scholarly journals Effect of a Multidisciplinary-Assisted Resident Diabetes Clinic on Resident Knowledge and Patient Outcomes

2013 ◽  
Vol 5 (1) ◽  
pp. 145-149 ◽  
Author(s):  
Margaret C. Lo ◽  
Morganna Freeman ◽  
M. Cecilia Lansang
Keyword(s):  
Patient Outcomes ◽  
Large Scale ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Patient Specific ◽  
Team Approach ◽  
Diabetes Knowledge ◽  
Diabetes Clinic ◽  
Practice Behavior ◽  
Patients With Diabetes

Abstract Background Despite the rising prevalence of diabetes, there is a paucity of diabetes curricula in residency training. The multidisciplinary diabetes team approach is underused in residency education. Objective To assess the feasibility of an innovative multidisciplinary resident diabetes clinic (MRDC) in enhancing (1) resident diabetes knowledge via a Diabetes Awareness Questionnaire, and (2) subsequent process and patient outcomes in patients with diabetes via a Diabetes Practice Behavior Checklist. Methods From October 2008 to February 2010, 14 internal medicine residents managed patients with uncontrolled diabetes in a weekly half-day MRDC for 1 month (total 4–5 half-day sessions/resident), with a collaborative team of internists, diabetes educators, an endocrinologist, and a pharmacist. The curriculum included didactic sessions, required readings, and patient-specific case discussions. A 20-question Diabetes Awareness Questionnaire was administered to each resident prerotation and postrotation. Records of 47 patients with diabetes in the residents' own continuity clinics (not the MRDC) were audited 6 months before and after the MRDC for Diabetes Practice Behavior Checklist measures (glycated hemoglobin, blood pressure, low-density lipoprotein cholesterol, retinal referral, foot exam, microalbumin screen). Pre-MRDC and post-MRDC data were compared via paired t test. Results The MRDC residents exhibited a modest increase in mean (SD) scores on the Diabetes Awareness Questionnaire (before, 8.2 [2.8]; after, 10.9 [2.8]; P  =  .02) and a modest mean (SD) performance increase in overall process outcomes from the Diabetes Practice Behavior Checklist (before, 74% [18%]; after, 84% [18%]; P  =  .004). No improvements occurred in patient outcomes. Conclusions Multidisciplinary diabetes teaching may be useful in fostering certain resident knowledge and performance measures but may not alter clinical outcomes. Further large-scale, longitudinal studies are needed to understand the effect of our curriculum on residents' diabetes knowledge and future practice behavior.

scholarly journals Statin prescription among patients with type 2 diabetes in Botswana: findings and implications

2019 ◽  
Author(s):  
Julius Chacha Mwita ◽  
Brian Godman ◽  
Tonya M Esterhuizen
Keyword(s):  
Type 2 Diabetes ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Secondary Data ◽  
Diabetes Clinic ◽  
Cholesterol Levels ◽  
Patients With Diabetes ◽  
Statin Prescription ◽  
Evidence Based Guideline

Abstract Background There is evidence of statin benefit among patients with diabetes regardless of their cholesterol levels or prior cardiovascular disease history. Despite the evidence, there is under-prescription of statins in clinical practice. This study aimed to assess statin prescriptions and associated factors among patients with type 2 diabetes in Botswana. Methods The study was a secondary data analysis of 374 randomly selected type 2 diabetes patients at a specialised diabetes clinic at Gaborone Botswana. We assessed the proportion of statin-eligible patients who are prescribed statins and evaluated the adjusted associations between various factors and statin prescription. Results Overall, 356 (95.2%) participants were eligible for a statin prescription. Clinicians prescribed statins in 162 (45.5%%; 95% confidence interval [CI]: 40.4% - 50.7%)) of eligible participants, and only one (5.5%) ineligible participant. The probability of statin prescription was high in participants with high baseline low-density lipoprotein cholesterol (risk ratio [RR]: 1.49; 95%CI: 1.17 - 1.89), increasing duration of diabetes (RR: 1.01; 95%CI 1.00 - 1.03) and the presence of chronic kidney disease (RR: 1.35; 95%CI: 1.06 - 1.74). Conclusion Most patients with type 2 diabetes are not receiving statins. Clinicians did not consider most guideline-recommended indications for statin prescription. The findings call for improvement in diabetes quality of care by implementing evidence-based guideline recommendations. Key words: statin, type 2 diabetes mellitus, prescription and Botswana

scholarly journals Statin prescription among patients with type 2 diabetes in Botswana: findings and implications

