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Diabetes in primary care

Ruth Webster, Abdul Salam, H Asita de Silva, Vanessa Selak, Sandrine Stepien, Senaka Rajapakse, Stanley Amarasekara, Naomali Amarasena, Laurent Billot, Arjuna P de Silva, Mervyn Fernando, Rama Guggilla, Stephen Jan, Jayanthimala Jayawardena, Pallab K Maulik, Sepalika Mendis, Suresh Mendis, Janake Munasinghe, Nitish Naik, Dorairaj Prabhakaran, Gotabaya Ranasinghe, Simon Thom, Nirmali Tisserra, Vajira Senaratne, Sanjeewa Wijekoon, Santharaj Wijeyasingam, Anthony Rodgers, Anushka Patel
Importance: Poorly controlled hypertension is a leading global public health problem requiring new treatment strategies. Objective: To assess whether a low-dose triple combination antihypertensive medication would achieve better blood pressure (BP) control vs usual care. Design, Setting, and Participants: Randomized, open-label trial of a low-dose triple BP therapy vs usual care for adults with hypertension (systolic BP >140 mm Hg and/or diastolic BP >90 mm Hg; or in patients with diabetes or chronic kidney disease: >130 mm Hg and/or >80 mm Hg) requiring initiation (untreated patients) or escalation (patients receiving monotherapy) of antihypertensive therapy...
August 14, 2018: JAMA: the Journal of the American Medical Association
Lubia Velázquez-López, Rubí Hernández-Sánchez, Ivonne Roy García, Abril Violeta Muñoz-Torres, Patricia Medina-Bravo, Jorge Escobedo-de la Peña
INTRODUCTION: Kidney disease is one of the main complications in the diabetic patient. Risk factors such as obesity, dyslipidemia, and hyperglycemia have been associated with increased urinary albumin excretion (UAE) and decreased glomerular filtration rates (GFR). However, the data are inconsistent. The objective of this study was to identify the primary risk factors associated with kidney disease in Mexican patients with type 2 diabetes. METHODS: A cross-sectional study was done in 395 patients with type 2 diabetes from four primary-care clinics...
August 14, 2018: Archives of Medical Research
Elizabeth J Mayer-Davis, David M Maahs, Michael Seid, Jamie Crandell, Franziska K Bishop, Kimberly A Driscoll, Christine M Hunter, Jessica C Kichler, Debra Standiford, Joan M Thomas
BACKGROUND: Adolescents with type 1 diabetes commonly have poor glycaemic control. We aimed to test the efficacy of a newly developed adaptive behavioral intervention (Flexible Lifestyles Empowering Change; FLEX) on metabolic and psychosocial outcomes in adolescents with type 1 diabetes. METHODS: Young people (13-16 years, type 1 diabetes duration >1 year, HbA1c of 64-119 mmol/mol [8·0-13·0%], and without other serious medical conditions or pregnancy) from two clinical sites (Colorado and Ohio, USA) were eligible for enrolment...
September 2018: Lancet Child & Adolescent Health
Andrzej Czyrski, Matylda Resztak, Tadeusz Hermann
Type 2 diabetes mellitus is a worldwide health problem. Many drugs can be used in its treatment. One of them is gliclazide - the sulfonylurea derivative. It is dosed in modified release tablets. The study aimed to determine the minimum steady-state concentration of gliclazide at patients taking modified release tablets. Fasting plasma glucose, insulin level, and glycated hemoglobin were also assayed in this study. Ten patients of the primary care physician clinic took 30-90 mg of gliclazide daily. The statistical analysis proved that there is a statistically significant correlation between insulin level and body weight (p = 0...
July 20, 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Edna Bosire, Emily Mendenhall, Gregory Barnabas Omondi, David Ndetei
This article investigates how international donor policies cultivate a form of biological sub-citizenship for those with diabetes in Kenya. We interviewed 100 patients at a public hospital clinic in Nairobi, half with a diabetes diagnosis. We focus on three vignettes that illustrate how our study participants differentially perceived and experienced living with and seeking treatment and care for diabetes compared to other conditions, with a special focus on HIV. We argue that biological sub-citizenship, where those with HIV have consistent and comprehensive free medical care and those with diabetes must pay out-of-pocket for testing and treatment, impedes diabetes testing and treatment...
August 16, 2018: Medical Anthropology Quarterly
Yazed AlRuthia, Haya Almalag, Ibrahim Sales, Ahmed Abdulrahman Albassam, Fawaz Abdullah Alharbi, Alanoud Mushaal Almutairi, Nouf Alquait, Yousif Asiri
BACKGROUND: Patients' trust in their physicians is critical to ensuring quality in healthcare. Despite the fact that both medication knowledge and trust in healthcare providers positively correlate with improved clinical outcomes, the presence of a link between these two attributes remains to be established. OBJECTIVES: To determine whether a relationship exists between patients' trust in their primary care physicians and their medication knowledge. METHODS: Patient trust was measured using the healthcare relationship (HCR) trust scale, and the medication knowledge by the self-reported medication knowledge questionnaire...
