Identification of Education Models to Improve Health Outcomes in Arab Women with Pre-Diabetes

Few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken. The present study evaluates the impact of a 6-month intensive lifestyle modification intervention delivered in primary care. Females from SA with prediabetes, aged 18–55 years, were recruited with 190 participants eligible following screening and randomly allocated to receive a 3-month one-on-one, intensive lifestyle modification (intervention group (IG) n = 95) or standard guidance (control group (CG) n = 95). Participants completed questionnaires including demographic, dietary and physical activity data. Blood samples were collected at baseline, 3 and 6 months. A total of 123 (74 IG (age 40.6 ± 9.8 years; body mass index (BMI) 31.2 ± 7.0 kg/m2) and 49 CG (age 40.6 ± 12.7 years; BMI 32.3 ± 5.4 kg/m2)) participants completed the study. After 6 months, haemoglobin A1c (HbA1c; primary endpoint) significantly improved in the IG than CG completers in between-group comparisons (p < 0.001). Comparison between groups showed significant improvements in overall energy intake, total and high density lipoprotein (HDL)-cholesterol in favour of IG (p-values < 0.001, 0.04 and <0.001, respectively). BMI and weight change were not clinically significant in between group comparisons. A 6-month, intense one-on-one intervention in lifestyle modification significantly improves glycaemic and cardio metabolic profile of females living in SA with pre-diabetes delivered in a primary care setting. Longer duration studies, using the same intervention, may determine whether a meaningful weight loss secondary to improved diet can be achieved.

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Therapeutic Lifestyle Modification Program Reduces Plasma Levels of the Chemokines CRP and MCP-1 in Subjects With Metabolic Syndrome

Biological Research For Nursing ◽

10.1177/1099800411416637 ◽

2011 ◽

Vol 15 (1) ◽

pp. 48-55 ◽

Cited By ~ 13

Author(s):

Eui Geum Oh ◽

So Youn Bang ◽

Soo Hyun Kim ◽

Sa Saeng Hyun ◽

Sang Hui Chu ◽

...

Keyword(s):

Metabolic Syndrome ◽

Lifestyle Modification ◽

Controlled Trial ◽

Intervention Group ◽

Density Lipoprotein ◽

High Sensitivity ◽

Retinol Binding Protein ◽

Control Group ◽

Necrosis Factor Alpha ◽

Hs Crp

Objective: The purpose of this study was to examine the effects of a 6-month therapeutic lifestyle modification (TLM) program on chemokines related to oxidative stress, inflammation, endothelial dysfunction, and arterial stiffness in subjects with metabolic syndrome (MetS). Methods: The authors performed a randomized controlled trial, assigning 52 women (mean age 62.7 ± 9.0 years) with MetS to a TLM intervention group ( n = 31) or a control group ( n = 21). The authors provided the TLM intervention group with health screening, exercise, low-calorie diet, and health education and counseling for 6 months and instructed the control group to maintain their usual lifestyle behaviors. Outcome variables included levels of myeloperoxidase (MPO), oxidized low-density lipoprotein (LDL), adiponectin, leptin, resistin, high-sensitivity C-reactive protein (hs-CRP), interleukin-1β, interleukin-6, tumor necrosis factor-alpha (TNF-α), CD40L, monocyte chemotactic protein-1 (MCP-1), retinol-binding protein 4 (RBP-4), endothelin-1, and brachial-ankle pulse wave velocity. The authors used generalized estimating equation (GEE) analyses to estimate the effects of the TLM program. Results: After the 6-month TLM program, hs-CRP levels decreased significantly, and MCP-1 levels increased at a significantly slower rate in the TLM group than they did in the control group (all p < .05). Conclusion: These results indicate that a TLM program could be effective for improving patient inflammatory states and may also be effective in preventing cardiovascular complications in subjects with MetS.

