Pub Date : 2026-02-01Epub Date: 2025-11-06DOI: 10.1016/j.pcd.2025.11.002
Himanshu Shekhar, Parth Aphale, Shashank Dokania
{"title":"Critical appraisal of “impact of a primary care-based mobile health intervention to ‘sit less and move more’ on HbA1c, blood pressure, and other clinical outcomes in office employees with type 2 diabetes”","authors":"Himanshu Shekhar, Parth Aphale, Shashank Dokania","doi":"10.1016/j.pcd.2025.11.002","DOIUrl":"10.1016/j.pcd.2025.11.002","url":null,"abstract":"","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Page 143"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472557","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}
Obesity is a significant public health issue, influenced by dietary, environmental, socioeconomic, and behavioral factors. Identifying these predictors is crucial for effective prevention strategies and policies. Cohort datasets provide a valuable resource for understanding long-term health trends and risk factors, offering robust insights into obesity determinants. This study aims to identify obesity predictors using cohort data from western Iran.
Methods
This study used the main phase and first follow-up data from the RaNCD cohort study, including 2064 participants with an obesity incidence of 18 %. We used a hybrid feature selection approach combining filter and wrapper methods using Linear Regression (LR) and Decision Tree (DT) algorithms. Training, testing, and evaluation were performed in Jupyter Notebook using Python 3.12.
Results
Fifty-seven variables were identified as significant predictors of BMI. Among them, anthropometric measures such as weight (r = 0.688) and waist circumference (r = 0.686) showed the strongest positive associations, while physical activity (MET, r = –0.151) had the strongest negative correlation. Anthropometric, demographic, and laboratory measures yielded the most accurate BMI predictions, whereas dietary and lifestyle factors contributed less, likely due to limited variability in self-reported data.
Conclusion
According to the results, anthropometric, demographic, and lab tests variables were three common predictors for obesity. Integrating these with basic clinical and laboratory data could improve early detection of metabolic risk in primary care screening programs. Public health programs should emphasize culturally tailored approaches to physical activity and dietary behavior to address obesity at the community level.
{"title":"Quantitative analysis of obesity predictors: Evidence from the Ravansar non-communicable disease (RaNCD) cohort study","authors":"Sharareh Rostam Niakan Kalhori , Farid Najafi , Seyed Mohammad Ayyoubzadeh , Fatemeh Sadat Mirebrahimzadeh , Soroush Heydari","doi":"10.1016/j.pcd.2025.10.007","DOIUrl":"10.1016/j.pcd.2025.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a significant public health issue, influenced by dietary, environmental, socioeconomic, and behavioral factors. Identifying these predictors is crucial for effective prevention strategies and policies. Cohort datasets provide a valuable resource for understanding long-term health trends and risk factors, offering robust insights into obesity determinants. This study aims to identify obesity predictors using cohort data from western Iran.</div></div><div><h3>Methods</h3><div>This study used the main phase and first follow-up data from the RaNCD cohort study, including 2064 participants with an obesity incidence of 18 %. We used a hybrid feature selection approach combining filter and wrapper methods using Linear Regression (LR) and Decision Tree (DT) algorithms. Training, testing, and evaluation were performed in Jupyter Notebook using Python 3.12.</div></div><div><h3>Results</h3><div>Fifty-seven variables were identified as significant predictors of BMI. Among them, anthropometric measures such as weight (r = 0.688) and waist circumference (r = 0.686) showed the strongest positive associations, while physical activity (MET, r = –0.151) had the strongest negative correlation. Anthropometric, demographic, and laboratory measures yielded the most accurate BMI predictions, whereas dietary and lifestyle factors contributed less, likely due to limited variability in self-reported data.</div></div><div><h3>Conclusion</h3><div>According to the results, anthropometric, demographic, and lab tests variables were three common predictors for obesity. Integrating these with basic clinical and laboratory data could improve early detection of metabolic risk in primary care screening programs. Public health programs should emphasize culturally tailored approaches to physical activity and dietary behavior to address obesity at the community level.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Pages 74-79"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369423","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 : 2026-02-01Epub Date: 2025-11-19DOI: 10.1016/j.pcd.2025.11.003
Shixuan Guo, Juan Shu
{"title":"Comment on: Cognitive impairment is associated with poor diabetic foot ulcer outcomes","authors":"Shixuan Guo, Juan Shu","doi":"10.1016/j.pcd.2025.11.003","DOIUrl":"10.1016/j.pcd.2025.11.003","url":null,"abstract":"","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Page 144"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558825","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 : 2026-02-01Epub Date: 2025-12-27DOI: 10.1016/j.pcd.2025.12.003
Chun Kwan O , Rachel NY Chan , Ka Pang Chan , Hongjiang Wu , Fanny MF Lam , Hester HC Lee , Elaine YK Chow , Andrea OY Luk , Ronald CW Ma , Yun Kwok Wing , Juliana CN Chan , Alice PS Kong
Background
We aimed to explore the prevalence of and clinical factors that identify obstructive sleep apnoea (OSA) in older adults with suboptimally-controlled type 2 diabetes (T2D) and comorbid insomnia.