August 9, 2018: Research in Social & Administrative Pharmacy: RSAP
Hatem A El Shora, Ahmed A El Beleehy, Amr A Abdelwahab, Gaser A Ali, Tarek E Omran, Essam A Hassan, Amr A Arafat
BACKGROUND:  Adequate pain control after cardiac surgery is essential. Paravertebral block is a simple technique and avoids the potential complications of epidural catheters. The objective of this study is to compare the effect of ultrasound-guided bilateral thoracic paravertebral block with thoracic epidural block on pain control after cardiac surgery. MATERIALS AND METHODS:  Between March 2016 and 2017, 145 patients who had cardiac surgery through median sternotomy were randomized by stratified blocked randomization into two groups...
August 16, 2018: Thoracic and Cardiovascular Surgeon
Dahai Yu, Yamei Cai, Jonathan Graffy, Daniel Holman, Zhanzheng Zhao, David Simmons
AIMS: Cerebrovascular disease is one of more typical reasons for hospitalisation and re-hospitalisation in people with type 2 diabetes. We aimed to derive and externally validate two risk prediction algorithms for cerebrovascular hospitalisation and re-hospitalisation. METHODS: Two independent cohorts were used to derive and externally validate the two risk scores. The development cohort comprises 4,704 patients with type 2 diabetes registered in 18 general practices across Cambridgeshire...
August 13, 2018: Diabetes Research and Clinical Practice
Megan Hoopes, Heather Angier, Lewis A Raynor, Andrew Suchocki, John Muench, Miguel Marino, Pedro Rivera, Nathalie Huguet
Objective: Medication adherence is an important aspect of chronic disease management. Electronic health record (EHR) data are often not linked to dispensing data, limiting clinicians' understanding of which of their patients fill their medications, and how to tailor care appropriately. We aimed to develop an algorithm to link EHR prescribing to claims-based dispensing data and use the results to quantify how often patients with diabetes filled prescribed chronic disease medications. Materials and Methods: We developed an algorithm linking EHR prescribing data (RxNorm terminology) to claims-based dispensing data (NDC terminology), within sample of adult (19-64) community health center (CHC) patients with diabetes from a network of CHCs across 12 states...
August 3, 2018: Journal of the American Medical Informatics Association: JAMIA
Khalid Mehmood, Nabeea Junaid
OBJECTIVE: To estimate the prevalence of undiagnosed diabetes in patients visiting the primary care physicians for any reason in urban outpatient settings. METHODS: This national, multicentre, non-interventional disease registry was conducted from October 2011 to August 2013 across Sindh and Punjab provinces of Pakistan and comprised randomly selected health centres with qualified general practitioners. Patients aged 45 years or more and willing to have a random blood sugar screening test were selected...
August 2018: JPMA. the Journal of the Pakistan Medical Association
R Ryan Reyes, Gavin Parker, Stephanie Garies, Cheryl Dolan, Susan Gerber, Beverly Burton, Tracy Burton, Jeff Brockmann, Rebecca Miyagishima, Neil Drummond
OBJECTIVE: To explore clinical indicators among patients with diabetes in southern Alberta and assess changes over time, and to compare patients with diabetes attending a reference clinic (RC), which had adapted its service model to address the specific needs of the patient population, with patients with diabetes attending comparison clinics (CCs) in the same region. DESIGN: Analysis of longitudinal data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN)...
August 2018: Canadian Family Physician Médecin de Famille Canadien
William Pedrosa, Juliana Beaudette Drummond, Beatriz Santana Soares, Antônio Ribeiro-Oliveira
OBJECTIVES: The water deprivation test (WDT) is widely used for the differential diagnosis of the polyuria-polydipsia syndrome (PPS). However, it is inconvenient and may not always be precise in differentiating partial forms of diabetes insipidus (DI) from primary polydipsia (PP). The aim of this study was to evaluate the results of a combined outpatient and inpatient overnight WDT protocol that included an overnight non-supervised period concerning its feasibility and safety. METHODS: Retrospective analysis of clinical data and laboratory results of 52 patients with PPS undergoing WDT in a single center was undertaken...
August 14, 2018: Endocrine Practice
Amani Zidan, Ahmed Awaisu, Maguy Saffouh El-Hajj, Samya Ahmad Al-Abdulla, Dianne Candy Rose Figueroa, Nadir Kheir
This study aimed to assess perceived medication-related burden among patients with multiple non-communicable diseases (NCDs) and to investigate the association between perceived burden and adherence to medication therapy. Using a cross-sectional study in three primary care clinics in Qatar, medication-related burden was measured using the Living with Medicines Questionnaire (LMQ) among adults with diabetes, with or without other comorbidities. Adherence was measured using the Adherence to Refills and Medications Scale (ARMS)...
