Pub Date : 2025-08-01Epub Date: 2025-04-25DOI: 10.1016/j.pcd.2025.04.001
Merve Murat Mehmed Ali̇ , Selda Celi̇k , Seda Er , Gulden Anataca
Aims
This study assessed the mediating role of cognitive emotion regulation strategies in the relationship between illness uncertainty and diabetes health-promoting self-care behaviours.
Methods
A cross-sectional study was conducted with 433 T2DM outpatients using the Mishel Uncertainty in Illness Scale, the Diabetes Health Promotion Self-Care Scale, and the Cognitive Emotion Regulation Questionnaire (CERQ). Data were analysed using SPSS (v.29) for descriptive and Pearson correlation tests, and Process Macro for SPSS (Model 4, v.4.2) for mediation analysis.
Results
There is a statistically significant, weak negative relationship between illness uncertainty and diabetes health promotion self-care scores (r = -0.105, p = 0.029). CERQ showed a weak negative correlation with illness uncertainty scores, whereas the questionnaire demonstrated a statistically significant, moderate positive correlation with diabetes health-promoting self-care (p < 0.05). The relationship between illness uncertainty and diabetes health- promoting self-care was mediated by CERQ such as self-blame (β= 0.083, 95 % CI= 0.019 – 0.155), acceptance (β= −0.031, 95 % CI= −0.061 – −0.007), rumination (β= −0.107, 95 % CI= −0.179 – −0.048), and positive reappraisal (β= −0.043, 95 % CI= −0.091 – −0.001).
Conclusions
Illness uncertainty negatively impacts self-care behaviours in T2DM patients. CERQ, including self-blame, acceptance, rumination, and positive reappraisal, play a mediating role, highlighting their potential in interventions to improve self-care.
{"title":"Bridging illness uncertainty and self-care: The role of cognitive emotion regulation in type 2 diabetes management","authors":"Merve Murat Mehmed Ali̇ , Selda Celi̇k , Seda Er , Gulden Anataca","doi":"10.1016/j.pcd.2025.04.001","DOIUrl":"10.1016/j.pcd.2025.04.001","url":null,"abstract":"<div><h3>Aims</h3><div>This study assessed the mediating role of cognitive emotion regulation strategies in the relationship between illness uncertainty and diabetes health-promoting self-care behaviours.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted with 433 T2DM outpatients using the Mishel Uncertainty in Illness Scale, the Diabetes Health Promotion Self-Care Scale, and the Cognitive Emotion Regulation Questionnaire (CERQ). Data were analysed using SPSS (v.29) for descriptive and Pearson correlation tests, and Process Macro for SPSS (Model 4, v.4.2) for mediation analysis.</div></div><div><h3>Results</h3><div>There is a statistically significant, weak negative relationship between illness uncertainty and diabetes health promotion self-care scores (r = -0.105, p = 0.029). CERQ showed a weak negative correlation with illness uncertainty scores, whereas the questionnaire demonstrated a statistically significant, moderate positive correlation with diabetes health-promoting self-care (p < 0.05). The relationship between illness uncertainty and diabetes health- promoting self-care was mediated by CERQ such as self-blame (β= 0.083, 95 % CI= 0.019 – 0.155), acceptance (β= −0.031, 95 % CI= −0.061 – −0.007), rumination (β= −0.107, 95 % CI= −0.179 – −0.048), and positive reappraisal (β= −0.043, 95 % CI= −0.091 – −0.001).</div></div><div><h3>Conclusions</h3><div>Illness uncertainty negatively impacts self-care behaviours in T2DM patients. CERQ, including self-blame, acceptance, rumination, and positive reappraisal, play a mediating role, highlighting their potential in interventions to improve self-care.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 4","pages":"Pages 375-382"},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035268","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 : 2025-06-01Epub Date: 2025-03-06DOI: 10.1016/j.pcd.2025.02.008
K. Kovanur Sampath , Yan Ann-Rong , S. Brownie
Background
Indigenous populations are disproportionately affected by type 2 diabetes mellitus (T2DM) and associated complications. However, the lack of cultural integration with the current management approach does not suit indigenous communities. Therefore, the aim of this scoping review is to map the existing literature related to culturally appropriate care and to establish the key characteristics of a culturally appropriate care provided to indigenous communities with T2D.