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Efficacy of different prediabetes program models in improving clinical outcomes in people with prediabetes

Proceedings of The Nutrition Society ◽

10.1017/s0029665120004711 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Rasha Al-Hamdan ◽

Fiona McCullough ◽

Amanda Avery ◽

Dara Al-Disi ◽

Nasser Al-Daghri

Keyword(s):

Social Media ◽

Standard Care ◽

Lifestyle Modification ◽

Educational Programs ◽

Control Group ◽

Haemoglobin A1c ◽

Cluster Randomised ◽

Clinically Significant ◽

Over Time ◽

Group Comparisons

AbstractBackground:Educational programs in general seem to have a clinically significant beneficial effect among the T2DM population in terms of improved glycaemic control. However, few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken.Objective:The present study evaluates for the first time, the differences in the effectiveness of the different educational programs [intensive lifestyle modification (Group Education Program, GEP), supervised education through social media (WhatsApp Education Group, WEP) and standard care via PHCCs (Control Group, CG)], among Saudi females with pre-diabetes.Methods:This was a 6-month, multi-center, 3-arm cluster, randomised, controlled (1:1:1), multi-intervention study conducted from July 2018 until March of 2019 in Riyadh, SA. A total of 1140 females from SA were cluster randomised equally to three groups, out of which only 253 [N = 100 GEP, N = 84 WEP and N = 69 CG] received intervention. Participants completed questionnaires including demographic, dietary and physical activity data. Anthropometrics, blood samples and dietary intake were collected at baseline and 6 months. A total of 120 [37 CG (age 50.9 ± 7.1 years; body mass index (BMI) 31.6 ± 5.8kg/m2), 40 GEP (age 42.9 ± 12.2 years; BMI 34.8 ± 9.0kg/m2) and 43 WEP (age 43.7 ± 8.1 years; BMI 30 ± 5.1kg/m2)] participants completed the study.Results:Haemoglobin A1c (HbA1c; primary endpoint) significantly improved in all groups over time, with no difference in between-group comparisons. Between group comparisons adjusted for age revealed a clinically significant reduction in BMI in favour of GEP (p = 0.02) post-intervention. A clinically significant reduction was also observed in favour of GEP in terms of weight (p = 0.003), waist circumference (p = 0.017), systolic and diastolic blood pressure (p-values < 0.01), triglycerides (p < 0.001) and caloric intake (p < 0.005) over time.Conclusion:Prediabetes education programs of 6-month duration, whether delivered through an intensive lifestyle modification, social media or standard care, are equally efficacious in improving HbA1c levels among Saudi women with prediabetes, but intensive lifestyle is superior in terms of weight reduction and over-all cardiometabolic improvement.

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A single Epley manoeuvre can improve self-perceptions of disability (quality of life) in patients with cp-BPPV: A randomised controlled trial in primary care.

10.21203/rs.3.rs-36678/v2 ◽

2020 ◽

Author(s):

Ricard Carrillo Muñoz ◽

Jose Luis Ballve Moreno ◽

Ivan Villar Balboa ◽

Yolanda Rando Matos ◽

Oriol Cunillera Puertolas ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Intervention Group ◽

