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Tan SHX, Ang SB, Tan NC, Lee CS, Koh EYL, Koh GCH, Wang Y. Cost-Effectiveness of a Home Telemonitoring System for Asian Adults with Type 2 Diabetes Mellitus. Telemed J E Health 2024. [PMID: 38916871 DOI: 10.1089/tmj.2024.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Background: Telemonitoring programs have been found to be effective in improving diabetic control by promoting patients' self-management of diabetes through medication adherence, dietary modifications, and exercise. Nonetheless, few studies have assessed the cost-effectiveness of telemonitoring for the self-management of diabetes based on real-world data. Methods: A randomized controlled trial entitled Optimizing care of Patients via Telehealth In Monitoring and Augmenting their control of Diabetes Mellitus was conducted among adults with Type 2 Diabetes Mellitus in Singapore. Individuals in the intervention group (n = 159) underwent a telemonitoring program comprising of remote patient monitoring, education, individualized health coaching, and teleconsultations, whereas individuals in the control group (n = 160) received regular care. Economic evaluation was conducted from health care system and societal perspectives in 2020 in Singapore dollars, using health outcomes and costs documented at baseline and at 6 month follow-up. One-way sensitivity analyses and bootstrapping to generate scatter plot on cost-effectiveness planes were done. Results: The adjusted reduction in HbA1c scores was greater in the intervention group by -0.41 (95% confidence interval [CI], -0.65 to -0.17), while the change in utility scores was higher in the intervention group by 0.011 (95% CI, -0.016 to 0.0378). From a health care perspective, the incremental cost-effectiveness ratio (ICER) of the telemonitoring program per unit improvement in HbA1c, per additional case of well-controlled diabetes, and per unit improvement in quality adjusted life years was SGD 580.44, SGD 9100.15, and SGD 21,476.36, respectively. From a societal perspective, the ICERs were SGD 817.20, SGD 12,812.02, and SGD 30,236.36, respectively. Conclusions: The Optimizing care of Patients via Telehealth In Monitoring and Augmenting their control of Diabetes Mellitus telemonitoring program was effective and potentially cost-effective for the management and control of diabetes among patients in primary care.
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Affiliation(s)
- Sharon Hui Xuan Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Seng Bin Ang
- Future Primary Care, MOH Office for Transformation, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Ngiap Chuan Tan
- Research Department, SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - Cia Sin Lee
- Research Department, SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | | | - Gerald Choon Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Future Primary Care, MOH Office for Transformation, Singapore, Singapore
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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Liu L, Chen Y, Li X, Wang J, Yang L. Therapeutic potential: The role of mesenchymal stem cells from diverse sources and their derived exosomes in diabetic nephropathy. Biomed Pharmacother 2024; 175:116672. [PMID: 38677249 DOI: 10.1016/j.biopha.2024.116672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 04/29/2024] Open
Abstract
Diabetic nephropathy (DN) is one of the most common microvascular complications in diabetic patients, with its incidence continuously increasing in recent years. DN causes renal tissue damage and functional decline, expedites the aging process of the kidneys, and may ultimately progress leading to end-stage renal disease, severely impacting the patient's quality of life and prognosis. Mesenchymal stem cells (MSCs) are highly valued for their multipotent differentiation, paracrine functions, immunomodulatory effects, and capacity for tissue repair. Particularly, exosomes (Exo) derived from MSCs (MSCs-Exo) are rich in bioactive molecules and facilitate intercellular communication, participating in various physiological and pathological processes. MSCs and MSCs-Exo, in particular, have been demonstrated to have therapeutic effects in DN treatment research by encouraging tissue repair, fibrosis inhibition, and inflammation reduction. Research has shown that MSCs and MSCs-Exo have therapeutic effects in DN treatment by promoting tissue repair, inhibiting fibrosis, and reducing inflammation. Recent studies underscore the potential of MSCs and MSCs-Exo, highlighting their broad applicability in DN treatment. This review aims to provide a comprehensive summary of the scientific developments in treating DN using MSCs and MSCs-Exo from diverse sources, while also exploring their future therapeutic possibilities in detail.
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Affiliation(s)
- Lixin Liu
- Departments of Geriatrics, The First Hospital of China Medical University, Shenyang, Liaoning 110001, PR China
| | - Yiman Chen
- Departments of Geriatrics, The First Hospital of China Medical University, Shenyang, Liaoning 110001, PR China
| | - Xuan Li
- Department of Vascular and Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning 110001, PR China.
| | - Juan Wang
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, PR China.
| | - Lina Yang
- Departments of Geriatrics, The First Hospital of China Medical University, Shenyang, Liaoning 110001, PR China; Department of International Physical Examination Center, The First Hospital of China Medical University, Shenyang, Liaoning 110001, PR China.
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Gohil K. An overview of diabetes-related foot ulcers. Br J Community Nurs 2024; 29:S30-S36. [PMID: 38814845 DOI: 10.12968/bjcn.2024.29.sup6.s30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
The escalating prevalence of diabetes mellitus presents concern due to its widespread organ damage, including the heart, kidneys, eyes, and nerves, leading to severe complications such as heart attacks, strokes, blindness, and diabetes-related foot ulcers (DFUs). Management in the community setting should be focused on prevention, assessment and patient-centred care. By understanding the complex aetiology, risk factors, and classification of DFUs, along with utilising evidence-based interventions like the Wound, Infection and Ischemia (WIfI) system, we can streamline care. Neuropathy, peripheral arterial disease and infection are major contributors to DFU development, highlighting the importance of early detection and intervention. Comprehensive care addressing vascular health, infection control, pressure offloading, wound management, metabolic control, and patient education is essential for successful DFU management. Ultimately, proactive prevention strategies and interdisciplinary collaboration are necessary in the management of DFUs and improving patient outcomes.
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Affiliation(s)
- Krishna Gohil
- Senior Lecturer in Prescribing and Podiatry, Faculty of Health, Education & Society, University of Northampton
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Alshowair A, Altamimi S, Alruhaimi FA, Alshahrani S, Alsuwailem F, Alkhaldi M, Abdalla H, Alkhuraiji FH, Alaqeel MS, Almureef SS, Alhawasy S, Abdel-Azeem A. Cost-Savings Associated with Multi-Disciplinary Team Approach for Reducing Macrovascular and Microvascular Complications in Patients with Type 2 Diabetes: A Predictive Model. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:211-223. [PMID: 38596283 PMCID: PMC11001564 DOI: 10.2147/ceor.s451739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Purpose This study aims to predict the expected cost savings associated with implementing a multidisciplinary team (MDT) approach to reduce macrovascular and microvascular complications among patients with type 2 diabetes mellitus (T2DM). Methods This economic evaluation study was conducted in Riyadh First Health Cluster, Saudi Arabia as a predictive model conceptualized by the authors based on models used in previous studies, particularly the CORE Diabetes Model. Our model was designed based on 1) the level of glycemic control among 24,755 T2DM patients served by MDTs; 2) the expected incidence of diabetes-related complications without intervention; 3) the predicted risk reduction of developing diabetes-related complications with MDTs. Costs of complications and cost savings were then calculated and expressed as mean incremental annual cost savings adjusted for a 1% reduction in HbA1c, and a 10 mmHg reduction in systolic blood pressure (SBP). Results Along with the expected reduction in all diabetes-related complications, the average incremental cost savings per diabetic patient is predicted to be ($38,878) with approximately ($11,108) in the year of complication onset and ($27,770) over the subsequent post-index 10-years. On adjustment of cost savings, the average incremental cost savings are predicted to be ($22,869) for each 1% reduction in HbA1c per diabetic patient and ($27,770) for every 10 mmHg reduction in SBP per diabetic patient. Conclusion MDT as a model of care is effective in glycemic control among T2DM patients with a predicted significant reduction of all diabetes-related complications and in turn, a predicted significant cost savings.
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Affiliation(s)
- Abdulmajeed Alshowair
- Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Saleh Altamimi
- Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Faisal A Alruhaimi
- Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Saad Alshahrani
- Academic and Training Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Fatima Alsuwailem
- Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Mona Alkhaldi
- Health Administration Office, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Haiam Abdalla
- Model of Care, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | | | - Montaser Saad Alaqeel
- Financial Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | | | - Salman Alhawasy
- Reporting Department, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Amro Abdel-Azeem
- Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine Zagazig University, Zagazig, Egypt
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Montero AR, Nassar CM, Ahmed S, Magee M. Pilot feasibility and efficacy of a strategy to sustain A1C improvement among diverse adults with type 2 diabetes completing a diabetes care management program. BMJ Open Diabetes Res Care 2024; 12:e003788. [PMID: 38471671 DOI: 10.1136/bmjdrc-2023-003788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Evidence-based strategies are needed to sustain improvements in outcomes following diabetes care management (DCM) programs. We examined the impact of Boot Camp-Plus (BC-Plus), an innovative sustaining strategy, on A1C among adults with type 2 diabetes completing a 3-month Diabetes Boot Camp (DBC). This health system sponsored program consisted of diabetes self-management education and support, medical nutrition therapy and antihyperglycemic medications management. RESEARCH DESIGN AND METHODS From March 2019 to July 2021, adult DBC completers with Medicare or a health system Medicaid or employee commercial plan were enrolled in BC-Plus for 9 months. DBC completers not meeting insurance eligibility or who declined to participate in BC-Plus acted as controls. During the first 3 months, BC-Plus participants received ongoing daily remote blood glucose (BG) monitoring; and during all 9 months, they received monthly check-in calls with BG review by a medical assistant who addressed needs for supplies/drugs, whether participants were checking BGs, and self-care encouragement. Escalation to a nurse practitioner occurred if the monthly BG trend was >200 mg/dL and/or several BG <80 mg/dL and/or new A1C >9.0% were identified. A1C was followed for an additional 9 months post-BC-Plus. A longitudinal mixed effects analysis was used to assess change in A1C from month 0 to month 21 of follow-up between BC-Plus participants versus controls. RESULTS A total of 838 DCM completers were identified, among whom 281 joined the BC-Plus intervention and 557 acted as controls. Mean age was 55.9 years; 58.2% were women; 66.2% were black; and 30.6% insured by Medicare. BC-Plus participants experienced significantly lower A1C compared with controls and remained below 8.0% to month 18. CONCLUSIONS Among completers of a 3-month DCM program, a low intensity 9-month sustaining strategy maintained A1C under 8.0% (HEDIS (Healthcare Effectiveness Data and Information Set) threshold for diabetes control) compared with controls for 15 months after completion of the initial DCM intervention.
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Affiliation(s)
- Alex Renato Montero
- MedStar Diabetes Institute, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
- Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Carine M Nassar
- MedStar Diabetes Institute, Washington, DC, USA
- MedStar Health Research Institute, Hyattsville, Maryland, USA
| | - Saba Ahmed
- Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Michelle Magee
- MedStar Diabetes Institute, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health Research Institute, Hyattsville, Maryland, USA
- MedStar Washington Hospital Center, Washington, DC, USA
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Xiong Y, Huo Z, Wong SYS, Yip BHK. Cost effectiveness of nonpharmacological prevention programs for diabetes: A systematic review of trial-based studies. Chronic Dis Transl Med 2024; 10:12-21. [PMID: 38450300 PMCID: PMC10914011 DOI: 10.1002/cdt3.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 03/08/2024] Open
Abstract
Trial-based economic value of prevention programs for diabetes is inexplicit. We aimed to review the cost-effectiveness of nonpharmacological interventions to prevent type-2 diabetes mellitus (T2DM) for high-risk people. Six electronic databases were searched up to March 2022. Studies assessing both the cost and health outcomes of nonpharmacological interventions for people at high-risk of T2DM were included. The quality of the study was assessed by the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. The primary outcome for synthesis was incremental cost-effectiveness ratios (ICER) for quality-adjusted life years (QALYs), and costs were standardized in 2022 US dollars. Narrative synthesis was performed, considering different types and delivery methods of interventions. Sixteen studies included five based on the US diabetes prevention program (DPP), six on non-DPP-based lifestyle interventions, four on health education, and one on screening plus lifestyle intervention. Compared with usual care, lifestyle interventions showed higher potential of cost-effectiveness than educational interventions. Among lifestyle interventions, DPP-based programs were less cost-effective (median of ICERs: $27,077/QALY) than non-DPP-based programs (median of ICERs: $1395/QALY) from healthcare perspectives, but with larger decreases in diabetes incidence. Besides, the cost-effectiveness of interventions was more possibly realized through the combination of different delivery methods. Different interventions to prevent T2DM in high-risk populations are both cost-effective and feasible in various settings. Nevertheless, economic evidence from low- and middle-income countries is still lacking, and interventions delivered by trained laypersons and combined with peer support sessions or mobile technologies could be potentially a cost-effective solution in such settings with limited resources.
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Affiliation(s)
- Yongyi Xiong
- Jockey Club School of Public Health and Primary Care, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong KongChina
| | - Zhaohua Huo
- Jockey Club School of Public Health and Primary Care, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong KongChina
| | - Samuel Y. S. Wong
- Jockey Club School of Public Health and Primary Care, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong KongChina
| | - Benjamin H. K. Yip
- Jockey Club School of Public Health and Primary Care, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong KongChina
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Wadden TA, Kushner RF, Chao AM. Bariatric Surgery Produces Long-Term Benefits in Patients With Type 2 Diabetes: Evidence Supporting Its Expanded Use and Coverage. JAMA 2024; 331:643-645. [PMID: 38411656 DOI: 10.1001/jama.2023.28141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
- Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Robert F Kushner
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ariana M Chao
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
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Chai XY, Bao XY, Dai Y, Dai XX, Zhang Y, Yang YL. Experience of humanistic nursing in hemodialysis nursing for patients with diabetic kidney disease. World J Diabetes 2024; 15:186-195. [PMID: 38464378 PMCID: PMC10921157 DOI: 10.4239/wjd.v15.i2.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/05/2023] [Accepted: 12/27/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD) is a prevalent complication of diabetes that often requires hemodialysis for treatment. In the field of nursing, there is a growing recognition of the importance of humanistic care, which focuses on the holistic needs of patients, including their emotional, psychological, and social well-being. However, the application of humanistic nursing in the context of hemodialysis for DKD patients remains relatively unexplored. AIM To explore the experience of humanistic nursing in hemodialysis nursing for DKD patients. METHODS Ninety-six DKD patients treated with hemodialysis from March 2020 to June 2022 were included in the study and divided into the control cluster (48 cases) and the study cluster (48 cases) according to different nursing methods; the control cluster was given routine nursing and the study cluster was given humanized nursing. The variances of negative emotion mark, blood glucose, renal function, the incidence of complications, life mark and nursing satisfaction before and after nur-sing were contrasted between the two clusters. RESULTS No significant difference in negative emotion markers between the two clusters were observed before nursing (P > 0.05), and the negative emotion markers of the two clusters decreased after nursing. The Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale markers were lower in the study cluster than the control cluster. The healing rate of patients in the study cluster was significantly higher than the control cluster (97.92% vs 85.42%, P < 0.05). Blood glucose parameters were not significantly different between the groups prior to nursing (P > 0.05). However, after nursing, blood urea nitrogen and serum creatinine (SCr) levels in the study cluster were lower than those in the control cluster (P < 0.05). The incidence rate of complications was significantly lower in the study group compared to the control cluster (6.25% vs 20.83%, P < 0.05). There was no significant difference in the life markers between the two clusters before nursing. While the life markers increased after nursing for both groups, the 36-item health scale markers in the study cluster were higher than those within the control cluster (P < 0.05). Finally, the nursing satisfaction rate was 93.75% in the study cluster, compared to 75% in the control cluster (P < 0.05). CONCLUSION In hemodialysis for DKD patients, the implementation of humanistic nursing achieved ideal results, effectively reducing patients' psychological negative emotion markers so that they can actively cooperate with the diagnosis and nursing, facilitate the control of blood glucose and the maintenance of residual renal function, reduce the occurrence of complications, and finally enhance the life quality and nursing satisfaction of patients. It is worthy of being widely popularized and applied.
