A Systematic Review of Barriers to Access-to-Care in Hispanics With Type 2 Diabetes

2018 ◽  
Vol 30 (3) ◽  
pp. 280-290 ◽  
Author(s):  
Sharon K. Titus ◽  
Merle Kataoka-Yahiro
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Access To Care ◽  
A Priori ◽  
Quantitative Studies ◽  
Barriers To Access ◽  
Diet And Exercise ◽  
Cost Factors

Introduction: A systematic review was conducted to highlight current barriers to access-to-care for Hispanics with type 2 diabetes (T2D). Method: PubMed and CINAHL databases (2010-2015) using PRISMA guidelines. 84 studies were identified, 12 quantitative studies were selected for review remained based on inclusion/exclusion criteria. There were five research questions: (1) What samples/settings were included? (2) What theories guided each study? (3) What were the study aims and (4) designs? (5) What barriers of access-to-care were identified? Barriers were placed into three categories set a priori. Results: The word “barrier” was in one study aim. Barriers of self (92%), provider (50%), and environment (25%) were identified. Self-care behaviors (diet and exercise), individual resources (cost factors), lack of providers specializing in T2D, and environmental factors affect Hispanics with T2D access-to-care. Discussion: These barriers to access underscore current importance to Hispanics with T2D. A follow-up review should be conducted as new barriers are expected to emerge.

Barriers to Access to Care in Hispanics With Type 2 Diabetes: A Systematic Review

2020 ◽  
pp. 154041532095638
Author(s):  
Sharon K. Titus ◽  
Merle Kataoka-Yahiro
Keyword(s):  
United States ◽  
Social Support ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Access To Care ◽  
Cause Of Death ◽  
The United States ◽  
Barriers To Access ◽  
Cost Factors

Introduction: Type 2 diabetes (T2D) is a major cause of death in the United States. Hispanics living in America suffer disproportionally with diabetes and is the fifth cause of death for them. A systematic review was conducted that highlighted barriers to access to care for Hispanics with T2D during the early years of the Affordable Care Act. Method: PubMed and CINAHL databases were searched (2010-2015) using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. From 84 studies, seven qualitative/mixed methods studies were reviewed based on inclusion/exclusion criteria. Barriers were placed into three categories set a priori. Results: All study samples were from different states, representing barriers across the United States. Persistent barriers were self (100%), provider (100%), and environment (71%). Covariates (culture and genetics), individual resources (cost factors, time, and social support), lack of providers or providers specializing in T2D, and environmental factors (lack of diabetes education, nutrition, and exercise programs) were found to affect Hispanics with T2D access to care. Conclusion: Cost factors, time, lack of social support, providers, and relevant programs remain prevalent barriers. As the Hispanic population increases and changes in the health care system are evolving, additional barriers to access to care are likely to emerge and must be explored.

scholarly journals Predictors of Loss to Follow-Up among Children with Type 2 Diabetes

2017 ◽  
Vol 87 (6) ◽  
pp. 377-384 ◽  
Author(s):  
Ashley Shoemaker ◽  
Peiyao Cheng ◽  
Robin L. Gal ◽  
Craig Kollman ◽  
William V. Tamborlane ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Parent Education ◽  
A Priori ◽  
Loss To Follow Up ◽  
Logistic Regression Models ◽  
Pediatric Diabetes ◽  
Diabetes Center ◽  
Lost To Follow Up

Background/Aims: Youth with type 2 diabetes (T2D) have poor compliance with medical care. This study aimed to determine which demographic and clinical factors differ between youth with T2D who receive care in a pediatric diabetes center versus youth lost to follow-up for >18 months. Methods: Data were analyzed from 496 subjects in the Pe­diatric Diabetes Consortium registry. Enrollment variables were selected a priori and analyzed with univariable and multivariable logistic regression models. Results: After a median of 1.3 years from enrollment, 55% of patients were lost to follow-up. The final model included age, race/ethnicity, parent education, and estimated distance to study site. The odds ratio (99% confidence interval) of loss to follow-up was 2.87 (1.34, 6.16) for those aged 15 to <18 years versus those aged 10 to <13 years and 6.57 (2.67, 16.15) for those aged ≥18 years versus those aged 10 to <13 years. Among patients living more than 50 miles from the clinic, the odds ra tio of loss to follow-up was 3.11 (1.14, 8.49) versus those living within 5 miles of the site. Conclusion: Older adolescents with T2D are more likely to be lost to follow-up, but other socioeconomic factors were not significant predictors of clinic follow-up.