August 13, 2018: Pharmacy (Basel, Switzerland)
Zachary Bouck, Graham Mecredy, Noah M Ivers, Ciara Pendrith, Ben Fine, Danielle Martin, Richard H Glazier, Joshua Tepper, Wendy Levinson, R Sacha Bhatia
BACKGROUND: Many evidence-based recommendations advocate against the use of routine chest x-rays for asymptomatic, low-risk outpatients; however, it is unclear how regularly chest x-rays are ordered in primary care. Our study aims to describe the frequency of, and variation in, routine chest x-ray use in low-risk outpatients among primary care physicians. METHODS: In this retrospective cohort study, Ontario residents aged 18 years and older with a periodic health examination (PHE) between Apr...
July 2018: CMAJ Open
Martin de Bock, Sybil A McAuley, Mary Binsu Abraham, Grant Smith, Jennifer Nicholas, Geoff R Ambler, Fergus J Cameron, Jan M Fairchild, Bruce R King, Elizabeth A Geelhoed, Elizabeth A Davis, David Norman O'Neal, Timothy W Jones
INTRODUCTION: Automated insulin delivery (also known as closed loop, or artificial pancreas) has shown potential to improve glycaemic control and quality of life in people with type 1 diabetes (T1D). Automated insulin delivery devices incorporate an insulin pump with continuous glucose monitoring(CGM) and an algorithm, and adjust insulin in real time. This study aims to establish the safety and efficacy of a hybrid closed-loop (HCL) system in a long-term outpatient trial in people with T1D aged 12 -<25 years of age, and compare outcomes with standard therapy for T1D as used in the contemporary community...
August 13, 2018: BMJ Open
Julia A Critchley, Iain M Carey, Tess Harris, Stephen DeWilde, Fay J Hosking, Derek G Cook
OBJECTIVE: Diabetes mellitus (DM) increases the risk of infections, but the effect of better control has not been thoroughly investigated. RESEARCH DESIGN AND METHODS: With the use of English primary care data, average glycated hemoglobin (HbA1c ) during 2008-2009 was estimated for 85,312 patients with DM ages 40-89 years. Infection rates during 2010-2015 compiled from primary care, linked hospital, and mortality records were estimated across 18 infection categories and further summarized as any requiring a prescription or hospitalization or as cause of death...
August 13, 2018: Diabetes Care
Guillaume Moulis, Berta Ibañez, Aurore Palmaro, Felipe Aizpuru, Eduardo Millan, Maryse Lapeyre-Mestre, Laurent Sailler, Koldo Cambra
Aim: The EPICHRONIC (EPIdemiology of CHRONIC diseases) project investigated the possibility of developing common procedures for French and Spanish electronic health care databases to enable large-scale pharmacoepidemiological studies on chronic diseases. A feasibility study assessed the prevalence of type 2 diabetes mellitus (T2DM) in Navarre and the Basque Country (Spain) and the Midi-Pyrénées region (France). Patients and methods: We described and compared database structures and the availability of hospital, outpatient, and drug-dispensing data from 5...
2018: Clinical Epidemiology
Brett Morgan, Steve Wooden
Management of chronic pain has become a significant challenge for primary care providers, and the population of patients with chronic pain is expected to increase. Common syndromes seen in the primary care setting include myofascial pain syndrome, fibromyalgia, chronic postsurgical pain, complex regional pain syndrome, and painful diabetic neuropathy. This article describes these syndromes and presents current treatment options.
September 2018: Nursing Clinics of North America
Jordan A Holmes, Roger F Anderson, Leroy G Hoffman, Timothy N Showalter, Mohit Kasibhatla, Sean P Collins, Michael A Papagikos, Brittany D Barbosa, Lori J Stravers, Zahra Mahbooba, Andrew Z Wang, Ronald C Chen
BACKGROUND: Prostate cancer survivors who receive androgen deprivation therapy (ADT) are at increased risk of cardiovascular disease. They require coordinated care between cancer specialist and primary care physicians (PCPs) to monitor for cancer control and manage cardiovascular risk factors. METHODS: We prospectively enrolled 103 men receiving ADT with radiotherapy from 7 institutions to assess cardiovascular risk factors and survivorship care. Medical records, fasting labs, and patient-reported outcomes using a validated instrument were assessed at baseline (pre-treatment) and 1 year post-RT...
August 9, 2018: International Journal of Radiation Oncology, Biology, Physics
Carlos Brotons, Irene Moral, Diana Fernández, Mireia Puig, Eva Calvo Bonacho, Paloma Martínez Muñoz, Carlos Catalina Romero, Luis Javier Quevedo Aguado
INTRODUCTION AND OBJECTIVES: To develop a predictive function of lifetime cardiovascular risk, including morbidity and mortality, in a healthy working population in Spain. METHODS: Retrospective cohort study. We selected healthy workers, aged 18 to 65 years, with no history of cardiovascular disease, who underwent a health assessment between 2004 and 2007. We used 70% of the cohort to develop the risk equation, and the remaining 30% to validate the equation. Four Cox proportional hazards models were constructed using cardiovascular events and competing events as dependent variables...
August 7, 2018: Revista Española de Cardiología
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