Seven studies reported findings with potential implications for improving delivery of diabetes care. CONCLUSION Research in NLP technology to study diabetes is growing quickly, although challenges (e.g. in analysis of more linguistically complex concepts) remain. Its potential to deliver evidence on treatment and improving quality of diabetes care is demonstrated by a number of studies. Further growth in this area would be aided by deeper collaboration between developers and end-users of natural language processing tools as well as by broader sharing of the tools themselves and related resources.
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Affiliation(s)
- Alexander Turchin
- Brigham and Women’s Hospital, Boston,
MA, USA
- Alexander Turchin, MD, MS, Brigham and
Women’s Hospital, 221 Longwood Avenue, Boston, MA 02115, USA.
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Kumah E, Abuosi AA, Ankomah SE, Anaba C. Self-management Education Program: The Case of Glycemic Control of Type 2 Diabetes. Oman Med J 2021; 36:e225. [PMID: 33585046 PMCID: PMC7868594 DOI: 10.5001/omj.2021.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 05/28/2019] [Indexed: 01/05/2023] Open
Abstract
Objectives Self-management education (SME) is recognized globally as a tool that enables patients to achieve optimal glucose control. While factors influencing the effectiveness of self-management interventions have been studied extensively, the impact of program length on clinical endpoints of patients diagnosed with diabetes is underdeveloped. This paper synthesized information from the existing literature to understand the effect of program length on glycated hemoglobin (HbA1C) in adults with type 2 diabetes mellitus. Methods We searched Web of Science, PubMed, Scopus, MEDLINE, EMBASE, PsychINFO, and the Cochrane Central Register of Controlled Trials to identify relevant English language publications on diabetes self-management education published between January 2000 and April 2019. Results The review included 25 randomized controlled trials, with 64.0% reporting significant changes in HbA1C. The studies classified as long-term (lasting one year and above) were associated with the greatest number of interventions achieving statistically significant (87.5% significant vs. 12.5% non-significant) differences in changes in HbA1C between the intervention and the control subjects, recording an overall between-group HbA1C mean difference of 0.6±0.3% (range = 0.2–1.2). Conclusions Our findings suggest that program length may change the effectiveness of educational interventions. Achieving sustained improvements in patients’ HbA1C levels will require long-term, ongoing SME, and support.
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Affiliation(s)
- Emmanuel Kumah
- Policy, Planning, Monitoring, and Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | | | - Cynthia Anaba
- Department of Administration, St. Dominic Hospital, Akwatia, Eastern Region, Ghana
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Kumah E, Afriyie EK, Abuosi AA, Ankomah SE, Fusheini A, Otchere G. Influence of the Model of Care on the Outcomes of Diabetes Self-Management Education Program: A Scoping Review. J Diabetes Res 2021; 2021:2969243. [PMID: 33688505 PMCID: PMC7914106 DOI: 10.1155/2021/2969243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 01/14/2021] [Accepted: 02/11/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) accounts for approximately 95% of all diabetes cases, making the disease a global public health concern. The increasing prevalence of T2DM has highlighted the importance of evidence-based guidelines for effective prevention, management, and treatment. Diabetes self-management education (DSME) can produce positive effects on patient behaviors and health status. Study objective. We synthesized findings from the existing studies to find out whether or not the impact of DSME on patient health behaviors and outcomes differ by the different models of diabetes care. That is, we determined whether there are differences in DSME outcomes when patient's care provider is a general practitioner, a specialist, a nurse, or a combination of these health professionals. METHODS Searches were made of six electronic databases to identify relevant English language publications on DSME from 2000 through 2019. Titles and abstracts of the search results were screened to select eligible papers for full-text screening. All eligible papers were retrieved, and full-text screening was done by three independent reviewers to select studies for inclusion in the final analysis. Twenty-one studies were included in the final analysis. The main outcome measures assessed were glycated hemoglobin (HbA1c), body mass index (BMI), diet, and physical activity. RESULTS The majority of the patients with diabetes were seen by primary care physicians. In general, the studies reported significant improvements in patient health behaviors and outcomes. Some differences in outcomes between the different models of care were observed. CONCLUSION Our findings suggest that the effects of DSME on patients' health behaviors and outcomes could differ by the different models of diabetes care. However, considering the limited sample of publications reviewed, and because none of the reviewed studies directly measured the impact of the DSME program on patient behaviors and outcomes, significant conclusions could not be reached.
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Affiliation(s)
- Emmanuel Kumah
- Policy, Planning, Monitoring, & Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Emmanuel K. Afriyie
- Laboratory Services Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aaron A. Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Ghana
| | - Samuel E. Ankomah
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Adam Fusheini
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Center for Health Literacy and Rural Health Promotion, P.O. Box GP1563, Accra, Ghana
| | - Godfred Otchere
- Policy, Planning, Monitoring, & Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Hu XJ, Wu HF, Li YT, Wang Y, Cheng H, Wang JJ, Mohammed BH, Tan I, Wang HHX. Influence of health education on clinical parameters in type 2 diabetic subjects with and without hypertension: A longitudinal, comparative analysis in routine primary care settings. Diabetes Res Clin Pract 2020; 170:108539. [PMID: 33161048 DOI: 10.1016/j.diabres.2020.108539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/26/2020] [Accepted: 10/18/2020] [Indexed: 12/14/2022]
Abstract
AIM To assess the influence of health education for type 2 diabetic patients with and without coexisting hypertension in routine primary care where intensive educational consultations were absent. METHODS A longitudinal cohort was constructed from 342 diabetic subjects who previously had regular exposure to face-to-face health education delivered quarterly during 2016-2017 under the national basic public health (BPH) service provision in an urbanised township in China. Clinical parameters were retrieved electronically from computerised BPH data platform at prior check-ups (2016-2017) and at the most recent check-up (2019). RESULTS The satisfactory clinical improvements upon health education were not sustained during subsequent observational years among study subjects. A significant increase in total cholesterol (0.28 mmol/L for between-group net changes, 95% confidence interval [CI] = 0.01-0.55 mmol/L, p = 0.039) were observed in diabetic subjects with coexisting hypertension. Older patients (adjusted odds ratio [aOR] = 0.87, 95%CI = 0.83-0.91, p less than 0.001), males (aOR = 0.50, 95%CI = 0.26-0.98, p = 0.043), and subjects with lower education level (aOR = 0.34, 95%CI = 0.17-0.67, p = 0.002) were less likely to maintain improvement of biomedical parameters. CONCLUSION The influence of face-to-face health education may not be prolonged in routine primary care where intensive provisions of educational consultations were less common. Diabetic patients with coexisting hypertension tend to have more difficulties in maintaining optimal lipid profiles.
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Affiliation(s)
- Xiu-Jing Hu
- School of Public Health, Sun Yat-Sen University, PR China
| | - Hua-Feng Wu
- Shishan Community Health Centre of Nanhai, Foshan, PR China
| | - Yu-Ting Li
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, PR China
| | - Yi Wang
- School of Public Health, Sun Yat-Sen University, PR China
| | - Hui Cheng
- School of Public Health, Sun Yat-Sen University, PR China
| | - Jia-Ji Wang
- School of Public Health, Guangzhou Medical University, Guangzhou, PR China; Guangdong-provincial Primary Healthcare Association (GDPHA), PR China
| | - Bedru H Mohammed
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Isabella Tan
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Harry H X Wang
- School of Public Health, Sun Yat-Sen University, PR China; JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland, UK.
