'It's a Dance between Managing Both': A Qualitative Study Exploring Perspectives of Persons With Knee Osteoarthritis and Type 2 Diabetes Mellitus on the Impact of Osteoarthritis on Diabetes Management and Daily Life

Background: The purpose of this study was to describe the impact of an Advanced Practice Pharmacist (APh) on lowering hemoglobin A1c (HbA1c) in patients with type 2 diabetes within a patient centered medical home (PCMH) and to classify the types of therapeutic decisions made by the APh. Methods: This was a retrospective study using data from electronic health records. The study evaluated a partnership between Chapman University School of Pharmacy and Providence St. Joseph Heritage Healthcare that provided diabetes management by an Advanced Practice Pharmacist in a PCMH under a collaborative practice agreement. Change in the HbA1c was the primary endpoint assessed in this study. The type of therapeutic decisions made by the APh were also evaluated. Descriptive analysis and Wilcoxon signed rank test were used to analyze data. Results: The study included 35 patients with diagnosis of type 2 diabetes mellitus managed by an APh from May 2017 to December 2017. Most of the patients were 60-79 years old (68.5%), 45.7% were female, and 45.7% were of Hispanic/Latino ethnicity. The average HbA1c was 8.8%±1.4% (range=6.0%-12.4%) and 7.5%±1.4% (range=5.5%-12.4%) at the initial and final APh visit, respectively (p<0.0001). Therapeutic decisions made by the APh included drug dose increase (35.5% of visits), drug added (16.4%), drug dose decrease (6.4%), drug switch (5.5%), and drug discontinuation (1.8%). Conclusion: The Advanced Practice Pharmacist’s interventions had a significant positive impact on lowering HbA1c in patients with type 2 diabetes mellitus in a PCMH. The most common therapeutic decisions made by the APh included drug dose increase and adding a new drug. Article Type: Pharmacy Practice

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Dyadic appraisal and coping with illness among older Chinese adults with type 2 diabetes mellitus: a qualitative study

Age and Ageing ◽

10.1093/ageing/afaa245 ◽

2020 ◽

Author(s):

Jiong Tu ◽

Yuyang Liu ◽

Xueji Wu ◽

Dong Xu ◽

Jing Liao

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Health Status ◽

Qualitative Study ◽

Diabetes Management ◽

Living Environment ◽

Older Couples ◽

Older Chinese

Abstract Introduction Diabetes management permeates patients’ daily routines and interacts with their living context. Less is known about how older Chinese couples view their supportive roles and the allocation of the management responsibility between them. Objectives To explore dyadic appraisal, coping and the barriers to diabetes management shared by older Chinese couples. Methods A qualitative study of older couples where at least one partner had type 2 diabetes mellitus was implemented in four communities of Guangzhou, China. Four focus groups containing 11 couples, and ten in-depth interviews with individual couples were conducted sequentially. All of the data were coded with Nvivo 11 using thematic analysis. Results The majority of the older couples interviewed appraised diabetes as a shared problem, taking part in monitoring and altering each other’s health status and behaviour. Limited knowledge and a lack of accurate information about diabetes negatively impacted the patients’ self-management and their spouse’s ability to support them. A female dominated-care pattern was evident that female spouses, regardless of their health status, were actively involved in or fully responsible for managing their husband’s health. Older couples’ management practices were also shaped by family responsibilities and their living environment. Conclusions Our study provides first-hand evidence of older Chinese couples’ daily interactions and the main barriers to diabetes management. It is vital to provide health education directly to older couples to empower them to access adequate mutual support when managing chronic diseases.

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Prevalence of Hypoglycemia, Treatment Satisfaction, Adherence and Their Associations with Glycemic Goals in Patients with Type 2 Diabetes Mellitus Treated with Sulfonylureas: Findings from the Real-Life Effectiveness and Care Patterns of Diabetes Management (RECAP-DM) in Romania

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2019-0006 ◽

2019 ◽

Vol 26 (1) ◽

pp. 55-64

Author(s):

