GPs' views on how low socioeconomic position affects diabetes management: an exploratory study

2004 ◽  
Vol 10 (3) ◽  
pp. 120 ◽  
Author(s):  
Vanessa Rose ◽  
Mark Harris ◽  
Maria Theresa Ho
Keyword(s):  
Socioeconomic Position ◽  
Diabetes Management ◽  
Financial Incentive ◽  
Educational Materials ◽  
Negative Attitudes ◽  
Low Socioeconomic ◽  
Low Health Literacy ◽  
Patient Barriers

Little is known about general practitioners? (GP) capacity to effectively manage diabetes among patients of low socioeconomic position (SEP), despite the high burden of type 2 diabetes in this group. Nine GPs involved in a diabetes program and practising in an area of socioeconomic disadvantage participated in a focus group on low-SEP patient barriers to diabetes management, GP problems in managing diabetes among this group, and strategies for improving diabetes management with low-SEP patients. GPs perceived that low health literacy, poverty and psychosocial issues, and negative attitudes towards health were barriers to diabetes management among low-SEP patients. Difficulties in providing care to low-SEP patients were related to the availability of allied health services and GP perceptions of increased stress in providing care to this group. Suggestions for improvements in diabetes management were focussed on providing educational materials to low-SEP patients that matched literacy levels, and initiating patient financial incentive schemes to assist diabetes management and attendance at follow-up consultations.

scholarly journals Does Two-Year Stability for Scale Scores of Psychosocial Factors Differ by Socioeconomic Position?

2009 ◽  
Vol 105 (3_suppl) ◽  
pp. 1009-1022 ◽  
Author(s):  
Johanna Lundberg ◽  
Nadine Karlsson ◽  
Margareta Kristenson
Keyword(s):  
Longitudinal Studies ◽  
Psychosocial Factors ◽  
Socioeconomic Position ◽  
Men And Women ◽  
Low Socioeconomic ◽  
Psychometric Scales ◽  
Scale Scores ◽  
The Stability ◽  
Attenuation Bias

Previous longitudinal studies have demonstrated the importance of measuring stability of risk factors over time to correct for attenuation bias. The present aim was to assess the stability of scores for eight psychometric scales over a 2-yr. period and whether stability differed by socioeconomic position. Baseline data were collected during 2003–2004 from 1,007 men and women ages 45 to 69 years. Follow-up data were collected in 2006 from a total of 795 men and women. Analysis showed that stability over 2 yr. was moderate and tended to be lower in groups of low socioeconomic position. It is suggested that correction of attenuation bias is relevant in longitudinal studies for psychosocial factors, especially for groups of low socioeconomic position.

Moving Diabetes Management From Clinic to Community: Development of a Prototype Based on Automated Voice Messaging

1997 ◽  
Vol 23 (6) ◽  
pp. 672-680 ◽  
Author(s):  
John D. Piette
Keyword(s):  
Patient Monitoring ◽  
Diabetes Management ◽  
Diabetes Education ◽  
Public Healthcare ◽  
Management Service ◽  
Randomized Controlled ◽  
Voice Messaging ◽  
Patients With Diabetes

The purpose of this study is twofold. First, it provides a review of the literature supporting the development of a new service to help patients with diabetes and their providers manage their care. This service, automated voice messaging (A VM) with nurse follow-up, allows for systematic and intensive patient monitoring and diabetes education as well as a means of focusing clinical resources where they are most needed. Second, it provides a description of a prototype AVM-based diabetes management service that has been developed as part of two ongoing, randomized, controlled trials to test the efficacy of AVM care for patients with Type 2 diabetes. Preliminary findings from implementing this service in two large public healthcare systems suggest that AVM-supported care is feasible, desirable by clinicians and patients with diabetes, and may identify serious health problems that otherwise would go unnoted through standard means of clinic-based patient care.

scholarly journals Depression and microvascular complications predict poor goal achievement among Colombian patients with type 2 diabetes

2017 ◽  
Vol 3 (2) ◽  
pp. 36-47
Author(s):  
Catalina Sanmiguel ◽  
María C. Luna ◽  
William Kattah ◽  
Carlos O. Mendivil
Keyword(s):  
Type 2 Diabetes ◽  
Metabolic Control ◽  
Latin American ◽  
Diabetes Management ◽  
Microvascular Complications ◽  
Good Control ◽  
Therapeutic Success ◽  
Poor Metabolic Control

