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Diabetes in primary care

Niina-Mari Inkeri, Merja Karjalainen, Maija Haanpää, Hannu Kautiainen, Juha Saltevo, Pekka Mäntyselkä, Miia Tiihonen
WHAT IS KNOWN AND OBJECTIVE: Anticholinergic drug use has been associated with a risk of central and peripheral adverse effects. There is a lack of information on anticholinergic drug use in persons with diabetes. The aim of this study is to investigate anticholinergic drug use and the association between anticholinergic drug use and self-reported symptoms in older community-dwelling persons with and without diabetes. METHODS: The basic population was comprised of Finnish community-dwelling primary care patients aged 65 and older...
October 12, 2018: Journal of Clinical Pharmacy and Therapeutics
Rachael Lazar, Laura Kersanske, Sarah L Braunstein
People living with HIV (PLWH) are frequently affected by comorbid medical conditions. Despite the importance of diagnosing and treating these conditions, testing rates for common comorbidities often fall short of primary care recommendations for PLWH. Clinical care data were obtained from the 2012 New York City (NYC) Medical Monitoring Project (MMP), a multi-site surveillance project that includes demographically representative cohorts of PLWH receiving medical care. Medical record abstraction data were analyzed to determine testing frequencies for potential comorbid conditions, including tuberculosis, hepatitis B and C, diabetes, syphilis, gonorrhea, and chlamydia, and to assess demographic, behavioral, and clinical factors associated with testing...
October 12, 2018: AIDS Care
Jesse Lachter, Carly Rosenberg, Tomer Hananiya, Iyad Khamaysi, Amir Klein, Kamel Yassin, Elizabeth Half
OBJECTIVE OF THE WORK: Pancreatic cancer (PC) is a deadly disease that is most commonly diagnosed at an incurable stage. Early diagnosis is the most important factor for improving prognosis. Evidence is beginning to accumulate that screening and surveillance may lead to the early detection of precursor lesions and/or pancreatic cancer in asymptomatic individuals. Proper screening methods and identification of such precursor lesions may enable effective pre-emptive interventions to prevent further fatalities...
October 4, 2018: Rambam Maimonides Medical Journal
Sule Ozel, Selen Yaman, Hatice Kansu-Celik, Necati Hancerliogullari, Nurgul Balci, Yaprak Engin-Ustun
OBJECTIVE:  The aim of this study was to analyze and compare obstetric and neonatal outcomes between Syrian refugees and ethnic Turkish women. METHODS:  Retrospective, observational study. A total of 576 Syrian refugees and 576 ethnic Turkish women were included in this study, which was conducted between January 2015 and December 2015 at a tertiary maternity training hospital in Ankara, Turkey. The demographic characteristics, obstetric and neonatal outcomes were compared...
October 11, 2018: Revista Brasileira de Ginecologia e Obstetrícia
Shadi Saleh, Angie Farah, Nour El Arnaout, Hani Dimassi, Christo El Morr, Carles Muntaner, Walid Ammar, Randa Hamadeh, Mohamad Alameddine
Background: Non-communicable diseases (NCDs) account for 85% of deaths in Lebanon and contribute to remarkable morbidity and mortality among refugees and underserved populations. This study assesses the perspectives of individuals with hypertension and/or diabetes in rural areas and Palestinian refugee camps towards a population based mHealth intervention called 'eSahha'. Methods: The study employs a mixed-methods design to evaluate the effectiveness of SMSs on self-reported perceptions of lifestyle modifications...
October 11, 2018: Journal of Public Health
Bernardette Rivas-Gomez, Paloma Almeda-Valdés, María Teresa Tussié-Luna, Carlos A Aguilar-Salinas
The purpose of this manuscript is to highlight the peculiarities of the Mexican population regarding the clinical expression, genetics, and treatment of lipid disorders. Furthermore, it is a call for action to address the existing gaps in care and research of dyslipidemias. The Mexican Mestizos are highly susceptible to metabolic disorders (i.e., low high-density lipoprotein cholesterol concentrations, hypertriglyceridemia, abdominal obesity, and type 2 diabetes); these conditions are associated with ethnic-specific genetic variants...
2018: Revista de Investigación Clínica; Organo del Hospital de Enfermedades de la Nutrición
Thomas H Wieringa, Maartje de Wit, Jos Wr Twisk, Frank J Snoek
Objective: Insulin glargine 300 (Gla-300) provides less hypoglycemia risk and more flexibility in injection time. The extent to which these effects translate into improved patient-reported outcomes (PROs) is unknown, and is the subject of this observational study. Research design and methods: Adults with type 2 diabetes treated with basal insulin for at least 6 months initiating Gla-300 were included. Data were collected at baseline (start Gla-300) and at 3-month and 6-month follow-up...