Methods
In this cross-sectional analysis, participants had age≥ 60 years, HbA1c7.5–10 % and comorbid insomnia [insomnia severity index (ISI)> 14] with no prior history of OSA. All participants had home sleep apnoea testing done to measure apnoea-hypopnea index (AHI) and completed questionnaires including self-reporting of habitual snoring (≥3 nights/week), Four-Variable Screening Tool (FVST) comprising sex, body mass index (BMI), blood pressure and frequency of snoring, and excessive daytime sleepiness (EDS) [Epworth Sleepiness Scale (ESS) score ≥ 10]. Mild, moderate, and severe OSA were defined by AHI 5 to < 15, ≥ 15 to < 30, and ≥ 30 events/hour respectively.
Results
Among 93 participants(mean age: 68.3 ± 4.8 years, 46 % men, BMI:24.8 ± 3.7 kg/m2), 87 % had OSA (43 % moderate-to-severe OSA) and 41.8 % had EDS. A diagnosis of OSA was associated with BMI[odd ratio(OR)1.233(95 %CI:1.015–1.498),p = 0.035], habitual snoring[8.107(2.192–29.977), p = 0.002], and FVST[1.386(1.132–1.698), p = 0.002]. The cut-off value of FVST≥ 5 or ESS≥ 10 had 100 % sensitivity and 20.8 (9.8–31.7)% specificity to detect moderate-to-severe OSA.
Conclusions
Older adults with suboptimally-controlled T2D and comorbid insomnia had high prevalence of undiagnosed OSA with FVST and EDS as potentially useful screening tools.
{"title":"High prevalence of undiagnosed obstructive sleep apnoea in older adults with suboptimally-controlled type 2 diabetes and comorbid insomnia","authors":"Chun Kwan O , Rachel NY Chan , Ka Pang Chan , Hongjiang Wu , Fanny MF Lam , Hester HC Lee , Elaine YK Chow , Andrea OY Luk , Ronald CW Ma , Yun Kwok Wing , Juliana CN Chan , Alice PS Kong","doi":"10.1016/j.pcd.2025.12.003","DOIUrl":"10.1016/j.pcd.2025.12.003","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to explore the prevalence of and clinical factors that identify obstructive sleep apnoea (OSA) in older adults with suboptimally-controlled type 2 diabetes (T2D) and comorbid insomnia.</div></div><div><h3>Methods</h3><div>In this cross-sectional analysis, participants had age≥ 60 years, HbA<sub>1c</sub>7.5–10 % and comorbid insomnia [insomnia severity index (ISI)> 14] with no prior history of OSA. All participants had home sleep apnoea testing done to measure apnoea-hypopnea index (AHI) and completed questionnaires including self-reporting of habitual snoring (≥3 nights/week), Four-Variable Screening Tool (FVST) comprising sex, body mass index (BMI), blood pressure and frequency of snoring, and excessive daytime sleepiness (EDS) [Epworth Sleepiness Scale (ESS) score ≥ 10]. Mild, moderate, and severe OSA were defined by AHI 5 to < 15, ≥ 15 to < 30, and ≥ 30 events/hour respectively.</div></div><div><h3>Results</h3><div>Among 93 participants(mean age: 68.3 ± 4.8 years, 46 % men, BMI:24.8 ± 3.7 kg/m<sup>2</sup>), 87 % had OSA (43 % moderate-to-severe OSA) and 41.8 % had EDS. A diagnosis of OSA was associated with BMI[odd ratio(OR)1.233(95 %CI:1.015–1.498),p = 0.035], habitual snoring[8.107(2.192–29.977), <em>p</em> = 0.002], and FVST[1.386(1.132–1.698), <em>p</em> = 0.002]. The cut-off value of FVST≥ 5 or ESS≥ 10 had 100 % sensitivity and 20.8 (9.8–31.7)% specificity to detect moderate-to-severe OSA.</div></div><div><h3>Conclusions</h3><div>Older adults with suboptimally-controlled T2D and comorbid insomnia had high prevalence of undiagnosed OSA with FVST and EDS as potentially useful screening tools.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Pages 80-87"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852112","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 : 2026-02-01Epub Date: 2025-10-30DOI: 10.1016/j.pcd.2025.10.004
Nizar Alsubahi , Wim Groot , Ahmed Ali Alzahrani , Milena Pavlova
