Diabetes Clinic Research Articles

Effectiveness of Jena DM® Herbal Formulation as Complementary Therapy to Conventional Oral Hypoglycemic Agents in Type-2 Diabetes Mellitus: A Quasi-experimental Study.

There is vast preclinical evidence that indicates that extracts from several Artemisia plant species have significant antidiabetic benefits. However, clinical evidence is limited to this effect. We sought to evaluate the effectiveness ofJena DM® (anArtemisia annua-based poly-herbal formulation) on glycemic control (Hb A1C) and insulin metabolism (HOMA), when administered as a complementary therapy in type-2 diabetes mellitus (T2DM). This study was supported by a research grant (JRD005) from Jena Herbals (U) Ltd, which is a local herbal medicines manufacturing facility in Uganda. We conducted a 12-week quasi-experimental study, involving 118 patients under routine follow-up at a diabetes and endocrinology clinic. Random assignment to either conventional or experimental study groups was done using a random number generator (Microsoft Excel version 16.0). Participant sociodemographic and clinical data as well as whole blood samples (3-5 mL) were obtained at scheduled clinic visits. Medication adherence was assessed using the Hill-Bone Scale, and adverse drug events (ADEs) using the Naranjo causality and the National Institute of Allergy and Infectious Diseases, Division of AIDS (DAIDS) scales. Group differences in glycemic control (HbA1C), fasting serum insulin (FSI) indices (% HOMA2-B, HOMA-IR), and other cardiometabolic parameters were assessed using independent samples t-test, and Pearson chi-square statistical tests were used. A p-value <0.05 was considered statistically significant. Ethical approvals were obtained before the study commencement. 12-week daily complementary therapy withJena DM® showed no significant effect on Hb A1C reduction (0.1 (95% CI: -0.56, 0.80) %;p=0.798); however, we observed a significant reduction in total body weight (2.0 (95% CI: 0.73, 3.28) kg;p=0.002). The overall frequency of self-reported ADEs including dizziness was significantly higher among patients that usedJena DM® (p=0.001).Epigastric pain was the most severe ADE necessitating clinical management. There was no significant difference in the homeostatic model assessment for insulin resistance (HOMA2-IR) between study groups. In contrast to a few studies that previously showed significanthypoglycemic effects ofArtemisia-basedextracts, this study did not show a statistically significant reduction on HbA1C during a 12-week complementary use ofJena DM® in patients withT2DM. Based on the findings of this study, future research should evaluate the long-term effects ofJena DM® on body weight, overall insulin metabolism, and the subsequent effect on glycemic control in T2DM.

Physical Activity Perceptions and Participation of People With Type II Diabetes Mellitus in the Dominican Republic.

Physical activity (PA) improves health outcomes for people with type II diabetes mellitus (diabetes), but little is known about PA among Dominicans. The purpose was to evaluate PA participation and perceptions among people with diabetes in the Dominican Republic (DR). Participants (N=29) were recruited from an urban diabetes clinic in DR. PA was assessed via accelerometry and Godin Leisure Time Exercise Questionnaire (GLTEQ). Eighteen women and 11 men enrolled (age: 55 ± 13 years; BMI: 28.6 ± 4.5 kg·m-2). Twenty-seven participants reached acceptable wear time. Using a one-minute bout minimum, moderate- to vigorous-intensity PA (MVPA) was 152.2 ± 59.7 min·day-1; no vigorous PA was recorded. GLTEQ scores (103 ± 98) classified 25 participants as active. Around 93% reported that PA was "very important" for their health. There was no association between GLTEQ and MVPA (p>0.2). Participants who reported being "very active" (n=17) did more MVPA than those who were "rarely active" or "somewhat active" (n=10; p=0.02). Dominicans with diabetesare highly physically active but do very little vigorous PA. The GLTEQ was not an accurate measure of PA. Future research should develop validated questionnaires and evaluate structured exercise and dietary interventions.

Diabetes distress and depression are independently associated with gastrointestinal symptoms in type 2 diabetes in Bangladesh.

