Pub Date : 2024-11-01DOI: 10.1016/j.pcd.2024.10.004
Stephen Wormall , Karen Richardson
Aims
Type 2 Diabetes Mellitus morbidity disproportionally effects the most socioeconomically deprived 20 % of England. Total Diet Replacement (TDR) is a high impact intervention currently commissioned by Integrated Care Boards (ICB). Finding and referring eligible, motivated patients is a significant challenge. This study evaluates a 12-month population health management, proactive referral intervention commissioned by Nottingham and Nottinghamshire ICB during a 2-year TDR pilot designed to supplement referrals from primary care.
Methods
A Diabetes specialist nurse clinically reviewed a list of potentially eligible patients found by searching routinely collected health care data from 16 primary care centres in 3 PCNs.
Results
19.7 % (50/254) of potential patients were referred during the intervention period. 19.3 % (49/254) were uncontactable. 39.8 % (101/254) declined referral. 17.7 % (45/254) were ineligible after clinical review. An interrupted time series analysis suggests monthly referrals increased during the study period due to the intervetion (F (1,22) = 5.19 p=0.0345). Searching for patients from more socioeconomically deprived areas (index of multiple deprivation deciles 1–3) did not meaningfully alter the referral yield (19.6 %, 19/97).
Conclusions
Proactive care interventions could be used to facilitate referrals to the TDR or other high impact interventions by healthcare commissioning bodies.
{"title":"Proactive total diet replacement referral for type 2 diabetes: A service evaluation","authors":"Stephen Wormall , Karen Richardson","doi":"10.1016/j.pcd.2024.10.004","DOIUrl":"10.1016/j.pcd.2024.10.004","url":null,"abstract":"<div><h3>Aims</h3><div>Type 2 Diabetes Mellitus morbidity disproportionally effects the most socioeconomically deprived 20 % of England. Total Diet Replacement (TDR) is a high impact intervention currently commissioned by Integrated Care Boards (ICB). Finding and referring eligible, motivated patients is a significant challenge. This study evaluates a 12-month population health management, proactive referral intervention commissioned by Nottingham and Nottinghamshire ICB during a 2-year TDR pilot designed to supplement referrals from primary care.</div></div><div><h3>Methods</h3><div>A Diabetes specialist nurse clinically reviewed a list of potentially eligible patients found by searching routinely collected health care data from 16 primary care centres in 3 PCNs.</div></div><div><h3>Results</h3><div>19.7 % (50/254) of potential patients were referred during the intervention period. 19.3 % (49/254) were uncontactable. 39.8 % (101/254) declined referral. 17.7 % (45/254) were ineligible after clinical review. An interrupted time series analysis suggests monthly referrals increased during the study period due to the intervetion (F (1,22) = 5.19 p=0.0345). Searching for patients from more socioeconomically deprived areas (index of multiple deprivation deciles 1–3) did not meaningfully alter the referral yield (19.6 %, 19/97).</div></div><div><h3>Conclusions</h3><div>Proactive care interventions could be used to facilitate referrals to the TDR or other high impact interventions by healthcare commissioning bodies.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 669-675"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.1016/j.pcd.2024.10.006
Nadine Fadhel Dhaher , Kerstin Brismar , Miriam Pikkemaat , Nael Shaat , Anton Nilsson , Louise Bennet
Background
Immigrants from the Middle East (ME) have a higher prevalence of type 2 diabetes (T2D) compared to the native-born Swedish population. In individuals free from T2D, ME immigrants are more insulin resistant and have lower levels of adjusted insulin secretion (Disposition index, DIo) compared to Swedish-born individuals. The ethnic differences are not fully explained by traditional risk factors. This has raised the question as to whether hormonal factors other than insulin are involved, contributing to higher T2D risk in ME immigrants.
Aims
In ME immigrants at high risk of developing T2D, we aimed to study the effect of a randomized culturally adapted lifestyle intervention on the levels of Vitamin D (25(OH)D), insulin-like growth factor 1 (IGF-1), Pro-neurotensin (Pro-NT) and Adiponectin. Furthermore, we aimed to study if the effect of the intervention was associated to these hormones, or if a direct effect of the intervention remained after accounting for these.
