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Hocking SL, Markovic TP, Lee CM, Picone TJ, Gudorf KE, Colagiuri S. Intensive Lifestyle Intervention for Remission of Early Type 2 Diabetes in Primary Care in Australia: DiRECT-Aus. Diabetes Care 2024; 47:66-70. [PMID: 37840461 PMCID: PMC10733653 DOI: 10.2337/dc23-0781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/04/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE We aimed to assess whether remission of type 2 diabetes (T2D) could be achieved with a low-energy total diet replacement (TDR) in an Australian primary care setting. RESEARCH DESIGN AND METHODS Individuals aged 20-65 years with T2D duration up to 6 years, BMI >27.0 kg/m2, and not treated with insulin were prescribed a 13-week low-energy TDR (Optifast; Nestlé Health Science) followed by 8-week structured food reintroduction and 31-week supported weight maintenance. The primary outcome was T2D remission at 12 months. RESULTS A total of 155 participants comprised the intention-to-treat population. At 12 months, T2D remission was achieved in 86 (56%) participants, with a mean adjusted weight loss of 8.1% (95% CI 7.2-9.1). Two serious adverse events requiring hospitalization related to the study intervention were reported. CONCLUSIONS At 12 months T2D remission was achieved for one in two Australian adults in a primary care setting.
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Affiliation(s)
- Samantha L. Hocking
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, University of Sydney, Sydney, Australia
- Metabolism and Obesity Service, Royal Prince Alfred Hospital, Sydney, Australia
| | - Tania P. Markovic
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, University of Sydney, Sydney, Australia
- Metabolism and Obesity Service, Royal Prince Alfred Hospital, Sydney, Australia
| | - Crystal M.Y. Lee
- School of Population Health, Curtin University, Perth, Australia
| | - Tegan J. Picone
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, University of Sydney, Sydney, Australia
| | | | - Stephen Colagiuri
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, University of Sydney, Sydney, Australia
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2
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Lee CMY, Gibson AA, Humphries J, Nassar N, Colagiuri S. Sex and age differences in the use of medications for diabetes and cardiovascular risk factors among 25,733 people with diabetes. PLoS One 2023; 18:e0287599. [PMID: 37874829 PMCID: PMC10597478 DOI: 10.1371/journal.pone.0287599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 06/08/2023] [Indexed: 10/26/2023] Open
Abstract
AIM To determine sex and age differences in the use of medications for diabetes and cardiovascular risk factors in people with diabetes in Australia. METHODS Pharmaceutical claims data of participants in the 45 and Up Study who self-reported having diabetes before 2013, were alive on 1st January 2013 and had at least one medication dispensing record between 1st January 2013 and 31st December 2019 were analysed. Annual sex and age-specific percentages of participants supplied specific medications were estimated for years 2013 to 2019. Percentages were reported for any glucose lowering medications and by drug class, any lipid modifying agents, and any blood pressure lowering medications. RESULTS Altogether 25,733 participants (45.2% women) with diabetes were included. The percentage of participants who were supplied with glucose lowering medications was consistently lower in women compared to men. In both sexes, the percentage of participants who were supplied with glucose lowering medications was lowest among those aged ≥75 years and this decreased over time. Similar findings were observed for lipid modifying agents and blood pressure lowering medications. The use of sodium glucose co-transporter 2 inhibitors increased substantially in participants aged <75 years since it became available in 2013. However, no sex differences were observed in its use among people with hospital-recorded history of cardiovascular disease. CONCLUSIONS Practitioners should be aware of possible sex disparities in the pharmacological treatment of diabetes and cardiovascular risk factors in people with diabetes in Australia. There is a possible time lag between reporting of research findings and uptake of sodium glucose co-transporter 2 inhibitors prescribing in individuals with diabetes and high cardiovascular risk in clinical practice, nevertheless, the result observed was consistent with the management guidelines at the time of the study.
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Affiliation(s)
- Crystal M. Y. Lee
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Alice A. Gibson
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Jacob Humphries
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Colagiuri
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
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3
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Gibson AA, Cox E, Gale J, Craig ME, King S, Chow CK, Colagiuri S, Nassar N. Association of oral health with risk of incident micro and macrovascular complications: A prospective cohort study of 24,862 people with diabetes. Diabetes Res Clin Pract 2023; 203:110857. [PMID: 37563015 DOI: 10.1016/j.diabres.2023.110857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
AIMS To investigate the association between self-reported oral health and incident micro and macrovascular diabetes complications. METHODS This prospective cohort study linked data from the 45 and Up Study, Australia, to administrative health records. The participants were 24,862 men and women, aged ≥45 years, with diabetes at baseline (2006-2009). The oral health of participants was assessed by questionnaire. Incident diabetes complications were determined using hospitalisation data and claims for medical services up until 2019. Hazard ratios for the association between oral health and incident complications were calculated using multivariable cox proportional hazards models. RESULTS Almost 60 % of participants had <20 teeth, and 38 % rated their teeth and gums as fair or poor. Compared with those with ≥20 teeth, those with 0 teeth had an increased risk of cardiovascular disease (aHR 1.24, 95 % CI: 1.15, 1.35), lower limb (aHR 1.22, 95 % CI: 1.11, 1.33) and kidney (aHR 1.19, 95 % CI: 1.11, 1.29) complications. Individuals with 1-9 teeth had an increased risk of eye complications (aHR 1.14, 95 % CI: 1.07, 1.22). The associations were generally consistent for poor self-rated teeth and gums. CONCLUSIONS Self-reported oral health measures may be a marker of elevated risk of complications in people with diabetes.
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Affiliation(s)
- Alice A Gibson
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia.
| | - Emma Cox
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia
| | - Joanne Gale
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Maria E Craig
- Charles Perkins Centre, The University of Sydney, NSW, Australia; Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Sydney, NSW, Australia
| | - Shalinie King
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sydney Dental School, Faculty of Medicine and Heath, The University of Sydney, NSW, Australia
| | - Clara K Chow
- Charles Perkins Centre, The University of Sydney, NSW, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, NSW, Australia
| | - Stephen Colagiuri
- Charles Perkins Centre, The University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Natasha Nassar
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia; Child Population and Translational Health Research, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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4
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Gibson AA, Cox E, Gale J, Craig ME, Eberhard J, King S, Chow CK, Colagiuri S, Nassar N. Oral health status and risk of incident diabetes: a prospective cohort study of 213,389 individuals aged 45 and over. Diabetes Res Clin Pract 2023; 202:110821. [PMID: 37453513 DOI: 10.1016/j.diabres.2023.110821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/18/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
AIMS To examine whether simple measures of oral health are associated with incident diabetes. METHODS This prospective cohort study linked data from the 45 and Up Study, Australia, to administrative health records. The study participants were 213,389 men and women, aged ≥ 45 years, with no diabetes at baseline. The oral health of participants was assessed by questionnaire. Incident diabetes cases were ascertained based on self-report in follow-up questionnaires, linked data on medical and pharmaceutical claims, and hospitalisation data up until 2019. The association between oral health and incident diabetes were calculated using multivariable cox proportional hazards models. RESULTS During 2,232,215 person-years of follow-up, 20,487 (9.6%) participants developed diabetes. Compared with those with ≥20 teeth, the adjusted hazard ratio (aHR) for incident diabetes was 1.12 (95% Confidence Interval (CI): 1.08, 1.17) for 10-19 teeth, 1.20 (1.14, 1.26) for 1-9 teeth and 1.15 (1.09, 1.21) for no teeth. Compared with those with excellent/very good teeth and gums, the aHR for incident diabetes was 1.07 (1.03, 1.12) for fair and 1.13 (1.07, 1.20) for poor teeth and gums. CONCLUSIONS Simple measures of oral health were associated with risk of developing diabetes, demonstrating the potential importance of oral health screening for diabetes prevention.
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Affiliation(s)
- Alice A Gibson
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia.
| | - Emma Cox
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia
| | - Joanne Gale
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Maria E Craig
- Charles Perkins Centre, The University of Sydney, NSW, Australia; Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Sydney, NSW, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Joerg Eberhard
- Charles Perkins Centre, The University of Sydney, NSW, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Shalinie King
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Clara K Chow
- Charles Perkins Centre, The University of Sydney, NSW, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, NSW, Australia
| | - Stephen Colagiuri
- Charles Perkins Centre, The University of Sydney, NSW, Australia; The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Natasha Nassar
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia; Child Population and Translational Health Research, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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Islam SMS, Siopis G, Sood S, Uddin R, Tegegne T, Porter J, Dunstan DW, Colagiuri S, Zimmet P, George ES, Maddison R. The burden of type 2 diabetes in Australia during the period 1990-2019: Findings from the global burden of disease study. Diabetes Res Clin Pract 2023; 199:110631. [PMID: 36965709 DOI: 10.1016/j.diabres.2023.110631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/24/2023] [Accepted: 03/14/2023] [Indexed: 03/27/2023]
Abstract
AIMS To describe morbidity and mortality trends of type 2 diabetes in Australia, from 1990 to 2019, compared with similar sociodemographic index (SDI) countries. METHODS Australia-specific Global Burden of Diseases data were used to estimate age-standardised, age-specific, and sex-specific rates for prevalence, years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life years (DALYs), and deaths due to type 2 diabetes between 1990 and 2019. Australian data were compared with 14 similar SDI countries. RESULTS Type 2 diabetes increased in Australia between 1990 and 2019. The age-standardised prevalence increased from 1,985 [95% Confidence Interval (CI): 1,786.7-2195.3] per 100,000 population, to 3,429 [95% CI 3,053.3-3,853.7]. Cases tripled, from 379,532 [342,465-419,475] to 1,307,261 [1,165,522-1,461,180]. The age-standardised death rates doubled, from 2,098 [1,953-2,203] per 100,000, to 4,122 [3,617-4,512]. DALYs doubled, from 70,348 [59,187-83,500] to 169,763 [129,792-216,150], with increases seen in YLDs and YLLs. Men displayed higher rates. Compared to similar SDI countries, Australia ranked 4th in terms of burden for type 2 diabetes. CONCLUSIONS The burden of type 2 diabetes in Australia has increased considerably over three decades. There is an urgent need to prioritise resource allocation for prevention programs, screening initiatives to facilitate early detection, and effective and accessible management strategies for the large proportion of the population impacted by type 2 diabetes.
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Affiliation(s)
- Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - George Siopis
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Surbhi Sood
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Riaz Uddin
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Teketo Tegegne
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Judi Porter
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - David W Dunstan
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia; Baker-Deakin Department Lifestyle and Diabetes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
| | | | - Paul Zimmet
- Department of Medicine, Monash University, Melbourne, VIC, Australia.
| | - Elena S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
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Sanai F, Sahid AS, Huvanandana J, Spoa S, Boyle LH, Hribar J, Wang DTY, Kwan B, Colagiuri S, Cox SJ, Telfer TJ. Evaluation of a Continuous Blood Glucose Monitor: A Novel and Non-Invasive Wearable Using Bioimpedance Technology. J Diabetes Sci Technol 2023; 17:336-344. [PMID: 34711074 PMCID: PMC10012362 DOI: 10.1177/19322968211054110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Frequent blood glucose level (BGL) monitoring is essential for effective diabetes management. Poor compliance is common due to the painful finger pricking or subcutaneous lancet implantation required from existing technologies. There are currently no commercially available non-invasive devices that can effectively measure BGL. In this real-world study, a prototype non-invasive continuous glucose monitoring system (NI-CGM) developed as a wearable ring was used to collect bioimpedance data. The aim was to develop a mathematical model that could use these bioimpedance data to estimate BGL in real time. METHODS The prototype NI-CGM was worn by 14 adult participants with type 2 diabetes for 14 days in an observational clinical study. Bioimpedance data were collected alongside paired BGL measurements taken with a Food and Drug Administration (FDA)-approved self-monitoring blood glucose (SMBG) meter and an FDA-approved CGM. The SMBG meter data were used to improve CGM accuracy, and CGM data to develop the mathematical model. RESULTS A gradient boosted model was developed using a randomized 80-20 training-test split of data. The estimated BGL from the model had a Mean Absolute Relative Difference (MARD) of 17.9%, with the Parkes error grid (PEG) analysis showing 99% of values in clinically acceptable zones A and B. CONCLUSIONS This study demonstrated the reliability of the prototype NI-CGM at collecting bioimpedance data in a real-world scenario. These data were used to train a model that could successfully estimate BGL with a promising MARD and clinically relevant PEG result. These results will enable continued development of the prototype NI-CGM as a wearable ring.
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Affiliation(s)
- Farid Sanai
- Scimita Ventures Pty Ltd, Sydney, NSW,
Australia
| | | | | | - Sandra Spoa
- Scimita Ventures Pty Ltd, Sydney, NSW,
Australia
| | | | | | | | | | - Stephen Colagiuri
- Boden Collaboration of Obesity,
Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, NSW,
Australia
- WHO Collaborating Centre on Physical
Activity, Nutrition and Obesity, The University of Sydney, Sydney, NSW,
Australia
| | - Shane J. Cox
- Scimita Ventures Pty Ltd, Sydney, NSW,
Australia
| | - Thomas J. Telfer
- Scimita Ventures Pty Ltd, Sydney, NSW,
Australia
- Thomas J. Telfer, PhD (Medicine), BSc (Adv)
(Hons I), Scimita Ventures Pty Ltd, 31/2 Bishop Street, St Peters, Sydney, NSW
2044, Australia.
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7
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Boelsen-Robinson T, Thow AM, Lee N, Gill T, Colagiuri S. Gambling, fast food and alcohol sponsorship in elite sport - perspectives from Australian sporting fans. BMC Public Health 2022; 22:2155. [PMID: 36419011 PMCID: PMC9685834 DOI: 10.1186/s12889-022-14479-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/14/2022] [Accepted: 10/27/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Public health bodies in Australia remain concerned about marketing of unhealthy commodities; namely unhealthy food, alcohol and gambling products. Children are particularly susceptible to the influence of unhealthy commodity marketing. This study explored adults' perceptions of unhealthy commodities sponsorship in elite sport and policies to restrict them. METHODS Four focus groups of 7-8 frequent sport spectators were recruited, including parents and non-parents, and located in inner and outer suburbs of Sydney, Australia. Results were analysed thematically. RESULTS Participants identified the contradictions of healthy messages of sport and unhealthy commodities, while highlighting the commercial value of sport sponsorship to sporting clubs. There is concern around children's exposure to effective and integrated marketing techniques when viewing sport, which encouraged unhealthy habits. Support for restricting sponsorship related to perceived product harm, with gambling viewed as having the greatest health impact. Participants were supportive of policies that reduced exposure of unhealthy commodities to children, but were concerned about the financial risk to sporting clubs. Governments and sports associations were identified as holding responsibility for enacting changes. CONCLUSION A number of options were identified for advocates to gain public and political traction to reduce unhealthy commodity sponsorship. There is potential for shifts away from unhealthy sponsorship by both governments and sports associations.