Gastrointestinal (GI) symptoms, common in type 2 diabetes (T2D), are typically bothersome, socially embarrassing, and impact negatively on quality of life. They may also contribute to diabetes distress (DD), but this has never been formally evaluated. We aimed to investigate the relationships between GI symptoms, DD and depressive symptoms in a large cohort of individuals with T2D in Bangladesh. 1406 unselected T2D individuals (female 58.8%; mean age 51.0 ± 12.5 years) from four diabetes clinics in Bangladesh completed validated questionnaires evaluating GI symptoms (PAGI-SYM), DD (DDS-17) and depressive symptoms (PHQ-9). 31.1% of participants reported GI symptoms (36.2% females, 23.7% males), while 51.1% had elevated DD and 37.8% depressive symptoms. GI symptoms exhibited independent relationships with both DD and depressive symptoms, and their likelihood was higher among those with DD (OR: 3.6 [2.2-5.6] and with depressive symptoms (OR: 5.9 [3.5-9.9]). GI symptoms are independently associated with both DD and depressive symptoms in people with T2D in Bangladesh.

Factors Associated with Antidiabetic Medications and Dietary Recommendation Adherence Among Patients with Type 2 Diabetes

ABSTRACT Introduction Diabetes mellitus is a global noncommunicable disease epidemic of public concern. Adherence poses a challenge to patients due to the long-term management of type 2 diabetes. This study assessed the factors associated with antidiabetic medications and dietary recommendation adherence among patients with type 2 diabetes in Ghana. Methods A hospital-based, cross-sectional study design was used to assess self-reported factors associated with antidiabetic medications and dietary recommendation adherence among 165 recruited type 2 diabetes patients who visited diabetic clinics of two selected municipal hospitals in the Volta region of Ghana. A structured questionnaire consisting of closed-ended questions was used. Phone calls were used to collect responses from participants using the structured questionnaire, which included the United Kingdom Diabetes Diet Questionnaire and Morisky Adherence Scale. Data collected were entered into a Microsoft Excel sheet and exported to STATA software (version 15) to analyze variables. Binary logistic regression was run to determine the association between the level of adherence (outcome variable) and the independent variables. A CI of 95% with a p-value of &amp;lt; 0.05 was statistically significant. Results Self-reported factors were as follows: forgetfulness (p = 0.0001), taking medication (p = 0.006), difficulty remembering to take medication (p = 0.001), worry about long-term intake of drugs (p = 0.0001), choice of high-fiber diet (p = 0.037), intake of processed or refined carbohydrate (p = 0.049) alcohol intake (p = 0.033), age (p = 0.015), occupation (p = 0.009), and patient waiting time (p = 0.020) were found to have contributed to medication/dietary nonadherence among the participants. Conclusion Patient adherence was low. Health authorities in the two selected hospitals should develop strategies to reduce the problem of poor adherence.

1112-P: Sustaining Show Rates in the Diabetes Clinic

1112-P: Sustaining Show Rates in the Diabetes Clinic

966-P: Diabetes Technology Outcomes in the Vulnerable Early Childhood Population at a Large Diabetes Clinic

966-P: Diabetes Technology Outcomes in the Vulnerable Early Childhood Population at a Large Diabetes Clinic

Outpatient Consultation of Diabetes and Cardiovascular Diseases Patients in Abuja Public Hospitals Based on Selected Indicators

AIM. Diabetes and cardiovascular diseases are among the reasons for most outpatient consultations. The study aimed to evaluate the reported experiences of patients being managed for diabetes and cardiovascular diseases in the outpatient clinics of Abuja public hospitals. METHOD. A prospective cross-sectional study of 787 systematically sampled patients receiving care in five public hospitals in Abuja was conducted. A structured questionnaire was used to collect data on the number of yearly consultations, problems encountered in accessing trained health personnel, time spent on hospital appointments, major treatment challenges, and ways to improve their experience on hospital visits. Consultation experience was defined as good or poor. Patients who consulted at least four times in a year, reported no problems in accessing trained health personnel, and had no treatment challenges were regarded as having a good consultation experience. Frequency, percentage, mean, and standard deviation were used to summarize the data. Logistic regression was used to predict and classify the binary outcomes. A p-value ≤ 0.05 was considered significant. RESULTS. More of the patients (66.2%) had up to four consultations in a year. Long waiting time (56.1%) was the common problem encountered when accessing trained medical personnel. The major treatment challenge was hospital waiting time (49.4%). The mean time spent in the hospital on appointment days was 5.04±1.80. Approximately 40% of the patients suggested proper scheduling of hospital appointments as the major way to improve treatment experiences. Poor consultation was recorded by 96.6% of the patients. Logistic regression showed that a higher educational level (OR = 0.031, 95% CI [0.008-0.119], _P=_0.001) was associated with reporting poor management. CONCLUSION. The average number of yearly consultations was below the minimum standard, and patients spent long hours on consultation days before meeting with healthcare personnel. Most patients were dissatisfied with the services received and rated them poor.