Methods
In this culturally adapted randomized controlled trial of four months duration, eligible ME immigrants at high risk of developing T2D identified in the MEDIM cohort were invited to participate. The intervention group (N= 35) received a culturally adapted lifestyle intervention program consisting of seven group sessions and cooking classes. The control group (N= 32) were given treatment as usual with oral and written information to improve their lifestyle habits. Using mixed models’ linear regression analysis, the changes in the levels of 25(OH)D, IGF-1, Adiponectin and Pro-NT were assessed by comparing the groups and we further studied the effects of the changes on insulin action and secretion.
Results
The adjusted levels of 25(OH)D significantly increased in the intervention group compared to the control group (β for the effect of the intervention on 25(OH)D: 0.061, 95 % CI 0.009–0.113, P = 0.023). The increase in insulin sensitivity index (ISI) observed in the intervention compared to the control group was altered after adjusting for 25(OH)D: 0.129, 95 % CI −0.016–0.274, P = 0.078). IGF-1, Adiponectin and Pro-NT did not significantly influence the change over time concerning insulin secretion.
Conclusion
Lifestyle intervention increases the adjusted levels of 25(OH)D. Moreover, the effect of the lifestyle intervention on insulin action and secretion was altered when adjusting for 25(OH)D.
{"title":"Impact of lifestyle intervention on vitamin D, Adiponectin, Insulin-like growth factor 1 and Proneurotensin in overweight individuals from the Middle East","authors":"Nadine Fadhel Dhaher , Kerstin Brismar , Miriam Pikkemaat , Nael Shaat , Anton Nilsson , Louise Bennet","doi":"10.1016/j.pcd.2024.10.006","DOIUrl":"10.1016/j.pcd.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Immigrants from the Middle East (ME) have a higher prevalence of type 2 diabetes (T2D) compared to the native-born Swedish population. In individuals free from T2D, ME immigrants are more insulin resistant and have lower levels of adjusted insulin secretion (Disposition index, DIo) compared to Swedish-born individuals. The ethnic differences are not fully explained by traditional risk factors. This has raised the question as to whether hormonal factors other than insulin are involved, contributing to higher T2D risk in ME immigrants.</div></div><div><h3>Aims</h3><div>In ME immigrants at high risk of developing T2D, we aimed to study the effect of a randomized culturally adapted lifestyle intervention on the levels of Vitamin D (25(OH)D), insulin-like growth factor 1 (IGF-1), Pro-neurotensin (Pro-NT) and Adiponectin. Furthermore, we aimed to study if the effect of the intervention was associated to these hormones, or if a direct effect of the intervention remained after accounting for these.</div></div><div><h3>Methods</h3><div>In this culturally adapted randomized controlled trial of four months duration, eligible ME immigrants at high risk of developing T2D identified in the MEDIM cohort were invited to participate. The intervention group (N= 35) received a culturally adapted lifestyle intervention program consisting of seven group sessions and cooking classes. The control group (N= 32) were given treatment as usual with oral and written information to improve their lifestyle habits. Using mixed models’ linear regression analysis, the changes in the levels of 25(OH)D, IGF-1, Adiponectin and Pro-NT were assessed by comparing the groups and we further studied the effects of the changes on insulin action and secretion.</div></div><div><h3>Results</h3><div>The adjusted levels of 25(OH)D significantly increased in the intervention group compared to the control group (β for the effect of the intervention on 25(OH)D: 0.061, 95 % CI 0.009–0.113, <em>P</em> = 0.023). The increase in insulin sensitivity index (ISI) observed in the intervention compared to the control group was altered after adjusting for 25(OH)D: 0.129, 95 % CI −0.016–0.274, <em>P</em> = 0.078). IGF-1, Adiponectin and Pro-NT did not significantly influence the change over time concerning insulin secretion.</div></div><div><h3>Conclusion</h3><div>Lifestyle intervention increases the adjusted levels of 25(OH)D. Moreover, the effect of the lifestyle intervention on insulin action and secretion was altered when adjusting for 25(OH)D.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 676-682"},"PeriodicalIF":2.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To determine the psychometric properties of the Slovenian versions of the Diabetes Empowerment Scale (DES), both the long form (S-DES-LF) and the short form (S-DES-SF).
Methods
Between April and September 2023, we recruited adults with type 2 diabetes (T2D) using convenient sampling in five primary health centres. We examined internal consistency, test-retest reliability, criterion validity, and discriminant validity. Confirmatory factor analysis (CFA) evaluated the fit of the one-and three-factor models for S-DES-SF and S-DES-LF, respectively.