Methods
Electronic databases such as PubMed, CINAHL, Science Direct and Cochrane Library were searched from inception to September 2024. Identified records from database literature searches were imported into Covidence®. Two independent reviewers screened and extracted the data. Studies included Indigenous people with T2D, culturally appropriate care, measurable outcomes, and any design. The research team collectively created a data charting table/form to standardize data collection that included PICO elements and PROGRESS-Plus factors for equity lens. A narrative synthesis was used to summarize the evidence.
Results
Seven studies met our eligibility criteria and were included in this scoping review. Overall, there is clear evidence that a culturally appropriate care results in better physiological outcomes and higher rates of adherence and engagement with a treatment plan and disease management processes. However, future studies need to gather and report on other PROGRESS factors that can cause inequity such as Religion, Education, Socioeconomic status of participants.
Conclusion
The findings of this review emphasise that a culturally appropriate care is crucial in improving health outcomes and engagement among Indigenous people with T2D. However, systemic barriers still exist, highlighting the need for broader structural changes.
{"title":"Culturally appropriate care for indigenous people with type 2 diabetes mellitus (T2DM)- a scoping review","authors":"K. Kovanur Sampath , Yan Ann-Rong , S. Brownie","doi":"10.1016/j.pcd.2025.02.008","DOIUrl":"10.1016/j.pcd.2025.02.008","url":null,"abstract":"<div><h3>Background</h3><div>Indigenous populations are disproportionately affected by type 2 diabetes mellitus (T2DM) and associated complications. However, the lack of cultural integration with the current management approach does not suit indigenous communities. Therefore, the aim of this scoping review is to map the existing literature related to culturally appropriate care and to establish the key characteristics of a culturally appropriate care provided to indigenous communities with T2D.</div></div><div><h3>Methods</h3><div>Electronic databases such as PubMed, CINAHL, Science Direct and Cochrane Library were searched from inception to September 2024. Identified records from database literature searches were imported into Covidence®. Two independent reviewers screened and extracted the data. Studies included Indigenous people with T2D, culturally appropriate care, measurable outcomes, and any design. The research team collectively created a data charting table/form to standardize data collection that included PICO elements and PROGRESS-Plus factors for equity lens. A narrative synthesis was used to summarize the evidence.</div></div><div><h3>Results</h3><div>Seven studies met our eligibility criteria and were included in this scoping review. Overall, there is clear evidence that a culturally appropriate care results in better physiological outcomes and higher rates of adherence and engagement with a treatment plan and disease management processes. However, future studies need to gather and report on other PROGRESS factors that can cause inequity such as Religion, Education, Socioeconomic status of participants.</div></div><div><h3>Conclusion</h3><div>The findings of this review emphasise that a culturally appropriate care is crucial in improving health outcomes and engagement among Indigenous people with T2D. However, systemic barriers still exist, highlighting the need for broader structural changes.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 238-245"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589068","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 : 2025-06-01Epub Date: 2025-03-19DOI: 10.1016/j.pcd.2025.02.009
Jesús Iturralde-Iriso , Aitana Lertxundi-Manterola , Iosu Delgado-Naranjo , Alfonso Barquilla-García , Rafael Manuel Micó-Pérez , José Polo-García , Sonsoles M. Velilla-Zancada , Naiara Cubelos-Fernández , Antonio Segura-Fragoso , Leovigildo Ginel-Mendoza , Vicente Pallares-Carratala , Miguel A. Prieto-Díaz , Sergio Cinza-Sanjurjo , Vicente Martín-Sanchez
The burden of disease attributable to excess body fat (EBF) in type 2 diabetes mellitus (T2DM) may be underestimated due to problems correlating BMI with body fat. The aim of this study is to compare the population attributable fraction (PAF) of EBF in T2DM assessed with various parameters.
Material and methods
Prevalence study based on the baseline visit of the IBERICAN study. Mixed unconditional logistic regression models were used to estimate the risk of T2DM for the various categories of BMI, of the estimation of EBF according to the CUN-BAE (Clínica Universidad de Navarra-Body Adiposity Estimator) and of waist circumference (WC), stratifying by sex. The PAF was calculated for each of the EBF estimates.
