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.

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 Different Effects of Lifestyle Intervention in High- and Low-Risk Prediabetes

2021 ◽  
Author(s):  
Andreas Fritsche ◽  
Robert Wagner ◽  
Martin Heni ◽  
Kostantinos Kantartzis ◽  
Jürgen Machann ◽  
...  
Keyword(s):  
High Risk ◽  
Lifestyle Intervention ◽  
Low Risk ◽  
Liver Fat ◽  
Liver Fat Content ◽  
Randomized Controlled ◽  
The Difference ◽  
Prevention Of Diabetes

Lifestyle intervention (LI) can prevent type 2 diabetes, but response to LI varies depending on risk subphenotypes. We tested if prediabetic individuals with low risk benefit from conventional LI and individuals with high risk benefit from an intensification of LI in a multi-center randomized controlled intervention over 12 months with 2 years follow up. 1105 prediabetic individuals based on ADA glucose criteria were stratified into a high- and low-risk phenotype, based on previously described thresholds of insulin secretion, insulin sensitivity and liver fat content. Low-risk individuals were randomly assigned to conventional LI according to the DPP protocol or control (1:1), high-risk individuals to conventional or intensified LI with doubling of required exercise (1:1). A total of 908 (82%) participants completed the study. In high-risk individuals, the difference between conventional and intensified LI in post-challenge glucose change was -0.29 mmol/l [CI:-0.54;-0.04], p=0.025. Liver fat (-1.34 percentage points [CI:-2.17;-0.50], p=0.002) and cardiovascular risk (-1.82[CI:-3.13-0.50],p=0.007) underwent larger reductions with intensified than with conventional LI. During a follow up of 3 years, intensified compared to conventional LI had a higher probability to normalize glucose tolerance (p=0.008). In conclusion, it is possible in high-risk individuals with prediabetes to improve glycemic and cardiometabolic outcomes by intensification of LI. Individualized, risk-phenotype-based LI may be beneficial for the prevention of diabetes.

scholarly journals Effectiveness and economic impact of a diabetes education program among adults with type 2 diabetes in South Texas

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matthew Lee Smith ◽  
Lixian Zhong ◽  
Shinduk Lee ◽  
Samuel D. Towne ◽  
Marcia G. Ory
Keyword(s):  
Type 2 Diabetes ◽  
Health Disparities ◽  
Education Program ◽  
Hemoglobin A1c ◽  
Diabetes Education ◽  
Cost Savings ◽  
South Texas ◽  
Outcome Variable

Abstract Background The long-term growth and sustained high prevalence of obesity in the US is likely to increase the burden of Type 2 diabetes. Hispanic individuals are particularly burdened by a larger share of diabetes than non-Hispanic White individuals. Given the existing health disparities facing this population, we aimed to examine the effectiveness and potential cost savings of the Diabetes Education Program (DEP) offered as part of Healthy South Texas, a state-legislated initiative to reduce health disparities in 27 counties in South Texas with a high proportion of Hispanic adults. Methods DEP is an 8-h interactive workshop taught in English and Spanish. After the workshop, participants receive quarterly biometric screenings and continuing education with a health educator for one year. Data were analyzed from 3859 DEP participants with Type 2 diabetes living in South Texas at five time points (baseline, 3-months, 6-months, 9-months, 12-months). The primary outcome variable of interest for study analyses was A1c. A series of independent sample t-tests and linear mixed-model regression analyses were used to identify changes over time. Two methods were then applied to estimate healthcare costs savings associated with A1c reductions among participants. Results The majority of participants were ages 45–64 years (58%), female (60%), Hispanic (66%), and had a high school education or less (75%). At baseline, the average hemoglobin A1c was 8.57%. The most substantial reductions in hemoglobin A1c were identified from baseline to 3-month follow-up (P < 0.001); however, the reduction in A1c remained significant from baseline to 12-month follow-up (P < 0.001). The healthcare cost savings associated with improved A1c for the program was estimated to be between $5.3 to $5.6 million over a two to three year period. Conclusion Findings support the effectiveness of DEP with ongoing follow-up for sustained diabetes risk management. While such interventions foster clinical-community collaboration and can improve patient adherence to recommended lifestyle behaviors, opportunities exist to complement DEP with other resources and services to enhance program benefits. Policy makers and other key stakeholders can assess the lessons learned in this effort to tailor and expand similar initiatives to potentially at-risk populations. Trial registration This community-based intervention is not considered a trial by ICMJE definitions, and has not be registered as such.

scholarly journals Different Effects of Lifestyle Intervention in High- and Low-Risk Prediabetes

2021 ◽  
Author(s):  
Andreas Fritsche ◽  
Robert Wagner ◽  
Martin Heni ◽  
Kostantinos Kantartzis ◽  
Jürgen Machann ◽  
...  
Keyword(s):  
High Risk ◽  
Lifestyle Intervention ◽  
Low Risk ◽  
Liver Fat ◽  
Liver Fat Content ◽  
Randomized Controlled ◽  
The Difference ◽  
Prevention Of Diabetes