Results
The results of 288 individuals, with a mean age of 67 ± 9.2 years, including 132 men and 156 women, showed excellent internal consistency and strong test-retest reliability for both the S-DES-LF (Cronbach’s α=0.90; ICC=0.95) and S-DES-SF (α=0.91; ICC=0.92). Criterion validity of the S-DES-LF was confirmed through known-groups validity, with higher education (p=0.016) and absence of comorbid hypertension (p=0.034) associated with greater empowerment. Discriminant validity was demonstrated by the lack of significant correlations between the S-DES-LF and S-DES-SF scores with age or gender. CFA confirmed a good fit for the S-DES-SF's one-factor model but not for S-DES-LF three-factor model.
Conclusions
S-DES-LF and S-DES-SF are valid and reliable tools for assessing diabetes empowerment in Slovenian people with T2D. Future research should further explore the convergent validity of scales.
{"title":"Psychometric properties of the Slovenian versions of the diabetes empowerment scale, long and short form, among the slovenian adults with type 2 diabetes","authors":"Tina Virtič Potočnik , Špela Miroševič , Matic Mihevc , Črt Zavrnik , Majda Mori Lukančič , Tonka Poplas Susič , Zalika Klemenc-Ketiš","doi":"10.1016/j.pcd.2024.10.002","DOIUrl":"10.1016/j.pcd.2024.10.002","url":null,"abstract":"<div><h3>Aims</h3><div>To determine the psychometric properties of the Slovenian versions of the Diabetes Empowerment Scale (DES), both the long form (S-DES-LF) and the short form (S-DES-SF).</div></div><div><h3>Methods</h3><div>Between April and September 2023, we recruited adults with type 2 diabetes (T2D) using convenient sampling in five primary health centres. We examined internal consistency, test-retest reliability, criterion validity, and discriminant validity. Confirmatory factor analysis (CFA) evaluated the fit of the one-and three-factor models for S-DES-SF and S-DES-LF, respectively.</div></div><div><h3>Results</h3><div>The results of 288 individuals, with a mean age of 67 ± 9.2 years, including 132 men and 156 women, showed excellent internal consistency and strong test-retest reliability for both the S-DES-LF (Cronbach’s α=0.90; ICC=0.95) and S-DES-SF (α=0.91; ICC=0.92). Criterion validity of the S-DES-LF was confirmed through known-groups validity, with higher education (p=0.016) and absence of comorbid hypertension (p=0.034) associated with greater empowerment. Discriminant validity was demonstrated by the lack of significant correlations between the S-DES-LF and S-DES-SF scores with age or gender. CFA confirmed a good fit for the S-DES-SF's one-factor model but not for S-DES-LF three-factor model.</div></div><div><h3>Conclusions</h3><div>S-DES-LF and S-DES-SF are valid and reliable tools for assessing diabetes empowerment in Slovenian people with T2D. Future research should further explore the convergent validity of scales.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 660-668"},"PeriodicalIF":2.6,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-20DOI: 10.1016/j.pcd.2024.10.005
Christina J. Dietz , Emily Doherty , John Emerson , Karen Kemper , Lior Rennert , Windsor Westbrook Sherrill
Objective
The American Diabetes Association Standards of Care recommends that individuals with diabetes receive self-management education, but the utilization of these services remains low. This study explores primary care providers’ knowledge and perceptions of diabetes self-management education and support (DSMES).
Study design
A convergent mixed methods study design grounded in the Theoretical Domains Framework was conducted with an initial provider survey, followed by semi-structured interview of a purposeful sub-sample of providers. The survey was distributed via REDCap and interviews were recorded and transcribed verbatim.
Results
A total of 140 PCP’s responded to the survey (response rate 37.63 %) and 17 participated in interviews. The average knowledge score of the correct selection of DSMES referral time points was 70.35 %. Five themes emerged in provider interviews: procedural knowledge, ability, beliefs, reinforcement, and cultural norms. Providers wanted bidirectional communication with the DSMES program and were more likely to refer if they had a cultural norm of referring.
Conclusion
Providers have limited knowledge of the appropriate time to refer to DSMES but expressed a willingness to refer. They emphasized the importance of providing their patients with appropriate self-management education and support.
