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}
Pub 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":"2025-08-13","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 : 2025-08-13DOI: 10.1016/j.pcd.2025.08.004
Stefanos Karakolias , George Mavridoglou , Nikolaos Polyzos
Aims
This study aimed to analyze the patterns and trends of antidiabetic medication prescriptions in Greece using data from the National Electronic Prescription Database.
Methods
This retrospective observational study used real-world data from the Greek electronic prescription database from 2015 to 2021. The study population included all patients with a confirmed diagnosis of diabetes mellitus. Data on medication details, prescribing patterns, and costs were extracted and analyzed using descriptive statistical methods.
Results
The study revealed that blood glucose-lowering drugs, excluding insulins (A10B), accounted for 86.1 % of the total quantity prescribed, while insulins (A10A) contributed significantly to the total cost (28.3 %). Newer drug classes like DPP-4 inhibitors and GLP-1 analogues showed increasing trends, while some older medications declined in use. Prescribing patterns varied among medical specialties, with internal medicine and general practice physicians being the primary prescribers of these drugs.
Conclusions
This study highlights significant shifts in antidiabetic medication prescribing patterns in Greece, with a trend towards newer drug classes. These findings have important implications for healthcare policy, including the need to promote the cost-effective use of newer medications, manage patient transitions between drug classes, and address insulin affordability and access.
{"title":"Trends and patterns in antidiabetic medication prescriptions: Insights from Greece’s electronic prescription database","authors":"Stefanos Karakolias , George Mavridoglou , Nikolaos Polyzos","doi":"10.1016/j.pcd.2025.08.004","DOIUrl":"10.1016/j.pcd.2025.08.004","url":null,"abstract":"<div><h3>Aims</h3><div>This study aimed to analyze the patterns and trends of antidiabetic medication prescriptions in Greece using data from the National Electronic Prescription Database.</div></div><div><h3>Methods</h3><div>This retrospective observational study used real-world data from the Greek electronic prescription database from 2015 to 2021. The study population included all patients with a confirmed diagnosis of diabetes mellitus. Data on medication details, prescribing patterns, and costs were extracted and analyzed using descriptive statistical methods.</div></div><div><h3>Results</h3><div>The study revealed that blood glucose-lowering drugs, excluding insulins (A10B), accounted for 86.1 % of the total quantity prescribed, while insulins (A10A) contributed significantly to the total cost (28.3 %). Newer drug classes like DPP-4 inhibitors and GLP-1 analogues showed increasing trends, while some older medications declined in use. Prescribing patterns varied among medical specialties, with internal medicine and general practice physicians being the primary prescribers of these drugs.</div></div><div><h3>Conclusions</h3><div>This study highlights significant shifts in antidiabetic medication prescribing patterns in Greece, with a trend towards newer drug classes. These findings have important implications for healthcare policy, including the need to promote the cost-effective use of newer medications, manage patient transitions between drug classes, and address insulin affordability and access.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 6","pages":"Pages 651-657"},"PeriodicalIF":2.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850235","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 : 2025-08-06DOI: 10.1016/j.pcd.2025.07.007
Muhammad Saad , Muhammad Umer Sohail , Saad Ahmed Waqas , Zainab Siddiqua Ibrahim , Muhammad Sameer Arshad , Peter Collins , Raheel Ahmed
Background
Hypertension frequently coexists with diabetes, affecting over two-thirds of diabetic patients and significantly increasing cardiovascular (CV) risk. While blood pressure (BP) reduction offers substantial benefits in this population, the optimal systolic blood pressure (SBP) target remains controversial. This meta-analysis evaluates the effects of intensive SBP lowering (<130 mmHg) versus standard therapy (<150 mmHg) on key CV outcomes in hypertensive patients with diabetes.
Methods
This systematic review and meta-analysis adhered to PRISMA guidelines and included randomized controlled trials (RCTs) assessing SBP targets in diabetic patients. Electronic databases were searched through December 2024. Hazard ratios (HRs) for all-cause mortality, CV death, heart failure (HF), stroke, major adverse cardiovascular events (MACE), and major coronary heart disease events were pooled using a random-effects model. Risk of bias was evaluated using the Cochrane Risk of Bias Tool.