Control of cardiometabolic risk factors and their association with carotid intima media thickness among patients with type 2 diabetes mellitus-single center experience in a developing country.

Type 2 diabetes mellitus (T2DM) is closely associated with atherosclerotic cardiovascular diseases (ASCVD). The objective of this study was to describe the degree of ASCVD risk factor control and their association with carotid intima-media thickness (CIMT) in T2DM patients followed up at a diabetes clinic in Southern, Sri Lanka. A crosssectional study was conducted to examine the association between CIMT and nonalcoholic fatty liver disease (NAFLD)in 300 T2DM patients. Both CIMT and its associations with modifiable cardiometabolic risk factors were examined using ultrasonography. The recommended optimal targets for risk factors were defined as glycated hemoglobin (HbA1C) < 7 %, absence of NAFLD, albumin-to-creatinine ratio (ACR) < 30 mg, triglyceride (TG) < 150 mg/dL, low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, high-density lipoprotein cholesterol (HDL-C) in men > 40 and in women > 50 mg/dL, systolic blood pressure (SBP) < 130 mmHg, and diastolic blood pressure (DBP) < 80 mmHg. SBP, DBP, LDL-C, TG, HDL-C, HbA1C, and ACR were optimally controlled in 59.3%, 75.0%, 46.7%, 84.3%, 46.0%, 33.0%, and 18.7% of patients, respectively. Notably, nearly half of the study subjects did not have NAFLD. Only three patients (1%) had achieved all therapeutic targets. There were statistically significant differences in CIMT between optimally controlled TG and suboptimally controlled TG group (p = 0.027) and between the groups with and without NAFLD (p = 0.045) when adjusted for age and duration of diabetes. CIMT showed significant and positive associations with LDL-C (p = 0.024), TG (p = 0.026), and NAFLD (p = 0.005). Among these, the presence of NAFLD had the highest odds of having higher CIMT when compared to LDL-C and TG. The majority of patients have not achieved the recommended targets for ASCVD risk factors and are at high risk of ASCVD. It is therefore necessary to identify the reasons for not achieving the treatment targets in order to reduce the ASCVD burden by controlling LDL-C, TG, and NAFLD.

Treatment intensification following glucagon-like peptide-1 receptor agonists in type 2 diabetes: Comparative effectiveness analyses between different basal insulins. RESTORE-G real-world study.

To compare the effectiveness of different basal insulins (BI) prescribed as an add-on to or switch from glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy. Retrospective, real-world data from electronic medical records of 32 Italian diabetes clinics were used, after propensity score adjustment, to compare effectiveness after 6 months of treatment with second- versus first-generation BI (2BI vs. 1BI) or glargine 300 U/ml versus degludec 100 U/ml (Gla-300 vs. Deg-100), when added to (ADD-ON) or in substitution of (SWITCH) GLP-1 RA. Only comparisons, including a minimum of 100 patients per group, were performed to ensure adequate robustness of the analyses. In the ADD-ON cohort (N = 700), greater benefits of 2BI versus 1BI were found in glycated haemoglobin {HbA1c; estimated mean difference: -0.32% [95% confidence interval (CI) -0.62; -0.02]; p = .04} and fasting blood glucose [FBG; -20.73 mg/dl (95% CI -35.62; -5.84); p = .007]. In the SWITCH cohort (N = 2097), greater benefits of 2BI versus 1BI were found in HbA1c [-0.22% (95% CI -0.42; -0.02); p = .03], FBG [-10.15 mg/dl (95% CI -19.04; -1.26); p = .03], and body weight [-0.67 kg (95% CI -1.30; -0.04); p = .04]. In the SWITCH cohort starting 2BI (N = 688), marked differences in favour of Gla-300 versus Deg-100 were documented in HbA1c [-0.89% (95% CI -1.26; -0.52); p < .001] and FBG [-17.89 mg/dl (95% CI -32.45; -3.33); p = .02]. Using propensity score matching as a sensitivity analysis, the benefit on HbA1c was confirmed [-0.55% (95% CI -1.02; -0.08); p = .02]. BI titration was suboptimal in all examined cohorts. 2BI are a valuable option to intensify GLP-1 RA therapy. Switching to Gla-300 versus Deg-100 was associated with greater HbA1c improvement.

