Diabetes Consultations Research Articles

Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings

BackgroundYoung people with diabetes experience poor clinical and psychosocial outcomes, and consider the health service ill-equipped in meeting their needs. Improvements, including alternative consulting approaches, are required to improve care quality and patient engagement. We examined how group-based, outpatient diabetes consultations might be delivered to support young people (16–25 years old) in socio-economically deprived, ethnically diverse settings.MethodsThis multi-method, comparative study recruited a total of 135 young people with diabetes across two implementation and two comparison sites (2017–2019). Informed by a ‘researcher-in-residence’ approach and complexity theory, we used a combination of methods: (a) 31 qualitative interviews with young people and staff and ethnographic observation in group and individual clinics, (b) quantitative analysis of sociodemographic, clinical, service use, and patient enablement data, and (c) micro-costing analysis.ResultsImplementation sites delivered 29 group consultations in total. Overall mean attendance per session was low, but a core group of young people attended repeatedly. They reported feeling better understood and supported, gaining new learning from peers and clinicians, and being better prepared to normalise diabetes self-care. Yet, there were also instances where peer comparison proved difficult to manage. Group consultations challenged deeply embedded ways of thinking about care provision and required staff to work flexibly to achieve local tailoring, sustain continuity, and safely manage complex interdependencies with other care processes. Set-up and delivery were time-consuming and required in-depth clinical and relational knowledge of patients. Facilitation by an experienced youth worker was instrumental. There was indication that economic value could derive from preventing at least one unscheduled consultation annually.ConclusionsGroup consulting can provide added value when tailored to meet local needs rather than following standardised approaches. This study illustrates the importance of adaptive capability and self-organisation when integrating new models of care, with young people as active partners in shaping service provision.Trial registrationISRCTN reference 27989430.

PSUN218 The Impact of Mandatory Pre-Operative Endocrinology Outpatient Consultation Before Elective Surgery in Patients with Diabetes Mellitus

Abstract Introduction A multi-departmental quality improvement initiative by endocrinology, internal medicine, surgery, and anesthesia became effective, making it the standard of care to call for an outpatient endocrinology consult for diabetic patients undergoing elective surgery in our hospital. Aim We tested our hypothesis that mandatory endocrinology consults prior to elective surgery decreases negative outcome parameters in patients with poorly controlled diabetes. Material and Method: Patients with diabetes mellitus (T2DM) who had an HbA1C 8% and above and who were planned to have elective surgery were seen by Endocrinology Service as an outpatient before the surgery date and were cleared until fasting glucose is less than 200 mg/dl or HbA1c is less than 8%. Retrospective analysis of 64 inpatient elective T2DM surgical patients, with no endocrine consults from 09/2019-12/2019 (Group I), comparing with 51 inpatient elective T2DM surgical patients from 09/2020-12/2020, with endocrine consults prior to surgery (Group II). Exclusion criteria: Emergency surgical patients and patients who received endocrine consults prior to surgery from September – December 2019. Primary outcome measure: Average capillary glucose, length of stay (LOS), the number of patients with hypoglycemic episodes (<70 mg/dl), hypoglycemia rate (number of glucose readings less than 70 mg/dl/the total number of capillary glucose measurements), readmission rate and infection rate. Mainly non-parametric statistical tests were utilized. Results There were 64 patients without endocrinology consult in 2019 (Group I) and 51 patients with endocrinology consult in 2020 (Group II). Although it was a mandatory policy, only 11 out of 51 patients were consulted to endocrinology. There was no difference in baseline characteristics of age, gender, average HbA1c, and type of surgery between the two groups. Average glucose during hospital stay, the number of patients who had hypoglycemia (13% versus 6%), average LOS, readmission within 30 days and postoperative infection rate were not statistically different between Group I and II. In Group I hypoglycemic events were 2% of all the capillary glucose measurements performed (17 hypoglycemia out of 852) and in Group II hypoglycemic events were %0.5 (3 out of 653) of all the capillary glucose measurements performed during surgical admission (p<0.05). The number of hypoglycemic events were lower with preoperative endocrine consults. Limitations of this study include fewer elective surgeries in 2020 due to Covid-19. Conclusion The number of hypoglycemic events were lower in patients with diabetes and preoperative mandatory endocrinology consultation. There was no difference in average glucose, LOS, the number of subjects with hypoglycemia, readmission or infection rate. The study should be repeated after more education about mandatory preoperative endocrinology consults to surgeons is delivered and after the COVID pandemic is over, when there are no restrictions on elective surgery. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Remote consultations for diabetes care in a post COVID-19 world.

