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Self-reported smoking, urine cotinine, and risk of type 2 diabetes: Findings from the PREVEND prospective cohort study 自我报告的吸烟、尿液中的可替宁与罹患 2 型糖尿病的风险:PREVEND前瞻性队列研究的结果。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 DOI: 10.1016/j.pcd.2024.04.004

Background

Smoking is a major risk factor for type 2 diabetes (T2D), but the evidence has mostly relied on self-reports. We aimed to compare the associations of smoking exposure as assessed by self-reports and urine cotinine with T2D.

Methods

Using the PREVEND prospective study, smoking status was assessed at baseline by self-reports and urine cotinine in 4708 participants (mean age, 53 years) without a history of diabetes. Participants were classified as never, former, light current and heavy current smokers according to self-reports and analogous cut-offs for urine cotinine. Hazard ratios (HRs) with 95% CIs were estimated for T2D.

Results

During a median follow-up of 7.3 years, 259 participants developed T2D. Compared with self-reported never smokers, the multivariable adjusted HRs (95% CI) of T2D for former, light current, and heavy current smokers were 1.02 (0.75–1.4), 1.41 (0.89–2.22), and 1.30 (0.88–1.93), respectively. The corresponding adjusted HRs (95% CI) were 0.84 (0.43–1.67), 1.61 (1.12–2.31), and 1.58 (1.08–2.32), respectively, as assessed by urine cotinine. Urine cotinine-assessed but not self-reported smoking status improved T2D risk prediction beyond established risk factors.

Conclusion

Urine cotinine assessed smoking status may be a stronger risk indicator and predictor of T2D compared to self-reported smoking status.

背景:吸烟是2型糖尿病(T2D)的主要风险因素,但证据大多依赖于自我报告。我们旨在比较通过自我报告和尿液可替宁评估的吸烟暴露与 T2D 的关系:利用 PREVEND 前瞻性研究,通过自我报告和尿液中的可替宁对 4708 名无糖尿病史的参与者(平均年龄 53 岁)的基线吸烟状况进行评估。根据自我报告和尿液中可替宁的类似临界值,将参与者分为从未吸烟者、曾经吸烟者、轻度吸烟者和重度吸烟者。结果估算出了T2D的危险比(HRs)和95% CIs:结果:在中位 7.3 年的随访期间,259 名参与者患上了终末期糖尿病。与自我报告的从不吸烟者相比,曾吸烟者、轻度吸烟者和重度吸烟者患 T2D 的多变量调整 HRs(95% CI)分别为 1.02(0.75-1.4)、1.41(0.89-2.22)和 1.30(0.88-1.93)。根据尿液中可替宁的评估,相应的调整后 HRs(95% CI)分别为 0.84(0.43-1.67)、1.61(1.12-2.31)和 1.58(1.08-2.32)。尿可替宁评估的吸烟状况比自我报告的吸烟状况更能预测T2D风险,而不是既有的风险因素:结论:与自我报告的吸烟状况相比,尿液中可替宁评估的吸烟状况可能是更强的T2D风险指标和预测因子。
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引用次数: 0
Editorial Board and Aims & Scopes 编辑委员会和目标与范围
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 DOI: 10.1016/S1751-9918(24)00131-1
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引用次数: 0
Diabetes type 2 prevalence is rising among young residents in Malmö, Sweden 在瑞典马尔默的年轻居民中,2 型糖尿病的发病率正在上升。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 DOI: 10.1016/j.pcd.2024.06.005

Aim

Type 2 diabetes is becoming more prevalent in many parts of the world. Malmö’s population has increased in recent years mainly because of migration from other parts of Sweden and the world in addition to increased birth rates. We aimed to explore diabetes prevalence in Malmö in 2011–2018 as well as the achieved treatment targets for selected diabetes-related outcomes.

Method

The current study is a part of the Cities Changing Diabetes Malmö project. Prevalence data were retrieved from the region’s primary care and hospital diagnosis register, and data on treatment targets were collected from the National Diabetes Register. The inclusion criteria were either being a resident of Malmö or using a primary healthcare centre located in Malmö.