{"title":"Understanding primary care provider’s knowledge and perceptions of diabetes self-management education and support","authors":"Christina J. Dietz , Emily Doherty , John Emerson , Karen Kemper , Lior Rennert , Windsor Westbrook Sherrill","doi":"10.1016/j.pcd.2024.10.005","DOIUrl":"10.1016/j.pcd.2024.10.005","url":null,"abstract":"<div><h3>Objective</h3><div>The American Diabetes Association Standards of Care recommends that individuals with diabetes receive self-management education, but the utilization of these services remains low. This study explores primary care providers’ knowledge and perceptions of diabetes self-management education and support (DSMES).</div></div><div><h3>Study design</h3><div>A convergent mixed methods study design grounded in the Theoretical Domains Framework was conducted with an initial provider survey, followed by semi-structured interview of a purposeful sub-sample of providers. The survey was distributed via REDCap and interviews were recorded and transcribed verbatim.</div></div><div><h3>Results</h3><div>A total of 140 PCP’s responded to the survey (response rate 37.63 %) and 17 participated in interviews. The average knowledge score of the correct selection of DSMES referral time points was 70.35 %. Five themes emerged in provider interviews: procedural knowledge, ability, beliefs, reinforcement, and cultural norms. Providers wanted bidirectional communication with the DSMES program and were more likely to refer if they had a cultural norm of referring.</div></div><div><h3>Conclusion</h3><div>Providers have limited knowledge of the appropriate time to refer to DSMES but expressed a willingness to refer. They emphasized the importance of providing their patients with appropriate self-management education and support.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 637-643"},"PeriodicalIF":2.6,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.pcd.2024.10.003
Stacey Fisher , Hannah Gray , Nicci Kelsall , Donna Lowes , Leon Jonker
Aims
Diabetic patients are at elevated risk of neuropathy; early detection is desirable to minimise the risk of complications. The Medipin pin-prick device was appraised as a screening tool for diabetic neuropathy.
Methods
Prospective cross-sectional comparative screening study in primary care setting, involving 389 participants with type 2 diabetes mellitus. The Medipin pin-prick method, involving dorsal application on the hallux of both feet, was compared to 10 g monofilament testing.
Results
The ternary and semi-quantitative approach for scoring Medipin pin-prick sensation give very similar results (Spearman rho 0.67, P < 0.001). A total of 59 % patients had no signs of neuropathy (sharp sensation), 38 % reported impaired sensation (dull sensation), and an absence of sensation occurred in 3 % of patients. For the monofilament dorsal method, the figures were 79 % no neuropathy, 14 % elevated risk, and 7 % neuropathy respectively, and with the monofilament plantar method 87 % of patients had no neuropathy and 13 % did. Correlation analyses showed that taller patients and those with existing neuropathic pain are at very modest increased risk of neuropathy.
Conclusions
The Medipin pin-prick device can identify diabetic neuropathy and detects (first signs of) neuropathy in relatively more patients than 10 g monofilament testing. The differential targeting of nerve types, namely predominant small (Medipin) versus large (monofilament) fibre, likely underpins the difference in outcomes.
{"title":"Pin-prick (Medipin) assessment for neuropathy in diabetes: Prospective screening study in primary care","authors":"Stacey Fisher , Hannah Gray , Nicci Kelsall , Donna Lowes , Leon Jonker","doi":"10.1016/j.pcd.2024.10.003","DOIUrl":"10.1016/j.pcd.2024.10.003","url":null,"abstract":"<div><h3>Aims</h3><div>Diabetic patients are at elevated risk of neuropathy; early detection is desirable to minimise the risk of complications. The Medipin pin-prick device was appraised as a screening tool for diabetic neuropathy.</div></div><div><h3>Methods</h3><div>Prospective cross-sectional comparative screening study in primary care setting, involving 389 participants with type 2 diabetes mellitus. The Medipin pin-prick method, involving dorsal application on the hallux of both feet, was compared to 10 g monofilament testing.</div></div><div><h3>Results</h3><div>The ternary and semi-quantitative approach for scoring Medipin pin-prick sensation give very similar results (Spearman rho 0.67, <em>P</em> < 0.001). A total of 59 % patients had no signs of neuropathy (sharp sensation), 38 % reported impaired sensation (dull sensation), and an absence of sensation occurred in 3 % of patients. For the monofilament dorsal method, the figures were 79 % no neuropathy, 14 % elevated risk, and 7 % neuropathy respectively, and with the monofilament plantar method 87 % of patients had no neuropathy and 13 % did. Correlation analyses showed that taller patients and those with existing neuropathic pain are at very modest increased risk of neuropathy.</div></div><div><h3>Conclusions</h3><div>The Medipin pin-prick device can identify diabetic neuropathy and detects (first signs of) neuropathy in relatively more patients than 10 g monofilament testing. The differential targeting of nerve types, namely predominant small (Medipin) versus large (monofilament) fibre, likely underpins the difference in outcomes.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 612-617"},"PeriodicalIF":2.6,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.pcd.2024.09.008
Sebastian Becker , Kadri Suija , Antti Valpas , Markku Koiranen , Juha Auvinen , Hannu Uusitalo , Esko Hussi , Sirkka Keinänen-Kiukaanniemi , Jaakko Tuomilehto , Jouko Saramies
Aims
Both erectile dysfunction (ED) and diabetes (DM) are common health problems that share risk factors. The aim of this study was to investigate whether ED can predict glucose metabolism dysfunctions in men at the primary care level.
