Pub Date : 2025-09-19DOI: 10.1016/j.pcd.2025.09.005
Angelica Cristello Sarteau , Nikhita R. Gopisetty , Jessica Sprinkles , Gabriella Ercolino , Angela Fruik , Rashmi Muthukkumar , Xiaorui Qu , Elizabeth Mayer-Davis , Anna R. Kahkoska
A cross-sectional survey (September-November 2023) among a clinic-based sample of American older adults aged 65 + with type 1 diabetes (n = 77, 95 % White, HbA1c 6.8 ± 1.1 %) suggests sub-optimal intakes of fruit, vegetables, whole grain, fiber, calcium, dairy, and added sugars according to the National Cancer Institute Dietary Screener Questionnaire.
{"title":"Nutrition among older adults with type 1 diabetes: Sub-optimal intakes of key dietary factors according to the Dietary Screener Questionnaire (DSQ)","authors":"Angelica Cristello Sarteau , Nikhita R. Gopisetty , Jessica Sprinkles , Gabriella Ercolino , Angela Fruik , Rashmi Muthukkumar , Xiaorui Qu , Elizabeth Mayer-Davis , Anna R. Kahkoska","doi":"10.1016/j.pcd.2025.09.005","DOIUrl":"10.1016/j.pcd.2025.09.005","url":null,"abstract":"<div><div>A cross-sectional survey (September-November 2023) among a clinic-based sample of American older adults aged 65 + with type 1 diabetes (n = 77, 95 % White, HbA1c 6.8 ± 1.1 %) suggests sub-optimal intakes of fruit, vegetables, whole grain, fiber, calcium, dairy, and added sugars according to the National Cancer Institute Dietary Screener Questionnaire.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 681-683"},"PeriodicalIF":2.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093346","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 : 2025-09-09DOI: 10.1016/j.pcd.2025.09.001
Anthony Figueroa , Ariella Palmieri , Lu Shi , Willie Leung
Aim
This study aims to compare the weekly resistance training (RT) frequency between people with diabetes, prediabetes, and without diabetes.
Methods
A total of 536,703 participants from 2017 to 2023 Behavioral Risk Factors Surveillance System were included in the analysis. Unadjusted and adjusted Poisson regression was performed to compare weekly resistance training frequency among participants with different diabetes statuses (without diabetes, prediabetes, and with diabetes).
Results
89.28 % (95 % CI [89.11, 89.45]) of participants did not have diabetes, 1.67 % (95 % CI [1.59, 1.73]) had prediabetes, and 9.10 % (95 % CI [8.91, 9.22]) had diabetes. Across the sample, the averages weekly RT frequency among the sample was 1.73 times (95 % CI [1.71, 1.74]). Participants without diabetes had the highest weekly RT frequency of 1.79 (95 % CI [1.71, 1.74]) times. Participants with prediabetes had the weekly RT frequency of 1.38 (95 % CI [1.26, 1.50]) times and participants with diabetes had the lowest average frequency between the three groups with 1.19 (95 % CI [1.15, 1.23]) times per week. The unadjusted and adjusted linear regression found that people with diabetes had less weekly RT frequency than participants without diabetes (β=-.60, p < .01; αβ=-.23, p < .01). Participants with prediabetes also had lower weekly RT frequency in the unadjusted regression compared to participants without diabetes (β=-.41, p < .01).
Conclusion
People with prediabetes and diabetes might face personal and environmental barriers in engaging in RT, leading to lower weekly RT frequency compared to those without diabetes. There is a need to overcome barriers and continue promote RT among people with and without diabetes.
