Primary Care Diabetes最新文献

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 HbA_1c <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 HbA_1c 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.

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.

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.

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.

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.

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.

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.

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.

Background

The epidemiology data and global burden of diabetic foot disease underscores the need for effective prevention strategies, which requires an early diagnosis. Patient-reported outcome measures are instruments based on a simple format, which favours their application. Currently, there is an absence of instruments with a broad enough scope to capture the diverse aspects involved in diabetic foot disease.

Objectives

To develop a questionnaire for the assessment of patients with diabetic foot disease and carry out an analysis of its validity and reliability.

Methods

The study was developed in two stages. Stage 1: the Delphi Panel was composed of 22 experts. The questionnaire is made up of 25 questions selected, after three rounds, from an initial sample of 68 questions. Stage 2: A validation study was performed. With a sample of 273 subjects, an exploratory factor analysis and an analysis of internal consistency, items response, and validity were carried out using the Diabetes Quality of Life, SF-12v2, Foot Function Index and EuroQol EQ5D questionnaires. Measurements of error and sensitivity to change were also analyzed.

Results

A 25-item questionnaire (DiaFootQ) was developed. It comprised two dimensions: 1) lifestyle and function; and 2) footwear and foot self-care. Sample (n=273) mean age was 69.77 years (±11.08). The internal consistency of DiafootQ was α=0.916, and item response values were ICC=0.862–0.998. External validity correlation levels ranged from r=0.386 to r=0.888.

Conclusion

DiaFootQ was developed. Integrating the main aspects involved in diabetic foot disease could help to detect more accurately the risk or severity of these patients. DiaFootQ is a well-structured, valid, and reliable tool whose use should be promoted in clinical and research settings.

Aims

The stigma of type 2 diabetes (T2D) has received growing attention in the healthcare setting. However, there has been almost no research examining how healthcare professional biases about diabetes relate to patient care. This cross-sectional study examined how physicians’ self-reported biases, stereotypes, and attributions about diabetes and obesity were related to their patient care practices.

Methods: Physicians treating T2D, specializing in internal medicine or endocrinology (n=205), completed a battery of online questionnaires.

Results: Physicians who attributed poor patient compliance as the primary barrier to provision of diabetes care had worse perceptions of individuals with T2D and were less likely to use person-centered approaches with their patients. Physicians’ stigmatizing attitudes about T2D were associated with less use of person-first language, while more positive perceptions of individuals with T2D were associated with greater use of motivational interviewing. Weight-related stigma was associated with less use of person-centered approaches to care and less confidence in their ability to provide care.

Conclusions:

Findings reiterate the associations between weight stigma and poorer physician communication and suggest that similar patterns occur in the provision of care for individuals with T2D. Physicians who treat T2D may benefit from stigma reduction interventions for both diabetes and weight-related stigmas.