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Affiliation(s)
- Xiao-Ying Chai
- Department of Nephrology, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Xiao-Yan Bao
- Department of Hemodialysis, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Ying Dai
- Department of Endocrinology, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Xing-Xing Dai
- Department of Nephrology, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Yu Zhang
- Department of Endocrinology, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Yu-Ling Yang
- Department of Nephrology, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
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Rajeswaren V, Lu V, Chen H, Patnaik JL, Manoharan N. Healthcare Resource Utilization and Costs in an At-Risk Population With Diabetic Retinopathy. Transl Vis Sci Technol 2024; 13:12. [PMID: 38359018 PMCID: PMC10876016 DOI: 10.1167/tvst.13.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024] Open
Abstract
Purpose Several investigators have suggested the cost-effectiveness of earlier screening, management of risk factors, and early treatment for diabetic retinopathy (DR). We aimed to evaluate the extent of health care utilization and cost of delayed care by insurance type in a vulnerable patient population. Methods A retrospective analysis of patients with DR was conducted using electronic medical record (EMR) data from January 2014 to December 2020 at Denver Health Medical Center, a safety net institution. Patients were classified by disease severity and insurance status. DR-specific costs were assessed via Current Procedural Terminology (CPT) codes over a 24-month follow-up period. Results Among the 313 patients, a higher proportion of non-English speaking patients were uninsured. Rates of proliferative DR at presentation differed across insurance groups (62% of uninsured, 42% of discount plan, and 33% of Medicare/Medicaid, P = 0.016). There was a significant difference in the total median cost between discount plan patients ($1258, interquartile range [IQR] = $0 - $5901) and both Medicare patients ($751, IQR = $0, $7148, P = 0.037) and Medicaid patients ($593, IQR = $0 - $6299, P = 0.025). Conclusions There were higher rates of proliferative DR at presentation among the uninsured and discount plan patients and greater total median cost in discount plan patients compared to Medicare or Medicaid. These findings prioritize mitigating gaps in insurance coverage and barriers to preventative care among vulnerable populations. Translational Relevance Advanced diabetic disease and increased downstream health care utilization and cost vary across insurance type, suggesting improved access to preventative care is needed in these specific at-risk populations.
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Affiliation(s)
- Vivian Rajeswaren
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Vivian Lu
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hongan Chen
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer L. Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Niranjan Manoharan
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
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Gallagher KA, Mills JL, Armstrong DG, Conte MS, Kirsner RS, Minc SD, Plutzky J, Southerland KW, Tomic-Canic M. Current Status and Principles for the Treatment and Prevention of Diabetic Foot Ulcers in the Cardiovascular Patient Population: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e232-e253. [PMID: 38095068 PMCID: PMC11067094 DOI: 10.1161/cir.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Despite the known higher risk of cardiovascular disease in individuals with type 2 diabetes, the pathophysiology and optimal management of diabetic foot ulcers (DFUs), a leading complication associated with diabetes, is complex and continues to evolve. Complications of type 2 diabetes, such as DFUs, are a major cause of morbidity and mortality and the leading cause of major lower extremity amputation in the United States. There has recently been a strong focus on the prevention and early treatment of DFUs, leading to the development of multidisciplinary diabetic wound and amputation prevention clinics across the country. Mounting evidence has shown that, despite these efforts, amputations associated with DFUs continue to increase. Furthermore, due to increasing patient complexity of management secondary to comorbid conditions, such as cardiovascular disease, the management of peripheral artery disease associated with DFUs has become increasingly difficult, and care delivery is often episodic and fragmented. Although structured, process-specific approaches exist at individual institutions for the management of DFUs in the cardiovascular patient population, there is insufficient awareness of these principles in the general medicine communities. Furthermore, there is growing interest in better understanding the mechanistic underpinnings of DFUs to better define personalized medicine to improve outcomes. The goals of this scientific statement are to provide salient background information on the complex pathogenesis and current management of DFUs in cardiovascular patients, to guide therapeutic and preventive strategies and future research directions, and to inform public policy makers on health disparities and other barriers to improving and advancing care in this expanding patient population.
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Abstract
BACKGROUND The coronavirus pandemic of 2019 (COVID-19) forced worldwide recognition and implementation of telehealth as a means of providing continuity of care by varied health care institutions. Diabetes is a global health threat with rates that continue to accelerate, thereby causing an increased need for clinicians to provide diabetes care and education to keep up with demand. Utilizing technology to provide education via phone/smartphone, video/audio, web, text message, mobile apps, or a combination of these methods can help improve patient access and clinical outcomes, cut costs, and close gaps in care. METHODS While numerous publications have summarized the various tools and technologies available for capturing remote clinical data and their relevance to diabetes care and self-management, this review focuses on self-educational telehealth tools available for diabetes self-management, their advantages and disadvantages, and factors that need to be considered prior to implementation. Recent relevant studies indexed by PubMed were included. RESULTS The widespread use and popularity of phones/smartphones, tablets, computers, and the Internet by patients of all age groups, cultures, socioeconomic and geographic areas allow for increased outreach, flexibility, and engagement with diabetes education, either in combination or as an adjunct to traditional in-person visits. Demonstrated benefits of using health technologies for diabetes self-management education include improved lifestyle habits, reduced hemoglobin A1C levels, decreased health care costs, and better medication adherence. Potential drawbacks include lack of regulation, need for staff training on methodologies used, the requirement for patients to be tech savvy, privacy concerns, lag time with technology updates/glitches, and the need for more long-term research data on efficacy. CONCLUSIONS Telehealth technologies for diabetes self-education improve overall clinical outcomes and have come a long way. With increasing numbers of patients with diabetes, it is expected that more optimal and user-friendly methodologies will be developed to fully engage and help patients communicate with their physicians.
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Affiliation(s)
- Vidya Sharma
- Department of Nutrition & Dietetics, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Ramaswamy Sharma
- Department of Cell Systems and Anatomy, Joe R. & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
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Liang D, Zhu W, Huang J, Dong Y. A health economic analysis of an integrated diabetes care program in China: based on real-world evidence. Front Public Health 2023; 11:1211671. [PMID: 38169641 PMCID: PMC10758444 DOI: 10.3389/fpubh.2023.1211671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction An integrated care program was set up in China to improve the collaboration between primary healthcare centers and hospitals on diabetes management. This study aims to evaluate the economic value of this program with real-world data and to examine whether it can be promoted in primary healthcare settings in China. Methods This integrated diabetes care program was implemented in Yuhuan City, China, to coordinate primary care and specialty care, treatment and prevention services, as well as the responsibilities of doctors and nurses. Cost-effectiveness analysis was used to compare the short-term economic value of this program (intervention group) versus usual diabetes management (control group). The cost data were collected from a societal perspective, while the effectiveness indicators pointed to the improvement of control rates of fasting blood glucose (FBG), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels after the 1 year intervention. In addition, cost-utility analysis was applied to evaluate the long-term value of the two groups. Patients' long-term diabetes management costs and quality-adjusted life years (QALYs) were simulated by the United Kingdom Prospective Diabetes Study Outcomes Model 2. Results The results showed that for 1% FBG, SPB, and DBP control rate improvement, the costs for the intervention group were 290.53, 124.39, and 249.15 Chinese Yuan (CNY), respectively, while the corresponding costs for the control group were 655.19, 610.43, and 1460.25 CNY. Thus, the intervention group's cost-effectiveness ratios were lower than those of the control group. In addition, compared to the control group, the intervention group's incremental costs per QALY improvement were 102.67 thousand CNY, which means that the intervention was cost-effective according to the World Health Organization's standards. Discussion In conclusion, this study suggested that this integrated diabetes care program created short-term and long-term economic values through patient self-management support, primary care strengthening, and care coordination. As this program followed the principles of integrated care reform, it can be promoted in China. Also, its elements can provide valuable experience for other researchers to build customized integrated care models.
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Affiliation(s)
- Di Liang
- School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment, National Health Commission, Shanghai, China
| | - Wenjun Zhu
- School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment, National Health Commission, Shanghai, China
| | - Jiayan Huang
- School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment, National Health Commission, Shanghai, China
| | - Yin Dong
- The People’s Hospital of Yuhuan, Taizhou, China
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13
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Sen CK. Human Wound and Its Burden: Updated 2022 Compendium of Estimates. Adv Wound Care (New Rochelle) 2023; 12:657-670. [PMID: 37756368 PMCID: PMC10615092 DOI: 10.1089/wound.2023.0150] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023] Open
Abstract
Significance: Chronic wounds affect 10.5 million (up 2.3 million from the 2014 update) of U.S. Medicare beneficiaries. Chronic wounds impact the quality of life of nearly 2.5% of the total population of the United States. This fraction is larger in the elderly. These wounds can lead to a range of complications and health care costs. Given the aging population, the continued threat of diabetes and obesity worldwide, and the persistent problem of infection, it is expected that chronic wounds will continue to be a substantial clinical, social, and economic challenge. Disparities in the prevalence and management of chronic wounds exist, with underserved communities and marginalized populations often facing greater challenges in accessing quality wound care. These disparities exacerbate the public health burden. Recent Advances: U.S. Centers for Medicare and Medicaid Services had proposed revision of its local coverage determination limiting the use of skin substitute grafts/cellular and/or tissue-based products for the treatment of diabetic foot ulcers and venous leg ulcers in the U.S. Medicare population. In response to the comment phase, this proposal has been put on hold. The U.S. Food and Drug Administration (FDA) has renewed its focus on addressing nonhealing chronic wounds and has outlined efforts to address identified barriers to product development for nonhealing chronic wounds. The new approach places emphasis on engaging key wound healing stakeholders, including academia, professional associations, patient groups, reimbursement organizations, and industry. Finally, recent advances demonstrating that wounds closed by current FDA definition of wound closure may remain functionally open because of deficiencies in restoration of barrier function warrant revisiting the wound closure endpoint. Such "closed" wounds that are functionally open, also known as invisible wounds, are likely to be associated with high wound recurrence. Future Directions: Addressing the public health problem of chronic wounds will require a multifaceted approach that includes prevention, improved wound care management, and addressing the underlying risk factors.
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Affiliation(s)
- Chandan K. Sen
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Medical Center Health System Wound Care Service, Pittsburgh, Pennsylvania, USA
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14
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Canakis A, Wall-Wieler E, Liu Y, Zheng F, Sharaiha RZ. Type 2 Diabetes Remission After Bariatric Surgery and Its Impact on Healthcare Costs. Obes Surg 2023; 33:3806-3813. [PMID: 37851285 PMCID: PMC10687155 DOI: 10.1007/s11695-023-06856-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Bariatric surgery is the most effective and durable treatment of obesity and can put type 2 diabetes (T2D) into remission. We aimed to examine remission rates after bariatric surgery and the impacts of post-surgical healthcare costs. MATERIALS AND METHODS Obese adults with T2D were identified in Merative™ (US employer-based retrospective claims database). Individuals who had bariatric surgery were matched 1:1 with those who did not with baseline demographic and health characteristics. Rates of remission and total healthcare costs were compared at 6-12 and 6-36 months after the index date. RESULTS Remission rates varied substantially by baseline T2D complexity; differences in rates at 1 year ranged from 41% for those with high-complexity T2D to 66% for those with low- to mid-complexity T2D. At 3 years, those who had bariatric surgery had 56% higher remission rates than those who did not have bariatric surgery, with differences of 73%, 59%, and 35% for those with low-, mid-, and high-complexity T2D at baseline. Healthcare costs were $3401 and $20,378 lower among those who had bariatric surgery in the 6 to 12 months and 6 to 36 months after the index date, respectively, than their matched controls. The biggest cost differences were seen among those with high-complexity T2D; those who had bariatric surgery had $26,879 lower healthcare costs in the 6 to 36 months after the index date than those who did not. CONCLUSION Individuals with T2D undergoing bariatric surgery have substantially higher rates of T2D remission and lower healthcare costs.
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Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
| | - Elizabeth Wall-Wieler
- Global Health Economics and Outcomes Research, Intuitive Surgical, 1020 Kifer Road, Sunnyvale, CA, 94086, USA
| | - Yuki Liu
- Global Health Economics and Outcomes Research, Intuitive Surgical, 1020 Kifer Road, Sunnyvale, CA, 94086, USA
| | - Feibi Zheng
- Global Health Economics and Outcomes Research, Intuitive Surgical, 1020 Kifer Road, Sunnyvale, CA, 94086, USA
- DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1283 York Ave, 9th Floor, New York, NY, 10065, USA.
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15
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Betzler BK, Chee EYL, He F, Lim CC, Ho J, Hamzah H, Tan NC, Liew G, McKay GJ, Hogg RE, Young IS, Cheng CY, Lim SC, Lee AY, Wong TY, Lee ML, Hsu W, Tan GSW, Sabanayagam C. Deep learning algorithms to detect diabetic kidney disease from retinal photographs in multiethnic populations with diabetes. J Am Med Inform Assoc 2023; 30:1904-1914. [PMID: 37659103 PMCID: PMC10654858 DOI: 10.1093/jamia/ocad179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/04/2023] Open
Abstract
OBJECTIVE To develop a deep learning algorithm (DLA) to detect diabetic kideny disease (DKD) from retinal photographs of patients with diabetes, and evaluate performance in multiethnic populations. MATERIALS AND METHODS We trained 3 models: (1) image-only; (2) risk factor (RF)-only multivariable logistic regression (LR) model adjusted for age, sex, ethnicity, diabetes duration, HbA1c, systolic blood pressure; (3) hybrid multivariable LR model combining RF data and standardized z-scores from image-only model. Data from Singapore Integrated Diabetic Retinopathy Program (SiDRP) were used to develop (6066 participants with diabetes, primary-care-based) and internally validate (5-fold cross-validation) the models. External testing on 2 independent datasets: (1) Singapore Epidemiology of Eye Diseases (SEED) study (1885 participants with diabetes, population-based); (2) Singapore Macroangiopathy and Microvascular Reactivity in Type 2 Diabetes (SMART2D) (439 participants with diabetes, cross-sectional) in Singapore. Supplementary external testing on 2 Caucasian cohorts: (3) Australian Eye and Heart Study (AHES) (460 participants with diabetes, cross-sectional) and (4) Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) (265 participants with diabetes, cross-sectional). RESULTS In SiDRP validation, area under the curve (AUC) was 0.826(95% CI 0.818-0.833) for image-only, 0.847(0.840-0.854) for RF-only, and 0.866(0.859-0.872) for hybrid. Estimates with SEED were 0.764(0.743-0.785) for image-only, 0.802(0.783-0.822) for RF-only, and 0.828(0.810-0.846) for hybrid. In SMART2D, AUC was 0.726(0.686-0.765) for image-only, 0.701(0.660-0.741) in RF-only, 0.761(0.724-0.797) for hybrid. DISCUSSION AND CONCLUSION There is potential for DLA using retinal images as a screening adjunct for DKD among individuals with diabetes. This can value-add to existing DLA systems which diagnose diabetic retinopathy from retinal images, facilitating primary screening for DKD.