<div><h3>Background</h3><div>Diabetes management has become a critical healthcare challenge globally, emphasizing the need for patient-centered care to improve the quality of services and enhance treatment outcomes. Patient experiences, perceived outcomes, and satisfaction are crucial to optimizing healthcare delivery, but each reflects different aspects of care. Understanding how these measures relate to each other is key to improving healthcare evaluation and avoiding dependence on a single metric. This study examines how patient-centered care (PCC) is associated with patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs), as well as overall patient satisfaction (PS) among people with diabetes.</div></div><div><h3>Method</h3><div>This study uses cross-sectional quantitative data from a structured, interviewer-administered questionnaire in 47 primary healthcare centers in Jeddah, Saudi Arabia, and is reported in accordance with the CROSS (Consensus-Based Checklist for Reporting of Survey Studies) guidelines. A total of 594 people with diabetes were recruited using random sampling from these centers. PCC was measured using the PCC-36 instrument. PREMs and PROMs were assessed using items adapted from the Swedish National Diabetes Register, while PS was measured using a validated single-item scale. Each was evaluated as a continuous measure, where higher scores indicate more positive experiences, outcomes, or satisfaction. A regression analysis was conducted to investigate the interrelationships between PREMs, PROMs, and PS and control for the effect of relevant sociodemographic and health-related characteristics. The data analysis was carried out using STATA 18.</div></div><div><h3>Result</h3><div>The results of the study indicated that PCC had a significant positive relationship with PROMs (β = 0.316, p < 0.01), PREMs (β = 0.063, p < 0.05), and PS (β = 0.689, p < 0.01). A strong residual correlation was observed between PREMs and PROMs (β = 0.734, p < 0.01), while the residual association between PREMs and PS was minimal (β = 0.063, p < 0.05). Emotional support was significantly associated with PROMs (β = 0.170, p < 0.01) and PREMs (β = 0.078, p < 0.01) but had a negative association with PS (β = −0.084, p < 0.1). Family and friends’ involvement was a significant predictor of PROMs (β = 0.193, p < 0.01), PREMs (β = 0.125, p < 0.01), and PS (β = 0.082, p < 0.05). Physical comfort was positively associated with PS (β = 0.128, p < 0.01) but negatively associated with PROMs (β = −0.143, p < 0.01) and PREMs (β = −0.056, p < 0.05). Access to care is significantly associated with PS (β = 0.176, p < 0.01).</div></div><div><h3>Conclusion</h3><div>This study highlights the crucial role of PCC, showing that higher levels of PCC are associated with more positive patient experiences, health outcomes, and satisfaction among people with diabetes. Key PCC factors include emotional s
背景：糖尿病管理已成为全球医疗保健的一个关键挑战，强调需要以患者为中心的护理，以提高服务质量和提高治疗效果。患者体验、感知结果和满意度对于优化医疗保健服务至关重要，但每个都反映了护理的不同方面。了解这些指标如何相互关联是改进医疗保健评估和避免依赖单一指标的关键。本研究探讨了以患者为中心的护理（PCC）如何与患者报告的体验测量（PREMs）和患者报告的结果测量（PROMs）以及糖尿病患者的总体患者满意度（PS）相关联。方法：本研究使用来自沙特阿拉伯吉达47个初级卫生保健中心的结构化访谈问卷的横断面定量数据，并根据CROSS（报告调查研究的共识清单）指南进行报告。研究人员从这些中心随机抽取了594名糖尿病患者。PCC采用PCC-36仪测定。PREMs和prom采用瑞典国家糖尿病登记册中的项目进行评估，而PS采用经过验证的单项目量表进行测量。每一项都是作为连续的衡量标准来评估的，分数越高表明越积极的经历、结果或满意度。对PREMs、PROMs和PS之间的相互关系进行回归分析，并对相关社会人口统计学和健康相关特征的影响进行控制。使用STATA 18进行数据分析。结果：研究结果表明PCC与PROMs呈显著正相关（β = 0.316, p ）。结论：本研究强调了PCC的重要作用，表明高水平的PCC与糖尿病患者更积极的患者体验、健康结果和满意度相关。关键的PCC因素包括情感支持、家人和朋友的参与以及获得护理。因此，以患者为中心的实践必须是糖尿病护理质量改进策略的组成部分。虽然PCC的变化在很大程度上解释了糖尿病患者报告的测量和满意度的变化，但忽略或未观察到的因素的变化驱动了这些测量。这些发现强调了进一步调查PS、PROMs和PREMs之间的性质和关系以及它们在根据患者优先级定制护理中的应用的重要性。