Results
Four RCTs involving 21,169 patients were included. Intensive SBP control significantly reduced stroke (HR: 0.71; p = 0.01), HF (HR: 0.69; p = 0.02), CV death (HR: 0.76; p = 0.04), and MACE (HR: 0.82; p < 0.0001) but showed no significant impact on all-cause mortality (HR: 0.90; p = 0.24) or major coronary heart disease events (HR: 0.93; p = 0.16). Heterogeneity was minimal across outcomes.
Conclusion
Intensive BP control reduces stroke, HF, CV death, and MACE in hypertensive diabetic patients, highlighting its role in CV risk management. Future research should explore subgroup effects.
{"title":"Effects of intensive blood pressure control on cardiovascular outcomes in patients with diabetes: A systematic review and meta-analysis","authors":"Muhammad Saad , Muhammad Umer Sohail , Saad Ahmed Waqas , Zainab Siddiqua Ibrahim , Muhammad Sameer Arshad , Peter Collins , Raheel Ahmed","doi":"10.1016/j.pcd.2025.07.007","DOIUrl":"10.1016/j.pcd.2025.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Hypertension frequently coexists with diabetes, affecting over two-thirds of diabetic patients and significantly increasing cardiovascular (CV) risk. While blood pressure (BP) reduction offers substantial benefits in this population, the optimal systolic blood pressure (SBP) target remains controversial. This meta-analysis evaluates the effects of intensive SBP lowering (<130 mmHg) versus standard therapy (<150 mmHg) on key CV outcomes in hypertensive patients with diabetes.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis adhered to PRISMA guidelines and included randomized controlled trials (RCTs) assessing SBP targets in diabetic patients. Electronic databases were searched through December 2024. Hazard ratios (HRs) for all-cause mortality, CV death, heart failure (HF), stroke, major adverse cardiovascular events (MACE), and major coronary heart disease events were pooled using a random-effects model. Risk of bias was evaluated using the Cochrane Risk of Bias Tool.</div></div><div><h3>Results</h3><div>Four RCTs involving 21,169 patients were included. Intensive SBP control significantly reduced stroke (HR: 0.71; p = 0.01), HF (HR: 0.69; p = 0.02), CV death (HR: 0.76; p = 0.04), and MACE (HR: 0.82; p < 0.0001) but showed no significant impact on all-cause mortality (HR: 0.90; p = 0.24) or major coronary heart disease events (HR: 0.93; p = 0.16). Heterogeneity was minimal across outcomes.</div></div><div><h3>Conclusion</h3><div>Intensive BP control reduces stroke, HF, CV death, and MACE in hypertensive diabetic patients, highlighting its role in CV risk management. Future research should explore subgroup effects.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 5","pages":"Pages 422-425"},"PeriodicalIF":2.3,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796583","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 : 2025-08-05DOI: 10.1016/j.pcd.2025.07.009
Miguel-Angel Muñoz , Victoria Cendrós , Elena Navas , Jose-Maria Verdú-Rotellar , Joan Barrot , Josep Franch
Objectives
To analyse the incidence of first hospitalization for heart failure (HF) in a cohort of patients newly diagnosed with type 2 diabetes mellitus (T2DM) compared with those without T2DM, attended in primary care.
Participants
Retrospective cohort study including both the entire adult population of Catalonia who developed T2DM (N = 518,232), and three paired controls for each of them (N = 1503,812), followed between January 2010 and December 2023. Patients’ characteristics and diagnostics were drawn from the System for the Development of Research in Primary Care (SIDIAP) database. Information on the first hospitalization was obtained from the hospital discharge database (CMBD).
Primary and secondary outcome measures
We analysed the incidence of first hospitalization for HF.