Results
A total of 7752 patients from IBERICAN study were eligible, of them 1536 (19.8 %) achieved T2DM criterion, The prevalence of diabetes was higher in men, in those with a lower level of education, and in those who reported a low level of physical activity. Subjects with diabetes were older, had a higher BMI, a higher CUN-BAE-estimated body fat percentage (eBFP) and a higher waist circumference. One in three cases T2DM risk was attributed to elevated BMI, whereas in the CUN-BAE case it was attributed to 9 out of 10 men and 2 out of 3 women. One out of two cases of T2DM in women, and less in men, was attributed to an excess WC.
Conclusions
The burden of disease attributable to EBF in the case of T2DM may be underestimated. Therefore, EBF should be used, together with BMI, WC -especially in women-, and the CUN-BAE to better estimate the risk of T2DM and to adapt dietary or lifestyle recommendations in daily clinical practice.
{"title":"Estimation of the population atributable fraction due a to excess body fat in primary care patients: IBERICAN study","authors":"Jesús Iturralde-Iriso , Aitana Lertxundi-Manterola , Iosu Delgado-Naranjo , Alfonso Barquilla-García , Rafael Manuel Micó-Pérez , José Polo-García , Sonsoles M. Velilla-Zancada , Naiara Cubelos-Fernández , Antonio Segura-Fragoso , Leovigildo Ginel-Mendoza , Vicente Pallares-Carratala , Miguel A. Prieto-Díaz , Sergio Cinza-Sanjurjo , Vicente Martín-Sanchez","doi":"10.1016/j.pcd.2025.02.009","DOIUrl":"10.1016/j.pcd.2025.02.009","url":null,"abstract":"<div><div>The burden of disease attributable to excess body fat (EBF) in type 2 diabetes mellitus (T2DM) may be underestimated due to problems correlating BMI with body fat. The aim of this study is to compare the population attributable fraction (PAF) of EBF in T2DM assessed with various parameters.</div></div><div><h3>Material and methods</h3><div>Prevalence study based on the baseline visit of the IBERICAN study. Mixed unconditional logistic regression models were used to estimate the risk of T2DM for the various categories of BMI, of the estimation of EBF according to the CUN-BAE (Clínica Universidad de Navarra-Body Adiposity Estimator) and of waist circumference (WC), stratifying by sex. The PAF was calculated for each of the EBF estimates.</div></div><div><h3>Results</h3><div>A total of 7752 patients from IBERICAN study were eligible, of them 1536 (19.8 %) achieved T2DM criterion, The prevalence of diabetes was higher in men, in those with a lower level of education, and in those who reported a low level of physical activity. Subjects with diabetes were older, had a higher BMI, a higher CUN-BAE-estimated body fat percentage (eBFP) and a higher waist circumference. One in three cases T2DM risk was attributed to elevated BMI, whereas in the CUN-BAE case it was attributed to 9 out of 10 men and 2 out of 3 women. One out of two cases of T2DM in women, and less in men, was attributed to an excess WC.</div></div><div><h3>Conclusions</h3><div>The burden of disease attributable to EBF in the case of T2DM may be underestimated. Therefore, EBF should be used, together with BMI, WC -especially in women-, and the CUN-BAE to better estimate the risk of T2DM and to adapt dietary or lifestyle recommendations in daily clinical practice.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 302-311"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672189","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}
To determine the prevalence of depression and anxiety during pregnancy and its association with GDM.
Methods
A total of 2141 pregnant women were recruited before 16 weeks of gestation (mean gestational age: 10.5 ± 2.9 weeks) from the STRiDE study in south India. Early GDM (eGDM) was detected in the first trimester, and late GDM (lGDM) during 24–28 weeks, both diagnosed using IADPSG criteria. Depression and anxiety were assessed using the PHQ-9 (score≥10) and GAD-7 (score≥7) scales, respectively.