Remote consultations for diabetes care in a post COVID-19 world.

Developing and pilot testing an oral health screening tool for diabetes care providers

BackgroundPeople with poorly managed diabetes are at greater risk of periodontal disease. Periodontal disease that is not effectively managed can affect glycaemic levels. Diabetes care providers, including general practitioners and diabetes educators, are encouraged to promote oral health of their clients. However, valid and reliable oral health screening tools that assess the risk of poor oral health, that are easy to administer among non-dental professionals, currently do not exist. Existing screening tools are difficult to incorporate into routine diabetes consultations due to their length. Thus, this study aimed to develop and pilot a short oral health screening tool that would identify risk of existing oral diseases and encourage appropriate referrals to the dental service.MethodsA three-item screening tool was developed after a comprehensive review of the literature and consensus from an expert panel. The tool was then piloted as part of a larger cross-sectional survey of 260 adults with diabetes who were accessing public diabetes clinics at two locations in Sydney, Australia. As part of the survey, participants completed the three-item screening tool and a 14-item validated tool, the Oral Health Impact Profile (OHIP-14), which has been used previously in the preliminary validation of screening tools. Sensitivity and specificity analyses were then undertaken comparing the results of the two tools.ResultsA statistically significant correlation was found between the shorter screening tool and the OHIP-14 (rho = 0.453, p < 0.001), indicating adequate validity. The three-item tool had high sensitivity (90.5%, 95% CI 84.9%, 94.7%), with a specificity of 46.3% (95% CI 37.7%, 55.2%). The negative predictive value was 81.4% (95% CI 71.3, 89.3). No single item performed as well regarding sensitivity and negative predictive value when compared to the three items collectively.ConclusionsThe three-item screening tool developed was found to be valid and sensitive in identifying risk of poor oral health, requiring oral health referrals, among people with diabetes in this pilot. This is a simple, accessible tool that diabetes care providers could incorporate into their routine consultations. Further validation against comprehensive dental assessments is needed to reassess the tool’s specificity and sensitivity in diverse settings.

Assessing and addressing diabetes distress among adults with type 2 diabetes: An online survey of Australian general practitioners

AimDiabetes distress is experienced by up to 36% of adults with type 2 diabetes. Australian type 2 diabetes guidelines recommend annual assessment of diabetes distress in general practice. This study explores general practitioners' knowledge, current practice, and factors influencing implementation of guidelines, including Person Reported Outcome Measure (PROM) use. MethodsA cross-sectional online survey was disseminated via e-mail to 4776 Australian general practitioners listed on the Australasian Medical Publishing Company database. Results264 (5%) surveys were returned. 75% indicated that general practitioners were the most appropriate professionals to assess diabetes distress. Sixteen percent reported asking about diabetes distress during type 2 diabetes consultations more than half the time, with 13% using a PROM more than half the time: 64% use the Kessler-10, and 1.9% use the Problem Areas in Diabetes (PAID) scale. While general practitioners had positive beliefs about the consequences of assessing and addressing diabetes distress, they also reported barriers in motivation, environment, and knowledge of guidelines. ConclusionMost respondents endorsed general practitioners’ role in assessing diabetes distress, but few ask about or assess diabetes distress in routine consultations. To support uptake of guideline recommendations for diabetes-specific PROM use, environmental factors, specifically time, need to be addressed.

The road to recovery: an interrupted time series analysis of policy intervention to restore essential health services in Mexico during the COVID-19 pandemic.