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13
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Bisio A, Gamarra E, Broglio F, Grassi G. Coping strategies in people with type 1 diabetes on insulin pump treatment. MINERVA ENDOCRINOL 2020; 44:336-343. [DOI: 10.23736/s0391-1977.19.03024-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Florez L, Shubina M, Turchin A. Predictors of glycemic control after decline of insulin therapy by patients with type 2 diabetes. J Diabetes Complications 2019; 33:107418. [PMID: 31477552 DOI: 10.1016/j.jdiacomp.2019.107418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/13/2019] [Accepted: 08/15/2019] [Indexed: 12/21/2022]
Abstract
AIM Decline of insulin therapy by patients is common but poorly investigated. We conducted this study to determine patient and treatment characteristics predictive of glycemic control after declining clinician recommendation to initiate insulin therapy. METHODS We retrospectively studied adults with type 2 diabetes mellitus treated at two academic medical centers between 1993 and 2014 who declined their healthcare provider recommendation to initiate insulin. RESULTS In a multivariable analysis of 300 study patients adjusted for demographics, comorbidities and clustering within providers, higher baseline HbA1c (OR 1.85; 95% CI 1.40 to 2.39; p < 0.001) and lifestyle changes (OR 8.39; 95% CI 3.26 to 21.55; p < 0.001) were associated with greater, while non-adherence to diabetes medications (OR 0.014; 95% CI 0.0025 to 0.085; p < 0.001) and discontinuation of a non-insulin diabetes medication (OR 0.30; 95% CI 0.11 to 0.80; p = 0.016) were associated with lower probability of HbA1c decrease after declining insulin therapy. CONCLUSION We identified patient characteristics and treatment strategies associated with success and failure of glycemic control after insulin therapy decline by the patient. This information can assist in selection of optimal therapeutic approaches for these individuals.
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Affiliation(s)
- Luisa Florez
- Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Maria Shubina
- Brigham and Women's Hospital, Boston, MA, United States of America
| | - Alexander Turchin
- Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
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15
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Shah MK, Moore MA, Narayan KMV, Ali MK. Trends in Lifestyle Counseling for Adults With and Without Diabetes in the U.S., 2005-2015. Am J Prev Med 2019; 57:e153-e161. [PMID: 31630765 PMCID: PMC6814385 DOI: 10.1016/j.amepre.2019.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Strong evidence shows that lifestyle change and weight loss stimulated by counseling improve glycemic control and lower comorbidities for patients with diabetes, but it is unclear whether diet or physical activity counseling for patients with diabetes in ambulatory settings has actually been responsive to this evidence. METHODS Data from the 2005-2015 National Ambulatory Medical Care Surveys were used to assess trends in provider-reported diet or exercise counseling during ambulatory care visits. The data were pooled and multivariate logistic regression models were built, adjusting for patient-, provider-, and practice-level characteristics to examine whether the provision of counseling varied by these characteristics. Data were analyzed from September 2018 to December 2018. RESULTS There were 42,234 adults with diabetes and 272,094 adults without diabetes. The proportions of patients with provider-reported Type 2 diabetes who received any diet or exercise counseling were no different over time, 30% in 2005 (95% CI=25%, 35%) and 25% in 2015 (95% CI=18%, 31%). Lower proportions of those without diabetes received any counseling, 17% in 2005 (95% CI=14%, 19%) and 15% in 2015 (95% CI=11%, 18%). Adjusted models showed that Hispanic patients had a higher likelihood of receiving diet or exercise counseling, compared with whites (OR=1.38, 95% CI=1.09, 1.75). Those aged 30-49 years were more likely to receive diet or exercise counseling than those aged >75 years (OR=1.51, 95% CI=1.27, 1.80). Compared with rural areas and other providers, visits in a metropolitan area (OR=1.27, 95% CI=1.09, 1.47) or with an advanced practice provider (OR=1.66, 95% CI=1.00, 2.75) had a higher likelihood of any diet or exercise counseling delivery. CONCLUSIONS Less than 30% of Americans with diabetes receive diet or exercise counseling in ambulatory visits, and this proportion has not changed significantly in a decade. Future interventions should focus on addressing this gap in counseling.
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Affiliation(s)
- Megha K Shah
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia; Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia.
| | - Miranda A Moore
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia; Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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16
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Zhang H, Goldberg SI, Hosomura N, Shubina M, Simonson DC, Testa MA, Turchin A. Lifestyle Counseling and Long-term Clinical Outcomes in Patients With Diabetes. Diabetes Care 2019; 42:1833-1836. [PMID: 31371430 DOI: 10.2337/dc19-0629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/28/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the relationship between lifestyle counseling in primary care settings and clinical outcomes in patients with diabetes. RESEARCH DESIGN AND METHODS We retrospectively studied hyperglycemic adults with diabetes treated at primary care practices between 2000 and 2014. We analyzed the relationship between frequency of lifestyle counseling (identified using natural language processing of electronic notes) and a composite outcome of death and cardiovascular events during subsequent follow-up. RESULTS Among patients with monthly counseling or more, 10-year cumulative incidence of the primary outcome was 33.0% compared with 38.1% for less than monthly counseling (P = 0.0005). In multivariable analysis, higher frequency of lifestyle counseling was associated with lower incidence of the primary outcome (hazard ratio 0.88 [95% CI 0.82-0.94]; P < 0.001). CONCLUSIONS More frequent lifestyle counseling was associated with a lower incidence of cardiovascular events and death among patients with diabetes.
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Affiliation(s)
- Huabing Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Brigham and Women's Hospital, Boston, MA
| | | | - Naoshi Hosomura
- Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | - Donald C Simonson
- Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | - Alexander Turchin
- Brigham and Women's Hospital, Boston, MA .,Harvard Medical School, Boston, MA.,Baim Institute for Clinical Research, Boston, MA
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17
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Emeka PM, AlMunjem MF, Rasool ST, Kamil N. Evaluation of Counseling Practices and Patient's Satisfaction Offered by Pharmacists for Diabetics Attending Outpatient Pharmacies in Al Ahsa. J Patient Exp 2019; 7:338-345. [PMID: 32821793 PMCID: PMC7410136 DOI: 10.1177/2374373519846945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Patient counseling can be helpful in improving the outcome of disease management, particularly chronic diseases such as diabetes mellitus, which is common in Saudi Arabia. The present study looks to investigate the levels of counseling and satisfaction among patients attending diabetic clinics in outpatient hospital pharmacy in Al Ahsa, Saudi Arabia. Method This is a cross-sectional investigation, carried out by using interview-structured questionnaire, targeting diabetes mellitus patients with or without comorbid states. The questionnaire was divided into 3 parts comprising of demographics, counseling types given while collecting prescription, and satisfaction rating of services provided. Result More males than females participated; most of whom were college graduates older than 51 years. Sixty-three percent of the entire participants are type 1 diabetic patients, while 37% are type 2 diabetes mellitus patients. Coexistence of hypercholesterolemia was higher among type 1 diabetes patients with 51.9%, while hypertension was more common among type 2 diabetic patients representing 68.2%. Findings also showed that counseling was provided for medication use among type 1 diabetic patients but was deficient in the case of type 2 diabetic patients. Patients received low level of counseling on side effects and healthy lifestyle living. Satisfaction level was only 11.1%, indicating that counseling services might be deficient. Conclusion This study has revealed poor counseling practices and low satisfaction levels in services provided by outpatient hospital pharmacies to diabetic patients. In the face of increasing prevalence of diabetes and comorbidity, counseling of diabetic patients is critical.