2019 ◽  
Author(s):  
Julius Chacha Mwita ◽  
Brian Godman ◽  
Tonya M Esterhuizen
Keyword(s):  
Type 2 Diabetes ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Secondary Data ◽  
Diabetes Clinic ◽  
Cholesterol Levels ◽  
Patients With Diabetes ◽  
Statin Prescription ◽  
Evidence Based Guideline

Abstract Background There is evidence of statin benefit among patients with diabetes regardless of their cholesterol levels or prior cardiovascular disease history. Despite the evidence, there is under-prescription of statins in clinical practice. This study aimed to assess statin prescriptions and associated factors among patients with type 2 diabetes in Botswana. Methods The study was a secondary data analysis of 500 randomly selected type 2 diabetes patients at a specialised diabetes clinic at Gaborone, Botswana. We assessed the proportion of statin-eligible patients who are prescribed statins and evaluated the adjusted associations between various factors and statin prescription. Results Overall, 477(95.4%) participants were eligible for statin prescription. Clinicians prescribed statins in 217 (45.5%%) of eligible participants, and only one(4.4%) ineligible participant. The probability of statin prescription was high in participants with high baseline low-density lipoprotein cholesterol (risk ratio [RR]: 1.49; 95%CI: 1.17-1.89), increasing duration of diabetes(RR: 1.01; 95%CI 1.00-1.03) and the presence of chronic kidney disease(RR: 1.35; 95%CI: 1.06-1.74). Conclusion Most patients with type 2 diabetes in Gaborone are not receiving statins. Clinicians did not consider most guideline-recommended indications for statin prescription. The findings call for improvement in diabetes quality of care by implementing evidence-based guideline recommendations.

scholarly journals Statin prescription among patients with type 2 diabetes in Botswana: findings and implications

2020 ◽  
Author(s):  
Julius Chacha Mwita ◽  
Brian Godman ◽  
Tonya M Esterhuizen
Keyword(s):  
Type 2 Diabetes ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Secondary Data ◽  
Diabetes Clinic ◽  
Cholesterol Levels ◽  
Patients With Diabetes ◽  
Statin Prescription ◽  
Evidence Based Guideline

Abstract Background There is evidence of statin benefit among patients with diabetes regardless of cholesterol levels or prior cardiovascular disease history. Despite the evidence, there is under-prescription of statins in clinical practice. This study aimed to assess statin prescriptions and associated factors among patients with type 2 diabetes in Botswana. Methods The study was a secondary data analysis of 500 randomly selected type 2 diabetes patients at a specialised diabetes clinic at Gaborone, Botswana. We assessed the proportion of statin-eligible patients who are prescribed statins and evaluated the adjusted associations between various factors and statin prescriptions. Results Overall, 477 (95.4%) participants were eligible for a statin prescription. Clinicians prescribed statins in 217 (45.5%) of eligible participants, and only one (4.4%) ineligible participant. The probability of a statin prescription was higher in participants with high baseline low-density lipoprotein cholesterol (risk ratio [RR]: 1.49; 95%CI: 1.17-1.89), increasing duration of diabetes (RR: 1.01; 95%CI 1.00-1.03) and the presence of chronic kidney disease (RR: 1.35; 95%CI: 1.06-1.74). Conclusion A large proportion with type 2 diabetes in Gaborone is not receiving statins. Clinicians did not consider most guideline-recommended indications for statin prescriptions. The findings call for improvement in diabetes quality of care by implementing evidence-based guideline recommendations. Keywords: statin, type 2 diabetes mellitus, prescription and Botswana

Conventional and bi-directional genetic evidence on resting heart rate and cardiometabolic traits

