Diabetes Guidelines Research Articles

138-LB: Improving Type 2 Diabetes Medication Prescribing

Background: For people with type 2 diabetes, implementing best practice guidelines for diabetes and cardiovascular comorbidities is important to reduce the risks of complications. Two adult medical clinics used population health EMR data reports to increase medication prescribing for statins, ACE & ARB, SGLT2 & GLP-1. Methods: The clinics tracked measures and used data analytics to identify a cohort population and medication needs for 6241 patients. Table 1 reflects data from a one-year pilot. Patients with a diagnosis of type 2 diabetes, duration of disease for at least one year, ages 18-75, with at least one in-person or telehealth visit were included. Results: Three medication prescribing baselines were tracked to improve type 2 diabetes and heart disease management. Prescribing rates of SGLT2 and GLP1 increased by 2%, ACE-I and ARB use increased by 1% and statins rates remained at 73%. Conclusion: The clinics used data to identify the cohort and prescribe necessary medications. Partnering with clinical pharmacists helped to support patients, educate providers, and standardize medication prescribing workflows. Planning care so that the teams consistently identified appropriate medications for diabetes and cardiovascular disease management were clinical priorities. While the goal rate of medication prescribing has not been achieved yet, new reporting workflows are now incorporated, setting up the clinics for continued improvement. Disclosure N. Rioles: None. M. Desimone: None. E. J. Hess: None. C. V. Iwummadu: None. E. L. Ospelt: None. S. Rompicherla: None. M. Greenfield: None. S. Tsai: None. Funding Helmsley Charitable Trust

Development and validation of explicit criteria to identify potentially inappropriate prescribing for adults with type 2 diabetes mellitus.

Early detection and timely resolution of potentially inappropriate prescribing (PIP) prevents adverse outcomes and improves patient care. An explicit tool specifically designed to detect PIP among people with Type 2 Diabetes Mellitus (T2DM) has not been published. This study aims to develop and validate the Inappropriate Medication Prescribing Assessment Criteria for Type 2 Diabetes Mellitus (IMPACT2DM); an explicit tool that can be used to identify PIP for adults with T2DM. Current national and international guidelines for the management of T2DM and drug information software programs were used to generate potential items. The content of the IMPACT2DM was validated by 2 consecutive rounds of Delphi method. Physicians and clinical pharmacists experienced in providing care for people with diabetes and authors of selected diabetes guidelines were invited to participate in the Delphi panel. Consensus was assumed if 90% (first round) and 85% (second round) of expert panelists showed agreement to include or exclude an item. A total of 95 potential items were generated from selected diabetes guidelines and drug information software programs. After the first Delphi round 27 items had ≥90% agreement and were included in the tool; 19 items were considered not PIP and were excluded from the tool. The second round contained 49 items; of these 43 were included and 6 were excluded from the tool. The final IMPACT2DM contains 70 items categorized by type of PIP and arranged in terms of medical conditions and medication classes. IMPACT2DM can be applied using information on medical charts and requires minimal or no clinical knowledge to assess quality of diabetes care and improve medication selection. IMPACT2DM has been developed from current quality evidence and undergone content validation. It is the first explicit tool specifically designed to identify PIP for adults with T2DM.

Accessibility of community pharmacy services and the use of online pharmacies in rural areas in Estonia

Early detection and timely resolution of potentially inappropriate prescribing (PIP) prevents adverse outcomes and improves patient care. An explicit tool specifically designed to detect PIP among people with Type 2 Diabetes Mellitus (T2DM) has not been published.This study aims to develop and validate the Inappropriate Medication Prescribing Assessment Criteria for Type 2 Diabetes Mellitus (IMPACT2DM); an explicit tool that can be used to identify PIP for adults with T2DM.Current national and international guidelines for the management of T2DM and drug information software programs were used to generate potential items. The content of the IMPACT2DM was validated by 2 consecutive rounds of Delphi method. Physicians and clinical pharmacists experienced in providing care for people with diabetes and authors of selected diabetes guidelines were invited to participate in the Delphi panel. Consensus was assumed if 90% (first round) and 85% (second round) of expert panelists showed agreement to include or exclude an item.A total of 95 potential items were generated from selected diabetes guidelines and drug information software programs. After the first Delphi round 27 items had ≥90% agreement and were included in the tool; 19 items were considered not PIP and were excluded from the tool. The second round contained 49 items; of these 43 were included and 6 were excluded from the tool. The final IMPACT2DM contains 70 items categorized by type of PIP and arranged in terms of medical conditions and medication classes. IMPACT2DM can be applied using information on medical charts and requires minimal or no clinical knowledge to assess quality of diabetes care and improve medication selection.IMPACT2DM has been developed from current quality evidence and undergone content validation. It is the first explicit tool specifically designed to identify PIP for adults with T2DM.