Results
Overall, 14.9 % had depression and 17.5 % had anxiety in early pregnancy. eGDM was diagnosed in 474 (20.4 %) and lGDM in 321 (19.3 %) women. Women with eGDM had higher prevalence of depression (20.9 %) than those with lGDM (15.6 %, p = 0.06) and those without GDM (13.3 %, p < 0.01). Anxiety was also higher in eGDM (21.1 %) compared to IGDM (15.3 %, p < 0.05) and women without GDM (16.6 %, p < 0.05). eGDM was significantly associated with depression (aOR=1.84, 95 % CI:1.37–2.47, p < 0.001) and anxiety (aOR=1.36, 95 % CI:1.03–1.79, p = 0.03) after adjusting for age, systolic blood pressure, BMI, socioeconomic status, and family history of diabetes.
Conclusion
Women with early GDM have a higher prevalence of depression and anxiety compared to those with late GDM and women without GDM. Early and universal screening for GDM should be done and its association with mental health wellbeing should be explored and supported.
{"title":"Prevalence of depression and anxiety among pregnant women with gestational diabetes mellitus in South Asia","authors":"Saite Hemavathy , Mohan Deepa , Ram Uma , Ramesh Gowri , Rajendra Pradeepa , Wesley Hannah , Chockalingam Shivashri , Radhakrishnan Subashini , Duraivel Mohaneswari , Yonas Ghebremichael-Weldeselassie , Ponnusamy Saravanan , Viswanathan Mohan , Ranjit Mohan Anjana","doi":"10.1016/j.pcd.2025.03.002","DOIUrl":"10.1016/j.pcd.2025.03.002","url":null,"abstract":"<div><h3>Aim</h3><div>To determine the prevalence of depression and anxiety during pregnancy and its association with GDM.</div></div><div><h3>Methods</h3><div>A total of 2141 pregnant women were recruited before 16 weeks of gestation (mean gestational age: 10.5 ± 2.9 weeks) from the STRiDE study in south India. Early GDM (eGDM) was detected in the first trimester, and late GDM (lGDM) during 24–28 weeks, both diagnosed using IADPSG criteria. Depression and anxiety were assessed using the PHQ-9 (score≥10) and GAD-7 (score≥7) scales, respectively.</div></div><div><h3>Results</h3><div>Overall, 14.9 % had depression and 17.5 % had anxiety in early pregnancy. eGDM was diagnosed in 474 (20.4 %) and lGDM in 321 (19.3 %) women. Women with eGDM had higher prevalence of depression (20.9 %) than those with lGDM (15.6 %, p = 0.06) and those without GDM (13.3 %, p < 0.01). Anxiety was also higher in eGDM (21.1 %) compared to IGDM (15.3 %, p < 0.05) and women without GDM (16.6 %, p < 0.05). eGDM was significantly associated with depression (aOR=1.84, 95 % CI:1.37–2.47, p < 0.001) and anxiety (aOR=1.36, 95 % CI:1.03–1.79, p = 0.03) after adjusting for age, systolic blood pressure, BMI, socioeconomic status, and family history of diabetes.</div></div><div><h3>Conclusion</h3><div>Women with early GDM have a higher prevalence of depression and anxiety compared to those with late GDM and women without GDM. Early and universal screening for GDM should be done and its association with mental health wellbeing should be explored and supported.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 322-328"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639949","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 : 2025-06-01Epub Date: 2025-02-18DOI: 10.1016/j.pcd.2025.02.005
Jie Ming Nigel Fong , Serena Low , Yang Xu , Pek Siang Edmund Teo , Gek Hsiang Lim , Huili Zheng , Keven Ang , Ngiap Chuan Tan , Cheng Boon Poh , Hui Boon Tay , Allen Yan Lun Liu , Choong Meng Chan , Chieh Suai Tan , Su Chi Lim , Yong Mong Bee , Jia Liang Kwek
Aims
The aim of this study was to develop and validate a prediction model for incident chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM), defined as eGFR < 60 ml/min/1.73m2 and/or urine albumin:creatinine ratio (UACR) > 3 mg/mmol in ≥ 2 consecutive readings ≥ 3 months apart.
