scholarly journals Targeted Adherence Intervention to Reach Glycemic Control with Insulin Therapy for patients with Diabetes (TARGIT-Diabetes): rationale and design of a pragmatic randomised clinical trial

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016551 ◽  
Author(s):  
Jennifer Lewey ◽  
Wenhui Wei ◽  
Julie C Lauffenburger ◽  
Sagar Makanji ◽  
Alan Chant ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Glycaemic Control ◽  
Insulin Therapy ◽  
Predictive Analytics ◽  
Controlled Trial ◽  
Central Component ◽  
Telephone Consultation ◽  
Patients With Diabetes ◽  
Adherence Intervention ◽  
The Impact

IntroductionAdherence to and persistence of medications for chronic diseases remains poor and many interventions to improve medication use have only been modestly effective. Targeting interventions to patients who are most likely to benefit should improve their efficiency and clinical impact. This study aims to test the impact of three cost-equivalent pharmacist-led interventions on insulin persistence and glycaemic control among patients with diabetes.Methods and analysisTARGIT-Diabetes (Targeted Adherence Intervention to Reach Glycemic Control with Insulin Therapy for patients with Diabetes) is a randomised controlled trial that will evaluate three different multifaceted pharmacist-outreach strategies for improving long-term insulin use among individuals with diabetes. We will randomise 6000 patients in a large insurer to one of three arms. The arms are designed to deliver an increasingly intensive intervention to a progressively targeted population, identified using predictive analytics. The central component of the intervention in all arms is a tailored telephone consultation with a pharmacist which varies across arms based on the: (A) proportion of patients offered the intervention and (B) intervention intensity, including follow-up frequency and cointerventions such as text reminders and interactions with patients’ providers. The primary outcome is insulin persistence, assessed using pharmacy claims data, and the secondary outcomes are glycaemic control as measured by glycosylated haemoglobin values, healthcare utilisation and healthcare spending.Ethics and disseminationThis protocol has been approved by the Institutional Review Board of Brigham and Women’s Hospital and the Privacy Board of Horizon Blue Cross Blue Shield of New Jersey. We plan to present the results of this trial at national meetings and in manuscripts submitted to peer-reviewed journals.Trial registration numberNCT 02846779.

Abstract 15980: Effects of a Concurrent Strength and Endurance Training Program in Diabetes Patients a Randomized Controlled Trial

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Daniela Bassi ◽  
Vivian M Arakelian ◽  
Renata G Mendes ◽  
Flavia C Caruso ◽  
José C Bonjorno Júnior ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Repeated Measures ◽  
Functional Performance ◽  
Controlled Trial ◽  
Intervention Strategy ◽  
Peak Torque ◽  
Peak Oxygen Consumption ◽  
Significant Difference ◽  
Patients With Diabetes ◽  
The Impact

