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Abstract
Do-It-Yourself closed loop systems are becoming increasingly popular as an alternative choice for managing type 1 diabetes. In this commentary, the issues that are faced by both the clinician and the person with diabetes are discussed from my perspective.
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Affiliation(s)
- Tien-Ming Hng
- Department of Diabetes and Endocrinology, Blacktown Hospital, Western Sydney Local Health District, NSW, Australia
- School of Medicine, Western Sydney University, Parramatta, NSW, Australia
- Tien-Ming Hng, MBBS, PhD, FRACP, Department of Diabetes and Endocrinology, Level 3, Western Sydney University Clinical School Building, Blacktown Hospital, PO Box 792, Blacktown, NSW 2148, Australia.
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Bolla AM, Dozio N, Scavini M, Succurro E, Tumminia A, Torlone E, Sasso FC, Vitacolonna E. Awareness about diabetes and pregnancy among diabetes specialists and fellows: The YoSID diabetes and pregnancy project. Nutr Metab Cardiovasc Dis 2020; 30:1520-1524. [PMID: 32665208 DOI: 10.1016/j.numecd.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/04/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Despite evidence that pregnancy planning improves outcomes, in Italy, as in many other countries worldwide, <50% of women with diabetes prepare their pregnancy. The aim of this study was to document training and knowledge on diabetes and pregnancy (D&P) among diabetes professionals. METHODS AND RESULTS We administered an anonymous online questionnaire, focused on diabetes and pregnancy planning, to diabetes team members. Between Nov-2017 and Jul-2018, n = 395 professionals (60% diabetes/endocrinology/internal medicine specialists, 28% fellows) completed the survey. Fifty-nine percent of the specialists, mainly (78%) those completing their fellowship after 2006, reported having received training on D&P during fellowship. Considering specialists reporting training, 43% correctly identified fetal risks of inadequate preconceptional glucose control and 55% maternal risks, 38% identified risks associated with overweight/obesity, and 39% would prescribe hormonal contraception to women with diabetes only if glucose control is good. CONCLUSIONS The results of our survey suggest the need to improve training and awareness of professionals in the area of diabetes and pregnancy.
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Affiliation(s)
- Andrea M Bolla
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Marina Scavini
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Andrea Tumminia
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi Hospital, Catania, Italy
| | - Elisabetta Torlone
- Endocrinology and Metabolic Diseases, University Hospital S. Maria della Misericordia, Perugia, Italy
| | - Ferdinando C Sasso
- University of Campania Luigi Vanvitelli, Department of Advanced Medical and Surgical Sciences, Naples, Italy
| | - Ester Vitacolonna
- Department of Medicine and Aging, G. d'Annunzio University, Chieti, Italy
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3
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Abstract
CONTEXT Physician burnout is a national problem that has gained increasing attention among the medical community. Many organizations like the American Medical Association, American College of Physicians, and the National Academy of Medicine are taking action. EVIDENCE ACQUISITION Endocrinologists and other members of the endocrine community are not immune to burnout. Approximately 47% of endocrinologists report feeling burnt out or have experienced symptoms of burnout, and this number is rising. EVIDENCE SYNTHESIS The consequences of burnout include personal factors such as stress, depression, and risk of suicide as well as organizational impacts like decreased quality of care, increased clinical errors, reduced empathy for patients, decreased patient satisfaction, and higher turnover rates, with some physicians leaving practice altogether. Burnout has substantial economic impacts at an organizational level, and high costs are associated with replacing, recruiting, and retraining endocrinologists. Endocrinologists identified feeling a lack of respect from administration, excessive bureaucratic tasks, increased computerization, emphasis on profit that has contributed to loss of control over schedules, and insufficient compensation as top contributors to burnout. One strategy to address burnout is to focus on the promotion of joy in work. Joy in work is guided by 4 key themes: meaning, camaraderie, choice, and equity. Each of these themes can be implemented through cocreating solutions. We discuss how each theme can be addressed among endocrine practices. CONCLUSION Ultimately, initiatives need to be implemented across the endocrinology community to cultivate joy and reduce burnout.