Methods
Model derivation was performed in the SingHealth Diabetes Registry, including patients aged ≥ 21 years diagnosed with T2DM without pre-existing CKD. External validation was performed in a single-center prospective observational cohort. Cox Proportional Hazard model was created to evaluate predictors associated with time-to-onset of incident CKD. Increasingly parsimonious models were assessed for discrimination and calibration. Models underwent external validation, benchmarking against existing models, and decision curve analysis.
Results
25,142 (59 %) of 42,552 patients in the derivation cohort developed CKD over a median 4.0 years (IQR 2.1–7.7) follow up. An 18-variable model, 12-variable model, and 4-variable model (including age, duration of T2DM, eGFR, and previous non-persistent albuminuria) was developed. The 4-variable model had a C-statistic of 0.78 and good calibration on plots of observed-versus-predicted risk. The 12-variable and 18-variable models performed similarly. In the external validation cohort of 2249 patients, of whom 1035 (46 %) developed incident CKD, the 4-variable model had a C-statistic of 0.87. All models had better discrimination than existing benchmarks. Decision curve analysis of the 4-variable model showed positive net benefit for any threshold probability above 16 % for 2-year and 28 % for 5-year CKD risk.
Conclusion
The 4-variable model for prediction of incident CKD in T2DM demonstrates good performance, predicts both eGFR and albuminuria endpoints, and is simple-to-use. This may guide personalized care, resource allocation and population health.
{"title":"Risk of onset of chronic kidney disease in type 2 diabetes mellitus (ROCK-DM): Development and validation of a 4-variable prediction model","authors":"Jie Ming Nigel Fong , Serena Low , Yang Xu , Pek Siang Edmund Teo , Gek Hsiang Lim , Huili Zheng , Keven Ang , Ngiap Chuan Tan , Cheng Boon Poh , Hui Boon Tay , Allen Yan Lun Liu , Choong Meng Chan , Chieh Suai Tan , Su Chi Lim , Yong Mong Bee , Jia Liang Kwek","doi":"10.1016/j.pcd.2025.02.005","DOIUrl":"10.1016/j.pcd.2025.02.005","url":null,"abstract":"<div><h3>Aims</h3><div>The aim of this study was to develop and validate a prediction model for incident chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM), defined as eGFR < 60 ml/min/1.73m2 and/or urine albumin:creatinine ratio (UACR) > 3 mg/mmol in ≥ 2 consecutive readings ≥ 3 months apart.</div></div><div><h3>Methods</h3><div>Model derivation was performed in the SingHealth Diabetes Registry, including patients aged ≥ 21 years diagnosed with T2DM without pre-existing CKD. External validation was performed in a single-center prospective observational cohort. Cox Proportional Hazard model was created to evaluate predictors associated with time-to-onset of incident CKD. Increasingly parsimonious models were assessed for discrimination and calibration. Models underwent external validation, benchmarking against existing models, and decision curve analysis.</div></div><div><h3>Results</h3><div>25,142 (59 %) of 42,552 patients in the derivation cohort developed CKD over a median 4.0 years (IQR 2.1–7.7) follow up. An 18-variable model, 12-variable model, and 4-variable model (including age, duration of T2DM, eGFR, and previous non-persistent albuminuria) was developed. The 4-variable model had a C-statistic of 0.78 and good calibration on plots of observed-versus-predicted risk. The 12-variable and 18-variable models performed similarly. In the external validation cohort of 2249 patients, of whom 1035 (46 %) developed incident CKD, the 4-variable model had a C-statistic of 0.87. All models had better discrimination than existing benchmarks. Decision curve analysis of the 4-variable model showed positive net benefit for any threshold probability above 16 % for 2-year and 28 % for 5-year CKD risk.</div></div><div><h3>Conclusion</h3><div>The 4-variable model for prediction of incident CKD in T2DM demonstrates good performance, predicts both eGFR and albuminuria endpoints, and is simple-to-use. This may guide personalized care, resource allocation and population health.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 312-321"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143461084","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 : 2025-06-01Epub Date: 2025-02-21DOI: 10.1016/j.pcd.2025.02.003
Maria del Mar Fernandez-Alvarez , Cristina Papín-Cano , Shelini Surendran , Ruben Martin-Payo
Aim
The purpose of this study was to assess the efficacy of an educational intervention based on the Behavior Change Wheel (BCW) framework for individuals with type 2 diabetes mellitus (T2DM) on dietary and physical activity recommendations in a Spanish region.