Results

The prevalence of type 2 diabetes in 2018 doubled from 2011 in the entire Malmö population. During the same period, the prevalence of type 1 diabetes remained stable at 0.49 %. In 2011, the type 2 diabetes prevalence was 2.46 % (2.76 % for males and 2.28 % for females), and in 2018, it was 4.26 % (4.84 % for males and 3.82 % for females). The increase was 139 % for residents aged 0–29 years, 119.6 % for residents aged 30–39 years, 96.2 % for residents aged 40–49 years, 102 % for residents aged 50–59 years, 98.2 % for residents aged 60–69 years, and 115.5 % for those aged 70–79 years. Finally, the increase was 60.9 % for those aged 80–84 years and 90.7 % for residents 90 years of age and older. The National Diabetes Register reported that during 2019, 58 % of all patients with diabetes using primary care in Malmö reached HbA1c <52 mmol/mol, 20 % had albuminuria, 36 % had retinopathy, and 21 % had not had their feet inspected by a healthcare professional during the last year. The median HbA1c was 52.6 mmol/mol, and 17 % were registered as active smokers.

Conclusion

Diabetes prevalence in Malmö has increased markedly in recent years, exacerbated by a rise in type 2 diabetes mainly in the younger population. Targets regarding p-glucose lowering treatments were not met by 42 %. One patient out of three had microvascular complications in the eye, one out of five had impaired kidney function, one out of five had not had their feet inspected, and one out of five was an active smoker. Active diabetes treatments need to be improved to reduce the number of younger patients developing microvascular complications. Preventive activities need to target younger populations to counteract even more residents developing type 2 diabetes.

目的:2 型糖尿病在世界许多地方都越来越普遍。近年来,马尔默的人口有所增加,主要原因是瑞典和世界其他地区的移民以及出生率的提高。我们旨在探讨 2011-2018 年马尔默市的糖尿病患病率以及选定的糖尿病相关结果的治疗目标:本研究是 "改变马尔默的糖尿病城市 "项目的一部分。患病率数据来自该地区的初级保健和医院诊断登记册,治疗目标数据来自国家糖尿病登记册。纳入标准为马尔默市居民或使用马尔默市初级医疗保健中心:2018年,马尔默全部人口的2型糖尿病患病率比2011年翻了一番。同期,1 型糖尿病的患病率稳定在 0.49%。2011 年,2 型糖尿病患病率为 2.46%(男性为 2.76%,女性为 2.28%),2018 年为 4.26%(男性为 4.84%,女性为 3.82%)。0-29 岁居民的增长率为 139%,30-39 岁居民的增长率为 119.6%,40-49 岁居民的增长率为 96.2%,50-59 岁居民的增长率为 102%,60-69 岁居民的增长率为 98.2%,70-79 岁居民的增长率为 115.5%。最后,80-84 岁居民的增幅为 60.9%,90 岁及以上居民的增幅为 90.7%。全国糖尿病登记报告显示,2019 年期间,在马尔默使用初级医疗服务的所有糖尿病患者中,58% 的 HbA1c 1c 达到 52.6 mmol/mol,17% 登记为活跃吸烟者:结论:近年来,马尔默市的糖尿病发病率明显上升,而主要在年轻人群中出现的 2 型糖尿病则加剧了这一趋势。42%的患者未达到降低血糖治疗的目标。每三名患者中就有一名患有眼部微血管并发症,每五名患者中就有一名肾功能受损,每五名患者中就有一名没有进行过足部检查,每五名患者中就有一名吸烟者。需要改进积极的糖尿病治疗方法,以减少出现微血管并发症的年轻患者人数。需要针对年轻群体开展预防活动,以防止更多居民患上 2 型糖尿病。
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引用次数: 0
Effectiveness of a multicomponent healthcare intervention on blood pressure and lipids among subjects with poorly controlled type 2 diabetes: Findings from the INTEGRA study 多成分医疗保健干预对血压和血脂控制不佳的 2 型糖尿病患者的效果:INTEGRA 研究结果。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 DOI: 10.1016/j.pcd.2024.05.001