BackgroundRecovery of health services disrupted by the COVID-19 pandemic represents a significant challenge in low- and middle-income countries. In April 2021, the Mexican Institute of Social Security (IMSS), which provides health care to 68.5 million people, launched the National Strategy for Health Services Recovery (Recovery policy). The study objective was to evaluate whether the Recovery policy addressed COVID-related declines in maternal, child health, and non-communicable diseases (NCDs) services.MethodsWe analysed the data of 35 IMSS delegations from January 2019 to November 2021 on contraceptive visits, antenatal care consultations, deliveries, caesarean sections, sick children’s consultations, child vaccination, breast and cervical cancer screening, diabetes and hypertension consultations, and control. We focused on the period before (April 2020 – March 2021) and during (April 2021 – November 2021) the Recovery policy and used an interrupted time series design and Poisson Generalized Estimating Equation models to estimate the association of this policy with service use and outcomes and change in their trends.ResultsDespite the third wave of the pandemic in 2021, service utilization increased in the Recovery period, reaching (at minimum) 49% of pre-pandemic levels for sick children’s consultations and (at maximum) 106% of pre-pandemic levels for breast cancer screenings. Evidence for the Recovery policy role was mixed: the policy was associated with increased facility deliveries (IRR = 1.15, 95%CI = 1.11-1.19) with a growing trend over time (IRR = 1.04, 95%CI = 1.03-1.05); antenatal care and child health services saw strong level effects but decrease over time. Additionally, the Recovery policy was associated with diabetes and hypertension control. Services recovery varied across delegations.ConclusionsHealth service utilization and NCDs control demonstrated important gains in 2021, but evidence suggests the policy had inconsistent effects across services and decreasing impact over time. Further efforts to strengthen essential health services and ensure consistent recovery across delegations are warranted.

Investigation of the potential association between the levels of global DNA methylation, vitamin B12 and type 2 diabetes in Iraqi patients

Type 2 diabetes mellitus (T2DM) is an epidemic metabolic disorder that has life threatening health complications if left undetected and untreated. Understanding its molecular landscape alterations, especially DNA methylation that regulates the genome transcription activity, would aid with the prevention and management of this disease. This study was set to investigate the global DNA methylations (assessed by measuring 5mC level), along with other disease-related clinical features, including body mass index (BMI) and serum vitamin B12, in T2DM patients in comparison to healthy controls. One hundred subjects (70 T2DM patients and 30 healthy controls) who attended Baghdad Teaching Hospital/ Department of Consulting Clinic - Endocrinology and Diabetes Consultant and the National Diabetes Center, Al-Mustansiriyah University, Baghdad, Iraq. Global DNA methylation levels were assessed using Methyl flash ™ Global DNA methylation (5-mC) ELISA Easy Kits. The results showed significant increase (P=0.0018) in the 5mC level of T2DM patients in comparison to the healthy subjects (0.578±0.208 vs. 0.422±0.110, respectively).

Healthcare Utilization and Adherence to Treatment Recommendations among Children with Type 1 Diabetes in Poland during the COVID-19 Pandemic.

Type 1 diabetes mellitus (T1D) is, next to obesity and asthma, the most common chronic disease in children in Poland. The results of T1D treatment strongly depend on the patient’s compliance with therapeutic recommendations, which entails the use of necessary health services. Based on a retrospective analysis of the data on health services provided in 2016–2020 to over 15.5 thousand patients with T1D in Poland, we assessed the compliance of the actual model of treatment of T1D in children with the current guidelines. It was found that only about 50% of patients received the number of diabetes consultations corresponding to the recognized standards, with about 15% of children with T1D remaining outside the public healthcare system. In the case of many outpatient services (ophthalmological, neurological, mental health), the number of consultations was extremely low—one order of magnitude lower than in general population and dropped even lower in 2020. This shows that the health needs of children with T1D are not being met within the public healthcare system. The COVID-19 pandemic caused significant limitations in access to healthcare in Poland. Compared to the pre-pandemic period there was a significant decrease (−27% compared to 2019) in the number of hospitalizations, and a substantial increase (+22% compared to 2019) in the number of diabetic ketoacidoses (DKA) cases. The proportion of hospitalizations caused by DKA rose to 8.9% compared to 7.3% in 2019.

People with diabetes and ambulance staff perceptions of a booklet-based intervention for diabetic hypoglycaemia, \u201cHypos can strike twice\u201d: a mixed methods process evaluation