Lifestyle intervention (LI) can prevent type 2 diabetes, but response to LI varies depending on risk subphenotypes. We tested if prediabetic individuals with low risk benefit from conventional LI and individuals with high risk benefit from an intensification of LI in a multi-center randomized controlled intervention over 12 months with 2 years follow up. 1105 prediabetic individuals based on ADA glucose criteria were stratified into a high- and low-risk phenotype, based on previously described thresholds of insulin secretion, insulin sensitivity and liver fat content. Low-risk individuals were randomly assigned to conventional LI according to the DPP protocol or control (1:1), high-risk individuals to conventional or intensified LI with doubling of required exercise (1:1). A total of 908 (82%) participants completed the study. In high-risk individuals, the difference between conventional and intensified LI in post-challenge glucose change was -0.29 mmol/l [CI:-0.54;-0.04], p=0.025. Liver fat (-1.34 percentage points [CI:-2.17;-0.50], p=0.002) and cardiovascular risk (-1.82[CI:-3.13-0.50],p=0.007) underwent larger reductions with intensified than with conventional LI. During a follow up of 3 years, intensified compared to conventional LI had a higher probability to normalize glucose tolerance (p=0.008). In conclusion, it is possible in high-risk individuals with prediabetes to improve glycemic and cardiometabolic outcomes by intensification of LI. Individualized, risk-phenotype-based LI may be beneficial for the prevention of diabetes.

scholarly journals Different Effects of Lifestyle Intervention in High- and Low-Risk Prediabetes

2021 ◽  
Author(s):  
Andreas Fritsche ◽  
Robert Wagner ◽  
Martin Heni ◽  
Kostantinos Kantartzis ◽  
Jürgen Machann ◽  
...  
Keyword(s):  
High Risk ◽  
Lifestyle Intervention ◽  
Low Risk ◽  
Liver Fat ◽  
Liver Fat Content ◽  
Randomized Controlled ◽  
The Difference ◽  
Prevention Of Diabetes

Lifestyle intervention (LI) can prevent type 2 diabetes, but response to LI varies depending on risk subphenotypes. We tested if prediabetic individuals with low risk benefit from conventional LI and individuals with high risk benefit from an intensification of LI in a multi-center randomized controlled intervention over 12 months with 2 years follow up. 1105 prediabetic individuals based on ADA glucose criteria were stratified into a high- and low-risk phenotype, based on previously described thresholds of insulin secretion, insulin sensitivity and liver fat content. Low-risk individuals were randomly assigned to conventional LI according to the DPP protocol or control (1:1), high-risk individuals to conventional or intensified LI with doubling of required exercise (1:1). A total of 908 (82%) participants completed the study. In high-risk individuals, the difference between conventional and intensified LI in post-challenge glucose change was -0.29 mmol/l [CI:-0.54;-0.04], p=0.025. Liver fat (-1.34 percentage points [CI:-2.17;-0.50], p=0.002) and cardiovascular risk (-1.82[CI:-3.13-0.50],p=0.007) underwent larger reductions with intensified than with conventional LI. During a follow up of 3 years, intensified compared to conventional LI had a higher probability to normalize glucose tolerance (p=0.008). In conclusion, it is possible in high-risk individuals with prediabetes to improve glycemic and cardiometabolic outcomes by intensification of LI. Individualized, risk-phenotype-based LI may be beneficial for the prevention of diabetes.

scholarly journals Novel Urinary Glycan Biomarkers Predict Cardiovascular Events in Patients With Type 2 Diabetes: A Multicenter Prospective Study With 5-Year Follow Up (U-CARE Study 2)

2021 ◽  
Vol 8 ◽  
Author(s):  
Koki Mise ◽  
Mariko Imamura ◽  
Satoshi Yamaguchi ◽  
Mayu Watanabe ◽  
Chigusa Higuchi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medical Information ◽  
Information Criterion ◽  
Cox Proportional Hazards ◽  
University Hospital ◽  
Net Reclassification Improvement ◽  
Patients With Diabetes ◽  
High Mannose

Background: Although various biomarkers predict cardiovascular event (CVE) in patients with diabetes, the relationship of urinary glycan profile with CVE in patients with diabetes remains unclear.Methods: Among 680 patients with type 2 diabetes, we examined the baseline urinary glycan signals binding to 45 lectins with different specificities. Primary outcome was defined as CVE including cardiovascular disease, stroke, and peripheral arterial disease.Results: During approximately a 5-year follow-up period, 62 patients reached the endpoint. Cox proportional hazards analysis revealed that urinary glycan signals binding to two lectins were significantly associated with the outcome after adjustment for known indicators of CVE and for false discovery rate, as well as increased model fitness. Hazard ratios for these lectins (+1 SD for the glycan index) were UDA (recognizing glycan: mixture of Man5 to Man9): 1.78 (95% CI: 1.24–2.55, P = 0.002) and Calsepa [High-Man (Man2–6)]: 1.56 (1.19–2.04, P = 0.001). Common glycan binding to these lectins was high-mannose type of N-glycans. Moreover, adding glycan index for UDA to a model including known confounders improved the outcome prediction [Difference of Harrel's C-index: 0.028 (95% CI: 0.001–0.055, P = 0.044), net reclassification improvement at 5-year risk increased by 0.368 (0.045–0.692, P = 0.026), and the Akaike information criterion and Bayesian information criterion decreased from 725.7 to 716.5, and 761.8 to 757.2, respectively].Conclusion: The urinary excretion of high-mannose glycan may be a valuable biomarker for improving prediction of CVE in patients with type 2 diabetes, and provides the rationale to explore the mechanism underlying abnormal N-glycosylation occurring in patients with diabetes at higher risk of CVE.Trial Registration: This study was registered with the University Hospital Medical Information Network on June 26, 2012 (Clinical trial number: UMIN000011525, URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000013482).