Reversal and Remission of T2DM - An Update for Practitioners.

Over the past 50 years, many countries around the world have faced an unchecked pandemic of obesity and type 2 diabetes (T2DM). As best practice treatment of T2DM has done very little to check its growth, the pandemic of diabesity now threatens to make health-care systems economically more difficult for governments and individuals to manage within their budgets. The conventional view has been that T2DM is irreversible and progressive. However, in 2016, the World Health Organization (WHO) global report on diabetes added for the first time a section on diabetes reversal and acknowledged that it could be achieved through a number of therapeutic approaches. Many studies indicate that diabetes reversal, and possibly even long-term remission, is achievable, belying the conventional view. However, T2DM reversal is not yet a standardized area of practice and some questions remain about long-term outcomes. Diabetes reversal through diet is not articulated or discussed as a first-line target (or even goal) of treatment by any internationally recognized guidelines, which are mostly silent on the topic beyond encouraging lifestyle interventions in general. This review paper examines all the sustainable, practical, and scalable approaches to T2DM reversal, highlighting the evidence base, and serves as an interim update for practitioners looking to fill the practical knowledge gap on this topic in conventional diabetes guidelines.

Heterogeneity among countries in primary cardiovascular prevention guidelines: missed opportunities for adherence and improved outcomes

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Bayer AG Background · Specialty-driven guidelines identify risk factors for cardiovascular (CV) events that may potentially be modified by lifestyle or pharmacotherapy. Purpose · Worldwide, the control of modifiable risk factors in people at high cardiovascular disease (CVD) risk remains poor. Our hypothesis is that differences in multiple, specialty-driven guidelines do not help, and may hinder, the accurate assessment of CV risk factors and their appropriate management in the individual patient that has multiple risk factors or comorbidities. Methods · We conducted a review of the most recent guidelines for CVD prevention, diabetes, hypertension, dyslipidaemia and chronic kidney disease used in Europe, Italy, the USA, China and South Korea to establish the commonalities and differences between risk factor targets, risk modifiers and treatment approaches. Results · The use of low dose aspirin in patients at high risk of CVD varies between regions, and between those with and without type 2 diabetes (T2D). In addition, the use of concomitant proton pump inhibitor (PPI) treatment, that may reduce the gastrointestinal bleeding risk and therefore allow more people to be included for low dose aspirin treatment consideration, is variable (see table). · There are also differences in the definitions of risk stratification, targets for major risk factors and the use of coronary artery calcium score (CAC) to identify high-risk, asymptomatic patients. · The LDL-C targets for patients with T2D at high CV risk vary from <1.8 mmol/L (<70 mg/dL)1,2,10 to <2.6 mmol/L (<100mg/dL);9 and those for patients with T2D at very high CV risk vary from <1.4 mmol/L (<55 mg/dL)1,2 to <1.8 mmol/L (<70 mg/dL).9 · Although CAC score is identified as a risk modifier in most guidelines, its use to guide treatment decisions in patients with ≥7.5% to <20% 10-year ASCVD risk is recommended in only two guidelines.4,6 Conclusion(s) · We suggest that physicians cannot synthesise specialty-based recommendations for a single patient with multiple comorbidities within a limited consultation time, and that this may be a major factor in the lack of progress in managing CV risk factors. · A more unified, consistent and global approach to primary prevention of CV disease across specialties may lead to greater guideline adherence, greater patient understanding and acceptance of therapy, and improved outcomes.

Epidemiologic Characteristics of Children with Diabetic Ketoacidosis Treated in a Pediatric Intensive Care Unit in a 10-Year-Period: Single Centre Experience in Croatia.

