scholarly journals Screening for prediabetes and type 2 diabetes in primary care: early detection, treatment and follow-up

2019 ◽  
Author(s):  
Katri Harcke
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Early Detection

Effect of Professional CGM (pCGM) on Glucose Management in Type 2 Diabetes Patients in Primary Care

2021 ◽  
pp. 193229682199872
Author(s):  
Gregg D. Simonson ◽  
Richard M. Bergenstal ◽  
Mary L. Johnson ◽  
Janet L. Davidson ◽  
Thomas W. Martens
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Glucose Monitoring ◽  
Care Model ◽  
Time In Range ◽  
Glucose Management ◽  
The Impact ◽  
Primary Care Management

Background: Little data exists regarding the impact of continuous glucose monitoring (CGM) in the primary care management of type 2 diabetes (T2D). We initiated a quality improvement (QI) project in a large healthcare system to determine the effect of professional CGM (pCGM) on glucose management. We evaluated both an MD and RN/Certified Diabetes Care and Education Specialist (CDCES) Care Model. Methods: Participants with T2D for >1 yr., A1C ≥7.0% to <11.0%, managed with any T2D regimen and willing to use pCGM were included. Baseline A1C was collected and participants wore a pCGM (Libre Pro) for up to 2 weeks, followed by a visit with an MD or RN/CDCES to review CGM data including Ambulatory Glucose Profile (AGP) Report. Shared-decision making was used to modify lifestyle and medications. Clinic follow-up in 3 to 6 months included an A1C and, in a subset, a repeat pCGM. Results: Sixty-eight participants average age 61.6 years, average duration of T2D 15 years, mean A1C 8.8%, were identified. Pre to post pCGM lowered A1C from 8.8% ± 1.2% to 8.2% ± 1.3% (n=68, P=0.006). The time in range (TIR) and time in hyperglycemia improved along with more hypoglycemia in the subset of 37 participants who wore a second pCGM. Glycemic improvement was due to lifestyle counseling (68% of participants) and intensification of therapy (65% of participants), rather than addition of medications. Conclusions: Using pCGM in primary care, with an MD or RN/CDCES Care Model, is effective at lowering A1C, increasing TIR and reducing time in hyperglycemia without necessarily requiring additional medications.

scholarly journals Clinical practice guideline for the prevention, early detection, diagnosis, management and follow up of type 2 diabetes mellitus in adults.

2016 ◽  
pp. 109-130 ◽  
Author(s):  
Pablo Aschner ◽  
Oscar Mauricio Muñoz ◽  
Diana Giron ◽  
Olga Milena Garcia ◽  
Daniel Gerardo Fernandez Ávila ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Clinical Practice ◽  
Early Detection ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Control Glucémico

En Colombia la Diabetes Mellitus es un problema de salud pública por lo que deben generarse e implementarse estrategias de prevención, diagnóstico, tratamiento y seguimiento, aplicables en todos los niveles de atención con miras a establecer el control de la diabetes en forma temprana y sostenida. Se elaboró una guía de práctica clínica siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social para recolectar de forma sistemática la evidencia científica y formular las recomendaciones utilizando la metodología GRADE. El presente documento muestra, de forma resumida, el resultado de ese proceso, incluyendo las recomendaciones y las consideraciones tenidas en cuenta para llegar a ellas. En términos generales, se propone un proceso de tamización mediante el cuestionario FINDRISC adaptado a población Colombiana que permite llegar a un diagnóstico temprano de la enfermedad y un algoritmo para el manejo inicial que es generalizable a la gran mayoría de los pacientes con DMT2 y que es sencillo de aplicar en atención primaria. También se hacen unas recomendaciones para escalar el tratamiento farmacológico de los pacientes que no alcanzan la meta o la pierden con el manejo inicial, teniendo en cuenta principalmente la evolución del peso y la individualización de la meta de control glucémico en poblaciones especiales. Finalmente se proponen algunas recomendaciones para la detección oportuna de las complicaciones micro y macrovasculares de la diabetes.

Dapagliflozin therapy for type 2 diabetes in primary care: Changes in HbA1c, weight and blood pressure over 2 years follow-up

2017 ◽  
Vol 11 (5) ◽  
pp. 437-444 ◽  
Author(s):  
J. Wilding ◽  
C. Bailey ◽  
U. Rigney ◽  
B. Blak ◽  
M. Kok ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Primary Care

Increase in Daily Steps After an Exercise Specialist Led Lifestyle Intervention for Adults With Type 2 Diabetes in Primary Care: A Controlled Implementation Trial

2015 ◽  
Vol 12 (11) ◽  
pp. 1492-1499 ◽  
Author(s):  
Steven T. Johnson ◽  
Clark Mundt ◽  
Weiyu Qiu ◽  
Allison Soprovich ◽  
Lisa Wozniak ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Glycemic Index ◽  
Control Group ◽  
Clinical Markers ◽  
Random Effects Models ◽  
Lifestyle Program ◽  
Exercise Specialist