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Affiliation(s)
- Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
| | - Evelyn Yi Lyn Chee
- School of Computing, National University of Singapore, 117417, Singapore
| | - Feng He
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
| | - Cynthia Ciwei Lim
- Department of Renal Medicine, Singapore General Hospital, 168753, Singapore
| | - Jinyi Ho
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
| | - Haslina Hamzah
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore Health Services, 168582, Singapore
| | - Gerald Liew
- Westmead Institute for Medical Research, University of Sydney, NSW 2145, Australia
| | - Gareth J McKay
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, United Kingdom
| | - Ruth E Hogg
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, United Kingdom
| | - Ian S Young
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, United Kingdom
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, 169857, Singapore
| | - Su Chi Lim
- Khoo Teck Puat Hospital, 768828, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, 117549, Singapore
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA 98104, United States
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, 169857, Singapore
| | - Mong Li Lee
- School of Computing, National University of Singapore, 117417, Singapore
| | - Wynne Hsu
- School of Computing, National University of Singapore, 117417, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, 169857, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, 169857, Singapore
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16
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Reynolds EL, Mizokami-Stout K, Putnam NM, Banerjee M, Albright D, Ang L, Lee J, Pop-Busui R, Feldman EL, Callaghan BC. Cost and utilization of healthcare services for persons with diabetes. Diabetes Res Clin Pract 2023; 205:110983. [PMID: 37890702 PMCID: PMC11037241 DOI: 10.1016/j.diabres.2023.110983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
AIMS Describe and compare healthcare costs and utilization for insured persons with type 1 diabetes (T1D), type 2 diabetes (T2D), and without diabetes in the United States. METHODS Using a nationally representative healthcare claims database, we identified matched persons with T1D, T2D, and without diabetes using a propensity score quasi-randomization technique. In each year between 2009 and 2018, we report costs (total and out-of-pocket) and utilization for all healthcare services and those specific to medications, diabetes-related supplies, visits to providers, hospitalizations, and emergency department visits. RESULTS In 2018, we found out-of-pocket costs and total costs were highest for persons with T1D (out-of-pocket: $2,037.2, total: $25,652.0), followed by T2D (out-of-pocket: $1,543.3, total: $22,408.1), and without diabetes (out-of-pocket: $1,122.7, total: $14,220.6). From 2009 to 2018, out-of-pocket costs were increasing for persons with T1D(+6.5 %) but decreasing for T2D (-7.5 %) and without diabetes (-2.3 %). Medication costs made up the largest proportion of out-of-pocket costs regardless of diabetes status (T1D: 51.4 %, T2D: 55.4 %,without diabetes: 51.1 %). CONCLUSIONS Given the substantial out-of-pocket costs for people with diabetes, especially for those with T1D, providers should screen all persons with diabetes for financial toxicity (i.e., wide-ranging problems stemming from healthcare costs). In addition, policies that aim to lower out-of-pocket costs of cost-effective diabetes related healthcare are needed with a particular focus on medications.
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Affiliation(s)
- Evan L Reynolds
- Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, 1914 Taubman Center SPC 5316, Ann Arbor, MI 48109-5316, USA.
| | - Kara Mizokami-Stout
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Brehm Tower, Suite 5100, SPC 5714, 1000 Wall Street, Ann Arbor, MI 48105, USA.
| | - Nathaniel M Putnam
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
| | - Mousumi Banerjee
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
| | - Dana Albright
- Department of Pediatrics, Division of Pediatric Psychology, University of Michigan, C.S. Mott Children's Hospital, Pediatric Psychology Clinic, 1540 East Medical Center Drive Level 5, Ann Arbor, MI 48109-5318, USA.
| | - Lynn Ang
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Brehm Tower, Suite 5100, SPC 5714, 1000 Wall Street, Ann Arbor, MI 48105, USA.
| | - Joyce Lee
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Michigan, Medical Professional Building, Room D3202, Box: 5718, 1522 Simpson Road East, Ann Arbor, MI 48109-5718, USA.
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Brehm Tower, Suite 5100, SPC 5714, 1000 Wall Street, Ann Arbor, MI 48105, USA.
| | - Eva L Feldman
- Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, 1914 Taubman Center SPC 5316, Ann Arbor, MI 48109-5316, USA.
| | - Brian C Callaghan
- Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, 1914 Taubman Center SPC 5316, Ann Arbor, MI 48109-5316, USA.
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17
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Zhao R, Zhang X, Wang S, Zhao N, Li D, Fan H. Factors affecting T2DM patients' behaviors associated with integrated treatment and prevention services in China. Int J Equity Health 2023; 22:223. [PMID: 37858125 PMCID: PMC10588159 DOI: 10.1186/s12939-023-02028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE To explore the relationship between type 2 diabetes mellitus (T2DM) patients' attitude, subjective norms (SN), perceived behavioral control (PBC), behavioral intention (BI) and behavior associated with integrated treatment and preventive (ITP) services. METHODS A convenient sampling method was employed at a community health center in Nanjing, China between January and July 2022. The collected data were processed using Epidata 3.1, SPSS 26.0, and AMOS 24.0. Descriptive statistics and a structural equation model based on the theory of planned behavior (TPB) were used to explore the correlation between the study variables. RESULTS 430 participants were eventually included, with a response rate of 98.6%. The mean age was 72.50 ± 5.69 years. The TPB model proved to be suitable and explained 41% of the variance in the BI. Attitude (β = 0.289, P < 0.001), SN (β = 0.314, P < 0.001) and PBC (β = 0.261, P < 0.001) were the main predictors of BI, and the SN was the strongest. BI (β = 0.452, P < 0.001) and PBC (β = 0.452, P < 0.001) had similar direct effects on patients' behavior. CONCLUSION The TPB model explained the behavioral variations associated with ITP services and provided a framework for developing targeted interventions and improving community-based ITP services for T2DM. To encourage patients to engage in desirable behaviors, interventions should focus on modifying patients' SN towards behavior associated with ITP services by promoting peer pressure and increasing the family's emphasis on health.
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Affiliation(s)
- Ran Zhao
- School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Xia Zhang
- School of Nursing, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Sizhe Wang
- School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Nan Zhao
- School of Nursing, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Dianjiang Li
- School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Hong Fan
- School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China.
- School of Nursing, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China.
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18
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Thomas SA, Browning CJ, Charchar FJ, Klein B, Ory MG, Bowden-Jones H, Chamberlain SR. Transforming global approaches to chronic disease prevention and management across the lifespan: integrating genomics, behavior change, and digital health solutions. Front Public Health 2023; 11:1248254. [PMID: 37905238 PMCID: PMC10613497 DOI: 10.3389/fpubh.2023.1248254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
Chronic illnesses are a major threat to global population health through the lifespan into older age. Despite world-wide public health goals, there has been a steady increase in chronic and non-communicable diseases (e.g., cancer, cardiovascular and metabolic disorders) and strong growth in mental health disorders. In 2010, 67% of deaths worldwide were due to chronic diseases and this increased to 74% in 2019, with accelerated growth in the COVID-19 era and its aftermath. Aging and wellbeing across the lifespan are positively impacted by the presence of effective prevention and management of chronic illness that can enhance population health. This paper provides a short overview of the journey to this current situation followed by discussion of how we may better address what the World Health Organization has termed the "tsunami of chronic diseases." In this paper we advocate for the development, validation, and subsequent deployment of integrated: 1. Polygenic and multifactorial risk prediction tools to screen for those at future risk of chronic disease and those with undiagnosed chronic disease. 2. Advanced preventive, behavior change and chronic disease management to maximize population health and wellbeing. 3. Digital health systems to support greater efficiencies in population-scale health prevention and intervention programs. It is argued that each of these actions individually has an emerging evidence base. However, there has been limited research to date concerning the combined population-level health effects of their integration. We outline the conceptual framework within which we are planning and currently conducting studies to investigate the effects of their integration.
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Affiliation(s)
- Shane A Thomas
- Vice Chancellor’s Office, Federation University, Ballarat, VIC, Australia
| | - Colette J Browning
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC, Australia
- Health Innovation and Transformation Centre (HITC), Federation University, Ballarat, VIC, Australia
| | - Fadi J Charchar
- Health Innovation and Transformation Centre (HITC), Federation University, Ballarat, VIC, Australia
| | - Britt Klein
- Health Innovation and Transformation Centre (HITC), Federation University, Ballarat, VIC, Australia
| | - Marcia G. Ory
- Center for Community Health and Aging, Texas A&M University, School of Public Health, College Station, TX, United States
| | - Henrietta Bowden-Jones
- National Problem Gambling Clinic, London, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Samuel R. Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Southern Gambling Service, and Southern Health NHS Foundation Trust, Southampton, United Kingdom
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19
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Wang S, Liu K, Shi Z, Chen Q, Tang S. Instruments for measuring patient health education competence among nursing personnel: protocol for a COSMIN-based systematic review. BMJ Open 2023; 13:e072905. [PMID: 37802627 PMCID: PMC10565267 DOI: 10.1136/bmjopen-2023-072905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION Health education, as a crucial strategic measure of disease prevention and control in the 21st century, has become an important part of healthcare. As the main deliverers of patient health education, nursing personnel's patient health education competence (PHEC) has received much attention. Instruments for assessing the PHEC of nursing personnel have been developed internationally, but there is a lack of systematic reviews and evaluations of the psychometric properties of these instruments. To effectively select appropriate PHEC assessment instruments in specific contexts, a systematic and comprehensive review and evaluation of these measurement instruments are needed. The goal of this systematic review is to systematically evaluate the psychometric properties of existing PHEC instruments. METHODS AND ANALYSIS In this study, eight databases will be searched between 1 March 2023 and 31 2023 to retrieve studies that include instrument(s) measuring the PHEC of nursing personnel. Two researchers will independently perform literature screening, data extraction and literature evaluation. In case of disagreement, a third researcher will be involved in the resolution. The measurement properties of PHEC assessment instruments will be systematically reviewed based on the consensus-based standards for the selection of health measurement instruments (COMSIN) methodology and guideline. ETHICS AND DISSEMINATION Ethical approval is not applicable for this study. We will share the findings from the study at national and/or international conferences and in a peer-reviewed journal in the fields of health education and/or patient education. PROSPERO REGISTRATION NUMBER CRD42023393293.
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Affiliation(s)
- Shuyi Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Ke Liu
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Zeya Shi
- Department of Nursing, Hunan Provincial People's Hospital, Changsha, China
| | - Qirong Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Xiangya Center for Evidence-Based Practice & Healthcare Innovation: A Joanna Briggs Institute Affiliated Group, Changsha, Hunan, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Xiangya Center for Evidence-Based Practice & Healthcare Innovation: A Joanna Briggs Institute Affiliated Group, Changsha, Hunan, China
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20
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Pacheco YJ, Marin ELN, Ocampo DB, Gutiérrez CBB, Salom GAM, Ruiz JB, Garzon GFM, Casado JJP, Agudelo IMH, Mendez JAV, Lopez EHD, Bohorquez UM, Chamorro DR, Carrascal AO, Suarez EB, Cole W, Serena T, Marquez CA, Woodmansey E. Consenso de expertos sobre la eficacia clínica y directrices sobre la terapia de oxígeno transdérmico continuo para la cicatrización de las heridas complejas o difíciles de cicatrizar. J Wound Care 2023; 32:1-37. [PMID: 37934612 DOI: 10.12968/jowc.2023.32.latam_sup_10.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Oxygen is pivotal for wound healing. Its lack or hypoxia can delay this process, especially in individuals with comorbidities, potentially resulting in complex or hard-to-heal wounds. The Colombian Association of Diabetes (ACD) and the Colombian Association of Internal Medicine (ACMI) collaborated with a diverse group of experts to provide recommendations on the efficacy and best practices of continuous transdermal oxygen therapy (TOTc) in the care of such wounds. METHOD A modified Delphi technique was employed to obtain controlled feedback and responses. Experts from various disciplines engaged in reviewing and discussing numerous relevant scientific studies, focusing on the role of TOTc in treating chronic ulcers. RESULTS Continuous transdermal oxygen therapy has proven to be an effective and safe treatment for chronic and/or hard-to-heal ulcers. This therapy directly addresses the wound's oxygen deficiency, providing an environment conducive to healing. Significant benefits were observed, including the acceleration of the healing process, wound size reduction, and an enhancement in patient quality of life. Its efficacy was found across various ulcer etiologies, underscoring its therapeutic versatility. CONCLUSIONS Continuous transdermal oxygen therapy is effective and safe for treating chronic and hard-to-heal ulcers. It's crucial to address each case individually and through a multidisciplinary approach to maximize this therapy's benefits. Both evidence and clinical experience back its utility across a variety of ulcer etiologies.