{"title":"Comparison of resistance training among individuals living with diabetes, prediabetes, and without diabetes: 2017–2023 BRFSS","authors":"Anthony Figueroa , Ariella Palmieri , Lu Shi , Willie Leung","doi":"10.1016/j.pcd.2025.09.001","DOIUrl":"10.1016/j.pcd.2025.09.001","url":null,"abstract":"<div><h3>Aim</h3><div>This study aims to compare the weekly resistance training (RT) frequency between people with diabetes, prediabetes, and without diabetes.</div></div><div><h3>Methods</h3><div>A total of 536,703 participants from 2017 to 2023 Behavioral Risk Factors Surveillance System were included in the analysis. Unadjusted and adjusted Poisson regression was performed to compare weekly resistance training frequency among participants with different diabetes statuses (without diabetes, prediabetes, and with diabetes).</div></div><div><h3>Results</h3><div>89.28 % (95 % CI [89.11, 89.45]) of participants did not have diabetes, 1.67 % (95 % CI [1.59, 1.73]) had prediabetes, and 9.10 % (95 % CI [8.91, 9.22]) had diabetes. Across the sample, the averages weekly RT frequency among the sample was 1.73 times (95 % CI [1.71, 1.74]). Participants without diabetes had the highest weekly RT frequency of 1.79 (95 % CI [1.71, 1.74]) times. Participants with prediabetes had the weekly RT frequency of 1.38 (95 % CI [1.26, 1.50]) times and participants with diabetes had the lowest average frequency between the three groups with 1.19 (95 % CI [1.15, 1.23]) times per week. The unadjusted and adjusted linear regression found that people with diabetes had less weekly RT frequency than participants without diabetes (β=-.60, p < .01; αβ=-.23, p < .01). Participants with prediabetes also had lower weekly RT frequency in the unadjusted regression compared to participants without diabetes (β=-.41, p < .01).</div></div><div><h3>Conclusion</h3><div>People with prediabetes and diabetes might face personal and environmental barriers in engaging in RT, leading to lower weekly RT frequency compared to those without diabetes. There is a need to overcome barriers and continue promote RT among people with and without diabetes.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 684-689"},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034723","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}
The weight-adjusted-waist index (WWI) emerges as a novel metric for assessing obesity, and this study aimed to determine the association between WWI and type 2 diabetes mellitus (T2DM).
Methods
We conducted a cross-sectional analysis using data collected at the inception of the Ravansar Non-communicable Disease (RaNCD) cohort study in 2014. A total of 8901 participants aged 35–65 were included in the study. The WWI is calculated by dividing the waist circumference (WC) in centimeters by the square root of the weight in kilograms. Logistic regression analysis was performed to assess the association between WWI and T2DM, adjusting for potential confounding variables.
Results
Individuals in the second quartile demonstrate a 56 % (OR: 1.56, 95 % CI: 1.23–1.99) higher odds of T2DM compared to those in first quartile. The odds of having T2DM was elevated in the third and fourth quartiles, with odds ratios of 1.81 (95 % CI: 1.43–2.20) and 2.15 (95 % CI: 1.71–2.71) respectively. After adjusting confounder variables, it is evident that the odds of diabetes in the second, third, and fourth quartiles of WWI has increased by 38 % (95 % CI: 1.07, 1.78), 47 % (95 % CI: 1.14, 1.91), and 43 % (95 % CI: 1.08, 1.89) respectively, compared to the first quartile (P trend = 0.001).
Conclusion
The results of the current study indicate that high levels of WWI are strongly associated to a higher risk of T2DM in Iranian adults. These study findings emphasize the significance of incorporating WWI into strategies for the prevention and management of T2DM.
