Glycemic control of type 2 diabetes mellitus across stages of renal impairment: information for primary care providers

Introduction: One of the greatest threats to achieving tight glycemic control is hypoglycemia, which can lead to decreased drug compliance, cardiovascular events, and even mortality. There is lack of literature on this complication in the Indian setting. This study will aid the primary care physician to achieve better glycemic control of the diabetic patients and provide patient education to prevent hypoglycemia. Materials and Methods: It was a cross-sectional study in which 390 patients with type 2 diabetes mellitus getting treated in a primary health center were assessed for symptoms of hypoglycemia. Results: Prevalence of hypoglycemia was 57.44% (95% CI 52.48-62.25). Severe hypoglycemia was found in 10.7% of the patients. The first reported symptom of hypoglycemia was dizziness (72.3%). The most common etiological factor leading to hypoglycemia was missing a meal (89.3%). Females were at a significant higher risk of developing hypoglycemia (OR 1.2, 95% CI 1.04-1.3, P < .05). Conclusion: This study has established the high prevalence of self-reported hypoglycaemia in the rural settings where resources are limited to monitor the glucose levels. The high prevalence urges the need for the primary care physicians to enquire about the hypoglycemic symptoms to all diabetic patients at each visit. It is also important to educate these patients about the symptoms of hypoglycemia and the importance of reporting of such symptoms, which will help in adjusting dose and preventing future attacks.

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Effectiveness of the Low Carb Program digital intervention to instigate and sustain self-management of type 2 diabetes and prediabetes in an NHS England GP practice: service evaluation of real-world data (Preprint)

10.2196/preprints.25751 ◽

2020 ◽

Author(s):

Charlotte Summers ◽

Simon Tobin ◽

David Unwin

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Primary Care ◽

Weight Loss ◽

Type 2 Diabetes Mellitus ◽

Body Weight ◽

Glycemic Control ◽

Real World ◽

Self Management

BACKGROUND Type 2 diabetes mellitus has serious health consequences, including blindness, amputation, and stroke. There is increasing evidence that type 2 diabetes may be effectively treated with a carbohydrate-reduced diet. Digital apps are increasingly used as an adjunct to traditional health care provisions to support behaviour change and remote self-management of long-term health conditions. OBJECTIVE Our objective was to evaluate the real-world 12-month outcomes of patients prescribed the Low Carb Program (LCP) digital health at a primary care NHS site, Norwood Surgery in Southport, United Kingdom. The Low Carb Program is a nutritionally focused, digitally delivered behaviour change intervention for glycemic control and weight loss for adults with prediabetes and type 2 diabetes. METHODS We evaluated the real-world, self-reported outcomes of patients referred to the Low Carb Program by doctors at an NHS GP surgery in Southport, United Kingdom. All of the NHS patients referred to the program were diagnosed with Type 2 diabetes mellitus (T2DM) or prediabetes and given the program at no cost (N=45; mean age 54.8, SD 13.2 years; 42% (19/45) women; mean glycated hemoglobin A1c (HbA1c) 56.7 mmol/mol (range 42.1mmol/mol - 96.7mmol/mol); mean body weight 89.4 kg (SD 13.8 kg). RESULTS Of the 100 people offered the program 45 participants enrolled, all of them (100%) activated their accounts and 37 (82.2%) individuals self-reported outcomes at 12-months. Of those who enrolled 45 (100%) patients completed at least 40% of the lessons, 32 (71.1%) individuals completed >9 out of 12 core lessons of the program. Glycemic control and weight loss improved, particularly for participants who completed >9 of the 12 core lessons in the program over 12-months; mean HbA1c went from 58.8 mmol/mol at baseline to 54.0 mmol/mol (4.78 mmol/mol, SD 4.60), t(31)=5.87, p<0.001) and reported an average 4.17% total body weight reduction with an average reduction of 3.85kg (SD 2.35), t(31)=9.27, p<0.001) at the 12-month follow up point. CONCLUSIONS Though the data presented here has several limitations, the use of a digital app prescribed to adults with T2DM or prediabetes in a primary care setting supporting a transition to a low carbohydrate diet appears to show significant improvements in glycaemic control and weight loss. Further research to understand more about factors affecting engagement and further positive health implications would be valuable.

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