Aim

We aimed to evaluate the impact of a multicomponent healthcare intervention, primarily designed to improve glycemic control, on blood pressure and lipids in individuals with poorly controlled type 2 diabetes mellitus (T2DM) in the Catalonian primary care setting

Methods

A cluster, non-randomized, controlled pragmatic trial was conducted across 11 primary care centers. The intervention group (N=225) received a comprehensive, patient-centered approach, including a dedicated monographic consultation to address therapeutic inertia. The control group (N=181) mirrored the intervention group but lacked the monographic consultation. Secondary endpoints included lipid and blood pressure control assessed at baseline and after a 12-month follow-up.

Results

245 participants completed the study over 12 months. We found no differences in the reduction of lipid laboratory parameters between the groups at the final visit. However, no significant differences were found between the groups for other lipids or the proportion of participants achieving lipid target values. Likewise, no differences were noted between the groups for blood pressure, its target control, and treatment at the final visit. Various clinical factors such as age, sex, diabetes duration, HbA1c levels, BMI, and macrovascular complications among the participants were associated with achieving lipid and blood pressure targets at the final visit.

Conclusion

The pragmatic multicomponent intervention proposed in the INTEGRA study, showed that including a component designed to reduce clinical inertia in the management of glycemia did not demonstrate benefits in improving lipids and blood pressure in patients with poorly controlled T2DM.

目的:我们的目标是评估加泰罗尼亚初级医疗机构中以改善血糖控制为主要目的的多成分医疗保健干预措施对血压和血脂控制不佳的 2 型糖尿病患者的影响 方法:我们在 11 个初级医疗中心开展了一项群集、非随机、对照的实用性试验。干预组(N=225)采用以患者为中心的综合方法,包括专门的专科咨询,以解决治疗惰性问题。对照组(人数=181)与干预组相同,但不提供专科咨询。次要终点包括基线和 12 个月随访后的血脂和血压控制评估。我们发现,在最后一次访问时,各组之间在血脂实验室参数的降低方面没有差异。但是,在其他血脂指标或达到血脂目标值的参与者比例方面,各组之间没有发现明显差异。同样,在最终检查时,各组之间在血压、血压目标控制和治疗方面也未发现差异。参与者的各种临床因素,如年龄、性别、糖尿病病程、HbA1c水平、体重指数和大血管并发症等,与最终就诊时血脂和血压是否达标有关:INTEGRA研究中提出的务实的多成分干预措施表明,在血糖管理中加入旨在减少临床惰性的成分,并不能对改善控制不佳的T2DM患者的血脂和血压产生益处。
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引用次数: 0
The use of wearable devices on physical activity levels among individuals living with diabetes: 2017 BRFSS 可穿戴设备对糖尿病患者体育锻炼水平的影响:2017 BRFSS。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 DOI: 10.1016/j.pcd.2024.05.004

Aim

This study aims to examine the association between wearing wearable devices and physical activity levels among people living with diabetes.

Methods

1298 wearable device users and nonusers living with diabetes from eight states of the 2017 Behavioral Risk Factors Surveillance System were included in the analysis. Unadjusted and adjusted linear regression was performed to determine the association between self-reported physical activity per week (min) and wearable device usage (users and nonusers) among people living with diabetes using survey analysis.

Results

84.97 % (95 % CI [80.39, 88.89]) of participants were nonusers of wearable devices, while 15.03 % (95 % CI [11.11, 19.61]) were users. Across the sample, the average weekly physical activity was 427.39 mins (95 % Cl [356.43, 498.35]). Nonusers had a higher physical activity per week with 433.83 mins (95 % CI [353.59, 514.07]), while users only had 392.59 mins (95 % CI [253.48, 531.69]) of physical activity per week. However, the differences between the two groups were non-statistically significant (p=.61). In both adjusted and unadjusted linear regressions between physical activity per week and wearable device usage, statistically significant associations were not found (unadjusted: β=-41.24, p=.62; adjusted: β=-56.41, p=.59).