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Affiliation(s)
- Tara Boelsen-Robinson
- Charles Perkins Centre, Faculty of Medicine and Health, Boden Initiative, University of Sydney, Sydney, 2006, NSW, Australia. .,Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Camperdown, NSW, Australia. .,Global Obesity Centre, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia.
| | - Anne-Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Camperdown, NSW, Australia
| | - Nancy Lee
- Charles Perkins Centre, University of Sydney, Sydney, 2006, NSW, Australia
| | - Tim Gill
- Charles Perkins Centre, Faculty of Medicine and Health, Boden Initiative, University of Sydney, Sydney, 2006, NSW, Australia
| | - Stephen Colagiuri
- Charles Perkins Centre, Faculty of Medicine and Health, Boden Initiative, University of Sydney, Sydney, 2006, NSW, Australia
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8
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Gregory GA, Robinson TIG, Linklater SE, Wang F, Colagiuri S, de Beaufort C, Donaghue KC, Magliano DJ, Maniam J, Orchard TJ, Rai P, Ogle GD. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study. Lancet Diabetes Endocrinol 2022; 10:741-760. [PMID: 36113507 DOI: 10.1016/s2213-8587(22)00218-2] [Citation(s) in RCA: 188] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Accurate data on type 1 diabetes prevalence, incidence, associated mortality and life expectancy are crucial to inform public health policy, but these data are scarce. We therefore developed a model based on available data to estimate these values for 201 countries for the year 2021 and estimate the projected prevalent cases in 2040. METHODS We fitted a discrete-time illness-death model (Markov model) to data on type 1 diabetes incidence and type 1 diabetes-associated mortality to produce type 1 diabetes prevalence, incidence, associated mortality and life expectancy in all countries. Type 1 diabetes incidence and mortality data were available from 97 and 37 countries respectively. Diagnosis rates were estimated using data from an expert survey. Mortality was modelled using random-forest regression of published type 1 diabetes mortality data, and life expectancy was calculated accordingly using life tables. Estimates were validated against observed prevalence data for 15 countries. We also estimated missing prevalence (the number of additional people who would be alive with type 1 diabetes if their mortality matched general population rates). FINDINGS In 2021, there were about 8·4 (95% uncertainty interval 8·1-8·8) million individuals worldwide with type 1 diabetes: of these 1·5 million (18%) were younger than 20 years, 5·4 million (64%) were aged 20-59 years, and 1·6 million (19%) were aged 60 years or older. In that year there were 0·5 million new cases diagnosed (median age of onset 39 years), about 35 000 non-diagnosed individuals died within 12 months of symptomatic onset. One fifth (1·8 million) of individuals with type 1 diabetes were in low-income and lower-middle-income countries. Remaining life expectancy of a 10-year-old diagnosed with type 1 diabetes in 2021 ranged from a mean of 13 years in low-income countries to 65 years in high-income countries. Missing prevalent cases in 2021 were estimated at 3·7 million. In 2040, we predict an increase in prevalent cases to 13·5-17·4 million (60-107% higher than in 2021) with the largest relative increase versus 2021 in low-income and lower-middle-income countries. INTERPRETATION The burden of type 1 diabetes in 2021 is vast and is expected to increase rapidly, especially in resource-limited countries. Most incident and prevalent cases are adults. The substantial missing prevalence highlights the premature mortality of type 1 diabetes and an opportunity to save and extend lives of people with type 1 diabetes. Our new model, which will be made publicly available as the Type 1 Diabetes Index model, will be an important tool to support health delivery, advocacy, and funding decisions for type 1 diabetes. FUNDING JDRF International.
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Affiliation(s)
- Gabriel A Gregory
- Life for a Child Program, Diabetes NSW, Glebe, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia; Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | | | - Fei Wang
- JDRF Australia, St Leonards, NSW, Australia
| | - Stephen Colagiuri
- Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Carine de Beaufort
- DECCP, Pediatric Clinic, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg; Department of Science, Technology and Medicine, University of Luxembourg, Luxembourg
| | - Kim C Donaghue
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia; Children's Hospital at Westmead, Westmead, NSW, Australia
| | | | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Monash University, School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
| | - Jayanthi Maniam
- Life for a Child Program, Diabetes NSW, Glebe, NSW, Australia
| | - Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Graham D Ogle
- Life for a Child Program, Diabetes NSW, Glebe, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.
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9
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Markovic TP, Proietto J, Dixon JB, Rigas G, Deed G, Hamdorf JM, Bessell E, Kizirian N, Andrikopoulos S, Colagiuri S. The Australian Obesity Management Algorithm: A simple tool to guide the management of obesity in primary care. Obes Res Clin Pract 2022; 16:353-363. [PMID: 36050266 DOI: 10.1016/j.orcp.2022.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/02/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022]
Abstract
Obesity is a complex and multifactorial chronic disease with genetic, environmental, physiological and behavioural determinants that requires long-term care. Obesity is associated with a broad range of complications including type 2 diabetes, cardiovascular disease, dyslipidaemia, metabolic associated fatty liver disease, reproductive hormonal abnormalities, sleep apnoea, depression, osteoarthritis and certain cancers. An algorithm has been developed (with PubMed and Medline searched for all relevant articles from 1 Jan 2000-1 Oct 2021) to (i) assist primary care physicians in treatment decisions for non-pregnant adults with obesity, and (ii) provide a practical clinical tool to guide the implementation of existing guidelines (summarised in Appendix 1) for the treatment of obesity in the Australian primary care setting. MAIN RECOMMENDATIONS AND CHANGES IN MANAGEMENT: Treatment pathways should be determined by a person's anthropometry (body mass index (BMI) and waist circumference (WC)) and the presence and severity of obesity-related complications. A target of 10-15% weight loss is recommended for people with BMI 30-40 kg/m2 or abdominal obesity (WC > 88 cm in females, WC > 102 cm in males) without complications. The treatment focus should be supervised lifestyle interventions that may include a reduced or low energy diet, very low energy diet (VLED) or pharmacotherapy. For people with BMI 30-40 kg/m2 or abdominal obesity and complications, or those with BMI > 40 kg/m2 a weight loss target of 10-15% body weight is recommended, and management should include intensive interventions such as VLED, pharmacotherapy or bariatric surgery, which may be required in combination. A weight loss target of > 15% is recommended for those with BMI > 40 kg/m2 and complications and they should be referred to specialist care. Their treatment should include a VLED with or without pharmacotherapy and bariatric surgery.
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Affiliation(s)
- Tania P Markovic
- Metabolism & Obesity Service, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia.
| | | | - John B Dixon
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC 3122, Australia.
| | - Georgia Rigas
- St George Private Hospital, Kogarah, NSW 2217, Australia.
| | - Gary Deed
- HealthCarePlus Medical Centre, Carindale, QLD 4152, Australia; Monash University, Clayton, VIC 3800, Australia.
| | - Jeffrey M Hamdorf
- Medical School, University of Western Australia, Crawley, WA 6009, Australia.
| | - Erica Bessell
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia.
| | - Nathalie Kizirian
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia.
| | | | - Stephen Colagiuri
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia.
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10
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Waller K, Furber S, Cook R, Allman-Farinelli M, Colagiuri S, Franco L, Moses R, Webb A, Bauman A. Effectiveness and costs of strategies to recruit Australian adults with type 2 diabetes into a text message intervention (DTEXT) study. Public Health Res Pract 2022; 32:31232113. [PMID: 35702755 DOI: 10.17061/phrp31232113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Karen Waller
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia; School of Health and Society, University of Wollongong, NSW, Australia;
| | - Susan Furber
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Rebecca Cook
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | | | - Stephen Colagiuri
- WHO Collaborating Centre for Physical Activity, Nutrition and Obesity, University of Sydney, NSW, Australia
| | - Lisa Franco
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Robert Moses
- Illawarra Shoalhaven Diabetes Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Alison Webb
- Illawarra Shoalhaven Diabetes Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Adrian Bauman
- School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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11
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Tremblay J, Haloui M, Attaoua R, Tahir R, Hishmih C, Harvey F, Marois-Blanchet FC, Long C, Simon P, Santucci L, Hizel C, Chalmers J, Marre M, Harrap S, Cífková R, Krajčoviechová A, Matthews DR, Williams B, Poulter N, Zoungas S, Colagiuri S, Mancia G, Grobbee DE, Rodgers A, Liu L, Agbessi M, Bruat V, Favé MJ, Harwood MP, Awadalla P, Woodward M, Hussin JG, Hamet P. Correction to: Polygenic risk scores predict diabetes complications and their response to intensive blood pressure and glucose control. Diabetologia 2021; 64:2355-2356. [PMID: 34448881 PMCID: PMC8587372 DOI: 10.1007/s00125-021-05544-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Johanne Tremblay
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada.
| | - Mounsif Haloui
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - Redha Attaoua
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - Ramzan Tahir
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - Camil Hishmih
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - François Harvey
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | | | - Carole Long
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - Paul Simon
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - Lara Santucci
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - Candan Hizel
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Michel Marre
- Clinique Ambroise Paré, Neuilly-sur-Seine, and Centre de Recherches des Cordeliers, Paris, France
| | - Stephen Harrap
- Department of Physiology, University of Melbourne, Melbourne, VIC, Australia
| | - Renata Cífková
- Center for Cardiovascular Prevention, First Faculty of Medicine, Charles University in Prague and Thomayer Hospital, Prague, Czech Republic
| | - Alena Krajčoviechová
- Center for Cardiovascular Prevention, First Faculty of Medicine, Charles University in Prague and Thomayer Hospital, Prague, Czech Republic
| | - David R Matthews
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, London, UK
| | - Neil Poulter
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Giuseppe Mancia
- Istituto Auxologico Italiano, University of Milano, Bicocca, Italy
| | - Diederick E Grobbee
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Liusheng Liu
- Beijing Hypertension League Institute, Beijing, China
| | | | - Vanessa Bruat
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | | | | | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Molecular Genetics and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK.
| | - Julie G Hussin
- Montreal Heart Institute, Research Center, Montréal, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Pavel Hamet
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada.
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12
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Abstract
Diabetes diagnosis has important implications for individuals. Diagnostic criteria for fasting and 2-hour plasma glucose and HbA1c are universally agreed. Intermediate hyperglycemia/prediabetes is a risk factor for diabetes and cardiovascular disease. Because risk is a continuum, determining cut-point is problematic and reflected in significant differences in recommended fasting glucose and HbA1c criteria. Many types of diabetes are recognized. Diabetes classification systems are limited by a lack of understanding of etiopathogenetic pathways leading to diminished β-cell function. The World Health Organization classification system is designed to assist clinical care decisions. Newly recognized phenotypic clusters of diabetes might inform future classification systems.
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Affiliation(s)
- Stephen Colagiuri
- Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales 2006, Australia.
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13
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Tremblay J, Haloui M, Attaoua R, Tahir R, Hishmih C, Harvey F, Marois-Blanchet FC, Long C, Simon P, Santucci L, Hizel C, Chalmers J, Marre M, Harrap S, Cífková R, Krajčoviechová A, Matthews DR, Williams B, Poulter N, Zoungas S, Colagiuri S, Mancia G, Grobbee DE, Rodgers A, Liu L, Agbessi M, Bruat V, Favé MJ, Harwood MP, Awadalla P, Woodward M, Hussin JG, Hamet P. Polygenic risk scores predict diabetes complications and their response to intensive blood pressure and glucose control. Diabetologia 2021; 64:2012-2025. [PMID: 34226943 PMCID: PMC8382653 DOI: 10.1007/s00125-021-05491-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/22/2021] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS Type 2 diabetes increases the risk of cardiovascular and renal complications, but early risk prediction could lead to timely intervention and better outcomes. Genetic information can be used to enable early detection of risk. METHODS We developed a multi-polygenic risk score (multiPRS) that combines ten weighted PRSs (10 wPRS) composed of 598 SNPs associated with main risk factors and outcomes of type 2 diabetes, derived from summary statistics data of genome-wide association studies. The 10 wPRS, first principal component of ethnicity, sex, age at onset and diabetes duration were included into one logistic regression model to predict micro- and macrovascular outcomes in 4098 participants in the ADVANCE study and 17,604 individuals with type 2 diabetes in the UK Biobank study. RESULTS The model showed a similar predictive performance for cardiovascular and renal complications in different cohorts. It identified the top 30% of ADVANCE participants with a mean of 3.1-fold increased risk of major micro- and macrovascular events (p = 6.3 × 10-21 and p = 9.6 × 10-31, respectively) and a 4.4-fold (p = 6.8 × 10-33) higher risk of cardiovascular death. While in ADVANCE overall, combined intensive blood pressure and glucose control decreased cardiovascular death by 24%, the model identified a high-risk group in whom it decreased the mortality rate by 47%, and a low-risk group in whom it had no discernible effect. High-risk individuals had the greatest absolute risk reduction with a number needed to treat of 12 to prevent one cardiovascular death over 5 years. CONCLUSIONS/INTERPRETATION This novel multiPRS model stratified individuals with type 2 diabetes according to risk of complications and helped to target earlier those who would receive greater benefit from intensive therapy.