Simona Popoviciu ◽

Anca Alionescu ◽

Irma Sisic

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Glycaemic Control ◽

Diabetes Management ◽

Real Life ◽

Haemoglobin A1c ◽

The Mean ◽

The Impact

Abstract Background and aims: The aim of this study was to assess the prevalence and evaluate the impact on several treatment and quality of life parameters of hypoglycemia in type 2 diabetes mellitus patients treated with sulfonylureas (SU) in Romania. Secondary objective was to determine the proportion of patients attaining haemoglobin A1c (HbA1c) target of <7%. Material and method: This was a multi-center, observational study using retrospective clinical chart and laboratory parameters review, and a cross-sectional survey in Romania. The sample in this study consisted of 385 patients. Socio-demographic and clinical variables were compared between patients with inadequate and adequate control. Results: The mean age of all enrolled subjects was 65.37 (33-87) years. The average BMI was 30.44 kg/m2. Mean diabetes duration was 7.76 (6 months -32) years with the mean age of diabetes at diagnosis of 57.75 (31-85) years. HbA1c was recorded for 238 subjects with mean value of 7.12 (4.8-10.97) %. Conclusions: The prevalence of hypoglycaemia in SU treated patients was 42.2%. Highest prevalence was in the 50-60 age category, at 49.2% and lowest among the eldest subjects (>70 years), at 38.6%. Prevalence of patients at the goal of HbA1c<7% was 50.8 %. Patients with adequate glycaemic control had more acceptable BMI than those with inadequate glycaemic control. In patients not achieving a goal of HbA1c < 7%, higher level of plasma glucose and total cholesterol was determined compared to those with adequate glycaemic control. There were no significant differences in the HDL-C, triglycerides or albumin:creatinine ratios in patients with both adequate and inadequate glycaemic control.

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Disclosure of Herbal Medicine Usage in Diabetes Management: A Qualitative Study amongst Type 2 Diabetes Mellitus Patients and Health Care Providers in Negeri Sembilan, Malaysia

Malaysian Journal of Social Sciences and Humanities (MJSSH) ◽

10.47405/mjssh.v6i1.617 ◽

2021 ◽

Vol 6 (1) ◽

pp. 279-288

Author(s):

Nadia Amirudin ◽

Albeny Joslyn Panting ◽

Rosnani Kassim ◽

Norbaidurah Ithnain

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Herbal Medicine ◽

Qualitative Study ◽

Health Care Providers ◽

Diabetes Management ◽

Communication Process ◽

Care Providers

The use of herbal medicine (HM) and its products has significantly increased in the past decade. Type 2 Diabetes mellitus patients (T2DM) are always rendering herbal medicine as an alternative to the current option of treatment to manage their disease. This article is aimed to explore the extent of communication process of patients who disclose their HM usage to healthcare providers (HCPs) and HCP’s experiences in managing these patients. Purposive sampling method was applied in this qualitative study, which involved 28 respondents from four government clinics in Negeri Sembilan, Malaysia. A semi-structured interview was developed for the in-depth interview (IDI) and focus group interview (FGD). Both IDIs and FGDs were audio-recorded and conducted for approximately (40–60) minutes. The contents were transcribed verbatim and thematically analysed. The majority of T2DM patients did not reveal their HM usage due to fear of negative feedback, never been inquired by HCP and bad experiences after disclosure. Whereas, patients will disclose if they have a good rapport with HCPs and HCP asked patients courteously. However, HCPs reported that they did not discuss HM usage with patients due to limited knowledge, patients refuse to admit and time constraint to consult patients. Communication between T2DM patients and HCPs during consultation concerning the proper use of HM alongside modern medicine needs to be improved. Therefore, a better understanding factor of HM usage and its disclosure would make patients more open-minded to discuss and encourage HCPs to be attentive to avoid any potential adverse effects in HM usage.

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BARRIERS TO PHYSICAL ACTIVITY IN RECENTLY DIAGNOSED TYPE 2 DIABETES MELLITUS PATIENTS: A QUALITATIVE STUDY

Nurse and Health: Jurnal Keperawatan ◽

10.36720/nhjk.v9i2.176 ◽

2020 ◽

Vol 9 (2) ◽

pp. 87-94

Author(s):