Aims: Many patients with type 2 diabetes (DM2) in Latin American countries remain insufficiently controlled. We aimed to identify factors associated with persistent poor metabolic control in Colombian patients with DM2.Methods: Retrospective one-year follow-up cohort study of adult patients with DM2. The primary outcome was persistent poor metabolic control (PPMC): HbA1c level >8% in all measurements during follow-up. Secondary outcomes were intermittent poor metabolic control (IPMC) and good control (GC: simultaneous achievement of HbA1c, blood pressure and LDL cholesterol goals). Multiple demographic, clinical and laboratory variables were predictors in multivariable logistical models. Results: Of 399 patients included, 50 had the primary endpoint during follow-up. Older age was negatively associated with PPMC (OR 0.40, 95%CI 0.17-0.92 for extreme quartiles), even after multivariate adjustment. Depression and the presence of multiple microvascular complications were strongly associated with the secondary endpoint IPMC (multivariate OR respectively 4.2, 95%CI 1.08-16.4 for depression; 5.61, 95%CI 1.03-30.6 for microvascular complications). Being unemployed was associated with significantly less odds of achieving GC (multivariate OR 0.19, 95%CI 0.04-0.95). Conclusions: Age, depression, the presence of microvascular complications and employment status were associated with the success or failure of diabetes management. These factors were better correlates of therapeutic success than the pharmacological agent employed.

Socioeconomic position and effectiveness of lifestyle intervention in prevention of type 2 diabetes: One-year follow-up of the FIN-D2D project

2011 ◽  
Vol 39 (6) ◽  
pp. 561-570 ◽  
Author(s):  
Nina Rautio ◽  
Jari Jokelainen ◽  
Heikki Oksa ◽  
Timo Saaristo ◽  
Markku Peltonen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Lifestyle Intervention ◽  
Socioeconomic Position ◽  
One Year

scholarly journals Is insulin the preferred treatment in persons with type 2 diabetes and liver cirrhosis?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fu-Shun Yen ◽  
Jung-Nien Lai ◽  
James Cheng-Chung Wei ◽  
Lu-Ting Chiu ◽  
Chih-Cheng Hsu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Liver Cirrhosis ◽  
Cardiovascular Events ◽  
Diabetes Management ◽  
Decompensated Cirrhosis ◽  
Research Database ◽  
Long Term Effects ◽  
Major Cardiovascular Events

Abstract Background Insulin is highly recommended for diabetes management in persons with liver cirrhosis. However, few studies have evaluated its long-term effects in these persons. We conducted this study to compare the risks of mortality, liver-related complications, and cardiovascular events in persons with type 2 diabetes mellitus (T2DM) and compensated liver cirrhosis. Methods From January 1, 2000, to December 31, 2012, we selected 2047 insulin users and 4094 propensity score-matched nonusers from Taiwan’s National Health Insurance Research Database. Cox proportional hazard models were used to assess the risks of outcomes. Results The mean follow-up time was 5.84 years. The death rate during the follow-up period was 5.28 and 4.07 per 100 person-years for insulin users and nonusers, respectively. In insulin users, the hazard ratios and 95% confidence intervals (CIs) of all-cause mortality, hepatocellular carcinoma, decompensated cirrhosis, hepatic failure, major cardiovascular events, and hypoglycemia were 1.31 (1.18–1.45), 1.18 (1.05–1.34), 1.53 (1.35–1.72), 1.26 (1.42–1.86), 1.41 (1.23–1.62), and 3.33 (2.45–4.53), respectively. Conclusions This retrospective cohort study indicated that among persons with T2DM and compensated liver cirrhosis, insulin users were associated with higher risks of death, liver-related complications, cardiovascular events, and hypoglycemia compared with insulin nonusers.

scholarly journals Occurrence of comorbidities in newly diagnosed type 2 diabetes patients and their impact after 11 years’ follow-up

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sophia Eilat-Tsanani ◽  
Avital Margalit ◽  
Liran Nevet Golan
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Management ◽  
Newly Diagnosed ◽  
Risk Of Death ◽  
High Prevalence ◽  
Long Term Follow Up ◽  
New Onset