{"title":"Patient-reported experience, patient-reported outcome and overall satisfaction with care: What matters most to people with diabetes?","authors":"Nizar Alsubahi , Wim Groot , Ahmed Ali Alzahrani , Milena Pavlova","doi":"10.1016/j.pcd.2025.10.004","DOIUrl":"10.1016/j.pcd.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Diabetes management has become a critical healthcare challenge globally, emphasizing the need for patient-centered care to improve the quality of services and enhance treatment outcomes. Patient experiences, perceived outcomes, and satisfaction are crucial to optimizing healthcare delivery, but each reflects different aspects of care. Understanding how these measures relate to each other is key to improving healthcare evaluation and avoiding dependence on a single metric. This study examines how patient-centered care (PCC) is associated with patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs), as well as overall patient satisfaction (PS) among people with diabetes.</div></div><div><h3>Method</h3><div>This study uses cross-sectional quantitative data from a structured, interviewer-administered questionnaire in 47 primary healthcare centers in Jeddah, Saudi Arabia, and is reported in accordance with the CROSS (Consensus-Based Checklist for Reporting of Survey Studies) guidelines. A total of 594 people with diabetes were recruited using random sampling from these centers. PCC was measured using the PCC-36 instrument. PREMs and PROMs were assessed using items adapted from the Swedish National Diabetes Register, while PS was measured using a validated single-item scale. Each was evaluated as a continuous measure, where higher scores indicate more positive experiences, outcomes, or satisfaction. A regression analysis was conducted to investigate the interrelationships between PREMs, PROMs, and PS and control for the effect of relevant sociodemographic and health-related characteristics. The data analysis was carried out using STATA 18.</div></div><div><h3>Result</h3><div>The results of the study indicated that PCC had a significant positive relationship with PROMs (β = 0.316, p < 0.01), PREMs (β = 0.063, p < 0.05), and PS (β = 0.689, p < 0.01). A strong residual correlation was observed between PREMs and PROMs (β = 0.734, p < 0.01), while the residual association between PREMs and PS was minimal (β = 0.063, p < 0.05). Emotional support was significantly associated with PROMs (β = 0.170, p < 0.01) and PREMs (β = 0.078, p < 0.01) but had a negative association with PS (β = −0.084, p < 0.1). Family and friends’ involvement was a significant predictor of PROMs (β = 0.193, p < 0.01), PREMs (β = 0.125, p < 0.01), and PS (β = 0.082, p < 0.05). Physical comfort was positively associated with PS (β = 0.128, p < 0.01) but negatively associated with PROMs (β = −0.143, p < 0.01) and PREMs (β = −0.056, p < 0.05). Access to care is significantly associated with PS (β = 0.176, p < 0.01).</div></div><div><h3>Conclusion</h3><div>This study highlights the crucial role of PCC, showing that higher levels of PCC are associated with more positive patient experiences, health outcomes, and satisfaction among people with diabetes. Key PCC factors include emotional s","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Pages 88-98"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423735","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 : 2025-12-01Epub Date: 2025-08-13DOI: 10.1016/j.pcd.2025.08.001
Nur Raziana Rozi , Christine Shamala Selvaraj , Jia-Kai Tan , Zhan-Foong Lim , Noor Wahidah Nordin , Nuqman Hakimi Mazhar , Haris Hafizal , Hooi-Chin Beh , Quan-Hziung Lim , Ying-Guat Ooi , Adina Abdullah , Wan Ahmad Hafiz Wan Md Adnan , Pavai Sthaneswar , Soo-Kun Lim , Lee-Ling Lim
Background
Chronic kidney disease (CKD) poses a significant health challenge globally. There is limited understanding of the challenges and opportunities to enhance CKD management from the perspectives of healthcare providers (HCPs) involved in the direct care of patients with CKD. To integrate a risk-based triage for nephrology referrals, namely the kidney failure risk equation (KFRE), we explored HCPs’ perspectives on the facilitators and barriers to CKD management before the implementation of KFRE.