{"title":"Association between the weight-adjusted waist index and type 2 diabetes mellitus: Evidence from the RaNCD study","authors":"Hawal Lateef Fateh , Mitra Bonyani , Ebrahim Shakiba , Jafar Navabi , Yahya Pasdar","doi":"10.1016/j.pcd.2025.08.007","DOIUrl":"10.1016/j.pcd.2025.08.007","url":null,"abstract":"<div><h3>Background</h3><div>The weight-adjusted-waist index (WWI) emerges as a novel metric for assessing obesity, and this study aimed to determine the association between WWI and type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional analysis using data collected at the inception of the Ravansar Non-communicable Disease (RaNCD) cohort study in 2014. A total of 8901 participants aged 35–65 were included in the study. The WWI is calculated by dividing the waist circumference (WC) in centimeters by the square root of the weight in kilograms. Logistic regression analysis was performed to assess the association between WWI and T2DM, adjusting for potential confounding variables.</div></div><div><h3>Results</h3><div>Individuals in the second quartile demonstrate a 56 % (OR: 1.56, 95 % CI: 1.23–1.99) higher odds of T2DM compared to those in first quartile. The odds of having T2DM was elevated in the third and fourth quartiles, with odds ratios of 1.81 (95 % CI: 1.43–2.20) and 2.15 (95 % CI: 1.71–2.71) respectively. After adjusting confounder variables, it is evident that the odds of diabetes in the second, third, and fourth quartiles of WWI has increased by 38 % (95 % CI: 1.07, 1.78), 47 % (95 % CI: 1.14, 1.91), and 43 % (95 % CI: 1.08, 1.89) respectively, compared to the first quartile (P trend = 0.001).</div></div><div><h3>Conclusion</h3><div>The results of the current study indicate that high levels of WWI are strongly associated to a higher risk of T2DM in Iranian adults. These study findings emphasize the significance of incorporating WWI into strategies for the prevention and management of T2DM.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 618-623"},"PeriodicalIF":2.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984042","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 : 2025-08-28DOI: 10.1016/j.pcd.2025.08.008
Suresh Rama Chandran , Ming Ming Teh , Hong Chang Tan , May Zin Oo , Alcey Ang Li Chang , Daphne Gardner
Aims
Identifying non-glycemic factors associated with high Glucose variability (GV).
Methods
A cross-sectional observational study recruited people with type 2 diabetes, who wore a Freestyle Libre Pro CGM. Independent variables: Age, sex, BMI, diabetes medication, diabetes duration, HbA1c and estimated glomerular filtration rate (eGFR). CGM-derived variables calculated included Time-in-Range (TIR, 70–180 mg/dl), below-range 1 (TBR1, <70 mg/dl), -below-range 2 (TBR2, <54 mg/dl) and -above-range (TAR, >180 mg/dl), coefficient of variation (%CV). A logistic regression model examined independent variables associated with high GV (CV ≥36 %). All analysis was done on R version 4.3.1
Results
T2D cohort (n = 403), 46 % women, had median age of 61 y, BMI of 26.5 kg/m2, diabetes duration 14 y, HbA1c 7.8 %(62 mmol/mol) and creatinine of 75 µmol/L. Using sulphonylurea, premixed or basal-bolus insulin had an odds ratio (OR) of 4.7 – 5.2 for CV ≥ 36 %. Longer diabetes duration [OR 1.2], and lower eGFR [OR 1.2] were associated with higher odds and older age [OR 0.8]and higher BMI [0.8] were associated with lower odds of CV≥ 36 %. Sex and HbA1c had no association with high GV.
Conclusion
Nonglycemic-factors like medication type, diabetes duration and eGFR can aid in identification of high GV even in low-CGM use settings.
{"title":"Identifying high glucose variability using non-glycemic factors in low continuous glucose monitoring use settings","authors":"Suresh Rama Chandran , Ming Ming Teh , Hong Chang Tan , May Zin Oo , Alcey Ang Li Chang , Daphne Gardner","doi":"10.1016/j.pcd.2025.08.008","DOIUrl":"10.1016/j.pcd.2025.08.008","url":null,"abstract":"<div><h3>Aims</h3><div>Identifying non-glycemic factors associated with high Glucose variability (GV).</div></div><div><h3>Methods</h3><div>A cross-sectional observational study recruited people with type 2 diabetes, who wore a Freestyle Libre Pro CGM. Independent variables: Age, sex, BMI, diabetes medication, diabetes duration, HbA1c and estimated glomerular filtration rate (eGFR). CGM-derived variables calculated included Time-in-Range (TIR, 70–180 mg/dl), below-range 1 (TBR1, <70 mg/dl), -below-range 2 (TBR2, <54 mg/dl) and -above-range (TAR, >180 mg/dl), coefficient of variation (%CV). A logistic regression model examined independent variables associated with high GV (CV ≥36 %). All analysis was done on R version 4.3.1</div></div><div><h3>Results</h3><div>T2D cohort (n = 403), 46 % women, had median age of 61 y, BMI of 26.5 kg/m<sup>2</sup>, diabetes duration 14 y, HbA1c 7.8 %(62 mmol/mol) and creatinine of 75 µmol/L. Using sulphonylurea, premixed or basal-bolus insulin had an odds ratio (OR) of 4.7 – 5.2 for CV ≥ 36 %. Longer diabetes duration [OR 1.2], and lower eGFR [OR 1.2] were associated with higher odds and older age [OR 0.8]and higher BMI [0.8] were associated with lower odds of CV≥ 36 %. Sex and HbA1c had no association with high GV.</div></div><div><h3>Conclusion</h3><div>Nonglycemic-factors like medication type, diabetes duration and eGFR can aid in identification of high GV even in low-CGM use settings.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 624-628"},"PeriodicalIF":2.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984238","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 : 2025-08-27DOI: 10.1016/j.pcd.2025.08.009
