Can type 2 diabetes be prevented in UK general practice? A lifestyle-change feasibility study (ISAIAH)

BackgroundEvidence shows type 2 diabetes mellitus (T2DM) can be effectively treated with a reduced-carbohydrate diet to support weight loss. Digital apps are increasingly used to support weight loss, yet little is known about their use as part of general practice diabetes care.AimDetermine the feasibility of signposting from routine NHS general practice to a digital weight management tool (Low Carb Program) for patients with T2DM and pre-diabetes.Design/settingMixed-methods feasibility study implemented within routine general practice consultations at four practices in the Midlands, England.MethodsGeneral practices offered signposting to eligible patients attending consultations of any type during a four-week recruitment period. Rates of offering and accepting signposting were recorded, with program registration, program completion and self-reported health outcomes (weight, HbA1c).ResultsSignposting was offered to 351 patients; 160 (45.6%) accepted, 103 (29.3%) registered with the intervention and 43 (26.9% of patients accepting signposting) completed the programme. GPs reported that signposting added between 1–4 minutes to the consultation length. Patients completing the programme reported greater weight loss (7.2 kg vs 1.6 kg, P<.001) and HbA1c improvements (–9.1 mmol/mol vs 1.7 mmol/mol, P<.001) compared to those who did not, and were more likely to reduce the number of general practice-prescribed diabetes medications.ConclusionsSignposting from real-world general practice to the Low Carb Programme is feasible and can potentially improve diabetes outcomes. Further research should explore whether the process of signposting can be enhanced to increase registration, identify whether additional practice-led support leads to increased programme completion, and confirm the intervention’s clinical and cost-effectiveness.

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Identification of Important Factors Affecting Use of Digital Individualised Coaching and Treatment of Type 2 Diabetes in General Practice: A Qualitative Feasibility Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083924 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3924

Author(s):

Pernille Ravn Jakobsen ◽

Jeanette Reffstrup Christensen ◽

Jesper Bo Nielsen ◽

Jens Søndergaard ◽

Dorte Ejg Jarbøl ◽

...

Keyword(s):

Type 2 Diabetes ◽

General Practice ◽

Lifestyle Intervention ◽

Feasibility Study ◽

Real Life ◽

Lifestyle Interventions ◽

Practice Setting ◽

General Practice Setting ◽

Diabetes Patients

Most type 2 diabetes patients are treated in general practice and there is a need of developing and implementing efficient lifestyle interventions. eHealth interventions have shown to be effective in promoting a healthy lifestyle. The purpose of this study was to test the feasibility, including the identification of factors of importance, when offering digital lifestyle coaching to type 2 diabetes patients in general practice. We conducted a qualitative feasibility study with focus group interviews in four general practices. We identified two overall themes and four subthemes: (1) the distribution of roles and lifestyle interventions in general practice (subthemes: external and internal distribution of roles) and (2) the pros and cons for digital lifestyle interventions in general practice (subthemes: access to real life data and change in daily routines). We conclude that for digital lifestyle coaching to be feasible in a general practice setting, it was of great importance that the general practitioners and practice nurses knew the role and content of the intervention. In general, there was a positive attitude in the general practice setting towards referring type 2 diabetes patients to digital lifestyle intervention if it was easy to refer the patients and if easily understandable and accessible feedback was implemented into the electronic health record. It was important that the digital lifestyle intervention was flexible and offered healthcare providers in general practice an opportunity to follow the type 2 diabetes patient closely.

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Management of Patients with Type 2 Diabetes Shared between a Specialized Outpatient Clinic and General Practice Was Noninferior to Mono Management in a Specialized Outpatient Clinic—A Prospective, Randomized, Noninferiority Trial

Diabetes ◽

10.2337/db18-6-or ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 6-OR

Author(s):

LENE MUNCH ◽

BIRGITTE B. BENNICH ◽

DORTHE OVERGAARD ◽

HANNE KONRADSEN ◽

HELLE V. MIDDELFART ◽

...

Keyword(s):

Type 2 Diabetes ◽

General Practice ◽

Outpatient Clinic ◽

Noninferiority Trial

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On-Demand, App-Delivered Coaching to Enable Diabetes Self-Management in Adults with Type 2 Diabetes—A Feasibility Study

Diabetes ◽

10.2337/db18-50-lb ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 50-LB

Author(s):

JOHN B. HERNANDEZ ◽

AMY ARMENTO LEE ◽

SCOTT ROBERTSON ◽

CARA SILVER ◽

AMIT MAJITHIA

Keyword(s):

Type 2 Diabetes ◽

Feasibility Study ◽

Self Management ◽

On Demand

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Associations between multimorbidity and glycaemia (HbA1c) in people with type 2 diabetes: cross-sectional study in Australian general practice

BMJ Open ◽

10.1136/bmjopen-2020-039625 ◽

2020 ◽

Vol 10 (11) ◽

pp. e039625

Author(s):

Jason I Chiang ◽

John Furler ◽

Frances Mair ◽

Bhautesh D Jani ◽

Barbara I Nicholl ◽

...

Keyword(s):

Type 2 Diabetes ◽

General Practice ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Linear Regression Models ◽

Sectional Study ◽

Cross Sectional ◽

Long Term Conditions ◽

Australian General Practice

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.

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