2018: BMJ Open Diabetes Research & Care
Signe T Andersen, Daniel R Witte, Jesper Fleischer, Henning Andersen, Torsten Lauritzen, Marit E Jørgensen, Troels S Jensen, Rodica Pop-Busui, Morten Charles
OBJECTIVE: To examine the course of cardiovascular autonomic neuropathy (CAN) and related cardiometabolic risk factors in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: CAN and cardiometabolic risk factors were assessed in the Danish arm of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen Detected Diabetes in Primary Care (ADDITION-Denmark) at 6-year ( n = 777) and 13-year ( n = 443) follow-up examinations. Cardiovascular autonomic reflex tests (CARTs)-that is, lying to standing, deep breathing, and the Valsalva maneuver-and 2-min resting heart rate variability (HRV) indices were obtained as the main measures of CAN...
October 10, 2018: Diabetes Care
Dominic Ehrmann, Bernhard Kulzer, Melanie Schipfer, Bernhard Lippmann-Grob, Thomas Haak, Norbert Hermanns
OBJECTIVE: Continuous subcutaneous insulin infusion (CSII) is the most advanced form of insulin delivery, but it requires structured education to provide users with the necessary knowledge/skills and to support their motivation. Currently, no structured education program designed to provide this training has been evaluated. We developed a CSII-specific, structured education program (Insulin Pump Treatment [INPUT]) and evaluated its impact on glycemic control, behavior, and psychosocial status...
October 10, 2018: Diabetes Care
Darrick Beckman, Jana Wardian, Tom J Sauerwein, Mark W True
RATIONALE: Since there are only 33 endocrinologists within the Department of Defence and over 150 000 beneficiaries with diabetes, most patients with diabetes will be treated by primary care providers (PCPs). Comprehensive diabetes care visits are extensive and the clinical practice guidelines (CPGs) routinely change; thus, providing current evidence-based care is difficult. Most professional development courses aim to update PCPs on CPGs but are often inadequate as they focus on only the PCPs (not the interdisciplinary team) without a plan to implement changes into practice...
October 10, 2018: Journal of Evaluation in Clinical Practice
B M Daly, B Arroll, R K R Scragg
AIM AND OBJECTIVES: To examine trends since a previous 2006-8 survey in diabetes knowledge held by primary health care nurses and their use of national diabetes guidelines, perceived ability to advise diabetes patients and preferences for further diabetes education. BACKGROUND: The obesity epidemic has led to a rapid increase in the prevalence of pre-diabetes and type 2 diabetes and to greater expectations for an expanded role for primary health care nurses in the prevention and community management of diabetes...
October 9, 2018: Journal of Clinical Nursing
C C Goh, K H Koh, Scp Goh, Yle Koh, N C Tan
Introduction: Achieving optimal glycated hemoglobin (HbA1c), blood pressure (BP), and LDL-Cholesterol (LDL-C) in patients mitigates macro- and micro-vascular complications, which is the key treatment goal in managing type 2 diabetes mellitus (T2DM). This study aimed to determine the proportion of patients in an urban community with T2DM and the above modifiable conditions attaining triple vascular treatment goals based on current practice guidelines. Methods: A questionnaire was distributed to adult Asian patients with dyslipidemia at two primary care clinics (polyclinics) in northeastern Singapore...
2018: Malaysian Family Physician
John-Michael Gamble, Eugene Chibrikov, William K Midodzi, Laurie K Twells, Sumit R Majumdar
OBJECTIVES: To compare population-based incidence rates of new-onset depression or self-harm in patients initiating incretin-based therapies with that of sulfonylureas (SU) and other glucose-lowering agents. DESIGN: Population-based cohort study. SETTING: Patients attending primary care practices registered with the UK-based Clinical Practice Research Datalink (CPRD). PARTICIPANTS: Using the UK-based CPRD, we identified two incretin-based therapies cohorts: (1) dipeptidyl peptidase-4 inhibitor (DPP-4i)-cohort, consisting of new users of DPP-4i and SU and (2) glucagon-like peptide-1 receptor agonists (GLP-1RA)-cohort, consisting of new users of GLP-1RA and SU, between January 2007 and January 2016...
October 8, 2018: BMJ Open
Kishu Waghela, Nagma Nigar Shah, Somen Saha
Introduction: In 2002, the Government of Chhattisgarh initiated a Community Health Worker program called the Mitanin Program, to strengthen the health system of Chhattisgarh. The current study was conducted with the twin objectives to assess morbidity pattern and health-seeking behavior in urban slums of Durg and Bhilai to understand the role of Mitanins in health seeking of their slum population. Methods: Ten urban slums, five each from Durg and Bhilai were selected through simple random sampling for the study...