Sebastián A. Gutiérrez-Romero , Agustín Pérez-Londoño , Valentina Cuéllar-Rodríguez , Isabela Correa-Osio , Carolina Betancourt-Villamizar , Carlos O. Mendivil
Aim
To estimate the prevalence of diabetes in urban Colombia and its associated socioeconomic correlates, associated nutrition and lifestyle habits, and sources of health information.
Methods
This was a probabilistically sampled, population-based survey undertaken in five major cities of Colombia between November and December 2022. Diabetes was defined as a prior diagnosis, use of antidiabetic medications, or random blood glucose ≥ 200 mg/dL. Data on lifestyle habits and preferred sources of health information were inquired with reference to the last year.
Results
We studied 1786 adults (55 % women). Diabetes prevalence was 12.9 % (13.6 % in women, 12.0 % in men), increasing linearly with age and adiposity. There was a 12-percent-point difference in diabetes prevalence between extreme categories of education among women, and a 7-percent-point difference between extreme categories of socioeconomic level among men. People with diabetes reported more frequently than people without it to have adopted almost all the inquired healthy lifestyle habits, but the difference was always < 10 %. Unexpectedly, the most frequently reported source of health information was healthcare professionals.
Conclusions
Diabetes is on the rise in urban Colombia, especially among socially disadvantaged groups. Education and empowerment of healthcare professionals may be a conduct to impact diabetes in Colombia and similar countries.
{"title":"Diabetes in urban Colombia: A cross-sectional study of its prevalence, lifestyle habits, and sources of health information","authors":"Sebastián A. Gutiérrez-Romero , Agustín Pérez-Londoño , Valentina Cuéllar-Rodríguez , Isabela Correa-Osio , Carolina Betancourt-Villamizar , Carlos O. Mendivil","doi":"10.1016/j.pcd.2025.08.009","DOIUrl":"10.1016/j.pcd.2025.08.009","url":null,"abstract":"<div><h3>Aim</h3><div>To estimate the prevalence of diabetes in urban Colombia and its associated socioeconomic correlates, associated nutrition and lifestyle habits, and sources of health information.</div></div><div><h3>Methods</h3><div>This was a probabilistically sampled, population-based survey undertaken in five major cities of Colombia between November and December 2022. Diabetes was defined as a prior diagnosis, use of antidiabetic medications, or random blood glucose ≥ 200 mg/dL. Data on lifestyle habits and preferred sources of health information were inquired with reference to the last year.</div></div><div><h3>Results</h3><div>We studied 1786 adults (55 % women). Diabetes prevalence was 12.9 % (13.6 % in women, 12.0 % in men), increasing linearly with age and adiposity. There was a 12-percent-point difference in diabetes prevalence between extreme categories of education among women, and a 7-percent-point difference between extreme categories of socioeconomic level among men. People with diabetes reported more frequently than people without it to have adopted almost all the inquired healthy lifestyle habits, but the difference was always < 10 %. Unexpectedly, the most frequently reported source of health information was healthcare professionals.</div></div><div><h3>Conclusions</h3><div>Diabetes is on the rise in urban Colombia, especially among socially disadvantaged groups. Education and empowerment of healthcare professionals may be a conduct to impact diabetes in Colombia and similar countries.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 629-635"},"PeriodicalIF":2.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984240","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 : 2025-08-26DOI: 10.1016/j.pcd.2025.08.006
Claus Rasmussen , Jesper Walther Larsen , Peter Clement Waldhauer Holm , Søren Terpager Jepsen , Gunnar Lauge Nielsen
Aims
Diabetes affects about 6 % of the global population, with 20 % developing foot ulcers. Gout impacts approximately 3 %, but fewer than 40 % receive adequate urate-lowering therapy to prevent or dissolve tophi in the feet. This study assessed adherence to recommended gout treatment in patients with diabetes.
