scholarly journals Diabetes and Frail Older Patients: Glycemic Control and Prescription Profile in Real Life

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 115
Author(s):  
Anne-Sophie Mangé ◽  
Arnaud Pagès ◽  
Sandrine Sourdet ◽  
Philippe Cestac ◽  
Cécile McCambridge
Keyword(s):  
Glycemic Control ◽  
Older Patients ◽  
Diabetes Management ◽  
Real Life ◽  
Cross Sectional ◽  
Glucose Lowering ◽  
Frailty Status ◽  
Frail Patients ◽  
Patients With Diabetes ◽  
Hba1c Target

(1) Background: The latest recommendations for diabetes management adapt the objectives of glycemic control to the frailty profile in older patients. The purpose of this study was to evaluate the proportion of older patients with diabetes whose treatment deviates from the recommendations. (2) Methods: This cross-sectional observational study was conducted in older adults with known diabetes who underwent an outpatient frailty assessment in 2016. Glycated hemoglobin (HbA1c) target is between 6% and 7% for nonfrail patients and between 7% and 8% for frail patients. Frailty was evaluated using the Fried criteria. Prescriptions of glucose-lowering drugs were analyzed based on explicit and implicit criteria. (3) Results: Of 110 people with diabetes with an average age of 81.7 years, 67.3% were frail. They had a mean HbA1c of 7.11%. Of these patients, 60.9% had at least one drug therapy problem in their diabetes management and 40.9% were potentially overtreated. The HbA1c distribution in relation to the targets varied depending on frailty status (p < 0.002), with overly strict control in frail patients (p < 0.001). (4) Conclusions: Glycemic control does not seem to be routinely adjusted to the health of frail patients. Several factors can lead to overtreatment of these patients.

scholarly journals Differences in Secure Messaging, Self-management, and Glycemic Control Between Rural and Urban Patients: Secondary Data Analysis

JMIR Diabetes ◽  
10.2196/32320 ◽  
2021 ◽  
Vol 6 (4) ◽  
pp. e32320
Author(s):  
Stephanie A Robinson ◽  
Dane Netherton ◽  
Mark Zocchi ◽  
Carolyn Purington ◽  
Arlene S Ash ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Diabetes Management ◽  
The United States ◽  
Diabetes Control ◽  
Self Management ◽  
Patient Portal ◽  
Cross Sectional ◽  
Secure Messaging ◽  
Patients With Diabetes ◽  
Rural Patients

Background Rural patients with diabetes have difficulty accessing care and are at higher risk for poor diabetes management. Sustained use of patient portal features such as secure messaging (SM) can provide accessible support for diabetes self-management. Objective This study explored whether rural patients’ self-management and glycemic control was associated with the use of SM. Methods This secondary, cross-sectional, mixed methods analysis of 448 veterans with diabetes used stratified random sampling to recruit a diverse sample from the United States (rural vs urban and good vs poor glycemic control). Administrative, clinical, survey, and interview data were used to determine patients’ rurality, use of SM, diabetes self-management behaviors, and glycemic control. Moderated mediation analyses assessed these relationships. Results The sample was 51% (n=229) rural and 49% (n=219) urban. Mean participant age was 66.4 years (SD 7.7 years). More frequent SM use was associated with better diabetes self-management (P=.007), which was associated with better glycemic control (P<.001). Among rural patients, SM use was indirectly associated with better glycemic control through improved diabetes self-management (95% CI 0.004-0.927). These effects were not observed among urban veterans with diabetes (95% CI –1.039 to 0.056). Rural patients were significantly more likely than urban patients to have diabetes-related content in their secure messages (P=.01). Conclusions More frequent SM use is associated with engaging in diabetes self-management, which, in turn, is associated with better diabetes control. Among rural patients with diabetes, SM use is indirectly associated with better diabetes control. Frequent patient-team communication through SM about diabetes-related content may help rural patients with diabetes self-management, resulting in better glycemic control.

scholarly journals Differences in Secure Messaging, Self-management, and Glycemic Control Between Rural and Urban Patients: Secondary Data Analysis (Preprint)

2021 ◽  
Author(s):  
Stephanie A Robinson ◽  
Dane Netherton ◽  
Mark Zocchi ◽  
Carolyn Purington ◽  
Arlene S Ash ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Diabetes Management ◽  
The United States ◽  
Diabetes Control ◽  
Self Management ◽  
Patient Portal ◽  
Cross Sectional ◽  
Secure Messaging ◽  
Patients With Diabetes ◽  
Rural Patients