Background and Objectives: The incidence of severe and moderate forms of DKA as the initial presentation of type 1 diabetes mellitus (T1D) is increasing, especially during the COVID-19 pandemic. This poses a higher risk of developing cerebral edema as a complication of diabetic ketoacidosis (DKA), as well as morbidity and mortality rates. The aim of this study was to determine the trend and clinical features of children treated in the last 10 years in the Pediatric Intensive Care Unit (PICU) due to the development of DKA. Materials and Methods: This retrospective study was performed in the PICU, Clinical Hospital Centre Rijeka, in Croatia. All children diagnosed with DKA from 2011–2020 were included in this study. Data were received from hospital medical documentation and patient paper history. The number of new cases and severity of DKA were identified and classified using recent International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines. Results: In this investigation period, 194 children with newly diagnosed T1D were admitted to our hospital: 58 of them were treated in the PICU due to DKA; 48 had newly diagnosed T1D (48/58); and ten previously diagnosed T1D (10/58). DKA as the initial presentation of T1D was diagnosed in 24.7% (48/194). Moderate or severe dehydration was present in 76% of the children at hospital admission. Polyuria, polydipsia, and Kussmaul breathing were the most common signs. Three patients (5.2%) developed cerebral edema, of whom one died. Conclusions: During the investigation period a rising trend in T1D was noted, especially in 2020. About one quarter of children with T1D presented with DKA at initial diagnosis in western Croatia, most of them with a severe form. Good education of the general population, along with the patients and families of children with diabetes, is crucial to prevent the development of DKA and thus reduce severe complications.

Nutrition and diabetes self-management in aged care: Exploring community-dwelling older adults' expectations.

To explore the diabetes self-management expectations of older adults with diabetes, not yet accessing residential aged care services. Admission to residential aged care (RAC) can create many interruptions to usual food choices and diabetes self-management, and we know little about the concerns of the emerging ageing population. This is a qualitative study employing focus groups and inductive thematic analysis involving 18 older adults with diabetes between the ages of 60 and 88, living in their own homes within an Australian city. Focus groups were recruited on a sequential basis and progressively analysed using an inductive process until data saturation was reached. Focus groups were digitally recorded and transcribed verbatim for thematic analysis. Three key themes were generated: autonomy, individualised dietary management and the food service system. Older adults speculated that they would want a collaborative approach to maintain their health in ageing and to self-manage their diabetes while feasible. Participants wanted autonomy over food choices, flexible meal timings and quality meals. There was a significant anxiety that aged care staff and existing food service systems in RAC could not support these preferences. Community-dwelling older adults with diabetes would highly value aged care services that facilitated autonomy, individualised nutrition support and flexibility, but feared this will not be feasible. The introduction of new diabetes and RAC guidelines may require an implementation plan to include the full food service system, from staff education to meal preparation, ordering and service.

New Diabetes Guidelines: Impact on Eligibility for Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-like Peptide-1 Receptor Agonists in Canada

ObjectivesRecent diabetes guidelines call for prescribing sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) for end-organ indications (cardiovascular disease [CVD], heart failure and chronic kidney disease) and for primary prevention of CVD in adults with multiple risk factors. Our aim was to assess the effect of new guidelines on the prevalence of SGLT2i/GLP-1RA–eligible adults, and their current rates of SGLT2i/GLP-1RA use. MethodsA cross-sectional study was conducted of Canadian adults (age ≥18 years) with diabetes on June 30, 2020, using electronic medical record data from primary care practices in 5 provinces (Alberta, Manitoba, Newfoundland, Ontario and Québec). Indications were determined from comorbidities, lab values and cardiovascular risk factors. ResultsEnd-organ indications were present in 34.1% of adults for SGLT2i and in 17.1% for GLP-1RA (CVD only). Rates of SGLT2i and GLP-1RA use were only 14.0% and 4.3%, respectively, in those with end-organ indications. The majority of these individuals had glycated hemoglobin ≤7.0%. The combination of end-organ and primary prevention indications increased eligibility for SGLT2i to 62.6%, and for GLP-1RA to 59.1%. ConclusionsThe implications of this sizeable reclassification of adults as SGLT2i/GLP-1RA indicated on health-care budgets and cost-effectiveness requires further study. In the meantime, targeted efforts are necessary to improve SGLT2i/GLP-1RA use in those with end-organ indications that have robust evidence of cardiovascular and kidney benefit from newer agents.