Background: The prevalence of diabetes have increased globally to epidemic proportions; glycemic control and treatment remains a challenge. Concurrent aerobic and resistance training programs (CART) have been widely recommended as an important strategy to improve physiologic and functional performance. Objective: The impact of CART programs on metabolic profile, glycemic control and exercise capacity status in patients with diabetes requires additional study, which is the primary aim of the current study. Materials and Methods: We evaluated 41 patients (15 female and 19 male, 50.8±7 years) with a confirmed diagnosis of diabetes. The subjects were randomized in two groups: sedentary group (SG) and CART group (CART-G). CART was performed 12 weeks, 3 times a week for approximately 1 hour per session (30 minutes aerobic and 30 minutes resistance). Body habitus was assessed by body mass index, waist circumference, and skinfolds. Peripheral muscular strength was evaluated by an isokinetic dynamometer and pulmonary gas exchange was measured breath-by-breath, using a portable telemetric system during maximal incremental exercise testing on a cycle ergometer. Statistical analysis included Shapiro-Wilk test follow by ANOVA two way repeated measures. Results: We observed a decrease in HbA1c (8.1±1.6 to 7.3±1.2%), cholesterol (198.38.1±50.3 to 186.8±35.1 mg/dL) and HOMA IR (6.4±6.8 to 5.0±1.4) in the CART-G compared to the SG. There was no significant difference in fasting plasma glucose. Although body weight did not significantly change after training, skinfold measurements indicated decreased body fat in the CART-G only. CART significantly enhanced muscle strength (p<0.05) (peak torque: 135.5±4 to 159.7±47.7 N.m) compared to the SG (Peak torque: 145.3±47.9 to 143±42.2 N.m). CART was also associated with a significant increase in peak oxygen consumption, from 22.9±6.1 to 27.2±4.7 ml•kg –1 •min –1 compared to the SG, from 21.7±4.5 to 21±3.3 ml•kg –1 •min –1 as well as the maximal workload (124.6±29.1 to 149.9±29 watts) compared to the SG (123.6±36.9 to 122.1±32.9 watts). Conclusion: We concluded that CART is an important intervention strategy, producing both physiologic and functional improvements, in patients with diabetes.

scholarly journals Muscle Strength and Glycaemic Control among Patients with Type 2 Diabetes

2020 ◽  
Author(s):  
Haya Abduhijleh ◽  
Joud Alalwani ◽  
Dana Alkhatib ◽  
Hiba Bawadi
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Muscle Strength ◽  
Glycaemic Control ◽  
Handgrip Strength ◽  
Poor Glycaemic Control ◽  
Patients With Diabetes ◽  
Insulin Use

Background: The prevalence of diabetes has been rising sharply since 1980, reaching 422 million cases worldwide in 2014. Physical activity and handgrip strength may be associated with good glycaemic control among patients with diabetes Objective: We tested the association between handgrip strength and glycemic control in type 2 diabetes patients, from National Health and Nutritional Examination Survey NHANES 2011-2014 and the contribution of the study covariates to this association. Hypothesis: Muscle strength is positively associated with glycemic control in type two diabetes. Methodology: This cross-sectional study examined the association between handgrip strength and glycaemic control among patients with diabetes. Data on 1058 participants aged 40 and older were collected from the NHANES. Muscle strength was assessed using a handgrip dynamometer, and blood samples were obtained to observe the glycaemic control values. Height, body weight, physical activity, insulin use, smoking status, alcohol use, participant demographics, and income-to-poverty ratio were all considered in the study. Results: logistic regression analysis was used to assess the association between handgrip strength and poor glycaemic control among participants with diabetes. Three models were used, each model adjusted to include different variables. OR values revealed no association between handgrip strength and glycaemic control. However, model 2, which was adjusted for sedentary activity, income-topoverty ratio, education, and smoking, shows a trend towards an association. Patients in quartile 4 of handgrip had 0.59 odds of poor glycaemic control, OR = 0.59 (95% CI: 0.34–1.02). However, in model 3 this effect was diluted when further adjusted for insulin use, OR = 0.81 (95% CI: 0.47– 1.38). Further analysis was performed to examine the mean decline in handgrip strength among non-insulin and insulin users. Non-insulin users, both men and women, have higher handgrip strength as compared to insulin users. Conclusion: There was no association found between handgrip and glycaemic control among patients with diabetes.

scholarly journals The Impact of a Nursing Strike on Glycemic Control in Hospitalized Patients with Diabetes

Cureus ◽  
2021 ◽  
Author(s):  
Kelsey H Sheahan ◽  
Amanda G Kennedy ◽  
Bradley J Tompkins ◽  
Allen B Repp ◽  
Matthew P Gilbert
Keyword(s):  
Glycemic Control ◽  
Hospitalized Patients ◽  
Patients With Diabetes ◽  
The Impact

scholarly journals Impact of Brief Smoking Cessation Intervention on Abstinence Rate and Glycaemic Control in Patients with Diabetes Mellitus: A Randomised Controlled Trial

