Introducing a telemonitoring platform for diabetic patients in primary care: Will it increase the socio-digital divide?

Background: Effective treatment of diabetes is not enough alone, there must be education and training from physicians and nurses to patients. To achieve education in correct manner there must be enough knowledge of physicians to apply care and teaching of these patients. The aim of the study was to evaluate the knowledge and education of physicians to diabetic patients in primary care in Saudi Arabia.Methods: Successive evaluation investigation through questionnaire. The work universe was made up of the 83 service areas of the 15 municipalities of Saudi Arabia, the sample of the total of the incorporated areas was initially made up of 625 health providers and 2,171 people with diabetes.Results: At the beginning of the study, the highest percentage of health providers surveyed declared that they did not know (78%) or that it was not defined (16.6) who should educate the person with diabetes, while the results at the end of the study show that 32% mentioned the doctor and the nurse and 62.7 the entire team of work (p=0.000) with a more adequate vision on the definition of responsibility for the fulfilment of this task and a generalized knowledge (97.5) of the existence of an education program in d diabetes that was useful for their compliance.Conclusions: Extension of the diabetes education program to Saudi Arabia achieved a significant change in the opinions of health providers on the health problem.

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Abstract 3892: Brooklyn AWAReness of StrokE in Diabetes Mellitus

Stroke ◽

10.1161/str.43.suppl_1.a3892 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Kessarin Panichpisal ◽

Benedict Tan ◽

Yogesh Moradiya ◽

Hasan Memon ◽

Volodymyr Vulkanov ◽

...

Keyword(s):

Diabetes Mellitus ◽

Primary Care ◽

Risk Factor ◽

High Risk ◽

Primary Care Physicians ◽

Current Status ◽

Medical Complications ◽

High Risk Population ◽

Diabetic Patients ◽

Stroke Risk Factor

OBJECTIVE: Diabetes mellitus (DM) is a common risk factor for stroke. Hence stroke awareness is very critical in diabetic patients. In order to design effective educational strategies for stroke intervention and prevention in this high risk group, we assessed the current status of knowledge about stroke symptoms, risk factors and activation of emergency medical services in individuals with DM. METHOD: A hospital-based survey was conducted between February and August 2011. Subjects who have DM were interviewed at 2 sites by trained Internal medicine, Neurology residents and medical students using a structured, closed-ended questionnaire. RESULTS: Two hundred and thirty subjects were interviewed, 64% female and 71% Caribbean-American and African-American. Seventy five percent of subjects had hypertension. Only sixty percent of subjects knew that they were high risk of stroke and only 46% had been informed by their primary care physician about this risk. More than 75% did not know their hemoglobin a1c and cholesterol levels. Stroke and diabetic ketoacidosis were the least recognized medical complications of DM (29%) while diabetic foot ulcer and diabetic nephropathy were the most recognized complications (54%). Hypertension was the most identified stroke risk factor (66%). Eighty-nine percent of respondents identified two or more stroke symptoms. Only 58% of respondents would call 911 for a stroke scenario. Subjects having DM > 10 years (p=0.02) and graduating from high school (p=0.002) were more likely to call 911, while people who had a history of kidney disease were less likely to call 911 (p=0.024). The two most common sources of information about stroke that DM patients received were from their primary care physicians (43%) and family and friends (35%). CONCLUSION: Stroke is one of the least recognized medical complications in DM patients. Primary care physicians play a very important role of stroke education in this high risk population.

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Screening in Diabetes Care: Detecting and Managing Depression in Diabetes

Screening for Depression in Clinical Practice ◽

10.1093/oso/9780195380194.003.0019 ◽

2009 ◽

Author(s):

Norbert Hermanns ◽

Bernhard Kulzer

Keyword(s):

Primary Care ◽

Diabetes Care ◽

Meta Analysis ◽

Treatment Options ◽

Recognition Rate ◽

Depression Screening ◽

Screening Tests ◽

Diabetic Patients ◽

Primary Care Settings ◽

Care Approach

The analysis of depression screening in diabetes according to the four criteria of the United Kingdom’s National Screening Committee shows that both screening tests and treatment options are available. However, results of the Cochrane meta-analysis about depression screening in primary care settings indicate that the implementation of depression screening needs a structured approach to link these two components. A stepped-care approach comprising verification of positive screening results, treatment options, assessment of response to treatment, and adaptation may carry favorable results with regard to reduction of depression as well as cost-effectiveness. The association between diabetes and distress has long been recognized. In 1685 Thomas Willis, a British physician, suggested that diabetes might be a consequence of prolonged sorrow. In the middle of the 20th century Alexander regarded diabetes as one of the seven major psychosomatic diseases. In more recent years these historical observations have been supported by growing empirical evidence of a special relationship between emotional distress and diabetes. A meta-analysis regarding depression and diabetes onset showed that the presence of depressed symptoms increased the risk of developing diabetes by 37%. However, the effect is bidirectional. Meta-analytic findings suggest that the comorbidity of depression and diabetes is frequent: approximately one third of diabetic patients report symptoms of depression, and a smaller group of10%of diabetic patients meet the criteria of a clinical depression. In diabetes care settings the recognition rate of depression in diabetic patients is disappointingly low, ranging between20%and50%. Even in more specialized diabetes care settings approximately 50% of depressed diabetic patients remain undetected. Thus, there are strong and compelling arguments in favor of depression screening in diabetes, and this is also recommended by several guidelines for diabetes care (Fig. 16.1). However, there are also arguments against depression screening. Studies analyzing the effectiveness of depression screening in primary care settings do not all support large-scale implementation of depression screening. Increasingly, there is a need to justify depression screening in different medical conditions with regard to its effectiveness and ethical and clinical implications and to specify whether screening as a routine or more selective case-finding is warranted.12 Screening for depression potentially exposes both false positives and true positives (but otherwise unrecognized cases) to stigmatization and potential discrimination by health insurance companies or employers.