Results
Over the 13-year period of the study, there were 24,565 (4.7 %) and 25,886 (1.7 %) episodes of first hospitalization for HF among those with and without T2DM, respectively. In patients with incident T2DM we found that hypertension (HR 8.59; 95 % CI 7.41 – 9.96), atrial fibrillation (HR 2.30; 95 % CI 2.15 – 2.45) and ischemic heart disease (HR 1.61; 95 %CI 1.50 – 1.72) were the main predictors of first hospitalization for HF. Chronic kidney disease, age, male sex, obesity, dyslipidemia, and global comorbidity, also contributed to the risk of incident heart failure.
Conclusions
Incidence of first hospitalization for HF in patients newly diagnosed with T2DM, attended in primary care is three-fold higher than in those without T2DM. This Incidence remains stable in spite of new therapeutic approaches.
{"title":"Incidence of first hospitalization for heart failure in type 2 diabetes mellitus: A population-based cohort study in primary care","authors":"Miguel-Angel Muñoz , Victoria Cendrós , Elena Navas , Jose-Maria Verdú-Rotellar , Joan Barrot , Josep Franch","doi":"10.1016/j.pcd.2025.07.009","DOIUrl":"10.1016/j.pcd.2025.07.009","url":null,"abstract":"<div><h3>Objectives</h3><div>To analyse the incidence of first hospitalization for heart failure (HF) in a cohort of patients newly diagnosed with type 2 diabetes mellitus (T2DM) compared with those without T2DM, attended in primary care.</div></div><div><h3>Participants</h3><div>Retrospective cohort study including both the entire adult population of Catalonia who developed T2DM (N = 518,232), and three paired controls for each of them (N = 1503,812), followed between January 2010 and December 2023. Patients’ characteristics and diagnostics were drawn from the System for the Development of Research in Primary Care (SIDIAP) database. Information on the first hospitalization was obtained from the hospital discharge database (CMBD).</div><div>Primary and secondary outcome measures</div><div>We analysed the incidence of first hospitalization for HF.</div></div><div><h3>Results</h3><div>Over the 13-year period of the study, there were 24,565 (4.7 %) and 25,886 (1.7 %) episodes of first hospitalization for HF among those with and without T2DM, respectively. In patients with incident T2DM we found that hypertension (HR 8.59; 95 % CI 7.41 – 9.96), atrial fibrillation (HR 2.30; 95 % CI 2.15 – 2.45) and ischemic heart disease (HR 1.61; 95 %CI 1.50 – 1.72) were the main predictors of first hospitalization for HF. Chronic kidney disease, age, male sex, obesity, dyslipidemia, and global comorbidity, also contributed to the risk of incident heart failure.</div></div><div><h3>Conclusions</h3><div>Incidence of first hospitalization for HF in patients newly diagnosed with T2DM, attended in primary care is three-fold higher than in those without T2DM. This Incidence remains stable in spite of new therapeutic approaches.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 5","pages":"Pages 471-477"},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791065","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 : 2025-07-30DOI: 10.1016/j.pcd.2025.07.006
Mengjuan Xue, Bin Lu
This manuscript addresses several comments raised by Dr. Liao on metabolic inflammatory syndrome (MIS) in type 2 diabetes inpatients. It explains the limitations including selection bias in the study population, lack of exploration of molecular mechanisms, and discrepancies in dyslipidemia findings.
{"title":"Response to comment on “Comment on characteristics of metabolic inflammatory syndrome among inpatients with type 2 diabetes: A cross-sectional study in China”","authors":"Mengjuan Xue, Bin Lu","doi":"10.1016/j.pcd.2025.07.006","DOIUrl":"10.1016/j.pcd.2025.07.006","url":null,"abstract":"<div><div>This manuscript addresses several comments raised by Dr. Liao on metabolic inflammatory syndrome (MIS) in type 2 diabetes inpatients. It explains the limitations including selection bias in the study population, lack of exploration of molecular mechanisms, and discrepancies in dyslipidemia findings.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 5","pages":"Pages 554-555"},"PeriodicalIF":2.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755530","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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