Conclusion

Further research is needed to determine the effectiveness of wearable devices in promoting physical activity among people with diabetes. Additionally, there is a need to determine how people with diabetes use wearable devices that could promote physical activity levels.

目的:本研究旨在探讨糖尿病患者佩戴可穿戴设备与体力活动水平之间的关联。方法:分析对象包括来自 2017 年行为风险因素监测系统 8 个州的 1298 名糖尿病患者中的可穿戴设备使用者和非使用者。通过调查分析,对糖尿病患者每周自我报告的体力活动(分钟)与可穿戴设备使用情况(用户和非用户)之间的关联进行了未调整和调整后的线性回归:84.97% (95 % CI [80.39, 88.89])的参与者不使用可穿戴设备,15.03% (95 % CI [11.11, 19.61])的参与者使用可穿戴设备。在所有样本中,平均每周运动时间为 427.39 分钟(95 % Cl [356.43, 498.35])。非使用者的每周体力活动量更大,为 433.83 分钟(95 % CI [353.59, 514.07]),而使用者的每周体力活动量仅为 392.59 分钟(95 % CI [253.48, 531.69])。不过,两组之间的差异无统计学意义(P=0.61)。在每周体力活动量与可穿戴设备使用量之间的调整和未调整线性回归中,均未发现有统计学意义的关联(未调整:β=-41.24,p=.62;调整:β=-56.41,p=.59):需要进一步研究确定可穿戴设备在促进糖尿病患者体育锻炼方面的有效性。此外,还需要确定糖尿病患者如何使用可促进体育锻炼水平的可穿戴设备。
{"title":"The use of wearable devices on physical activity levels among individuals living with diabetes: 2017 BRFSS","authors":"","doi":"10.1016/j.pcd.2024.05.004","DOIUrl":"10.1016/j.pcd.2024.05.004","url":null,"abstract":"<div><h3>Aim</h3><p>This study aims to examine the association between wearing wearable devices and physical activity levels among people living with diabetes.</p></div><div><h3>Methods</h3><p>1298 wearable device users and nonusers living with diabetes from eight states of the 2017 Behavioral Risk Factors Surveillance System were included in the analysis. Unadjusted and adjusted linear regression was performed to determine the association between self-reported physical activity per week (min) and wearable device usage (users and nonusers) among people living with diabetes using survey analysis.</p></div><div><h3>Results</h3><p>84.97 % (95 % CI [80.39, 88.89]) of participants were nonusers of wearable devices, while 15.03 % (95 % CI [11.11, 19.61]) were users. Across the sample, the average weekly physical activity was 427.39 mins (95 % Cl [356.43, 498.35]). Nonusers had a higher physical activity per week with 433.83 mins (95 % CI [353.59, 514.07]), while users only had 392.59 mins (95 % CI [253.48, 531.69]) of physical activity per week. However, the differences between the two groups were non-statistically significant <em>(p=.</em>61). In both adjusted and unadjusted linear regressions between physical activity per week and wearable device usage, statistically significant associations were not found (unadjusted: β=-41.24, <em>p=</em>.62; adjusted: β=-56.41, <em>p</em>=.59).</p></div><div><h3>Conclusion</h3><p>Further research is needed to determine the effectiveness of wearable devices in promoting physical activity among people with diabetes. Additionally, there is a need to determine how people with diabetes use wearable devices that could promote physical activity levels.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201340","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}
引用次数: 0
Long-term risk of overweight in offspring of Chinese women with gestational diabetes defined by IADPSG's but not by WHO's criteria 根据 IADPSG 标准而非世界卫生组织标准界定的妊娠糖尿病中国女性后代超重的长期风险。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 DOI: 10.1016/j.pcd.2024.05.002

Aims

To examine long-term risk of overweight in offspring of women with gestational diabetes mellitus (GDM) defined by the International Association of Diabetes and Pregnancy Study Group (IADPSG)'s criteria but not by the 1999 World Health Organization (WHO)'s criteria.