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Affiliation(s)
- Yamile Jubiz Pacheco
- Coordinadora zona norte de Suramérica ante el D-Foot International. Médico diabetóloga-experta en el cuidado del pie diabético y heridas complejas. Jefe unidad interdisciplinaria de pie diabético y heridas complejas
| | | | - Dora Bernal Ocampo
- Médica especialista en medicina familiar. Vicepresidenta confederación Iberoamericana de medicina familiar. Presidenta Asociación Colombiana de Sociedades Científicas
| | | | - Gustavo Adolfo Marquez Salom
- Médico especialista en medicina interna y clínica de hipertensión. Diabetólogo experto en pie diabético y heridas complejas. Director centro de atención integral de personas con diabetes y comorbilidades
| | - Jaime Brugés Ruiz
- Médico diabetólogo experto en pie diabético y heridas complejas. Director fundación Medicus - Cartagena
| | - Gary Fernando Monclou Garzon
- Médico especialista en ortopedia y traumatología. Especialista en cirugía de cadera reconstructiva. Magister en educación médica. Jefe del servicio de ortopedia Clínica Palermo - Bogotá
| | - John Jairo Perez Casado
- Médico especialista en ortopedia y traumatología. Reconstrucción, salvamento de extremidades y técnicas microquirúrgicas
| | - Iván Mauricio Hernández Agudelo
- Méico especialista en ortopedia y traumatología. Fellowship trauma y cirugía reconstructiva Medizinische Hochschule Hannover. Cirujano trauma y reconstructivo Clínica Palermo - Clínica Universidad La Sabana
| | | | - Enfermera Hilsen Duran Lopez
- Enfermera profesional especialista en cuidado de persona con heridas, ostomías, y lesiones de piel. Coordinadora de la unidad de heridas del Hospital Militar Central Colombia
| | - Ulises Múnera Bohorquez
- Médico experto en el cuidado de heridas complejas. Presidente Fundepiel Colombia 2022-2024. Autor del libro Introducción al mundo de las heridas, Editorial Bonaventuriano
| | - Damaris Romero Chamorro
- Médico especialista en cirugía plástica, Estética y reconstructiva. Miembro de la Federación IberoLatinoamericana de Cirugía Plástica FILACP. Secretaría ejecutiva, Sociedad Colombiana de Cirugía Plástica, Estética y Reconstructiva. Miembro Sociedad Americana de Cirugía Plástica
| | - Alexandra Otero Carrascal
- Médico especialista en cirugía plástica, Reconstructiva y estética. Subespecialista en mano. Miembro del Grupo Colombiano Interdisciplinario de Pie Diabético y Heridas Complejas
| | - Emerson Barajas Suarez
- Médico especialista en cirugía vascular y endovascular. Especialista en docencia universitaria
| | - Windy Cole
- Licenciatura en biología, Universidad de Cincinnati. Doctor en medicina podológica, Kent State University College. Médico especialista certificado en cuidado de heridas, American Board of Wound Management. Director de investigación de cuidado de heridas, Facultad de Medicina Podiátrica de la Universidad de Kent. Editor de la sección del consejo asesor editorial, cirugía podológica
| | - Thomas Serena
- Doctor en Medicina (MD), Universidad Estatal de Pensilvania. Vicepresidente Anterior, Colegio Americano de medicina hiperbárica. Presidente anterior, Asociación para el Avance del Cuidado de Heridas. Licenciatura en biología, pre-médica - The College of William and Mary
| | - Camilo Acosta Marquez
- MSc Magister Ingeniería Biomédica - Universidad de los Andes. Ingeniero Eléctrico - Universidad de los Andes. Doctor (PhD) en Robótica Abertay University, Dundee, Escocia. Postdoctorado en Robótica Aplicada a la Rehabilitación - Abertay University, Dundee, Escocia
| | - Emma Woodmansey
- Doctor of Philosophy (PhD), gut microbiology, University of Dundee. BSc (Hons) degree, medical microbiology, University of Dundee
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21
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Silina EV, Stupin VA, Manturova NE, Ivanova OS, Popov AL, Mysina EA, Artyushkova EB, Kryukov AA, Dodonova SA, Kruglova MP, Tinkov AA, Skalny AV, Ivanov VK. Influence of the Synthesis Scheme of Nanocrystalline Cerium Oxide and Its Concentration on the Biological Activity of Cells Providing Wound Regeneration. Int J Mol Sci 2023; 24:14501. [PMID: 37833949 PMCID: PMC10572590 DOI: 10.3390/ijms241914501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
In the ongoing search for practical uses of rare-earth metal nanoparticles, cerium dioxide nanoparticles (nanoceria) have received special attention. The purpose of this research was to study the biomedical effects of nanocrystalline forms of cerium oxide obtained by different synthesis schemes and to evaluate the effect of different concentrations of nanoceria (from 10-2 to 10-6 M) on cells involved in the regeneration of skin cell structures such as fibroblasts, mesenchymal stem cells, and keratinocytes. Two different methods of nanoceria preparation were investigated: (1) CeO-NPs-1 by precipitation from aqueous solutions of cerium (III) nitrate hexahydrate and citric acid and (2) CeO-NPs-2 by hydrolysis of ammonium hexanitratocerate (IV) under conditions of thermal autoclaving. According to the X-ray diffraction, transmission electron microscopy, and dynamic light scattering data, CeO2-1 consists of individual particles of cerium dioxide (3-5 nm) and their aggregates with diameters of 60-130 nm. CeO2-2 comprises small aggregates of 8-20 nm in diameter, which consist of particles of 2-3 nm in size. Cell cultures of human fibroblasts, human mesenchymal stem cells, and human keratinocytes were cocultured with different concentrations of nanoceria sols (10-2, 10-3, 10-4, 10-5, and 10-6 mol/L). The metabolic activity of all cell types was investigated by MTT test after 48 and 72 h, whereas proliferative activity and cytotoxicity were determined by quantitative cell culture counting and live/dead test. A dependence of biological effects on the method of nanoceria preparation and concentration was revealed. Data were obtained with respect to the optimal concentration of sol to achieve the highest metabolic effect in the used cell cultures. Hypotheses about the mechanisms of the obtained effects and the structure of a fundamentally new medical device for accelerated healing of skin wounds were formulated. The method of nanoceria synthesis and concentration fundamentally and significantly change the biological activity of cell cultures of different types-from suppression to pronounced stimulation. The best biological activity of cell cultures was determined through cocultivation with sols of citrate nanoceria (CeO-NPs-1) at a concentration of 10-3-10-4 M.
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Affiliation(s)
- Ekaterina V. Silina
- Institute of Biodesign and Modeling of Complex Systems, Center of Bioelementology and Human Ecology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (M.P.K.); (A.A.T.); (A.V.S.)
| | - Victor A. Stupin
- Department of Hospital Surgery, Pirogov Russian National Research Medical University, 117997 Moscow, Russia;
| | - Natalia E. Manturova
- Department of Plastic and Reconstructive Surgery, Cosmetology and Cell Technologies, Pirogov Russian National Research Medical University, 117997 Moscow, Russia;
| | - Olga S. Ivanova
- Frumkin Institute of Physical Chemistry and Electrochemistry, Russian Academy of Sciences, 119071 Moscow, Russia;
| | - Anton L. Popov
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, 142290 Pushchino, Russia; (A.L.P.); (E.A.M.)
| | - Elena A. Mysina
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, 142290 Pushchino, Russia; (A.L.P.); (E.A.M.)
| | - Elena B. Artyushkova
- Research Institute of Experimental Medicine, Kursk State Medical University, 305041 Kursk, Russia; (E.B.A.); (A.A.K.); (S.A.D.)
| | - Alexey A. Kryukov
- Research Institute of Experimental Medicine, Kursk State Medical University, 305041 Kursk, Russia; (E.B.A.); (A.A.K.); (S.A.D.)
| | - Svetlana A. Dodonova
- Research Institute of Experimental Medicine, Kursk State Medical University, 305041 Kursk, Russia; (E.B.A.); (A.A.K.); (S.A.D.)
| | - Maria P. Kruglova
- Institute of Biodesign and Modeling of Complex Systems, Center of Bioelementology and Human Ecology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (M.P.K.); (A.A.T.); (A.V.S.)
| | - Alexey A. Tinkov
- Institute of Biodesign and Modeling of Complex Systems, Center of Bioelementology and Human Ecology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (M.P.K.); (A.A.T.); (A.V.S.)
- Laboratory of Ecobiomonitoring and Quality Control, Yaroslavl State University, 150003 Yaroslavl, Russia
| | - Anatoly V. Skalny
- Institute of Biodesign and Modeling of Complex Systems, Center of Bioelementology and Human Ecology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (M.P.K.); (A.A.T.); (A.V.S.)
- Laboratory of Ecobiomonitoring and Quality Control, Yaroslavl State University, 150003 Yaroslavl, Russia
| | - Vladimir K. Ivanov
- Kurnakov Institute of General and Inorganic Chemistry, Russian Academy of Sciences, 119991 Moscow, Russia;
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Litchfield I, Barrett T, Hamilton-Shield J, Moore T, Narendran P, Redwood S, Searle A, Uday S, Wheeler J, Greenfield S. Current evidence for designing self-management support for underserved populations: an integrative review using the example of diabetes. Int J Equity Health 2023; 22:188. [PMID: 37697302 PMCID: PMC10496394 DOI: 10.1186/s12939-023-01976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/26/2023] [Indexed: 09/13/2023] Open
Abstract
AIMS With numerous and continuing attempts at adapting diabetes self-management support programmes to better account for underserved populations, its important that the lessons being learned are understood and shared. The work we present here reviews the latest evidence and best practice in designing and embedding culturally and socially sensitive, self-management support programmes. METHODS We explored the literature with regard to four key design considerations of diabetes self-management support programmes: Composition - the design and content of written materials and digital tools and interfaces; Structure - the combination of individual and group sessions, their frequency, and the overall duration of programmes; Facilitators - the combination of individuals used to deliver the programme; and Context - the influence and mitigation of a range of individual, socio-cultural, and environmental factors. RESULTS We found useful and recent examples of design innovation within a variety of countries and models of health care delivery including Brazil, Mexico, Netherlands, Spain, United Kingdom, and United States of America. Within Composition we confirmed the importance of retaining best practice in creating readily understood written information and intuitive digital interfaces; Structure the need to offer group, individual, and remote learning options in programmes of flexible duration and frequency; Facilitators where the benefits of using culturally concordant peers and community-based providers were described; and finally in Context the need to integrate self-management support programmes within existing health systems, and tailor their various constituent elements according to the language, resources, and beliefs of individuals and their communities. CONCLUSIONS A number of design principles across the four design considerations were identified that together offer a promising means of creating the next generation of self-management support programme more readily accessible for underserved communities. Ultimately, we recommend that the precise configuration should be co-produced by all relevant service and patient stakeholders and its delivery embedded in local health systems.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Tim Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
| | - Julian Hamilton-Shield
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 2NT, UK
- The Royal Hospital for Children in Bristol, Bristol, BS2 8BJ, UK
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Theresa Moore
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
- Queen Elizabeth Hospital, Birmingham, B15 2GW, UK
| | - Sabi Redwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Aidan Searle
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Suma Uday
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jess Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
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Singh K, Kondal D, Menon VU, Varthakavi PK, Viswanathan V, Dharmalingam M, Bantwal G, Sahay RK, Masood MQ, Khadgawat R, Desai A, Prabhakaran D, Narayan KMV, Phillips VL, Tandon N, Ali MK. Cost-effectiveness of a multicomponent quality improvement care model for diabetes in South Asia: The CARRS randomized clinical trial. Diabet Med 2023; 40:e15074. [PMID: 36815284 DOI: 10.1111/dme.15074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness of a multicomponent strategy versus usual care in people with type 2 diabetes in South Asia. DESIGN Economic evaluation from healthcare system and societal perspectives. SETTING Ten diverse urban clinics in India and Pakistan. PARTICIPANTS 1146 people with type 2 diabetes (575 in the intervention group and 571 in the usual care group) with mean age of 54.2 years, median diabetes duration: 7 years and mean HbA1c: 9.9% (85 mmol/mol) at baseline. INTERVENTION Multicomponent strategy comprising decision-supported electronic health records and non-physician care coordinator. Control group received usual care. OUTCOME MEASURES Incremental cost-effectiveness ratios (ICERs) per unit achievement in multiple risk factor control (HbA1c <7% (53 mmol/mol) and SBP <130/80 mmHg or LDLc <2.58 mmol/L (100 mg/dL)), ICERs per unit reduction in HbA1c, 5-mmHg unit reductions in systolic BP, 10-unit reductions in LDLc (mg/dl) (considered as clinically relevant) and ICER per quality-adjusted life years (QALYs) gained. ICERs were reported in 2020 purchasing power parity-adjusted international dollars (INT$). The probability of ICERs being cost-effective was considered depending on the willingness to pay (WTP) values as a share of GDP per capita for India (Int$ 7041.4) and Pakistan (Int$ 4847.6). RESULTS Compared to usual care, the annual incremental costs per person for intervention group were Int$ 1061.9 from a health system perspective and Int$ 1093.6 from a societal perspective. The ICER was Int$ 10,874.6 per increase in multiple risk factor control, $2588.1 per one percentage point reduction in the HbA1c, and $1744.6 per 5 unit reduction in SBP (mmHg), and $1271 per 10 unit reduction in LDLc (mg/dl). The ICER per QALY gained was $33,399.6 from a societal perspective. CONCLUSIONS In a trial setting in South Asia, a multicomponent strategy for diabetes care resulted in better multiple risk factor control at higher costs and may be cost-effective depending on the willingness to pay threshold with substantial uncertainty around cost-effectiveness for QALYs gained in the short term (2.5 years). Future research needs to confirm the long-term cost-effectiveness of intensive multifactorial intervention for diabetes care in diverse healthcare settings in LMICs.
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Affiliation(s)
- Kavita Singh
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, India
| | - V Usha Menon
- Amrita Institute of Medical Sciences, Department of Endocrinology & Diabetes, Kochi, Kerala, India
| | - Premlata K Varthakavi
- TNM College & BYL Nair Charity Hospital, Department of Endocrinology, Mumbai, Maharashtra, India
| | - Vijay Viswanathan
- MV Hospital for Diabetes & Diabetes Research Centre, Chennai, Tamil Nadu, India
| | - Mala Dharmalingam
- Bangalore Endocrinology & Diabetes Research Centre, Bangalore, Karnataka, India
| | - Ganapati Bantwal
- Department of Endocrinology, St. John's Medical College & Hospital, Bangalore, Karnataka, India
| | - Rakesh Kumar Sahay
- Department of Endocrinology, Osmania General Hospital, Hyderabad, Telangana, India
| | - Muhammad Qamar Masood
- Department of Medicine, Section of Endocrinology and Diabetes, Aga Khan University, Karachi, Pakistan
| | - Rajesh Khadgawat
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ankush Desai
- Endocrine Unit, Department of Medicine, Goa Medical College, Bambolim, Goa, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
- Centre for Chronic Disease Control, New Delhi, India
| | - K M Venkat Narayan
- Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Mohammed K Ali
- Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
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24
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Bober T, Rothenberger S, Lin J, Ng JM, Zupa M. Factors Associated With Receipt of Diabetes Self-Management Education and Support for Type 2 Diabetes: Potential for a Population Health Management Approach. J Diabetes Sci Technol 2023; 17:1198-1205. [PMID: 37264614 PMCID: PMC10563527 DOI: 10.1177/19322968231176303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Population health management approaches can help target diabetes resources like Diabetes Self-Management Education and Support (DSMES) to individuals at the highest risk of complications and poor outcomes. Little is known about patient characteristics associated with DSMES receipt since widespread uptake of telemedicine for diabetes care in 2020. METHODS In this retrospective cohort study, we used electronic medical record (EMR) data to assess patterns of DSMES delivery from May 2020 to May 2022 among adults who used telemedicine for type 2 diabetes (T2D) endocrinology care in a large integrated health system. Multilevel regression models were used to evaluate the association of key patient characteristics with DSMES receipt. RESULTS Of 3530 patients in the overall cohort, 401 patients (11%) received DSMES. In adjusted multivariable logistic regression, higher baseline HbA1c (odds ratios [OR] 3.10 [95% confidence interval 2.22-4.33] for HbA1c ≥9% vs <7%), insulin regimen complexity (OR 3.53 [2.59-4.80] for multiple daily injections vs no insulin), and number of noninsulin medications (OR 1.17 [1.05-1.30] per 1 additional medication) were significantly associated with receipt of DSMES, whereas rurality and area-level deprivation of patient residence were not. CONCLUSIONS Diabetes Self-Management Education and Support remains underutilized in this cohort of adults using telemedicine to access endocrinology care for T2D. Factors contributing to clinical complexity increased the odds of receiving DSMES. These results support a potential population health management approach using EMR data, which could target DSMES resources to those at higher risk of poor outcomes. This risk-stratified approach may be even more effective now that more people can access DSMES via telemedicine in addition to in-person care.