scholarly journals Periodontal Therapy for Improving Lipid Profiles in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 20 (15) ◽  
pp. 3826 ◽  
Author(s):  
Siddharth Garde ◽  
Rahena Akhter ◽  
Mai Anh Nguyen ◽  
Clara K. Chow ◽  
Joerg Eberhard
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Clinical Trials ◽  
Type 2 Diabetes Mellitus ◽  
Lipid Profiles ◽  
Periodontal Therapy ◽  
Inflammatory Disorder

Periodontitis is a chronic inflammatory disorder often seen in patients with diabetes mellitus (DM). Individuals with diabetes are at a greater risk of developing cardiovascular complications and this may be related, in part, to lipid abnormalities observed in these individuals. The objective of this systematic review is to compile the current scientific evidence of the effects of periodontal treatment on lipid profiles in patients with type 2 diabetes mellitus. Through a systematic search using MEDLINE, EMBASE, PubMed, and Web of Science, 313 articles were identified. Of these, seven clinical trials which met all inclusion criteria were chosen for analysis. Between baseline and 3-month follow-up, there was a statistically significant reduction in the levels of total cholesterol (mean differences (MD) −0.47 mmol/L (95% confidence interval (CI), −0.75, −0.18, p = 0.001)), triglycerides (MD −0.20 mmol/L (95% CI −0.24, −0.16, p < 0.00001)) favouring the intervention arm, and a statistically significant reduction in levels of high density lipoprotein (HDL) (MD 0.06 mmol/L (95% CI 0.03, 0.08, p < 0.00001)) favouring the control arm. No significant differences were observed between baseline and 6-month follow-up levels for any lipid analysed. The heterogeneity between studies was high. This review foreshadows a potential benefit of periodontal therapy for lipid profiles in patients suffering from type 2 DM, however, well designed clinical trials using lipid profiles as primary outcome measures are warranted.

scholarly journals Risk of all-cause and CHD mortality in women versus men with type 2 diabetes: a systematic review and meta-analysis

2019 ◽  
Vol 180 (4) ◽  
pp. 243-255 ◽  
Author(s):  
Guodong Xu ◽  
Dingyun You ◽  
Liping Wong ◽  
Donghui Duan ◽  
Fanqian Kong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Web Of Science ◽  
Meta Analysis ◽  
Prospective Cohort Studies ◽  
Hazard Ratios ◽  
Inverse Variance ◽  
All Cause Mortality

Objective Previous studies have shown sex-specific differences in all-cause and CHD mortality in type 2 diabetes. We performed a systematic review and meta-analysis to provide a global picture of the estimated influence of type 2 diabetes on the risk of all-cause and CHD mortality in women vs men. Methods We systematically searched PubMed, EMBASE and Web of Science for studies published from their starting dates to Aug 7, 2018. The sex-specific hazard ratios (HRs) and their pooled ratio (women vs men) of all-cause and CHD mortality associated with type 2 diabetes were obtained through an inverse variance-weighted random-effects meta-analysis. Subgroup analyses were used to explore the potential sources of heterogeneity. Results The 35 analyzed prospective cohort studies included 2 314 292 individuals, among whom 254 038 all-cause deaths occurred. The pooled women vs men ratio of the HRs for all-cause and CHD mortality were 1.17 (95% CI: 1.12–1.23, I2 = 81.6%) and 1.97 (95% CI: 1.49–2.61, I2 = 86.4%), respectively. The pooled estimate of the HR for all-cause mortality was approximately 1.30 in articles in which the duration of follow-up was longer than 10 years and 1.10 in articles in which the duration of follow-up was less than 10 years. The pooled HRs for all-cause mortality in patients with type 2 diabetes was 2.33 (95% CI: 2.02–2.69) in women and 1.91 (95% CI: 1.72–2.12) in men, compared with their healthy counterparts. Conclusions The effect of diabetes on all-cause and CHD mortality is approximately 17 and 97% greater, respectively, for women than for men.

scholarly journals Non-Pharmacological Interventions to Manage Type 2 Diabetes in Older Hispanics: A Systematic Review