Methods

We followed up 1681 mother-child pairs for 8 years in Tianjin, China. Overweight in children aged 1–5 and 6–8 were respectively defined as body mass index-for-age and -sex above the 2 z-score and 1 z-score curves of the WHO’s child growth standards. Logistic regression was performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs) of hyperglycemia indices at oral glucose tolerance test and GDMs defined by different criteria for offspring overweight at different ages.

Results

Offspring of women with fasting plasma glucose ≥5.1 mmol/L were at increased risk of overweight at 6–8 years old (OR:1.45, 95% CI: 1.09–1.93). GDM defined by the IADPSG’s criteria only was associated with increased risk of childhood overweight at 6–8 years old (1.65, 1.13–2.40), as compared with non-GDM by either of the two sets of criteria.

Conclusions

Newly defined GDM by the IADPSG’s criteria increased the risk of offspring overweight aged 6–8 years.

目的:研究根据国际糖尿病与妊娠研究协会(IADPSG)的标准而非世界卫生组织(WHO)1999年的标准界定的妊娠糖尿病(GDM)妇女的后代长期超重的风险:我们对中国天津的 1681 对母婴进行了为期 8 年的跟踪调查。1-5岁和6-8岁儿童超重的定义分别为体重指数(年龄和性别)高于世界卫生组织儿童生长标准的2 z分数曲线和1 z分数曲线。通过逻辑回归得出了不同年龄段后代超重的口服葡萄糖耐量试验高血糖指数和按不同标准定义的 GDM 的几率比(ORs)和 95% 置信区间(CIs):空腹血浆葡萄糖≥5.1 mmol/L的妇女的后代在6-8岁时超重的风险增加(OR:1.45,95% CI:1.09-1.93)。仅根据 IADPSG 标准定义的 GDM 与根据两套标准中任何一套定义的非 GDM 相比,6-8 岁儿童超重风险增加(1.65,1.13-2.40):结论:根据 IADPSG 标准新定义的 GDM 会增加 6-8 岁儿童超重的风险。
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引用次数: 0
The association between sociodemographic characteristics, clinical indicators and body mass index in a population at risk of type 2 diabetes: A cross-sectional study in two Colombian cities 2 型糖尿病高危人群的社会人口特征、临床指标和体重指数之间的关联:哥伦比亚两个城市的横断面研究。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 DOI: 10.1016/j.pcd.2024.06.001

Aims

To assess the association between sociodemographic and clinical factors with body mass index (BMI) in a population at risk of type 2 diabetes (T2D) in Bogotá and Barranquilla, Colombia.

Methods

This cross-sectional study used data from the PREDICOL Study. Participants with a FINDRISC ≥ 12 who underwent an Oral Glucose Tolerance Test (OGTT) were included in the study (n=1166). The final analytical sample size was 1101 participants. Those with missing data were excluded from the analysis (n=65). The main outcome was body mass index (BMI), which was categorized as normal, overweight, and obese. We utilized unadjusted and adjusted ordinal logistic regression analysis to calculate odds ratios (OR) and 95 % confidence intervals (CI).

Results

The prevalence of overweight and obesity was 41 % (n=449) and 47 % (n=517), respectively. Participants with a 2-hour glucose ≥139 mg/dl had 1.71 times higher odds of being overweight or obese (regarding normal weight) than participants with normal 2-hour glucose values. In addition, being a woman, waist circumference altered, and blood pressure >120/80 mmHg were statistically significantly associated with a higher BMI.

Conclusion

Strategies to control glycemia, blood pressure, and central adiposity are needed in people at risk of T2D. Future studies should be considered with a territorial and gender focus, considering behavioral, and sociocultural patterns.

