scholarly journals Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study.

2021 ◽  
Author(s):  
Sara Guillen-Aguinaga ◽  
Luis Forga ◽  
Antonio Brugos-Larumbe ◽  
Francisco Guillen-Grima ◽  
Laura Guillen-Aguinaga ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Low Income ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Vascular Events ◽  
Primary Care Health ◽  
Hba1c Control ◽  
History Of

Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. There is variability in clinical practice. The objectives are to analyze the variability in the control of Blood Pressure (BP), HbA1c, and LDL-C in T2D patients and its influence on admissions due to cardiovascular events (CVE) Methods: We analyzed the electronic records in Primary Care Health centers in Navarra (Spain) and hospital admission for CVE. We follow 480637 people from 2012 to 2016. We calculated indicators of control of patients with T2D for each year, percentage with: HbA1c < 7%; HbA1c >= 9%; BP <140/90 mmHg; LDL-C <100 mg/dl. We used logistic and Cox regression. Results: Patients in the best control GP practices cluster are 2.5 times more likely to have HbA1c <7% [OR: 2.46 (95% CI: 2.29-3.64)]. Poor HbA1c control ≥ 9% is more likely in the worst control cluster [OR: 1.73 (95% CI:1.63-1.83)]. The probability of admission for CVE increases with age, being male, low income, obesity, history of CVE, having HbA1c ≥ 9%, and belonging to a GP practice in the cluster of HbA1C ≥ 9% worst control. In contrast, it decreases in patients with HbA1c <7%, BP<140/90 mmHg and LDL <100 mg/dl.

scholarly journals Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study

2021 ◽  
Vol 10 (24) ◽  
pp. 5854
Author(s):  
Sara Guillen-Aguinaga ◽  
Luis Forga ◽  
Antonio Brugos-Larumbe ◽  
Francisco Guillen-Grima ◽  
Laura Guillen-Aguinaga ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Hospital Admissions ◽  
Glycosylated Hemoglobin ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
General Practitioner Practice ◽  
Vascular Events ◽  
Primary Care Health

Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. This study aimed to analyze how the differences in delivered care (variability of glycosylated hemoglobin (HbA1c) achieved targets) affect hospital admissions for cardiovascular events (CVEs) in T2D patients. Methods: We analyzed the electronic records in primary care health centers at Navarra (Spain) and hospital admission for CVEs. We followed 26,435 patients with T2D from 2012 to 2016. The variables collected were age, sex, health center, general practitioner practice (GPP), and income. The clinical variables were diagnosis of T2D, weight, height, body mass index (BMI), blood pressure (BP), HbA1c, low-density lipoprotein cholesterol (LDL-C), smoking, and antecedents of CVEs. We calculated, in each GPP practice, the proportion of patients with HbA1c ≥ 9. A non-hierarchical K-means cluster analysis classified GPPs into two clusters according to the level of compliance with HbA1C ≥ 9% control indicators. We used logistic and Cox regressions. Results: T2D patients had a higher probability of admission for CVEs when they belonged to a GPP in the worst control cluster of HbA1C ≥ 9% (HR = 1.151; 95% CI, 1.032–1.284).

scholarly journals Pain in Patients With Type 2 Diabetes-Related Polyneuropathy Is Associated With Vascular Events and Mortality

2020 ◽  
Vol 105 (9) ◽  
pp. 3005-3014
Author(s):  
Brittany R Lapin ◽  
Kevin M Pantalone ◽  
Alex Milinovich ◽  
Shannon Morrison ◽  
Andrew Schuster ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Proportional Hazards ◽  
Negative Binomial ◽  
Cox Proportional Hazards ◽  
Vascular Events ◽  
Proportional Hazards Regression ◽  
Increased Risk ◽  
History Of ◽  
Mortality Hazard Ratio