Methods
A two-arm pragmatic randomized pilot trial was developed. The intervention consisted of a 6-month period with three components: face-to-face counseling, a phone call, and specially designed written guidelines focusing on dietary and physical activity recommendations The primary outcome was changes in dietary and physical activity recommendations. The secondary outcome, the impact of the intervention on HbA1c levels, body mass index, and the frequency of consultations to primary care.
Results
n = 208 patients were recruited. Individuals in the intervention experienced a significative improvement in adherence to dietary recommendations (+0.52; p-value<0.001), physical activity (+0.79; p-value<0.001), and a decrease in HbA1c levels (0.11 %; p-value=0.04).
Conclusion
The 6-month intervention, designed for T2DM patients and based on the BCW model, has demonstrated effectiveness in improving adherence to healthy dietary and physical activity recommendations, as well as reducing HbA1c levels.
{"title":"Td2Ast project: A pragmatic intervention on diet and physical activity for patients with type 2 diabetes mellitus","authors":"Maria del Mar Fernandez-Alvarez , Cristina Papín-Cano , Shelini Surendran , Ruben Martin-Payo","doi":"10.1016/j.pcd.2025.02.003","DOIUrl":"10.1016/j.pcd.2025.02.003","url":null,"abstract":"<div><h3>Aim</h3><div>The purpose of this study was to assess the efficacy of an educational intervention based on the Behavior Change Wheel (BCW) framework for individuals with type 2 diabetes mellitus (T2DM) on dietary and physical activity recommendations in a Spanish region.</div></div><div><h3>Methods</h3><div>A two-arm pragmatic randomized pilot trial was developed. The intervention consisted of a 6-month period with three components: face-to-face counseling, a phone call, and specially designed written guidelines focusing on dietary and physical activity recommendations The primary outcome was changes in dietary and physical activity recommendations. The secondary outcome, the impact of the intervention on HbA1c levels, body mass index, and the frequency of consultations to primary care.</div></div><div><h3>Results</h3><div>n<!--> <!-->=<!--> <!-->208 patients were recruited. Individuals in the intervention experienced a significative improvement in adherence to dietary recommendations (+0.52; p-value<0.001), physical activity (+0.79; p-value<0.001), and a decrease in HbA1c levels (0.11 %; p-value=0.04).</div></div><div><h3>Conclusion</h3><div>The 6-month intervention, designed for T2DM patients and based on the BCW model, has demonstrated effectiveness in improving adherence to healthy dietary and physical activity recommendations, as well as reducing HbA1c levels.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 270-276"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477320","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 : 2025-06-01Epub Date: 2025-03-10DOI: 10.1016/j.pcd.2025.03.001
Francesc Alòs , Anna Puig-Ribera , Judit Bort-Roig , Emilia Chirveches-Pérez , Anna Berenguera , Carlos Martin-Cantera , Ma Àngels Colomer
Introduction
Type 2 diabetes mellitus (DM2) is one of the main public health threats of the 21st century. Half of the people with DM2 worldwide are not diagnosed. The high prevalence, underdiagnosis and complications of diabetes highlight the need for identifying people at risk. Sedentary behaviour (SB) or prolonged sitting is a major predisposing risk factor for the increasing prevalence of DM2. Incorporating SB measures into clinical practice systems for identifying individuals more likely to have DM2 should be considered.
Objective
To develop a mathematical model for clinical practice that allows early identification of office employees at risk of DM2 based on objective data on SB.
Methods
A cross-sectional study with a cross-validation procedure was conducted. Anthropometric variables (sex, age and body mass index, BMI), sleep time (hours; measured by ActivPAL3M devices), and SB patterns (sedentary breaks and time spent in sedentary bouts of four different lengths; measured by ActivPAL3M devices) of two groups of office employees (adults with and without diabetes) were compared. Eighty-one participants had DM2 and 132 had normal glucose metabolism (NGM). The risk of having DM2 was modelled using generalized linear models (GLM), particularly a logistic regression model.