Control Group ◽

Perceived Disability ◽

Self Perceptions ◽

Perceptions Of Disability ◽

The Impact

Abstract Background: Posterior canal benign paroxysmal positional vertigo (pc-BPPV) causes physical, functional, and emotional impairment. The treatment of choice is the Epley manoeuvre (EM). The purpose of the study was to compare the impact of the EM and a sham manoeuvre in primary care on self-perceived disability. Method: Randomised, double-blind, sham-controlled clinical trial conducted in primary care with a follow-up of 1 year. Patients aged ≥18 years old diagnosed with pc-BPPV according to the Dix-Hallpike test (DHT) were randomised to an intervention (EM) group or a control (sham manoeuvre) group. The main study covariables were age, sex, history of depression and anxiety, presence of nystagmus in the DHT, patient-perceived disability assessed with the Dizziness Handicap Inventory-screening version (DHI-S). Data were analyzed using bivariate and multivariate mixed Tobit analyses. Results: Overall, 134 patients were studied: 66 in the intervention group and 68 in the control group. Median age was 52 years (interquartile range [IQR], 38.25–68.00 years) and 76.12% of the patients were women. The DHT triggered nystagmus in 40.30% of patients. The median total DHI-S score for the overall sample at baseline was 16 (IQR, 8.00–22.00); 16 [IQR, 10.5–24.0] vs 10 [6.0–14.0] for women vs men ( P <0.001) and 16 [IQR, 10.0-24.0] vs 12 [IQR, 8.0–18.0] for patients without nystagmus vs those with nystagmus ( P =0.033).Patients treated with the EM experienced a mean reduction of 2.03 points in DHI-S score over the follow-up period compared with patients in the sham group. Conclusion: Pc-BPPV affects the quality of life of primary care patients. A single EM can improve self-perceptions of disability by around 2 points on the DHI-S scale, Trial registration : ClinicalTrials.gov Identifier: NCT01969513. Retrospectively registered. First Posted: October 25, 2013. https://clinicaltrials.gov/ct2/show/NCT01969513

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Impact of Epley manoeuvre on self-perceived disability: A randomised controlled trial in primary care

10.21203/rs.3.rs-36678/v1 ◽

2020 ◽

Author(s):

Ricard Carrillo Muñoz ◽

Jose Luis Ballve Moreno ◽

Ivan Villar Balboa ◽

Yolanda Rando Matos ◽

Oriol Cunillera Puertolas ◽

...

Keyword(s):

Primary Care ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Controlled Clinical Trial ◽

Double Blind ◽

Perceived Disability ◽

Randomised Controlled ◽

The Impact

Abstract Background: Posterior canal benign paroxysmal positional vertigo (pc-BPPV) causes physical, functional, and emotional impairment. The treatment of choice is the Epley manoeuvre (EM). The purpose of the study was to compare the impact of the EM and a sham manoeuvre in primary care on self-perceived disability.Method: Randomised, double-blind, sham-controlled clinical trial conducted in primary care with a follow-up of 1 year. Patients aged ≥18 years old diagnosed with pc-BPPV according to the Dix-Hallpike test (DHT) were randomised to an intervention (EM) group or a control (sham manoeuvre) group. The main study covariables were age, sex, history of depression and anxiety, presence of nystagmus in the DHT, patient-perceived disability assessed with the Dizziness Handicap Inventory-screening version (DHI-S). Data were analyzed using bivariate and multivariate mixed Tobit analyses. Results: Overall, 134 patients were studied: 66 in the intervention group and 68 in the control group. Median age was 52 years (interquartile range [IQR], 38.25–68.00 years) and 76.12% of the patients were women. The DHT triggered nystagmus in 40.30% of patients. The median total DHI-S score for the overall sample at baseline was 16 (IQR, 8.00–22.00); 16 [IQR, 10.5–24.0] vs 10 [6.0–14.0] for women vs men (P<0.001) and 16 [IQR, 10.0-24.0] vs 12 [IQR, 8.0–18.0] for patients without nystagmus vs those with nystagmus (P=0.033).Patients treated with the EM experienced a mean reduction of 2.03 points in DHI-S score over the follow-up period compared with patients in the sham group. Conclusion: Pc-BPPV affects the quality of life of primary care patients. A single EM can improve self-perceptions of disability by around 2 points on the DHI-S scale, Trial registration: ClinicalTrials.gov Identifier: NCT01969513. Retrospectively registered. First Posted: October 25, 2013. https://clinicaltrials.gov/ct2/show/NCT01969513

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The impact of medication reviews conducted in primary care on hospital admissions and mortality - a randomized controlled trial

10.21203/rs.2.11674/v1 ◽

2019 ◽

Author(s):