Effect of inadequate care on diabetes complications and healthcare resource utilization during management of type 2 diabetes in the United States

ABSTRACT Objective To estimate the effects of inadequate type 2 diabetes mellitus (T2D) care on health outcomes, utilizing a model that incorporates patient, physician, and health-system factors. Methods The most recently available (years 2016–2018) Medical Expenditure panel survey longitudinal data was used to identify adults with type 2 diabetes who had received inadequate diabetes care. American Diabetes Association Standards of Diabetes guidelines were used to define inadequate care, resulting in five categories: lifestyle management, immunization, pharmacologic therapy, physical examination, and laboratory evaluation. For each of the five categories, propensity score 1:1 matching was used to match individuals who received inadequate care to similar individuals who did not. After matching, cohorts were followed for one year. The cohorts were compared by total healthcare expenditure change from baseline, total emergency healthcare visits change from baseline, total newly developed diabetes-related complications, and total days absent from school or work change from baseline. Results 1,619 adults with T2D, representing 15,781,346 individuals met study inclusion criteria, of which 22.60%, 22.80%, 49.21%, 23,93%, and 23,45% received inadequate lifestyle management, immunizations, pharmacologic therapies, physical examinations, and laboratory tests, respectively. After propensity score matching, those who had received inadequate care had increased healthcare expenditure change from baseline and more new diabetes-related complications in the following year. After adjusting for residual covariate imbalance, those that had received inadequate pharmacologic therapies had approximately 0.20 increased instances of emergency healthcare utilization and 0.10 increase in new diabetes-related complications. Those that had received inadequate laboratory tests had 0.26 additional increased instances emergency healthcare utilization. Conclusion Inadequate T2D care is an extensive issue that may have substantial economic burden and may lead to increased diabetes-related complications. Those who did not receive medications or laboratory tests that were consistent with ADA guidelines had significantly increased emergency healthcare utilization in the following year. These findings highlight the importance of careful monitoring of T2D.

Adherence of physicians to evidence-based management guidelines for treating type 2 diabetes and atherosclerotic cardiovascular disease in Ajman, United Arab Emirates

BackgroundGood adherence by physicians to treatment guidelines for type II diabetes mellitus (T2DM) could improve therapy outcome for patients. In this retrospective, cross-sectional study, we assessed physicians’ adherence to evidence-based guidelines for T2DM management in adult patients (aged ≥18 years) with either confirmed atherosclerotic cardiovascular disease (ASCVD) or those at high risk of developing ASCVD at the Thumbay Academic Health Center, United Arab Emirates (UAE).MethodsRelevant data was obtained from patients’ medical records, assessed, and compared based on the 2018 diabetes guidelines of the American Diabetes Association and European Association for the Study of Diabetes.ResultsA total of 218 patients (186 males and 32 females) were included in the analysis. Of these, 122 were prescribed either sodium-glucose co-transporter-2(SGLT2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists and 34 were prescribed both. The overall adherence to the guidelines was 56%, which was significantly influenced by body mass index (BMI), hemoglobin A1c (HbA1c) levels, and estimated average glucose (eAG).ConclusionsAdherence to guidelines was significantly high when treating patients with elevated levels of HbA1c and eAG, suggesting that physicians are more likely to prescribe SGLT2 inhibitors or/and GLP-1 receptor agonists to such patients. Physicians’ adherence to guidelines was significantly correlated with patients’ BMI and the levels of HbA1c and eAG. To the best of our knowledge, this is the first study conducted on diabetes and its risk factors in UAE.

IDF21-0479 A machine-learning tool to assess CV risk in T2DM patients without established CVD: The MARK-2 analysis

Background: Cardiovascular risk assessment is the cornerstone for choosing the most appropriate antihyperglycemic agent according to most type 2 diabetes guidelines. However, amongst the plethora of risk scores available, only the QRISK 3 CV risk score is validated for T2DM. One of the major obstacles in the use of such scores is the time consumed in the process, which becomes a deterrent in a busy schedule. The QRISK 3 scoring requires 21 inputs to assess the 10-year CV risk. Aim: We performed the MARK survey assessing the utility of the QRISK 3 CV risk score in the Indian population (n=1,538) recruited from five zones (east, west, north, south, and central). The aim of the present analysis was to explore means of reducing the number of inputs to make the scoring faster and more acceptable for routine clinical use. Method: Machine learning techniques were used to analyse the existing MARK data. Preliminarily, the data was split into a training (80%) and a testing (20%) set. The XGBoost algorithm was used to create the model needed to identify the clinical parameters of interest. Twenty-nine iterations were required to identify the minimum log loss value between the training and testing data sets. With the model in place, dimension reduction techniques were employed to identify the clinical parameters of importance based on the gain values accrued. As a final step, a confusion matrix was created to assess the model accuracy and precision. Results: We could identify ten parameters of clinical interest capable of predicting the 10-year CV risk comparable with the QRISK 3 score (with 21 parameters). The parameters identified by ML were age, gender, BMI, smoking status, blood pressure, being treated with anti-hypertensive agents, angina, total cholesterol, total cholesterol/HDL ratio, and CKD. This dimension reduction was possible with a model accuracy of 95.12%. Discussion: One of the prime reasons for the cardiovascular risk assessment applications not becoming popular with the physicians is that they are extremely time consuming. The QRISK 3 CV risk assessment application is validated in T2DM. However, the physician needs to assess and enter 21 parameters to get the output. We have attempted to simplify the process by identifying parameters of similar predictive potential with the help of machine learning and prepare a risk assessment score with nearly half of the parameters required compared to QRISK 3. This analysis was successful in identifying ten clinical parameters with a 95.12% accuracy compared to the QRISK3 risk engine. We plan to incorporate these reduced entities into a simpler application capable of assisting physicians into rapid identification of CV risk.