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Affiliation(s)
- Promise M Emeka
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Hofuf, Al Ahsa, Saudi Arabia
| | - Manea Fares AlMunjem
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Hofuf, Al Ahsa, Saudi Arabia
| | - Sahibzada Tasleem Rasool
- Department of Biomedical Sciences College of Clinical Pharmacy, King Faisal University, Hofuf, Al Ahsa, Saudi Arabia
| | - Noor Kamil
- Department of Pharmacology, Barrett Hodgson University, Karachi, Pakistan
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18
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Saengtipbovorn S. Efficacy of Brief Lifestyle Change in conjunction with Dental Care (Brief-LCDC) Programs on glycemic and periodontal status among DM patients. JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.1108/jhr-09-2018-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
A global trend of type 2 diabetes prevalence is rising. Preventing and managing of systemic and dental complications is crucial to decrease negative effects on glycemic control. The purpose of this paper is to estimate the efficacy of Brief Lifestyle Change in conjunction with Dental Care (Brief-LCDC) Programs to decrease glycemic level and improve periodontal status in patients with type 2 diabetes.
Design/methodology/approach
Health Center 54 conducted randomized controlled trial among 192 patients (96 intervention and 96 control) from February to August 2018. Group education for lifestyle modification, individual oral hygiene instruction and lifestyle counseling by motivational interviewing was provided to the intervention group at baseline. Motivation of lifestyle modification every month by multimedia was also provided to the intervention group. The usual program was provided to the control group. At baseline and a six-month follow-up, glycemic level and periodontal status were assessed from participants. Data were analyzed by descriptive statistic, t-test, χ2 test, Fisher’s exact test, Repeated measure ANOVA and multiple linear regression.
Findings
Glycemic level and periodontal status were lower in the intervention group than the control group at the sixth-month followed up with statistical significances. Glycemic level and periodontal status had negatively correlated to intervention group with statistically significant.
Originality/value
Brief-LCDC Program which incorporated lifestyle modification and oral health care had efficacious to decrease glycemic level and improve periodontal status in patients with type 2 diabetes. Early prevention program by Brief-LCDC Program is crucial to prevent dental complications.
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19
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Arasu A, Moran LJ, Robinson T, Boyle J, Lim S. Barriers and Facilitators to Weight and Lifestyle Management in Women with Polycystic Ovary Syndrome: General Practitioners' Perspectives. Nutrients 2019; 11:nu11051024. [PMID: 31067757 PMCID: PMC6566405 DOI: 10.3390/nu11051024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Weight and lifestyle management is advocated as the first-line treatment for polycystic ovary syndrome (PCOS) by evidence-based guidelines. Current literature describes both systems- and individual-related challenges that general practitioners (GPs) face when attempting to implement guideline recommendations for lifestyle management into clinical practice for the general population. The GPs’ perspective in relation to weight and lifestyle advice for PCOS has not been captured. Methods: Fifteen GPs were recruited to take part in semi-structured interviews. NVIVO software was used for qualitative analysis. Results: We report that GPs unanimously acknowledge the importance of weight and lifestyle management in PCOS. Practice was influenced by both systems-related and individual-related facilitators and barriers. Individual-related barriers include perceived lack of patient motivation for weight loss, time pressures, lack of financial reimbursement, and weight management being professionally unrewarding. System-related barriers include costs of accessing allied health professionals and unavailability of allied health professionals in certain locations. Individual-related facilitators include motivated patient subgroups such as those trying to get pregnant and specific communication techniques such as motivational interviewing. System-related facilitators include the GP’s role in chronic disease management. Conclusions: This study contributes to the understanding of barriers and facilitators that could be addressed to optimize weight and lifestyle management in women with PCOS in primary care.
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Affiliation(s)
- Alexis Arasu
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3168, Australia.
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3168, Australia.
| | - Tracy Robinson
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3168, Australia.
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3168, Australia.
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3168, Australia.
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20
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Ungar N, Schmidt L, Gabrian M, Haussmann A, Tsiouris A, Sieverding M, Steindorf K, Wiskemann J. Which self-management strategies do health care professionals recommend to their cancer patients? An experimental investigation of patient age and treatment phase. J Behav Med 2018; 42:342-352. [PMID: 30353398 DOI: 10.1007/s10865-018-9980-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
Abstract
This vignette based study aimed to examine recommendations of health care professionals (HCPs) in promoting self-management strategies to cancer patients. Nine-hundred-forty-two physicians and nurses were asked to (1) indicate if they would recommend self-management strategies to a vignette cancer patient, and (2) to specify those in an open format. Vignettes included a manipulation of patient age (60 vs. 75 years) and treatment phase (currently treated versus treatment completed). Six categories emerged through coding a total of 2303 recommendations: physical activity (71.8%), nutrition (64.3%), psychological support (36.7%), medical support (29.2%), conscious living (17.2%) and naturopathy (12.3%). While psychological support was particularly recommended during treatment, physical activity was more frequently recommended after completion of treatment. Results suggest that HCPs recommend a variety of self-management strategies besides standard medical treatment. Patient's treatment phase and age seem to partly influence recommendation behavior, potentially indicating insecurities regarding acute treatment situations and age-related stereotypes.
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Affiliation(s)
- Nadine Ungar
- Institute of Psychology, Heidelberg University, Hauptstr. 47-51, 69117, Heidelberg, Germany.
| | - Laura Schmidt
- Institute of Psychology, Heidelberg University, Hauptstr. 47-51, 69117, Heidelberg, Germany
| | - Martina Gabrian
- Institute of Psychology, Heidelberg University, Hauptstr. 47-51, 69117, Heidelberg, Germany
| | - Alexander Haussmann
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Angeliki Tsiouris
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Hospital Heidelberg, Heidelberg, Germany
| | - Monika Sieverding
- Institute of Psychology, Heidelberg University, Hauptstr. 47-51, 69117, Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Hospital Heidelberg, Heidelberg, Germany
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21
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Kumah E, Sciolli G, Toraldo ML, Murante AM. The diabetes self-management educational programs and their integration in the usual care: A systematic literature review. Health Policy 2018; 122:866-877. [PMID: 30007520 DOI: 10.1016/j.healthpol.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/02/2018] [Accepted: 06/06/2018] [Indexed: 12/14/2022]
Abstract
The increasing prevalence of type 2 diabetes has highlighted the importance of evidence-based guidelines for effective prevention, management and treatment. Diabetes self-management education (SME) produces positive effects on patient behaviours and health status. We analyzed the literature to identify (i) the level of integration between usual care and SME programs and (ii) any possible differences across them in terms of outcomes. Searches were made on three databases - PubMed, Scopus and Web of Science - to identify relevant publications on diabetes SME to 2015, which also describe the provider of usual care. In total, 49 studies met the inclusion criteria. We identified three levels of integration (high, medium and low) between usual care and SME programs based on the level of involvement of usual care professionals within the SME programs. In most cases, the primary care physician was responsible for the diabetes patients. Patient health behaviors and/or outcomes improve in most of the studies, independently from the level of integration. However, findings suggest that when patients/participants could perceive that usual care provider is highly involved in SME delivery, educational programs produced results that appear to be more positive.
