scholarly journals The development of multimorbidity during 16 years after diagnosis of type 2 diabetes

2018 ◽  
Vol 8 (1) ◽  
pp. 2235042X1880165 ◽  
Author(s):  
Sandra Pouplier ◽  
Maria Åhlander Olsen ◽  
Tora Grauers Willadsen ◽  
Håkon Sandholdt ◽  
Volkert Siersma ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Disease ◽  
Diabetes Care ◽  
Cox Regression ◽  
Neurological Diseases ◽  
Gastrointestinal Diseases ◽  
Diabetes Diagnosis ◽  
Prevalent Disease ◽  
Diabetes Patients

Objective: The aims of this study were to (1) quantify the development and composition of multimorbidity (MM) during 16 years following the diagnosis of type 2 diabetes and (2) evaluate whether the effectiveness of structured personal diabetes care differed between patients with and without MM. Research design and methods: One thousand three hundred eighty-one patients with newly diagnosed type 2 diabetes were randomized to receive either structured personal diabetes care or routine diabetes care. Patients were followed up for 19 years in Danish nationwide registries for the occurrence of outcomes. We analyzed the prevalence and degree of MM based on 10 well-defined disease groups. The effect of structured personal care in diabetes patients with and without MM was analyzed with Cox regression models. Results: The proportion of patients with MM increased from 31.6% at diabetes diagnosis to 80.4% after 16 years. The proportion of cardiovascular and gastrointestinal diseases in surviving patients decreased, while, for example, musculoskeletal, eye, and neurological diseases increased. The effect of the intervention was not different between type 2 diabetes patients with or without coexisting chronic disease. Conclusions: In general, the proportion of patients with MM increased after diabetes diagnosis, but the composition of chronic disease changed during the 16 years. We found cardiovascular and musculoskeletal disease to be the most prevalent disease groups during all 16 years of follow-up. The post hoc analysis of the intervention showed that its effectiveness was not different among patients who developed MM compared to those who continued to have diabetes alone.

scholarly journals Involvement of dietitians in diabetes care, results from a secondary care hospital in Greece

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Zoe Pafili ◽  
Sophia Samara ◽  
Charilaos Dimosthenopoulos ◽  
Olga Gkortzi
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Care ◽  
Secondary Care ◽  
Diabetes Management ◽  
Nutrition Therapy ◽  
Dietary Advice ◽  
Diabetes Diagnosis ◽  
Diabetes Patients

AbstractIntroductionAccording to diabetes care standards nutrition therapy should be an integral part of diabetes management, and all individuals with diabetes should be referred to a registered dietitian for nutrition therapy at—or soon after—diagnosis and for ongoing follow-up. There is limited international data that indicate that a large percentage of people with diabetes have not received structured diabetes education and have not visited a dietitian. The aim of this study was to assess the involvement of dietitians in diabetes care in Greece.Materials and MethodsAll adult diabetic patients admitted to a secondary care general hospital in Greece during 30 consecutive days were included in the study. Patients admitted in the ICU, CICU, day clinics and hemodialysis patients were excluded. Data were obtained by personal interviews using a 40 item questionnaire which included 10 questions regarding number of visits to dietitians for diabetes management, whether patients were referred by their doctors or sought dietary advice by their own, reasons for visiting a dietitian, goal achievement and patient satisfaction.ResultsIn total 124 patients (68 males and 56 females) with diabetes were admitted to the hospital during the study period (4 type 1, 114 type 2 and 6 pregnancy diabetes). Data were obtained from 3 (22.8 ± 6 yrs, 26.1 ± 5.7kg/m2,8.3 ± 5.9 yrs with diabetes),105 (76.6 ± 11.3 yrs, 28.0 ± 5.3 kg/m2, 12.8 ± 9.3 yrs with diabetes), and 5 (32.6 ± 4.4 yrs, 28.5 ± 4.0 kg/m2) patients with type 1, type 2 and pregnancy diabetes respectively. Two out of 3 type 1 diabetes and 1 out of 5 patients with pregnancy diabetes interviewed reported to have been referred to a dietitian by their doctor. Only 5.7% (6 patients) of type 2 diabetes patients reported to have been referred to a dietitian by their doctor and another 5.7% have visited a dietitian on their own initiative. Five out of 6 referrals were at diabetes diagnosis. The number of encounters with a dietitian ranged from 1 to 24 with patients seeking to loose weight having the greater number of encounters. Of type 2 diabetes patients 94.3% did not receive lifestyle advice before commencing diabetes medication whereas 25% did not receive any dietary advice by any health professional even after starting medication.ConclusionsIn our cohort the majority of diabetes patients had not received dietary counseling by a dietitian, whereas about one fourth of type 2 diabetes patients had not received any dietary advice.

scholarly journals Management of Chronic Disease and Hospitalization Due to Diabetes among Type 2 Diabetes Patients in Korea: Using the National Sample Cohort Data 2002–2013