AbstractThe burden of type 2 diabetes is growing, not only through increased incidence, but also through its comorbidities. Concordant comorbidities for type 2 diabetes, such as cardiovascular diseases, are considered expected outcomes of the disease or disease complications, while discordant comorbidities are not considered to be directly related to type 2 diabetes and are less extensively addressed under diabetes management. Here we show that the combination of concordant and discordant comorbidities appears frequently in persons with diabetes (75%). Persons with combined comorbidities visited family physicians more than persons with discordant, concordant or no comorbidity (17.3 ± 10.2, 11.6 ± 6.5, 8.7 ± 6.8, 6.3 ± 6.6 visits/person/year respectively, p < 0.0001). The risk of death during the study period was highest in persons with combined comorbidities and discordant only comorbidities (HR = 33.4; 95% CI 12.5–89.2 and HR = 33.5; 95% CI 11.7–95.8), emphasizing the contribution of discordant comorbidities to the outcome. Our study is unique as a long-term follow-up of an 11-year cohort of 9725 persons with new-onset type 2 diabetes. The findings highlight the contribution of discordant comorbidity to the burden of the disease. The high prevalence of the combination of both concordant and discordant comorbidities, and their appearance before the onset of type 2 diabetes, indicates a continuum of morbidity.

scholarly journals Clinical Features, Biochemical Profile, and Response to Standard Treatment in Lean, Normal-Weight, and Overweight/Obese Indian Type 2 Diabetes Patients

2021 ◽  
Vol 17 (2) ◽  
pp. 68-74
Author(s):  
Ahmad Faraz ◽  
Hamid Ashraf ◽  
Jamal Ahmad
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Diabetes Management ◽  
Normal Weight ◽  
Cross Sectional ◽  
Northern India

BACKGROUND: Much evidence is available on the relationship between type 2 diabetes mellitus (T2D) and obesity, but less on T2D in lean individuals. AIM: This study was conducted in 12,069 T2D patients from northern India to find out which clinical and biochemical features are related to lean, normal weight, and overweight/obese T2D patients. METHODS: The study was conducted at two endocrine clinics in northern India as a retrospective cross-sectional study. The records of all patients who attended these clinics from January 2018 to December 2019 were screened. After screening 13,400 patients, 12,069 were labelled as type 2 diabetes mellitus according to the criteria of the American Diabetes Association, 2020, and were included in the study. The patients were subdivided into the three groups by their body mass index (BMI): lean (BMI < 18), normal weight (BMI = 18-22.9), overweight/obese (BMI ≥ 23). The study evaluated how the three subgroups responded to standard diabetes management, including antidiabetic medication and lifestyle interventions. RESULTS: Of a total of 12,069 patients 327 (2.7%) were lean, 1,841 (15.2%) of normal weight, and 9,906 (82.1%) overweight/obese. Lean patients were younger, but had more severe episodes of hyperglycemia. All three subgroups experienced significant improvements in glycemic control during follow-up; HbA1c values were significantly lowered in the overweight/obese group during follow-up compared with baseline. CONCLUSIONS: While overweight/obese patients could benefit from the improvements in glycemic control achieved by lowering HbA1c, lean and normal-weight patients had more severe and difficult-to-control hyperglycemia.

Socioeconomic position and cardiovascular risk factors among people with screen-detected Type 2 DM: Six-year follow-up of the ADDITION-Denmark trial

2014 ◽  
Vol 8 (4) ◽  
pp. 322-329 ◽  
Author(s):  
Else-Marie Dalsgaard ◽  
Mogens Vestergaard ◽  
Mette Vinther Skriver ◽  
Knut Borch-Johnsen ◽  
Torsten Lauritzen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Socioeconomic Position ◽  
Type 2 Dm

scholarly journals Follow-up care delivery in community-based hypertension and type 2 diabetes management: a multi-centre, survey study among rural primary care physicians in China

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yi Wang ◽  
Xiu-Jing Hu ◽  
Harry H. X. Wang ◽  
Hong-Yan Duan ◽  
Ying Chen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Diabetes Management ◽  
Care Delivery ◽  
Target Frequency ◽  
Rural Primary Care ◽  
Follow Up Care