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Affiliation(s)
- Emmanuel Kumah
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Italy
| | - Giulia Sciolli
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Italy
| | - Maria Laura Toraldo
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Italy
| | - Anna Maria Murante
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Italy.
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22
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Hicks K, Howard M, Murano P. A Gap in the United States Healthcare System: Physician Nutrition Education Knowledge and Application. MEDEDPUBLISH 2017; 6:193. [PMID: 38406404 PMCID: PMC10885313 DOI: 10.15694/mep.2017.000193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Physicians demonstrate an insufficiency in medical nutrition training, yet are expected to deliver nutrition counseling to patients with chronic disease. There is a clear understanding that unhealthy lifestyle behaviors (e.g. smoking, physical inactivity, poor diet) contribute to morbidity and mortality across the nation and worldwide. A preventable contribution to millions of deaths annually, which can be mitigated via brief nutrition and lifestyle counseling. Primary care is the ideal venue to deliver nutrition education and counseling, with a majority of all Americans regularly visiting their physician offices. With preventive medicine on the rise, is it imperative that a physician is proficient to have a sense of medical nutrition, to briefly counsel patients. This missing link, if fixed, will change the healthcare delivery system and overall patient outcomes for the better.
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23
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Lv N, Xiao L, Simmons ML, Rosas LG, Chan A, Entwistle M. Personalized Hypertension Management Using Patient-Generated Health Data Integrated With Electronic Health Records (EMPOWER-H): Six-Month Pre-Post Study. J Med Internet Res 2017; 19:e311. [PMID: 28928111 PMCID: PMC5627043 DOI: 10.2196/jmir.7831] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/29/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND EMPOWER-H (Engaging and Motivating Patients Online With Enhanced Resources-Hypertension) is a personalized-care model facilitating engagement in hypertension self-management utilizing an interactive Web-based disease management system integrated with the electronic health record. The model is designed to support timely patient-provider interaction by incorporating decision support technology to individualize care and provide personalized feedback for patients with chronic disease. Central to this process were patient-generated health data, including blood pressure (BP), weight, and lifestyle behaviors, which were uploaded using a smartphone. OBJECTIVE The aim of this study was to evaluate the program among patients within primary care already under management for hypertension and with uncontrolled BP. METHODS Using a 6-month pre-post design, outcome measures included office-measured and home-monitored BP, office-measured weight, intervention contacts, diet, physical activity, smoking, knowledge, and health-related quality of life. RESULTS At 6 months, 55.9% of participants (N=149) achieved office BP goals (<140/90 mm Hg; P<.001) and 86.0% achieved clinically meaningful reduction in office BP (reduction in systolic BP [SBP] ≥5 mm Hg or diastolic BP [DBP] ≥3 mm Hg). At baseline, 25.2% of participants met home BP goals (<135/85 mm Hg), and this percentage significantly increased to 71.4% (P<.001) at 6 months. EMPOWER-H also significantly reduced both office and home SBP and DBP, decreased office-measured weight and consumption of high-salt and high-fat foods (all P<.005), and increased intake of fruit and vegetables, minutes of aerobic exercise, and hypertension knowledge (all P<.05). Patients with higher home BP upload frequencies had significantly higher odds of achieving home BP goals. Patients receiving more total intervention, behavioral, pharmaceutical contacts had significantly lower odds of achieving home BP goals but higher improvements in office BP (all P<.05). CONCLUSIONS EMPOWER-H significantly improved participants' office-measured and home-monitored BP, weight, and lifestyle behaviors, suggesting that technologically enabled BP home-monitoring, with structured use of patient-generated health data and a personalized care-plan facilitating patient engagement, can support effective clinical management. The experience gained in this study provides support for the feasibility and value of using carefully managed patient-generated health data in the day-to-day clinical management of patients with chronic conditions. A large-scale, real-world study to evaluate sustained effectiveness, cost-effectiveness, and scalability is warranted.
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Affiliation(s)
- Nan Lv
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Lan Xiao
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Martha L Simmons
- Office of Patient Experience, Sutter Health, Mountain View, CA, United States
| | - Lisa G Rosas
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States.,Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Albert Chan
- Office of Patient Experience, Sutter Health, Mountain View, CA, United States
| | - Martin Entwistle
- Office of Patient Experience, Sutter Health, Mountain View, CA, United States.,Ares Health Solutions, Pasadena, CA, United States
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24
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Hempler NF, Joensen LE, Willaing I. Relationship between social network, social support and health behaviour in people with type 1 and type 2 diabetes: cross-sectional studies. BMC Public Health 2016; 16:198. [PMID: 26926867 PMCID: PMC4772283 DOI: 10.1186/s12889-016-2819-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 02/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychosocial and behavioural aspects of diabetes may differ according to diabetes type. This study compared people with type 1 and type 2 diabetes with respect to social relations (cohabitation status, contact with the social network and social support) and health behaviours (diet and physical activity). Furthermore, we examined whether potential differences in health behaviour between people with type 1 and type 2 diabetes were influenced by education level and social relations. METHODS We conducted two cross-sectional surveys consisting of people with type 2 diabetes (N = 1081) and type 1 diabetes (N = 2419) from a specialist diabetes clinic. Gender-stratified stepwise multiple regression models assessed differences by diabetes type and other variables of interest. RESULTS Significant associations were found between diabetes type and social network, social support and health behaviour. No differences were observed regarding cohabitation status. People with type 2 diabetes were less physically active, less likely to follow recommended diet (men), had fewer contacts with family and friends and were less certain of counting on help in case of severe illness than people with type 1 diabetes. No impact of education level, social network and social support were observed concerning differences in health behaviours by diabetes type; however, in women, the association between physical activity and diabetes type was not significant after adjustment for social relations and education level. CONCLUSIONS People with type 2 diabetes had less contact with the social network, less certainty about support in case of severe illness and fewer healthy behaviours than people with type 1 diabetes. It may be important to draw attention to differences in health behaviours and social relations between people with type 1 and type 2 diabetes in diabetes care, patient education and support initiatives.
