Socializing the evidence for diabetes control to develop “mindlines”: a qualitative pilot study

Background Evidence on specific interventions to improve diabetes control in primary care is available, but this evidence is not always well-implemented. The concept of “mindlines” has been proposed to explain how clinicians integrate evidence using specifics of their practices and patients to produce knowledge-in-practice-in-context. The goal of this pilot study was to operationalize this concept by creating a venue for clinician-staff interaction concerning evidence. The research team attempted to hold “mindlines”-producing conversations in primary care practices about evidence to improve diabetes control. Methods Each of four primary care practices in a single health system held practice-wide conversations about a simple diabetes intervention model over a provided lunch. The conversations were relatively informal and encouraged participation from all. The research team recorded the conversations and took field notes. The team analyzed the data using a framework adapted from the “mindlines” research and noted additional emergent themes. Results While most of the conversation concerned barriers to implementation of the simple diabetes intervention model, there were examples of practices adopting and adapting the evidence to suit their own needs and context. Performance metrics regarding diabetes control for the four practices improved after the intervention. Conclusion It appears that the type of conversations that “mindlines” research describes can be generated with facilitation around evidence, but further research is required to better understand the limitations and impact of this intervention.

Developing a health economic model for Asians with type 2 diabetes based on the Japan Diabetes Complications Study and the Japanese Elderly Diabetes Intervention Trial

IntroductionCost-effectiveness analyses are becoming increasingly important in Japan following the introduction of a health technology assessment scheme. The study objective was to develop an economic model to evaluate the cost-effectiveness of two interventions for type 2 diabetes in a Japanese population.Research design and methodsThe Japan Diabetes Complications Study/Japanese Elderly Diabetes Intervention Trial risk engine (JJRE) Cost-Effectiveness Model (JJCEM) was developed, incorporating validated risk equations in Japanese patients with type 2 diabetes from the JJRE. Weibull regression models were developed for progression of the model outcomes, and a targeted literature review was performed to inform default values for utilities and costs. To illustrate outcomes, two simulated analyses were performed in younger (aged 40 years) and older (aged 80 years) Japanese populations, comparing a hypothetical treatment with placebo.ResultsThe model considers a population based on user-defined values for 11 baseline characteristic parameters and simulates rates of diabetic complications over a defined time horizon. Costs, quality-adjusted life years, and an incremental cost-effectiveness ratio are estimated. The model provides disaggregated results for two competing interventions, allowing visualization of the key drivers of cost and utility. A scatterplot of simulations and cost-effectiveness acceptability curve are generated for each analysis.ConclusionsThis is the first cost-effectiveness model for East Asian patients with type 2 diabetes, developed using Japan-specific risk equations. This population constitutes the largest share of the global population with diabetes, making this model highly relevant. The model can be used to evaluate the cost-effectiveness of anti-diabetic interventions in patients with type 2 diabetes in Japan and other East Asian populations.

Socializing The Evidence For Diabetes Control To Develop “Mindlines”: A Qualitative Pilot Study

Background:Evidence on specific interventions to improve diabetes control in primary care is available, but this evidence is not always well-implemented. The concept of “mindlines” has been proposed to explain how clinicians integrate evidence using specifics of their practices and patients to produce knowledge-in-practice-in-context. We designed a pilot study to operationalize this concept by creating a venue for clinician-staff interaction concerning evidence. We attempted to hold “mindlines”-producing conversations in primary care practices about evidence to improve diabetes control.Methods:In each of four primary care practices in a single health system, we held a practice-wide conversation about a simple diabetes intervention model over a provided lunch. We attempted to keep the conversation relatively informal and encouraged participation from all. We recorded the conversations and took field notes. We analyzed the data using a framework adapted from the “mindlines” research and noted additional emerging themes.Results:While most of the conversation concerned barriers to implementation of the simple diabetes intervention model, we noted examples of practices adopting and adapting the evidence to suit their own needs and context. Performance metrics regarding diabetes control for the four practices improved after the intervention. Conclusion:It appears that the type of conversations that “mindlines” research describes can be generated with facilitation around evidence, but further research is required to better understand the limitations and impact of this intervention.