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 983-984
Author(s):  
Edgar Vieira ◽  
Kayleigh Sherbutt ◽  
Madison Scanlan ◽  
Heather Frederick
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Diabetes Management ◽  
Glycosylated Hemoglobin ◽  
Pharmacological Interventions ◽  
Exercise Interventions ◽  
Diet And Exercise ◽  
Hba1c Levels

Abstract Type 2 diabetes is a serious public health problem that affects millions of Americans. Hispanics are disproportionately affected and have high incidence of type 2 diabetes. Lifestyle modifications in diet and increased physical activity are recommended in addition to medication. The purpose of this systematic review was to analyze the scientific literature concerning the effects of exercise, nutrition, and combined diet and exercise interventions on type 2 diabetes management in older Hispanics. We searched three databases for studies that included dietary interventions, exercise interventions, or a combination to manage type 2 diabetes in older Hispanics. A total of 653 studies were screened and reviewed, with seven being included in the review. Our findings indicate that physical activity interventions significantly reduce glycosylated hemoglobin, and diet interventions also led to decreased levels of HbA1c. There is a significant effect in HbA1c levels on individuals receiving a combination of diet and exercise interventions compared to control groups. Implementing diet or exercise interventions in older Hispanics with Type 2 diabetes leads to significantly reduced glycosylated hemoglobin levels; the effects of combined diet and exercise interventions were not superior to the effects of single interventions in HbA1c levels. Exercise and diet seem to be effective non-pharmacological interventions to manage type 2 diabetes in older Hispanics, but additional research is needed.

scholarly journals Egg consumption and risk of type 2 diabetes: findings from 3 large US cohort studies of men and women and a systematic review and meta-analysis of prospective cohort studies

2020 ◽  
Vol 112 (3) ◽  
pp. 619-630 ◽  
Author(s):  
Jean-Philippe Drouin-Chartier ◽  
Amanda L Schwab ◽  
Siyu Chen ◽  
Yanping Li ◽  
Frank M Sacks ◽  
...  
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Cohort Studies ◽  
Prospective Cohort ◽  
Meta Analysis ◽  
Egg Consumption ◽  
Prospective Cohort Studies ◽  
Incident Cases

ABSTRACT Background Whether egg consumption is associated with the risk of type 2 diabetes (T2D) remains unsettled. Objectives We evaluated the association between egg consumption and T2D risk in 3 large US prospective cohorts, and performed a systematic review and meta-analysis of prospective cohort studies. Methods We followed 82,750 women from the Nurses’ Health Study (NHS; 1980–2012), 89,636 women from the NHS II (1991–2017), and 41,412 men from the Health Professionals Follow-up Study (HPFS; 1986–2016) who were free of T2D, cardiovascular disease, and cancer at baseline. Egg consumption was assessed every 2–4 y using a validated FFQ. We used Cox proportional hazard models to estimate HRs and 95% CIs. Results During a total of 5,529,959 person-years of follow-up, we documented 20,514 incident cases of T2D in the NHS, NHS II, and HPFS. In the pooled multivariable model adjusted for updated BMI, lifestyle, and dietary confounders, a 1-egg/d increase was associated with a 14% (95% CI: 7%, 20%) higher T2D risk. In random-effects meta-analysis of 16 prospective cohort studies (589,559 participants; 41,248 incident T2D cases), for each 1 egg/d, the pooled RR of T2D was 1.07 (95% CI: 0.99, 1.15; I2 = 69.8%). There were, however, significant differences by geographic region (P for interaction = 0.01). Each 1 egg/d was associated with higher T2D risk among US studies (RR: 1.18; 95% CI: 1.10, 1.27; I2 = 51.3%), but not among European (RR: 0.99; 95% CI: 0.85, 1.15; I2 = 73.5%) or Asian (RR: 0.82; 95% CI: 0.62, 1.09; I2 = 59.1%) studies. Conclusions Results from the updated meta-analysis show no overall association between moderate egg consumption and risk of T2D. Whether the heterogeneity of the associations among US, European, and Asian cohorts reflects differences in egg consumption habits warrants further investigation. This systematic review was registered at www.crd.york.ac.uk/prospero as CRD42019127860.

scholarly journals Prognostic models for predicting the risk of foot ulcer or amputation in people with type 2 diabetes: a systematic review and external validation study

Diabetologia ◽  
2021 ◽  
Author(s):  
Joline W. J. Beulens ◽  
Josan S. Yauw ◽  
Petra J. M. Elders ◽  
Talitha Feenstra ◽  
Ron Herings ◽  
...  
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Data Extraction ◽  
External Validation ◽  
Foot Ulcer ◽  
Predictive Performance ◽  
Prognostic Models ◽  
Bias Assessment