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Affiliation(s)
- Timothy Bober
- Center for Research on Health Care,
Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Scott Rothenberger
- Center for Research on Health Care,
Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Jonathan Lin
- Center for Research on Health Care,
Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Jason M. Ng
- Division of Endocrinology and
Metabolism, University of Pittsburgh, Pittsburgh, PA, USA
| | - Margaret Zupa
- Division of Endocrinology and
Metabolism, University of Pittsburgh, Pittsburgh, PA, USA
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25
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Fan M, Stephan AJ, Emmert-Fees K, Peters A, Laxy M. Health and economic impact of improved glucose, blood pressure and lipid control among German adults with type 2 diabetes: a modelling study. Diabetologia 2023; 66:1693-1704. [PMID: 37391625 PMCID: PMC10390361 DOI: 10.1007/s00125-023-05950-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/18/2023] [Indexed: 07/02/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to estimate the long-term health and economic consequences of improved risk factor control in German adults with type 2 diabetes. METHODS We used the UK Prospective Diabetes Study Outcomes Model 2 to project the patient-level health outcomes and healthcare costs of people with type 2 diabetes in Germany over 5, 10 and 30 years. We parameterised the model using the best available data on population characteristics, healthcare costs and health-related quality of life from German studies. The modelled scenarios were: (1) a permanent reduction of HbA1c by 5.5 mmol/mol (0.5%), of systolic BP (SBP) by 10 mmHg, or of LDL-cholesterol by 0.26 mmol/l in all patients, and (2) achievement of guideline care recommendations for HbA1c (≤53 mmol/mol [7%]), SBP (≤140 mmHg) or LDL-cholesterol (≤2.6 mmol/l) in patients who do not meet the recommendations. We calculated nationwide estimates using age- and sex-specific quality-adjusted life year (QALY) and cost estimates, type 2 diabetes prevalence and population size. RESULTS Over 10 years, a permanent reduction of HbA1c by 5.5 mmol/mol (0.5%), SBP by 10 mmHg or LDL-cholesterol by 0.26 mmol/l led to per-person savings in healthcare expenditures of €121, €238 and €34, and 0.01, 0.02 and 0.015 QALYs gained, respectively. Achieving guideline care recommendations for HbA1c, SBP or LDL-cholesterol could reduce healthcare expenditure by €451, €507 and €327 and gained 0.03, 0.05 and 0.06 additional QALYs in individuals who did not meet the recommendations. Nationally, achieving guideline care recommendations for HbA1c, SBP and LDL-cholesterol could reduce healthcare costs by over €1.9 billion. CONCLUSIONS/INTERPRETATION Sustained improvements in HbA1c, SBP and LDL-cholesterol control among diabetes patients in Germany can lead to substantial health benefits and reduce healthcare expenditures.
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Affiliation(s)
- Min Fan
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.
- German Center for Diabetes Research (DZD), Munich, Germany.
- Institute of Health Economics and Health Care Management, Helmholtz Munich, Munich, Germany.
| | - Anna-Janina Stephan
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Munich, Munich, Germany
| | - Karl Emmert-Fees
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Munich, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Munich, Munich, Germany
| | - Michael Laxy
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Munich, Munich, Germany
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26
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Jepson H, Lazzarini PA, Garrett M, Carroll MR. How does the clinical practice of Aotearoa New Zealand podiatrists align with international guidelines for the prevention of diabetes-related foot disease? A cross-sectional survey. J Foot Ankle Res 2023; 16:53. [PMID: 37605269 PMCID: PMC10464278 DOI: 10.1186/s13047-023-00651-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Given the importance of preventive care for the lower limb in people with diabetes, and the absence of local guidelines in Aotearoa New Zealand (NZ), the aim of this study was to determine the alignment of assessment and management used in the prevention of diabetes-related foot disease by NZ podiatrists to the international prevention guideline recommendations. METHODS A 37-item web-based survey was developed using a 5-point Likert scale (0 = always; 5 = never) based on the International Working Group of the Diabetic Foot (IWGDF) 2019 prevention guidelines and included domains on participant demographics, sector, caseloads, guidelines, screening, management, education, and referral. The survey was distributed to NZ podiatrists through the NZ podiatry association and social media. Participants completing > 50% of items were included. The Mann-Whitney U test was used to examine differences between sector subgroups. RESULTS Seventy-seven responses (16.3% of the NZ podiatry workforce) were received, of which 52 completed > 50% of items and were included. Of those 52 podiatrists, 73% were from the private sector. Public sector podiatrists reported higher weekly caseloads of patients with diabetes (p = 0.03) and foot ulcers (p < 0.001). The New Zealand Society for the Study of Diabetes (NZSSD) risk stratification pathway and IWGDF guidelines were the two most frequently utilised guidance documents. Participants reported median scores of at least "often" (< 2) for all items in the assessment and management, inspection, examination, and education provision domains for people with a high-risk foot. More than 50% of respondents reported screening more frequently than guideline recommendations for people with a very low to moderate risk foot. Structured education program was only used by 4 (5%) participants. Public sector podiatrists reported greater provision of custom-made footwear (p = 0.04) and multi-disciplinary team care (p = 0.03). CONCLUSION NZ podiatrists generally follow international guideline recommendations with respect to screening, self-care education, appropriate footwear, and treatment of risk factors for people at-risk of diabetes-related foot disease. However there may be over-screening of people with very low to medium risk occurring in clinical practice. Increasing access to integrated healthcare, custom-made footwear and structured educational programmes appear to be areas of practice that could be developed in future to help prevent diabetes-related foot disease in NZ.
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Affiliation(s)
- Hannah Jepson
- Department of Podiatry, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- Metro North Hospital and Health Service, Allied Health Research Collaborative, Brisbane, QLD, Australia
| | - Michele Garrett
- Community and Long Term Conditions Directorate, Te Toka Tumai, Auckland, New Zealand
| | - Matthew R Carroll
- Department of Podiatry, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
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27
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Molina R, Enriquez M. Enhancing Diabetes Health Outcomes Among Haitian Migrants Living in Dominican Bateyes. Sci Diabetes Self Manag Care 2023; 49:281-290. [PMID: 37313730 DOI: 10.1177/26350106231178838] [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] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to better understand the factors that influence the ability of batey adults to self-manage their type 2 diabetes mellitus (T2DM). METHODS A qualitative descriptive approach was used to conduct in-depth, individual interviews in Spanish. Participants (n = 12) were health care workers and members of a nongovernmental organization (NGO) that provides direct diabetes care to batey residents via free, pop-up, mobile medical clinics. Conventional content analysis was used to identify categories and common themes in the data. RESULTS Participants described daily existence in the bateyes as a constant "scarcity of resources." Additionally, four themes and one subtheme emerged that participants felt impacted diabetes health outcomes and the ability of NGO health care workers to provide diabetes care. CONCLUSIONS NGO members, while committed to serve and improve health outcomes for the batey population, often felt overwhelmed. Findings from this qualitative descriptive study may be used to inform novel interventions, which are needed, to enhance the diabetes outcomes of the batey residents who are living with T2DM. In addition, strategies are needed to build diabetes care infrastructure in the batey community.
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Affiliation(s)
- Rosalia Molina
- Research College of Nursing, Kansas City, Missouri
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Maithe Enriquez
- Research College of Nursing, Kansas City, Missouri
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
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Varghese JS, Anjana RM, Geldsetzer P, Sudharsanan N, Manne-Goehler J, Thirumurthy H, Bhattacharyya S, Narayan KMV, Mohan V, Tandon N, Ali MK. National Estimates of the Adult Diabetes Care Continuum in India, 2019-2021. JAMA Intern Med 2023:2807945. [PMID: 37523192 PMCID: PMC10391358 DOI: 10.1001/jamainternmed.2023.3070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Importance Diabetes is widespread and treatable, but little is known about the diabetes care continuum (diagnosis, treatment, and control) in India and how it varies at the national, state, and district levels. Objective To estimate the adult population levels of diabetes diagnosis, treatment, and control in India at national, state, and district levels and by sociodemographic characteristics. Design, Setting, and Participants In this cross-sectional, nationally representative survey study from 2019 to 2021, adults in India from 28 states, 8 union territories, and 707 districts were surveyed for India's Fifth National Family Health Survey (NFHS-5). The survey team collected data on blood glucose among all adults (18-98 years) who were living in the same household as eligible participants (pregnant or nonpregnant female individuals aged 15-49 years and male individuals aged 15-54 years). The overall sample consisted of 1 895 287 adults. The analytic sample was restricted to those who either self-reported having diabetes or who had a valid measurement of blood glucose. Exposures The exposures in this survey study were district and state residence; urban vs rural residence; age (18-39 years, 40-64 years, or ≥65 years); sex; and household wealth quintile. Main Outcomes and Measures Diabetes was defined by self-report or high capillary blood glucose (fasting: ≥126 mg/dL [to convert to mmol/L, multiply by 0.0555]; nonfasting: ≥220 mg/dL). Among respondents who had previously been diagnosed with diabetes, the main outcome was the proportion treated based on self-reported medication use and the proportion controlled (fasting: blood glucose <126 mg/dL; nonfasting: ≤180 mg/dL). The findings were benchmarked against the World Health Organization (WHO) Global Diabetes Compact targets (80% diagnosis; 80% control among those diagnosed). The variance in indicators between and within states was partitioned using variance partition coefficients (VPCs). Results Among 1 651 176 adult respondents (mean [SD] age, 41.6 [16.4] years; 867 896 [52.6%] female) with blood glucose measures, the proportion of individuals with diabetes was 6.5% (95% CI, 6.4%-6.6%). Among adults with diabetes, 74.2% (95% CI, 73.3%-75.0%) were diagnosed. Among those diagnosed, 59.4% (95% CI, 58.1%-60.6%) reported taking medication, and 65.5% (95% CI, 64.5%-66.4%) achieved control. Diagnosis and treatment were higher in urban areas, older age groups, and wealthier households. Among those diagnosed in the 707 districts surveyed, 246 (34.8%) districts met the WHO diagnosis target, while 76 (10.7%) districts met the WHO control target. Most of the variability in diabetes diagnosis (VPC, 89.1%), treatment (VPC, 85.9%), and control (VPC, 95.6%) were within states, not between states. Conclusions and Relevance In this survey study, the diabetes care continuum in India is represented by considerable district-level variation, age-related disparities, and rural-urban differences. Surveillance at the district level can guide state health administrators to prioritize interventions and monitor achievement of global targets.
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Affiliation(s)
- Jithin Sam Varghese
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California
- Chan Zuckerberg Biohub-San Francisco, San Francisco, California
| | - Nikkil Sudharsanan
- Professorship of Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Munich, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - K M Venkat Narayan
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Mohammed K Ali
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
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Wu Y, Min H, Li M, Shi Y, Ma A, Han Y, Gan Y, Guo X, Sun X. Effect of Artificial Intelligence-based Health Education Accurately Linking System (AI-HEALS) for Type 2 diabetes self-management: protocol for a mixed-methods study. BMC Public Health 2023; 23:1325. [PMID: 37434126 DOI: 10.1186/s12889-023-16066-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Patients with type 2 diabetes (T2DM) have an increasing need for personalized and Precise management as medical technology advances. Artificial intelligence (AI) technologies on mobile devices are being developed gradually in a variety of healthcare fields. As an AI field, knowledge graph (KG) is being developed to extract and store structured knowledge from massive data sets. It has great prospects for T2DM medical information retrieval, clinical decision-making, and individual intelligent question and answering (QA), but has yet to be thoroughly researched in T2DM intervention. Therefore, we designed an artificial intelligence-based health education accurately linking system (AI-HEALS) to evaluate if the AI-HEALS-based intervention could help patients with T2DM improve their self-management abilities and blood glucose control in primary healthcare. METHODS This is a nested mixed-method study that includes a community-based cluster-randomized control trial and personal in-depth interviews. Individuals with T2DM between the ages of 18 and 75 will be recruited from 40-45 community health centers in Beijing, China. Participants will either receive standard diabetes primary care (SDPC) (control, 3 months) or SDPC plus AI-HEALS online health education program (intervention, 3 months). The AI-HEALS runs in the WeChat service platform, which includes a KBQA, a system of physiological indicators and lifestyle recording and monitoring, medication and blood glucose monitoring reminders, and automated, personalized message sending. Data on sociodemography, medical examination, blood glucose, and self-management behavior will be collected at baseline, as well as 1,3,6,12, and 18 months later. The primary outcome is to reduce HbA1c levels. Secondary outcomes include changes in self-management behavior, social cognition, psychology, T2DM skills, and health literacy. Furthermore, the cost-effectiveness of the AI-HEALS-based intervention will be evaluated. DISCUSSION KBQA system is an innovative and cost-effective technology for health education and promotion for T2DM patients, but it is not yet widely used in the T2DM interventions. This trial will provide evidence on the efficacy of AI and mHealth-based personalized interventions in primary care for improving T2DM outcomes and self-management behaviors. TRIAL REGISTRATION Biomedical Ethics Committee of Peking University: IRB00001052-22,058, 2022/06/06; Clinical Trials: ChiCTR2300068952, 02/03/2023.
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Affiliation(s)
- Yibo Wu
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Hewei Min
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
| | - Yuhui Shi
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Aijuan Ma
- Beijing Center for Disease Control and Prevention, Beijing, China
| | - Yumei Han
- Beijing Medical Examination Center, Beijing, China
| | - Yadi Gan
- Daxing District Center for Disease Control and Prevention of Beijing, Beijing, China
| | - Xiaohui Guo
- Peking University First Hospital, Beijing, China
| | - Xinying Sun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China.