BackgroundHypoglycaemia is a potentially serious condition, characterised by lower-than-normal blood glucose levels, common in people with diabetes (PWD). It can be prevented and self-managed if expert support, such as education on lifestyle and treatment, is provided. Our aim was to conduct a process evaluation to investigate how ambulance staff and PWD perceived the “Hypos can strike twice” booklet-based ambulance clinician intervention, including acceptability, understandability, usefulness, positive or negative effects, and facilitators or barriers to implementation.MethodsWe used an explanatory sequential design with a self-administered questionnaire study followed by interviews of people with diabetes and ambulance staff. We followed the Medical Research Council framework for process evaluations of complex interventions to guide data collection and analysis. Following descriptive analysis (PWD and staff surveys), exploratory factor analysis was conducted to identify staff questionnaire subscales and multiple regression models were fitted to identify demographic predictors of overall and subscale scores.Results113 ambulance staff members and 46 PWD completed the survey. We conducted interviews with four ambulance staff members and five PWD who had been attended by an ambulance for a hypoglycaemic event. Based on surveys and interviews, there were positive attitudes to the intervention from both ambulance staff and PWD. Although the intervention was not always implemented, most staff members and PWD found the booklet informative, easy to read and to use or explain. PWD who completed the survey reported that receiving the booklet reminded and/or encouraged them to test their blood glucose more often, adjust their diet, and have a discussion/check up with their diabetes consultant. Interviewed PWD felt that the booklet intervention would be more valuable to less experienced patients or those who cannot manage their diabetes well. Overall, participants felt that the intervention could be beneficial, but were uncertain about whether it might help prevent a second hypoglycaemic event and/or reduce the number of repeat ambulance attendances.ConclusionsThe ‘Hypos may strike twice’ intervention, which had demonstrable reductions in repeat attendances, was found to be feasible, acceptable to PWD and staff, prompting reported behaviour change and help-seeking from primary care.Trial registrationRegistered with ClinicalTrials.gov: NCT04243200 on 27 January 2020.

Nurse’s contribution to the diabetes annual review and funded programmes in Auckland, New Zealand

AimsExamine trends in nurse’s contribution to diabetes funded programmes,estimate total nurse consultations, and document the division of diabetes care between doctors and nurses in general practice. MethodsAll primary health care nurses in Auckland were identified in 2006-8 and 2016 and 26% and 24% were randomly surveyed, achieving response rates of 86%and 73%, respectively. Participants completed a self-administered and telephone questionnaire detailing their contribution to diabetes funded programmes. ResultsIn response to more people with diabetes, significantly more nurses in 2016 consulted patients, provided follow-up care, completed Diabetes Annual Reviews independently of doctors (48%), accessed more educational resources (including theinternet) and 63% felt supported, compared with 27% and 55% of nurses respectively,in 2006-8. The main reason nurses surveyed did not participate in diabetes reviews was because designated nurses conducted them, with more reporting this in 2016 (55%) compared to 32% in 2006-8. Most nurses in the 2016 survey addressed cardiovascular risk such as blood pressure, smoking cessation, physical activity and nutrition during the review. ConclusionsNurses conducted more diabetes consultations and reviews, addressed cardiovascular risk in 2016 and reported increased support for participating in diabetes reviews within general practice, compared with nurses in 2006-8.

Association of personalised care plans with monitoring and control of clinical outcomes, prescription of medication and utilisation of primary care services in patients with type 2 diabetes: an observational real-world study

Objective To study the association of personalised care plans with monitoring and controlling clinical outcomes, prescription of cardiovascular and antihyperglycaemic medication and utilisation of primary care services in patients with type 2 diabetes (T2D). Patients Primary care T2D outpatients from the Rovaniemi Health Centre. Setting The municipal health centre, Rovaniemi, Finland. Design A cross-sectional, observational, retrospective register-based study. The patients were divided into three groups: ‘no care plan entries’ (usual care); ‘1–2 care plan entries’; and ‘3 or more care plan entries’. Main outcome measures Monitoring of clinical and biochemical measures, achievement of treatment targets, prescription of cardiovascular and antihyperglycemic medication, and use of primary care services. Results A total of 5104 patients with T2D (mean age 65.5 years (SD 12.4)), of which 67% had at least one care plan entry. Compared to usual care, the establishment of a care plan (either care plan group) was associated with better monitoring of glycosylated haemoglobin A1c, low-density-lipoprotein cholesterol, systolic blood pressure (sBP), and renal function, and there was more frequent prescription of all cardiovascular and antihyperglycemic medication. Patients in either care plan group were more likely to achieve sBP target (p < 0.05). Patients without a care plan had more unplanned primary care physician contacts compared to patients in care plan groups (p < 0.001). Conclusion Establishment of a care plan is associated with more intensive and focussed care of patients with T2D. The appropriate use of primary care resources is essential and personalised care plans may contribute to the treatment of patients with T2D. Key Points Care planning aims to empower patients with type 2 diabetes. This study demonstrates that personalised care planning is associated with more frequent monitoring for clinical outcomes, more frequent prescription of cardiovascular and antihyperglycemic medication and more frequent utilisation of planned diabetes consultations when compared to usual care.

A Solution Focused Approach of Delivering Virtual Paediatric Diabetes Consultations During the COVID-19 Pandemic.