Methods
An 11-year population-based cohort study was conducted in men born between 1933 and 1956. The baseline survey was conducted in 2007–2008, with a follow-up examination 11 years later. The International Index of Erectile Function (IIEF-5) questionnaire was used to assess erectile function. Dysglycemia was evaluated using and a 2-hour oral glucose tolerance test (2hOGTT), in combination with health registry data.
Results
At baseline, men with ED but without a history of known DM exhibited a significantly higher prevalence of undetected DM, odds ratio (OR) 4.7 (95 % CI 1.6, 14.4), and preDM, OR 1.9 (1.1, 3.2), compared with men without ED. Over an 11-year follow-up period, a significantly increased cumulative incidence of DM was observed in men who reported symptoms of ED at the start of the study.
Conclusions
The symptoms of ED appear to be an early warning sign of existing DM and preDM and predict an increased risk of developing abnormal glucose metabolism in the future.
{"title":"Erectile dysfunction as a predictive indicator of asymptomatic diabetes and prediabetes","authors":"Sebastian Becker , Kadri Suija , Antti Valpas , Markku Koiranen , Juha Auvinen , Hannu Uusitalo , Esko Hussi , Sirkka Keinänen-Kiukaanniemi , Jaakko Tuomilehto , Jouko Saramies","doi":"10.1016/j.pcd.2024.09.008","DOIUrl":"10.1016/j.pcd.2024.09.008","url":null,"abstract":"<div><h3>Aims</h3><div>Both erectile dysfunction (ED) and diabetes (DM) are common health problems that share risk factors. The aim of this study was to investigate whether ED can predict glucose metabolism dysfunctions in men at the primary care level.</div></div><div><h3>Methods</h3><div>An 11-year population-based cohort study was conducted in men born between 1933 and 1956. The baseline survey was conducted in 2007–2008, with a follow-up examination 11 years later. The International Index of Erectile Function (IIEF-5) questionnaire was used to assess erectile function. Dysglycemia was evaluated using and a 2-hour oral glucose tolerance test (2hOGTT), in combination with health registry data.</div></div><div><h3>Results</h3><div>At baseline, men with ED but without a history of known DM exhibited a significantly higher prevalence of undetected DM, odds ratio (OR) 4.7 (95 % CI 1.6, 14.4), and preDM, OR 1.9 (1.1, 3.2), compared with men without ED. Over an 11-year follow-up period, a significantly increased cumulative incidence of DM was observed in men who reported symptoms of ED at the start of the study.</div></div><div><h3>Conclusions</h3><div>The symptoms of ED appear to be an early warning sign of existing DM and preDM and predict an increased risk of developing abnormal glucose metabolism in the future.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 618-623"},"PeriodicalIF":2.6,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.pcd.2024.09.010
Wei Liang , Ka Ming Chow , Xiaoying Ni , Yetunde Oluwafunmilayo Tola , Suzanne Hoi Shan Lo
Aims
To describe the development of a culturally adapted, evidence-based, and theory-driven diabetes self-management programme for Chinese adults with type 2 diabetes receiving insulin injection therapy and to assess the feasibility, acceptability, and preliminary effects of the newly developed intervention.
Methods
The Medical Research Council framework was adopted to guide the intervention development and a feasibility study. A prospective, two-arm, parallel-group, assessor-blinded randomised controlled trial was conducted. Participants were randomly allocated to receive either the newly developed intervention or parallel attention control contact from community nurses. Between-group differences in changes in outcome variables were analysed using the Mann-Whitney U test.