Abstract Background Follow-up care is crucial but challenging for disease management particularly in rural areas with limited healthcare resources and clinical capacity, yet few studies have been conducted from the perspective of rural primary care physicians (PCPs). We assessed the frequency of follow-up care delivered by rural PCPs for hypertension and type 2 diabetes – the two most common long-term conditions. Methods We conducted a multi-centre, self-administered survey study built upon existing general practice course programmes for rural PCPs in four provinces. Information on follow-up care delivery were collected from rural PCPs attending centralised in-class teaching sessions using a set of close-ended, multiple choice questions. Binary logistic regression analysis was performed to examine physician-level factors associated with non-attainment of the target frequency of follow-up care for hypertension and type 2 diabetes, respectively. The final sample consisted of rural PCPs from 52 township-level regions. The Complex Samples module was used in the statistical analysis to account for the multistage sample design. Results The overall response rate was 91.4%. Around one fifth of PCPs in rural practices did not achieve the target frequency of follow-up care delivery (18.7% for hypertension; 21.6% for type 2 diabetes). Higher education level of physicians, increased volume of daily patients seen, and no provision of home visits were risk factors for non-attainment of the target frequency of follow-up care for both conditions. Moreover, village physicians with less working experiences tended to have less frequent follow-up care delivery in type 2 diabetes management. Conclusions Efforts that are solely devoted to enhancing rural physicians’ education may not directly translate into strong motivation and active commitment to service provision given the possible existence of clinical inertia and workload-related factors. Risk factors identified for target non-attainment in the follow-up care delivery may provide areas for capacity building programmes in rural primary care practice.

Improved Glycemic Control With a Digital Health Intervention in Adults With Type 2 Diabetes: Retrospective Study (Preprint)

2021 ◽  
Author(s):  
Gretchen Zimmermann ◽  
Aarathi Venkatesan ◽  
Kelly Rawlings ◽  
Michael Scahill
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Diabetes Management ◽  
Digital Health ◽  
Management Program ◽  
Health Intervention ◽  
Diabetes Management Program ◽  
Program Engagement

BACKGROUND Traditional lifestyle interventions have shown limited success in improving diabetes related outcomes. Digital interventions with continuously available support and personalized educational content may offer unique advantages for self-management and glycemic control. OBJECTIVE In the present study, we evaluate changes in glycemic control among participants with type 2 diabetes who enrolled in a digital diabetes management program. METHODS The study employed a single-arm, retrospective design. A total of 950 participants with a HbA1c baseline value of at least 7.0% enrolled in the Vida Health Diabetes Management Program. The intervention included one-to-one remote sessions with a Vida provider and structured lessons and tools related to diabetes management. Hemoglobin A1c (HbA1c) was the primary outcome measure. A total of 258 (27.2%) participants had a follow-up HbA1c completed at least 90 days from program start. Paired t-tests were utilized to evaluate changes in HbA1c between baseline and follow-up. Additionally, a cluster-robust multiple regression analysis was employed to evaluate the relationship between high and low program engagement and HbA1c change. A repeated measures ANOVA was used to evaluate difference in HbA1c as a function of measurement period (ie, pre-Vida enrollment, baseline, and post-enrollment follow-up). RESULTS We observed a significant reduction in HbA1c of -0.81 points between baseline (M = 8.68, SD = 1.7) and follow-up (M = 7.88, SD = 1.46), t(257) = 7.71, P = .00). Among participants considered high-risk (baseline HbA1c >= 8), there was an average reduction of -1.44 points between baseline (M = 9.73, SD = 1.68) and follow-up (M = 8.29, SD = 1.64), t(139) = 9.14, P = .00). Additionally, average follow-up HbA1c (M = 7.82, SD = 1.41) was significantly lower than pre-enrollment HbA1c (M = 8.12, SD = 1.46), F(2, 210) = 22.90, P = .00. There was also significant effect of engagement on HbA1c change, β = -.60, P = .00, such that high engagement was associated with a greater decrease in HbA1c (M = -1.02, SD = 1.60) compared to low-engagement, (M = -.61, SD = 1.72). CONCLUSIONS The present study revealed clinically meaningful improvements in glycemic control among participants enrolled in a digital diabetes management intervention. Higher program engagement was associated with greater improvements in HbA1c. The findings of the present study suggest that digital health intervention may represent an accessible, scalable, and effective solution to diabetes management and improved HbA1c. The study was limited by a non-randomized, observational design and limited post-enrollment follow-up data.

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