BACKGROUND Rural patients with diabetes have difficulty accessing care and are at higher risk for poor diabetes management. Sustained use of patient portal features such as secure messaging (SM) can provide accessible support for diabetes self-management. OBJECTIVE This study explored whether rural patients’ self-management and glycemic control was associated with the use of SM. METHODS This secondary, cross-sectional, mixed methods analysis of 448 veterans with diabetes used stratified random sampling to recruit a diverse sample from the United States (rural vs urban and good vs poor glycemic control). Administrative, clinical, survey, and interview data were used to determine patients’ rurality, use of SM, diabetes self-management behaviors, and glycemic control. Moderated mediation analyses assessed these relationships. RESULTS The sample was 51% (n=229) rural and 49% (n=219) urban. Mean participant age was 66.4 years (SD 7.7 years). More frequent SM use was associated with better diabetes self-management (<i>P</i>=.007), which was associated with better glycemic control (<i>P</i>&lt;.001). Among rural patients, SM use was indirectly associated with better glycemic control through improved diabetes self-management (95% CI 0.004-0.927). These effects were not observed among urban veterans with diabetes (95% CI –1.039 to 0.056). Rural patients were significantly more likely than urban patients to have diabetes-related content in their secure messages (<i>P</i>=.01). CONCLUSIONS More frequent SM use is associated with engaging in diabetes self-management, which, in turn, is associated with better diabetes control. Among rural patients with diabetes, SM use is indirectly associated with better diabetes control. Frequent patient-team communication through SM about diabetes-related content may help rural patients with diabetes self-management, resulting in better glycemic control.

scholarly journals Suboptimal glycemic control among subjects with diabetes mellitus in India: a subset analysis of cross-sectional wave-7 (2016) data from the International Diabetes Management Practices Study (IDMPS)

2020 ◽  
Vol 11 ◽  
pp. 204201882093721
Author(s):  
Ambady Ramachandran ◽  
Sunil M. Jain ◽  
Sagarika Mukherjee ◽  
Sanjeev Phatak ◽  
Shailesh Pitale ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Management Practices ◽  
Diabetes Management ◽  
Diabetes Education ◽  
Glycated Haemoglobin ◽  
Oral Glucose ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Glycemic Targets

Objective: To assess the real-world management practices of subjects with type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM) in India. Methods: This cross-sectional study was conducted between 7 March 2016 and 15 May 2016 in India as part of the seventh wave (2016) of the International Diabetes Management Practices Study (IDMPS). Adult subjects with T1DM or T2DM visiting physicians during a 2-week recruitment period were included. Results: A total of 55 physicians included 539 subjects who met eligibility criteria. Of 495 subjects with T2DM, 303 were treated with oral glucose lowering drugs (OGLDs) only, 158 were treated with OGLD + insulin, and 27 received insulin only. Among 44 subjects with T1DM receiving insulin, 13 (29.5%) were also treated with OGLD therapy. The most commonly used insulin regimens were basal alone (69/184; 37.5%) and premixed alone (63/184; 34.2%) in subjects with T2DM, and basal + prandial insulin (24/44; 54.5%) in subjects with T1DM. Proportions of subjects achieving glycemic targets were low [glycated haemoglobin (HbA1c) <7%: T1DM = 7.3% (3/44), T2DM = 25.2% (106/495); as targeted by the treating physician: T1DM = 31.8% (14/44), T2DM = 32.1% (59/185); global target: T1DM = 4.8% (2/42) and T2DM = 1.7% (8/482)]. In subjects with T2DM, HbA1c <7% was noted in 11/22 subjects receiving insulin only and 76/260 receiving only OGLDs. Lack of experience in self-managing insulin dosing, poor diabetes education and failure to titrate insulin dosages were the main reasons for non-achievement of glycemic targets. Conclusion: Timely insulinization, education and empowerment of people with diabetes may help improve glycemic control in India.

scholarly journals Diagnostic and Therapeutic Challenges in the Management of Intermediate and Frail Elderly Multiple Myeloma Patients