Risk Factors for Ten-Year Risk of Osteoporosis in Type 2 DM Patients Attending Tikur Anbessa Specialized Hospital Diabetic Center Cross-sectional Study

&amp;lt;i&amp;gt;Background&amp;lt;/i&amp;gt;: Type 2 diabetes mellitus (T2DM) is a major contributing factor to osteoporotic fractures via different mechanisms. This study assessed the ten-year risk of osteoporosis and associated factors for osteoporotic fractures in T2DM patients. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: Data from 175 type diabetes mellites (T2DM) patients over 40 years attending a diabetes clinic at Tikur Anbessa Specialized Hospital (TASH) were collected. Demographic information, diabetic complications, blood sugar levels, and other medical illnesses were collected by a structured questionnaire and from an electronic medical record system. The 10-year fracture risk assessment (FRAX) tool was used without bone mineral density (BMD) measurement. multivariate logistic regression was used to analyze factors associated with fragility fractures. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: Half the participants were female, with a median age of 60. Most were married, well-educated, and urban residents. The median duration of diabetes was 11 years. The median FRAX score indicated a moderate 10-year risk of hip fracture (≥3%) and a high risk of major osteoporotic fracture (≥20%). Overall, 30.9% of patients had a high 10-year risk of osteoporotic fracture. The majority (78.3%) had macrovascular complications, with neuropathy, retinopathy, and nephropathy being the common ones. Higher FBS, higher HbA1c, and the presence of macrovascular complications were significantly associated with a higher risk of fractures. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: This study found a high prevalence (30.9%) of a 10-year risk of osteoporotic fractures in T2 DM patients. Poor glycemic control (higher HbA1c and FBS) and the presence of macrovascular complications were significantly associated with an increased 10-year osteoporotic fracture risk.

Prevalence of Clinically Significant Liver Fibrosis as Measured by Transient Elastography due to Non-alcoholic Fatty Liver Disease in Indian Individuals with Type 2 Diabetes Mellitus.

There is high prevalence of non-alcoholic fatty liver disease in individuals with type 2 diabetes mellitus (T2D), and available evidence suggests higher prevalence of NASH and advanced stages of fibrosis among T2D. Data regarding prevalence of clinically significant liver fibrosis (CSLF) in individuals with T2D is scarce. We investigated the prevalence of transient elastography (TE)-proven CSLF among patients of T2D attending a diabetes clinic at a tertiary care center. A cross-sectional descriptive evaluation study of 603 consecutive adults with T2D was conducted to detect CSLF using TE. Steatosis was diagnosed using a controlled attenuation parameter >237 dB/m. The prevalence of CSLF was 22.7%, and the prevalence of steatosis was 58.9% in our study. A higher body mass index (BMI) (P = 0.001), aspartate aminotransferase (AST; P = 0.0001), alanine aminotransferase (ALT; P = 0.0001), and low platelets (P = 0.0001) were independent factors associated with CSLF. Elevated ALT and AST (≥40 units/L) levels were present in only 27.7% and 37.2% of individuals with CSLF, respectively. Twenty-six (4.31%) individuals had LSM > 13.0 kPa. CSLF is highly prevalent in T2D patients attending a diabetes clinic at a tertiary care center, and the majority of such individuals have normal transaminase levels. Higher BMI, AST, and ALT values and lower platelet counts are associated with liver fibrosis.