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Affiliation(s)
- Johanne Tremblay
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada.
| | - Mounsif Haloui
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - Redha Attaoua
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - Ramzan Tahir
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - Camil Hishmih
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - François Harvey
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | | | - Carole Long
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - Paul Simon
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - Lara Santucci
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - Candan Hizel
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Michel Marre
- Clinique Ambroise Paré, Neuilly-sur-Seine, and Centre de Recherches des Cordeliers, Paris, France
| | - Stephen Harrap
- Department of Physiology, University of Melbourne, Melbourne, VIC, Australia
| | - Renata Cífková
- Center for Cardiovascular Prevention, First Faculty of Medicine, Charles University in Prague and Thomayer Hospital, Prague, Czech Republic
| | - Alena Krajčoviechová
- Center for Cardiovascular Prevention, First Faculty of Medicine, Charles University in Prague and Thomayer Hospital, Prague, Czech Republic
| | - David R Matthews
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Bryan Williams
- University College London, Institute of Cardiovascular Science, London, UK
| | - Neil Poulter
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Giuseppe Mancia
- Istituto Auxologico Italiano, University of Milano, Bicocca, Italy
| | - Diederick E Grobbee
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Liusheng Liu
- Beijing Hypertension League Institute, Beijing, China
| | | | - Vanessa Bruat
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | | | | | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Molecular Genetics and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK.
| | - Julie G Hussin
- Montreal Heart Institute, Research Center, Montréal, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Pavel Hamet
- Department of Medicine, University of Montréal, CRCHUM, Québec, Canada.
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14
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Waller K, Furber S, Bauman A, Allman-Farinelli M, van den Dolder P, Hayes A, Facci F, Franco L, Webb A, Moses R, Cook R, Gugusheff J, Owen K, Colagiuri S. Effectiveness and acceptability of a text message intervention (DTEXT) on HbA1c and self-management for people with type 2 diabetes. A randomized controlled trial. Patient Educ Couns 2021; 104:1736-1744. [PMID: 33334634 DOI: 10.1016/j.pec.2020.11.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Determine the effectiveness and acceptability of a text message intervention (DTEXT) on HbA1c and self-management behaviors for Australian adults with type 2 diabetes. METHODS Using intention to treat analysis and generalized estimating equations, this randomized controlled trial of 395 adults determined change in HbA1c at 3 and 6 months between the intervention and control group. Secondary outcomes included change in nutrition, physical activity, blood lipid profile, body mass index, quality of life, self-efficacy, medication taking and program acceptability. RESULTS No significant difference was observed between the intervention or control group for HbA1c at 3 months (P = 0.23) or 6 months (P = 0.22). Significant improvements were seen in consumption of vegetables at 3 months (P < 0.001) and 6 months (P = 0.04); fruit at 3 months (P = 0.046) and discretionary sweet foods at 3 months (P = 0.02). No other significant effects seen. The intervention demonstrated high rates of acceptability (94.0%) and minimal withdrawal (1.5%). CONCLUSIONS DTEXT was an acceptable text message intervention that improved some nutritional behaviors in people with type 2 diabetes, but did not significantly improve HbA1c or other outcomes. Further research is required to optimize DTEXT. PRACTICE IMPLICATIONS DTEXT provides an acceptable, feasible form of self-management support that may complement existing diabetes care.
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Affiliation(s)
- Karen Waller
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, Australia; School of Health and Society, University of Wollongong, Keiraville, Australia.
| | - Susan Furber
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, Australia; School of Public Health and Community Medicine, University of NSW, Kensington, Australia
| | - Adrian Bauman
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Paul van den Dolder
- Ambulatory and Primary Health Care, Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Alison Hayes
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Franca Facci
- Integrated Chronic Disease Management Stream, Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Lisa Franco
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Alison Webb
- Illawarra Shoalhaven Diabetes Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Robert Moses
- Illawarra Shoalhaven Diabetes Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Rebecca Cook
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Jessica Gugusheff
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Epidemiology and Evidence, NSW Ministry of Health, St Leonards, Australia
| | - Katherine Owen
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Stephen Colagiuri
- Boden Collaboration of Obesity, Nutrition, Exercise and Eating Disorders. University of Sydney, Sydney, Australia; WHO Collaborating Centre on Physical Activity, Nutrition and Obesity. University of Sydney, Sydney, Australia
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15
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do Vale Moreira NC, Ceriello A, Basit A, Balde N, Mohan V, Gupta R, Misra A, Bhowmik B, Lee MK, Zuo H, Shi Z, Wang Y, Montenegro RM, Fernandes VO, Colagiuri S, Boulton AJM, Hussain A. Race/ethnicity and challenges for optimal insulin therapy. Diabetes Res Clin Pract 2021; 175:108823. [PMID: 33887353 DOI: 10.1016/j.diabres.2021.108823] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/11/2022]
Abstract
AIMS We aimed to review insulin dosing recommendations, insulin regulation and its determinants, glycaemic response to carbohydrates, and the efficacy and safety of insulin therapy in different races/ethnicities. METHODS We searched for articles in PubMed and Google Scholar databases up to 31 March 2021, with the following keywords: "ethnicity", "diabetes", "insulin", "history of insulin", "insulin therapy", "food/rice", "carbohydrate intake", "insulin resistance", "BMI", "insulin dosing", "insulin sensitivity", "insulin response", "glycaemic index", "glycaemic response", "efficacy and safety", with interposition of the Boolean operator "AND".In addition, we reviewed the reference lists of the articles found. RESULTS The differential effect of race/ethnicity has not yet been considered in current insulin therapy guidelines. Nevertheless, body size and composition, body mass index, fat distribution, diet, storage, and energy expenditure vary significantly across populations. Further, insulin sensitivity, insulin response, and glycaemicresponse to carbohydrates differ by ethnicity. These disparities may lead to different insulin requirements, adversely impacting the efficacy and safety of insulin therapy among ethnic groups. CONCLUSIONS Race/ethnicity affects glucose metabolism and insulin regulation.Until now, international guidelines addressing racial/ethnic-specific clinical recommendations are limited. Comprehensive updated insulin therapy guidelines by ethnicity are urgently needed.
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Affiliation(s)
| | | | - Abdul Basit
- Baquai Medical University, Karachi, Pakistan
| | - Naby Balde
- Endocrinology and Diabetes Department, Donka Conakry University Hospital, Conakry, Guinea; Foundation Diabetes and NCD, Conakry, Guinea; International Diabetes Federation, IDF, Brussels, Belgium
| | - V Mohan
- Dr. Mohans Diabetes Specialties Centre, Chennai, India
| | | | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Delhi, India
| | - Bishwajit Bhowmik
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Moon K Lee
- International Diabetes Federation, IDF, Brussels, Belgium; Division of Endocrinology & Metabolism, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
| | - Hui Zuo
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Renan M Montenegro
- Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Fortaleza-Ceará, Brazil
| | | | - Stephen Colagiuri
- International Diabetes Federation, IDF, Brussels, Belgium; Boden Collaboration, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Andrew J M Boulton
- International Diabetes Federation, IDF, Brussels, Belgium; University of Manchester, UK
| | - Akhtar Hussain
- Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Fortaleza-Ceará, Brazil; International Diabetes Federation, IDF, Brussels, Belgium; Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh; Faculty of Health Sciences, Nord University, Bodø, Norway.
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16
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Beran D, Colagiuri S, Ernoult N, Ewen M, Fleury C, Lepeska M, Londeix P, Pfiester E, Yudkin JS, Besançon S. Failing to address access to insulin in its centenary year would be a catastrophic moral failure. Lancet Diabetes Endocrinol 2021; 9:194-196. [PMID: 33675694 DOI: 10.1016/s2213-8587(21)00048-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/20/2022]
Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva 1211, Switzerland; Geneva University Hospitals, Geneva, Switzerland.
| | - Stephen Colagiuri
- Boden Collaboration, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, SNW, Australia
| | | | | | - Cynthia Fleury
- Conservatoire National des Arts et Métiers, Paris, France
| | | | - Pauline Londeix
- NGO Santé Diabète, Grenoble, France; Observatoire de la Transparence dans les Politiques du Médicament, Paris, France
| | | | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK
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17
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Siopis G, Colagiuri S, Allman-Farinelli M. Effectiveness of dietetic intervention for people with type 2 diabetes: A meta-analysis. Clin Nutr 2021; 40:3114-3122. [PMID: 33413914 DOI: 10.1016/j.clnu.2020.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/20/2020] [Accepted: 12/05/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Diet is central to treatment of type 2 diabetes. This review aimed to compare the effectiveness of nutrition therapy delivered by dietitians to nutrition advice delivered by other healthcare professionals in adults with type 2 diabetes on metabolic parameters. METHODS Cochrane CENTRAL, CINAHL, EMBASE, MEDLINE and PsychINFO were searched for randomised controlled trials of three months duration or longer, published from 1st January 2008 to 18th June 2019. Relevant data were extracted from studies with additional author information. Random-effects meta-analysis assessed mean changes in HbA1c and other clinical parameters. PROSPERO registration number: CRD42019130528. RESULTS Of 2477 records identified, fourteen studies, involving 3338 participants, were eligible for qualitative synthesis and meta-analysis. The mean changes [95% CI] at follow-up in HbA1c, BMI, weight, LDL cholesterol, systolic and diastolic blood pressure were -0·47 [-0·92, -0·02] %, -0·38 [-0·63, -0·13] kg/m2, -1·49 [-2·14, -0·84] kg, -0·15 [-0·33, 0·04] mmol/L, -0·75 [-2·45, 0·96] mm Hg and -1·17 [-4·52, 2·17] mm Hg respectively in favour of the intervention group. The quality of evidence was limited due to heterogeneity, risk of bias, publication bias and indirectness. CONCLUSIONS Nutrition therapy provided by dietitians was associated with better clinical parameters of type 2 diabetes, including clinically significant improved glycaemic control, across diverse multiethnic patient groups from all six inhabited continents. This conclusion should be reflected in clinical guidelines.
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Affiliation(s)
- George Siopis
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia.
| | - Stephen Colagiuri
- WHO Collaborating Centre for Physical Activity, Nutrition and Obesity, The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
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18
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Siopis G, Colagiuri S, Allman-Farinelli M. People With Type 2 Diabetes Report Dietitians, Social Support, and Health Literacy Facilitate Their Dietary Change. J Nutr Educ Behav 2021; 53:43-53. [PMID: 33077370 DOI: 10.1016/j.jneb.2020.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/22/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To describe the experiences and perspectives of people with type 2 diabetes mellitus (T2DM) regarding dietetic services and to suggest improvements for their access and delivery. DESIGN Semistructured telephone interviews. SETTING Urban and rural Australia. PARTICIPANTS A total of 30 English-speaking adults with T2DM recruited by means of electronic advertisements and posters. PHENOMENON OF INTEREST Engagement with services, adherence to diet, and perspectives regarding dietetic services. ANALYSIS Capability, opportunity, and motivation model of behavior and theoretical domains framework informed the analysis. RESULTS Participants were predominantly middle-aged, White, university-educated, and full-time professionals. Most had been diagnosed with T2DM for 2 years or more, were overweight or obese, were on glucose-lowering medication, and had visited the dietitian at least once. Two inter-related behaviors were identified: eating a healthy diet for T2DM and participating with dietetic services. Health literacy, as well as support by family, friends, and professionals, were reported as enablers for both these behaviors. Barriers stated included misconceptions about diets and the role of dietitians, unpleasant previous experiences with services, and lack of social support. CONCLUSIONS AND IMPLICATIONS These data support that improving health literacy of people with T2DM, in conjunction with social support by family and friends and professional support by dietitians, is likely to facilitate dietary behavior change.
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Affiliation(s)
- George Siopis
- School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia.
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19
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Siopis G, Colagiuri S, Allman-Farinelli M. Doctors identify regulatory barriers for their patients with type 2 diabetes to access the nutritional expertise of dietitians. Aust J Prim Health 2021; 27:312-318. [PMID: 33352088 DOI: 10.1071/py20228] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022]
Abstract
Diet is central to the management of type 2 diabetes (T2D) and better outcomes are achieved when the dietary intervention is delivered by a dietitian. Yet, many people with T2D never see a dietitian. It has been proposed that doctors prefer to provide the dietary advice themselves or rely on medication to treat their patients instead of referring them to a dietitian. This study aimed to collect the opinions and perspectives of doctors with regard to the dietary management of people with T2D in Australia. GPs and physicians treating people with T2D were recruited to participate in semistructured interviews conducted over the telephone. Inductive thematic analysis of content was conducted. Five GPs and seven physicians participated in the study. The qualitative analysis identified four main themes: the importance and role of diet in the management of T2D; the perceived value of dietetic care; access to dietetic services; and patients' motivation to consult a dietitian. All participants acknowledged the importance of diet in the treatment of T2D and all but one preferred to refer patients to a dietitian for nutritional management. Among the reported barriers to accessing dietetic services were: specialist physicians' lack of access to the national referral scheme for chronic conditions; patients' financial circumstances; and inadequacy of the number of subsidised sessions. It is important to facilitate and subsidise access to dietetic services through existing mechanisms by increasing the number of visits on the chronic disease management scheme and providing referral rights to specialist physicians.
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Affiliation(s)
- George Siopis
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW 2006, Australia; and Corresponding author.
| | - Stephen Colagiuri
- Charles Perkins Centre, Boden Collaboration, The University of Sydney, Sydney, NSW 2006, Australia
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW 2006, Australia
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Sainsbury E, Shi Y, Flack J, Colagiuri S. The diagnosis and management of diabetes in Australia: Does the "Rule of Halves" apply? Diabetes Res Clin Pract 2020; 170:108524. [PMID: 33164851 DOI: 10.1016/j.diabres.2020.108524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/10/2020] [Accepted: 10/15/2020] [Indexed: 01/17/2023]
Abstract
The Rule of Halves (ROH) is a theoretical framework which states that roughly half of all people with a condition are diagnosed; half of those diagnosed receive care; half of those who receive care achieve their treatment targets; and half of those who reach their targets achieve the desired treatment outcomes. This review examined the applicability of the ROH to diabetes in Australia. Five databases were searched for articles and government reports published between January 2000 and August 2019. Data was extracted for each level of the framework, and pooled sample proportions calculated for the total population and sub-group analysis by ethnicity and type of diabetes. The results showed that 72% of people with diabetes are diagnosed. Approximately 50% are receiving standard care, and 40-60% are meeting treatment targets for HbA1c, blood pressure and lipid levels. Overall, Australia is doing better than the ROH when it comes to achieving treatment outcomes; prevalence of microvascular complications was 20-30% and cardiovascular disease 62%. Indigenous people were less likely to meet treatment targets and more likely to experience adverse complications of diabetes. This review indicates the ROH does generally apply for diabetes care and management in Australia, highlighting the need for further improvement.