Abstract Purpose Type 2 diabetes–related polyneuropathy (DPN) is associated with increased vascular events and mortality, but determinants and outcomes of pain in DPN are poorly understood. We sought to examine the effect of neuropathic pain on vascular events and mortality in patients without DPN, DPN with pain (DPN + P), and DPN without pain (DPN-P). Methods A retrospective cohort study was conducted within a large health system of adult patients with type 2 diabetes from January 1, 2009 through December 31, 2016. Using an electronic algorithm, patients were classified as no DPN, DPN + P, or DPN-P. Primary outcomes included number of vascular events and time to mortality. Independent associations with DPN + P were evaluated using multivariable negative binomial and Cox proportional hazards regression models, adjusting for demographics, socioeconomic characteristics, and comorbidities. Results Of 43 945 patients with type 2 diabetes (age 64.6 ± 14.0 years; 52.1% female), 13 910 (31.7%) had DPN: 9104 DPN + P (65.4%) vs 4806 DPN-P (34.6%). Vascular events occurred in 4538 (15.1%) of no DPN patients, 2401 (26.4%) DPN + P, and 1006 (20.9%) DPN-P. After adjustment, DPN + P remained a significant predictor of number of vascular events (incidence rate ratio [IRR] = 1.55, 95% CI, 1.29-1.85), whereas no DPN was protective (IRR = 0.70, 95% CI, 0.60-0.82), as compared to DPN-P. Compared to DPN-P, DPN + P was also a significant predictor of mortality (hazard ratio = 1.42, 95% CI, 1.25-1.61). Conclusions Our study found a significant association between pain in DPN and an increased risk of vascular events and mortality. This observation warrants longitudinal study of the risk factors and natural history of pain in DPN.

scholarly journals Influence of social determinants, diabetes knowledge, health behaviors, and glycemic control in type 2 diabetes: An analysis from real-world evidence

2020 ◽  
Author(s):  
Rubén Silva-Tinoco ◽  
Teresa Cuatecontzi-Xochitiotzi ◽  
Viridiana De la Torre-Saldaña ◽  
Enrique León-García ◽  
Javier Serna-Alvarado ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Glycemic Control ◽  
Mexico City ◽  
Low Income ◽  
Self Care ◽  
Diabetes Knowledge ◽  
Care Behavior

Abstract Background Although important achievements have been done in type 2 diabetes mellitus (T2D) treatment and glycemic control, new strategies may take advantage of non-pharmacological approaches and of other potential determinants of health (e.g., socioeconomic status, education, diabetes knowledge, physical activity, and self-care behavior). However, the relationships between these factors are not totally clear and have not been studied in the context of large urban settings. This study aimed to explore the relationship between these determinants of glycemic control (GC) in a low-income urban population from Mexico City, focused in exploring potential the mediation of self-care behaviors in the association between diabetes knowledge and GC.Methods A multicenter cross-sectional study was conducted in patients with type 2 diabetes (T2D) from 28 primary care outpatient centers located in Mexico City. Using multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and GC. The mediation analyses to determine the pathways on glycemic control were done using linear regression models, where the significance of indirect effects was calculated with bootstrapping.Results The population (N=513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Both socioeconomic status and level of education were directly associated with diabetes knowledge. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with GC (β: -0.102, 95% Confidence Interval [95% CI] -0.189, -0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with GC (for physical activity: β: -0.112, 95% CI -0.194, -0.029). The association between diabetes knowledge and GC was not observed after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p-value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on GC was 17% independently mediated by physical activity (p-value: 0.049). Conclusions Socioeconomic and educational gradients influence diabetes knowledge among primary care patients with type 2 diabetes. Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on GC. Our results indicate that diabetes knowledge should be reinforced in low-income T2D patients, with an emphasis on the benefits physical activity has on improving GC.

scholarly journals Engagement in e-cycling and the self-management of type 2 diabetes: a qualitative study in primary care

BJGP Open ◽  
2019 ◽  
Vol 3 (2) ◽  
pp. bjgpopen18X101638 ◽  
Author(s):  
Aidan Searle ◽  
Emma Ranger ◽  
Jez Zahra ◽  
Byron Tibbitts ◽  
Angie Page ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
The Self ◽  
Self Management ◽  
Post Intervention ◽  
Practice Nurses ◽  
Qualitative Interview Study ◽  
Primary Care Health ◽  
Care Health

