scholarly journals The “cost” of treating to target: cross-sectional analysis of patients with poorly controlled type 2 diabetes in Australian general practice

2013 ◽  
Vol 14 (1) ◽  
Author(s):  
John Furler ◽  
Justin W S Hii ◽  
Danny Liew ◽  
Irene Blackberry ◽  
James Best ◽  
...  
BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e039625
Author(s):  
Jason I Chiang ◽  
John Furler ◽  
Frances Mair ◽  
Bhautesh D Jani ◽  
Barbara I Nicholl ◽  
...  

ObjectivesTo explore the prevalence of multimorbidity as well as individual and combinations of long-term conditions (LTCs) in people with type 2 diabetes (T2D) attending Australian general practice, using electronic health record (EHR) data. We also examine the association between multimorbidity condition count (total/concordant(T2D related)/discordant(unrelated)) and glycaemia (glycated haemoglobin, HbA1c).DesignCross-sectional study.SettingAustralian general practice.Participants69 718 people with T2D with a general practice encounter between 2013 and 2015 captured in the MedicineInsight database (EHR Data from 557 general practices and >3.8 million Australian patients).Primary and secondary outcome measuresPrevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%).ResultsMean (SD) age 66.42 (12.70) years, 46.1% female and mean (SD) HbA1c 7.1 (1.4)%. More than 90% of participants with T2D were living with multimorbidity. Discordant conditions were more prevalent (83.4%) than concordant conditions (69.9 %). The three most prevalent discordant conditions were: painful conditions (55.4%), dyspepsia (31.6%) and depression (22.8%). The three most prevalent concordant conditions were hypertension (61.4%), coronary heart disease (17.1%) and chronic kidney disease (8.5%). The three most common combinations of conditions were: painful conditions and hypertension (38.8%), painful conditions and dyspepsia (23.1%) and hypertension and dyspepsia (22.7%). We found no associations between any multimorbidity counts (total, concordant and discordant) or combinations and HbA1c.ConclusionsMultimorbidity was common in our cohort of people with T2D attending Australian general practice, but was not associated with glycaemia. Although we did not explore mortality in this study, our results suggest that the increased mortality in those with multimorbidity and T2D observed in other studies may not be linked to glycaemia. Interestingly, discordant conditions were more prevalent than concordant conditions with painful conditions being the second most common comorbidity. Better understanding of the implications of different patterns of multimorbidity in people with T2D will allow more effective tailored care.


2017 ◽  
Vol 51 (12) ◽  
pp. 1277-1288 ◽  
Author(s):  
Georga Cooke ◽  
Amanda Tapley ◽  
Elizabeth Holliday ◽  
Simon Morgan ◽  
Kim Henderson ◽  
...  

2016 ◽  
Vol 8 (4) ◽  
pp. 295 ◽  
Author(s):  
Simon Morgan ◽  
Amanda Tapley ◽  
Kim M Henderson ◽  
Neil A Spike ◽  
Lawrie A McArthur ◽  
...  

ABSTRACT INTRODUCTION Eye conditions are common presentations in Australian general practice, with the potential for serious sequelae. Pre-vocational ophthalmology training for General Practitioner (GP) trainees is limited. AIM To describe the rate, nature and associations of ophthalmic problems managed by Australian GP trainees, and derive implications for education and training. METHODS Cross-sectional analysis from an ongoing cohort study of GP trainees’ clinical consultations. Trainees recorded demographic, clinical and educational details of consecutive patient consultations. Descriptive analyses report trainee, patient and practice demographics. Proportions of all problems managed in these consultations that were ophthalmology-related were calculated with 95% confidence intervals (CI). Associations were tested using simple logistic regression within the generalised estimating equations (GEE) framework. RESULTS In total, 884 trainees returned data on 184,476 individual problems or diagnoses from 118,541 encounters. There were 2649 ophthalmology-related problems, equating to 1.4% (95% CI: 1.38–1.49) of all problems managed. The most common eye presentations were conjunctivitis (32.5% of total problems), eyelid problems (14.9%), foreign body (5.3%) and dry eye (4.7%). Statistically significant associations were male trainee; male patient and patient aged 14 years or under; the problem being new and the patient being new to both trainee and practice; urban and of higher socioeconomic status practice location; the practice nurse not being involved; planned follow up not arranged; referral made; in-consultation information sought; and learning goals generated. DISCUSSION Trainees have comparable ophthalmology exposure to established GPs. However, associations with referral and information-seeking suggest GP trainees find ophthalmic problems challenging, reinforcing the critical importance of appropriate training.


2012 ◽  
Vol 62 (603) ◽  
pp. e663-e670 ◽  
Author(s):  
Rohini Mathur ◽  
Douglas Noble ◽  
Dianna Smith ◽  
Trisha Greenhalgh ◽  
John Robson

2021 ◽  
Author(s):  
Hang Li ◽  
Jie Lin ◽  
Yi ying Liu ◽  
Yao Liu ◽  
Qin Wan

Abstract Background Carotid atherosclerosis (CAS) lacks a simple and relatively accurate predictor. Triglyceride glucose (TyG) index is a simple indicator of insulin resistance, but the association between TyG index and CAS in patients with type 2 diabetes mellitus (T2DM) is less certain. This study aimed to investigate whether TyG index can predict CAS onset effectively. Methods In total, 1476 T2DM patients were included in cross-sectional analysis. TyG index (calculated by ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]) was split into tertiles (Tertile1-Tertile3). The main outcome was CAS prevalence as defined with carotid intima-media thickness (CIMT) ≥ 1.0 mm or carotid plaque. Logistic regression analysis was used to analyze the association between TyG index and CAS in patients with T2DM. Results In cross-sectional analysis, a total of 62.3% of T2DM patients had CAS, patients with a higher TyG index had a higher risk of CAS (χ2 = 13.856, P < 0.01). After confounder adjustment, patients with T2DM in the high tertile of TyG index had a greater risk to developing CAS than those in the low tertile (OR = 1.451, 95% CI =1.107-1.902, P = 0.007). Higher TyG index values were also associated with increased odds of CAS in patients with T2DM who were female, who were younger than 65 years old, who suffered from hypertension or obesity. Conclusion TyG index was significantly associated with CAS, suggesting that TyG index is a potential predictor for CAS in patients with T2DM.


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