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30
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Lin A, Lu S. Plastic Surgery Roles in Wound Centers in the Northeastern United States. Ann Plast Surg 2023; 90:S674-S676. [PMID: 36881743 DOI: 10.1097/sap.0000000000003497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Wound care is a substantial industry costing nearly $19 billion USD, and dedicated wound care centers play a critical role via a multidisciplinary team-based approach. At the same time, plastic surgeons are often considered experts in evaluation and management of wounds, particularly chronic and complex wounds. However, the extent of direct involvement of plastic surgeons in wound care centers is unclear. In this study, we sought to evaluate the presence of plastic surgeons and other specialties in wound care centers across all Northeastern states Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Jersey, New York, New Hampshire, Pennsylvania, Rhode Island, Virginia, West Virginia, and Vermont. METHODS A comprehensive list of wound care clinics in northeastern United States was obtained from the Healogics website. For each site, information was gathered via website listings, including number of providers and the professional certification/specialization for each provider. Providers were those with qualifications including Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Doctor of Physical Therapy (DPT), Doctor of Podiatric Medicine (DPM), Certified Registered Nurse Anesthetist (CRNA), Certified Registered Nurse Practitioner (CRNP), Physician Associate (PA), and Physical Therapist (PT). RESULTS A total of 118 Healogics wound care clinics and 492 providers were located across 14 northeastern states including District of Columbia. After researching each location, updated in November 2022, plastic surgeons were only 3.7% (18 of 492) providers employed. Specialties such as internal medicine (90 of 492 [18%]), general surgery (76 of 492 [15%]), podiatry (68 of 292 [13.8% ]), and other midlevel providers such as nurse practitioners (35 of 492 [7.1%]) were more frequently employed over plastic surgery. All plastic surgeons were board certified the American Board of Plastic Surgery. CONCLUSIONS Wound care requires collaboration between specialties, with significant repercussions on health care costs and patient outcomes. Plastic surgery provides unique surgical services for the healing of wounds, and the natural expectation would be that plastic surgery should be heavily involved at wound care centers. However, the data do not reflect significant involvement at an official level. Further studies will investigate causes and the societal, financial, and patient impacts of this lack of direct engagement. Although many plastic surgeons may not desire the majority of their practice to be wound care management, it stands to reason that some affiliation, at least for patient awareness and referral, may be warranted.
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Affiliation(s)
- Andrea Lin
- From the Penn State College of Medicine, Hershey, PA
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31
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Zheng M, Bernardo C, Stocks N, Hu P, Gonzalez-Chica D. Diabetes mellitus monitoring and control among adults in Australian general practice: a national retrospective cohort study. BMJ Open 2023; 13:e069875. [PMID: 37185189 PMCID: PMC10151933 DOI: 10.1136/bmjopen-2022-069875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES This study investigated whether the monitoring and control of clinical parameters are better among patients with newly compared with past recorded diabetes diagnosis. DESIGN Retrospective cohort study. SETTING MedicineInsight, a national general practice database in Australia. PARTICIPANTS 101 875 'regular' adults aged 18+ years with past recorded (2015-2016) and 9236 with newly recorded (2017) diabetes diagnosis. MAIN OUTCOME MEASURES Two different groups of outcomes were assessed in 2018. The first group of outcomes was the proportion of patients with clinical parameters (ie, glycated haemoglobin A1c (HbA1c), blood pressure (BP), total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, estimated glomerular filtration rate and albumin-to-creatinine ratio) monitored at least once in 2018. The second group of outcomes were those related to diabetes control in 2018 (HbA1c ≤7.0%, (BP) ≤140/90 mm Hg, total cholesterol <4.0 mmol/L and LDL-C <2.0 mmol/L). Adjusted ORs (ORadj) and adjusted probabilities (%) were obtained based on logistic regression models adjusted for practice variables and patients' socio-demographic and clinical characteristics. RESULTS The study included 111 111 patients (51.7% men; mean age 65.3±15.0 years) with recorded diabetes diagnosis (11.0% of all 1 007 714 adults in the database). HbA1c was monitored in 39.2% (95% CI 36.9% to 41.6%) of patients with newly recorded and 45.2% (95% CI 42.6% to 47.8%) with past recorded diabetes (ORadj 0.78, 95% CI 0.73 to 0.82). HbA1c control was achieved by 78.4% (95% CI 76.7% to 80.0%) and 54.4% (95% CI 53.4% to 55.4%) of monitored patients with newly or past recorded diabetes, respectively (ORadj 3.11, 95% CI 2.82 to 3.39). Less than 20% of patients with newly or past recorded diabetes had their HbA1c, BP and total cholesterol levels controlled (ORadj 1.08, 95% CI 0.97 to 1.21). CONCLUSIONS The monitoring of clinical parameters was lower among patients with newly than past recorded diabetes. However, diabetes control was similarly low in both groups, with only one in five monitored patients achieving control of all clinical parameters.
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Affiliation(s)
- Mingyue Zheng
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carla Bernardo
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peng Hu
- School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - David Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
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32
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Gregg EW, Buckley J, Ali MK, Davies J, Flood D, Mehta R, Griffiths B, Lim LL, Manne-Goehler J, Pearson-Stuttard J, Tandon N, Roglic G, Slama S, Shaw JE. Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact. Lancet 2023; 401:1302-1312. [PMID: 36931289 PMCID: PMC10420388 DOI: 10.1016/s0140-6736(23)00001-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/17/2022] [Accepted: 12/20/2022] [Indexed: 03/15/2023]
Abstract
The Global Diabetes Compact is a WHO-driven initiative uniting stakeholders around goals of reducing diabetes risk and ensuring that people with diabetes have equitable access to comprehensive, affordable care and prevention. In this report we describe the development and scientific basis for key health metrics, coverage, and treatment targets accompanying the Compact. We considered metrics across four domains: factors at a structural, system, or policy level; processes of care; behaviours and biomarkers such as glycated haemoglobin (HbA1c); and health events and outcomes; and three risk tiers (diagnosed diabetes, high risk, or whole population), and reviewed and prioritised them according to their health importance, modifiability, data availability, and global inequality. We reviewed the global distribution of each metric to set targets for future attainment. This process led to five core national metrics and target levels for UN member states: (1) of all people with diabetes, at least 80% have been clinically diagnosed; and, for people with diagnosed diabetes, (2) 80% have HbA1c concentrations below 8·0% (63·9 mmol/mol); (3) 80% have blood pressure lower than 140/90 mm Hg; (4) at least 60% of people 40 years or older are receiving therapy with statins; and (5) each person with type 1 diabetes has continuous access to insulin, blood glucose meters, and test strips. We also propose several complementary metrics that currently have limited global coverage, but warrant scale-up in population-based surveillance systems. These include estimation of cause-specific mortality, and incidence of end-stage kidney disease, lower-extremity amputations, and incidence of diabetes. Primary prevention of diabetes and integrated care to prevent long-term complications remain important areas for the development of new metrics and targets. These metrics and targets are intended to drive multisectoral action applied to individuals, health systems, policies, and national health-care access to achieve the goals of the Global Diabetes Compact. Although ambitious, their achievement can result in broad health benefits for people with diabetes.
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Affiliation(s)
- Edward W Gregg
- School of Population Health, RCSI, University of Medicine and Health Sciences, Dublin, Ireland; School of Public Health, Imperial College London, London, UK.
| | - James Buckley
- School of Public Health, Imperial College London, London, UK
| | - Mohammed K Ali
- Hubert Department of Global Health and Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Roopa Mehta
- Unidad de Investigacion en Enfermedades Metabolicas, Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ben Griffiths
- School of Public Health, Imperial College London, London, UK
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Jonathan Pearson-Stuttard
- School of Public Health, Imperial College London, London, UK; Health Analytics, Lane Clark & Peacock, London, UK
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Gojka Roglic
- Department of Noncommunicable Diseases, WHO, Geneva, Switzerland
| | - Slim Slama
- Department of Noncommunicable Diseases, WHO, Geneva, Switzerland
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute and School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Llamas-Saez C, Saez-Vaquero T, Jiménez-García R, López-de-Andrés A, Carabantes-Alarcón D, Zamorano-León JJ, Cuadrado-Corrales N, Pérez-Farinos N, Wärnberg J. Cross Sectional and Case-Control Study to Assess Time Trend, Gender Differences and Factors Associated with Physical Activity among Adults with Diabetes: Analysis of the European Health Interview Surveys for Spain (2014 & 2020). J Clin Med 2023; 12:jcm12062443. [PMID: 36983443 PMCID: PMC10057052 DOI: 10.3390/jcm12062443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: We aim to assess the time trend from 2014 to 2020 in the prevalence of physical activity (PA), identify gender differences and sociodemographic and health-related factors associated with PA among people with diabetes, and compare PA between people with and without diabetes. (2) Methods: We conducted a cross-sectional and a case-control study using as data source the European Health Interview Surveys for Spain (EHISS) conducted in years 2014 and 2020. The presence of diabetes and PA were self-reported. Covariates included socio-demographic characteristics, health-related variables, and lifestyles. To compare people with and without diabetes, we matched individuals by age and sex. (3) Results: The number of participants aged ≥18 years with self-reported diabetes were 1852 and 1889 in the EHISS2014 and EHISS2020, respectively. The proportion of people with diabetes that had a medium or high frequency of PA improved from 48.3% in 2014 to 52.6% in 2020 (p = 0.009), with 68.5% in 2014 and 77.7% in 2020 being engaged in two or more days of PA (p < 0.001). Males with diabetes reported more PA than females with diabetes in both surveys. After matching by age and gender, participants with diabetes showed significantly lower engagement in PA than those without diabetes. Among adults with diabetes, multivariable logistic regression showed confirmation that PA improved significantly from 2014 to 2020 and that male sex, higher educational level, and better self-rated health were variables associated to more PA. However, self-reported comorbidities, smoking, or BMI > 30 were associated to less PA. (4) Conclusions: The time trend of PA among Spanish adults with diabetes is favorable but insufficient. The prevalence of PA in this diabetes population is low and does not reach the levels of the general population. Gender differences were found with significantly more PA among males with diabetes. Our result could help to improve the design and implementation of public health strategies to improve PA among people with diabetes.
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Affiliation(s)
- Carlos Llamas-Saez
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | | | - Rodrigo Jiménez-García
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - Ana López-de-Andrés
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - David Carabantes-Alarcón
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - José J Zamorano-León
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - Natividad Cuadrado-Corrales
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - Napoleón Pérez-Farinos
- Epi-PHAAN Research Group, School of Medicine, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain
| | - Julia Wärnberg
- Epi-PHAAN Research Group, School of Health Sciences, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain
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Wang GX, Hu XY, Zhao HX, Li HL, Chu SF, Liu DL. Development and validation of a diabetic retinopathy risk prediction model for middle-aged patients with type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2023; 14:1132036. [PMID: 37008912 PMCID: PMC10050549 DOI: 10.3389/fendo.2023.1132036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
Objectives The study aims to establish a predictive nomogram of diabetic retinopathy(DR) for the middle-aged population with type 2 diabetes mellitus (T2DM). Methods This retrospective study screened 931 patients with T2DM between 30 and 59 years of age from the 2011-2018 National Health and Nutrition Examination Survey database. The development group comprised 704 participants from the 2011-2016 survey, and the validation group included 227 participants from the 2017-2018 survey. The least absolute shrinkage and selection operator regression model was used to determine the best predictive variables. The logistic regression analysis built three models: the full model, the multiple fractional polynomial (MFP) model, and the stepwise (stepAIC) selected model. Then we decided optimal model based on the receiver operating characteristic curve (ROC). ROC, calibration curve, Hosmer-Lemeshow test, and decision curve analysis (DCA) were used to validate and assess the model. An online dynamic nomogram prediction tool was also constructed. Results The MFP model was selected to be the final model, including gender, the use of insulin, duration of diabetes, urinary albumin-to-creatinine ratio, and serum phosphorus. The AUC was 0.709 in the development set and 0.704 in the validation set. According to the ROC, calibration curves, and Hosmer-Lemeshow test, the nomogram demonstrated good coherence. The nomogram was clinically helpful, according to DCA. Conclusion This study established and validated a predictive model for DR in the mid-life T2DM population, which can assist clinicians quickly determining who is prone to develop DR.
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Affiliation(s)
- Gao-Xiang Wang
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Shenzhen, Guangdong, China
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong, China
| | - Xin-Yu Hu
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong, China
- Department of Endocrinology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Heng-Xia Zhao
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong, China
| | - Hui-Lin Li
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong, China
| | - Shu-Fang Chu
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong, China
| | - De-Liang Liu
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong, China
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Lin S, Ma Y, Xu Y, Lu L, He J, Zhu J, Peng Y, Yu T, Congdon N, Zou H. Artificial Intelligence in Community-Based Diabetic Retinopathy Telemedicine Screening in Urban China: Cost-effectiveness and Cost-Utility Analyses With Real-world Data. JMIR Public Health Surveill 2023; 9:e41624. [PMID: 36821353 PMCID: PMC9999255 DOI: 10.2196/41624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/13/2022] [Accepted: 01/12/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Community-based telemedicine screening for diabetic retinopathy (DR) has been highly recommended worldwide. However, evidence from low- and middle-income countries (LMICs) on the choice between artificial intelligence (AI)-based and manual grading-based telemedicine screening is inadequate for policy making. OBJECTIVE The aim of this study was to test whether the AI model is more worthwhile than manual grading in community-based telemedicine screening for DR in the context of labor costs in urban China. METHODS We conducted cost-effectiveness and cost-utility analyses by using decision-analytic Markov models with 30 one-year cycles from a societal perspective to compare the cost, effectiveness, and utility of 2 scenarios in telemedicine screening for DR: manual grading and an AI model. Sensitivity analyses were performed. Real-world data were obtained mainly from the Shanghai Digital Eye Disease Screening Program. The main outcomes were the incremental cost-effectiveness ratio (ICER) and the incremental cost-utility ratio (ICUR). The ICUR thresholds were set as 1 and 3 times the local gross domestic product per capita. RESULTS The total expected costs for a 65-year-old resident were US $3182.50 and US $3265.40, while the total expected years without blindness were 9.80 years and 9.83 years, and the utilities were 6.748 quality-adjusted life years (QALYs) and 6.753 QALYs in the AI model and manual grading, respectively. The ICER for the AI-assisted model was US $2553.39 per year without blindness, and the ICUR was US $15,216.96 per QALY, which indicated that AI-assisted model was not cost-effective. The sensitivity analysis suggested that if there is an increase in compliance with referrals after the adoption of AI by 7.5%, an increase in on-site screening costs in manual grading by 50%, or a decrease in on-site screening costs in the AI model by 50%, then the AI model could be the dominant strategy. CONCLUSIONS Our study may provide a reference for policy making in planning community-based telemedicine screening for DR in LMICs. Our findings indicate that unless the referral compliance of patients with suspected DR increases, the adoption of the AI model may not improve the value of telemedicine screening compared to that of manual grading in LMICs. The main reason is that in the context of the low labor costs in LMICs, the direct health care costs saved by replacing manual grading with AI are less, and the screening effectiveness (QALYs and years without blindness) decreases. Our study suggests that the magnitude of the value generated by this technology replacement depends primarily on 2 aspects. The first is the extent of direct health care costs reduced by AI, and the second is the change in health care service utilization caused by AI. Therefore, our research can also provide analytical ideas for other health care sectors in their decision to use AI.