Methods
From a prospective cohort of gout patients, confirmed by microscopy-identified urate crystals, we identified those with concomitant diabetes. Patients were treated in various real-life healthcare settings. The primary outcome was achieving target serum urate levels four years post-diagnosis: < 0.36 mmol/L for general gout management and < 0.30 mmol/L for tophi patients.
Results: Of 286 gout patients, 85 (30 %) had diabetes. The median age was 71 years, and 76 % were male, with common comorbidities. Urate levels sufficient to prevent new tophi were maintained by 58 %. However, 45 % had tophi at diagnosis, and only 46 % of these achieved levels low enough to dissolve tophi.
Conclusions
Gout in patients with diabetes is often inadequately managed, potentially leading to persistent tophi, which may ulcerate and contribute to foot ulcers. These findings likely reflect typical treatment settings. Affordable and effective gout treatment could prevent tophi formation and improve outcomes. Consideration of gout screening in diabetes management guidelines is recommended.
{"title":"Adherence to gout treatment guidelines in patients with diabetes: A Danish prospective cohort study with 4 years of follow-up","authors":"Claus Rasmussen , Jesper Walther Larsen , Peter Clement Waldhauer Holm , Søren Terpager Jepsen , Gunnar Lauge Nielsen","doi":"10.1016/j.pcd.2025.08.006","DOIUrl":"10.1016/j.pcd.2025.08.006","url":null,"abstract":"<div><h3>Aims</h3><div>Diabetes affects about 6 % of the global population, with 20 % developing foot ulcers. Gout impacts approximately 3 %, but fewer than 40 % receive adequate urate-lowering therapy to prevent or dissolve tophi in the feet. This study assessed adherence to recommended gout treatment in patients with diabetes.</div></div><div><h3>Methods</h3><div>From a prospective cohort of gout patients, confirmed by microscopy-identified urate crystals, we identified those with concomitant diabetes. Patients were treated in various real-life healthcare settings. The primary outcome was achieving target serum urate levels four years post-diagnosis: < 0.36 mmol/L for general gout management and < 0.30 mmol/L for tophi patients.</div><div>Results: Of 286 gout patients, 85 (30 %) had diabetes. The median age was 71 years, and 76 % were male, with common comorbidities. Urate levels sufficient to prevent new tophi were maintained by 58 %. However, 45 % had tophi at diagnosis, and only 46 % of these achieved levels low enough to dissolve tophi.</div></div><div><h3>Conclusions</h3><div>Gout in patients with diabetes is often inadequately managed, potentially leading to persistent tophi, which may ulcerate and contribute to foot ulcers. These findings likely reflect typical treatment settings. Affordable and effective gout treatment could prevent tophi formation and improve outcomes. Consideration of gout screening in diabetes management guidelines is recommended.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 613-617"},"PeriodicalIF":2.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984071","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 : 2025-08-20DOI: 10.1016/j.pcd.2025.08.005
Elizabeth Hickman, Clare Gillies, Kamlesh Khunti, Samuel Seidu
Objectives
To investigate healthcare professionals’ (HCPs) perspectives towards deprescribing in older adults living with multiple long term conditions (MLTCs), including those at the end of life, using the validated Healthcare Professionals’ Attitudes Towards Deprescribing (HATD) tool, and to explore implications for medication management in conditions such as diabetes, where polypharmacy is common.