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Bretherton I, Grossmann M, Leemaqz SY, Zajac JD, Cheung AS. Australian endocrinologists need more training in transgender health: A national survey. Clin Endocrinol (Oxf) 2020; 92:247-257. [PMID: 31845345 DOI: 10.1111/cen.14143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/28/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE An increasing number of trans and gender diverse (TGD) individuals are seeking gender-affirming hormone therapy for gender transition. Little is known about the levels of training, experience and confidence of endocrinologists in providing care and lack of training and experience is a potential barrier to individuals seeking appropriate and timely health care. We aimed to assess the level of training and confidence of Australian endocrinologists and trainees in the endocrine management of trans and gender diverse individuals in a representative sample. DESIGN Endocrinologist and trainee members of the Endocrine Society of Australia were invited to participate in an anonymous 14-item survey. Of the 545 members, 147 clinicians (95 adult endocrinologists, 2 paediatric endocrinologists and 50 endocrinology trainees) responded. RESULTS When presented with a scenario regarding commencement of gender-affirming hormone therapy, only 19% felt confident providing clinical care to TGD individuals. Compared to other areas of endocrinology, 75% felt less or not at all confident in commencing hormone therapy in a TGD patient. No training in transgender medicine during medical school or during their endocrinology training was reported by 96% and 60%, respectively. There were significantly higher levels of confidence in all aspects including performing a consultation in those who had previously seen a TGD patient. The desire for more training was high (91%). CONCLUSIONS These results highlight the shortfall in training in TGD health care amongst endocrinologists and show that prior clinical experience is associated with higher levels of confidence. Medical schools and endocrinology fellowship training programmes will need to adapt to meet the increasing demand for quality TGD health services.
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Affiliation(s)
- Ingrid Bretherton
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Vic., Australia
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Vic., Australia
| | - Shalem Y Leemaqz
- Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Jeffrey D Zajac
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Vic., Australia
| | - Ada S Cheung
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Vic., Australia
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Danoff A. Endocrinologists Can Contribute to the Care of People Impacted by the Opioid Epidemic. J Clin Endocrinol Metab 2020; 105:5645392. [PMID: 31778171 PMCID: PMC7053405 DOI: 10.1210/clinem/dgz237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/27/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Ann Danoff
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Correspondence: Ann Danoff, MD, Chief, Medical Service, CPL Michael J. Crescenz VA Medical Center, 3900 Woodland Ave., Rm 822 East, Philadelphia, PA 19104. E-mail:
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Anichini R, Brocco E, Caravaggi CM, Da Ros R, Giurato L, Izzo V, Meloni M, Uccioli L. Physician experts in diabetes are natural team leaders for managing diabetic patients with foot complications. A position statement from the Italian diabetic foot study group. Nutr Metab Cardiovasc Dis 2020; 30:167-178. [PMID: 31848052 DOI: 10.1016/j.numecd.2019.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/17/2019] [Revised: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 12/16/2022]
Abstract
Diabetic foot syndrome (DFS) is a complex disease. The best outcomes are reported with the multi-disciplinary team (MDT) approach, where each member works collaboratively according to his/her expertise. However, which health provider should act as the team leader (TL) has not been determined. The TL should be familiar with the management of diabetes, related complications and comorbidities. He/she should be able to diagnose and manage foot infections, including prompt surgical treatment of local lesions, such as abscesses or phlegmons, in an emergent way in the first meeting with the patient. According to the Organization for Economic Co-operation and Development (OECD) reports, Italy is one of countries with a low amputation rate in diabetic patients. Many factors might have contributed to this result, including 1)the special attention directed to diabetes by the public health system, which has defined diabetes as a "protected disease", and accordingly, offers diabetic patients, at no charge, the best specialist care, including specific devices, and 2)the presence of a network of diabetic foot (DF) clinics managed by diabetologists with medical and surgical expertise. The health care providers all share a "patient centred model" of care, for which they use their internal medicine background and skills in podiatric surgery to manage acute or chronic needs in a timely manner. Therefore, according to Italian experiences, which are fully reported in this document, we believe that only a skilled diabetologist/endocrinologist should act as a TL. Courses and university master's degree programmes focused on DF should guarantee specific training for physicians to become a TL.