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Affiliation(s)
- Senlin Lin
- Department of Eye Disease Prevention and Control, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Yingyan Ma
- Department of Eye Disease Prevention and Control, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Yi Xu
- Department of Eye Disease Prevention and Control, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Lina Lu
- Department of Eye Disease Prevention and Control, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jiangnan He
- Department of Eye Disease Prevention and Control, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jianfeng Zhu
- Department of Eye Disease Prevention and Control, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Yajun Peng
- Department of Eye Disease Prevention and Control, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Tao Yu
- Department of Eye Disease Prevention and Control, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.,Orbis International, New York, NY, United States.,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haidong Zou
- Department of Eye Disease Prevention and Control, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
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36
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Handelsman Y, Butler J, Bakris GL, DeFronzo RA, Fonarow GC, Green JB, Grunberger G, Januzzi JL, Klein S, Kushner PR, McGuire DK, Michos ED, Morales J, Pratley RE, Weir MR, Wright E, Fonseca VA. Early intervention and intensive management of patients with diabetes, cardiorenal, and metabolic diseases. J Diabetes Complications 2023; 37:108389. [PMID: 36669322 DOI: 10.1016/j.jdiacomp.2022.108389] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023]
Abstract
Increasing rates of obesity and diabetes have driven corresponding increases in related cardiorenal and metabolic diseases. In many patients, these conditions occur together, further increasing morbidity and mortality risks to the individual. Yet all too often, the risk factors for these disorders are not addressed promptly in clinical practice, leading to irreversible pathologic progression. To address this gap, we convened a Task Force of experts in cardiology, nephrology, endocrinology, and primary care to develop recommendations for early identification and intervention in obesity, diabetes, and other cardiorenal and metabolic diseases. The recommendations include screening and diagnosis, early interventions with lifestyle, and when and how to implement medical therapies. These recommendations are organized into primary and secondary prevention along the continuum from obesity through the metabolic syndrome, prediabetes, diabetes, hypertension, dyslipidemia, nonalcoholic fatty liver disease (NAFLD), atherosclerotic cardiovascular disease (ASCVD) and atrial fibrillation, chronic kidney disease (CKD), and heart failure (HF). The goal of early and intensive intervention is primary prevention of comorbidities or secondary prevention to decrease further worsening of disease and reduce morbidity and mortality. These efforts will reduce clinical inertia and may improve patients' well-being and adherence.
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Affiliation(s)
| | - Javed Butler
- Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, TX, USA; University of Mississippi Medical Center, Jackson, MS, USA
| | - George L Bakris
- American Heart Association Comprehensive Hypertension Center, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Ralph A DeFronzo
- University of Texas Health Science Center at San Antonio, Texas Diabetes Institute, San Antonio, TX, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, UCLA Preventative Cardiology Program, UCLA Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jennifer B Green
- Division of Endocrinology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - George Grunberger
- Grunberger Diabetes Institute, Internal Medicine and Molecular Medicine & Genetics, Wayne State University School of Medicine, Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Bloomfield Hills, MI, USA; Department of Internal Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - James L Januzzi
- Cardiology Division, Harvard Medical School, Massachusetts General Hospital, Cardiometabolic Trials, Baim Institute, Boston, MA, USA
| | - Samuel Klein
- Washington University School of Medicine, Saint Louis, MO, USA; Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - Pamela R Kushner
- University of California Medical Center, Kushner Wellness Center, Long Beach, CA, USA
| | - Darren K McGuire
- University of Texas Southwestern Medical Center, and Parkland Health and Hospital System, Dallas, TX, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javier Morales
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Advanced Internal Medicine Group, PC, East Hills, NY, USA
| | | | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eugene Wright
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Vivian A Fonseca
- Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, LA, USA
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37
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Melamed OC, Kalia S, Moineddin R, Greiver M, Kloiber S, Mulsant BH, Selby P, O'Neill BG. Factors Associated With Initiation of Antidepressant Medication in Adults With Type 1 and Type 2 Diabetes: A Primary Care Retrospective Cohort Study in Ontario, Canada. Can J Diabetes 2023; 47:11-18. [PMID: 35933314 DOI: 10.1016/j.jcjd.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/08/2022] [Accepted: 05/23/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Depression in patients with diabetes mellitus is common and associated with poorer outcomes. This study aims to identify demographic, socioeconomic and medical factors associated with the initiation of antidepressant medication after a diagnosis of diabetes in adult patients without a previous prescription for antidepressants. We also examined frequency of primary care visits in the year after antidepressant initiation compared with the year before treatment began. METHODS This was a retrospective cohort study using routinely collected electronic medical record data spanning January 2011 to December 2019 from the University of Toronto Practice-based Research Network (UTOPIAN) Data Safe Haven. Our primary outcome was a first prescription for an antidepressant in patients with diabetes. We used a mixed-effects logistic regression model to identify sociodemographic and medical factors associated with this event. RESULTS Among 22,750 patients with diabetes mellitus, 3,055 patients (13.4%) began taking an antidepressant medication. Increased odds of antidepressant initiation were observed in younger patients (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.39 to 2.26), females (OR, 1.60; 95% CI, 1.46 to 1.7), those receiving insulin treatment (OR, 1.59; 95% CI, 1.43 to 1.78) and cases of polypharmacy (OR, 3.67; 95% CI, 3.29 to 4.11). There was an increase in the mean number of primary care visits from 4.6 to 5.9 per year after antidepressant initiation. CONCLUSIONS In patients with diabetes, age, sex and medical characteristics were associated with the initiation of antidepressants. These patients accessed primary care more frequently. Screening and prevention of depression, particularly in these subgroups, could reduce its personal and systemic burdens.
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Affiliation(s)
- Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Sumeet Kalia
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Toronto, Ontario, Canada
| | - Stefan Kloiber
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Braden G O'Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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38
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Onaisi R, Dumont R, Hasselgard-Rowe J, Safar D, Haller DM, Maisonneuve H. Multimorbidity and statin prescription for primary prevention of cardiovascular diseases: A cross-sectional study in general practice in France. Front Med (Lausanne) 2023; 9:1089050. [PMID: 36698814 PMCID: PMC9868625 DOI: 10.3389/fmed.2022.1089050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Background Statins are a first line, evidence-based yet underprescribed treatment for cardiovascular primary prevention. In primary care settings, multimorbidity is a complex situation which makes it difficult to apply prevention guidelines. Aim To assess the associations between multimorbidity and prescription of statins in accordance with the 2016 ESC recommendations ("appropriate prescription"), and to identify the factors and conditions associated with these prescriptions. Design and setting Cross-sectional prospective study in the French region of Rhône-Alpes among 40 general practitioners and their patients. Methods We examined the association between appropriate statin prescription and several patient characteristics, including multimorbidity, using multivariate logistic regression models. Results Between August 2017 and February 2019, 327 patients were included in the study. Seventy-four (22.6%) were on statin medication and 199 (60.9%) exhibited multimorbidity, defined as ≥2 diseases. Only 22.5% of eligible patients were prescribed statins for primary prevention. Diabetes was most strongly associated with appropriate statin prescription (aOR 8.10, CI 95: 3.81-17.80). Multimorbidity was not associated with appropriate statin prescription (aOR 1.31, CI 95: 0.54-3.26), except in the presence of diabetes which defined diabetic multimorbidity (aOR 10.46, CI 95: 4.87-23.35). Conversely, non-diabetic multimorbidity was associated with lower odds of being appropriately prescribed a statin (aOR 0.26, CI 95: 0.12-0.56). Conclusion Multimorbidity, in itself, does not seem to be a determinant factor for appropriate statin prescription. The latter appears to be determined by a patient's type of multimorbidity, especially the presence or not of diabetes. Differentiating between diabetic and non-diabetic multimorbidity may be a pragmatic way for GPs to improve primary prevention in a patient-centered and shared decision-making approach.
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Affiliation(s)
- Racha Onaisi
- Department of General Practice, University of Bordeaux, Bordeaux, France,*Correspondence: Racha Onaisi,
| | - Roxane Dumont
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - David Safar
- University College of General Medicine, University Claude Bernard Lyon 1, Lyon, France
| | - Dagmar M. Haller
- Faculty of Medicine, University Institute for Primary Care, University of Geneva, Geneva, Switzerland
| | - Hubert Maisonneuve
- Faculty of Medicine, University Institute for Primary Care, University of Geneva, Geneva, Switzerland,Hubert Maisonneuve,
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39
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Zhang Y, Carter HE, Lazzarini PA, Cramb S, Pacella R, van Netten JJ, Cheng Q, Derhy PH, Kinnear EM, McPhail SM. Cost-effectiveness of guideline-based care provision for patients with diabetes-related foot ulcers: A modelled analysis using discrete event simulation. Diabet Med 2023; 40:e14961. [PMID: 36135359 PMCID: PMC10946962 DOI: 10.1111/dme.14961] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/12/2022] [Accepted: 09/19/2022] [Indexed: 11/28/2022]
Abstract
AIMS The provision of guideline-based care for patients with diabetes-related foot ulcers (DFU) in clinical practice is suboptimal. We estimated the cost-effectiveness of higher rates of guideline-based care, compared with current practice. METHODS The costs and quality-adjusted life-years (QALYs) associated with current practice (30% of patients receiving guideline-based care) were compared with seven hypothetical scenarios with increasing proportion of guideline-based care (40%, 50%, 60%, 70%, 80%, 90% and 100%). Comparisons were made using discrete event simulations reflecting the natural history of DFU over a 3-year time horizon from the Australian healthcare perspective. Incremental cost-effectiveness ratios were calculated for each scenario and compared to a willingness-to-pay of AUD 28,000 per QALY. Probabilistic sensitivity analyses were conducted to incorporate joint parameter uncertainty. RESULTS All seven scenarios with higher rates of guideline-based care were likely cheaper and more effective than current practice. Increased proportions compared with current practice resulted in between AUD 0.28 and 1.84 million in cost savings and 11-56 additional QALYs per 1000 patients. Probabilistic sensitivity analyses indicated that the finding is robust to parameter uncertainty. CONCLUSIONS Higher proportions of patients receiving guideline-based care are less costly and improve patient outcomes. Strategies to increase the proportion of patients receiving guideline-based care are warranted.
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Affiliation(s)
- Yuqi Zhang
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social WorkQueensland University of TechnologyBrisbaneAustralia
- Centre for Data ScienceQueensland University of TechnologyBrisbaneAustralia
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Hannah E. Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social WorkQueensland University of TechnologyBrisbaneAustralia
| | - Peter A. Lazzarini
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social WorkQueensland University of TechnologyBrisbaneAustralia
- Allied Health Research CollaborativeThe Prince Charles HospitalBrisbaneAustralia
| | - Susanna Cramb
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social WorkQueensland University of TechnologyBrisbaneAustralia
- Centre for Data ScienceQueensland University of TechnologyBrisbaneAustralia
| | - Rosana Pacella
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUK
| | - Jaap J. van Netten
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social WorkQueensland University of TechnologyBrisbaneAustralia
- Department of Rehabilitation Medicine, Amsterdam Movement SciencesAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Qinglu Cheng
- Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Patrick H. Derhy
- Clinical Access and Redesign UnitQueensland HealthBrisbaneAustralia
| | - Ewan M. Kinnear
- Allied Health Research CollaborativeThe Prince Charles HospitalBrisbaneAustralia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social WorkQueensland University of TechnologyBrisbaneAustralia
- Digital Health and Informatics DirectorateMetro South HealthBrisbaneAustralia
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40
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Wang Y, Zhang P, Shao H, Andes LJ, Imperatore G. Medical Costs Associated With Diabetes Complications in Medicare Beneficiaries Aged 65 Years or Older With Type 1 Diabetes. Diabetes Care 2023; 46:149-155. [PMID: 36399714 DOI: 10.2337/dc21-2538] [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: 12/08/2021] [Accepted: 10/25/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To estimate medical costs associated with 17 diabetes complications and treatment procedures among Medicare beneficiaries aged ≥65 years with type 1 diabetes. RESEARCH DESIGN AND METHODS With use of the 2006-2017 100% Medicare claims database for beneficiaries enrolled in fee-for-service plans and Part D, we estimated the annual cost of 17 diabetes complications and treatment procedures. Type 1 diabetes and its complications and procedures were identified using ICD-9/ICD-10, procedure, and diagnosis-related group codes. Individuals with type 1 diabetes were followed from the year when their diabetes was initially identified in Medicare (2006-2015) until death, discontinuing plan coverage, or 31 December 2017. Fixed-effects regression was used to estimate costs in the complication occurrence year and subsequent years. The cost proportion of a complication was equal to the total cost of the complication, calculated by multiplying prevalence by the per-person cost divided by the total cost for all complications. All costs were standardized to 2017 U.S. dollars. RESULTS Our study included 114,879 people with type 1 diabetes with lengths of follow-up from 3 to 10 years. The costliest complications per person were kidney failure treated by transplant ($77,809 in the occurrence year and $13,556 in subsequent years), kidney failure treated by dialysis ($56,469 and $41,429), and neuropathy treated by lower-extremity amputation ($40,698 and $7,380). Sixteen percent of the total medical cost for diabetes complications was for treating congestive heart failure. CONCLUSIONS Costs of diabetes complications were large and varied by complications. Our results can assist in cost-effectiveness analysis of treatments and interventions for preventing or delaying diabetes complications in Medicare beneficiaries aged ≥65 years with type 1 diabetes.
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Affiliation(s)
- Yu Wang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hui Shao
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Linda J Andes
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Wang X, Yuan CX, Xu B, Yu Z. Diabetic foot ulcers: Classification, risk factors and management. World J Diabetes 2022; 13:1049-1065. [PMID: 36578871 PMCID: PMC9791567 DOI: 10.4239/wjd.v13.i12.1049] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/18/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic foot ulceration is a devastating complication of diabetes that is associated with infection, amputation, and death, and is affecting increasing numbers of patients with diabetes mellitus. The pathogenesis of foot ulcers is complex, and different factors play major roles in different stages. The refractory nature of foot ulcer is reflected in that even after healing there is still a high recurrence rate and amputation rate, which means that management and nursing plans need to be considered carefully. The importance of establishment of measures for prevention and management of DFU has been emphasized. Therefore, a validated and appropriate DFU classification matching the progression is necessary for clinical diagnosis and management. In the first part of this review, we list several commonly used classification systems and describe their application conditions, scope, strengths, and limitations; in the second part, we briefly introduce the common risk factors for DFU, such as neuropathy, peripheral artery disease, foot deformities, diabetes complications, and obesity. Focusing on the relationship between the risk factors and DFU progression may facilitate prevention and timely management; in the last part, we emphasize the importance of preventive education, characterize several of the most frequently used management approaches, including glycemic control, exercise, offloading, and infection control, and call for taking into account and weighing the quality of life during the formulation of treatment plans. Multidisciplinary intervention and management of diabetic foot ulcers (DFUs) based on the effective and systematic combination of these three components will contribute to the prevention and treatment of DFUs, and improve their prognosis.