Abstract Aims/hypothesis Approximately 25% of people with type 2 diabetes experience a foot ulcer and their risk of amputation is 10–20 times higher than that of people without type 2 diabetes. Prognostic models can aid in targeted monitoring but an overview of their performance is lacking. This study aimed to systematically review prognostic models for the risk of foot ulcer or amputation and quantify their predictive performance in an independent cohort. Methods A systematic review identified studies developing prognostic models for foot ulcer or amputation over minimal 1 year follow-up applicable to people with type 2 diabetes. After data extraction and risk of bias assessment (both in duplicate), selected models were externally validated in a prospective cohort with a 5 year follow-up in terms of discrimination (C statistics) and calibration (calibration plots). Results We identified 21 studies with 34 models predicting polyneuropathy, foot ulcer or amputation. Eleven models were validated in 7624 participants, of whom 485 developed an ulcer and 70 underwent amputation. The models for foot ulcer showed C statistics (95% CI) ranging from 0.54 (0.54, 0.54) to 0.81 (0.75, 0.86) and models for amputation showed C statistics (95% CI) ranging from 0.63 (0.55, 0.71) to 0.86 (0.78, 0.94). Most models underestimated the ulcer or amputation risk in the highest risk quintiles. Three models performed well to predict a combined endpoint of amputation and foot ulcer (C statistics >0.75). Conclusions/interpretation Thirty-four prognostic models for the risk of foot ulcer or amputation were identified. Although the performance of the models varied considerably, three models performed well to predict foot ulcer or amputation and may be applicable to clinical practice. Graphical abstract

scholarly journals Effect of Family Empowerment on Self Care of Patients with Type-2 Diabetes Mellitus: A Systematic Review

2021 ◽  
Vol 9 (F) ◽  
pp. 224-233
Author(s):  
Rianti Pramita ◽  
Siti Saidah Nasution ◽  
Jenny Marlindawani
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Self Care ◽  
Good Effect ◽  
Diagram Method ◽  
Family Empowerment

Introduction: Diabetes Mellitus Type 2 (T2DM) is a chronic disease that will be suffered for life, so it is necessary to provide education to patients and families so that it is easy to understand the course of the disease, prevention and obstacles in the management of T2DM. Family empowerment can be started by optimizing family functions to help patients with T2DM to adapt and comply with self-care actions through four dimensions, empathic (emotional), encouragement (reward), facilitative (instrumental), and participatory (participation). This systematic review aims to identify and evaluate the effect of family empowerment interventions on self-care for T2DM patients. Methods: The database used for article searches consisted of EBSCO, PubMed and ProQuest using relevant keywords based on the topic and title of the study. The selection of articles used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram method, the overall results were 2,635 articles and 8 articles that fit the inclusion criteria and were analyzed descriptively narrative and had met the methodological quality study according to JBI guidelines (Joanna Briggs Critical Appraising Methodology). Results: 8 articles with the Family Empowerment Process Model intervention program and the Diabetes Mellitus Education Program which is a family-oriented program that includes education classes, group discussions, home visits, and telephone follow-up. Education is provided to families through direct discussion and through telephone calls with a duration of each call of approximately 15 to 20 minutes scheduled for 9 am to 12 noon. Follow-up was done by telephone in the intervention group for approximately 3 months to 12 months. Conclusion: The findings of this systematic review indicate that family empowerment interventions based on health education can have a good effect on improving self-care for patients with type 2 diabetes mellitus

scholarly journals Cardiovascular outcomes associated with SGLT-2 inhibitors versus other glucose-lowering drugs in patients with type 2 diabetes: A real-world systematic review and meta-analysis

2020 ◽  
Author(s):  
Chun-xing Li ◽  
Shuo Liang ◽  
Lingyan Gao ◽  
Hua Liu
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Real World ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Cardiovascular Outcome ◽  
Glucose Lowering