Veronica Milos Nymberg ◽

Cecilia Lenander ◽

Beata Borgström Bolmsjö

Keyword(s):

Primary Care ◽

Elderly Patients ◽

Usual Care ◽

Frail Elderly ◽

Hospital Admissions ◽

Intervention Group ◽

Control Group ◽

Randomized Controlled ◽

Medication Reviews ◽

The Impact

Abstract Background Drug-related problems among the elderly population are common and increasing. Multi-professional medication reviews (MR) have arisen as a method to optimize drug therapy for frail elderly patients. Research has not yet been able to show conclusive evidence of the effect of MRs on mortality or hospital admissions. Aim The aim of this study was to assess the impact of MRs’ on hospital admissions and mortality after six and 12 months in a frail population of 369 patients in primary care in a randomized controlled study. Methods Patients were blindly randomized to an intervention group (receiving MRs) and a control group (receiving usual care). Descriptive data on mortality and hospital admissions at six and 12 months were collected. Survival analysis was performed for time to death and time to the first hospital admission within 12 months. Results Of the total number of 369 included patients, 182 were randomized to the intervention group and 187 to the control group. Most of the patients (75%) were females and lived in nursing homes. At six months, 50 patients of the baseline population (27%) in the control group had been admitted to hospital at least once, compared to 40 patients (21%) in the intervention group. At 12 months, the percentage had increased to 70 (37%) in the control group compared to 53 (29%) in the intervention group. Compared to usual care, we found that MRs reduced the risk of hospital admissions within 12 months by 36% (HR = 0.64, 95% CI 0.45-0.90), but found no difference on mortality (HR = 1.12, 95% CI 0.78-1.61) between the groups. Conclusion We suggest that MRs should be recommended in the care of frail elderly patients with expected benefits on hospital admissions.

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Effectiveness of a psychoeducational group intervention in patients with mild/moderate depression in primary care (PC): randomized controlled trial

European Psychiatry ◽

10.1016/s0924-9338(11)72323-9 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 616-616 ◽

Cited By ~ 2

Author(s):

R. Casañas ◽

R. Catalan ◽

M. Casas ◽

A. Raya ◽

E.M. Fernandez ◽

...

Keyword(s):

Primary Care ◽

Depressive Symptoms ◽

Group Intervention ◽

Intervention Group ◽

Control Group ◽

Medical Illness ◽

Mild Depression ◽

Psychoeducational Group ◽

Moderate Depression ◽

The Impact

BackgroundDue to the high prevalence of depressive symptoms in PC (Ayuso, 2001) is relevant to know the impact of the psychoeducation in the management of these symptoms to decrease the prevalence in the PC population.ObjectiveTo compare the effectiveness of a psychoeducational group intervention in patients with mild/moderate depression in PC.Methods242 participants older than 20 years with ICD-10 mild/moderate depression were recruited through nurse/general practice in 12 urban primary health care centers in Barcelona city. Randomization was realised by means of a computer program. Exclusion criteria: severe mental disorder, major depressive disorder, use of secondary mental health services and acute medical illness. The intervention group (IG) received a psycoeducational group program (12 weekly 1,5h sessions) leads by two nurses. The program was an adaptation of Coping With Depression (CWD) (Lewinsohn, 1989). The control group (CG) received TAU. Outcome measures: Sociodemographic, BDI and EuroQol-5D questionnaires pre-post intervention.Results232 patients were included, IG (n = 121) and CG (n = 112), of whom 86 patients had mild depression (BDI≤ 18) and 146 moderate depression (BDI≥ 19). The sample characteristics were as follow: 90% women with mean age of 53,27 (SD = 12,72)The intervention was associated with significant improvements in BDI (t(230) =-2.25; p = 0.025). Separately analyze the sample: Patients with mild depression: (t(83) =-2.52; p = 0.014).Patients with moderate depression: (t(141) =-2.62; p = 0.010). Posttest results show that this intervention has statistically significant effect on depressive symptoms in overall sample and in mild/moderate depression separately.ConclusionsThe psychoeducational intervention is effective treatment in both mild and moderate depressive symptoms in primary care.