目的:在哥伦比亚波哥大和巴兰基亚的 2 型糖尿病(T2D)高危人群中,评估社会人口和临床因素与体重指数(BMI)之间的关联:这项横断面研究使用了 PREDICOL 研究的数据。FINDRISC ≥ 12 并接受了口服葡萄糖耐量试验(OGTT)的参与者被纳入研究(n=1166)。最终的分析样本量为 1101 人。分析中剔除了数据缺失者(n=65)。主要结果是体重指数(BMI),分为正常、超重和肥胖。我们利用未经调整和调整的序数逻辑回归分析来计算几率比(OR)和 95 % 的置信区间(CI):超重和肥胖的发生率分别为 41%(人数=449)和 47%(人数=517)。与 2 小时血糖值正常的参与者相比,2 小时血糖值≥139 mg/dl 的参与者超重或肥胖的几率是正常体重的 1.71 倍。此外,女性、腰围改变和血压 >120/80 mmHg 与较高的体重指数有显著的统计学关联:结论:对于有 T2D 风险的人群,需要采取控制血糖、血压和中心脂肪率的策略。未来的研究应关注地域和性别,考虑行为和社会文化模式。
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引用次数: 0
Knowledge and prescribing behaviour of Flemish general practitioners regarding novel glucose-lowering medications: Online cross-sectional survey 佛兰德全科医生对新型降糖药物的了解和处方行为:在线横断面调查。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 DOI: 10.1016/j.pcd.2024.06.002

Aims

To determine the knowledge and prescribing behaviour regarding new type 2 diabetes medication in general practice. Physicians in Belgium are bound by the prescription criteria which do not always correspond to the international guidelines.

Design & method

A mixed methods study with an online questionnaire was conducted in Flanders to collect data on demographic characteristics, theoretical knowledge, and prescribing behaviour, using ten theoretical questions and six clinical cases, based on the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) guidelines and the Belgian reimbursement criteria.

Results

201 GPs and GPs in training were included in this study with a median age of 30 years and 68 % female participants. On the knowledge questionnaire, the mean test result was 7.15/15 (= 48 %) with a median of 8. Further analysis showed that 90 % of the respondents correctly recommended a sodium-glucose cotransporter 2 (sglt2) inhibitor when the clinical case showed a comorbidity of heart failure, whereas only 42 % suggested correctly a glucagon-like peptide 1 (GLP-1) agonist if presence of cardiovascular disease. Subgroup analysis showed no statistically significant demographic differences in obtained test results. Regarding prescription behaviour, 23 % of the respondents would prescribe medication that did not match the reimbursement criteria in at least one of the 6 proposed clinical cases.

Conclusion

This study highlights the need for enhanced knowledge and updated prescribing practices among Flemish GPs and Trainee GPs to effectively manage patients with T2DM.