Abstract Background Glucose lowering agents that reduce the risk of major cardiovascular events would be considered a major advance. Despite the reduction of cardiovascular risk by sodium-glucose cotransporter 2 inhibitors (SGLT-2i) has been confirmed by some large randomized controlled studies and systematic reviews, exact indicators of cardiovascular risk remained controversial. Whether consistent results can be obtained in clinical practice is unclear. Therefore, in this meta-analysis, we examined the real-world effect of SGLT-2i on cardiovascular outcome in patients with type 2 diabetes mellitus (T2DM).Methods We did a real-world systematic review and meta-analysis of cardiovascular outcome of SGLT-2i in patients with T2DM. We searched PubMed and Embase for trials published up to October 23, 2019. Data search and extraction were completed with a standardized data form and any discrepancies were resolved by consensus. The primary outcome was major adverse cardiovascular events (MACE) and all-cause mortality (ACM). Secondary outcomes were hospitalization for heart failure (HHF), atrial fibrillation (AF), myocardial infarction (MI), stroke, cardiovascular mortality (CVM), unstable angina (UA), heart failure (HF). Odds ratio (OR) with 95% CIs were pooled across trials, and cardiovascular outcomes were stratified by baseline incidence of cardiovascular disease (CVD), usage rate of cardiovascular benefit drug, follow-up period and region.Results Fourteen trials enrolling 3,157,259 patients were included. SGLT-2i reduced MACE (OR, 0.71; 95% CI 0.67,0.75, P<0.001) and ACM (OR, 0.53; 95% CI 0.49,0.57, P<0.001) compared to other glucose lowering drugs (oGLD). Compared with oGLD, SGLT-2i had significantly lowered the risk of HHF (OR, 0.56; 95% CI 0.46,0.68, P<0.001), MI (OR, 0.77; 95% CI 0.73,0.81, P<0.001), stroke (OR, 0.75; 95% CI 0.72,0.78, P<0.001), CVM (OR, 0.58; 95% CI 0.49,0.69, P<0.001) and HF(OR, 0.56; 95% CI 0.48,0.67, P<0.001), but there was no benefit from UA or AF. Subgroup analysis showed SGLT-2i reduced the risk of MACE, ACM, HHF, MI, stroke, CVM and HF with a similar benefit regardless of the incidence of CVD was (20-30)% or < 15%, (15-30)% and <15% have been treated with GLP-1 receptor agonists (GLP-1RA), >80% and<70% have been treated with statins or both GLP-1RA and statins. SGLT-2i reduced the risk of ACM in low-risk population (P<0.001). No inconsistencies were found when stratification was performed at 1 or (3-4) years of follow-up. SGLT-2i showed similar cardiovascular benefits in the Nordic countries, Asia and the United States.Conclusions The predominant impact of SGLT-2i is on cardiovascular outcome driven predominantly by reduction in MACE, ACM, HHF, MI, stroke, CVM, HF, but not UA or AF. SGLT-2i have robust benefits on reducing MACE, ACM, HHF, MI, stroke, CVM and HF regardless of a history of usage rate of GLP-1RA and/or statins and /or metformin.

scholarly journals Health literacy in context: struggling to self-manage diabetes. A longitudinal qualitative study

2020 ◽  
Author(s):  
Xavier Debussche ◽  
Maryvette Balcou-Debussche ◽  
Delphine Ballet ◽  
Jessica Caroupin-Soupoutevin
Keyword(s):  
Social Support ◽  
Type 2 Diabetes ◽  
Health Literacy ◽  
Disease Management ◽  
Qualitative Study ◽  
Health Professionals ◽  
Health Knowledge ◽  
Diet And Exercise

Abstract ObjectiveConsidering health literacy is a key element for health service responsiveness to self-management needs in diabetes. This qualitative study aimed to provide a detailed analysis of the health literacy of people with type 2 diabetes in relation to their daily self-care practices.MethodsInterviews (n=86) were conducted as part of the qualitative study ERMIES-ethnosocio, at the beginning and at the end of a structured educational care. The interviews focused on food practices, exercise, treatment, relationship to health information and professionals.ResultsThree poles structured into eight themes characterized practices in context: health knowledge, disease management, expertise and social support. The relationships of participants in each of the eight themes were differentiated, ranging from functional to interactive and critical. Treatment and follow-up were essentially functional, while diet and exercise remained more interactive. Social support and relationship to health professionals were important determinants of disease management. Conclusion and Practice implicationsTreatment management and disease monitoring remain primarily the job of health professionals, as opposed to diet, physical activity and social support being part of ordinary practice. Decision-making, as a shared social task, as well as resources for participation in health services, should be considered for relevant interventions in type 2 diabetes.

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