2021 ◽  
Author(s):  
Khansaa Albaroodi ◽  
Syed Azhar Syed Sulaiman ◽  
Ahmed Awaisu ◽  
Asrul Shafie
Keyword(s):  
Blood Pressure ◽  
Smoking Cessation ◽  
Randomised Controlled Trial ◽  
Glycaemic Control ◽  
Tobacco Cessation ◽  
Controlled Trial ◽  
Smoking Cessation Intervention ◽  
Cessation Intervention ◽  
Patients With Diabetes ◽  
Randomised Controlled

Abstract Aims: This study aimed to evaluate the impact of brief smoking cessation intervention on smoking cessation outcomes as well as on glycaemic and blood pressure control among patients with diabetes.Methods: This was a randomised controlled trial involving patients with diabetes who smoked tobacco and attended the out-patient Diabetes Clinic at Penang Hospital in Malaysia. One hundred forty participants were randomised into either control (n = 70) or intervention (n = 70) groups. The intervention consisted of a 5-minute physician-delivered brief counselling on tobacco cessation using 5A’s strategy (Ask, Advise, Assess, Assist, and Arrange) in addition to usual care for patients with diabetes, while the control group received only the usual care. Results: There was no significant difference between the two groups with respect to glucose control, blood pressure levels, and smoking abstinence rates (P >0.05). Furthermore, significant main effects were found between the groups with respect to the number of cigarettes smoked per day (F [1,116] = 6.306). Conclusions: Brief smoking cessation intervention did not result in better abstinence rates or glycaemic control in patients with diabetes. However, it resulted in reduction in the number of cigarettes smoked per day over the study period (6 months), which is the first step in the tobacco cessation process. Trial registrationApproval for the conduct of this study was granted by the Medical Research Ethics Committee of the Ministry of Health, Malaysia and the Clinical Research Centre at Hospital Pulau Pinang, Malaysia (NMRR-11-477-9538) at (05-10-2011).

scholarly journals An Analysis of Medtronic Minimed 670g Insulin Pump Use in Clinical Practice and the Impact on Glycemic Control, Quality of Life, and Compliance

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A455-A456
Author(s):  
Maxwell E Horowitz ◽  
William Kaye ◽  
Gary Pepper ◽  
Kathyrn Reynolds ◽  
Shital Patel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Insulin Pump ◽  
Control Quality ◽  
The Mean ◽  
Reasonable Choice ◽  
High Degree ◽  
The Impact