Methods
We used a mixed methods approach to explore HCPs’ perspectives on the 1) facilitators and barriers to CKD management and 2) perceived benefits and challenges of implementing KFRE, a risk-based triage to guide nephrology referrals at the Universiti Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. Interviews were audio recorded, transcribed verbatim, and thematically analyzed. Quantitatively, provider job satisfaction surveys were performed.
Results
Overall, 111 HCPs completed the surveys, with the majority being mostly satisfied with the physical surroundings, co-workers, and supervision received. Mixed responses were expressed about the amount of work and equipment provided. Interviews were conducted among 27 HCPs from the three main CKD care provider groups (primary care medicine, nephrology, and endocrinology). The facilitators’ and barriers’ themes were identified. The top three barriers to CKD management were suboptimal patients’ insights, gaps in practices and confidences, and shortfalls in the healthcare system. By contrast, a good interdisciplinary network and accessibility to specialist resources were the key facilitators. They underscored the importance of human resources empowerment, continuous patient education, and structured interdisciplinary collaboration. HCPs perceived risk-based triage using the KFRE as potentially useful for more targeted care.
Conclusion
We identified several modifiable barriers and facilitators warranting attention to improve the health outcomes of people with CKD. A risk-based triage approach using the KFRE appears promising in facilitating targeted nephrology referrals for better care and resource allocations.
{"title":"Kidney failure risk equation (KFRE), A risk-based triage for nephrology referrals: A mixed-methods study at pre-implementation phase among healthcare providers","authors":"Nur Raziana Rozi , Christine Shamala Selvaraj , Jia-Kai Tan , Zhan-Foong Lim , Noor Wahidah Nordin , Nuqman Hakimi Mazhar , Haris Hafizal , Hooi-Chin Beh , Quan-Hziung Lim , Ying-Guat Ooi , Adina Abdullah , Wan Ahmad Hafiz Wan Md Adnan , Pavai Sthaneswar , Soo-Kun Lim , Lee-Ling Lim","doi":"10.1016/j.pcd.2025.08.001","DOIUrl":"10.1016/j.pcd.2025.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease (CKD) poses a significant health challenge globally. There is limited understanding of the challenges and opportunities to enhance CKD management from the perspectives of healthcare providers (HCPs) involved in the direct care of patients with CKD. To integrate a risk-based triage for nephrology referrals, namely the kidney failure risk equation (KFRE), we explored HCPs’ perspectives on the facilitators and barriers to CKD management before the implementation of KFRE.</div></div><div><h3>Methods</h3><div>We used a mixed methods approach to explore HCPs’ perspectives on the 1) facilitators and barriers to CKD management and 2) perceived benefits and challenges of implementing KFRE, a risk-based triage to guide nephrology referrals at the Universiti Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. Interviews were audio recorded, transcribed verbatim, and thematically analyzed. Quantitatively, provider job satisfaction surveys were performed.</div></div><div><h3>Results</h3><div>Overall, 111 HCPs completed the surveys, with the majority being mostly satisfied with the physical surroundings, co-workers, and supervision received. Mixed responses were expressed about the amount of work and equipment provided. Interviews were conducted among 27 HCPs from the three main CKD care provider groups (primary care medicine, nephrology, and endocrinology). The facilitators’ and barriers’ themes were identified. The top three barriers to CKD management were suboptimal patients’ insights, gaps in practices and confidences, and shortfalls in the healthcare system. By contrast, a good interdisciplinary network and accessibility to specialist resources were the key facilitators. They underscored the importance of human resources empowerment, continuous patient education, and structured interdisciplinary collaboration. HCPs perceived risk-based triage using the KFRE as potentially useful for more targeted care.</div></div><div><h3>Conclusion</h3><div>We identified several modifiable barriers and facilitators warranting attention to improve the health outcomes of people with CKD. A risk-based triage approach using the KFRE appears promising in facilitating targeted nephrology referrals for better care and resource allocations.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 636-645"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857307","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 : 2025-12-01Epub 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":"2025-12-01","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 : 2025-12-01Epub 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":"2025-12-01","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}
This study aims to evaluate the changes in clinical profiles, complications, and treatment modalities of people with diabetes after a decade of implementing the multidisciplinary Risk Assessment and Management Program in DM (RAMP-DM).