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Affiliation(s)
- Emma Sainsbury
- University of Sydney, Charles Perkins Centre, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Australia.
| | - Yumeng Shi
- University of Sydney, Charles Perkins Centre, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Australia.
| | - Jeff Flack
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney NSW, Australia.
| | - Stephen Colagiuri
- University of Sydney, Charles Perkins Centre, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Australia.
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Colagiuri S, Wilson M. WHO Insulin Access Workshop 21-25 September 2020 - Joint IDF, JDRF and NCDA statement. Diabetes Res Clin Pract 2020; 170:108594. [PMID: 33308612 DOI: 10.1016/j.diabres.2020.108594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Thow AM, Lencucha RA, Rooney K, Colagiuri S, Lenzen M. Implications for farmers of measures to reduce sugars consumption. Bull World Health Organ 2020; 99:41-49. [PMID: 33658733 DOI: 10.2471/blt.19.249177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 09/25/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To estimate the impact of reduced consumption of free sugars in line with World Health Organization recommendations, on sugar farmers globally. Methods Using multiregion input-output analysis, we estimated the proportional impact on production volumes of a 1% reduction in free sugars consumption by the public. We extracted data on sugar production from the Food and Agriculture Organization of the United Nations database for the top 15 sugar-cane- and beet-producing countries globally, and created a custom multiregion input-output database to assess the proportions of production going to human consumption, drawing on household expenditure surveys and national input-output databases (data valid for years 2000-2015). We also considered the impact on production volumes in relation to countries' gross domestic product. Findings A high proportion of current sugar production from these countries goes to human consumption, and would thus be impacted by reduced consumption of sugars. The largest impacts on cane sugar production, and thus on farmers, would likely occur in Brazil, China, India and Thailand and on beet production in Belarus, Germany, Russian Federation and United States of America. Conclusion A global opportunity exists for public health leadership to bring together the health, economic, environmental and agriculture sectors to collaborate and build capacity for promotion of alternative livelihoods for sugar farmers. Lessons regarding strategy and the importance of political economy factors can be learnt from tobacco control measures. Further research to quantify the impact of reductions in sugars consumption would provide useful insights for designing policies to complement and strengthen efforts to improve diets and health.
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Affiliation(s)
- Anne Marie Thow
- Charles Perkins Centre, Faculty of Medicine and Health, D17, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Raphael A Lencucha
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
| | - Kieron Rooney
- Charles Perkins Centre, Faculty of Medicine and Health, D17, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Stephen Colagiuri
- Charles Perkins Centre, Faculty of Medicine and Health, D17, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Manfred Lenzen
- School of Physics, University of Sydney, Sydney, Australia
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Siopis G, Wang L, Colagiuri S, Allman‐Farinelli M. Cost effectiveness of dietitian‐led nutrition therapy for people with type 2 diabetes mellitus: a scoping review. J Hum Nutr Diet 2020; 34:81-93. [DOI: 10.1111/jhn.12821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/06/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- G. Siopis
- Charles Perkins Centre School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
| | - L. Wang
- Charles Perkins Centre School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
| | - S. Colagiuri
- Boden Collaboration The University of Sydney Sydney NSW Australia
| | - M. Allman‐Farinelli
- Charles Perkins Centre School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
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Scott ES, Januszewski AS, O'Connell R, Fulcher G, Scott R, Kesaniemi A, Wu L, Colagiuri S, Keech A, Jenkins AJ. Long-Term Glycemic Variability and Vascular Complications in Type 2 Diabetes: Post Hoc Analysis of the FIELD Study. J Clin Endocrinol Metab 2020; 105:5885040. [PMID: 32766757 DOI: 10.1210/clinem/dgaa361] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
AIMS To investigate whether long-term glycemic variability (GV) is associated with vascular complication development in type 2 diabetes. METHODS In a post hoc FIELD trial analysis, GV was calculated as the standard deviation and coefficient of variation (CV) of glycated hemoglobin A1c (HbA1c) and fasting plasma glucose. Baseline variables were compared across quartiles of on-study variability by chi square and ANOVA. Prospective associations between baseline to 2-year GV and subsequent vascular and mortality outcomes were analyzed using landmark logistic and Cox proportional hazards regression. RESULTS Baseline factors associated with higher on-study GV included younger age, male gender, longer diabetes duration, and higher pharmacological therapies usage. Both HbA1c and fasting glucose CV were associated with increased risk of microvascular complications (HR 1.02 [95% CI, 1.01-1.03] P < 0.01; and HR 1.01 [95% CI, 1.00-1.01] P < 0.001, respectively). HbA1c and fasting glucose CV were associated with increased cardiovascular disease (HR 1.02 [95% CI, 1.00-1.04]; and HR 1.01 [95% CI, 1.00-1.02], both P < 0.05). HbA1c CV associated with increased stroke (HR 1.03 [95% CI, 1.01-1.06) P < 0.01). Glucose CV associated with increased coronary events (HR 1.01 [95% CI, 1.00-1.02] P < 0.05). Both HbA1c and glucose CV associated with increased total mortality (HR 1.04 [95% CI, 1.02-1.06]; and HR 1.01 [95% CI, 1.01-1.02], both P < 0.001) and noncardiovascular mortality (HR 1.05 [95% CI, (1.03-1.07]; and HR 1.02 [95% CI, 1.01-1.03], both P < 0.001). HbA1c CV associated with coronary mortality (HR 1.04 [95% CI, 1.01-1.07] P < 0.05). CONCLUSIONS Long-term GV was associated with increased risk of vascular outcomes in type 2 diabetes.
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Affiliation(s)
- Emma S Scott
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, University of Sydney, Sydney, Australia
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
| | - Andrzej S Januszewski
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, University of Sydney, Sydney, Australia
| | - Rachel O'Connell
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, University of Sydney, Sydney, Australia
| | - Gregory Fulcher
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - Russell Scott
- Canterbury District Health Board, Christchurch, New Zealand
| | - Antero Kesaniemi
- Oulu Medical Research Centre, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Linda Wu
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, University of Sydney, Sydney, Australia
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
| | | | - Anthony Keech
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, University of Sydney, Sydney, Australia
| | - Alicia J Jenkins
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, University of Sydney, Sydney, Australia
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25
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Gibson AA, Humphries J, Gillies M, Nassar N, Colagiuri S. Adherence to eye examination guidelines among individuals with diabetes: An analysis of linked health data. Clin Exp Ophthalmol 2020; 48:1229-1238. [PMID: 32710452 DOI: 10.1111/ceo.13830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/29/2020] [Accepted: 07/17/2020] [Indexed: 11/27/2022]
Abstract
IMPORTANCE Screening for diabetic retinopathy for early detection and treatment can prevent vision loss. BACKGROUND We aimed to assess rates of eye examination of people with diabetes, adherence with national guidelines and investigate characteristics of those who do not adhere. DESIGN We used data from the 45 and Up Study, a cohort study of 267 153 randomly selected residents aged ≥45 years from New South Wales, Australia. Individual survey data collected in 2006 to 2009 were linked to corresponding national Medicare Benefits Schedule claims data for 2006 to 2016. PARTICIPANTS The study sample included 24 832 participants who reported having diabetes and at least 5 years of observation. METHODS Claims for visits to optometrists or ophthalmologists were assessed to estimate rates of eye examination. Poisson regression models were used to investigate factors associated with non-adherence. MAIN OUTCOME MEASURE Participants were classified as adherent if the average time between eye care claims was consistent with national guideline of having an eye exam every 2 years. RESULTS Of 50% to 75% people with diabetes met the biennial eye examination guidelines and only 21% to 28% with diabetes duration ≥10 years were adherent to the annual eye examination guideline. Characteristics associated with greatest (~1.3-fold) risk of non-adherence were smoking, age <60 years and higher income. CONCLUSIONS AND RELEVANCE There is a clear need to improve rates of adherence to eye examination guidelines among people with diabetes to reduce the personal and societal burden of diabetic retinopathy.
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Affiliation(s)
- Alice A Gibson
- The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jacob Humphries
- The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Gillies
- Discipline of Ophthalmology and Eye Health, Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Colagiuri
- The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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26
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Nguyen ATM, Akhter R, Garde S, Scott C, Twigg SM, Colagiuri S, Ajwani S, Eberhard J. The association of periodontal disease with the complications of diabetes mellitus. A systematic review. Diabetes Res Clin Pract 2020; 165:108244. [PMID: 32526263 DOI: 10.1016/j.diabres.2020.108244] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
Abstract
This review investigated the association of periodontal disease with diabetes mellitus (DM) and diabetic complications. PubMed/MEDLINE was searched including search terms "periodontal" OR "periodontitis" AND "diabetic complications" OR "diabetic retinopathy" OR "diabetic nephropathy" OR "diabetic neuropathy" OR "cardiovascular disease diabetes" OR "myocardial infarction diabetes" OR "cerebrovascular disease diabetes" OR "stroke diabetes" OR "peripheral vascular disease diabetes". Fourteen studies included in this review consistently reported an increased risk for diabetic complications including microvascular, macrovascular and death in the presence of periodontal disease. Higher risks for diabetic retinopathy (odds ratios: 2.8-8.7), neuropathy (3.2-6.6), nephropathy (1.9-8.5), cardiovascular complications (1.28-17.7) and mortality (2.3-8.5) were reported for people with diabetes with periodontitis compared to those with diabetes who have no periodontitis. This novel review summarizes current data providing further evidence of a link between poor oral health and DM and its complications. It has also drawn attention to major limitations of the available data linking periodontal disease and diabetic complications.
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Affiliation(s)
- Anh Thi Mai Nguyen
- The University of Sydney School of Dentistry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Rahena Akhter
- The University of Sydney School of Dentistry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Siddharth Garde
- The University of Sydney School of Dentistry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Claire Scott
- Oral Health Clinic, Royal Prince Alfred Hospital, Sydney, Australia
| | - Stephen M Twigg
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Stephen Colagiuri
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia
| | - Shilpi Ajwani
- Oral Health Services, Sydney Dental Hospital, Sydney Local Health District, Australia
| | - Joerg Eberhard
- The University of Sydney School of Dentistry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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27
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Siopis G, Colagiuri S, Allman-Farinelli M. Efficacy of Nutrition Counseling by a Dietitian in Improving Clinical Outcomes for People with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of RCTs. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa043_132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Nutrition therapy is crucial for the treatment of type 2 diabetes. Preliminary data indicate that nutrition therapy delivered by accredited dietitians achieves better clinical outcomes than when delivered by other healthcare professionals. We compared dietetic intervention provided by accredited dietitians with nutrition advice provided by other healthcare professionals.
Methods
Systematic literature review and meta-analysis of RCTs of type 2 diabetes management programmes (3 months or more) implementing medical nutrition therapy and reporting changes in haemoglobin A1c (HbA1c) and other clinical outcomes that have been published in CENTRAL, CINAHL, EMBASE, MEDLINE and PsychINFO between 2008 to 18th June 2019.
Results
Seven studies with a total of 950 participants were included in the meta-analysis. The mean changes [95% CI:] at six or twelve months follow-up in HbA1c, BMI, weight and low-density lipoprotein (LDL) were –0.37 [–0.56, –0.19], –0.56 [–1.14, 0.02], –2.40 [–3.59, –1.20] and –0.16 [–0.29, –0.02] respectively in favour of the intervention group.
Conclusions
Nutrition intervention provided by a dietitian results in better clinical outcomes of type 2 diabetes, compared with that delivered by other healthcare professionals. Further longitudinal randomised studies are warranted to elucidate long-term (more than one year) effects of the interventions.
Funding Sources
Nil funding.