scholarly journals Review of the Effectiveness of Information and Communication Technology (ICTs) in the Treatment of Type 1 and Type 2 Diabetes

2019 ◽  
Vol 8 (1) ◽  
pp. 12
Author(s):  
Parnian Asgari ◽  
Elham Nazari
Keyword(s):  
Information Technology ◽  
Technology Acceptance ◽  
Information And Communication Technology ◽  
Communication Technology ◽  
Diabetes Management ◽  
Cost Optimization ◽  
Patients With Diabetes ◽  
Information And Communication

Introduction: In the field of health, information and communication technology plays an important role, the world is experiencing the era of communication, the field of health is not asymmetrical. According to the study, Iran is one of the countries that is at high risk of diabetes, and continues to increase in Iran and in most countries. The purpose of this paper is to review the literature on the effectiveness of Information and Communication Technology (ICTs) in the treatment of type 1 and type 2 diabetes.Material and Methods: This study was conducted as a review and through a search of valid information databases such as PubMed, Science direct, and Google Scholar. After the final extraction from the 106 papers in the cellular field 37% and 36% in telemedicine and 27% in the Internet topic from 2010 to 2018, were finalized.Results: The findings of the study showed that the recent developments in information technology combined with services for cost optimization have increased and the current use of information technology (IT) offers unique opportunities for patients with diabetes. Internet, mobile phone and telemedicine services can facilitate and improve communication between patients and healthcare professionals and play an important role in managing diabetes. The growing challenge is the proper management of diabetes to play an important role by employing innovative approaches aimed at improving patient outcomes and reducing the incidence of adverse healthcare systems.Conclusion: This study is an overview of information and communication technology research in diabetes management and can help researchers measure the effectiveness of information and communication technology in diabetes self-care and therapeutic systems in different areas and motivate self-management. Cost reduction, technology acceptance and satisfaction.

Abstract NS5: Use of a Multidisciplinary Approach to Successfully Improve Inpatient Diabetes Self-Management Education and Diabetes Medication Reconciliation at Discharge for Persons With Diabetes and Stroke at a Major Academic Medical Center

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Suzanne Stone ◽  
Nancy Drobycki ◽  
Mark Johnson
Keyword(s):  
Medication Reconciliation ◽  
Medical Center ◽  
Diabetes Education ◽  
Academic Medical Center ◽  
Blood Pressure Reduction ◽  
Diabetes Medication ◽  
Effective Discharge ◽  
Inpatient Diabetes ◽  
Patients With Diabetes

Background: Persons with diabetes are 1.5 times more likely to have a stroke. Research shows that there is a correlation between increasing diabetes and stroke. Education for stroke patients, however, continues to focus on medication management and blood pressure reduction. American Diabetes Association indicates, “There should be a structured discharge plan tailored to the individual patient with diabetes.” Transitioning from the acute care is risky for diabetics, recommendations now include individualized education for diabetics with stroke. 40% of the stroke population at our institution showed risk factors for diabetes, yet 11% received diabetes education, and only 59% had diabetes medication pre-prescribed at discharge. The stroke team initiated an inpatient diabetes education to increase patient awareness and medication adherence. Purpose: The purpose of this project was to identify and address barriers related to the provision of individualized inpatient diabetes education and outpatient diabetes medication reconciliation for persons with diabetes and stroke. Method: The Endocrinology team was consulted for patients with diabetes and stroke with an A1c level of 7%. These team worked collaboratively to establish a consult process. Endocrinology APPs provided diabetic education and advised the Neurology team on the appropriate discharge medication regimen and follow-up. The stroke coordinator provided reminders during rounds to assure that consults were ordered for patients with diabetes having A1c 7% or greater. Results: Inpatient diabetes education improved from 11% in 2017 to 96% in 2019. Diabetes medication reconciliation, with listing of diabetes medications on the after visit summary at discharge increased from 59% in 2017 to 93% in 2019. Conclusions: Both metrics reflect improvement over a 2-year period, showing that collaboration between the Endocrinology and Neurology teams is key to effective discharge planning, diabetes medication reconciliation and outpatient follow-up.

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