Results
The newly developed intervention consists of one individual interview session, three group-based education sessions, and two telephone-based maintenance sessions. A total of 24 participants were recruited with the recruitment rate and overall retention rate of 77.4 % and 95.8 %, respectively. The results indicated that the intervention participants reported significantly greater improvements in self-efficacy (Hedge’s g = 1.69) and self-management behaviours (Hedge’s g = 3.24), and reductions in diabetes-related distress (Hedge’s g = 1.49) compared with those in the control group (all p 0.05).
Conclusion
The diabetes self-management programme was feasible and acceptable. The intervention showed promising patient-centred benefits. A future large-scale randomised controlled trial is warranted.
目的:介绍针对接受胰岛素注射治疗的中国成年2型糖尿病患者开发的适应文化、循证和理论驱动的糖尿病自我管理项目,并评估新开发的干预措施的可行性、可接受性和初步效果:方法:采用医学研究委员会的框架来指导干预措施的开发和可行性研究。进行了一项前瞻性、双臂、平行组、评估者盲法随机对照试验。参与者被随机分配到接受新开发的干预措施或接受社区护士提供的平行注意力对照接触。试验结果采用 Mann-Whitney U 检验分析结果变量变化的组间差异:新开发的干预措施包括一次个人访谈、三次小组教育和两次电话维护。共招募了 24 名参与者,招募率和总体保留率分别为 77.4 % 和 95.8 %。结果表明,与对照组相比,干预参与者的自我效能(Hedge's g = 1.69)和自我管理行为(Hedge's g = 3.24)均有明显改善,与糖尿病相关的困扰(Hedge's g = 1.49)也有所减少(所有数据均小于 0.05):结论:糖尿病自我管理计划是可行和可接受的。结论:糖尿病自我管理计划是可行和可接受的,干预措施显示了以患者为中心的良好效果。未来有必要进行大规模随机对照试验。
{"title":"Development, feasibility, and preliminary effects of a culturally adapted, evidence-based, and theory-driven diabetes self-management programme for Chinese adults with type 2 diabetes receiving insulin injection therapy","authors":"Wei Liang , Ka Ming Chow , Xiaoying Ni , Yetunde Oluwafunmilayo Tola , Suzanne Hoi Shan Lo","doi":"10.1016/j.pcd.2024.09.010","DOIUrl":"10.1016/j.pcd.2024.09.010","url":null,"abstract":"<div><h3>Aims</h3><div>To describe the development of a culturally adapted, evidence-based, and theory-driven diabetes self-management programme for Chinese adults with type 2 diabetes receiving insulin injection therapy and to assess the feasibility, acceptability, and preliminary effects of the newly developed intervention.</div></div><div><h3>Methods</h3><div>The Medical Research Council framework was adopted to guide the intervention development and a feasibility study. A prospective, two-arm, parallel-group, assessor-blinded randomised controlled trial was conducted. Participants were randomly allocated to receive either the newly developed intervention or parallel attention control contact from community nurses. Between-group differences in changes in outcome variables were analysed using the Mann-Whitney U test.</div></div><div><h3>Results</h3><div>The newly developed intervention consists of one individual interview session, three group-based education sessions, and two telephone-based maintenance sessions. A total of 24 participants were recruited with the recruitment rate and overall retention rate of 77.4 % and 95.8 %, respectively. The results indicated that the intervention participants reported significantly greater improvements in self-efficacy (Hedge’s <em>g</em> = 1.69) and self-management behaviours (Hedge’s <em>g</em> = 3.24), and reductions in diabetes-related distress (Hedge’s <em>g</em> = 1.49) compared with those in the control group (all <em>p</em> <span><math><mo><</mo></math></span> 0.05).</div></div><div><h3>Conclusion</h3><div>The diabetes self-management programme was feasible and acceptable. The intervention showed promising patient-centred benefits. A future large-scale randomised controlled trial is warranted.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 649-659"},"PeriodicalIF":2.6,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-03DOI: 10.1016/j.pcd.2024.09.007
Setor K. Kunutsor , Borenyi S. Seidu , Samuel Seidu
Background
Whether the cardiovascular treatment benefits of sodium–glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) differ by baseline use of statins/lipid lowering therapy is unclear. This systematic review and meta-analysis investigated whether baseline statin use (users vs non-users) influences the cardiovascular and kidney benefits of SGLT-2is and GLP-1RAs in patients with type 2 diabetes (T2D).