BackgroundPhysical activity (PA) is important in the management of type 2 diabetes (T2DM), however many people find it difficult to implement and/or sustain in the self-management of the condition. Electrically assisted cycling (e-cycling) may be viewed as a means of self-management in which effort is invested to balance the interplay of lifestyle factors and disease progression.AimTo explore engagement with an e-cycling intervention conducted with adults with T2DM.Design & settingProspective qualitative interview study with adults in central Bristol (UK) and surrounding suburbs, in the context of the self-management of T2DM in primary care.MethodInterviews were conducted with 20 individuals with T2DM (42–70 years, 11 male, 9 female) prior to their participation in a 20-week e-cycling intervention. Post-intervention interviews were conducted with 18 participants (11 male, 7 female). Interviews were transcribed verbatim and inductive thematic analysis was undertaken.ResultsParticipants were aware that PA contributed to the management of their diabetes. Engagement with e-cycling was viewed as both an acceptable and a social lifestyle intervention. Furthermore, participants were unhappy with the volume of medication used to manage their diabetes and e-cycling fostered autonomy in the management of T2DM. GPs and practice nurses were regarded as an important source of reliable information, and were considered to be best placed to talk about interventions to increase PA.ConclusionE-cycling is viewed as an acceptable form of PA to aid the self-management of T2DM. E-cycling may support people with T2DM to reduce their medication intake and in turn foster greater autonomy in managing the condition. The findings have implications for the role of primary care health professionals in supporting both patients and significant others in adoption of e-cycling.

scholarly journals Gestational Diabetes Mellitus and the Risks of Overall and Type-Specific Cardiovascular Diseases: A Population- and Sibling-Matched Cohort Study

2021 ◽  
Author(s):  
Yongfu Yu ◽  
Melissa Soohoo ◽  
Henrik Toft Sørensen ◽  
Jiong Li ◽  
Onyebuchi A. Arah
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Cox Regression ◽  
Maternal History ◽  
History Of ◽  
The Impact

<b>OBJECTIVE</b> <p>To evaluate associations between gestational diabetes mellitus (GDM) and various incident cardiovascular disease (CVD) endpoints, considering the effects of mediating role of type 2 diabetes and shared environmental/familial factors.</p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>This population-based cohort study included 1002486 parous women in Denmark during 1978-2016. We used Cox regression to (i) examine the associations of GDM with overall and type-specific CVDs using full-cohort and sibling-matched analysis; (ii) quantify the impact of type 2 diabetes after GDM using mediation analysis; and (iii) assess whether these associations were modified by pre-pregnancy obesity or maternal history of CVD.</p> <p><b>RESULTS</b></p> <p>Women with a history of GDM had a 40% increased overall CVD risk (hazard ratio [HR]: 1.40, 95% confidence interval [CI]: 1.35-1.45). Sibling-matched analyses yielded similar results(HR, 1.44; 95%CI, 1.28-1.62). Proportion of association between GDM and overall CVD explained by subsequent type 2 diabetes was 23.3%(15.4%-32.8%). We observed increased risks of specific CVDs, including 65% increased stroke risk and more than two-fold risks for myocardial infarction, heart failure, and peripheral artery disease. The elevated overall risks were more pronounced among women with GDM and pre-pregnancy obesity or maternal history of CVD. </p> <p><b>CONCLUSIONS</b></p> <p>A history of GDM was associated with increased risks of overall and specific CVDs. Increased risks were partly explained by subsequent type 2 diabetes and the need to identify other pathways remains important. Continuous monitoring of women with a history of GDM, especially those with pre-pregnancy obesity or maternal history of CVD, may provide better opportunities to reduce their cardiovascular risk.</p>

P6270Empagliflozin reduces the total burden of first and recurrent hospitalisations in patients with type 2 diabetes and established cardiovascular disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D McGuire ◽  
B Zinman ◽  
S E Inzucchi ◽  
S D Anker ◽  
C Wanner ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Recurrent Events ◽  
Negative Binomial ◽  
Cox Regression ◽  
Standard Of Care ◽  
History Of ◽  
Outcome Trial ◽  
Cv Disease ◽  
Total Burden