目的:了解全科医生对 2 型糖尿病新药的了解程度和处方行为。比利时的医生受到处方标准的约束,而这些标准并不总是符合国际指南:在佛兰德斯开展了一项在线问卷调查的混合方法研究,根据美国糖尿病协会/欧洲糖尿病研究协会(ADA/EASD)指南和比利时报销标准,通过10个理论问题和6个临床案例,收集有关人口特征、理论知识和处方行为的数据。进一步分析表明,当临床病例显示合并心力衰竭时,90% 的受访者正确推荐使用钠-葡萄糖共转运体 2 (sglt2) 抑制剂,而当存在心血管疾病时,只有 42% 的受访者正确推荐使用胰高血糖素样肽 1 (GLP-1) 激动剂。分组分析表明,测试结果在统计学上没有明显的人口统计学差异。在处方行为方面,23% 的受访者会在 6 个建议的临床病例中至少开出一种不符合报销标准的药物:本研究强调,佛兰德全科医生和全科医生培训生需要加强知识和更新处方实践,以有效管理 T2DM 患者。
{"title":"Knowledge and prescribing behaviour of Flemish general practitioners regarding novel glucose-lowering medications: Online cross-sectional survey","authors":"","doi":"10.1016/j.pcd.2024.06.002","DOIUrl":"10.1016/j.pcd.2024.06.002","url":null,"abstract":"<div><h3>Aims</h3><p>To determine the knowledge and prescribing behaviour regarding new type 2 diabetes medication in general practice. Physicians in Belgium are bound by the prescription criteria which do not always correspond to the international guidelines.</p></div><div><h3>Design &amp; method</h3><p>A mixed methods study with an online questionnaire was conducted in Flanders to collect data on demographic characteristics, theoretical knowledge, and prescribing behaviour, using ten theoretical questions and six clinical cases, based on the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) guidelines and the Belgian reimbursement criteria.</p></div><div><h3>Results</h3><p>201 GPs and GPs in training were included in this study with a median age of 30 years and 68 % female participants. On the knowledge questionnaire, the mean test result was 7.15/15 (= 48 %) with a median of 8. Further analysis showed that 90 % of the respondents correctly recommended a sodium-glucose cotransporter 2 (sglt2) inhibitor when the clinical case showed a comorbidity of heart failure, whereas only 42 % suggested correctly a glucagon-like peptide 1 (GLP-1) agonist if presence of cardiovascular disease. Subgroup analysis showed no statistically significant demographic differences in obtained test results. Regarding prescription behaviour, 23 % of the respondents would prescribe medication that did not match the reimbursement criteria in at least one of the 6 proposed clinical cases.</p></div><div><h3>Conclusion</h3><p>This study highlights the need for enhanced knowledge and updated prescribing practices among Flemish GPs and Trainee GPs to effectively manage patients with T2DM.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307723","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}
引用次数: 0
Efficacy of using telecare services for community-dwelling people with diabetes: A systematic review and meta-analysis 为居住在社区的糖尿病患者提供远程护理服务的效果:系统回顾与荟萃分析。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 DOI: 10.1016/j.pcd.2024.06.008

Objective

To evaluate the glycated hemoglobin (HbA1c), blood pressure, self-efficacy, and quality of life efficacy of using telecare services for community-dwelling people with diabetes.

Methods

Cochrane Library, Web of Science, PsycINFO, PubMed, EMBASE, CINAHL, and Scopus databases were systematically searched from their inception dates to June 22, 2023. Two evaluators independently selected and evaluated eligible studies. A protocol was registered in PROSPERO.

Results

An analysis of 17 studies that included 3586 subjects showed that telecare significantly improved the management of patients with diabetes. Compared to controls, intervention care had significant benefits regarding HbA1c (MD = −0.30, 95 % CI = −0.44 – −0.17, 16 studies), systolic blood pressure (MD = −2.45, 95 % CI = −4.53 – −0.36, P = 0.02), self-efficacy (MD = 0.36, 95 % CI = 0.04 – 0.67, P = 0.03) and quality of life (MD = 0.37, 95 % CI = 0.05 – 0.70, P = 0.02). However, diastolic blood pressure (MD = −1.37, 95 % CI = −3.34 – −0.61, P = 0.17) was not found to be significantly affected.

Conclusions

Telecare is effective in improving self-management among community-dwelling people with diabetes, suggesting an effective means for them to achieve self-management.

目的评估社区糖尿病患者使用远程护理服务对糖化血红蛋白(HbA1c)、血压、自我效能和生活质量的影响:对 Cochrane Library、Web of Science、PsycINFO、PubMed、EMBASE、CINAHL 和 Scopus 数据库进行了系统检索,检索时间从开始检索之日起至 2023 年 6 月 22 日。两名评估员独立选择并评估了符合条件的研究。结果:对纳入 3586 名受试者的 17 项研究进行的分析表明,远程护理能显著改善糖尿病患者的管理。与对照组相比,干预护理在 HbA1c(MD = -0.30,95 % CI = -0.44 -0.17,16 项研究)、收缩压(MD = -2.45,95 % CI = -4.53 -0.36,P = 0.02)、自我效能(MD = 0.36,95 % CI = 0.04 - 0.67,P = 0.03)和生活质量(MD = 0.37,95 % CI = 0.05 - 0.70,P = 0.02)方面有明显优势。然而,舒张压(MD = -1.37, 95 % CI = -3.34 -0.61, P = 0.17)并未受到显著影响:结论:远程护理能有效改善社区糖尿病患者的自我管理,是他们实现自我管理的有效手段。
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引用次数: 0
The effects of multidisciplinary collaborative care on cardiovascular risk factors among patients with diabetes in primary care settings: A systematic review and meta-analysis 多学科协作护理对基层医疗机构糖尿病患者心血管风险因素的影响:系统回顾与荟萃分析。
IF 2.6 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 DOI: 10.1016/j.pcd.2024.05.003