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Affiliation(s)
- Nana F Hempler
- Steno Diabetes Center, Health Promotion Research, Niels Steensens Vej 8, 2820, Gentofte, Denmark.
| | - Lene E Joensen
- Steno Diabetes Center, Health Promotion Research, Niels Steensens Vej 8, 2820, Gentofte, Denmark
| | - Ingrid Willaing
- Steno Diabetes Center, Health Promotion Research, Niels Steensens Vej 8, 2820, Gentofte, Denmark
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Ting DSW, Cheung GCM, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol 2016; 44:260-77. [DOI: 10.1111/ceo.12696] [Citation(s) in RCA: 444] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 12/07/2015] [Accepted: 12/21/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Daniel Shu Wei Ting
- Singapore National Eye Center, Singapore Health Service (SingHealth); Singapore Singapore
- Singapore Eye Research Institute; Singapore Singapore
| | - Gemmy Chui Ming Cheung
- Singapore National Eye Center, Singapore Health Service (SingHealth); Singapore Singapore
- Singapore Eye Research Institute; Singapore Singapore
- Duke-NUS Graduate Medical School; Singapore Singapore
| | - Tien Yin Wong
- Singapore National Eye Center, Singapore Health Service (SingHealth); Singapore Singapore
- Singapore Eye Research Institute; Singapore Singapore
- Duke-NUS Graduate Medical School; Singapore Singapore
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Hosomura N, Goldberg SI, Shubina M, Zhang M, Turchin A. Electronic Documentation of Lifestyle Counseling and Glycemic Control in Patients With Diabetes. Diabetes Care 2015; 38:1326-32. [PMID: 26070590 DOI: 10.2337/dc14-2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 03/28/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To establish quantitative characteristics of lifestyle counseling documentation associated with improved glycemic control in patients with diabetes. RESEARCH DESIGN AND METHODS We retrospectively studied 10,870 hyperglycemic (HbA1c ≥7.0% [53 mmol/mol]) adults with diabetes followed at primary care practices affiliated with two academic hospitals between 2000 and 2010. Documentation intensity was represented by the mean number of characters per note documenting lifestyle counseling. Heterogeneity was calculated as the normalized Levenshtein distance between lifestyle counseling sentences between consecutive notes. Cox proportional hazards model was constructed to assess association of heterogeneity and intensity of lifestyle counseling documentation to time to HbA1c <7.0% (53 mmol/mol) while adjusting for demographics, initial HbA1c level, insulin therapy, medication intensification, and frequency of lifestyle counseling. RESULTS Comparing patients in the highest versus lowest tertile by documentation heterogeneity and documentation intensity, median time to HbA1c <7.0% (53 mmol/mol) was 26 vs. 39 months and 24 vs. 39 months, respectively (P < 0.001 for all). In multivariable analysis, an increase of documentation heterogeneity by 0.15 units and an increase of documentation intensity by 45 characters/note was associated with hazard ratios of 1.08 (95% CI 1.04-1.12; P < 0.001) and 1.27 (95% CI 1.23-1.31; P < 0.001) for time to HbA1c target, respectively. CONCLUSIONS Higher heterogeneity and intensity of lifestyle counseling documentation in provider notes were associated with better glycemic control. Further studies involving direct observation of patient care are needed to establish the nature of the relationship between documentation characteristics and patient outcomes.
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Affiliation(s)
- Naoshi Hosomura
- Division of Endocrinology, Brigham and Women's Hospital, Boston, MA
| | - Saveli I Goldberg
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Maria Shubina
- Division of Endocrinology, Brigham and Women's Hospital, Boston, MA
| | - Mary Zhang
- Division of Endocrinology, Brigham and Women's Hospital, Boston, MA
| | - Alexander Turchin
- Division of Endocrinology, Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA Harvard Clinical Research Institute, Boston, MA
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Saengtipbovorn S, Taneepanichskul S. Effectiveness of lifestyle change plus dental care program in improving glycemic and periodontal status in aging patients with diabetes: a cluster, randomized, controlled trial. J Periodontol 2015; 86:507-15. [PMID: 25597411 DOI: 10.1902/jop.2015.140563] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Currently, there is an increased prevalence of diabetes mellitus among the aging adult population. To minimize adverse effects on glycemic control, prevention and management of general and oral complications in patients with diabetes are essential. The objective of this study is to assess the effectiveness of the lifestyle change plus dental care (LCDC) program to improve glycemic and periodontal status in aging patients with diabetes. METHODS A cluster, randomized, controlled trial was conducted in Health Centers 54 (intervention) and 59 (control) from October 2013 to April 2014. Sixty-six patients with diabetes per health center were included. At baseline, the intervention group attended 20-minute lifestyle and oral health education, individual lifestyle counseling, application of a self-regulation manual, and individual oral hygiene instruction. At month 3, the intervention group received individual lifestyle counseling and oral hygiene instruction. The intervention group received booster education every visit by viewing a 15-minute educational video. The control group received a routine program. Participants were assessed at baseline and 3- and 6-month follow-up for glycemic and periodontal status. Data were analyzed by using descriptive statistic, χ(2) test, Fisher exact test, t test, and repeated-measures analysis of variance. RESULTS After the 6-month follow-up, participants in the intervention group had significantly lower glycated hemoglobin, fasting plasma glucose, plaque index, gingival index, probing depth, and attachment loss when compared with the control group. CONCLUSION The combination of lifestyle change and dental care in one program improved both glycemic and periodontal status in older patients with diabetes.
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Brunisholz KD, Briot P, Hamilton S, Joy EA, Lomax M, Barton N, Cunningham R, Savitz LA, Cannon W. Diabetes self-management education improves quality of care and clinical outcomes determined by a diabetes bundle measure. J Multidiscip Healthc 2014; 7:533-42. [PMID: 25473293 PMCID: PMC4247143 DOI: 10.2147/jmdh.s69000] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The purpose of this study was to determine the impact of diabetes self-management education (DSME) in improving processes and outcomes of diabetes care as measured by a five component diabetes bundle and HbA1c, in individuals with type 2 diabetes mellitus (T2DM). METHODS A retrospective analysis was performed for adult T2DM patients who received DSME training in 2011-2012 from an accredited American Diabetes Association center at Intermountain Healthcare (IH) and had an HbA1c measurement within the prior 3 months and 2-6 months after completing their first DSME visit. Control patients were selected from the same clinics as case-patients using random number generator to achieve a 1 to 4 ratio. Case and control patients were included if 1) pre-education HbA1c was between 6.0%-14.0%; 2) their main provider was a primary care physician; 3) they met the national Healthcare Effectiveness Data and Information Set criteria for inclusion in the IH diabetes registry. The IH diabetes bundle includes retinal eye exam, nephropathy screening or prescription of angiotensin converting enzyme or angiotensin receptor blocker; blood pressure <140/90 mmHg, LDL <100 mg/dL, HbA1c <8.0%. RESULTS DSME patients had a significant difference in achievement of the five element IH diabetes bundle and in HbA1c % compared to those without DSME. After adjusting for possible confounders in a multivariate logistic regression model, DSME patients had a 1.5 fold difference in improvement in their diabetes bundle and almost a 3 fold decline in HbA1c compared to the control group. CONCLUSION Standardized DSME taught within an IH American Diabetes Association center is strongly associated with a substantial improvement in patients meeting all five elements of a diabetes bundle and a decline in HbA1c beyond usual care. Given the low operating cost of the DSME program, these results strongly support the value adding benefit of this program in treating T2DM patients.