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Impact of Pharmacist-Led Diabetes Management in Primary Care Clinics

INNOVATIONS in pharmacy ◽

10.24926/iip.v9i2.985 ◽

2018 ◽

Vol 9 (2) ◽

pp. 17

Author(s):

Benjamin Pontefract ◽

Benjamin S. King ◽

Cynthia A. King ◽

David M Gothard

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Usual Care ◽

Diabetes Management ◽

Intervention Group ◽

Control Group ◽

Original Research ◽

Diabetic Patients ◽

Primary Care Clinics ◽

The Impact

Purpose: Current literature supports that pharmacists effectively lower hemoglobin A1c (HbA1c) in diabetic patients. Little data exists on pharmacists’ effects on comorbidity management, patient satisfaction, or financial viability of these positions. This study looked to assess the impact of pharmacists on diabetes management compared to usual care. Methods: This multi-site, two-part study includes a retrospective chart review of patients referred to the pharmacist versus usual care within a large academic health system. The pharmacists collaborated under a consult agreement with primary care physicians. The second part of the study assessed patient satisfaction through an abbreviated CG-CAHPS survey. Results:A total of 206 patients with diabetes for an average of 12 years were included. The average patient age was 62 years with 60% of patients identifying as female and 81% as African-American. Patients were enrolled in a 2:1 fashion with 138 patients in the intervention group. Average baseline HbA1c was 10.1% in the intervention group and 9.3% in the control group (p= 0.0125). At 6 months, the mean change in HbA1c was -2.17% and 0.48% for the intervention and control groups respectively (p Conclusion: Pharmacists are effective at lowering HbA1c in primary care clinics, and patients were highly satisfied with these services. While direct revenue from this service did not meet cost, the pharmacist did positively affect outcomes that contribute to reimbursement. Treatment of Human Subjects: IRB review/approval required and obtained Type: Original Research

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Impact of a walking intervention during pregnancy on post-partum weight retention and infant anthropometric outcomes

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174414000117 ◽

2014 ◽

Vol 5 (3) ◽

pp. 259-267 ◽

Cited By ~ 10

Author(s):

K. L. Kong ◽

C. Campbell ◽

K. Wagner ◽

A. Peterson ◽

L. Lanningham-Foster

Keyword(s):

Lifestyle Modification ◽

Post Partum ◽

Child Outcomes ◽

Intervention Group ◽

Control Group ◽

Weight Retention ◽

Obese Women ◽

Growth Trend ◽

Walking Intervention ◽

The Impact

Few studies have investigated the impact of lifestyle interventions during pregnancy on post-partum weight retention and infant growth. Thirty seven previously non-exercising, overweight or obese pregnant women were randomly assigned to a walking intervention or non-intervention control. For the follow-up study, weight of the mother and weight, length and body composition of the infant were collected at 1 month post-partum (n=37) and 6 months post-partum (n=33). Analysis of variance and linear regression were conducted to determine the differences and association in maternal post-partum weight retention and child outcomes. At 6 months post-partum, weight retention of obese women in the intervention group (Int-OB) was −0.10±8.11 kg; while, obese women in the control group (Con-OB) was 6.35±7.47 kg. A significantly higher percentage of Con-OB women retained more than 5 kg at 6 months post-partum (P=0.046). Even though statistically non-significant between the groups, the growth trend observed among offspring of obese women in the control group was consistently higher than the offspring of obese women in the intervention group from birth to 6-months. Third trimester gestational weight gain rate significantly predicted 6-m weight-for-length z-score after controlling for birth weight, treatment group and pre-pregnancy body mass index (r2=0.31, β=1.75, P=0.03). The reduced post-partum weight retention observed among the obese women in the intervention group may be explained in part by the lifestyle modification during pregnancy.