Method
A cross-sectional online survey using the HATD questionnaire was disseminated across the United Kingdom from November 2023 to January 2024. Eligible participants were HCPs with experience managing older adults with MLTCs and/or those receiving end of life care. The tools 23-items covered five domains: concerns about deprescribing, perceived medication burden, organisational support, assurance in deprescribing decisions, and patient involvement. Quantitative data were summarised descriptively.
Results
Sixty-six HCPs participated (53 % doctors, 27 % pharmacists, 21 % allied health professionals). Many expressed discomfort in stopping medications initiated by specialists, particularly due to concerns about symptom recurrence or misattributed patient deterioration. Most recognised high medication burden, acknowledged that some drugs were no longer required, and agree deprescribing could improve quality of life. Barriers included lack of time, workload pressures, and insufficient training. Thematic analysis identified six key issues including perceived risk and fear of complains, absence of clear guidance, tensions between evidence based practice and multimorbidity, influence of specialist authority, resource constraints, and deprescribing as a potential routine practice.
Conclusions
Significant barriers to deprescribing persist in UK practice, highlighting the need for clearer guidance, training, and multidisciplinary collaboration to optimise prescribing, including in chronic conditions such as diabetes.
{"title":"The Healthcare Professionals Attitudes Towards Deprescribing (HATD) tool in older persons with multiple long-term chronic conditions and those on palliative care: A mixed methods study","authors":"Elizabeth Hickman, Clare Gillies, Kamlesh Khunti, Samuel Seidu","doi":"10.1016/j.pcd.2025.08.005","DOIUrl":"10.1016/j.pcd.2025.08.005","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate healthcare professionals’ (HCPs) perspectives towards deprescribing in older adults living with multiple long term conditions (MLTCs), including those at the end of life, using the validated Healthcare Professionals’ Attitudes Towards Deprescribing (HATD) tool, and to explore implications for medication management in conditions such as diabetes, where polypharmacy is common.</div></div><div><h3>Method</h3><div>A cross-sectional online survey using the HATD questionnaire was disseminated across the United Kingdom from November 2023 to January 2024. Eligible participants were HCPs with experience managing older adults with MLTCs and/or those receiving end of life care. The tools 23-items covered five domains: concerns about deprescribing, perceived medication burden, organisational support, assurance in deprescribing decisions, and patient involvement. Quantitative data were summarised descriptively.</div></div><div><h3>Results</h3><div>Sixty-six HCPs participated (53 % doctors, 27 % pharmacists, 21 % allied health professionals). Many expressed discomfort in stopping medications initiated by specialists, particularly due to concerns about symptom recurrence or misattributed patient deterioration. Most recognised high medication burden, acknowledged that some drugs were no longer required, and agree deprescribing could improve quality of life. Barriers included lack of time, workload pressures, and insufficient training. Thematic analysis identified six key issues including perceived risk and fear of complains, absence of clear guidance, tensions between evidence based practice and multimorbidity, influence of specialist authority, resource constraints, and deprescribing as a potential routine practice.</div></div><div><h3>Conclusions</h3><div>Significant barriers to deprescribing persist in UK practice, highlighting the need for clearer guidance, training, and multidisciplinary collaboration to optimise prescribing, including in chronic conditions such as diabetes.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 646-650"},"PeriodicalIF":2.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984245","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 : 2025-08-15DOI: 10.1016/j.pcd.2025.08.002
Jazlan Jamaluddin , Nik Aminah Nik Abdul Kadir , Lin Xiang Goh , Dayang Haniffa Abang Hashim , Nur Athirah Rosli , Nurfauzani Ibrahim , Sharifah Syadiyah Syed Saffi , Siti Nur Hidayah Abd Rahim
Introduction
Fasting during Ramadan is a religious obligation for Muslims but poses health risks for individuals with diabetes mellitus. The International Diabetes Federation–Diabetes and Ramadan Alliance (IDF-DAR) introduced a risk stratification tool in 2021 to guide clinicians, though its utility in primary care settings remains limited.