2018 ◽  
Vol 15 (11) ◽  
pp. 2541
Author(s):  
Sang Lee ◽  
Woorim Kim ◽  
Sarah Oh ◽  
Jieun Yang ◽  
Jieun Jang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Disease ◽  
National Sample ◽  
Self Management ◽  
Management Skills ◽  
Cohort Data ◽  
Onset Of Diabetes ◽  
Cox Proportional Hazard Regression ◽  
Diabetes Patients

To prevent negative outcomes for diabetes patients, developing self-management skills is imperative. This study aimed to examine the association between management of chronic disease (MCD), which mainly involves educating patients about their chronic diseases for obtaining self-management skills and hospitalization due to diabetes among type 2 diabetes patients in Korea. Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 54,031 type 2 diabetes patients were included in the study. If patients received the MCD within 1 year from the onset of diabetes, we categorized them as “MCD received patients” We reclassified these groups into five groups: “non-receiving”, “1–3 times”, “4–6 times”, “7–9 times” and “10–12 times” The dependent variable of this study was hospitalization due to diabetes. Cox proportional hazard regression was used. Of the patients, 86.2% (n = 46,571) did not received the MCD within the 1 year from the onset of diabetes. The number of MCDs received increased and the hazard ratio (HR) for hospitalization due to diabetes decreased; particularly, patients who received MCD 10–12 times per annum showed the lowest HR for hospitalization due to diabetes compared to patients in the MCD non-received group (1–3 times per annum: HR: 0.81, p = 0.0001; 4–6 times per annum: HR: 0.82, p = 0.0248; 7–9 times per annum: HR: 0.75, p = 0.0054; 10–12 times per annum: HR: 0.61, p < 0.0001). Considering the importance of raising self-managing diabetes skills, the findings can aid in determining the outcomes of the MCD program.

scholarly journals The Association Between Age at Diagnosis of Type 2 Diabetes and Albuminuria in Chinese Adults

2020 ◽  
Author(s):  
Shujing Wu ◽  
Shanshan Liu ◽  
Zhiyun Zhao ◽  
Mian Li ◽  
Tiange Wang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Duration ◽  
Age At Diagnosis ◽  
Diabetes Diagnosis ◽  
Chinese Adults ◽  
Younger Age ◽  
Study Sites ◽  
Normal Controls ◽  
Diabetes Patients

Abstract Background: Type 2 diabetes is increasingly diagnosed at a younger age worldwide and in China. Limited data are available regarding the association between age at diabetes diagnosis and risks of albuminuria, which is a common microvascular complication in diabetes patients. In addition, few studies on age at diagnosis and outcomes have fully accounted for the complex interplay between age at diagnosis and the actual age or diabetes duration, all of which are independently associated with vascular risks.Methods: We used data from a nationwide multicenter study with 207,961 participants recruited from 25 communities across mainland China during 2010-2012. Age, sex, and study sites were matched for 31,366 screen-detected type 2 diabetes and 31,366 normal controls. Age, sex, study sites, and diabetes duration were matched for 7,490 self-reported type 2 diabetes and 7,490 normal controls. Risks of having albuminuria in matched type 2 diabetes vs. normal controls were examined using multivariable logistic regression analysis in strata of age at type 2 diabetes diagnosis (<50, 50-59, 60-69, or ≥70 years). Albuminuria was defined as urinary albumin-to-creatinine ratio ≥30 mg/g.Results: Percentages of albuminuria were significantly higher among type 2 diabetes patients compared with normal controls in each stratum of age at diagnosis. Although the absolute rate of albuminuria is higher in older adults, the odds ratio of albuminuria in type 2 diabetes vs. matched controls decreased with increasing age at diagnosis. For participants with diabetes diagnosed at an age of <50, 50-59, 60-69, or ≥70 years, the multivariable adjusted risk of albuminuria increased by 81%, 60%, 45%, and 33% for screen-detected diabetes, and 135%, 121%, 90%, and 58% for self-reported diabetes compared with their normal controls, respectively. Conclusions: A younger age at diagnosis of type 2 diabetes is associated with a more significantly elevated risk of albuminuria than an older age at diagnosis in Chinese adults.

scholarly journals Patient’s Experiences and Satisfaction in Diabetes Care and Out-of-Pocket Expenditure for Follow-Up Care Among Diabetes Patients in Urban Puducherry, South India

2020 ◽  
Vol 7 (6) ◽  
pp. 1445-1449
Author(s):  
TK Priya ◽  
Venkatachalam Jayaseelan ◽  
Yuvaraj Krishnamoorthy ◽  
Manikandanesan Sakthivel ◽  
Marie Gilbert Majella
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Type 2 Diabetes Mellitus ◽  
Health Facility ◽  
Diabetes Care ◽  
Private Facility ◽  
Level Of Satisfaction ◽  
Diabetes Patients