2021 ◽  
Author(s):  
Tao Huang ◽  
Wenxiu Wang ◽  
Jingjia Wang ◽  
Jun Lv ◽  
Canqing Yu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Large Scale ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Heat Rate ◽  
Resting Heart Rate ◽  
Causal Inferences ◽  
Reactive Protein ◽  
Cardiometabolic Traits

Abstract Objectives To examine the direction, strength and causality of the associations of resting heart rate (RHR) with cardiometabolic traits. Methods We assessed the strength of associations between measured RHR and cardiometabolic traits in 506,211 and 372,452 participants from China Kadoorie Biobank (CKB) and UK Biobank (UKB). Mendelian randomization (MR) analyses were used to make causal inferences in 99,228 and 371,508 participants from CKB and UKB, respectively. Results We identified significant, directionally-concordant observational associations between RHR and higher total cholesterol, triglycerides (TG), low-density lipoprotein, C-reactive protein (CRP), glucose, body mass index, waist-hip ratio (WHR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) after the Bonferroni correction. MR analyses showed that 10 beat/min higher genetically-predicted RHR were trans-ethnically associated with a higher DBP (beta 2.059 [95%CI 1.544, 2.574] mmHg in CKB; 2.037 [1.845, 2.229] mmHg in UKB), higher CRP (0.180 [0.057, 0.303] log mg/L in CKB; 0.154 [0.134, 0.174] log mg/L in UKB), higher TG (0.052 [-0.009, 0.113] log mmol/L in CKB; 0.020 [0.010, 0.030] log mmol/L in UKB) and higher WHR (0.218 [-0.033, 0.469] % in CKB; 0.225 [0.111, 0.339] % in UKB). In the opposite direction, higher genetically-predicted SBP, TG, glucose, WHR and lower high-density lipoprotein were associated with elevated RHR. Conclusion Our large-scale analyses provide causal evidence between RHR and cardiometabolic traits, highlighting the importance of monitoring heat rate as a means of alleviating the adverse effect of metabolic disorders.

scholarly journals Subanalysis of the OZIRKA study: efficacy of Ozalex (rosuvastatin) in patients with diabetes mellitus

HYPERTENSION ◽  
2021 ◽  
Vol 14 (2) ◽  
pp. 30-38
Author(s):  
Yu.M. Sirenko ◽  
O.O. Torbas ◽  
S.M. Kushnir
Keyword(s):  
Diabetes Mellitus ◽  
Total Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Final Analysis ◽  
High Density Lipoproteins ◽  
Open Population ◽  
Lipid Metabolism Disorders ◽  
Patients With Diabetes

Background. Diabetes mellitus (DM) remains one of the most important cardiovascular risk factors significantly worsening the prognosis in patients with hypertension and dyslipidemia. The leading role among drugs for the treatment of such patients belongs to statins with their powerful influence on the development and progression of atherosclerosis and its complications. We used the OZIRKA study database and performed additional subanalysis to study the effects of rosuvastatin in patients with diabetes and dyslipidemia. Purpose: to study the effect of Ozalex (rosuvastatin) on lipid and cholesterol levels in patients with lipid metabolism disorders and hypercholesterolemia and DM. Materials and methods. It was a prospective open population study. The recruitment of patients was conducted from March to December 2019. The analysis of the study data was conducted from June to November 2020. Results. A total of 20,000 patients from all over Ukraine were included in the study. The full follow-up period was completed by 18,100 patients, of whom 17,530 had all the necessary data, they were included in the final analysis. The mean follow-up period was 2.2 months. Approximately 13 % of patients included in the study had DM type 2. We observed a significant reduction in total cholesterol, low-density lipoprotein (LDL) and triglyceride levels in patients with diabetes. In addition, there was a tendency to an increase in the level of high-density lipoproteins in this group of patients. In general, it can be noted that there was a significant improvement in lipid profile in patients with diabetes: the level of total cholesterol decreased by 28 %, LDL cholesterol — by 34 %, triglycerides — by 24 %. Administration of rosuvastatin did not impair glucose control in any way in the group of patients with DM; moreover, even in the group of people without DM, there was no negative effect of rosuvastatin on fasting glucose level. Conclusions. In general, we can recommend Ozalex in a dose of 10 to 20 mg as an optimal start of statin therapy at the stage of primary care for patients with DM.

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