The onset of the COVID-19 global pandemic rapidly accelerated the use of virtual consultations into everyday practice. A solution focused approach (SFA) has been established in paediatric diabetes care, resulting in positive clinical outcomes and communication. The aim of this study was to assess feedback from paediatric diabetes patients and their parents or carers regarding virtual consultations, using a solution focused approach, in a hospital setting. An electronic survey was sent to patients following their virtual consultation. Of those surveyed, 86% recommended video consultations to be part of their diabetes care. Qualitative data showed reduced travel time, comfort, reduced need for parking and convenience as the highest areas improved through video consultations. Clinical care was shown to be positive and addressed patients concerns, the majority of respondents (84%) reported that the appointment was about what they wanted it to be about. Using the solution focused model helped overcome the challenges faced with virtual consultations particularly with concerns surrounding safeguarding issues, confidentiality, audio/video difficulties and also helped to support the patient journey.

User Behaviors and User-Generated Content in Chinese Online Health Communities: Comparative Study.

BackgroundOnline health communities (OHCs) have increasingly gained traction with patients, caregivers, and supporters globally. Chinese OHCs are no exception. However, user-generated content (UGC) and the associated user behaviors in Chinese OHCs are largely underexplored and rarely analyzed systematically, forfeiting valuable opportunities for optimizing treatment design and care delivery with insights gained from OHCs.ObjectiveThis study aimed to reveal both the shared and distinct characteristics of 2 popular OHCs in China by systematically and comprehensively analyzing their UGC and the associated user behaviors.MethodsWe concentrated on studying the lung cancer forum (LCF) and breast cancer forum (BCF) on Mijian, and the diabetes consultation forum (DCF) on Sweet Home, because of the importance of the 3 diseases among Chinese patients and their prevalence on Chinese OHCs in general. Our analysis explored the key user activities, small-world effect, and scale-free characteristics of each social network. We examined the UGC of these forums comprehensively and adopted the weighted knowledge network technique to discover salient topics and latent relations among these topics on each forum. Finally, we discussed the public health implications of our analysis findings.ResultsOur analysis showed that the number of reads per thread on each forum followed gamma distribution (HL=0, HB=0, and HD=0); the number of replies on each forum followed exponential distribution (adjusted RL2=0.946, adjusted RB2=0.958, and adjusted RD2=0.971); and the number of threads a user is involved with (adjusted RL2=0.978, adjusted RB2=0.964, and adjusted RD2=0.970), the number of followers of a user (adjusted RL2=0.989, adjusted RB2=0.962, and adjusted RD2=0.990), and a user’s degrees (adjusted RL2=0.997, adjusted RB2=0.994, and adjusted RD2=0.968) all followed power-law distribution. The study further revealed that users are generally more active during weekdays, as commonly witnessed in all 3 forums. In particular, the LCF and DCF exhibited high temporal similarity (ρ=0.927; P<.001) in terms of the relative thread posting frequencies during each hour of the day. Besides, the study showed that all 3 forums exhibited the small-world effect (mean σL=517.15, mean σB=275.23, and mean σD=525.18) and scale-free characteristics, while the global clustering coefficients were lower than those of counterpart international OHCs. The study also discovered several hot topics commonly shared among the 3 disease forums, such as disease treatment, disease examination, and diagnosis. In particular, the study found that after the outbreak of COVID-19, users on the LCF and BCF were much more likely to bring up COVID-19–related issues while discussing their medical issues.ConclusionsUGC and related online user behaviors in Chinese OHCs can be leveraged as important sources of information to gain insights regarding individual and population health conditions. Effective and timely mining and utilization of such content can continuously provide valuable firsthand clues for enhancing the situational awareness of health providers and policymakers.

A real-world approach of delivering virtual paediatric diabetes consultations during the COVID-19 pandemic

A real-world approach of delivering virtual paediatric diabetes consultations during the COVID-19 pandemic

Postpartum opportunistic advice in primary care for women who have had gestational diabetes: a qualitative study of health care professionals\u2019 views