Background

Multidisciplinary collaborative care has been widely recommended as an effective strategy for managing diabetes; however, the cardiovascular risk factors of patients with diabetes are often inadequately managed in primary care settings. This study aimed to assess the effect of multidisciplinary collaboration on cardiovascular risk factors among patients with diabetes in primary care settings.

Methods

Five databases (i.e., Medline, Embase, CINAHL, SCOPUS and CENTRAL) were systematically searched to retrieve randomised controlled trials. Studies were eligible for inclusion if the interventions included a multidisciplinary team with professionals from at least three health disciplines and focused on patients with diabetes in primary care settings. A random-effects model was used to calculate the pooled effects.

Results

In total, 19 studies comprising 6538 patients were included in the meta-analysis. The results showed that compared with usual care, multidisciplinary collaborative care significantly reduced cardiovascular risk factors, including mean systolic blood pressure (–3.27 mm Hg, 95 % confidence interval [CI]: –4.72 to –1.82, p < 0.01), diastolic blood pressure (–1.4 mm Hg, 95 % CI: –2.32 to –0.47, p < 0.01), glycated haemoglobin (–0.42 %, 95 % CI: –0.59 to –0.25, p < 0.01), low-density lipoprotein (–0.16 mmol/L, 95 % CI: –0.26 to –0.06, p < 0.01) and high-density lipoprotein (0.06 mmol/L, 95 % CI: 0.00–0.12, p < 0.05). The subgroup analysis showed multidisciplinary collaboration was more effective in reducing cardiovascular risk factors when it comprised team members from a number of different disciplines, combined pharmacological and non-pharmacological components, included both face-to-face and remote interactions and was implemented in high-income countries.

Conclusion

Multidisciplinary collaborative care is associated with reduced cardiovascular risk factors among patients with diabetes in primary care. Further studies need to be conducted to determine the optimal team composition.

背景:多学科协作护理已被广泛推荐为管理糖尿病的有效策略;然而,在初级医疗机构中,糖尿病患者的心血管风险因素往往得不到充分管理。本研究旨在评估多学科协作对初级医疗机构糖尿病患者心血管风险因素的影响:系统检索了五个数据库(即 Medline、Embase、CINAHL、SCOPUS 和 CENTRAL),以检索随机对照试验。如果干预措施包括一个多学科团队,其中至少有来自三个健康学科的专业人员,并且以初级医疗机构中的糖尿病患者为研究对象,则符合纳入条件。采用随机效应模型计算汇总效应:荟萃分析共纳入了 19 项研究,涉及 6538 名患者。结果显示,与常规护理相比,多学科协作护理能显著降低心血管风险因素,包括平均收缩压(-3.27 mm Hg,95 % 置信区间 [CI]:-4.72 至 -1.82, p < 0.01)、舒张压(-1.4 mm Hg,95 % 置信区间:-2.32 至 -0.47,p <0.01)、糖化血红蛋白(-0.42 %,95 % 置信区间:-0.59 至 -0.25,p <0.01)、低密度脂蛋白(-0.16 mmol/L,95 % 置信区间:-0.26 至 -0.06,p <0.01)和高密度脂蛋白(0.06 mmol/L,95 % 置信区间:0.00 至 0.12,p <0.05)。亚组分析表明,当多学科协作由来自不同学科的团队成员组成、结合药物和非药物成分、包括面对面和远程互动以及在高收入国家实施时,能更有效地降低心血管风险因素:结论:多学科协作护理与初级医疗中糖尿病患者心血管风险因素的降低有关。需要开展进一步研究,以确定最佳团队组成。
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Primary Care Diabetes
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