Results
Five non-invasive clinical variables that were significantly correlated to DM2 with no collinearity were included in the mathematical model: sex, age, BMI, sleep time (hours) and sedentary breaks < 20 minutes (number/day). The validated model correctly classified 94.58 % of the participants with DM2 and 97.99 % of participants with NGM. The sensitivity was 94.58 % and the specificity 97.99 %. Additionally, the model allowed the design of a preventive tool to recommend changes in the SB pattern based on the participant’s anthropometric profile, aiming to reduce the risk of developing DM2 in office employees.
Conclusion
This study highlights the importance of incorporating SB measures in primary care clinical practice. Our mathematical model suggests that including SB could enhance the early identification of adults at risk of DM2. Further research is needed to validate these findings and assess the practical application of the mathematical model in clinical practice.
{"title":"Incorporating sedentary behaviour for identifying risk of type 2 diabetes: Implications for primary care","authors":"Francesc Alòs , Anna Puig-Ribera , Judit Bort-Roig , Emilia Chirveches-Pérez , Anna Berenguera , Carlos Martin-Cantera , Ma Àngels Colomer","doi":"10.1016/j.pcd.2025.03.001","DOIUrl":"10.1016/j.pcd.2025.03.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Type 2 diabetes mellitus (DM2) is one of the main public health threats of the 21st century. Half of the people with DM2 worldwide are not diagnosed. The high prevalence, underdiagnosis and complications of diabetes highlight the need for identifying people at risk. Sedentary behaviour (SB) or prolonged sitting is a major predisposing risk factor for the increasing prevalence of DM2. Incorporating SB measures into clinical practice systems for identifying individuals more likely to have DM2 should be considered.</div></div><div><h3>Objective</h3><div>To develop a mathematical model for clinical practice that allows early identification of office employees at risk of DM2 based on objective data on SB.</div></div><div><h3>Methods</h3><div>A cross-sectional study with a cross-validation procedure was conducted. Anthropometric variables (sex, age and body mass index, BMI), sleep time (hours; measured by ActivPAL3M devices), and SB patterns (sedentary breaks and time spent in sedentary bouts of four different lengths; measured by ActivPAL3M devices) of two groups of office employees (adults with and without diabetes) were compared. Eighty-one participants had DM2 and 132 had normal glucose metabolism (NGM). The risk of having DM2 was modelled using generalized linear models (GLM), particularly a logistic regression model.</div></div><div><h3>Results</h3><div>Five non-invasive clinical variables that were significantly correlated to DM2 with no collinearity were included in the mathematical model: sex, age, BMI, sleep time (hours) and sedentary breaks < 20 minutes (number/day). The validated model correctly classified 94.58 % of the participants with DM2 and 97.99 % of participants with NGM. The sensitivity was 94.58 % and the specificity 97.99 %. Additionally, the model allowed the design of a preventive tool to recommend changes in the SB pattern based on the participant’s anthropometric profile, aiming to reduce the risk of developing DM2 in office employees.</div></div><div><h3>Conclusion</h3><div>This study highlights the importance of incorporating SB measures in primary care clinical practice. Our mathematical model suggests that including SB could enhance the early identification of adults at risk of DM2. Further research is needed to validate these findings and assess the practical application of the mathematical model in clinical practice.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 214-220"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607535","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 : 2025-06-01Epub Date: 2025-03-28DOI: 10.1016/j.pcd.2025.03.009
Carolina Guiriguet , Mercè Bustos , Roser Cantenys , Eduardo Hermosilla , Joan Camús , Manuel Medina , Carina Aguilar Martín , Alessandra Queiroga Gonçalves , Ester Gavaldà-Espelta , Francesc Xavier Cos , Núria Nadal , Mireia Fàbregas , Francesc Fina , Leonardo Méndez-Boo , Elisabet Balló , Margarita Garcia Canela , Magdalena Lladó , Ariadna Mas , Ermengol Coma , Sara Rodoreda
Aim
To assess the impact of an electronic scheduling tool (Planificat) on the management of type 2 diabetes mellitus (T2DM) in primary care settings.