Methods
A retrospective observational study was conducted on adults with diabetes attending government health clinics in Malaysia from April 15 to June 15, 2024. Medical records of those who attempted fasting during Ramadan were reviewed. The primary outcome was a composite of hypoglycaemia, hyperglycaemia, diabetes-related hospitalization, or dehydration leading to breaking the fast. Discriminative performance of the IDF-DAR tool was evaluated using area under the receiver operating characteristic curve (AUC). Calibration was assessed via the Hosmer-Lemeshow test.
Results
A total of 310 patients were included (99 % with type 2 diabetes). The mean age was 61 years and the median diabetes duration was 7 years. Adverse fasting outcomes were observed in 18.4 % of patients, with hypoglycaemia being the most common (13.5 %). The IDF-DAR risk stratification tool demonstrated good discriminative ability, achieving an area under the ROC curve (AUC) of 0.78 (95 % CI: 0.72–0.84). At the recommended cut-off for distinguishing low-moderate from high-risk categories, the tool achieved a sensitivity of 92.9 % and a specificity of 40.9 %. The Hosmer-Lemeshow goodness-of-fit test indicated poor agreement between observed and predicted adverse outcomes, with a statistically significant result (P < 0.05).
Conclusion
The IDF-DAR risk stratification tool identifies high-risk patients fasting during Ramadan in primary care. However, its poor calibration and specificity as highlights the need for refinement of the model to improve its predictive accuracy. Enhancing the tool's calibration could allow for better individual risk estimation and more precise clinical decision-making in diverse primary care settings.
{"title":"Validation of the IDF-DAR risk tool for fasting in Ramadan for adults with diabetes mellitus in primary care: A nationwide multicentre study in Malaysia","authors":"Jazlan Jamaluddin , Nik Aminah Nik Abdul Kadir , Lin Xiang Goh , Dayang Haniffa Abang Hashim , Nur Athirah Rosli , Nurfauzani Ibrahim , Sharifah Syadiyah Syed Saffi , Siti Nur Hidayah Abd Rahim","doi":"10.1016/j.pcd.2025.08.002","DOIUrl":"10.1016/j.pcd.2025.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Fasting during Ramadan is a religious obligation for Muslims but poses health risks for individuals with diabetes mellitus. The International Diabetes Federation–Diabetes and Ramadan Alliance (IDF-DAR) introduced a risk stratification tool in 2021 to guide clinicians, though its utility in primary care settings remains limited.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted on adults with diabetes attending government health clinics in Malaysia from April 15 to June 15, 2024. Medical records of those who attempted fasting during Ramadan were reviewed. The primary outcome was a composite of hypoglycaemia, hyperglycaemia, diabetes-related hospitalization, or dehydration leading to breaking the fast. Discriminative performance of the IDF-DAR tool was evaluated using area under the receiver operating characteristic curve (AUC). Calibration was assessed via the Hosmer-Lemeshow test.</div></div><div><h3>Results</h3><div>A total of 310 patients were included (99 % with type 2 diabetes). The mean age was 61 years and the median diabetes duration was 7 years. Adverse fasting outcomes were observed in 18.4 % of patients, with hypoglycaemia being the most common (13.5 %). The IDF-DAR risk stratification tool demonstrated good discriminative ability, achieving an area under the ROC curve (AUC) of 0.78 (95 % CI: 0.72–0.84). At the recommended cut-off for distinguishing low-moderate from high-risk categories, the tool achieved a sensitivity of 92.9 % and a specificity of 40.9 %. The Hosmer-Lemeshow goodness-of-fit test indicated poor agreement between observed and predicted adverse outcomes, with a statistically significant result (P < 0.05).</div></div><div><h3>Conclusion</h3><div>The IDF-DAR risk stratification tool identifies high-risk patients fasting during Ramadan in primary care. However, its poor calibration and specificity as highlights the need for refinement of the model to improve its predictive accuracy. Enhancing the tool's calibration could allow for better individual risk estimation and more precise clinical decision-making in diverse primary care settings.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 608-612"},"PeriodicalIF":2.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862749","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}
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