Machine learning for diabetes clinical decision support: a review.

Type 2 diabetes has recently acquired the status of an epidemic silent killer, though it is non-communicable. There are two main reasons behind this perception of the disease. First, a gradual but exponential growth in the disease prevalence has been witnessed irrespective of age groups, geography or gender. Second, the disease dynamics are very complex in terms of multifactorial risks involved, initial asymptomatic period, different short-term and long-term complications posing serious health threat and related co-morbidities. Majority of its risk factors are lifestyle habits like physical inactivity, lack of exercise, high body mass index (BMI), poor diet, smoking except some inevitable ones like family history of diabetes, ethnic predisposition, ageing etc. Nowadays, machine learning (ML) is increasingly being applied for alleviation of diabetes health burden and many research works have been proposed in the literature to offer clinical decision support in different application areas as well. In this paper, we present a review of such efforts for the prevention and management of type 2 diabetes. Firstly, we present the medical gaps in diabetes knowledge base, guidelines and medical practice identified from relevant articles and highlight those that can be addressed by ML. Further, we review the ML research works in three different application areas namely—(1) risk assessment (statistical risk scores and ML-based risk models), (2) diagnosis (using non-invasive and invasive features), (3) prognosis (from normoglycemia/prior morbidity to incident diabetes and prognosis of incident diabetes to related complications). We discuss and summarize the shortcomings or gaps in the existing ML methodologies for diabetes to be addressed in future. This review provides the breadth of ML predictive modeling applications for diabetes while highlighting the medical and technological gaps as well as various aspects involved in ML-based diabetes clinical decision support.

Ramazan Orucu Tutan Diabetes Mellitus Hastalarında Kendi Kendine Glikoz Takibinin Glisemik Kontrole Etkisi

Aim: It is known that a significant number of patients with diabetes insist on fasting in the month of Ramadan, despite the advice of their physicians and reliable authorities. In order to provide the best possible care and support to these patients, the International Diabetes Federation (IDF) and the Diabetes and Ramadan (DAR) International Alliance practical guidelines have been created by the International Alliance. The aim of this study was to investigate the effect of consulting a physician and self glucose monitoring on diabetes management during Ramadan in patients with fasting diabetes.Methods: With this retrospective observational study, patients over 18 years of age who were diagnosed with diabetes, who came to the diabetes outpatient clinic for control after Ramadan and who made their follow-up from our outpatient clinic before Ramadan, were included. Everyone who intends to fast (previous or not) has been asked about previous fasting experiences, questions about whether they consulted the doctor before Ramadan, and those who fasted, how they spent this Ramadan, the questionnaire was filled. The biochemical data of fasting patients before and after Ramadan were analyzed.Results: A total of 394 patients with diabetes participated in the questionnaire and 98 of them (24.9 %) who were fasted were included in the study. The mean age of the fasting patients with diabetes was 59.7 ± 12.3 years and39.2 %werefemale. It was detected that 86.7% of the fasting people were fasting for more than 15 days. Fasting rates were higher in males than females (32.4% to 20.8%) It was found that 25.9% of patients with type 2 DM and 10.3% of patients with type 1 DM were fasting. It was determined that 62.8% of the patients intending to fast were consulted to the physician about this subject, 55.3% of them were determined risk by physician and 70% of them followed up with selfmonitoring blood glucose (SMBG). It was determined that 23.4% (23/98) of fasting patients had a reduction in the number or dose of diabetes medications used; 5.1% (5/98) experienced a complication that would disrupt fasting; 16.3% gained weight (2.8 ± 2.4 kg) and 23.5% lost weight (2.7 ± 1.9 kg). A significant increase in HbA1c and a significant decrease in UACR were detected. It has been determined that A1c control of those who follow with SMBG is better protected than those who do not.Conclusion: In our study, it was seen that a quarter of patients with diabetes fasted. The most valuable result of this study is that the diabetic patients have achieved a more successful diabetes control by providing self-auto control mechanism with SMBG, regardless of whether or not they have received medical advice by physician consultationin Ramadan.