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3106
Author(s):  
Francesca Bonello ◽  
Mario Boccadoro ◽  
Alessandra Larocca
Keyword(s):  
Multiple Myeloma ◽  
Elderly Patients ◽  
Treatment Options ◽  
Real Life ◽  
Frailty Status ◽  
Frail Patients ◽  
Multidimensional Evaluation ◽  
Choice Of Treatment ◽  
Choice Of Therapy

Multiple myeloma (MM) mostly affects elderly patients, which represent a highly heterogeneous population. Indeed, comorbidities, frailty status and functional reserve may vary considerably among patients with similar chronological age. For this reason, the choice of treatment goals and intensity is particularly challenging in elderly patients, and it requires a multidimensional evaluation of the patients and the disease. In recent years, different tools to detect patient frailty have been developed, and the International Myeloma Working Group frailty score currently represents the gold standard. It identifies intermediate-fit and frail patients requiring gentler treatment approaches compared to fit patients, aiming to preserve quality of life and prevent toxicities. This subset of patients is underrepresented in clinical trials, and studies exploring frailty-adapted approaches are scarce, making the choice of therapy extremely challenging. Treatment options for intermediate-fit and frail patients might include dose-adapted combinations, doublets, and less toxic combinations based on novel agents. This review analyzes the available tools for the assessment of frailty and possible strategies to improve the discriminative power of the scores and expand their use in real-life and clinical trial settings. Moreover, it addresses the main therapeutic challenges in the management of intermediate-fit and frail MM patients at diagnosis and at relapse.

scholarly journals Barriers to care in patients with diabetes and poor glycemic control—A cross-sectional survey

PLoS ONE ◽  
2017 ◽  
Vol 12 (5) ◽  
pp. e0176135 ◽  
Author(s):  
Kerry A. McBrien ◽  
Christopher Naugler ◽  
Noah Ivers ◽  
Robert G. Weaver ◽  
David Campbell ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Barriers To Care ◽  
Poor Glycemic Control ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Patients With Diabetes

scholarly journals Social Support, Self-Care Behaviour and Self-Efficacy in Patients with Type 2 Diabetes during the COVID-19 Pandemic: A Cross-Sectional Study

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1607
Author(s):  
Premalatha Paulsamy ◽  
Rizwan Ashraf ◽  
Shadia Hamoud Alshahrani ◽  
Kalaiselvi Periannan ◽  
Absar Ahmed Qureshi ◽  
...  
Keyword(s):  
Social Support ◽  
Glycemic Control ◽  
Self Efficacy ◽  
Diabetes Management ◽  
Self Care ◽  
Cross Sectional Study ◽  
The Self ◽  
Sectional Study ◽  
Cross Sectional

Diabetes mellitus is a major public health issue that considerably impacts mortality, morbidity, and healthcare costs worldwide. The COVID-19 pandemic has created havoc in diabetes management, too, like other spectrums of life. A descriptive, cross-sectional study was adopted to determine the effect of Social Support, Self-Care Behaviour and Self-Efficacy in Type 2 Diabetes Mellitus (T2D) during this COVID-19 pandemic. Two hundred T2D patients who satisfied the inclusion criteria were chosen using a convenient sampling procedure. The tool consists of four sections, including socio-demographic characteristics, Multidimensional Scale of Perceived Social Support (MSPSS), revised Summary of Diabetes Self-Care Activities (SDSCA) Scale and modified Diabetes Management Self-Efficacy Scale (DMS). Descriptive and inferential statistics were used to analyze the obtained data. The mean and SD of diabetic management self-efficacy is 5.74 (1.95) and 4.37 (1.4), respectively, for patients with HbA1c < 6.5% and HbA1c ≥ 6.5%. The self-care activities of the patients who had good glycemic control were 4.31 (2.06) compared to 3.50 (1.73) who did not. The social support received by the patients was 6.13 (2.13) vs. 5.31 (1.67) among patients with glycemic control vs. no control. The results show that social support (p = 0.04), self-efficacy (p =0.01) and self-care activities (p = 0.001) were significantly related to the level of glycemic control of the T2D patients. A significant relationship was also identified between gender (p = 0.036), age (p = 0.001) and education status (p = 0.000) with HbA1c control of the participants. This study demonstrates a significant relationship between social support, self-care behaviours, self-efficacy and glycemic management in T2D patients. During this COVID-19 pandemic, interventions to enhance the self-care activities like exercise and social support to boost their self-efficacy; for better diabetes management, reducing diabetes complications or prolonging their onset are the need of the hour.

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