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Affiliation(s)
- Xuan Wang
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Chong-Xi Yuan
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Bin Xu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Zhi Yu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
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42
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Zeng H, Yuan C, Morze J, Fu R, Wang K, Wang L, Sun F, Ji JS, Giovannucci EL, Song M. New onset of type 2 diabetes after colorectal cancer diagnosis: Results from three prospective US cohort studies, systematic review, and meta-analysis. EBioMedicine 2022; 86:104345. [PMID: 36371990 PMCID: PMC9663870 DOI: 10.1016/j.ebiom.2022.104345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 09/30/2022] [Accepted: 10/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Limited data indicate that patients with colorectal cancer (CRC) are at higher risk of developing type 2 diabetes (T2D). We prospectively examined the risk of T2D between individuals with and without CRC in three large cohorts and conducted a meta-analysis. METHODS We assessed the diagnosis of CRC and T2D among 111,485 women from the Nurses' Health Study, 112,958 women from the Nurses' Health Study II, and 46,581 men from the Health Professionals Follow-up Study. We used multivariable Cox regression with time-varying covariates to calculate the hazard ratio (HR) of T2D in relation to CRC diagnosis. We further performed a systematic review and meta-analysis of cohort studies. FINDINGS Up to 36 years of follow-up (6.9 million person-years), we documented 3402 incident CRC cases and 26,469 T2D cases. Compared to non-CRC individuals, those with CRC were more likely to develop T2D (multivariable-adjusted HR 1.20, 95% CI 1.05-1.38). The association was most evident for individuals with fewer risk factors for T2D. In the meta-analysis of seven cohort studies (1,061,744 participants), CRC was associated with higher T2D risk (meta-analysis HR 1.21, 95% CI 1.11-1.31, I2 = 57.9%). By CRC duration, a statistically significant association was observed in the first 10 years but not after 10 years of CRC diagnosis (≤5 years, meta-analysis HR 1.32, 95% CI 1.27-1.36; 5.1-10 years, 1.14 [1.04-1.25]; >10 years, 1.14 [0.91-1.37]). INTERPRETATION CRC was associated with increased T2D risk, especially in the first ten years after CRC diagnosis. Our findings highlight the importance of T2D prevention for CRC survivorship care. FUNDING NHS cohort infrastructure grant (UM1 CA186107), NHS program project grant that funds cancer research (P01 CA87969), NHS II cohort infrastructure grant (U01 CA176726), HPFS cohort infrastructure grant (U01 CA167552) and the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2021-I2M-1-010).
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Affiliation(s)
- Hongmei Zeng
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA
| | - Chen Yuan
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA
| | - Jakub Morze
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA; Department of Cardiology and Internal Medicine, School of Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn 10-082, Poland
| | - Ruiying Fu
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Kai Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Liang Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Center of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 528406, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing 100191, China
| | - Edward L Giovannucci
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
| | - Mingyang Song
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02115, USA.
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43
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Aly S, Sheu EG. Comment on: Glycemic outcomes in patients with type 2 diabetes after bariatric surgery compared with routine care: a population-based, real-world cohort study in the United Kingdom. Surg Obes Relat Dis 2022; 18:1376-1377. [PMID: 36224081 DOI: 10.1016/j.soard.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Sherif Aly
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eric G Sheu
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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44
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Lum KY, Oppong R, Kigozi J. Economic Evaluation of Type 2 Diabetes Mellitus Interventions in Low- and Middle-Income Countries: A Systematic Review of the Literature. Asia Pac J Public Health 2022; 34:752-760. [PMID: 36039503 DOI: 10.1177/10105395221122643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The primary aim of this study is to assess the evidence on the cost-effectiveness of type 2 diabetes mellitus (T2DM) interventions with a focus on diabetes education, lifestyle modifications, surgical intervention, and pharmacological therapy in low- and middle-income countries (LMICs). A systematic review was conducted to identify economic evaluations of T2DM interventions published in LMICs for the period 2009-2019. A total of 25 studies were identified, with more than half of the studies being decision analytic models. Critical appraisal of the identified studies showed they were of good quality. Overall, the reported interventions in this review were very heterogeneous, which made them difficult to compare. However, there was strong evidence suggesting that diabetes education was a very cost-effective strategy in LMICs. Further evidence on affordability and budget impact of bariatric surgery is required before adopting the intervention. Metformin-based therapy showed promising evidence on cost-effectiveness and thus should be offered to T2DM patients in LMICs. On the contrary, the cost-effectiveness of lifestyle modifications remains understudied in LMICs. The findings in this review can inform policy guidance toward the inclusion of T2DM interventions in the benefit packages for Universal Health Coverage in LMICs.
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Affiliation(s)
- Kah Yee Lum
- Institute for Health Management, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia
| | | | - Jesse Kigozi
- Health Economics Unit, University of Birmingham, UK
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45
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Wang Y, Zhang P, Shao H, Andes LJ, Imperatore G. Medical Costs Associated With Diabetes Complications in Medicare Beneficiaries Aged 65 Years or Older With Type 2 Diabetes. Diabetes Care 2022; 45:2570-2576. [PMID: 36102675 DOI: 10.2337/dc21-2151] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 08/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate medical costs associated with 17 major diabetes-related complications and treatment procedures among Medicare beneficiaries aged ≥65 years with type 2 diabetes. RESEARCH DESIGN AND METHODS Claims data from 100% of Medicare beneficiaries enrolled in fee-for-service plans from 2006 to 2017 were analyzed. Records with type 2 diabetes and complications were identified using ICD-9, ICD-10, and diagnosis-related group codes. The index year was the year when a person was first identified as having diabetes with an inpatient claim or an outpatient claim plus another inpatient/outpatient claim in the 2 years following the first claim in Medicare. Included individuals were followed from index years until death, discontinuation of plan coverage, or 31 December 2017. Fixed-effects regression was used to estimate the cost in years when the complication event occurred and in subsequent years. The total cost for each complication was calculated for 2017 by multiplying the complication prevalence by the cost estimate. All costs were standardized to 2017 U.S. dollars. RESULTS Our study included 10,982,900 beneficiaries with type 2 diabetes. Follow-up ranged from 3 to 10 years. The three costliest complications were kidney failure treated by transplant (occurring year $79,045, subsequent years $17,303), kidney failure treated by dialysis ($54,394, $38,670), and lower-extremity amputation ($38,982, $8,084). Congestive heart failure accounted for the largest share (18%) of total complication costs. CONCLUSIONS Costs associated with diabetes complications were substantial. Our cost estimates provide essential information needed for conducting economic evaluation of treatment and programs to prevent and delay diabetes complications in Medicare beneficiaries.
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Affiliation(s)
- Yu Wang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hui Shao
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.,Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Linda J Andes
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Rando MM, Biscetti F, Cecchini AL, Nardella E, Nicolazzi MA, Angelini F, Iezzi R, Eraso LH, Dimuzio PJ, Pitocco D, Gasbarrini A, Massetti M, Flex A. Serum high mobility group box-1 levels associated with cardiovascular events after lower extremity revascularization: a prospective study of a diabetic population. Cardiovasc Diabetol 2022; 21:214. [PMID: 36244983 PMCID: PMC9571458 DOI: 10.1186/s12933-022-01650-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background Peripheral arterial disease (PAD) is one of the most disabling cardiovascular complications of type 2 diabetes mellitus and is indeed associated with a high risk of cardiovascular and limb adverse events. High mobility group box-1 (HMGB-1) is a nuclear protein involved in the inflammatory response that acts as a pro-inflammatory cytokine when released into the extracellular space. HMBG-1 is associated with PAD in diabetic patients. The aim of this study was to evaluate the association between serum HMGB-1 levels and major adverse cardiovascular events (MACE) and major adverse limb events (MALE) after lower-extremity endovascular revascularization (LER) in a group of diabetic patients with chronic limb-threatening ischemia (CLTI). Methods We conducted a prospective observational study of 201 diabetic patients with PAD and CLTI requiring LER. Baseline serum HMGB-1 levels were determined before endovascular procedure. Data on cardiovascular and limb outcomes were collected in a 12-month follow-up. Results During the follow-up period, 81 cases of MACE and 93 cases of MALE occurred. Patients who subsequently developed MACE and MALE had higher serum HMGB-1 levels. Specifically, 7.5 ng/mL vs 4.9 ng/mL (p < 0.01) for MACE and 7.2 ng/mL vs 4.8 ng/mL (p < 0.01) for MALE. After adjusting for traditional cardiovascular risk factors, the association between serum HMGB-1 levels and cardiovascular outcomes remained significant in multivariable analysis. In our receiver operating characteristic (ROC) curve analysis, serum HMGB-1 levels were a good predictor of MACE incidence (area under the curve [AUC] = 0.78) and MALE incidence (AUC = 0.75). Conclusions This study demonstrates that serum HMGB-1 levels are associated with the incidence of MACE and MALE after LER in diabetic populations with PAD and CLTI.
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Singh S, Price H, Fayers K, Leal J, Donoghue V, Hempenstall J, Lewis P, O'Halloran P, Tsiachristas A. The WISDOM self-management intervention: A cost-effectiveness analysis to support the transformation of type 2 diabetes care in England. Diabet Med 2022; 39:e14928. [PMID: 35900906 PMCID: PMC9544153 DOI: 10.1111/dme.14928] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the cost-effectiveness of the WISDOM self-management intervention for type 2 diabetes compared with care as usual. DESIGN We performed a difference-in-differences analysis to estimate differences in risk factors for diabetes complications between people in the WISDOM group (n = 25, 276) and a control group (n = 15, 272) using GP records. A decision analytic model was then used to extrapolate differences in risk factors into costs and outcomes in the long term. SETTING Participating GP practices in West Hampshire and Southampton, UK. PARTICIPANTS All people diagnosed with type 2 diabetes between January 1990 and March 2020 (n = 40,548). OUTCOMES Diabetes-related complications, quality-adjusted life years (QALYs) and costs to the English National Health Service at 5 years and lifetime. INTERVENTIONS The WISDOM intervention included risk stratification, self-management education programme to professionals and people with type 2 diabetes, and monitoring of key treatment targets. RESULTS WISDOM was associated with less atrial fibrillation [p = 0.001], albuminuria [p = 0.002] and blood pressure [p = 0.098]. Among all people in the intervention group, WISDOM led to 51 [95%CI: 25; 76] QALYs gained and saved £278,036 [95%CI: -631,900; 176,392] in the first 5 years after its implementation compared with care as usual. During those people' lifetime, WISDOM led to 253 [95%CI: 75; 404] QALYs gained and cost saving of £126,380 [95%CI: -1,466,008; 1,339,628]. The gains in QALYs were a result of reduced diabetes-related complications through improved management of the associated risk factors. CONCLUSIONS The WISDOM risk-stratification and education intervention for type 2 diabetes appear to be cost-effective compared to usual care by reducing diabetes complications.
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Affiliation(s)
- Surya Singh
- Health Economics Research Centre, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | | | - Kate Fayers
- Southern Health NHS Foundation TrustSouthamptonUK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | | | | | - Paul Lewis
- Dorset County Hospital NHS Foundation TrustDorchesterUK
| | | | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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Arroba AI, Aguilar-Diosdado M. Special Issue “The Prevention, Treatment, and Complications of Diabetes Mellitus”. J Clin Med 2022; 11:jcm11185305. [PMID: 36142952 PMCID: PMC9501071 DOI: 10.3390/jcm11185305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ana I. Arroba
- Research Unit, Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009 Cádiz, Spain
- Department of Endocrinology and Metabolism, Hospital Puerta del Mar, 11009 Cádiz, Spain
| | - Manuel Aguilar-Diosdado
- Research Unit, Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009 Cádiz, Spain
- Department of Endocrinology and Metabolism, Hospital Puerta del Mar, 11009 Cádiz, Spain
- School of Medicine, Cadiz University (UCA), Ana de Viya 21, 11009 Cadiz, Spain
- Correspondence:
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Kuo S, Yang CT, Herman WH, Lisabeth LD, Ye W. National Trends in the Achievement of Recommended Strategies for Stroke Prevention in U.S. Adults With Type 2 Diabetes, 2001-2018. Diabetes Care 2022; 45:2003-2011. [PMID: 35834174 PMCID: PMC9472506 DOI: 10.2337/dc21-2283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/07/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the national prevalence of and trends in achieving current guideline-recommended treatment goals and pharmacotherapies for primary and secondary prevention of stroke among U.S. adults with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS We performed serial cross-sectional analyses in 4,834 adults aged ≥45 years with T2D who participated in the 2001-2018 National Health and Nutrition Examination Survey. With stratification by stroke history, we estimated the proportion of adults with T2D who achieved current guideline-recommended strategies for stroke prevention. Preventive strategies for stroke were benchmarked against diabetes care and cardiovascular risk reduction guidelines. RESULTS Overall in 2001-2018, among those without stroke history, the proportion who achieved primary stroke prevention strategies ranged from 8.4% (95% CI 6.8-10.1) for aspirin/clopidogrel treatment in those with a higher cardiovascular disease risk to 80.5% (78.8-82.2) for nonsmoking. Among those with stroke history, the proportion who achieved secondary stroke prevention strategies ranged from 11.8% (8.7-14.8) for weight control to 80.0% (74.9-84.9) for glycemic control. From 2001 to 2018, among those without stroke history, there was a significant increase in statin therapy (Ptrend < 0.0001), smoking abstinence (Ptrend = 0.01), and ACE inhibitor/angiotensin receptor blocker treatment for hypertension (Ptrend = 0.04) but a substantial decline in weight control (Ptrend < 0.001). Among those with stroke history, only statin therapy (Ptrend = 0.01) increased significantly over time. CONCLUSIONS During 2001-2018, the achievement of some current guideline-recommended strategies for stroke prevention among U.S. adults with T2D improved but remains a challenge overall. Efforts are needed to improve implementation of strategies for stroke prevention in this population.
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Affiliation(s)
- Shihchen Kuo
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Ting Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - William H. Herman
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Lynda D. Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Wen Ye
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
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Dahal PK, Rawal LB, Mahumud RA, Paudel G, Sugishita T, Vandelanotte C. Economic Evaluation of Health Behavior Interventions to Prevent and Manage Type 2 Diabetes Mellitus in Asia: A Systematic Review of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10799. [PMID: 36078539 PMCID: PMC9518060 DOI: 10.3390/ijerph191710799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Health behavior interventions implemented in Asian countries often lack economic evaluations that effectively address the problems of type 2 diabetes mellitus. This review systematically assessed the existing literature on economic evaluation of health behavior interventions to prevent and manage type 2 diabetes mellitus for people living in Asian countries. Eligible studies were identified through a search of six bibliographic databases, namely, PubMed, Scopus, Public Health Database by ProQuest, Cumulative Index to Nursing and Allied Health Literature Complete, Web of Science, and Google Scholar. Randomized controlled trials of health behavior interventions and studies published in the English language from January 2000 to May 2022 were included in the review. The search yielded 3867 records, of which 11 studies were included in the review. All included studies concluded that health behavior interventions were cost-effective. Eight of these studies undertook an evaluation from a health system perspective, two studies used both societal and health system perspectives, and one study utilized a societal and multi-payer perspective. This review identified the time horizon, direct and indirect medical costs, and discount rates as the most important considerations in determining cost effectiveness. These findings have implications in extending health behavior interventions to prevent and manage type 2 diabetes mellitus in low-resource settings, and are likely to yield the most promising outcomes for people with type 2 diabetes mellitus.
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Affiliation(s)
- Padam Kanta Dahal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW 2000, Australia or
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD 4702, Australia
| | - Lal B. Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW 2000, Australia or
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD 4702, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW 2751, Australia
| | - Rashidul Alam Mahumud
- NHRMC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Grish Paudel
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW 2000, Australia or
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD 4702, Australia
| | - Tomohiko Sugishita
- Section of Global Health, Division of Public Health, Department of Public Health, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Corneel Vandelanotte
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD 4702, Australia
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