Abstract Background and aims The EMPA-REG OUTCOME trial included patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular (CV) disease. Empagliflozin reduced the risk of 3-point major adverse CV events (MACE; composite of CV death, myocardial infarction [MI], or stroke) by 14%, CV death by 38% and hospitalisation for heart failure (HF) by 35% vs placebo in analyses of time to first event. We assessed the effect of empagliflozin on all-cause hospitalisation in post-hoc analyses of all (first and recurrent) events. Materials and methods Patients were randomised to receive empagliflozin 10 mg, empagliflozin 25 mg, or placebo in addition to standard of care. We assessed the effects of empagliflozin pooled vs placebo on first event of all-cause hospitalisation using Cox regression and all (first and recurrent) events of all-cause hospitalisation using a negative binomial model. Results A total of 7020 patients were treated (4687 empagliflozin; 2333 placebo, mean [SD] age 63 [9] years, 71% male, 47% with history of MI, 23% with history of stroke, 10% with HF). In this analysis, 1725/4687 (36.8%) empagliflozin patients and 925/2333 (39.6%) placebo patients experienced an event leading to hospitalisation. The adjusted hazard ratio (HR; 95% CI) vs placebo for first all-cause hospitalisation using the Cox regression model was 0.89 (0.82, 0.96; p=0.0033; Figure); In analyses of all (first and recurrent) hospitalisation events, there were 3168 events in the empagliflozin group and 1863 in the placebo group. The adjusted event rate ratio (95% CI) vs placebo was 0.83 (0.76, 0.91; p<0.0001; Figure). Conclusion In the EMPA-REG OUTCOME trial, risk reductions with empagliflozin were seen in both first and all hospitalisation events and were numerically more favourable in analyses of all events vs analyses of first events. These analyses expand on the favourable CV effects of empagliflozin by also showing a reduction in the total burden of hospitalisation events in patients with T2D and established CV disease. Acknowledgement/Funding Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance

scholarly journals Skin autofluorescence predicts cancer in subjects with type 2 diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e001312
Author(s):  
Ninon Foussard ◽  
Alice Larroumet ◽  
Marine Rigo ◽  
Kamel Mohammedi ◽  
Laurence Baillet-Blanco ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cox Regression ◽  
Skin Autofluorescence ◽  
Cox Regression Analysis ◽  
Screening Programs ◽  
Biological Studies ◽  
History Of ◽  
Risk Of Cancer

IntroductionSubjects with type 2 diabetes have an excess risk of cancer. The potential role of advanced glycation end products (AGEs) accumulated during long-term hyperglycemia in cancer development has been suggested by biological studies but clinical data are missing. AGEs can be estimated by measuring the skin autofluorescence. We searched whether the skin autofluorescence could predict new cancers in persons with type 2 diabetes.Research design and methodsFrom 2009 to 2015, we measured the skin autofluorescence of 413 subjects hospitalized for uncontrolled or complicated type 2 diabetes, without any history of cancer. The participants were followed for at least 1 year and the occurrences of new cancers were compared according to their initial skin autofluorescences.ResultsThe participants were mainly men (57.9%), with poorly controlled (HbA1c 72±14 mmol/mol or 8.7%±1.8%) and/or complicated type 2 diabetes. Their median skin autofluorescence was 2.6 (2.2–3.0) arbitrary units. Forty-five new cancer cases (10.9%) were registered during 4.8±2.3 years of follow-up: 75.6% of these subjects had skin autofluorescence higher than the median (χ2: p=0.001). By Cox regression analysis adjusted for age, gender, body mass index, history of smoking and renal parameters, skin autofluorescence >2.6 predicted a 2.57-fold higher risk of cancer (95% CI 1.28 to 5.19, p=0.008). This association remained significant after excluding the eight cancers that occurred in the 4 years after inclusion (OR 2.95, 95% CI 1.36 to 6.38, p=0.006). As a continuous variable, skin autofluorescence was also related to new cancers (OR 1.05, 95% CI 1.01 to 1.10, p=0.045).ConclusionsSkin autofluorescence, a potential marker of glycemic memory, predicts the occurrence of cancer in subjects with type 2 diabetes. This relation provides a new clinical argument for the role of AGEs in cancer. Their estimation by measuring the skin autofluorescence may help select subjects with diabetes in cancer screening programs.