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The impact of medication reviews conducted in primary care on hospital admissions and mortality - an observational follow up of a randomized controlled trial

10.21203/rs.2.11674/v2 ◽

2020 ◽

Author(s):

Veronica Milos Nymberg ◽

Cecilia Lenander ◽

Beata Borgström Bolmsjö

Keyword(s):

Primary Care ◽

Elderly Patients ◽

Usual Care ◽

Frail Elderly ◽

Hospital Admissions ◽

Intervention Group ◽

Control Group ◽

Randomized Controlled ◽

Medication Reviews ◽

The Impact

Abstract Background Drug-related problems among the elderly population are common and increasing. Multi-professional medication reviews (MRs) have arisen as a method to optimize drug therapy for frail elderly patients. Research has not yet been able to show conclusive evidence of the effect of MRs on mortality or hospital admissions. Aim The aim of this study was to assess the impact of MRs’ on hospital admissions and mortality after six and 12 months in a frail population of 369 patients in primary care in a randomized controlled study. Methods Patients were blindly randomized to an intervention group (receiving MRs) and a control group (receiving usual care). Descriptive data on mortality and hospital admissions at six and 12 months were collected. Survival analysis was performed for time to death and time to the first hospital admission within 12 months. Results Of the total number of 369 included patients, 182 were randomized to the intervention group and 187 to the control group. Most of the patients (75%) were females and lived in nursing homes. At six months, 50 patients of the baseline population (27%) in the control group had been admitted to hospital at least once, compared to 40 patients (21%) in the intervention group. At 12 months, the percentage had increased to 70 (37%) in the control group compared to 53 (29%) in the intervention group. Compared to usual care, we found that MRs reduced the risk of hospital admissions within 12 months by 42% (HR = 0.58, 95% CI 0.37-0.92), but found no difference on mortality (HR = 1.12, 95% CI 0.78-1.61) between the groups. Conclusion We suggest that MRs should be recommended in the care of frail elderly patients with expected benefits on delayed hospital admissions.

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Early detection of anaemia in primary care with haemoglobinometry: ANHEMOG clinical trial protocol

BMC Family Practice ◽

10.1186/s12875-021-01548-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Boris Trenado Luengo ◽

Rosa García-Sierra ◽

Maria Asunción Wilke Trinxant ◽

Esther Díaz Mondelo ◽

Ramon Miralles Baseda ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Chronic Diseases ◽

Response Times ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Monthly Basis ◽

The Impact

Abstract Background Detecting, treating and monitoring anaemia has a functional, social and economic impact on patients’ quality of life and the health system, since inadequate monitoring can lead to more accident & emergency visits and hospitalizations. The aim of this study is to evaluate the impact in the patient clinical outcomes of using haemoglobinometry to early detect anaemia in patients with chronic anaemia in primary care. Methods Randomized controlled trial Capillary haemoglobin will be measured using a haemoglobinometer on a monthly basis in the intervention group. In the control group, the protocol currently in force at the primary care centre will be followed and venous haemoglobin will be measured. Any cases of anaemia detected in either group will be referred to the transfusion circuit of the reference hospital. Discusion The results will shed light on the impact of the intervention on the volume of hospitalizations and accident & emergency (A&E) visits due to anaemia, as well as patients’ quality of life. Chronic and repeated bouts of anaemia are detected late, thus leading to decompensation in chronic diseases and, in turn, more A&E visits and hospitalizations. The intervention should improve these outcomes since treatment could be performed without delay. Improving response times would decrease decompensation in chronic diseases, as well as A&E visits and hospitalizations, and improve quality of life. The primary care nurse case manager will perform the intervention, which should improve existing fragmentation between different care levels. Trial registration NCT04757909. Registered 17 February 2021. Retrospectively registered.

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