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Gabriel R, Boukichou Abdelkader N, Acosta T, Gilis-Januszewska A, Gómez-Huelgas R, Makrilakis K, Kamenov Z, Paulweber B, Satman I, Djordjevic P, Alkandari A, Mitrakou A, Lalic N, Colagiuri S, Lindström J, Egido J, Natali A, Pastor JC, Teuschl Y, Lind M, Silva L, López-Ridaura R, Tuomilehto J. Early prevention of diabetes microvascular complications in people with hyperglycaemia in Europe. ePREDICE randomized trial. Study protocol, recruitment and selected baseline data. PLoS One 2020; 15:e0231196. [PMID: 32282852 PMCID: PMC7153858 DOI: 10.1371/journal.pone.0231196] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 03/14/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives To assess the effects of early management of hyperglycaemia with antidiabetic drugs plus lifestyle intervention compared with lifestyle alone, on microvascular function in adults with pre-diabetes. Methods Trial design: International, multicenter, randomised, partially double-blind, placebo-controlled, clinical trial. Participants Males and females aged 45–74 years with IFG, IGT or IFG+IGT, recruited from primary care centres in Australia, Austria, Bulgaria, Greece, Kuwait, Poland, Serbia, Spain and Turkey. Intervention Participants were randomized to placebo; metformin 1.700 mg/day; linagliptin 5 mg/day or fixed-dose combination of linagliptin/metformin. All patients were enrolled in a lifestyle intervention program (diet and physical activity). Drug intervention will last 2 years. Primary Outcome: composite end-point of diabetic retinopathy estimated by the Early Treatment Diabetic Retinopathy Study Score, urinary albumin to creatinine ratio, and skin conductance in feet estimated by the sudomotor index. Secondary outcomes in a subsample include insulin sensitivity, beta-cell function, biomarkers of inflammation and fatty liver disease, quality of life, cognitive function, depressive symptoms and endothelial function. Results One thousand three hundred ninety one individuals with hyperglycaemia were assessed for eligibility, 424 excluded after screening, 967 allocated to placebo, metformin, linagliptin or to fixed-dose combination of metformin + linagliptin. A total of 809 people (91.1%) accepted and initiated the assigned treatment. Study sample after randomization was well balanced among the four groups. No statistical differences for the main risk factors analysed were observed between those accepting or rejecting treatment initiation. At baseline prevalence of diabetic retinopathy was 4.2%, severe neuropathy 5.3% and nephropathy 5.7%. Conclusions ePREDICE is the first -randomized clinical trial with the aim to assess effects of different interventions (lifestyle and pharmacological) on microvascular function in people with pre-diabetes. The trial will provide novel data on lifestyle modification combined with glucose lowering drugs for the prevention of early microvascular complications and diabetes. Registration - ClinicalTrials.Gov Identifier: NCT03222765 - EUDRACT Registry Number: 2013-000418-39
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Affiliation(s)
- Rafael Gabriel
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
- World Community for Prevention of Diabetes Foundation (WCPD), Madrid, Spain
| | - Nisa Boukichou Abdelkader
- EVIDEM CONSULTORES, Madrid, Spain
- Asociación para la Investigación y Prevención de la Diabetes y Enfermedades Cardiovasculares (PREDICOR), Madrid, Spain
| | - Tania Acosta
- EVIDEM CONSULTORES, Madrid, Spain
- Department of Public Health. Universidad del Norte, Barranquilla, Colombia
| | | | | | | | - Zdravko Kamenov
- University Multi-Profile Hospital for Active Treatment Alexandrovska EAD, Sofia, Bulgaria
| | - Bernhard Paulweber
- Gemeinnuetzige Salzburger Landeskliniken Betriebsgesellschaft, (SALK) Salzburg, Austria
| | | | - Predrag Djordjevic
- General Hospital Medical System Beograd-MSB Belgrade Serbia, Beograd, Serbia
| | | | | | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stephen Colagiuri
- The University of Sydney, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney, Australia
| | - Jaana Lindström
- National Institute for Health and Welfare, Helsinki, Finland
| | - Jesús Egido
- Renal, Vascular and Diabetes Research Laboratory, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Andrea Natali
- Department of Internal Medicine, Universita di Pisa, Pisa, Italy
| | - J Carlos Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Hospital Clínico Universitario, Valladolid, Spain
| | - Yvonne Teuschl
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Marcus Lind
- Västra Götalands Läns Landsting, Gothenburg, Sweden
| | | | | | - Jaakko Tuomilehto
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
- World Community for Prevention of Diabetes Foundation (WCPD), Madrid, Spain
- National Institute for Health and Welfare, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
- King Abdulaziz University, Jeddah, Saudi Arabia
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Williams R, Karuranga S, Malanda B, Saeedi P, Basit A, Besançon S, Bommer C, Esteghamati A, Ogurtsova K, Zhang P, Colagiuri S. Global and regional estimates and projections of diabetes-related health expenditure: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 2020; 162:108072. [PMID: 32061820 DOI: 10.1016/j.diabres.2020.108072] [Citation(s) in RCA: 384] [Impact Index Per Article: 96.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 12/11/2022]
Abstract
AIMS Diabetes and its complications have a significant economic impact on individuals and their families, health systems and national economies. METHODS The direct health expenditure of diabetes was calculated relying on the following inputs: diagnosed and undiagnosed diabetes prevalence estimates, United Nations population estimates, World Health Organization health expenditure per capita and ratios of health expenditure for people with diabetes compared to people without diabetes. RESULTS The estimated global direct health expenditure on diabetes in 2019 is USD 760 billion and is expected to grow to a projected USD 825 billion by 2030 and USD 845 billion by 2045. There is a wide variation in annual health expenditures on diabetes. The United States of America has the highest estimated expenditure with USD 294.6 billion, followed by China and Brazil, with USD 109.0 billion and USD 52.3 billion, respectively. The age group with the largest annual diabetes-related health expenditure is 60-69 years with USD 177.7 billion, followed by 50-59 years, and 70-79 years with USD 173.0 billion and USD 171.5 billion, respectively. Slightly higher diabetes-related health expenditure is seen in women than in men (USD 382.6 billion vs. USD 377.6 billion, respectively). The same difference is expected to be present in 2030 and 2045. CONCLUSIONS There were large disparities between high-, middle- and low-income countries with total health expenditures in high-income countries being over 300 times those in low-income countries. The ratio for annual direct health expenditure per person between these groups of countries is more than 38-fold.
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Affiliation(s)
- Rhys Williams
- Diabetes Research Unit Cymru, Swansea University, Swansea, United Kingdom
| | | | - Belma Malanda
- International Diabetes Federation, Brussels, Belgium
| | - Pouya Saeedi
- International Diabetes Federation, Brussels, Belgium.
| | - Abdul Basit
- Baqai Institute of Diabetology and Endocrinology (BIDE), Pakistan
| | | | | | | | - Katherine Ogurtsova
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
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Siopis G, Colagiuri S, Allman-Farinelli M. Dietitians' experiences and perspectives regarding access to and delivery of dietetic services for people with type 2 diabetes mellitus. Heliyon 2020; 6:e03344. [PMID: 32072049 PMCID: PMC7011049 DOI: 10.1016/j.heliyon.2020.e03344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 11/15/2019] [Accepted: 01/30/2020] [Indexed: 01/12/2023] Open
Abstract
AIMS Dietetic intervention improves glycaemic control of type 2 diabetes mellitus (T2DM). The aim of this study was to explore the views of Australian dietitians with respect to the nutritional management of people with T2DM, patient access to dietitians and any suggested improvements for access to and delivery of dietetic services. METHODS Semi-structured interviews were conducted via telephone with 31 dietitians counselling people with T2DM and consulting a minimum of two sessions per week in private and/or non-private practice. RESULTS Participants came from urban and rural areas, public and private practice and with a range of years of practice. Themes that emerged from the interviews included the importance of dietetic services for people with T2DM; the referral pathways and beliefs about lack of referrals to dietitians; the perceptions on adequacy of the current dietetic services available for people with T2DM; and the recommendations on services available for people with T2DM. CONCLUSION Considering the evidence that diet is key in the prevention and management of T2DM, it is suggested current funding and service provision be reviewed with a focus on treating the aetiology of diabetes.
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Affiliation(s)
- George Siopis
- The University of Sydney, Charles Perkins Centre, School of Life and Environmental Sciences, Sydney, NSW, Australia
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31
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Lee CMY, Colagiuri S, Woodward M, Gregg EW, Adams R, Azizi F, Gabriel R, Gill TK, Gonzalez C, Hodge A, Jacobs Jr DR, Joseph JJ, Khalili D, Magliano DJ, Mehlig K, Milne R, Mishra G, Mongraw-Chaffin M, Pasco JA, Sakurai M, Schreiner PJ, Selvin E, Shaw JE, Wittert G, Yatsuya H, Huxley RR. Comparing different definitions of prediabetes with subsequent risk of diabetes: an individual participant data meta-analysis involving 76 513 individuals and 8208 cases of incident diabetes. BMJ Open Diabetes Res Care 2019; 7:e000794. [PMID: 31908797 PMCID: PMC6936411 DOI: 10.1136/bmjdrc-2019-000794] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/16/2019] [Accepted: 11/22/2019] [Indexed: 01/05/2023] Open
Abstract
Objective There are currently five widely used definition of prediabetes. We compared the ability of these to predict 5-year conversion to diabetes and investigated whether there were other cut-points identifying risk of progression to diabetes that may be more useful. Research design and methods We conducted an individual participant meta-analysis using longitudinal data included in the Obesity, Diabetes and Cardiovascular Disease Collaboration. Cox regression models were used to obtain study-specific HRs for incident diabetes associated with each prediabetes definition. Harrell's C-statistics were used to estimate how well each prediabetes definition discriminated 5-year risk of diabetes. Spline and receiver operating characteristic curve (ROC) analyses were used to identify alternative cut-points. Results Sixteen studies, with 76 513 participants and 8208 incident diabetes cases, were available. Compared with normoglycemia, current prediabetes definitions were associated with four to eight times higher diabetes risk (HRs (95% CIs): 3.78 (3.11 to 4.60) to 8.36 (4.88 to 14.33)) and all definitions discriminated 5-year diabetes risk with good accuracy (C-statistics 0.79-0.81). Cut-points identified through spline analysis were fasting plasma glucose (FPG) 5.1 mmol/L and glycated hemoglobin (HbA1c) 5.0% (31 mmol/mol) and cut-points identified through ROC analysis were FPG 5.6 mmol/L, 2-hour postload glucose 7.0 mmol/L and HbA1c 5.6% (38 mmol/mol). Conclusions In terms of identifying individuals at greatest risk of developing diabetes within 5 years, using prediabetes definitions that have lower values produced non-significant gain. Therefore, deciding which definition to use will ultimately depend on the goal for identifying individuals at risk of diabetes.
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Affiliation(s)
- Crystal Man Ying Lee
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
- Boden Collaboration for Obesity, Nutrition and Exercise & Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Colagiuri
- Boden Collaboration for Obesity, Nutrition and Exercise & Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of Oxford, Oxford, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Edward W Gregg
- Department of Epidemiology and Statistics, School of Public Health, Imperial College London, London, UK
| | - Robert Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Respiratory and Sleep Service, Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rafael Gabriel
- National School of Public Health, National Institute of Health Carlos III, Madrid, Spain
| | - Tiffany K Gill
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Clicerio Gonzalez
- Unidad de Investigación en Diabetes y Riesgo Cardiovascular, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico
| | - Allison Hodge
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David R Jacobs Jr
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Dianna J Magliano
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Kirsten Mehlig
- Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | - Roger Milne
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Gita Mishra
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Morgana Mongraw-Chaffin
- Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Julie A Pasco
- Department of Clinical and Biomedical Sciences, Barwon Health, The University of Melbourne, Geelong, Victoria, Australia
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Masaru Sakurai
- Department of Social and Environmental Medicine, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jonathan E Shaw
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Gary Wittert
- Discipline of Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Hiroshi Yatsuya
- Department of Public Health, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Rachel R Huxley
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
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Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, Colagiuri S, Guariguata L, Motala AA, Ogurtsova K, Shaw JE, Bright D, Williams R. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9 th edition. Diabetes Res Clin Pract 2019; 157:107843. [PMID: 31518657 DOI: 10.1016/j.diabres.2019.107843] [Citation(s) in RCA: 4630] [Impact Index Per Article: 926.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023]
Abstract
AIMS To provide global estimates of diabetes prevalence for 2019 and projections for 2030 and 2045. METHODS A total of 255 high-quality data sources, published between 1990 and 2018 and representing 138 countries were identified. For countries without high quality in-country data, estimates were extrapolated from similar countries matched by economy, ethnicity, geography and language. Logistic regression was used to generate smoothed age-specific diabetes prevalence estimates (including previously undiagnosed diabetes) in adults aged 20-79 years. RESULTS The global diabetes prevalence in 2019 is estimated to be 9.3% (463 million people), rising to 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045. The prevalence is higher in urban (10.8%) than rural (7.2%) areas, and in high-income (10.4%) than low-income countries (4.0%). One in two (50.1%) people living with diabetes do not know that they have diabetes. The global prevalence of impaired glucose tolerance is estimated to be 7.5% (374 million) in 2019 and projected to reach 8.0% (454 million) by 2030 and 8.6% (548 million) by 2045. CONCLUSIONS Just under half a billion people are living with diabetes worldwide and the number is projected to increase by 25% in 2030 and 51% in 2045.
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Affiliation(s)
- Pouya Saeedi
- International Diabetes Federation, Brussels, Belgium.
| | | | | | - Belma Malanda
- International Diabetes Federation, Brussels, Belgium
| | | | - Nigel Unwin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | | | - Ayesha A Motala
- Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Durban, South Africa
| | - Katherine Ogurtsova
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | - Dominic Bright
- Diabetes Research Unit Cymru, Swansea University, Swansea, United Kingdom
| | - Rhys Williams
- Diabetes Research Unit Cymru, Swansea University, Swansea, United Kingdom
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Meyerowitz-Katz G, Seelan S, Gaur P, Francisco R, Ferdousi S, Astell-Burt T, Feng X, Colagiuri S, Maberly G, Hng TM. Detecting the hidden burden of pre-diabetes and diabetes in Western Sydney. Diabetes Res Clin Pract 2019; 151:247-251. [PMID: 31004674 DOI: 10.1016/j.diabres.2019.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/26/2019] [Accepted: 04/12/2019] [Indexed: 12/21/2022]
Abstract
AIMS Examining pre-diabetes and diabetes rates using glycated haemoglobin (HbA1c) in emergency department (ED) and in general practice (GP) in western Sydney. METHODS Epidemiological study of HbA1c measurements in individuals ≥18 years receiving a blood test (1) in the hospital setting of the ED at Blacktown/Mt Druitt hospital (1/06/2016 to 31/05/2018) and (2) in primary care involving Bridgeview Medical Practice (BVMP) (1/03/2017 to 01/02/2018) as well as other general practices (June 2018 only). RESULTS Totals of 55,568 individuals from ED and 5911 individuals from GP. The prevalence of diabetes in tested individuals was 17.3% (n = 9704) in ED and 17.4% (n = 1027) in GP. The prevalence of pre-diabetes in ED was 30.2% (n = 16,854) and 26.6% (n = 1576) in GP. Regression controlling for age, season, and gender revealed a weekly increase of 1.1% in odds for diabetes and 1.5% for pre-diabetes (p < 0.001), in line with the yearly absolute increase of 1% in rate for both tested and coded hospital patients. In BVMP the rate of diabetes rose by 22% during the testing period from 8.9% to 11%. CONCLUSIONS There exists a high burden of diabetes both in hospitals and general practice. Testing in ED and general practice revealed similarly high burdens of diabetes across different areas of the healthcare system. In the appropriate hospital and primary care setting, HbA1c can be used to identify individuals with diabetes that may benefit from targeted intervention.
