Building the evidence for integrated care for type 2 diabetes: a pilot study

2016 ◽  
Vol 22 (5) ◽  
pp. 409 ◽  
Author(s):  
Jessica L. Browne ◽  
Jane Speight ◽  
Carina Martin ◽  
Christopher Gilfillan
Keyword(s):  
Type 2 Diabetes ◽  
Integrated Care ◽  
Diabetes Care ◽  
Controlled Trial ◽  
Care Model ◽  
Service Setting ◽  
Quality Of Diabetes Care ◽  
The Impact

Integrated care models have the potential to reduce fragmentation in the health system and improve outcomes for people with type 2 diabetes. A pilot evaluation of an integrated care model for people with type 2 diabetes in Melbourne, Australia, is reported on. Two studies were conducted: (1) a 6-month pilot randomised controlled trial (n=56) evaluating the impact of the integrated care model relative to hospital outpatient clinics; and (2) a cross-sectional study (n=92) of patients attending the two services. The primary outcome was diabetes-specific distress; secondary outcomes were perceived quality of diabetes care, diabetes-specific self-efficacy and glycated haemoglobin (HbA1c). There was no effect of service setting on diabetes-specific distress. Participants from the integrated care setting perceived the quality of diabetes care to be higher than did participants from the hospital clinics. Significant HbA1c improvements were observed over time, but with no effect of service setting. The model holds promise for people with type 2 diabetes who need more specialist/multidisciplinary care than can be provided in primary care. Patients’ evaluations of the quality of diabetes care received at the integrated care service are very positive, which is likely to be one of the key strengths of the integrated model.

scholarly journals AMD Annals 2020 - Synopsis on Type 2 Diabetes. Evaluation of AMD quality indicators of type 2 diabetes care in Italy

2021 ◽  
Vol 24 (1) ◽  
pp. 19
Author(s):  
Michelli , A.
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Care ◽  
Data File ◽  
New Drugs ◽  
Lipid Lowering ◽  
Type2 Diabetes ◽  
Quality Of Diabetes Care ◽  
Hba1c Levels

OBJECTIVE OF THE STUDY The AMD 2020 Annals on Type 2 Diabetes (DM2) set out to show, 2 years after the last evaluation, how the quality of DM2 care has evolved in Italy. DESIGN AND METHODS In order to participate in the initiative, the centers had to be equipped with information systems capable of guaranteeing the standardized extraction of the information necessary for the creation of the AMD Data File. The data analyzed concern socio-de-mographic and clinical characteristics and volume of activity. The selection of indicators is based on Revision 8 of June 2019 (AMD Annals website). RESULTS DM2 patients increased to 473,740 (57.1% M; 42.9% F, 67.4% aged> 65 y). 6% new diagnoses. All monitoring indicators, of favorable and unfavorable outcome, have improved: 52.9% of DM2 have HbA1c levels <= 7.0%(53 mmol/mol), 63.5% have LDL cholesterol values <100 mg / dl, 53,5% have blood pressure levels <140/80 mmHg, 39.9% are obese. The proportion of patients with GFR <60 mL/min*1.73 m2 rose to 29%, and 7.1% had GFR <30 mL / min. Therapy: there is a reduction in the use of sulfonylureas and glinides (19.9%); stable use of insulin; new drugs are increasingly prescribed (DPPIVi:21%; GLP1-RA: 5.9%; SGLT2i: 9.6%). 60.8% are on lipid-lowering treatment, 70% are on antihypertensive therapy, but 48.6% are not on target. Complications: 22% have diabetic retinopathy; 7.5% had myocardial infarction, 2.7 had a stroke, 14.7% had a history of cardiovascular disease. 50.8% of subjects with age>75a have HbA1c levels <= 7.0%(53 mmol/mol), of these 16.3% are treated with drugs that can induce hypoglycemia. Patients with Q Score> 25 are growing (60.3%). CONCLUSIONS The AMD 2020 Annals on DM2 show a marked improvement in all indicators of quality of care, but large areas of undertreatment and other overtreatment remain, and call to action. KEY WORDS AMD Annals; type2 diabetes mellitus; quality of diabetes care in type 2 diabetes patients in Italy; undertreatment; overtreatment.

scholarly journals Association of mental disorders and quality of diabetes care – A six-year follow-up study of type 2 diabetes patients in North Karelia, Finland