Objective:To determine the effectiveness of an exercise specialist led lifestyle program for adults with type 2 diabetes in primary care.Methods:Eligible participants from 4 primary care networks in Alberta, Canada were assigned to either a lifestyle program or a control group. The program targeted increased daily walking through individualized daily pedometer step goals for the first 3 months and brisk walking speed, along with substitution of low-relative to high-glycemic index foods over the next 3 months. The outcomes were daily steps, diet, and clinical markers, and were compared using random effects models.Results:198 participants were enrolled (102 in the intervention and 96 in the control). For all participants, (51% were women), mean age 59.5 (SD 8.3) years, A1c 6.8% (SD 1.1), BMI 33.6 kg/m2 (SD 6.5), systolic BP 125.6 mmHg (SD 16.2), glycemic index 51.7 (4.6), daily steps 5879 (SD 3130). Daily steps increased for the intervention compared with the control at 3-months (1292 [SD 2698] vs. 418 [SD 2458] and 6-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted P = .002). No significant differences were observed for diet or clinical outcomes.Conclusions:A 6-month lifestyle program delivered in primary care by an exercise specialist can be effective for increasing daily walking among adults with recently diagnosed type 2 diabetes. This short-term increase in daily steps requires longer follow-up to estimate the potential impact on health outcomes.

scholarly journals Patients’ views on interactions with practitioners for type 2 diabetes: a longitudinal qualitative study in primary care over 10 years

2017 ◽  
Vol 68 (666) ◽  
pp. e36-e43 ◽  
Author(s):  
Hajira Dambha-Miller ◽  
Barbora Silarova ◽  
Greg Irving ◽  
Ann Louise Kinmonth ◽  
Simon J Griffin
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Descriptive Analysis ◽  
Free Text ◽  
Individual Level ◽  
Face To Face ◽  
Relational Continuity ◽  
Over Time

BackgroundIt has been suggested that interactions between patients and practitioners in primary care have the potential to delay progression of complications in type 2 diabetes. However, as primary care faces greater pressures, patient experiences of patient–practitioner interactions might be changing.AimTo explore the views of patients with type 2 diabetes on factors that are of significance to them in patient–practitioner interactions in primary care after diagnosis, and over the last 10 years of living with the disease.Design and settingA longitudinal qualitative analysis over 10 years in UK primary care.MethodThe study was part of a qualitative and quantitative examination of patient experience within the existing ADDITION-Cambridge and ADDITION-Plus trials from 2002 to 2016. The researchers conducted a qualitative descriptive analysis of free-text comments to an open-ended question within the CARE measure questionnaire at 1 and 10 years after diagnosis with diabetes. Data were analysed cross-sectionally at each time point, and at an individual level moving both backwards and forwards between time points to describe emergent topics.ResultsAt the 1-year follow-up, 311 out of 1106 (28%) participants had commented; 101 out of 380 (27%) participants commented at 10-year follow-up; and 46 participants commented at both times. Comments on preferences for face-to-face contact, more time with practitioners, and relational continuity of care were more common over time.ConclusionThis study highlights issues related to the wider context of interactions between patients and practitioners in the healthcare system over the last 10 years since diagnosis. Paradoxically, these same aspects of care that are valued over time from diagnosis are also increasingly unprotected in UK primary care.

scholarly journals Primary care experience and remission of Type 2 diabetes: a population-based prospective cohort study

2020 ◽  
Author(s):  
Hajira Dambha-Miller ◽  
Alexander Day ◽  
Ann Louise Kinmonth ◽  
Simon J Griffin
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Weight Loss ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Population Based ◽  
Care Experience

Abstract Background Remission of Type 2 diabetes is achievable through dietary change and weight loss. In the UK, lifestyle advice and referrals to weight loss programmes predominantly occur in primary care where most Type 2 diabetes is managed. Objective To quantify the association between primary care experience and remission of Type 2 diabetes over 5-year follow-up. Methods A prospective cohort study of adults with Type 2 diabetes registered to 49 general practices in the East of England, UK. Participants were followed-up for 5 years and completed the Consultation and Relational Empathy measure (CARE) on diabetes-specific primary care experiences over the first year after diagnosis of the disease. Remission at 5-year follow-up was measured with HbA1c levels. Univariable and multivariable logistic regression models were constructed to quantify the association between primary care experience and remission of diabetes. Results Of 867 participants, 30% (257) achieved remission of Type 2 diabetes at 5 years. Six hundred twenty-eight had complete data at follow-up and were included in the analysis. Participants who reported higher CARE scores in the 12 months following diagnosis were more likely to achieve remission at 5 years in multivariable models; odds ratio = 1.03 (95% confidence interval = 1.01–1.05, P = 0.01). Conclusion Primary care practitioners should pay greater attention to delivering optimal patient experiences alongside clinical management of the disease as this may contribute towards remission of Type 2 diabetes. Further work is needed to examine which aspects of the primary care experience might be optimized and how these could be operationalized.