July 2018: Indian Journal of Community Medicine
Aisha T Langford, Binhuan Wang, Natasha A Orzeck-Byrnes, Sneha R Aidasani, Lu Hu, Melanie Applegate, Dana N Moloney, Mary Ann Sevick, Erin S Rogers, Natalie K Levy
BACKGROUND: Insulin titration is typically done face-to-face with a clinician; however, this can be a burden for patients due to logistical issues associated with in-person clinical care. The Mobile Insulin Titration Intervention (MITI) used basic cell phone technology including text messages and phone calls to help patients with diabetes find their optimal basal insulin dose (OID). OBJECTIVE: To evaluate sociodemographic and clinical correlates of reaching OID, text message response rate, and days needed to reach OID...
September 17, 2018: Patient Education and Counseling
Marcel H A Muskiet, Lennart Tonneijck, Yao Huang, Minzhi Liu, Aramesh Saremi, Hiddo J L Heerspink, Daniël H van Raalte
BACKGROUND: The results of the ELIXA trial demonstrated the cardiovascular safety of lixisenatide, a short-acting glucagon-like peptide-1 receptor agonist, in patients with type 2 diabetes and acute coronary syndrome. In this exploratory analysis of ELIXA, we investigate the effect of lixisenatide on renal outcomes. METHODS: ELIXA was a randomised, double-blind, placebo-controlled trial, done at 828 sites in 49 countries. Patients with type 2 diabetes and a recent coronary artery event were randomly assigned (1:1) to a daily subcutaneous injection of lixisenatide (10-20 μg) or volume-matched placebo, in addition to usual care, until at least 844 patients had an adjudicated major adverse cardiovascular event included in the primary outcome...
October 1, 2018: Lancet Diabetes & Endocrinology
Maya H Maloney, Stephanie R Schilz, Jeph Herrin, Lindsey R Sangaralingham, Nilay D Shah, Andrew J Barkmeier
PURPOSE: Intravitreal anti-VEGF pharmacotherapy has become standard of care for the management of diabetic macular edema (DME). The systemic safety profile of this treatment in routine clinical practice remains incompletely understood. We used a large claims database to investigate the risk of systemic adverse events (SAEs) in patients receiving anti-VEGF for DME, compared to controls treated with macular laser photocoagulation or intravitreal corticosteroid. DESIGN: Retrospective cohort study SUBJECTS: Using a large U...
October 4, 2018: Ophthalmology
Gordon D Schiff, Elissa Klinger, Alejandra Salazar, Jeffrey Medoff, Mary G Amato, E John Orav, Shimon Shaykevich, Enrique V Seoane, Lake Walsh, Theresa E Fuller, Patricia C Dykes, David W Bates, Jennifer S Haas
BACKGROUND: Medication adverse events are important and common yet are often not identified by clinicians. We evaluated an automated telephone surveillance system coupled with transfer to a live pharmacist to screen potentially drug-related symptoms after newly starting medications for four common primary care conditions: hypertension, diabetes, depression, and insomnia. METHODS: Cluster randomized trial with automated calls to eligible patients at 1 and 4 months after starting target drugs from intervention primary care clinics compared to propensity-matched patients from control clinics...
October 5, 2018: Journal of General Internal Medicine
Robert I Griffiths, Emily C McFadden, Richard J Stevens, Jose M Valderas, Bernadette A Lavery, Nada F Khan, Nancy L Keating, Clare R Bankhead
PURPOSE: Overlooking other medical conditions during cancer treatment and follow-up could result in excess morbidity and mortality, thereby undermining gains associated with early detection and improved treatment of cancer. We compared the quality of care for diabetes patients subsequently diagnosed with breast, colorectal, or prostate cancer to matched, diabetic non-cancer controls. METHODS: Longitudinal cohort study using primary care records from the Clinical Practice Research Datalink, United Kingdom...
October 6, 2018: Journal of Cancer Survivorship: Research and Practice
Ulrika Öberg, Ulf Isaksson, Lena Jutterström, Carl Johan Orre, Åsa Hörnsten
BACKGROUND: Digital health services are increasing rapidly worldwide. Strategies to involve patients in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance, and there is a need to optimize the delivery of care such as self-management support. Digitalized solutions have the potential to modify and personalize the way in which people use primary health services, both by increasing access to information and providing other forms of support at a distance. It is a challenge to integrate core values of person-centered care into digitalized health care services...
March 12, 2018: JMIR diabetes
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