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Affiliation(s)
- Kimberly D Brunisholz
- Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA ; Institute for Healthcare Delivery, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Pascal Briot
- Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA ; Institute for Healthcare Delivery, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Sharon Hamilton
- Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Elizabeth A Joy
- Office of Research, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Michael Lomax
- Institute for Healthcare Delivery, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Nathan Barton
- Institute for Healthcare Delivery, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Lucy A Savitz
- Institute for Healthcare Delivery, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Wayne Cannon
- Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA
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Saengtipbovorn S, Taneepanichskul S. Effectiveness of lifestyle change plus dental care (LCDC) program on improving glycemic and periodontal status in the elderly with type 2 diabetes. BMC Oral Health 2014; 14:72. [PMID: 24934646 PMCID: PMC4069273 DOI: 10.1186/1472-6831-14-72] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/09/2014] [Indexed: 12/16/2022] Open
Abstract
Background Currently, there is an increased prevalence of diabetes mellitus among the elderly. To minimize adverse effects on glycemic control, prevention and management of general and oral complications in diabetic patients is essential. The purpose of the present study is to assess the effectiveness of a Lifestyle Change plus Dental Care (LCDC) program to improve glycemic and periodontal status in the elderly with type 2 diabetes. Methods A quasi-experimental study was conducted in Health Centers 54 (intervention) and 59 (control) from October 2013 to January 2014. 66 diabetic patients per health center were included. At baseline, the intervention group attended a 20 minute lifestyle and oral health education program, individual lifestyle counseling using motivational interviewing (MI), application of self regulation manual, and individual oral hygiene instruction. The intervention group received booster education every visit by viewing a 15 minute educational video. The control group received a routine program. Participants were assessed at baseline and 3 month follow up for glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), body mass index (BMI), periodontal status, knowledge, attitude and practice of oral health and diabetes mellitus. Data were analyzed by using descriptive statistic, Chi-square test, Fisher’s exact test, t-test, and multiple linear regression. Results After the 3 month follow up, a multiple linear regression analysis showed that the intervention group was significantly negatively correlated in both glycemic and periodontal status. Participants in the intervention group had significantly lower glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), plaque index score, gingival index score, pocket depth, clinical attachment level (CAL), and percentage of bleeding on probing (BOP) when compared to the control group. Conclusions The combination of lifestyle change and dental care in one program improved both glycemic and periodontal status in the elderly with type 2 diabetes. Trial registration ClinicalTrials.in.th: TCTR20140602001.
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Type 2 diabetes patients' perspectives on lifestyle counselling and weight management in general practice: a qualitative study. BMC FAMILY PRACTICE 2014; 15:97. [PMID: 24885605 PMCID: PMC4027991 DOI: 10.1186/1471-2296-15-97] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 05/07/2014] [Indexed: 11/25/2022]
Abstract
Background Lifestyle counselling is a pivotal aspect of diabetes care. But general practitioners (GPs) often have problems in finding their role in patients’ weight management. The aims of this study were to investigate the experiences of type 2 diabetes patients with lifestyle counselling from their GPs and to explore how patients’ preferences regarding counselling are embedded in the context of self-management and wider cultural aspects of nutrition. Methods Narrative interviews were conducted with 35 people with type 2 diabetes aged between 35 and 77 years. The interviews were transcribed verbatim and analysed using the thematic framework method. Results Many patients had a strong feeling of personal responsibility for weight reduction as integral to diabetes self-management but found it difficult to integrate the changes their disease requires into their self-management activities. They attached great importance to their GPs’ advice on diet. While some patients appreciated direct communication, others regarded dramatic pictures as either unhelpful or offending. A serious problem was the incompatibility of the dietary recommendations with daily life resulting in a reluctance to adjust the whole diet to the needs of diabetes care. Conclusions Ambivalence towards patient self-management and tensions between the necessary changes to patients’ lifestyles and their culture, makes the GP’s role difficult and full of conflict. Instead of focusing exclusively on the guidelines of diabetes management and provision of information, GPs should explore the patients’ capabilities of self-management through open communication and accept their patients’ wishes to protect nutrition as part of their culture.
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Hazlehurst BL, Lawrence JM, Donahoo WT, Sherwood NE, Kurtz SE, Xu S, Steiner JF. Automating assessment of lifestyle counseling in electronic health records. Am J Prev Med 2014; 46:457-64. [PMID: 24745635 PMCID: PMC4511267 DOI: 10.1016/j.amepre.2014.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 12/09/2013] [Accepted: 01/02/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Numerous population-based surveys indicate that overweight and obese patients can benefit from lifestyle counseling during routine clinical care. PURPOSE To determine if natural language processing (NLP) could be applied to information in the electronic health record (EHR) to automatically assess delivery of weight management-related counseling in clinical healthcare encounters. METHODS The MediClass system with NLP capabilities was used to identify weight-management counseling in EHRs. Knowledge for the NLP application was derived from the 5As framework for behavior counseling: Ask (evaluate weight and related disease), Advise at-risk patients to lose weight, Assess patients' readiness to change behavior, Assist through discussion of weight-loss methods and programs, and Arrange follow-up efforts including referral. Using samples of EHR data between January 1, 2007, and March 31, 2011, from two health systems, the accuracy of the MediClass processor for identifying these counseling elements was evaluated in postpartum visits of 600 women with gestational diabetes mellitus (GDM) compared to manual chart review as the gold standard. Data were analyzed in 2013. RESULTS Mean sensitivity and specificity for each of the 5As compared to the gold standard was at or above 85%, with the exception of sensitivity for Assist, which was 40% and 60% for each of the two health systems. The automated method identified many valid Assist cases not identified in the gold standard. CONCLUSIONS The MediClass processor has performance capability sufficiently similar to human abstractors to permit automated assessment of counseling for weight loss in postpartum encounter records.
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Affiliation(s)
- Brian L Hazlehurst
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.