Methods
A two-phase cross-sectional study was conducted to examine the evolution of care for people with diabetes in 13 public primary care clinics from 1 August 2008 to 31 July 2009 and 1 August 2019 to 31 July 2020.
Results
The average systolic blood pressure (SBP) improved from 131.66±16.89 to 126.88±12.54 mmHg (P<0.001). Hemoglobin A1c (HbA1c) and low-density lipoprotein concentration (LDL-C) improved from 7.47±1.4 to 6.88±1.00% (P<0.001) and 3.09±0.85 to 2.01±0.68 mmol/L (P<0.001), respectively. However, the percentage of patients with ischemic heart disease (IHD) rose from 7.73% to 10.47% (P<0.001), and stroke increased from 8.22% to 12.44% (P<0.001) over the decade.
Conclusions
This is the first study to demonstrate the improvement of clinical parameters and treatment modalities of diabetes care in a public primary care setting over a decade. The increasing prevalence of IHD and stroke may be related to the aging population and the decreasing trend of all-cause mortality among people with diabetes.
{"title":"Evolution of Diabetes Mellitus Care in Hong Kong Public Primary Care Setting: Changes after 10-year Implementation of Risk Assessment and Management Program in Diabetes Mellitus (RAMP-DM)","authors":"Fangfang Jiao, Lapkin Chiang, Yim Chu Li, Catherine Xiaorui Chen","doi":"10.1016/j.pcd.2025.10.002","DOIUrl":"10.1016/j.pcd.2025.10.002","url":null,"abstract":"<div><h3>Aims</h3><div>This study aims to evaluate the changes in clinical profiles, complications, and treatment modalities of people with diabetes after a decade of implementing the multidisciplinary Risk Assessment and Management Program in DM (RAMP-DM).</div></div><div><h3>Methods</h3><div>A two-phase cross-sectional study was conducted to examine the evolution of care for people with diabetes in 13 public primary care clinics from 1 August 2008 to 31 July 2009 and 1 August 2019 to 31 July 2020.</div></div><div><h3>Results</h3><div>The average systolic blood pressure (SBP) improved from 131.66±16.89 to 126.88±12.54 mmHg (P<0.001). Hemoglobin A1c (HbA1c) and low-density lipoprotein concentration (LDL-C) improved from 7.47±1.4 to 6.88±1.00% (P<0.001) and 3.09±0.85 to 2.01±0.68 mmol/L (P<0.001), respectively. However, the percentage of patients with ischemic heart disease (IHD) rose from 7.73% to 10.47% (P<0.001), and stroke increased from 8.22% to 12.44% (P<0.001) over the decade.</div></div><div><h3>Conclusions</h3><div>This is the first study to demonstrate the improvement of clinical parameters and treatment modalities of diabetes care in a public primary care setting over a decade. The increasing prevalence of IHD and stroke may be related to the aging population and the decreasing trend of all-cause mortality among people with diabetes.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 671-677"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282370","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":"2025-12-01","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}
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