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Affiliation(s)
- Gideon Meyerowitz-Katz
- Western Sydney Local Health District, Australia; Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Australia; School of Public Health, Peking Union Medical College, Tsinghua University and the Chinese Academy of Medical Sciences, China
| | - Shanthini Seelan
- Bridgeview Medical Practice, Australia; School of Public Health, Peking Union Medical College, Tsinghua University and the Chinese Academy of Medical Sciences, China
| | - Pankaj Gaur
- Western Sydney Local Health District, Australia; School of Public Health, Peking Union Medical College, Tsinghua University and the Chinese Academy of Medical Sciences, China
| | - Rona Francisco
- Western Sydney Local Health District, Australia; School of Public Health, Peking Union Medical College, Tsinghua University and the Chinese Academy of Medical Sciences, China
| | - Shahana Ferdousi
- School of Public Health, Peking Union Medical College, Tsinghua University and the Chinese Academy of Medical Sciences, China; Wentwest, Western Sydney Primary Health Network, Australia
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Australia; Menzies Centre for Health Policy, University of Sydney, Australia; School of Public Health, Peking Union Medical College, Tsinghua University and the Chinese Academy of Medical Sciences, China
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Australia; Menzies Centre for Health Policy, University of Sydney, Australia; School of Public Health, Peking Union Medical College, Tsinghua University and the Chinese Academy of Medical Sciences, China
| | - Stephen Colagiuri
- School of Public Health, Peking Union Medical College, Tsinghua University and the Chinese Academy of Medical Sciences, China; Boden Institute, University of Sydney, Australia
| | - Glen Maberly
- Western Sydney Local Health District, Australia; University of Sydney, Australia; School of Public Health, Peking Union Medical College, Tsinghua University and the Chinese Academy of Medical Sciences, China
| | - Tien-Ming Hng
- Western Sydney Local Health District, Australia; University of Western Sydney, Australia; School of Public Health, Peking Union Medical College, Tsinghua University and the Chinese Academy of Medical Sciences, China
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Lymer S, Cunich M, Colagiuri S. Simulated economic impacts of Australian Obesity Management Algorithm implementation: microsimulation modelling to 2030. Obes Res Clin Pract 2019. [DOI: 10.1016/j.orcp.2018.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Waller K, Furber S, Bauman A, Allman-Farinelli M, van den Dolder P, Hayes A, Facci F, Franco L, Webb A, Moses R, Colagiuri S. DTEXT - text messaging intervention to improve outcomes of people with type 2 diabetes: protocol for randomised controlled trial and cost-effectiveness analysis. BMC Public Health 2019; 19:262. [PMID: 30832638 PMCID: PMC6399841 DOI: 10.1186/s12889-019-6550-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Diabetes prevalence is rapidly increasing, with type 2 diabetes predicted to be the leading contributor of non-communicable disease in Australia by 2020. It is anticipated that rates of type 2 diabetes will continue to increase if factors such as overweight and obesity, low physical activity and poor nutrition are not addressed. The majority of Australians with type 2 diabetes do not meet the guidelines for optimal diabetes management, and access to diabetes education is limited. This highlights the need for new interventions that can reduce existing barriers to diabetes education, attain greater population reach and support self-management strategies for people with type 2 diabetes. Mobile phone text messages have shown promising results as an intervention for people with chronic disease. They have the ability to achieve high levels of engagement and broad population reach, whilst requiring minimal resources. There is however, no evidence on the effect of text messaging to improve the health of people with type 2 diabetes in Australia. METHODS/DESIGN This randomised controlled trial aims to investigate if a 6 month text message intervention (DTEXT) can lead to improvements in glycated haemoglobin (HbA1c) and diabetes self-management among Australian residents in New South Wales (NSW) with type 2 diabetes. Community dwelling adults (n = 340) will be recruited with the primary outcome being change in HbA1c at 6 months. Secondary outcomes include behaviour change for diabetes self-management, self-efficacy, quality of life and intervention acceptability. An economic evaluation will be conducted using a funder plus patient perspective. DISCUSSION This study will provide evidence on the effectiveness and cost effectiveness of a text message intervention to reduce HbA1c and enhance self-management of type 2 diabetes in the Australian population. If successful, this intervention could be used as a model to complement and extend existing diabetes care in the Australian health care system. TRIAL REGISTRATION The study has been registered with the Australian New Zealand Clinical Trials Registry, Trial ID: ACTRN12617000416392 . Registered: 23 March 2017.
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Affiliation(s)
- Karen Waller
- Illawarra Shoalhaven Local Health District, Warrawong, Australia.
| | - Susan Furber
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | | | | | | | | | - Franca Facci
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Lisa Franco
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Alison Webb
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Robert Moses
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
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Arafat Y, Mohamed Ibrahim MI, Awaisu A, Colagiuri S, Owusu Y, Morisky DE, AlHafiz M, Yousif A. Using the transtheoretical model's stages of change to predict medication adherence in patients with type 2 diabetes mellitus in a primary health care setting. ACTA ACUST UNITED AC 2019; 27:91-99. [PMID: 30729403 DOI: 10.1007/s40199-019-00246-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Qatar is currently experiencing a worrying increase in the prevalence of diabetes mellitus (DM). One of the most common reasons for uncontrolled DM is non-adherence to medications. The socio-behavioral intervention has proven effective in some chronic illnesses. OBJECTIVES To assess the stages of change (SOC) and medication adherence scores of type 2 diabetes mellitus (T2DM) patients visiting primary healthcare institutions in Qatar, and to evaluate the cause and effect relationship between SOC and adherence to antidiabetic medications. METHODS The 8-item Morisky Medication Adherence Scale (MMAS-8) was used to assess medication adherence, and a 2-item SOC questionnaire was utilized to classify the SOC. The analysis to determine if the SOC could predict medication adherence while controlling for demographic characteristics, total number of prescribed medications and disease duration was done using hierarchical multiple regression. RESULTS The final analysis included 387 patients. In relation to medication adherence, majority of the patients were in the maintenance stage (76.7%), followed by the preparation stage (14.7%), the action stage (3.9%), the contemplation stage (3.4%) and the precontemplation stage (1.3%). Most of the patients were in high adherence towards antidiabetic medications (50.3%) followed by low level (26.4%) and medium level (23.3%). SOC was significant and positively predicted medication adherence, which accounted for around 58 to 60% (p < 0.001) while controlling for covariates. CONCLUSIONS SOC was significant and positively predicted medication adherence. The study recommends that the SOC questionnaire could potentially be used to identify patients at risk for low adherence.
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Affiliation(s)
- Yara Arafat
- Clinical Pharmacy and Practice Section, College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar
| | | | - Ahmed Awaisu
- Clinical Pharmacy and Practice Section, College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar
| | | | - Yaw Owusu
- Clinical Pharmacy and Practice Section, College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar
| | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | | | - Ahmed Yousif
- Pharmacy Department, Westbay Healthcare Center, Doha, Qatar
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Lymer S, Schofield D, Colagiuri S, Shrestha R, Lee C. The impact of weight-loss interventions on health expenditure in Australia: Evidence from a microsimulation model of obesity and chronic disease. Obes Res Clin Pract 2019. [DOI: 10.1016/j.orcp.2016.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
AIMS To assess and compare the direct healthcare and non-healthcare costs and government subsidies by body weight and diabetes status. METHODS The Australian Diabetes, Obesity and Lifestyle study collected health service utilization and health-related expenditure data at the 2011-2012 follow-up surveys. Costing data were available for 4,409 participants. Unit costs for 2016-2017 were used where available or were otherwise inflated to 2016-2017 dollars. Age- and sex-adjusted costs per person were estimated using generalized linear models. RESULTS The annual total direct cost ranged from $1,998 per person with normal weight to $2,501 per person with obesity in participants without diabetes. For those with diabetes, total direct costs were $2,353 per person with normal weight, $3,263 per person with overweight, and $3,131 per person with obesity. Additional expenditure as government subsidies ranged from $5,649 per person with normal weight and no diabetes to $8,085 per person with overweight and diabetes. In general, direct costs and government subsidies were higher for overweight and obesity compared to normal weight, regardless of diabetes status, but were more noticeable in the diabetes sub-group. The annual total excess cost compared with normal weight people without diabetes was 26% for obesity alone and 46% for those with obesity and diabetes. LIMITATIONS Participants included in this study represented a healthier cohort than the Australian population. The relatively small sample of people with both obesity and diabetes prevented a more detailed analysis by obesity class. CONCLUSION Overweight and obesity are associated with increased costs, which are further increased in individuals who also have diabetes. Interventions to prevent overweight and obesity or reduce weight in people who are overweight or obese, and prevent diabetes, should reduce the financial burden.
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Affiliation(s)
- Crystal Man Ying Lee
- a Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders , University of Sydney , NSW , Australia
- b School of Public Health , Curtin University , Perth , WA , Australia
| | | | | | - Jonathan E Shaw
- d Baker Heart and Diabetes Institute , Melbourne , VIC , Australia
| | | | - Stephen Colagiuri
- a Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders , University of Sydney , NSW , Australia
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Colagiuri S, Matthews D, Leiter LA, Chan SP, Sesti G, Marre M. The place of gliclazide MR in the evolving type 2 diabetes landscape: A comparison with other sulfonylureas and newer oral antihyperglycemic agents. Diabetes Res Clin Pract 2018; 143:1-14. [PMID: 29802958 DOI: 10.1016/j.diabres.2018.05.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/04/2018] [Accepted: 05/16/2018] [Indexed: 02/06/2023]
Abstract
The sulfonylureas are effective oral glucose-lowering agents with a long history of clinical use. While all have the same general mechanism of action, their pharmacokinetic properties are influenced by factors such as dosage, rate of absorption, duration of action, route of elimination, tissue specificity, and binding affinity for pancreatic β-cell receptor. The result is a class of agents with similar HbA1c-lowering efficacy, but well-documented differences in terms of effects on hypoglycemia, and cardiovascular and renal safety. This review examines the differences between currently available sulfonylureas with a focus on how gliclazide modified release (MR) differs from other members of this class and from newer oral antihyperglycemic agents in the form of dipeptidyl peptidase-4 (DPP4) and sodium- glucose cotransporter 2 (SGLT2) inhibitors. The first part focuses on major outcome trials that have been conducted with the sulfonylureas and new oral agents. Consideration is then given to factors important for day-to-day prescribing including efficacy and durability, weight changes, hypoglycemia, renal effects and cost. Based on current evidence, third-generation sulfonylureas such as gliclazide MR possess many of the properties desired of a type 2 diabetes drug including high glucose-lowering efficacy, once-daily oral administration, few side effects other than mild hypoglycemia, and cardiovascular safety.
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Affiliation(s)
- Stephen Colagiuri
- Boden Institute of Obesity, Nutrition and Exercise, University of Sydney, Sydney, NSW, Australia.
| | - David Matthews
- Oxford Centre for Diabetes, Endocrinology and Metabolism, and Harris Manchester College, University of Oxford, Oxford, UK
| | - Lawrence A Leiter
- Division of Endocrinology & Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Siew Pheng Chan
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur 50603, W.P., Malaysia
| | - Giorgio Sesti
- Department of Medical and Surgical Science, University Magna-Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Michel Marre
- Diabetes Department, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, Université Denis Diderot Paris 7, and INSERM U1138, Paris, France
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Lymer S, Schofield D, Cunich M, Lee CMY, Fuller N, Caterson I, Colagiuri S. The Population Cost-Effectiveness of Weight Watchers with General Practitioner Referral Compared with Standard Care. Obesity (Silver Spring) 2018; 26:1261-1269. [PMID: 30138545 DOI: 10.1002/oby.22216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 04/19/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to assess population-level cost-effectiveness of the Weight Watchers (WW) program with doctor referral compared with standard care (SC) for Australian adults with overweight and obesity. METHODS The target population was Australian adults ≥ 20 years old with BMI ≥ 27 kg/m2 , whose obesity status was subsequently modeled for 2015 to 2025. A microsimulation model (noncommunicable disease model [NCDMod]) was used to assess the incremental cost-effectiveness of WW compared with SC. A health system perspective was taken, and outcomes were measured by obesity cases averted in 2025, BMI units averted for 2015 to 2025, and quality-adjusted life years for 2015 to 2025. Univariate sensitivity testing was used to measure variations in the model parameters. RESULTS The WW intervention resulted in 60,445 averted cases of obesity in 2025 (2,311 more cases than for SC), extra intervention costs of A$219 million, and cost savings within the health system of A$17,248 million (A$82 million more than for SC) for 2015 to 2025 compared with doing nothing. The modeled WW had an incremental cost-effectiveness ratio of A$35,195 in savings per case of obesity averted in 2025. WW remained dominant over SC for the different scenarios in the sensitivity analysis. CONCLUSIONS The WW intervention represents good value for money. The WW intervention needs serious consideration in a national package of obesity health services.
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Affiliation(s)
- Sharyn Lymer
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Economic, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, Ryde, New South Wales, Australia
- Department of Economics, Macquarie University, Ryde, New South Wales, Australia
| | - Michelle Cunich
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Economic, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Crystal Man Ying Lee
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Fuller
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian Caterson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Colagiuri
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- WHO Collaborating Centre on Physical Activity, Nutrition & Obesity, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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Lee AS, Colagiuri S, Flack JR. Successful implementation of diabetes audits in Australia: the Australian National Diabetes Information Audit and Benchmarking (ANDIAB) initiative. Diabet Med 2018; 35:929-936. [PMID: 29633347 DOI: 10.1111/dme.13635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 01/02/2023]
Abstract
AIM We developed and implemented a national audit and benchmarking programme to describe the clinical status of people with diabetes attending specialist diabetes services in Australia. METHODS The Australian National Diabetes Information Audit and Benchmarking (ANDIAB) initiative was established as a quality audit activity. De-identified data on demographic, clinical, biochemical and outcome items were collected from specialist diabetes services across Australia to provide cross-sectional data on people with diabetes attending specialist centres at least biennially during the years 1998 to 2011. RESULTS In total, 38 155 sets of data were collected over the eight ANDIAB audits. Each ANDIAB audit achieved its primary objective to collect, collate, analyse, audit and report clinical diabetes data in Australia. Each audit resulted in the production of a pooled data report, as well as individual site reports allowing comparison and benchmarking against other participating sites. CONCLUSIONS The ANDIAB initiative resulted in the largest cross-sectional national de-identified dataset describing the clinical status of people with diabetes attending specialist diabetes services in Australia. ANDIAB showed that people treated by specialist services had a high burden of diabetes complications. This quality audit activity provided a framework to guide planning of healthcare services.