Creating diabetes guidelines for the individual not just the illness

For more than 30 years the American Diabetes Association (ADA) has developed and published recommendations and related documents for clinical practice for diabetes care. ADA's Standards of Medical Care in Diabetes document,1 referred to as the Standards of Care, is intended to inform clinicians, researchers, policy makers, payers (ie, federal and commercial insurance, and federal and states assistance programmes, and health maintenance organisations) of the components of diabetes care, general treatment goals, and tools to evaluate the quality of care.

Combined training increases thermogenic fat activity in patients with overweight and type 2 diabetes.

Exercise is an important strategy in the management of diabetes. Experimental studies have shown that exercise acts, at least in part, by inducing the production of myokines that improve metabolic control and activate brown/beige adipose tissue depots. Combined training (CT) is recommended by the major diabetes guidelines due to its metabolic and cardiovascular benefits, however, its impact on brown/beige adipose tissue activities has never been tested in humans with overweight and type 2 diabetes (T2D). Here, we evaluated the effects of 16-week combined training (CT) program on brown adipose tissue activity; browning and autophagy markers, and serum pro-thermogenic/inflammatory inducers in patients with overweight and T2D. Thirty-four patients with overweight and T2D were assigned to either a control group (CG) or a combined training group (CTG) in a randomized and controlled study. Functional/fitness parameters, anthropometry/body composition parameters, blood hormone/biochemical parameters, thermogenic/autophagic gene expression in subcutaneous adipose tissue were evaluated before and at the end of the intervention. In addition, cold-induced 18-Fluoroxyglucose Positron Emission Computed Tomography (18F-FDG PET/CT) was performed in the training group before and after the end of the intervention. CT increased cervical/supraclavicular brown adipose tissue (BAT) thermogenic activity (p = 0.03) as well as in perirenal adipose tissue (p = 0.02). In addition, CT increased the expression of genes related to thermogenic profile (TMEM26: + 95%, p = 0.04; and EPSTI1: + 26%, p = 0.03) and decreased autophagic genes (ULK1: -15%, p = 0.04; LC3: -5%, p = 0.02; and ATG4: -22%, p < 0.001) in subcutaneous adipose tissue. There were positive correlations between Δ% BAT activity with Δ% of post training energy expenditure cold exposure, HDL-c, IL4, adiponectin, irisin, meteorin-like, and TMEM26 and ZIC1 genes, besides negative correlations with LDL-c, total cholesterol and C-reactive protein. This is the first evidence of the beneficial actions of CT on adipose tissue thermogenic activity in humans, and it adds important support for the recommendation of CT as a strategy in the management of diabetes.

Has the COVID-19 Pandemic Affected the Prevalence of Diabetic Ketoacidosis in Polish Children with Newly Diagnosed Type 1 Diabetes? An Example of the Largest Polish Pediatric Diabetes Center (Upper Silesia-Katowice, Poland).

Purpose: The aim of this study was to analyze the prevalence of diabetic ketoacidosis (DKA) in children with newly disclosed type 1 diabetes (T1D) during the COVID-19 pandemic in 2020 compared to 2019. Methods: A retrospective analysis of the history database of all hospitalized children in our department. The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines were used for the diagnosis of DKA. Results: The database of children with newly disclosed T1D included 196 patients (89 girls and 107 boys) from 2019, and 223 patients (113 girls and 110 boys) from 2020 (a total of 419 patients—202 girls and 217 boys) aged 0 to 18 years. A significantly higher percentage of DKA was observed in 2020 compared to the previous year (47.53% vs. 35.2% [p = 0.005]). The percentage of severe DKA increased in 2020 compared to 2019 (18.39% vs. 14.07% [p = 0.118]). Compared to 2019, the average HbA1c level was higher in 2020 (12.57 ± 2.75% vs. 11.95 ± 2.89% [p < 0.025]), and the average pH level (7.26 vs. 7.31 [p = 0.002], and average HCO3 level (16.40 vs. 18.66 [p = 0.001]) were lower, respectively. Conclusions: During the COVID-19 (2020) pandemic, the incidence of DKA increased in Polish children with newly diagnosed T1D. The conclusions from the analysis of the functioning of health systems during the pandemic should be used in the future to prevent, in similar periods, an increase in severe complications of delayed diagnosis of T1D.