Competing Risks Model to Evaluate Dropout Dynamics Among the Type 1 Diabetes Patients Registered with the Changing Diabetes in Children (CDiC) Program

Understanding the survival dynamics of registered patients on a disease control program is a vital issue for the success of program objectives. Dropout of registered patients from such a program is a critical issue, hindering the effectiveness of the program. This study aimed to identify the risk factors of dropout of patients who were registered on the Changing Diabetes in Children (CDiC) program, taking a case of Uganda. Survival analysis was done by integrating competing risk of factors associated with attrition from the CDiC program. The data for the study was obtained from patients with type 1 diabetes mellitus (T1DM) registered during 2009-2018 at health units with specialized pediatric diabetes clinics from various regions in Uganda. The study considered follow-up data of 1132 children with T1DM. Our analysis revealed that the Body Mass Index (BMI) significantly influences dropout time, with patients classified as underweight showing higher hazards than those with normal BMI. Moreover, when considering competing risks, dropout hazards increased. Comparing the Cox model with the Fine and Gray model shows the latter exhibiting a smaller AIC value, which indicates its superiority in the time-to-dropout analysis. Thus, utilizing methods that integrate competing risks for CDiC dropout analysis is preferable and recommended for related studies. These findings provide actionable insights for enhancing CDiC program efficacy.

Effect of a multicomponent quality improvement strategy on sustained achievement of diabetes care goals and macrovascular and microvascular complications in South Asia at 6.5 years follow-up: Post hoc analyses of the CARRS randomized clinical trial.

Diabetes control is poor globally and leads to burdensome microvascular and macrovascular complications. We aimed to assess post hoc between-group differences in sustained risk factor control and macrovascular and microvascular endpoints at 6.5 years in the Center for cArdiovascular Risk Reduction in South Asia (CARRS) randomized trial. This parallel group individual randomized clinical trial was performed at 10 outpatient diabetes clinics in India and Pakistan from January 2011 through September 2019. A total of 1,146 patients with poorly controlled type 2 diabetes (HbA1c ≥8% and systolic BP ≥140 mm Hg and/or LDL-cholesterol ≥130 mg/dL) were randomized to a multicomponent quality improvement (QI) strategy (trained nonphysician care coordinator to facilitate care for patients and clinical decision support system for physicians) or usual care. At 2.5 years, compared to usual care, those receiving the QI strategy were significantly more likely to achieve multiple risk factor control. Six clinics continued, while 4 clinics discontinued implementing the QI strategy for an additional 4-year follow-up (overall median 6.5 years follow-up). In this post hoc analysis, using intention-to-treat, we examined between-group differences in multiple risk factor control (HbA1c <7% plus BP <130/80 mm Hg and/or LDL-cholesterol <100 mg/dL) and first macrovascular endpoints (nonfatal myocardial infarction, nonfatal stroke, death, revascularization [angioplasty or coronary artery bypass graft]), which were co-primary outcomes. We also examined secondary outcomes, namely, single risk factor control, first microvascular endpoints (retinopathy, nephropathy, neuropathy), and composite first macrovascular plus microvascular events (which also included amputation and all-cause mortality) by treatment group and whether QI strategy implementation was continued over 6.5 years. At 6.5 years, assessment data were available for 854 participants (74.5%; n = 417 [intervention]; n = 437 [usual care]). In terms of sociodemographic and clinical characteristics, participants in the intervention and usual care groups were similar and participants at sites that continued were no different to participants at sites that discontinued intervention implementation. Patients in the intervention arm were more likely to exhibit sustained multiple risk factor control than usual care (relative risk: 1.77; 95% confidence interval [CI], 1.45, 2.16), p < 0.001. Cumulatively, there were 233 (40.5%) first microvascular and macrovascular events in intervention and 274 (48.0%) in usual care patients (absolute risk reduction: 7.5% [95% CI: -13.2, -1.7], p = 0.01; hazard ratio [HR] = 0.72 [95% CI: 0.61, 0.86]), p < 0.001. Patients in the intervention arm experienced lower incidence of first microvascular endpoints (HR = 0.68 [95% CI: 0.56, 0.83), p < 0.001, but there was no evidence of between-group differences in first macrovascular events. Beneficial effects on microvascular and composite vascular outcomes were observed in sites that continued, but not sites that discontinued the intervention. In urban South Asian clinics, a multicomponent QI strategy led to sustained multiple risk factor control and between-group differences in microvascular, but not macrovascular, endpoints. Between-group reductions in vascular outcomes at 6.5 years were observed only at sites that continued the QI intervention, suggesting that practice change needs to be maintained for better population health of people with diabetes. ClinicalTrials.gov NCT01212328.