Methods
We identified relevant cardiovascular outcome trials (CVOTs) and observational cohort studies from MEDLINE, Embase, the Cochrane Library, and bibliographic searches up to March 2024. The analysis pooled study-specific hazard ratios (HRs) with 95 % confidence intervals (CIs) for outcomes, categorized by baseline statin use status. We also assessed the interactions between these medications and baseline statin use by calculating and pooling the ratio of HRs (RHRs) within each trial.
Results
Twenty-five articles (13 articles comprising 6 unique CVOTs and 12 articles comprising 9 unique cohort studies) were eligible. In CVOTs of SGLT-2is, the HRs (95 % CIs) of MACE; composite of CVD death or hospitalisation for heart failure; stroke; and kidney events in statin users were 0.90 (0.82–1.00), 0.78 (0.60–1.02), 1.00 (0.77–1.31), and 0.60 (0.53–0.69), respectively. The corresponding estimates were similar in non-statin users. In CVOTs of GLP-1RAs, the HRs (95 % CIs) for MACE in statin and non-statin users were 0.81 (0.73–0.90) and 0.92 (0.77–1.11), respectively. In observational cohort studies, SGLT-2is similarly reduced the risk of several cardiovascular and kidney outcomes in both statin and non-statin users. The estimated RHRs and p-values for interaction indicated that baseline statin use status did not significantly modify the cardio-kidney benefits of SGLT-2is and GLP-1RAs.
Conclusions
Aggregate analyses of intervention and real-world evidence show that SGLT-2is and GLP-1RAs provide comparable cardio-kidney benefits in patients with T2D, regardless of baseline statin use status. PROSPERO Registration: CRD42024498939
{"title":"Cardiovascular effectiveness of newer glucose-lowering agents, with and without baseline lipid-lowering therapy in type 2 diabetes: A systematic meta-analysis of cardiovascular outcome trials and real-world evidence","authors":"Setor K. Kunutsor , Borenyi S. Seidu , Samuel Seidu","doi":"10.1016/j.pcd.2024.09.007","DOIUrl":"10.1016/j.pcd.2024.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Whether the cardiovascular treatment benefits of sodium–glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) differ by baseline use of statins/lipid lowering therapy is unclear. This systematic review and meta-analysis investigated whether baseline statin use (users vs non-users) influences the cardiovascular and kidney benefits of SGLT-2is and GLP-1RAs in patients with type 2 diabetes (T2D).</div></div><div><h3>Methods</h3><div>We identified relevant cardiovascular outcome trials (CVOTs) and observational cohort studies from MEDLINE, Embase, the Cochrane Library, and bibliographic searches up to March 2024. The analysis pooled study-specific hazard ratios (HRs) with 95 % confidence intervals (CIs) for outcomes, categorized by baseline statin use status. We also assessed the interactions between these medications and baseline statin use by calculating and pooling the ratio of HRs (RHRs) within each trial.</div></div><div><h3>Results</h3><div>Twenty-five articles (13 articles comprising 6 unique CVOTs and 12 articles comprising 9 unique cohort studies) were eligible. In CVOTs of SGLT-2is, the HRs (95 % CIs) of MACE; composite of CVD death or hospitalisation for heart failure; stroke; and kidney events in statin users were 0.90 (0.82–1.00), 0.78 (0.60–1.02), 1.00 (0.77–1.31), and 0.60 (0.53–0.69), respectively. The corresponding estimates were similar in non-statin users. In CVOTs of GLP-1RAs, the HRs (95 % CIs) for MACE in statin and non-statin users were 0.81 (0.73–0.90) and 0.92 (0.77–1.11), respectively. In observational cohort studies, SGLT-2is similarly reduced the risk of several cardiovascular and kidney outcomes in both statin and non-statin users. The estimated RHRs and <em>p</em>-values for interaction indicated that baseline statin use status did not significantly modify the cardio-kidney benefits of SGLT-2is and GLP-1RAs.</div></div><div><h3>Conclusions</h3><div>Aggregate analyses of intervention and real-world evidence show that SGLT-2is and GLP-1RAs provide comparable cardio-kidney benefits in patients with T2D, regardless of baseline statin use status. PROSPERO Registration: CRD42024498939</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 589-598"},"PeriodicalIF":2.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}