Change in cardiometabolic risk factors among Asian Indian adults recruited in a mHealth-based diabetes prevention trial

Objective India is experiencing an increasing prevalence of type 2 diabetes and cardiovascular diseases. Mobile health technology may be a strategy to reduce the risk of cardiometabolic disorders. This paper reports on the effect of a mobile health intervention on cardiometabolic risk factors. Methods The mobile health and diabetes intervention was a 12-week reality television-based mobile health program application delivered via videos, short message service and infographics through a smartphone application followed-up weekly by health coach calls. mobile health and diabetes was conducted in a randomized control trial mode randomized controlled trial methodology in three Indian cities (Chennai, Bengaluru and New Delhi) with participants recruited via community screening events. This paper looks at the pre–post changes in cardiometabolic risks among the participants and the place of demography in influencing these. Results The mobile health and diabetes intervention group experienced a small reduction in waist circumference (1.8 cm) compared to the control group (0.5 cm, p < 0.05) and a greater decrease in systolic blood pressure (2.7 mmHg) compared to the control group ( p < 0.05). The improvements in cardiometabolic risk factors were more pronounced in individuals with obesity, although overall effects were very modest Conclusions Cardiometabolic risk factors can be reduced with a mobile health application using human coaching, especially in obese individuals, but the improvements are small. To be more effective and clinically meaningful, intensive engagement with the participants is probably required.

Clinical and metabolic characteristics of the Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I) randomised clinical trial cohort

ObjectivesDiabetes Intervention Accentuating Diet and Enhancing Metabolism-I (DIADEM-I) is the first randomised controlled trial (RCT) in the Middle East and North Africa (MENA) region testing the effectiveness of an intensive lifestyle intervention (ILI) for weight loss and diabetes remission. We report on the recruitment process and baseline characteristics of the DIADEM-I cohort based on origin (Middle East vs North Africa), and waist circumference.DesignDIADEM-I is an open-label randomised, controlled, parallel group RCT recruiting young individuals (18–50 years) with early type 2 diabetes (≤3 years since diagnosis) originating from MENA. Individuals from primary care were randomised to usual medical care or ILI (total dietary replacement phase using meal replacement products, followed by staged food reintroduction and physical activity support). The primary outcome is weight loss at 12 months. Other outcomes are glycaemic control and diabetes remission.SettingPrimary care, Qatar.Participants147 (73% men) randomised within DIADEM-I who were included in the final trial data analysis.Outcome measuresRecruitment metrics, and baseline clinical and metabolic characteristics.ResultsOf 1498 people prescreened, 267 (18%) were invited for screening and 209 (78%) consented. 173 (83%) were eligible. 15 (7%) withdrew before randomisation and the remaining 158 were randomised. Mean age was 42.1 (SD 5.6) years and mean body mass index was: 36.3 (5.5) kg/m2 (women) and 34.4 (5.4) kg/m2 (men). Mean diabetes duration was 1.8 (1.0) years and mean glycosylated haemoglobin (HbA1c) was 7.0% (1.30) (52.5 mmol/mol (SD 14.3)). Participants originated from 13 countries. Those from North Africa reported greater physical activity and had lower family history of diabetes. 90% of subjects were taking diabetes medications and 31% antihypertensives. Those with greater waist circumference had significantly higher insulin resistance and lower quality of life.ConclusionRecruitment of participants originating from the MENA region into the RCT was successful, and study participation was readily accepted. While DIADEM-I participants originated from 13 countries, there were few baseline differences amongst participants from Middle East versus North Africa, supporting generalisability of RCT results.Trial registration numberISRCTN20754766; NCT03225339