Initial Education for Families with Children Diagnosed with Type 1 Diabetes: Consensus from Experts in a Delphi Study

ABSTRACT A child’s diagnosis of type 1 diabetes can create major challenges for the family, and early education about the disease is crucial. The aim of this study was to identify and reach expert consensus about the priority of topics for the two initial weeks of education of families with a child diagnosed with type 1 diabetes. Specialist nurses (n = 15) working with children and adolescents with diabetes at Swedish pediatric clinics participated in a Delphi study. We sent these experts three rounds of a web survey and analyzed their answers using qualitative content analysis and descriptive statistics. The results show the experts’ consensus on the most important educational topics for families of a child diagnosed with type 1 diabetes. The highest priority topics were actions for hypo-/hyperglycemia, blood-glucose monitoring, symptoms of hypo-/hyperglycemia and adjustment of insulin. The experts’ top-ranked educational topics were in line with the International Society for Pediatric and Adolescent Diabetes guidelines for educating children with type 1 diabetes and also considered important by children and their families. The topics identified here can help nurses educate children with type 1 diabetes, contribute to further research into type 1 diabetes education, and inform the development of national guidelines.

Commentary on the 2020 update of the KDOQI clinical practice guideline for nutrition in chronic kidney disease.

Commentary on the 2020 update of the KDOQI clinical practice guideline for nutrition in chronic kidney disease.

Measurement of obesity in primary care practice: chronic conditions matter.

Lay Summary Primary care providers can deliver tailored advice and support to patients who are overweight or have obesity. The 2020 Canadian Adult Obesity Practice Guideline for primary care providers recommended that patients’ waist circumference (WC) be measured if their height and weight place them in the overweight or Class I obesity category. The guideline does not recommend how often providers should measure WC nor describe how often this is measured in current practice. We reviewed electronic medical records (EMRs) of 707,819 Canadian adult patients aged 40 and older. Among them, 48.7% had 1 or more body mass index (BMI) recorded; 11.5% had at least 1 waist measurement recorded. Of those with a BMI classified as overweight or having Class I obesity, 23.7% had at least 1 WC measurement recorded, which differed by chronic disease. WC was documented in more patients who had diabetes mellitus (36.8%) than hypertension (26.1%), or osteoarthritis (24.3%). This difference may be reflective of more specific advice in diabetes guidelines. To our knowledge, this is the first study to describe documentation of WC measurement for patients who are overweight or have Class I obesity in Canadian primary care EMRs across obesity-related conditions.

Level of Awareness About Risk Factors Associated with Diabetic Foot in Type 2 Diabetic Patients

Background: Diabetes mellitus is a chronic illness that needs continuous monitoring and treatment. In order to avoid diabetic foot issues, there has to be more awareness and understanding of the signs of diabetic foot, risk factors, and early screenings. Objective: Aim of the current study was level of awareness about risk factors associated with diabetic foot in Type 2 diabetic patients Methodology: This cross sectional study was carried out at the Medicine Department, Khyber Teaching Hospital, Peshawar for duration of one year from January 2021 to December 2021. Data was collected from all diabetic type 2 patients by using pre-designed questionnaire. A total of 350 subjects were included in the study. Data analysis was performed by employing SPSS version 21. Results: In our study, based on level of awareness about risk factors of diabetic foot, 133 (38%) subjects have poor awareness, 91 (26%) have average awareness whereas 126 (36%) patients have good level of awareness about risk factors of diabetic foot. Conclusion: Our study concludes that on the basis of current diabetic foot care guidelines, the level of awareness of diabetic type 2 patients about diabetic foot was sub-optimal. Patients with diabetes mellitus should be aware of the medications and lifestyle changes that may help them better manage their blood sugar levels and avoid complications. Keywords: Level of awareness; Risk factors; Diabetic foot; Type 2 diabetes