scholarly journals Characteristics of men and women with diabetes

2021 ◽  
Author(s):  
Enza Gucciardi ◽  
Shirley Chi-Tyan Wang ◽  
Lisa Amaral ◽  
Donna E. Stewart
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Diabetes Education ◽  
Primary Care Providers ◽  
Self Management ◽  
Care Providers ◽  
Family History Of Diabetes ◽  
Men And Women ◽  
History Of

OBJECTIVE To determine whether men and women with type 2 diabetes have different psychosocial, behavioural, and clinical characteristics at the time of their first visit to a diabetes education centre. DESIGN A questionnaire on psychosocial and behavioural characteristics was administered at participants’ first appointments. Clinical and disease-related data were collected from their medical records. Bivariate analyses (χ2 test, t test, and Mann-Whitney test) were conducted to examine differences between men and women on the various characteristics. SETTING Two diabetes education centres in the greater Toronto area in Ontario. PARTICIPANTS A total of 275 men and women with type 2 diabetes. RESULTS Women were more likely to have a family history of diabetes, previous diabetes education, and higher expectations of the benefits of self-management. Women reported higher levels of social support from their diabetes health care team than men did, and had more depressive symptoms, higher body mass, and higher levels of high-density lipoprotein cholesterol than men did. CONCLUSION The results of this study provide evidence that diabetes prevention, care, and education need to be targeted to men and women differently. Primary care providers should encourage men to attend diabetes self-management education sessions and emphasize the benefits of self-care. Primary care providers should promote regular diabetes screening and primary prevention to women, particularly women with a family history of diabetes or a high body mass index; emphasize the importance of weight management for those with and without diabetes; and screen diabetic women for depressive symptoms.

scholarly journals Gestational Diabetes Mellitus and the Risks of Overall and Type-Specific Cardiovascular Diseases: A Population- and Sibling-Matched Cohort Study

2021 ◽  
Author(s):  
Yongfu Yu ◽  
Melissa Soohoo ◽  
Henrik Toft Sørensen ◽  
Jiong Li ◽  
Onyebuchi A. Arah
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Cox Regression ◽  
Maternal History ◽  
History Of ◽  
The Impact

<b>OBJECTIVE</b> <p>To evaluate associations between gestational diabetes mellitus (GDM) and various incident cardiovascular disease (CVD) endpoints, considering the effects of mediating role of type 2 diabetes and shared environmental/familial factors.</p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>This population-based cohort study included 1002486 parous women in Denmark during 1978-2016. We used Cox regression to (i) examine the associations of GDM with overall and type-specific CVDs using full-cohort and sibling-matched analysis; (ii) quantify the impact of type 2 diabetes after GDM using mediation analysis; and (iii) assess whether these associations were modified by pre-pregnancy obesity or maternal history of CVD.</p> <p><b>RESULTS</b></p> <p>Women with a history of GDM had a 40% increased overall CVD risk (hazard ratio [HR]: 1.40, 95% confidence interval [CI]: 1.35-1.45). Sibling-matched analyses yielded similar results(HR, 1.44; 95%CI, 1.28-1.62). Proportion of association between GDM and overall CVD explained by subsequent type 2 diabetes was 23.3%(15.4%-32.8%). We observed increased risks of specific CVDs, including 65% increased stroke risk and more than two-fold risks for myocardial infarction, heart failure, and peripheral artery disease. The elevated overall risks were more pronounced among women with GDM and pre-pregnancy obesity or maternal history of CVD. </p> <p><b>CONCLUSIONS</b></p> <p>A history of GDM was associated with increased risks of overall and specific CVDs. Increased risks were partly explained by subsequent type 2 diabetes and the need to identify other pathways remains important. Continuous monitoring of women with a history of GDM, especially those with pre-pregnancy obesity or maternal history of CVD, may provide better opportunities to reduce their cardiovascular risk.</p>

Primary Care Health Care Use for Patients With Type 2 Diabetes During the COVID-19 Pandemic

Diabetes Care ◽  
2021 ◽  
pp. dc210853
Author(s):  
Anita D. Misra-Hebert ◽  
Bo Hu ◽  
Kevin M. Pantalone ◽  
Elizabeth R. Pfoh
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Health Care ◽  
Health Care Use ◽  
Primary Care Health ◽  
Care Health
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