BackgroundWomen who have had gestational diabetes during pregnancy are at very high risk of developing type 2 diabetes later in life, but their understanding of the risks is often limited. In this study we explored the views of health care professionals regarding offering brief opportunistic advice to women after their pregnancy, during unrelated consultations in primary care, relating to reducing diabetes risk.MethodsThe study took place in three Health Boards in Scotland. We conducted semi-structured one-to-one interviews (either face-to-face or telephone) with two health visitors, three practice nurses, two GPs, two diabetes consultants and two obstetricians. A focus group with five health visitors was also held. A topic guide was followed, covering the feasibility and acceptability of delivering brief opportunistic advice during a routine consultation, the optimal way to identify and recall women with previous gestational diabetes, and the possible content and timing of any such intervention. A thematic approach was used to analyse the qualitative data generated.ResultsThe interviews/discussion lasted from 15 to 51 min. There was widespread support from all participants for offering opportunistic advice, and general consensus that health visitors would be best placed to do this as part of the Universal Health Visiting Pathway in Scotland. Thematic analysis generated three significant points of discussion: implications for training of health visitors, the need for a systematic approach to identifying women with gestational diabetes, and the optimal timing of delivery. Despite an already demanding schedule of providing advice and education to women, health visitors were confident that they could offer educational advice, provided that they received appropriate training to do so. However, there would need to be a watertight system for identifying women in their care who had had gestational diabetes. In terms of timing, later visits around 6–8 months after delivery were considered most suitable.ConclusionsThere is support from health care professionals, and most pertinently from health visitors, that the frequency of routine visits with women during the Universal Health Visiting Pathway programme in Scotland provides potential opportunities for education around future diabetes risk to women who have had gestational diabetes.

Disruption in essential health services in Mexico during COVID-19: an interrupted time series analysis of health information system data

IntroductionThe COVID-19 pandemic has disrupted health systems around the world. The objectives of this study are to estimate the overall effect of the pandemic on essential health service use and...

Abstract #1042704: Effectiveness of Teleconsultations Across Middle East And Africa (MENA) and India In T2DM To Deliver Continuity of Care During The COVID-19 Pandemic

The COVID-19 pandemic has accelerated growth and acceptance of telemedicine services. We evaluated 110 patients across the SugarDoctor database who were already registered before the pandemic and were provided the teleconsultations during COVID-19 pandemic. The teleconsultations were distinctively structured to not just the reactively address the medical issues but also were structured to proactively deliver E health education over the online platform. There was a significant reduction in HbA1c from the mean baseline 9.5% (±1.7, 95% CI 9-10) to 8.6% (±2.5, 95% CI 7.9 to 9.3) (reduction of 0.9%, p = 0.0393). The overall time span in the HbA1c evaluation was 2.9 years (±1.3, 95% CI 2.5 to 3.3). 27 patients were from Mumbai and rest were from MENA, with majority of patients from Saudi Arabia. Varied issues were addressed ranging from HbA1c follow up to providing advise for management of diabetic foot ulcers.The patients expressed satisfaction over the virtual connect for the undivided attention that was provided, with reliable internet connectivity. The new eyeball connect based, remote digital diabetes consultation model has potential to improve glycemic care, which appears to have improvement in the overall quality of life and in long term would mitigate complications due to T2DM. We attribute the impact of teleconsultations for the efficient delivery of diabetes care for the past efforts during the earlier face to face consultations to drive the importance of self-management of diabetes. The role of telehealth in T2DM has expanded dramatically during the coronavirus pandemic and would remain a major practical health care delivery modality going forward.

Conversations of opportunity in diabetes care

Anne Phillips explores the ways in which diabetes consultations can be maximised to deliver the best effects for people living with diabetes and health professionals involved in their care Changes to diabetes care due to the COVID-19 pandemic have caused extra pressures for both people living with diabetes and the health professionals involved in their care. Virtual and remote consulting has caused many health professionals to experience stress and usual face-to-face conversations with people living with diabetes have changed in context, frequency and delivery. The nuances of non-verbal communication can be lost in virtual consultations, so it is vitally important that health professionals are aware of this and consider how to deliver consultation conversations to the best effect. It is imperative that every contact counts and every virtual and face-to-face consultation has meaning for the person living with diabetes to maximise the benefit for the individual and their circumstances.

Use of patient-reported outcome measures (PROMs) in clinical diabetes consultations: the DiaPROM randomised controlled pilot trial

ObjectiveTo pilot test the proposed DiaPROM trial components and address uncertainties associated with conducting a full-scale randomised controlled trial (RCT) to evaluate whether such a trial is feasible.DesignTwo-arm pilot RCT.ParticipantsAdults...

Identifying sustainable lifestyle strategies for maintaining good glycemic control: a validation of qualitative findings

IntroductionDiabetes self-care practices are less effective outside of controlled research settings, and almost half of patients do not achieve good glycemic control. Qualitative studies suggest some lifestyle strategies may be...