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PTU-036 Screening of type II diabetic patients for liver fibrosis with fibroscan in primary care

10.1136/gutjnl-2019-bsgabstracts.245 ◽

2019 ◽

Author(s):

Wilson Siu ◽

Megan Stephen ◽

Stuart Shand ◽

Pauline Dundas ◽

Ashis Mukhopadhya

Keyword(s):

Primary Care ◽

Liver Fibrosis ◽

Diabetic Patients ◽

Type Ii

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SELF-GLUCOSE MONITORING AND HYPOGLYCEMIA RISK IN OLDER RURAL VETERANS WITH TYPE 2 DIABETES

Innovation in Aging ◽

10.1093/geroni/igz038.980 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S263-S263

Author(s):

Willy Marcos Valencia ◽

Kaicheng Wang ◽

Kiranmayee Muralidhar ◽

Stuti Dang

Keyword(s):

Primary Care ◽

Glucose Monitoring ◽

Multivariate Logistic Regression Model ◽

High Risk Population ◽

Diabetic Patients ◽

Chi Square ◽

Self Monitoring ◽

Frequent Monitoring ◽

Primary Care Teams

Abstract Hypoglycemia evaluation is expected in every encounter with diabetic patients. However, self-monitoring and self-management may not be complete at home, and limited by geriatric syndromes. Furthermore, hypoglycemia risk increases with age, and rurality may limit access to frequent monitoring. We identified 112 rural veterans with high hypoglycemia risk, using the local medication database (sulfonylureas and insulin), combined with age and glycated hemoglobin (HbA1c). Statistical analyses were conduct using SAS 9.4 (Cary, NC). We used Chi-square, Fisher’s, One-way ANOVA for baseline variables, and a multivariate logistic regression model to assess the association of hypoglycemia and risk factors, including age, HbA1c%, self-monitoring, and knowledge. Hypoglycemia was reported in 30.4% of cases, of whom the majority were younger than those not reporting hypoglycemia (72.0±4.3 vs 75.0±6.5 years, p=.015). Baseline HbA1c% was higher in cases with hypoglycemia compared to those without (7.7±1.6% versus 7.3±1.2%, not statistically significant). There were no significant differences between pharmacologic regimens, self-monitoring, and general knowledge. Veterans who knew hypoglycemia symptoms were 6 times more likely to reported hypoglycemia, compared with veterans who did not know any symptoms. We contacted primary care teams (PCT) for whom medications were adjusted. Hypoglycemia risk is high in the older population, and telemedicine programs can support primary care teams to improve management of their patients. Poor symptom knowledge needs to be addressed, while considering special attention for hypoglycemia unawareness in the oldest age group. We are implementing a project using continuous glucose monitoring in this high-risk population.

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Primary care visits can reduce the risk of potentially avoidable hospitalizations among persons with diabetes in France

European Journal of Public Health ◽

10.1093/eurpub/ckaa137 ◽

2020 ◽

Vol 30 (6) ◽

pp. 1056-1061

Author(s):

Vera Georgescu ◽

Anders Green ◽

Peter B Jensen ◽

Sören Möller ◽

Eric Renard ◽

...

Keyword(s):

Primary Care ◽

Health Status ◽

Protective Effect ◽

Care Setting ◽

Primary Care Setting ◽

Exposure Period ◽

Diabetic Patients ◽

Indirect Measure ◽

Individual Level ◽

Avoidable Hospitalizations

Abstract Background Diabetes is a frequent chronic condition, which can lead to costly complications if not managed well in the primary care setting. Potentially avoidable hospitalizations (PAH) are considered as an indirect measure of primary care. However, the association between primary care use and PAH in diabetic patients has not been investigated in France. Methods We investigate the association between primary care indicators and PAH at an individual level among persons with diabetes in a population-based cohort study on the French national health insurance database (EGB sample). PAH occurrence in 2013 was modeled as a function of primary care use and access, health status and socio-economic indicators over the exposure period 2011–12 using a cause-specific hazards model with death as a competing event. Results We included 25 293 diabetics in our cohort, among which 385 (1.5%) experienced at least 1 PAH in 2013. After adjustment on health status indicators, primary care use had a protective effect against PAH. Diabetic patients who had seen a general practitioner (GP) 10–14 times had a reduced hazard of PAH compared to less frequent encounters (HR=0.49, P<0.001). The effect size decreased when the number of encounters increased, suggesting a remaining confounding effect of health status. Conclusions For the first time in France, this study shows a protective effect of the number of GP encounters against PAH at an individual level and highlights the importance of a frequent monitoring of diabetic patients in the primary care setting to prevent PAH occurrence.

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