| | - Jean M Lawrence
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California
| | - William T Donahoo
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado
| | - Nancy E Sherwood
- HealthPartners Institute for Education & Research, Minneapolis, Minnesota
| | - Stephen E Kurtz
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Stan Xu
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado
| | - John F Steiner
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado
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Olsen M, Anderbro T, Amsberg S, Leksell J, Moberg E, Lisspers J, Gudbjörnsdottir S, Johansson UB. Psychometric Properties of the Swedish Version of the Fear of Complications Questionnaire. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojemd.2014.44008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zhang M, Shubina M, Morrison F, Turchin A. Following the money: copy-paste of lifestyle counseling documentation and provider billing. BMC Health Serv Res 2013; 13:377. [PMID: 24225135 PMCID: PMC3850686 DOI: 10.1186/1472-6963-13-377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 09/27/2013] [Indexed: 11/15/2022] Open
Abstract
Background Evidence suggests that copy-pasted components of electronic notes may not reliably reflect the care delivered. Federal agencies have raised concerns that such components may be used to justify inappropriately inflated claims for reimbursement. It is not known whether copied information is used to justify higher evaluation and management (E&M) charges. Methods This retrospective cohort study aimed to assess the relationship between the level of evaluation and management (E&M) charges and the method of documentation (none, distinct or copied) of lifestyle counseling (diet, exercise and weight loss) for patients with diabetes mellitus. To determine the association, an ordered multinomial logistic regression model that corrected for clustering within individual providers and patients and adjusted for patient and encounter characteristics was utilized. E&M charge level served as the primary outcome variable. Patients were included if they were followed by primary care physicians affiliated with two academic hospitals for a minimum of two years between 01/01/2000 and 12/13/2009. Results Lifestyle counseling was documented in 65.4% of 155,168 primary care encounters of 16,164 patients. Copied counseling was identified in 12,527 encounters. In multivariable analysis higher E&M charges were associated with older patient age, longer notes, treatment with insulin, medication changes and acute complaints. However, copied lifestyle counseling was associated with a decrease of 70.5% in the odds of higher E&M charge levels when time spent on counseling (required to justify higher charges based on counseling) was recorded (p<0.0001). This finding is opposite to what would have been expected if the impetus for copied documentation of lifestyle counseling was an increase in submitted E&M charges. Conclusion There is no evidence that copied documentation of lifestyle counseling is used to justify higher evaluation and management charges. Higher charges were generally associated with indicators of complexity of care.
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Glasgow RE, Strycker LA, King DK, Toobert DJ. Understanding who benefits at each step in an internet-based diabetes self-management program: application of a recursive partitioning approach. Med Decis Making 2013; 34:180-91. [PMID: 23913917 DOI: 10.1177/0272989x13498156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Efforts to predict success in chronic disease management programs have been generally unsuccessful. OBJECTIVE To identify patient subgroups associated with success at each of 6 steps in a diabetes self-management (DSM) program. DESIGN Using data from a randomized trial, recursive partitioning with signal detection analysis was used to identify subgroups associated with 6 sequential steps of program success: agreement to participate, completion of baseline, initial website engagement, 4-month behavior change, later engagement, and longer-term maintenance. SETTING The study was conducted in 5 primary care clinics within Kaiser Permanente Colorado. PATIENTS Different numbers of patients participated in each step, including 2076, 544, 270, 219, 127, and 89. All measures available were used to address success at each step. Intervention. Participants were randomized to receive either enhanced usual care or 1 of 2 Internet-based DSM programs: 1) self-administered, computer-assisted self-management and 2) the self-administered program with the addition of enhanced social support. MEASUREMENTS Two sets of potential predictor variables and 6 dichotomous outcomes were created. RESULTS Signal detection analysis differentiated successful and unsuccessful subgroups at all but the final step. Different patient subgroups were associated with success at these different steps. Demographic factors (education, ethnicity, income) were associated with initial participation but not with later steps, and the converse was true of health behavior variables. LIMITATIONS Analyses were limited to one setting, and the sample sizes for some of the steps were modest. CONCLUSIONS Signal detection and recursive partitioning methods may be useful for identifying subgroups that are more or less successful at different steps of intervention and may aid in understanding variability in outcomes.
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Affiliation(s)
- Russell E Glasgow
- Implementation Science, Division of Cancer Control and Population Science, National Cancer Institute, Rockville, Maryland (REG)
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Noordman J, Koopmans B, Korevaar JC, van der Weijden T, van Dulmen S. Exploring lifestyle counselling in routine primary care consultations: the professionals' role. Fam Pract 2013; 30:332-40. [PMID: 23221102 DOI: 10.1093/fampra/cms077] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND It is generally acknowledged that GPs and practice nurses (PNs) may significantly contribute to a patient's healthy lifestyle behaviour. Two counselling techniques are known to strengthen this process: tailoring information and advice about lifestyle behaviour to a patient and motivational interviewing (MI). It is not clear to what extent GPs and PNs actually apply these techniques during routine consultations. OBJECTIVES To examine how GPs and PNs discuss patients' lifestyle behaviour, in terms of the level of tailoring of information and advice and their application of MI. METHODS We randomly videotaped GP-patient and PN-patient consultations within Dutch general practices and selected 124 and 141 consultations, respectively, that included any discussion about the patient's lifestyle. These were analysed, using the 'Behaviour Change Counselling Index', level of tailoring and content of lifestyle counselling. RESULTS Information about lifestyle is mainly given in generic terms by GPs and PNs. In contrast, advice about smoking behaviour more often seems to be tailored to the patient. GPs hardly ever applied MI in their consultations about patient's lifestyle behaviour. PNs trained in MI did apply this technique, but to some extent only. CONCLUSION Both GPs and PNs somehow perform lifestyle counselling according to generally acknowledged criteria. However, for both, there is room for improvement in the application of MI skills and in tailoring of information and advice about lifestyle behaviour. Effort needs to be put into integrating such techniques into busy daily practice while simultaneously complying with the many other clinical demands.
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Affiliation(s)
- Janneke Noordman
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands.
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Morrison F, Shubina M, Goldberg SI, Turchin A. Performance of primary care physicians and other providers on key process measures in the treatment of diabetes. Diabetes Care 2013; 36:1147-52. [PMID: 23230095 PMCID: PMC3631881 DOI: 10.2337/dc12-1382] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Studies have shown that patients without a consistent primary care provider have inferior outcomes. However, little is known about the mechanisms for these effects. This study aims to determine whether primary care physicians (PCPs) provide more frequent medication intensification, lifestyle counseling, and patient encounters than other providers in the primary care setting. RESEARCH DESIGN AND METHODS This retrospective cohort study included 584,587 encounters for 27,225 patients with diabetes and elevated A1C, blood pressure, and/or LDL cholesterol monitored for at least 2 years. Encounters occurred at primary care practices affiliated with two teaching hospitals in eastern Massachusetts. RESULTS Of the encounters documented, 83% were with PCPs, 13% were with covering physicians, and 5% were with midlevel providers. In multivariable analysis, the odds of medication intensification were 49% (P < 0.0001) and 26% (P < 0.0001) higher for PCPs than for covering physicians and midlevel providers, respectively, whereas the odds of lifestyle counseling were 91% (P < 0.0001) and 21% (P = 0.0015) higher. During visits with acute complaints, covering physicians were even less likely, by a further 52% (P < 0.0001), to intensify medications, and midlevel providers were even less likely, by a further 41% (P < 0.0001), to provide lifestyle counseling. Compared with PCPs, the hazard ratios for time to the next encounter after a visit without acute complaints were 1.11 for covering physicians and 1.19 for midlevel providers (P < 0.0001 for both). CONCLUSIONS PCPs provide better care through higher rates of medication intensification and lifestyle counseling. Covering physicians and midlevel providers may enable more frequent encounters when PCP resources are constrained.