Yulia Kurniawati ◽

Ninuk Dian Kurniawati ◽

Ririn Probowati

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Health Literacy ◽

Qualitative Study ◽

Diabetes Management ◽

Phenomenological Approach ◽

Media Technology

Background: Physical activity as one of diabetes management plays important role in maintaining glycemic control. Not all diabetics are doing adequate physical activity. Especially for recently diagnosed type 2 Diabetes Mellitus patients with the characteristic haven’t adopt diabetes management properly.Objectives: The aim of this study to reveal the barriers in physical activity that faced by recently diagnosed type 2 Diabetes Mellitus patients.Methods: Qualitative study with phenomenological approach was conducted in 10 recently diagnosed type 2 Diabetes Mellitus patients in Primary Health Care Kedungdoro and Asemrowo, Surabaya. The participants were selected based on inclusion criteria, namely patients aged 25-45 years old, under 6 months diagnosed, spoke in Indonesian or Javanese well. The exclusion criteria were patients with complication. Semi-structured in-depth interviews guided by interview guideline was conducted to obtain the information about barrier in physical activity. There were six questions in interview guideline. Then data from interview was analyzed by Colaizzi method.Results: Two themes were emerged as barriers in physical activity namely time expenditure and health literacy. Participants’ time expenditure refers to the limited time in doing physical activity, namely obligation to others and lack of spare time. Health literacy refers to the ability in searching and using health information. The barrier in health literacy aspect namely physical activity substitute and different information that got from others.Conclusion: The barriers of physical activity were problem in time flexibility, activity substitute, and need for straightening various information. Using media technology and involving family to promote and remind the physical activity can be suggested. Keywords: Barriers, Diabetes Mellitus Type 2, Recently Diagnosed, Physical Activity

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The role of incretin-based therapies in the management of type 2 diabetes mellitus: perspectives on the past, present and future

Diabetes Mellitus ◽

10.14341/dm11493 ◽

2020 ◽

Vol 22 (5) ◽

pp. 461-466

Author(s):

Juris J. Meier

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetes Management ◽

Therapeutic Potential ◽

Dipeptidyl Peptidase 4 ◽

Receptor Agonists ◽

Clinical Conditions ◽

The Impact

The ever-increasing burden of type 2 diabetes mellitus (T2DM) worldwide, has led to the emergence of several antidiabetes drugs with different modes of action. Incretin hormones and their effect on glucose metabolism and pathogenesis of T2DM has been a landmark discovery in the management of this increasingly prevalent metabolic disorder. Glucagon like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors are the two major classes of incretin-based therapies that regulate glucose mechanism through multiple pathways, demonstrate weight loss (GLP-1 receptor agonists) or a weight-neutral effect (DPP-4 inhibitors), and are associated with a low risk of hypoglycaemia and other adverse events. In addition, evidence reflects their possible therapeutic potential in the treatment of other clinical conditions such as obesity, cardiovascular disease and liver disorders. This review explores the availability and the impact of GLP-1 receptor agonists and DPP-4 inhibitors as potential therapeutic strategies for T2DM along with their future in the landscape of diabetes management and other clinical conditions.

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The Impact of Obesity on Incidence of Type 2 Diabetes Mellitus (T2DM) among Women with Polycystic Ovary Syndrome (PCOS)

Diabetes ◽

10.2337/db18-1612-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1612-P

Author(s):

NADIRA SULTANA KAKOLY ◽

ARUL EARNEST ◽

HELENA TEEDE ◽

LISA MORAN ◽

DEBORAH LOXTON ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Ovary Syndrome ◽

The Impact

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The Impact of Bariatric Surgery in Patients with Type-2 Diabetes Mellitus

Current Diabetes Reviews ◽

10.2174/157339911795843087 ◽

2011 ◽

Vol 7 (3) ◽

pp. 185-189 ◽

Cited By ~ 6

Author(s):

Richdeep S. Gill ◽

Arya M. Sharma ◽

David P. Al-Adra ◽

Daniel W. Birch ◽

Shahzeer Karmali

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Bariatric Surgery ◽

Type 2 Diabetes Mellitus ◽

The Impact

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Effects of ertugliflozin on kidney composite outcomes, renal function and albuminuria in patients with type 2 diabetes mellitus: an analysis from the randomised VERTIS CV trial

Diabetologia ◽

10.1007/s00125-021-05407-5 ◽

2021 ◽

Author(s):

David Z. I. Cherney ◽

◽

Bernard Charbonnel ◽

Francesco Cosentino ◽

Samuel Dagogo-Jack ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Kidney Disease ◽