Estimating the Economic Burden of Type 2 Diabetes Among the Elderly in Tehran Province

Background: The prevalence of non-communicable diseases such as diabetes tends to rise with age, peaking among the elderly population. Objectives: This study aimed to estimate the economic burden of type 2 diabetes mellitus (T2DM) among the elderly in Tehran province. Methods: This research employs a descriptive-analytical approach, focusing on T2DM patients who attended the specialized diabetes clinic of Tehran province in 2019. A total of 1256 cases were included in the study. Data collection involved reviewing hospital records and accessing information from the accounting department. Data analysis was conducted using Excel software. Results: The economic burden of T2DM amounted to 432,471,301,510 Rials. Among this, 230,841,323,930 Rials (53.3%) were attributed to the costs of diagnosis and treatment, while 180,365,897,580 Rials (41.7%) were associated with treating disease complications. Additionally, 9,043,200,000 Rials (2%) accounted for non-medical direct costs (NMDC), and 12,220,880 Rials (0.3%) were attributed to NMDC due to complications. Conclusions: Given the substantial financial burden incurred by elderly T2DM patients and the constraints on healthcare resources, it is imperative to prioritize preventive and therapeutic measures for this demographic. Comprehensive efforts are needed to mitigate the costs and consequences of this disease within the healthcare system.

WED-278 MASLD assessment using a novel point of care device the Hepatoscope™ in diabetes and obesity clinics

WED-278 MASLD assessment using a novel point of care device the Hepatoscope™ in diabetes and obesity clinics

The impact of GLP-1 receptor agonist shortages on glycaemic Control: Findings from an Australian specialist diabetes clinic

There have been shortages of glucagon-like peptide-1 receptor agonists (GLP-1 RA) for type 2 diabetes (T2D) care. Analyses of data from 811 T2D adults at an Australian specialist diabetes clinic (1/2019–10/2023) who received ≥ 2 GLP-1 RA prescriptions before and during the shortage showed median HbA1c levels significantly increased by 0.3 %.

Oral Health-Related Knowledge, Attitudes, and Practices of Diabetic Patients in Tanzania

AimTo assess oral health-related knowledge, attitude, and practices (KAP) of patients with diabetes mellitus (DM) attending public diabetic clinics in Dar es Salaam, Tanzania. MethodologyThis study involved adult patients diagnosed with DM. A questionnaire with questions related to oral health KAP was used. Data analysis was done using SPSS software v26. Multivariate regression analysis was utilized for response analysis. An alpha of less than 0.05 was considered to indicate statistical significance. ResultsParticipants with good levels of KAP related to oral health comprised 51.0%, 82.3%, and 20.6%, respectively. The odds of good oral health knowledge among participants were almost 2 folds higher in participants with high education levels and 7 folds higher in those who had been referred to a dentist by a physician. Participants with good oral health knowledge had 5.5 times higher odds of having a good attitude. The participants with high education levels were almost 3 times more likely to have good practice. ConclusionAbout half of the patients with DM have good oral health-related knowledge. A majority have good compliance towards oral health, but only a limited number have good oral health-related practices. The level of education and previous referrals to dental professionals were found to be predictors of good knowledge regarding dental health.

Children and adolescents with type 1 diabetes in Aotearoa New Zealand: An online survey of workforce and outcomes 2021.