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Affiliation(s)
- R Anichini
- Diabetes Unit and Diabetic Foot Unit, Area Pistoiese, AUSL Centro Toscana, Italy
| | - E Brocco
- Diabetic Foot Unit, Foot and Ankle Clinic, Abano Terme Polyclinic, Abano Terme, Italy
| | - C M Caravaggi
- Diabetic Foot Department, IRCCS Multimedica Milan, Italy
| | - R Da Ros
- Diabetes Center AAS2 Monfalcone-Gorizia, Italy
| | - L Giurato
- Diabetic Foot Unit, Department of Medicine Systems, University of Tor Vergata, Rome, Italy
| | - V Izzo
- Diabetic Foot Unit, Department of Medicine Systems, University of Tor Vergata, Rome, Italy
| | - M Meloni
- Diabetic Foot Unit, Department of Medicine Systems, University of Tor Vergata, Rome, Italy
| | - L Uccioli
- Diabetic Foot Unit, Department of Medicine Systems, University of Tor Vergata, Rome, Italy.
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Piltonen TT, Ruokojärvi M, Karro H, Kujanpää L, Morin-Papunen L, Tapanainen JS, Stener-Victorin E, Sundrström-Poromaa I, Hirschberg AL, Ravn P, Glintborg D, Mellembakken JR, Steingrimsdottir T, Gibson-Helm M, Vanky E, Andersen M, Arffman RK, Teede H, Falah-Hassani K. Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe. PLoS One 2019; 14:e0226074. [PMID: 31877155 PMCID: PMC6932801 DOI: 10.1371/journal.pone.0226074] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/18/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To date, little is known about differences in the knowledge, diagnosis making and treatment strategies of health care providers regarding polycystic ovary syndrome (PCOS) across different disciplines in countries with similar health care systems. To inform guideline translation, we aimed to study physician reported awareness, diagnosis and management of PCOS and to explore differences between medical disciplines in the Nordic countries and Estonia. METHODS This cross-sectional survey was conducted among 382 endocrinologists and obstetrician-gynaecologists in the Nordic countries and Estonia in 2015-2016. Of the participating physicians, 43% resided in Finland, 18% in Denmark, 16% in Norway, 13% in Estonia, and 10% in Sweden or Iceland, and 75% were obstetrician-gynaecologists. Multivariable logistic regression models were run to identify health care provider characteristics for awareness, diagnosis and treatment of PCOS. RESULTS Clinical features, lifestyle management and comorbidity were commonly recognized in women with PCOS, while impairment in psychosocial wellbeing was not well acknowledged. Over two-thirds of the physicians used the Rotterdam diagnostic criteria for PCOS. Medical endocrinologists more often recommended lifestyle management (OR = 3.6, CI 1.6-8.1) or metformin (OR = 5.0, CI 2.5-10.2), but less frequently OCP (OR = 0.5, CI 0.2-0.9) for non-fertility concerns than general obstetrician-gynaecologists. The physicians aged <35 years were 2.2 times (95% CI 1.1-4.3) more likely than older physicians to recommend lifestyle management for patients with PCOS for fertility concerns. Physicians aged 46-55 years were less likely to recommend oral contraceptive pills (OCP) for patients with PCOS than physicians aged >56 (adjusted odds ratio (OR) = 0.4, 95% CI 0.2-0.8). CONCLUSION Despite well-organized healthcare, awareness, diagnosis and management of PCOS is suboptimal, especially in relation to psychosocial comorbidities, among physicians in the Nordic countries and Estonia. Physicians need more education on PCOS and evidence-based information on Rotterdam diagnostic criteria, psychosocial features and treatment of PCOS, with the recently published international PCOS guideline well needed and welcomed.