Methods
This paired cohort study used data from the Catalan primary care electronic health records. The intervention cohort, using Planificat, included all patients aged 15 years or older with T2DM and was matched 1:1 with a control cohort. The study period lasted one year. Mixed general linear models estimated Odds Ratios (OR) and 95 % confidence intervals (95 %CI) for primary outcomes, including T2DM clinical tests (LDL cholesterol, HbA1c), visit frequency, and non-attendance rates.
Results
A total of 51,619 patients (mean age 68.3 years, 42.1 % of female sex) and their paired controls were included. In the primary analysis, significant increases were observed in the Planificat group (N = 18,542) regarding several measures: cholesterol tests performed (83.5 % vs. 75.4 %; OR: 1.65 [95 %CI: 1.57–1.74]), HbA1c tests performed (83.7 % vs. 75.4 %; OR: 1.7 [95 %CI: 1.61–1.79]), and electrocardiograms (65 % vs. 52 %; OR: 1.72 [95 %CI: 1.65–1.8]). Additionally, there was a 36 % increase in patients achieving HbA1c levels < 8 % (OR: 1.36 [95 %CI: 1.3–1.42]). Statistically significant improvements of 30 % and 40 % were also observed in foot and retinopathy screenings, respectively. Face-to-face visits with general practitioners and non-attendance rates remained comparable between cohorts, while face-to-face nurse visits increased by 7 %.
Conclusions
Planificat significantly improved T2DM management indicators, promoting proactive scheduling and enhancing follow-up in primary care without impacting face-to-face visits. These findings support its integration as a complementary strategy for optimizing chronic disease management.
{"title":"Enhancing the follow-up for patients with type 2 diabetes mellitus using a proactive scheduling computer tool: A paired cohort study in primary care","authors":"Carolina Guiriguet , Mercè Bustos , Roser Cantenys , Eduardo Hermosilla , Joan Camús , Manuel Medina , Carina Aguilar Martín , Alessandra Queiroga Gonçalves , Ester Gavaldà-Espelta , Francesc Xavier Cos , Núria Nadal , Mireia Fàbregas , Francesc Fina , Leonardo Méndez-Boo , Elisabet Balló , Margarita Garcia Canela , Magdalena Lladó , Ariadna Mas , Ermengol Coma , Sara Rodoreda","doi":"10.1016/j.pcd.2025.03.009","DOIUrl":"10.1016/j.pcd.2025.03.009","url":null,"abstract":"<div><h3>Aim</h3><div>To assess the impact of an electronic scheduling tool (Planificat) on the management of type 2 diabetes mellitus (T2DM) in primary care settings.</div></div><div><h3>Methods</h3><div>This paired cohort study used data from the Catalan primary care electronic health records. The intervention cohort, using Planificat, included all patients aged 15 years or older with T2DM and was matched 1:1 with a control cohort. The study period lasted one year. Mixed general linear models estimated Odds Ratios (OR) and 95 % confidence intervals (95 %CI) for primary outcomes, including T2DM clinical tests (LDL cholesterol, HbA1c), visit frequency, and non-attendance rates.</div></div><div><h3>Results</h3><div>A total of 51,619 patients (mean age 68.3 years, 42.1 % of female sex) and their paired controls were included. In the primary analysis, significant increases were observed in the Planificat group (N = 18,542) regarding several measures: cholesterol tests performed (83.5 % vs. 75.4 %; OR: 1.65 [95 %CI: 1.57–1.74]), HbA1c tests performed (83.7 % vs. 75.4 %; OR: 1.7 [95 %CI: 1.61–1.79]), and electrocardiograms (65 % vs. 52 %; OR: 1.72 [95 %CI: 1.65–1.8]). Additionally, there was a 36 % increase in patients achieving HbA1c levels < 8 % (OR: 1.36 [95 %CI: 1.3–1.42]). Statistically significant improvements of 30 % and 40 % were also observed in foot and retinopathy screenings, respectively. Face-to-face visits with general practitioners and non-attendance rates remained comparable between cohorts, while face-to-face nurse visits increased by 7 %.</div></div><div><h3>Conclusions</h3><div>Planificat significantly improved T2DM management indicators, promoting proactive scheduling and enhancing follow-up in primary care without impacting face-to-face visits. These findings support its integration as a complementary strategy for optimizing chronic disease management.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 334-340"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744540","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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