2020 ◽  
Vol 166 ◽  
pp. 108312
Author(s):  
Nazma Akter Nazu ◽  
Katja Wikström ◽  
Marja-Leena Lamidi ◽  
Jaana Lindström ◽  
Hilkka Tirkkonen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Mental Disorders ◽  
Diabetes Care ◽  
Follow Up Study ◽  
Quality Of Diabetes Care ◽  
Diabetes Patients

Effect of Professional CGM (pCGM) on Glucose Management in Type 2 Diabetes Patients in Primary Care

2021 ◽  
pp. 193229682199872
Author(s):  
Gregg D. Simonson ◽  
Richard M. Bergenstal ◽  
Mary L. Johnson ◽  
Janet L. Davidson ◽  
Thomas W. Martens
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Glucose Monitoring ◽  
Care Model ◽  
Time In Range ◽  
Glucose Management ◽  
The Impact ◽  
Primary Care Management

Background: Little data exists regarding the impact of continuous glucose monitoring (CGM) in the primary care management of type 2 diabetes (T2D). We initiated a quality improvement (QI) project in a large healthcare system to determine the effect of professional CGM (pCGM) on glucose management. We evaluated both an MD and RN/Certified Diabetes Care and Education Specialist (CDCES) Care Model. Methods: Participants with T2D for >1 yr., A1C ≥7.0% to <11.0%, managed with any T2D regimen and willing to use pCGM were included. Baseline A1C was collected and participants wore a pCGM (Libre Pro) for up to 2 weeks, followed by a visit with an MD or RN/CDCES to review CGM data including Ambulatory Glucose Profile (AGP) Report. Shared-decision making was used to modify lifestyle and medications. Clinic follow-up in 3 to 6 months included an A1C and, in a subset, a repeat pCGM. Results: Sixty-eight participants average age 61.6 years, average duration of T2D 15 years, mean A1C 8.8%, were identified. Pre to post pCGM lowered A1C from 8.8% ± 1.2% to 8.2% ± 1.3% (n=68, P=0.006). The time in range (TIR) and time in hyperglycemia improved along with more hypoglycemia in the subset of 37 participants who wore a second pCGM. Glycemic improvement was due to lifestyle counseling (68% of participants) and intensification of therapy (65% of participants), rather than addition of medications. Conclusions: Using pCGM in primary care, with an MD or RN/CDCES Care Model, is effective at lowering A1C, increasing TIR and reducing time in hyperglycemia without necessarily requiring additional medications.

scholarly journals Reduced Health-Related Quality of Life in Body Constitutions of Yin-Xu, and Yang-Xu, Stasis in Patients with Type 2 Diabetes: Taichung Diabetic Body Constitution Study

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Chia-I Tsai ◽  
Yi-Chang Su ◽  
Shih-Yi Lin ◽  
I-Te Lee ◽  
Cheng-Hung Lee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Type 2 Diabetes ◽  
Health Related Quality ◽  
Body Constitution ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related ◽  
The Impact

Aim. To evaluate how health-related quality of life (HRQOL) and traditional Chinese medicine (TCM) constitutions of Yin-Xu, Yang-Xu, and Stasis are related in type 2 diabetes patients. Method. Seven hundred and five subjects were recruited in 2010 for this study from a Diabetes Shared Care Network in Taiwan. Generic and disease-specific HRQOL were assessed by the short form 36 (SF-36) and the diabetes impact measurement scale (DIMS). Constitutions of Yin-Xu, Yang-Xu, and Stasis were then assessed by the body constitution questionnaire (BCQ), a questionnaire consisting of 44 items that evaluate the physiological state based on subjective symptoms and signs. Results. Estimated effects of the Ying-Xu and Stasis on all scales of the SF-36 were significantly negative, while estimated effects of the Yang-Xu on all scales (except for SF, RE, MH, and MCS) were significantly negative. For DIMS, the estimated effects of the Ying-Xu and Stasis on all scales were significantly negative except for Stasis on well-being, while Yang-Xu has a significantly negative effect only on symptoms. Conclusions. This study demonstrates that TCM constitutions of Yin-Xu, Yang-Xu, and Stasis are closely related to a reduction in HRQOL. These findings support the need for further research into the impact of intervention for TCM constitutions on HRQOL in patients with type 2 diabetes.

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