Abstract Background: This study evaluated the use of the Medtronic MiniMed 670G system in adults with type 1 diabetes mellitus from a large endocrinology practice and its impact on glycemic control, quality of life (QoL), compliance and safety. Methods: 84 participants completed one site visit for data collection. Percentage of time in range (TIR: 70–180 mg/dL), hyperglycemia (&gt;180 mg/dL), hypoglycemia (&lt;70 mg/dL), HbA1c, average blood glucose (ABG), and other metrics were evaluated at the last visit using the system (LVMM) and compared between the last visit on previous insulin therapy (LVPT). Participants completed three questionnaires to assess QoL. Continuation of the auto mode feature was determined to assess compliance. Results: The mean percentage of TIR at the LVPT was 46.26 ± 18.82% while that at the LVMM was 73.39 ± 12.95%. This represents a significant increase in percentage of TIR of 27.13% (p &lt; 0.001). The mean percentage of time in hyperglycemia at the LVPT was 47.42 ± 20.39% while that at the LVMM was 23.51 ± 11.65%, representing a significant decrease of 23.90% (p &lt; 0.001). The mean percentage of time in hypoglycemia at the LVPT was 6.17 ± 7.91% while that at the LVMM was 2.94 ± 4.72%, representing a significant decrease of 3.22% (p = 0.004). The mean HbA1c at the LVPT was 7.36 ± 1.03% (57 mmol/mol) while that at the LVMM was 7.45 ± 0.85% (58 mmol/mol), representing an increase of 0.09% (p = 0.337). For those with HbA1c greater than or equal to 7.5% at LVPT, the mean HbA1c at the LVPT was 8.49 ± 0.78% (69 mmol/mol) while that at the LVMM was 8.00 ± 0.85% (64 mmol/mol), representing a significant decrease of 0.48% (p = 0.007). For those with HbA1c less than 7.5% at LVPT, the mean HbA1c at the LVPT was 6.78 ± 0.53% (51 mmol/mol) while that at the LVMM was 7.16 ± 0.69% (55 mmol/mol), representing a significant increase of 0.38% (p&lt; 0.001). Patients with LVPT HbA1c less than 7.5% (58 mmol/mol) had a significant reduction in hypoglycemia (&lt;70 mg/dL) from 7.40% to 2.56% (p = 0.001), whereas the reduction in patients with LVPT HbA1c greater than or equal to 7.5% (58 mmol/mol) was from 4.11% to 3.59% (p = 0.758). QoL questionnaires revealed good satisfaction with the system and 86% of participants continued use in auto mode. Conclusions: The use of the Medtronic MiniMed 670G system resulted in a TIR above the recommended target and a significant increase in the percentage of TIR compared to previous insulin therapy. While there was no significant change in HbA1c in the overall population, those with higher HbA1c values at baseline had a reduced percentage of time in hyperglycemia, while those with lower HbA1c values had a reduced percentage of time in hypoglycemia, indicating improvement in parameters specific to each subgroup. The system may be a reasonable choice for patients struggling with significant amounts of hypoglycemia. Use of the system resulted in a high degree of patient satisfaction and excellent compliance in the use of the system.

scholarly journals Flash CGM Is Associated With Reduced Diabetes Events and Hospitalizations in Insulin-Treated Type 2 Diabetes

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Richard M Bergenstal ◽  
Matthew S D Kerr ◽  
Gregory J Roberts ◽  
Diana Souto ◽  
Yelena Nabutovsky ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Emergency Services ◽  
Glucose Monitoring ◽  
Emergency Department Utilization ◽  
Acting Insulin ◽  
Acute Diabetes ◽  
The Impact

Abstract Purpose Suboptimal glycemic control among individuals with diabetes is a leading cause of hospitalizations and emergency department utilization. Use of flash continuous glucose monitoring (flash CGM) improves glycemic control in type 1 and type 2 diabetes, which may result in lower risk for acute and chronic complications that require emergency services and/or hospitalizations. Methods In this retrospective, real-world study, we analyzed IBM MarketScan Commercial Claims and Medicare Supplemental databases to assess the impact of flash CGM on diabetes-related events and hospitalizations in a cohort of 2463 individuals with type 2 diabetes who were on short- or rapid-acting insulin therapy. Outcomes were changes in acute diabetes-related events (ADE) and all-cause inpatient hospitalizations (ACH), occurring during the first 6 months after acquiring the flash CGM system compared with event rates during the 6 months prior to system acquisition. ICD-10 codes were used to identify ADE for hypoglycemia, hypoglycemic coma, hyperglycemia, diabetic ketoacidosis, and hyperosmolarity. Results ADE rates decreased from 0.180 to 0.072 events/patient-year (hazard ratio [HR]: 0.39 [0.30, 0.51]; P &lt; 0.001) and ACH rates decreased from 0.420 to 0.283 events/patient-year (HR: 0.68 [0.59 0.78]; P &lt; 0.001). ADE reduction occurred regardless of age or gender. Conclusions Acquisition of the flash CGM system was associated with reductions in ADE and ACH. These findings provide support for the use of flash CGM in type 2 diabetes patients treated with short- or rapid-acting insulin therapy to improve clinical outcomes and potentially reduce costs.

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