Serum Creatinine ◽

Renal Dialysis ◽

Composite Endpoint ◽

Composite Outcome ◽

The Impact

Abstract Aims/hypothesis In previous work, we reported the HR for the risk (95% CI) of the secondary kidney composite endpoint (time to first event of doubling of serum creatinine from baseline, renal dialysis/transplant or renal death) with ertugliflozin compared with placebo as 0.81 (0.63, 1.04). The effect of ertugliflozin on exploratory kidney-related outcomes was evaluated using data from the eValuation of ERTugliflozin effIcacy and Safety CardioVascular outcomes (VERTIS CV) trial (NCT01986881). Methods Individuals with type 2 diabetes mellitus and established atherosclerotic CVD were randomised to receive ertugliflozin 5 mg or 15 mg (observations from both doses were pooled), or matching placebo, added on to existing treatment. The kidney composite outcome in VERTIS CV (reported previously) was time to first event of doubling of serum creatinine from baseline, renal dialysis/transplant or renal death. The pre-specified exploratory composite outcome replaced doubling of serum creatinine with sustained 40% decrease from baseline in eGFR. In addition, the impact of ertugliflozin on urinary albumin/creatinine ratio (UACR) and eGFR over time was assessed. Results A total of 8246 individuals were randomised and followed for a mean of 3.5 years. The exploratory kidney composite outcome of sustained 40% reduction from baseline in eGFR, chronic kidney dialysis/transplant or renal death occurred at a lower event rate (events per 1000 person-years) in the ertugliflozin group than with the placebo group (6.0 vs 9.0); the HR (95% CI) was 0.66 (0.50, 0.88). At 60 months, in the ertugliflozin group, placebo-corrected changes from baseline (95% CIs) in UACR and eGFR were −16.2% (−23.9, −7.6) and 2.6 ml min−1 [1.73 m]−2 (1.5, 3.6), respectively. Ertugliflozin was associated with a consistent decrease in UACR and attenuation of eGFR decline across subgroups, with a suggested larger effect observed in the macroalbuminuria and Kidney Disease: Improving Global Outcomes in Chronic Kidney Disease (KDIGO CKD) high/very high-risk subgroups. Conclusions/interpretation Among individuals with type 2 diabetes and atherosclerotic CVD, ertugliflozin reduced the risk for the pre-specified exploratory composite renal endpoint and was associated with preservation of eGFR and reduced UACR. Trial registration ClinicalTrials.gov NCT01986881 Graphical abstract

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Impact of timing of randomization after an acute coronary syndrome and subsequent events in patients with type 2 diabetes mellitus: an analysis of the EXAMINE trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.3067 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Elharram ◽

A Sharma ◽

W White ◽

G Bakris ◽

P Rossignol ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Clinical Trials ◽

Type 2 Diabetes Mellitus ◽

Acute Coronary Syndrome ◽

Primary Outcome ◽

Funding Source ◽

Coronary Syndrome ◽

The Impact

Abstract Background The timing of enrolment following an acute coronary syndrome (ACS) may influence cardiovascular (CV) outcomes and potentially treatment effect in clinical trials. Using a large contemporary trial in patients with type 2 diabetes mellitus (T2DM) post-ACS, we examined the impact of timing of enrolment on subsequent CV outcomes. Methods EXAMINE was a randomized trial of alogliptin versus placebo in 5380 patients with T2DM and a recent ACS. The primary outcome was a composite of CV death, non-fatal myocardial infarction [MI], or non-fatal stroke. The median follow-up was 18 months. In this post hoc analysis, we examined the occurrence of subsequent CV events by timing of enrollment divided by tertiles of time from ACS to randomization: 8–34, 35–56, and 57–141 days. Results Patients randomized early (compared to the latest times) had less comorbidities at baseline including a history of heart failure (HF; 24.7% vs. 33.0%), prior coronary artery bypass graft (9.6% vs. 15.9%), or atrial fibrillation (5.9% vs. 9.4%). Despite the reduced comorbidity burden, the risk of the primary outcome was highest in patients randomized early compared to the latest time (adjusted hazard ratio [aHR] 1.47; 95% CI 1.21–1.74) (Figure 1). Similarly, patients randomized early had an increased risk of recurrent MI (aHR 1.51; 95% CI 1.17–1.96) and HF hospitalization (1.49; 95% CI 1.05–2.10). Conclusion In a contemporary cohort of T2DM with a recent ACS, early randomization following the ACS increases the risk of CV events including recurrent MI and HF hospitalization. This should be taken into account when designing future clinical trials. Figure 1 Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Takeda Pharmaceutical

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