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Affiliation(s)
- A S Lee
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
- Department of Endocrinology, Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, Charles Perkins Centre, Sydney, NSW, Australia
| | - S Colagiuri
- Sydney Medical School, Charles Perkins Centre, Sydney, NSW, Australia
- Boden Institute of Obesity, Nutrition, Exercise& Eating Disorders, University of Sydney, Sydney, NSW, Australia
| | - J R Flack
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
- Western Sydney University, Sydney, NSW, Australia
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Sainsbury E, Kizirian NV, Partridge SR, Gill T, Colagiuri S, Gibson AA. Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract 2018. [PMID: 29522789 DOI: 10.1016/j.diabres.2018.02.026] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nutrition therapy is considered a key component of diabetes management, yet evidence around the ideal macronutrient composition of the diet remains inconclusive. A systematic review and meta-analysis was performed to assess the effects of carbohydrate-restricted diets (≤45% of total energy) compared to high carbohydrate diets (>45% of total energy) on glycemic control in adults with diabetes mellitus. Six databases were searched for articles published between January 1980 and August 2016. Primary outcome was between-group difference in HbA1c change. Individual effect sizes were standardized, and a meta-analysis performed to calculate pooled effect size using random effects. 25 RCTs involving 2412 participants were included. Carbohydrate-restricted diets, in particular those that restrict carbohydrate to <26% of total energy, produced greater reductions in HbA1c at 3 months (WMD -0.47%, 95% CI: -0.71, -0.23) and 6 months (WMD -0.36%, 95% CI: -0.62, -0.09), with no significant difference at 12 or 24 months. There was no difference between moderately restricted (26-45% of total energy) and high carbohydrate diets at any time point. Although there are issues with the quality of the evidence, this review suggests that carbohydrate-restricted diets could be offered to people living with diabetes as part of an individualised management plan.
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Affiliation(s)
- Emma Sainsbury
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, NSW 2006, Australia.
| | - Nathalie V Kizirian
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, NSW 2006, Australia.
| | - Stephanie R Partridge
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, NSW 2006, Australia.
| | - Timothy Gill
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, NSW 2006, Australia.
| | - Stephen Colagiuri
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, NSW 2006, Australia.
| | - Alice A Gibson
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, NSW 2006, Australia.
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Sainsbury E, Hendy C, Magnusson R, Colagiuri S. Public support for government regulatory interventions for overweight and obesity in Australia. BMC Public Health 2018; 18:513. [PMID: 29669551 PMCID: PMC5907362 DOI: 10.1186/s12889-018-5455-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/12/2018] [Indexed: 12/11/2022] Open
Abstract
Background There is growing recognition among public health circles of the need for regulatory action for overweight and obesity, but there has been limited research into whether the Australian public supports government intervention. This study aimed to determine the level of public support for food-related regulations for obesity, and to assess the determinants of support. Methods A nationally representative sample of Australian adults (n = 2011) was recruited by market research company Online Research Unit to complete an online survey. The survey measured respondents’ perception of the obesity problem in Australia, and level of agreement on a 5-point Likert scale (strongly disagree to strongly agree) with proposed regulations in three domains; advertising, sponsorship of children’s sport, and taxation. Binary logistic regression models were run to examine the association between demographic variables and support for regulation. Results The majority of respondents (92.5%) considered overweight and obesity to be a somewhat or very serious problem in Australia, and almost 90% felt there should be at least some government regulation to protect the public. Respondents agreed that the government should regulate food and beverage advertising (69.5%), with strongest support for restricting unhealthy food advertising to children (78.9%). There was lower support for prohibiting unhealthy food and beverage company sponsorship of children’s sport (63.4% agreement), and for taxing sugar-sweetened beverages (54.5%), although the majority were still in favour. Support for fiscal policies slightly increased if revenue was to be used for health purposes. Females and tertiary educated respondents showed stronger agreement with proposed regulations (p < 0.05). Conclusions The survey findings suggest the majority of the Australian population recognises obesity to be a serious health problem, and support government regulation of the food environment as a population-level preventative strategy. Electronic supplementary material The online version of this article (10.1186/s12889-018-5455-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, 2006, Australia.
| | - Chelsea Hendy
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, 2006, Australia
| | - Roger Magnusson
- Sydney Law School, The University of Sydney, Camperdown, 2006, Australia
| | - Stephen Colagiuri
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, 2006, Australia
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van Steen SC, Woodward M, Chalmers J, Li Q, Marre M, Cooper ME, Hamet P, Mancia G, Colagiuri S, Williams B, Grobbee DE, DeVries JH. Haemoglobin glycation index and risk for diabetes-related complications in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Diabetologia 2018; 61:780-789. [PMID: 29308539 PMCID: PMC6448976 DOI: 10.1007/s00125-017-4539-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/21/2017] [Indexed: 12/21/2022]
Abstract
AIMS/HYPOTHESIS Previous studies have suggested that the haemoglobin glycation index (HGI) can be used as a predictor of diabetes-related complications in individuals with type 1 and type 2 diabetes. We investigated whether HGI was a predictor of adverse outcomes of intensive glucose lowering and of diabetes-related complications in general, using data from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. METHODS We studied participants in the ADVANCE trial with data available for baseline HbA1c and fasting plasma glucose (FPG) (n = 11,083). HGI is the difference between observed HbA1c and HbA1c predicted from a simple linear regression of HbA1c on FPG. Using Cox regression, we investigated the association between HGI, both categorised and continuous, and adverse outcomes, considering treatment allocation (intensive or standard glucose control) and compared prediction of HGI and HbA1c. RESULTS Intensive glucose control lowered mortality risk in individuals with high HGI only (HR 0.74 [95% CI 0.61, 0.91]; p = 0.003), while there was no difference in the effect of intensive treatment on mortality in those with high HbA1c. Irrespective of treatment allocation, every SD increase in HGI was associated with a significant risk increase of 14-17% for macrovascular and microvascular disease and mortality. However, when adjusted for identical covariates, HbA1c was a stronger predictor of these outcomes than HGI. CONCLUSIONS/INTERPRETATION HGI predicts risk for complications in ADVANCE participants, irrespective of treatment allocation, but no better than HbA1c. Individuals with high HGI have a lower risk for mortality when on intensive treatment. Given the discordant results and uncertain relevance beyond HbA1c, clinical use of HGI in type 2 diabetes cannot currently be recommended.
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Affiliation(s)
- Sigrid C van Steen
- Department of Endocrinology, Academic Medical Centre, University of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands.
| | - Mark Woodward
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - John Chalmers
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Michel Marre
- Department of Endocrinology, Hôpital Bichat-Claude Bernard, Université Paris, Paris, France
| | - Mark E Cooper
- Diabetes Domain, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Pavel Hamet
- Centre de Rechercher, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Istituto Auxologico Italiano, Milan, Italy
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition and Exercise, University of Sydney, Sydney, NSW, Australia
| | - Bryan Williams
- National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK
| | - Diederick E Grobbee
- Julius Clinical, Zeist, the Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - J Hans DeVries
- Department of Endocrinology, Academic Medical Centre, University of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
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Jun M, Ohkuma T, Zoungas S, Colagiuri S, Mancia G, Marre M, Matthews D, Poulter N, Williams B, Rodgers A, Perkovic V, Chalmers J, Woodward M. Changes in Albuminuria and the Risk of Major Clinical Outcomes in Diabetes: Results From ADVANCE-ON. Diabetes Care 2018; 41:163-170. [PMID: 29079715 DOI: 10.2337/dc17-1467] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/26/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the association between 2-year changes in urine albumin-to-creatinine ratio (UACR) and the risk of clinical outcomes in type 2 diabetes. RESEARCH DESIGN AND METHODS We analyzed data from 8,766 participants in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation Post-Trial Observational Study (ADVANCE-ON). Change in UACR was calculated from UACR measurements 2 years apart, classified into three groups: decrease in UACR of ≥30%, minor change, and increase in UACR of ≥30%. By analyzing changes from baseline UACR groups, categorized into thirds, we repeated these analyses accounting for regression to the mean (RtM). The primary outcome was the composite of major macrovascular events, renal events, and all-cause mortality; secondary outcomes were these components. Cox regression models were used to estimate hazard ratios (HRs). RESULTS Over a median follow-up of 7.7 years, 2,191 primary outcomes were observed. Increases in UACR over 2 years independently predicted a greater risk of the primary outcome (HR for ≥30% UACR increase vs. minor change: 1.26; 95% CI 1.13-1.41), whereas a decrease in UACR was not significantly associated with lower risk (HR 0.93; 95% CI 0.83-1.04). However, after allowing for RtM, the effect of "real" decrease in UACR on the primary outcome was found to be significant (HR 0.84; 95% CI 0.75-0.94), whereas the estimated effect on an increase was unchanged. CONCLUSIONS Changes in UACR predicted changes in the risk of major clinical outcomes and mortality in type 2 diabetes, supporting the prognostic utility of monitoring albuminuria change over time.
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Affiliation(s)
- Min Jun
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Toshiaki Ohkuma
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Sophia Zoungas
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Giuseppe Mancia
- Istituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy
| | - Michel Marre
- INSERM, UMR S1138, Centre de Recherche des Cordeliers, Paris, France.,Department of Diabetology, Endocrinology and Nutrition, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - David Matthews
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K
| | - Neil Poulter
- International Centre for Circulatory Health, Imperial College, London, U.K
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, U.K
| | - Anthony Rodgers
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - John Chalmers
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia.,The George Institute for Global Health, University of Oxford, Oxford, U.K.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD
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Lee CMY, Versace VL, Malo JA, Shaw JE, Dunbar JA, Colagiuri S. Screening for diabetes prevention with diabetes risk scores - A balancing act. Diabetes Res Clin Pract 2018; 135:120-127. [PMID: 29155122 DOI: 10.1016/j.diabres.2017.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022]
Abstract
AIMS To compare the diabetes prevention impact and cost of several screening scenarios for diabetes prevention programs with the scenario which included an oral glucose tolerance test (OGTT). METHODS We included 4864 participants of the Australian Diabetes, Obesity and Lifestyle study who were aged ≥40 years, did not have known diabetes at baseline, and attended the five year follow-up. The proportions of participants eligible or ineligible for diabetes prevention program were estimated for each scenario. The costs of screening and diabetes prevention programs were also estimated. RESULTS Screening with OGTT alone identified 21% of participants as eligible for diabetes prevention. While 3.1% of the cohort were identified as high risk and developed diabetes after five years, 1.0% of the cohort were identified as low risk and developed diabetes. The population prevention potential (i.e. sensitivity) for OGTT alone was 76.5%. Screening all Australian adults aged ≥40 years in 2015 by OGTT would have cost a total of AU$2025 million (AU$1031 million on screening and AU$994 million on prevention programs). The total costs of screening and prevention were substantially lower when AUSDRISK was used alone or in combination with a blood test. However, the population prevention potentials were also lower (ranged from 20.1% to 50.7%). CONCLUSIONS A blood test post non-invasive risk assessment is a worthwhile step in the process of enrolling participants in a diabetes prevention program. Nevertheless, there will be ineligible individuals who proceed to diabetes.
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Affiliation(s)
- Crystal Man Ying Lee
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Level 2 Charles Perkins Centre D17, University of Sydney, NSW 2006, Australia; School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Vincent L Versace
- School of Medicine, Deakin Rural Health, Deakin University, PO Box 423, VIC 3280, Australia
| | - Jonathan A Malo
- Communicable Diseases Branch, Queensland Health, Level 3, 15 Butterfield St, Herston, QLD 4005, Australia; National Centre for Epidemiology and Public Health, Australian National University, Acton, ACT 2601, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC 3004, Australia
| | - James A Dunbar
- Centre for Population Health Research, Deakin University, Melbourne, VIC 3125, Australia
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Level 2 Charles Perkins Centre D17, University of Sydney, NSW 2006, Australia.
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Taing CY, Gibson AA, Colagiuri S, Vita P, Cardona-Morrell M, Bauman A, Moore M, Williams M, Milat A, Hony J, Lin S, Gwizd M, Fiatarone Singh MA. Primary analysis of the Mandarin-speaking sub-study within the Sydney diabetes prevention program. Diabetes Res Clin Pract 2017; 132:118-126. [PMID: 28834772 DOI: 10.1016/j.diabres.2017.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/21/2017] [Accepted: 07/26/2017] [Indexed: 12/16/2022]
Abstract
AIM There is strong and consistent evidence from large scale randomised controlled trials that type 2 diabetes can be prevented or delayed through lifestyle modification which improves diet quality, increases physical activity and achieves weight loss in people at risk. Worldwide, the prevalence of type 2 diabetes is increasing in individuals of Chinese descent. Culturally tailored programs are required to address the risk in the Chinese population. This paper analyses effectiveness of a culturally tailored community-based lifestyle modification program (Sydney Diabetes Prevention Program (SDPP)) targeting Mandarin speakers. The SDPP was a 12 month translational study aiming to promote increased physical activity and dietary changes. Effectiveness was assessed through the improvement of anthropometric, metabolic, physical activity and dietary outcomes and number of goals met. METHODS Seventy-eight Mandarin-speaking participants at a high risk (Australian Diabetes Risk, AUSDRISK≥15) of developing diabetes were recruited for this study. RESULTS In this cohort, waist circumference, total cholesterol and fat intake significantly improved at the 12-month review. In comparison to the English-speaking stream, the Mandarin-speaking stream achieved fewer improvements in outcomes and goals. CONCLUSION The SDPP was not effective in reducing the risk factors associated with developing type 2 diabetes in this cohort of high risk Mandarin-speaking individuals living in Sydney.