scholarly journals Prediction of type 2 diabetes risk in people with non-diabetic hyperglycaemia: model derivation and validation using UK primary care data

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037937
Author(s):  
Briana Coles ◽  
Kamlesh Khunti ◽  
Sarah Booth ◽  
Francesco Zaccardi ◽  
Melanie J Davies ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Prognostic Models ◽  
Predictor Variables ◽  
Validation Dataset ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Primary Care Data

ObjectiveUsing primary care data, develop and validate sex-specific prognostic models that estimate the 10-year risk of people with non-diabetic hyperglycaemia developing type 2 diabetes.DesignRetrospective cohort study.SettingPrimary care.Participants154 705 adult patients with non-diabetic hyperglycaemia.Primary outcomeDevelopment of type 2 diabetes.MethodsThis study used data routinely collected in UK primary care from general practices contributing to the Clinical Practice Research Datalink. Patients were split into development (n=109 077) and validation datasets (n=45 628). Potential predictor variables, including demographic and lifestyle factors, medical and family history, prescribed medications and clinical measures, were included in survival models following the imputation of missing data. Measures of calibration at 10 years and discrimination were determined using the validation dataset.ResultsIn the development dataset, 9332 patients developed type 2 diabetes during 293 238 person-years of follow-up (31.8 (95% CI 31.2 to 32.5) per 1000 person-years). In the validation dataset, 3783 patients developed type 2 diabetes during 115 113 person-years of follow-up (32.9 (95% CI 31.8 to 33.9) per 1000 person-years). The final prognostic models comprised 14 and 16 predictor variables for males and females, respectively. Both models had good calibration and high levels of discrimination. The performance statistics for the male model were: Harrell’s C statistic of 0.700 in the development and 0.701 in the validation dataset, with a calibration slope of 0.974 (95% CI 0.905 to 1.042) in the validation dataset. For the female model, Harrell’s C statistics were 0.720 and 0.718, respectively, while the calibration slope was 0.994 (95% CI 0.931 to 1.057) in the validation dataset.ConclusionThese models could be used in primary care to identify those with non-diabetic hyperglycaemia most at risk of developing type 2 diabetes for targeted referral to the National Health Service Diabetes Prevention Programme.

scholarly journals Metformin use and risk of cancer in patients with type 2 diabetes: a cohort study of primary care records using inverse probability weighting of marginal structural models

2019 ◽  
Vol 48 (2) ◽  
pp. 527-537 ◽  
Author(s):  
Ruth E Farmer ◽  
Deborah Ford ◽  
Rohini Mathur ◽  
Nish Chaturvedi ◽  
Rick Kaplan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Cancer Risk ◽  
Structural Models ◽  
Marginal Structural Models ◽  
Diabetes Diagnosis ◽  
Inverse Probability ◽  
Risk Of Cancer

Abstract Background Previous studies provide conflicting evidence on whether metformin is protective against cancer. When studying time-varying exposure to metformin, covariates such as body mass index (BMI) and glycated haemoglobin (HbA1c) may act as both confounders and causal pathway variables, and so cannot be handled adequately by standard regression methods. Marginal structural models (MSMs) with inverse probability of treatment weights (IPTW) can correctly adjust for such confounders. Using this approach, the main objective of this study was to estimate the effect of metformin on cancer risk compared with risk in patients with T2DM taking no medication. Methods Patients with incident type 2 diabetes (T2DM) were identified in the Clinical Practice Research Datalink (CPRD), a database of electronic health records derived from primary care in the UK. Patients entered the study at diabetes diagnosis or the first point after this when they had valid HbA1c and BMI measurements, and follow-up was split into 1-month intervals. Logistic regression was used to calculate IPTW; then the effect of metformin on all cancers (including and excluding non-melanoma skin cancer) and breast, prostate, lung, colorectal and pancreatic cancers was estimated in the weighted population. Results A total of 55 629 T2DM patients were alive and cancer-free at their study entry; 2530 people had incident cancer during a median follow-up time of 2.9 years [interquartile range (IQR) 1.3–5.4 years]. Using the MSM approach, the hazard ratio (HR) for all cancers, comparing treatment with metformin with no glucose-lowering treatment, was 1.02 (0.88–1.18). Results were robust to a range of sensitivity analyses and remained consistent when estimating the treatment effect by length of exposure. We also found no evidence of a protective effect of metformin on individual cancer outcomes. Conclusions We find no evidence that metformin has a causal association with cancer risk.

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