To survey the national workforce that manages children and adolescents with type 1 diabetes (T1D) in Aotearoa New Zealand and compare with glycaemic outcomes for 2021. A representative from each tertiary and regional diabetes service in Aotearoa New Zealand was asked to participate in an online survey assessing health-care professional (HCP) workforce numbers operating for the 2021 calendar year. Regional full-time-equivalent (FTE), glycaemic outcomes and population demographics were compared to a previously reported workforce surveys (2015 and 2019). Seventeen sites responded - including all four large tertiary centres - serving >99% of children and adolescents with T1D in Aotearoa New Zealand. HCP resourcing varied across sites, with median (range) HCP/100 patient ratios of: doctors: 0.40 (0.16-1.11), nurses: 1.19 (0.29-5.56), dietitians: 0.25 (0-1.11) and psychologist/social workers: 0 (0-0.26). No site met all of the International Society of Paediatric and Adolescent Diabetes (ISPAD) recommendations of HCP/100 patient ratios. Measures of socio-economic deprivation predicted HbA1c, rather than the diabetes clinic attended. Overall, only 15.1% (240/1585) of patients had an HbA1c less than the recommended 53 mmol/mol. The Aotearoa New Zealand workforce for children and adolescents with T1D is under-resourced and no site meets the ISPAD recommendations. There has been no significant increase in HCP/100 patient ratios compared to previous workforce surveys over the last decade. Few children and adolescents with T1D meet the recommended HbA1c. Resourcing according to recommended clinical need is required if equity in outcomes for young people with T1D is to be addressed.

Impact of Risk Stratification in Patients With Diabetes Mellitus in a Health System Specialty Pharmacy Setting

Background: Integrated pharmacist care into health systems results in significant A1c reduction and improved outcomes in patients with diabetes. However, little is known about the adoption of Health System Specialty Pharmacy (HSSP) chronic disease management (CDM) services within diabetes clinics. Risk stratification is proven to enhance care in various patient populations. Objective: The objective of this study is to describe how the implementation of risk stratification in the HSSP setting results in optimized patient outcomes in diabetes. Method: This is a retrospective descriptive study reporting the results of expanding the HSSP care model to implement risk stratified CDM services for patients with diabetes. A total of 285 patients were enrolled in the HSSP CDM pharmacy services and were stratified into high- or low-risk groups. Results: Eighty-eight patients were stratified as high-risk with an average baseline A1c of 11.47% and a most recent average of 8.84%. The remaining 285 patients were stratified into the low-risk group. Their average baseline A1c was 7.48% and the last recorded average A1c was 7.15%. Patients not enrolled in HSSP CDM services (N = 100) had a lower reduction in average A1c compared to patients enrolled in the program. Conclusion: Patients stratified into high- and low-risk groups had greater reductions in A1c compared to patients who did not use HSSP CDM services. These results showcase the success of risk stratification and demonstrate the impact HSSP has on patients needing CDM services and outlines a strategy to provide the greatest impact in a high-volume patient population.

Medication errors at a diabetes management center in a resource-poor setting.

Medication errors are known to cause adverse drug reactions, hospital admissions and mortality. In most resource-poor settings, medication errors occur but are undocumented. This study sought to investigate medication errors in a diabetic clinic at Komfo Anokye Teaching Hospital (KATH), Ghana. The research combined both qualitative and quantitative data collection methods. The quantitative aspect involved retrospectively reviewing patient folders over two years (1st January 2019 to 31st December 2021). Patients' folders were reviewed to identify possible medication errors. The qualitative arm explored underlying factors and experiences related to medication errors through interviews with healthcare workers. Ten healthcare professionals at KATH were interviewed using an interview guide. A total of 264 patients' folders were retrieved. The majority (23.11%) of the patients were between 18 and 25 y.o., and there were more females (52.27%) than males. About 60% of the patients had diabetes and hypertension comorbidity. The overall prevalence of medication errors was 18.18%. The most prevalent type of medication error identified was wrong drug formulation (n = 19, 39.58%). About 47.92% of the medication errors resulted in adverse events and this was predominantly caused by antidiabetic drugs (47.83%) and anti-hypertensive drugs (34.78%). Patients in the age category of 26-35 y.o. [aOR: 0.31, CI: 0.11-0.90] had reduced odds of medication errors whilst patients with comorbidity of diabetes and hypertension [aOR: 5.95, CI: 2.43-14.60] had an increased odds of medication errors. Large patient population, low staff numbers and inadequate knowledge of drugs by healthcare workers were factors that contributed to medication errors. Medication errors was moderately high in this diabetic clinic, and the errors led to a number of adverse events. Age, diabetes and hypertension comorbidity, large patient population, low staff numbers, and inadequate knowledge about drugs were identified as factors that influenced medication errors.