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Affiliation(s)
- Cecilia Y Taing
- The University of Sydney, Exercise, Health and Performance Faculty Research Group, Lidcombe, NSW 2141, Australia.
| | - Alice A Gibson
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney, NSW 2006, Australia; The University of Sydney, Charles Perkins Centre, Sydney, NSW 2006, Australia
| | - Stephen Colagiuri
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney, NSW 2006, Australia; The University of Sydney, Charles Perkins Centre, Sydney, NSW 2006, Australia
| | - Philip Vita
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney, NSW 2006, Australia
| | - Magnolia Cardona-Morrell
- The University of New South Wales, The Simpson Centre for Health Services Research, South Western Sydney Clinical School, Sydney, NSW 1466, Australia
| | - Adrian Bauman
- The University of Sydney, Charles Perkins Centre, Sydney, NSW 2006, Australia; The University of Sydney, Prevention Research Collaboration, School of Public Health, Sydney, NSW 2006, Australia
| | - Michael Moore
- Inner West Sydney Medicare Local, Ashfield, NSW 2131, Australia
| | - Mandy Williams
- South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
| | - Andrew Milat
- New South Wales Ministry of Health, North Sydney, NSW 2060, Australia; The University of Sydney, Sydney Medical School, Sydney, NSW 2006, Australia
| | - Jacky Hony
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney, NSW 2006, Australia
| | - Sophia Lin
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney, NSW 2006, Australia
| | - Melissa Gwizd
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney, NSW 2006, Australia
| | - Maria A Fiatarone Singh
- The University of Sydney, Exercise, Health and Performance Faculty Research Group, Lidcombe, NSW 2141, Australia; The University of Sydney, Charles Perkins Centre, Sydney, NSW 2006, Australia; The University of Sydney, Sydney Medical School, Sydney, NSW 2006, Australia; Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Center on Aging at Tufts University, Boston, MA 02111, USA
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Mohammedi K, Woodward M, Marre M, Colagiuri S, Cooper M, Harrap S, Mancia G, Poulter N, Williams B, Zoungas S, Chalmers J. Comparative effects of microvascular and macrovascular disease on the risk of major outcomes in patients with type 2 diabetes. Cardiovasc Diabetol 2017; 16:95. [PMID: 28750645 PMCID: PMC5530952 DOI: 10.1186/s12933-017-0574-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/21/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Microvascular disease is associated with a high risk of macrovascular events in patients with type 2 diabetes, but the impact of macrovascular disease on the risk of microvascular events remains unknown. We sought to evaluate the respective effects of prior microvascular and macrovascular disease on the risk of major outcomes, including microvascular events, in these patients. METHODS Participants in the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation (ADVANCE) trial (n = 11,140) and the ADVANCE-ON post-trial study (n = 8494) were categorized into 4 groups at baseline: dual absence of microvascular or macrovascular disease (n = 6789), presence of microvascular disease alone (n = 761), macrovascular disease alone (n = 3196), and both (n = 394). Outcomes were all-cause mortality, major macrovascular events (MACE), and major clinical microvascular events. RESULTS All-cause mortality, MACE, and major clinical microvascular events occurred in 2265 (20%), 2166 (19%), and 807 (7%) participants respectively, during a median follow-up of 9.9 (inter-quartile interval 5.6-10.9) years. The adjusted hazard ratios [95% CI] of death, MACE, and major clinical microvascular events were each greater in patients with baseline microvascular disease (1.43 [1.20-1.71], 1.64 [1.37-1.97], and 4.74 [3.86-5.82], respectively), macrovascular disease (1.43 [1.30-1.57], 2.04 [1.86-2.25], and 1.26 [1.06-1.51]) or both (2.01 [1.65-2.45], 2.92 [2.40-3.55], and 6.30 [4.93-8.06]) compared with those without these conditions. No interaction was observed between baseline microvascular and macrovascular disease for these events. The addition of microvascular disease (change in c-statistic [95% CI] 0.005 [0.002-0.008], p = 0.02) or macrovascular disease (0.005 [0.002-0.007], p < 0.0001) considered separately or together (0.011 [0.007-0.014], p < 0.0001) improved the discrimination and the classification (integrated discrimination improvement (IDI): 0.013 [0.010-0.016], p < 0.001; net reclassification improvement (NRI): 0.021 [0.011-0.032], p < 0.001) of the risk of all-cause mortality. Microvascular disease improved discrimination (0.009 [0.003-0.014]) and classification (IDI: 0.008 [0.006-0.010]; NRI: 0.011 [0.001-0.020]) of MACE. Baseline macrovascular disease modestly enhanced IDI (0.002 [0.001-0.002]) and NRI (0.041 [0.002-0.087]), but not discrimination, of major clinical microvascular events. CONCLUSIONS Microvascular and macrovascular disease are independently associated with the 10-year risk of death, MACE, and major clinical microvascular events in patients with type 2 diabetes. The coexistence of these conditions was associated with the highest risks.
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Affiliation(s)
- Kamel Mohammedi
- The George Institute for Global Health, University of Sydney, Sydney, NSW Australia
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
- Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France
| | - Mark Woodward
- The George Institute for Global Health, University of Sydney, Sydney, NSW Australia
- The George Institute for Global Health, University of Oxford, Oxford, UK
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Michel Marre
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
- Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France
- University Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, University of Sydney, Sydney, NSW Australia
| | - Mark Cooper
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC Australia
| | - Stephen Harrap
- The University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC Australia
| | - Giuseppe Mancia
- The University of Milan-Bicocca and Istituto Auxologico Italiano, Milan, Italy
| | - Neil Poulter
- The International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London (UCL) and NIHR UCL Hospitals Biomedical Research Centre, London, UK
| | - Sophia Zoungas
- The George Institute for Global Health, University of Sydney, Sydney, NSW Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC Australia
| | - John Chalmers
- The George Institute for Global Health, University of Sydney, Sydney, NSW Australia
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Ohkuma T, Woodward M, Jun M, Muntner P, Hata J, Colagiuri S, Harrap S, Mancia G, Poulter N, Williams B, Rothwell P, Chalmers J. Prognostic Value of Variability in Systolic Blood Pressure Related to Vascular Events and Premature Death in Type 2 Diabetes Mellitus: The ADVANCE-ON Study. Hypertension 2017; 70:461-468. [PMID: 28584014 DOI: 10.1161/hypertensionaha.117.09359] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/20/2017] [Accepted: 05/01/2017] [Indexed: 01/22/2023]
Abstract
Visit-to-visit variability in systolic blood pressure (SBP) is a risk factor for cardiovascular events. However, whether it provides additional predictive information beyond traditional risk factors, including mean SBP, in the long term is unclear. The ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) was a randomized controlled trial in patients with type 2 diabetes mellitus; ADVANCE-ON (ADVANCE-Observational) followed-up patients subsequently. In these analyses, 9114 patients without major macrovascular or renal events or death during the first 24 months were included. Data on SBP from 6 visits during the first 24 months after randomization were used to estimate visit-to-visit variability in several ways: the primary measure was the standard deviation. Events accrued during the following 7.6 years. The primary outcome was a composite of major macrovascular and renal events and all-cause mortality. Standard deviation of SBP was log-linearly associated with an increased risk of the primary outcome (P<0.001) after adjustment for mean SBP and other cardiovascular risk factors. The hazard ratio (HR; 95% confidence interval [CI]) in the highest, compared with the lowest, tenth of the standard deviation was 1.39 (1.15-1.69). Results were similar for major macrovascular events alone and all-cause mortality alone (both P<0.01). Addition of standard deviation of SBP significantly improved 8-year risk classification (continuous net reclassification improvement, 5.3%). Results were similar for other measures of visit-to-visit variability, except maximum SBP. Visit-to-visit variability in SBP is an independent predictor of vascular complications and death, which improves risk prediction beyond that provided by traditional risk factors, including mean SBP.
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Affiliation(s)
- Toshiaki Ohkuma
- From the George Institute for Global Health (T.O., M.W., M.J., J.H., J.C.), and Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School (S.C.), University of Sydney, New South Wales, Australia; The George Institute for Global Health, University of Oxford, United Kingdom (M.W.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.); Departments of Epidemiology (P.M.) and Medicine (P.M.), University of Alabama at Birmingham; Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (S.H.); University of Milan-Bicocca and Instituto Auxologico Italiano (G.M.); International Centre for Circulatory Health, Imperial College, London, UK (N.P.); Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK (B.W.); and Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.R.)
| | - Mark Woodward
- From the George Institute for Global Health (T.O., M.W., M.J., J.H., J.C.), and Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School (S.C.), University of Sydney, New South Wales, Australia; The George Institute for Global Health, University of Oxford, United Kingdom (M.W.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.); Departments of Epidemiology (P.M.) and Medicine (P.M.), University of Alabama at Birmingham; Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (S.H.); University of Milan-Bicocca and Instituto Auxologico Italiano (G.M.); International Centre for Circulatory Health, Imperial College, London, UK (N.P.); Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK (B.W.); and Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.R.)
| | - Min Jun
- From the George Institute for Global Health (T.O., M.W., M.J., J.H., J.C.), and Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School (S.C.), University of Sydney, New South Wales, Australia; The George Institute for Global Health, University of Oxford, United Kingdom (M.W.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.); Departments of Epidemiology (P.M.) and Medicine (P.M.), University of Alabama at Birmingham; Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (S.H.); University of Milan-Bicocca and Instituto Auxologico Italiano (G.M.); International Centre for Circulatory Health, Imperial College, London, UK (N.P.); Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK (B.W.); and Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.R.)
| | - Paul Muntner
- From the George Institute for Global Health (T.O., M.W., M.J., J.H., J.C.), and Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School (S.C.), University of Sydney, New South Wales, Australia; The George Institute for Global Health, University of Oxford, United Kingdom (M.W.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.); Departments of Epidemiology (P.M.) and Medicine (P.M.), University of Alabama at Birmingham; Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (S.H.); University of Milan-Bicocca and Instituto Auxologico Italiano (G.M.); International Centre for Circulatory Health, Imperial College, London, UK (N.P.); Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK (B.W.); and Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.R.)
| | - Jun Hata
- From the George Institute for Global Health (T.O., M.W., M.J., J.H., J.C.), and Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School (S.C.), University of Sydney, New South Wales, Australia; The George Institute for Global Health, University of Oxford, United Kingdom (M.W.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.); Departments of Epidemiology (P.M.) and Medicine (P.M.), University of Alabama at Birmingham; Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (S.H.); University of Milan-Bicocca and Instituto Auxologico Italiano (G.M.); International Centre for Circulatory Health, Imperial College, London, UK (N.P.); Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK (B.W.); and Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.R.)
| | - Stephen Colagiuri
- From the George Institute for Global Health (T.O., M.W., M.J., J.H., J.C.), and Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School (S.C.), University of Sydney, New South Wales, Australia; The George Institute for Global Health, University of Oxford, United Kingdom (M.W.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.); Departments of Epidemiology (P.M.) and Medicine (P.M.), University of Alabama at Birmingham; Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (S.H.); University of Milan-Bicocca and Instituto Auxologico Italiano (G.M.); International Centre for Circulatory Health, Imperial College, London, UK (N.P.); Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK (B.W.); and Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.R.)
| | - Stephen Harrap
- From the George Institute for Global Health (T.O., M.W., M.J., J.H., J.C.), and Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School (S.C.), University of Sydney, New South Wales, Australia; The George Institute for Global Health, University of Oxford, United Kingdom (M.W.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.); Departments of Epidemiology (P.M.) and Medicine (P.M.), University of Alabama at Birmingham; Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (S.H.); University of Milan-Bicocca and Instituto Auxologico Italiano (G.M.); International Centre for Circulatory Health, Imperial College, London, UK (N.P.); Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK (B.W.); and Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.R.)
| | - Giuseppe Mancia
- From the George Institute for Global Health (T.O., M.W., M.J., J.H., J.C.), and Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School (S.C.), University of Sydney, New South Wales, Australia; The George Institute for Global Health, University of Oxford, United Kingdom (M.W.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.); Departments of Epidemiology (P.M.) and Medicine (P.M.), University of Alabama at Birmingham; Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (S.H.); University of Milan-Bicocca and Instituto Auxologico Italiano (G.M.); International Centre for Circulatory Health, Imperial College, London, UK (N.P.); Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK (B.W.); and Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.R.)
| | - Neil Poulter
- From the George Institute for Global Health (T.O., M.W., M.J., J.H., J.C.), and Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School (S.C.), University of Sydney, New South Wales, Australia; The George Institute for Global Health, University of Oxford, United Kingdom (M.W.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.); Departments of Epidemiology (P.M.) and Medicine (P.M.), University of Alabama at Birmingham; Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (S.H.); University of Milan-Bicocca and Instituto Auxologico Italiano (G.M.); International Centre for Circulatory Health, Imperial College, London, UK (N.P.); Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK (B.W.); and Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.R.)
| | - Bryan Williams
- From the George Institute for Global Health (T.O., M.W., M.J., J.H., J.C.), and Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School (S.C.), University of Sydney, New South Wales, Australia; The George Institute for Global Health, University of Oxford, United Kingdom (M.W.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.); Departments of Epidemiology (P.M.) and Medicine (P.M.), University of Alabama at Birmingham; Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (S.H.); University of Milan-Bicocca and Instituto Auxologico Italiano (G.M.); International Centre for Circulatory Health, Imperial College, London, UK (N.P.); Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK (B.W.); and Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.R.)
| | - Peter Rothwell
- From the George Institute for Global Health (T.O., M.W., M.J., J.H., J.C.), and Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School (S.C.), University of Sydney, New South Wales, Australia; The George Institute for Global Health, University of Oxford, United Kingdom (M.W.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.); Departments of Epidemiology (P.M.) and Medicine (P.M.), University of Alabama at Birmingham; Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (S.H.); University of Milan-Bicocca and Instituto Auxologico Italiano (G.M.); International Centre for Circulatory Health, Imperial College, London, UK (N.P.); Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK (B.W.); and Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.R.)
| | - John Chalmers
- From the George Institute for Global Health (T.O., M.W., M.J., J.H., J.C.), and Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School (S.C.), University of Sydney, New South Wales, Australia; The George Institute for Global Health, University of Oxford, United Kingdom (M.W.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.); Departments of Epidemiology (P.M.) and Medicine (P.M.), University of Alabama at Birmingham; Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (S.H.); University of Milan-Bicocca and Instituto Auxologico Italiano (G.M.); International Centre for Circulatory Health, Imperial College, London, UK (N.P.); Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK (B.W.); and Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.R.).
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Chalasani S, Peiris DP, Usherwood T, Redfern J, Neal BC, Sullivan DR, Colagiuri S, Zwar NA, Li Q, Patel A. Reducing cardiovascular disease risk in diabetes: a randomised controlled trial of a quality improvement initiative. Med J Aust 2017; 206:436-441. [DOI: 10.5694/mja16.00332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 12/13/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Santhi Chalasani
- The George Institute for International Health, University of Sydney, Sydney, NSW
| | - David P Peiris
- The George Institute for International Health, University of Sydney, Sydney, NSW
| | - Tim Usherwood
- Sydney Medical School, University of Sydney, Sydney, NSW
| | - Julie Redfern
- The George Institute for International Health, University of Sydney, Sydney, NSW
- Sydney Medical School, University of Sydney, Sydney, NSW
| | - Bruce C Neal
- The George Institute for International Health, University of Sydney, Sydney, NSW
| | | | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition and Exercise, University of Sydney, Sydney, NSW
- UNSW Australia, Sydney, NSW
| | | | - Qiang Li
- The George Institute for International Health, University of Sydney, Sydney, NSW
| | - Anushka Patel
- The George Institute for International Health, University of Sydney, Sydney, NSW
- Sydney Medical School, University of Sydney, Sydney, NSW
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