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Affiliation(s)
- Terhi T. Piltonen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
- * E-mail:
| | - Maria Ruokojärvi
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | - Helle Karro
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Linda Kujanpää
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | - Juha S. Tapanainen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Angelica L. Hirschberg
- Department of Women’s and Children’s Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Pernille Ravn
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Jan Roar Mellembakken
- Department of Reproductive Medicine, Division of Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Thora Steingrimsdottir
- Department of Obstetrics and Gynecology, Landspitali University Hospital, School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway
| | - Marianne Andersen
- Department of Language and Culture, UiT—The Arctic University of Norway, Tromsø, Norway
| | - Riikka K. Arffman
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kobra Falah-Hassani
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
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Loeken MR. Importance of long-term care of diabetic women starting in pregnancy. Diabetes Metab Res Rev 2017; 33:10.1002/dmrr.2906. [PMID: 28486767 PMCID: PMC5640448 DOI: 10.1002/dmrr.2906] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/15/2017] [Accepted: 05/04/2017] [Indexed: 11/06/2022]
Abstract
Large scale, multi-center, controlled studies have demonstrated the importance of glycemic control, as indicated by HbA1c levels, in reducing the incidence and progression of diabetic complications. However, Yasue Omori, who began practicing medicine in Tokyo 60 years ago, in 1957, has the vantage point of long-term continuing care for women with type 2 diabetes, some for several decades. An internist who specializes in diabetic pregnancy, Dr Omori began caring for many of her patients during their pregnancies and continued to care for them following their deliveries, some now more than 50 years. Surprisingly, despite lack of optimal HbA1c levels, they have suffered relatively few diabetic complications. As reported in "The importance of nonstop treatment after delivery for pregnant women with type 2 diabetes" in Diabetes/Metabolism Research and Reviews, Omori and colleagues present a historical perspective that provides evidence that a long-term patient-care giver relationship following pregnancy can be valuable in reducing the onset and progression of diabetic complications.
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Affiliation(s)
- Mary R Loeken
- Section on Islet and Regenerative Cell Biology, Joslin Diabetes Center, Department of Medicine, Harvard Medical School, Boston, MA, USA
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Andrade LF, Rapp T, Sevilla-Dedieu C. Exploring the determinants of endocrinologist visits by patients with diabetes. Eur J Health Econ 2016; 17:1173-1184. [PMID: 27038624 DOI: 10.1007/s10198-016-0794-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 06/15/2015] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Diabetes is today a major public health concern in terms of its financial and social burden. Previous studies have revealed that specialist care for patients with diabetes leads to more positive outcomes than care by general practitioners (GPs) alone. The aim of this study was to estimate the determinants of endocrinologist consultation by patients with diabetes. METHODS We used a two-part model to explore both the decision to consult and the frequency of consultations. We used claim data collected for 65,633 affiliates of a French social security provider. Patients were aged over 18 and treated for diabetes (types I and II). We controlled for patients' socioeconomic characteristics, type of diabetes treatment, medical care, and health status. We also controlled for variables, such as the cost of a visit, the distance to the nearest endocrinologist's office, the density of medical practitioners and the prevalence of diabetes in the area. RESULTS The results show that the parameters associated with the decision to consult an endocrinologist were considerably different from factors associated with the frequency of consultations. A marked positive effect of income on the decision to consult was found, whereas travel time to the office had a negative impact on both the decision to consult and the frequency of consultations. Increasing treatment complexity is associated with a higher probability of consulting an endocrinologist. We found evidence of a significant substitution effect between GPs and endocrinologists. Finally, consultation price is a barrier to seeing an endocrinologist. CONCLUSION Given that financial barriers were identified in the relatively wealthy population analysed here, it is likely that this may be even more of an obstacle in the general population.
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Affiliation(s)
- Luiz Flavio Andrade
- MGEN Foundation for Public Health, 3 square Max Hymans, 75748, Paris Cedex 15, France
- LIRAES (EA 4470), University of Paris Descartes, 12 rue de l'École de médecine, 75270, Paris Cedex 06, France
| | - Thomas Rapp
- LIRAES (EA 4470), University of Paris Descartes, 12 rue de l'École de médecine, 75270, Paris Cedex 06, France
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