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Affiliation(s)
- Fritha Morrison
- Division of Endocrinology, Brigham and Women’s Hospital, Boston, MA, USA
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Dacey M, Arnstein F, Kennedy MA, Wolfe J, Phillips EM. The impact of lifestyle medicine continuing education on provider knowledge, attitudes, and counseling behaviors. MEDICAL TEACHER 2013; 35:e1149-56. [PMID: 23137250 DOI: 10.3109/0142159x.2012.733459] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND There is a need for effective continuing medical education (CME) programs to increase healthcare providers' knowledge and skills in lifestyle medicine so that healthcare providers are better equipped to assist patients in adopting and maintaining healthier lifestyle behaviors. AIMS To evaluate the impact of five live face-to-face CME programs in lifestyle medicine on providers' barriers, knowledge, confidence, and professional counseling behaviors. METHODS 200 participants completed researcher-generated surveys before and 90 days after each CME program. Paired t-tests measured significant changes for all outcome variables, and regression analyses assessed predictors of these changes. RESULTS Barriers that were targeted during the programs, i.e. lack of knowledge/skills, lack of materials, and perceived poor patient compliance showed highly significant improvement. Participants also reported significant changes in knowledge, confidence, and counseling behaviors in the areas of exercise and stress management. Some improvements occurred in areas that the CME programs did not target as much, i.e. nutrition, smoking, and weight management. The greatest predictor of change was the baseline level of scores. Those participants who could most benefit from change did show the largest improvements. CONCLUSIONS Live CME programs can be effective in educating healthcare providers about topics within the rapidly expanding field of lifestyle medicine.
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Affiliation(s)
- Marie Dacey
- Institute of Lifestyle Medicine and Spaulding Rehabilitation Hospital, USA.
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Gee ME, Pickett W, Janssen I, Johnson JA, Campbell NR. Health Behaviors for Hypertension Management in People With and Without Coexisting Diabetes. J Clin Hypertens (Greenwich) 2013; 15:389-96. [DOI: 10.1111/jch.12093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/09/2013] [Accepted: 02/21/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Marianne E. Gee
- Department of Community Health and Epidemiology; Queen's University; Kingston ON Canada
- Centre for Chronic Disease Prevention; Public Health Agency of Canada; Ottawa ON Canada
| | - William Pickett
- Department of Community Health and Epidemiology; Queen's University; Kingston ON Canada
- Department of Emergency Medicine; Queen's University; Kingston ON Canada
| | - Ian Janssen
- Department of Community Health and Epidemiology; Queen's University; Kingston ON Canada
- School of Kinesiology and Health Studies; Queen's University; Kingston ON Canada
| | - Jeffrey A. Johnson
- Department of Public Health Sciences; University of Alberta; Edmonton AB Canada
| | - Norman R.C. Campbell
- Departments of Medicine; Community Health Sciences and of Physiology and Pharmacology; Libin Cardiovascular Institute; University of Calgary; Calgary AB Canada
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Kalra S, Kalra B. Counselling Patients for GLP-1 Analogue Therapy: Comparing GLP-1 Analogue with Insulin Counselling. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:638-40. [PMID: 23272306 PMCID: PMC3530320 DOI: 10.4103/1947-2714.104315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology and Gynaecology, Bharti Hospital, Karnal, India. E-mail:
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Tournier M, Bégaud B, Cougnard A, Auleley GR, Deligne J, Blum-Boisgard C, Thiébaut ACM, Verdoux H. Influence of the drug exposure definition on the assessment of the antipsychotic metabolic impact in patients initially treated with mood-stabilizers. Br J Clin Pharmacol 2012; 74:189-96. [PMID: 22257309 DOI: 10.1111/j.1365-2125.2012.04184.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Metabolic disturbances represent a well-known side effect of second generation antipsychotics. However, studies comparing second generation antipsychotic drugs (SGAPs) and first generation antipsychotic drugs (FGAPs) through administrative databases have shown contrasting findings, which may be attributable to methodological differences. WHAT THIS PAPER ADDS • The definition of antipsychotic exposure impacts on the association between antipsychotics and metabolic risk in studies carried out through administrative databases. • Considering cumulative exposure to antipsychotics or including patients exposed to an antipsychotic drug for months or years is likely to over-represent patients who tolerate the drug well with a depletion of susceptible effects. • Antipsychotic drug exposure is a time-varying determinant and episodes of no use, past use and current use should be distinguished over the study period to avoid any misclassification bias that might lead to misleading findings. AIMS To assess the influence of three definitions of antipsychotic exposure on the comparison between first generation (FGAP) and second generation (SGAP) antipsychotic drugs and 'conventional' mood stabilizers towards the risk of metabolic events using (i) a dichotomous measure (exposed/non-exposed over the follow-up), (ii) a categorical measure taking into account the chronology of exposure at the time of the metabolic event (current, recent and no use) and (iii) a continuous measure (cumulative duration). METHODS A historical fixed cohort was identified from the 2004-2006 claims database of the French health insurance programme for self-employed workers, including 3172 patients aged 18 years and over who used conventional mood stabilizers over a 3 month period. A metabolic event was defined as an incident dispensing of an anti-diabetic or lipid-lowering drug. RESULTS A metabolic event occurred in 367 patients (11.6%). At least one FGAP had been prescribed in 29% of patients who did not develop a metabolic event and in 22% of patients who developed a metabolic event. In addition, at least one SGAP had been prescribed in 12% of patients who did not develop a metabolic event and in 7% of patients who developed a metabolic event. Compared with conventional mood stabilizers, the risk of a metabolic event was negatively associated with exposure to SGAPs over the follow-up period (HR 0.53, 95% CI 0.34, 0.82, P= 0.004), positively associated with recent, but not current, exposure to SGAPs (HR 2.1, 95% CI 1.2, 3.7, P= 0.006) and not associated with cumulative duration of SGAPs (HR 1.001, 95% CI 0.999, 1.003, P= 0.20). CONCLUSIONS The definition of exposure to antipsychotics in epidemiological studies exploring their metabolic impact is of paramount importance in understanding this association. Different definitions can lead to opposite and seemingly nonsensical results. Not taking into account past exposure, in order to minimize the depletion of susceptible effects, may lead to absurd results.
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Abstract
By definition, brittle diabetes (BD) is an unstable condition. Patients with BD suffer chronically from poor metabolic control, characterized by severe instability of glycemic values with frequent and unpredictable hypoglycemic and/or diabetic ketoacidosis episodes that cannot be attributed to failure in management. Quality of life is dramatically compromised because of very frequent acute complications leading to hospital admissions and because of premature chronic complications. It remains difficult to identify all patients with BD as diagnostic criteria are still not well defined. In practice, metabolic instability is manifested most obviously by chaotic glycemic profiles, which show greater and more unpredictable variation than in "stable" patients with diabetes. It is important that patients with BD are not adequately controlled, even by closely supervised, intensive insulin regimens, including continuous subcutaneous and/or intravenous insulin infusion. Their care is often very expensive in terms of time and resources, and their lives are constantly at risk for severe metabolic derangement. Management can also be frustrating and demoralizing for everyone involved, including the patient's family as well as the diabetes care team. Adopting a team approach, involving a broad range of disciplines, is essential in treating patients with BD and helping them to achieve and maintain both normoglycemia and quality of life.
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Affiliation(s)
- Christina Voulgari
- 3rd Department of Internal Medicine, Athens Regional General Hospital G Gennimatas, University Medical School, Athens, Greece.
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