Introduction: Type 2 diabetes mellitus has huge economic burden for both patient and health-care system. Management of the condition in India faces multiple challenges such as paucity of trained medical and paramedical staff, poor quality, lack of satisfaction with services, and unaffordability of services. Objective: To determine the level of satisfaction and the out-of-pocket expenditure for type 2 diabetes patients receiving treatment from public and private sectors in urban Puducherry. Methods: This was a cross-sectional analytical study conducted in Urban Health Centre area of tertiary care center from August to September 2016. A total of 200 patients suffering from type 2 diabetes mellitus for 1 year or more and resided for at least a year in Puducherry were included in the study. Among the 200 participants, 100 were receiving care from government and 100 from private facility. Result and conclusion: Median cost of diabetes care in government facility was 2000 INR while in private facility was 13050 INR. About 70.1% of the patients were satisfied with the health-care services received. There was no significant difference in the level of satisfaction between government and private health facility. Almost three-fourths of the diabetes patients are satisfied with the care received irrespective of the type of health facility. The cost of diabetes care is more for patients seeking care from private sector than public sector. Availability of insulin and free syringes in the primary health center, provision of specialized footwear, and spectacles free of cost can help in reducing the out-of-pocket expenditure.

scholarly journals Development of a model to predict 5-year risk of severe hypoglycemia in patients with type 2 diabetes

2018 ◽  
Vol 6 (1) ◽  
pp. e000527 ◽  
Author(s):  
Lisa S Chow ◽  
Rachel Zmora ◽  
Sisi Ma ◽  
Elizabeth R Seaquist ◽  
Pamela J Schreiner
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Prediction Model ◽  
Cox Regression ◽  
Severe Hypoglycemia ◽  
Diabetes Diagnosis ◽  
Reductase Inhibitors ◽  
Accord Study ◽  
Glycemic Management

ObjectiveWe constructed a predictive model of long-term risk for severe hypoglycemia (SH: hypoglycemia requiring assistance) in patients with type 2 diabetes (T2DM).Research design and methodsData from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study (original n=10 251, n=5135 used in the current analysis), a randomized, multicenter, double 2×2 factorial design study examining the effect of glycemic, blood pressure, and lipid control on cardiovascular outcomes in patients with diagnosed T2DM, were used. Over the follow-up (3.76±1.12 years), the ACCORD participants experienced 607 incident SH events. Cox regression was used to identify the SH risk prediction model.ResultsWe identified 17 predictors—glycemic management, age, race, education, waist circumference, medications (insulin, antihypertensive, HMG-CoA reductase inhibitors, sulfonylurea, biguanide and meglitinide), years since diabetes diagnosis, history of hypoglycemia in the last week, systolic blood pressure, diastolic blood pressure, serum creatinine, and urinary albumin creatinine ratio—to construct a prediction model for SH (c-statistic=0.782). Using this information, we derived point scores to estimate the 5-year risk for SH in individual patients with T2DM. After adjusting for other variables in the model, the three strongest predictors for SH over 5 years were intensive glycemic management (HR=2.37, 95% CI 1.99 to 2.83), insulin use (HR=2.14, 95% CI 1.77 to 2.59), and antihypertensive medication use (HR=1.90, 95% CI 1.26 to 2.86).ConclusionUsing the ACCORD data, we identified attributes to predict 5-year risk of SH in patients with T2DM, which warrant evaluation in broader populations to determine applicability.

scholarly journals Visual impairment and mortality in patients with type 2 diabetes

2019 ◽  
Vol 7 (1) ◽  
pp. e000638
Author(s):  
Volkert Siersma ◽  
Rasmus Køster-Rasmussen ◽  
Christine Bruun ◽  
Niels de Fine Olivarius ◽  
Audun Brunes
Keyword(s):  
Type 2 Diabetes ◽  
Visual Acuity ◽  
Visual Impairment ◽  
Cox Regression ◽  
Independent Predictor ◽  
Diabetes Diagnosis ◽  
Newly Diagnosed ◽  
All Cause Mortality ◽  
Related Mortality

ObjectiveTo evaluate whether visual acuity impairment was an independent predictor of mortality in patients with type 2 diabetes.Research design and methodsThis is a 19-year follow-up of a cohort of 1241 patients newly diagnosed with type 2 diabetes and aged 40 years or over. Visual acuity was assessed by practicing ophthalmologists both at diabetes diagnosis and after 6 years. The logarithmic value of the visual acuity (logMAR) was the exposure. Multivariable Cox regression models were adjusted for multiple potential confounders including cardiovascular disease, and censored for potential mediators, that is, fractures/trauma. Primary outcomes were from national registers: all-cause mortality and diabetes-related mortality.ResultsVisual impairment at diabetes diagnosis was robustly associated with subsequent 6-year all-cause mortality. Per 1 unit reduced logMAR acuity the incidence rate of all-cause mortality increased with 51% (adjusted HR: 1.51; 95% CI 1.12 to 2.03) and of fractures/trauma with 59% (HR: 1.59; 95% CI 1.18 to 2.15), but visual acuity was not associated with diabetes-related mortality. After censoring for fractures/trauma, visual acuity was still an independent risk factor for all-cause mortality (HR: 1.68; 95% CI 1.23 to 2.30). In contrast, visual acuity 6 years after diabetes diagnosis was not associated with the subsequent 13 years’ incidence of any of the outcomes, as an apparent association with all-cause mortality and diabetes-related mortality was explained by confounding from comorbidity.ConclusionsVisual acuity measured by ophthalmologists in patients newly diagnosed with type 2 diabetes was an independent predictor of mortality in the short term.

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