Diabetes Health Care Research Articles

Health Beliefs, Self-Care Behaviors and Quality of Life in Adults with Type 2 Diabetes.

AimDiabetes mellitus is a lifelong metabolic disease accompanied by acute and chronic complications and requires continuous medical care. The aim of this study is to investigate the effect of the diabetes self-management educational intervention given to individuals with type 2 diabetes on their health beliefs, self-care activities, and quality of life.MethodA single group randomized quasi-experimental study with the pre- and post-intervention design was conducted in two family health centers (n=60). The self-care activities, health beliefs, and quality of life of patients with type 2 diabetes were investigated.ResultsThe mean pre- and post-intervention blood glucose subscale scores were 1.57±0.91 and 3.22±1.06, respectively. The mean pre- and post-intervention social/vocational issues subscale scores were 29.26±5.54 and 33.26±3.19, respectively. The mean scores of the quality of life increased in the primary school graduates and in those who previously had no diabetes intervention after the intervention program. It was determined that the mean body mass index values of the participants decreased after the intervention.ConclusionIt is recommended to organize and implement periodic diabetes self-management educational intervention programs in family health centers and in centers providing diabetes health care to improve health beliefs and to increase self-care activities and quality of life in individuals with diabetes.

Patient Portal Functionalities and Patient Outcomes Among Patients With Diabetes: Systematic Review.

BackgroundPatient portal use could help improve the care and health outcomes of patients with diabetes owing to functionalities, such as appointment booking, electronic messaging (e-messaging), and repeat prescription ordering, which enable patient-centered care and improve patient self-management of the disease.ObjectiveThis review aimed to summarize the evidence regarding patient portal use (portals that are connected to electronic health care records) or patient portal functionality use (eg, appointment booking and e-messaging) and their reported associations with health and health care quality outcomes among adult patients with diabetes.MethodsWe searched the MEDLINE, Embase, and Scopus databases and reported the review methodology using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three independent reviewers screened titles and abstracts, and two reviewers assessed the full texts of relevant studies and performed data extraction and quality assessments of the included studies. We used the Cochrane Collaboration Risk of Bias Tool and the National Heart, Lung and Blood Institute (NHLBI) Study Quality Assessment Tool to assess the risk of bias of the included studies. Data were summarized through narrative synthesis.ResultsTwelve studies were included in this review. Five studies reported overall patient portal use and its association with diabetes health and health care quality outcomes. Six studies reported e-messaging or email use–associated outcomes, and two studies reported prescription refill–associated outcomes. The reported health outcomes included the associations of patient portal use with blood pressure, low-density lipoprotein cholesterol, and BMI. Few studies reported health care utilization outcomes such as office visits, emergency department visits, and hospitalizations. A limited number of studies reported overall quality of care for patients with diabetes who used patient portals.ConclusionsThe included studies mostly reported improved glycemic control outcomes for patients with diabetes who used patient portals. However, limitations of studying the effects of patient portals exist, which do not guarantee whether the outcomes reported are completely the result of patient portal use or if confounding factors exist. Randomized controlled trials and mixed-methods studies could help understand the mechanisms involved in health outcome improvements and patient portal use among patients with diabetes.Trial RegistrationInternational Prospective Register of Systematic Reviews (PROSPERO) CRD42019141131; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019141131.International Registered Report Identifier (IRRID)RR2-10.2196/14975

Association between processes of diabetes care and health care utilization in patients with diabetes: Evidence from a nationally representative US sample.

This study examined the association between quality of processes of diabetes care in terms of adherence to American Diabetes Association (ADA)-recommended guidelines and health care utilization in patients with diabetes. Adults with diabetes were identified from the pool of five panels of the Medical Expenditure Panel Survey, a nationally representative US sample, between 2012 and 2017. The Diabetes Care Survey was used to determine adherence to the ADA-recommended guidelines for processes of diabetes care if all of the following were performed annually: glycosylated hemoglobin check, foot examination, dilated eye examination, lipid panel, influenza immunization, blood pressure check, and dental examination. Health care utilization in terms of inpatient hospitalization, and emergency department (ED) and outpatient visits were estimated using two-part hurdle models. An estimated 26.3 million adults with diabetes were derived from the pooled 5-panel data, of which 7.8% met the ADA-recommended guidelines for processes of diabetes care, and adherence rates of individual recommendations were generally below 50%. Overall, adults who adhered to the ADA-recommendations were older, non-Hispanic white, and married nonsmokers with private insurance and higher income. Mean inpatient hospital stays, ED, and outpatient visits between ADA-adherent vs nonadherent patients were 0.98 vs 1.62 (P < .001), 0.36 vs 0.39 (P = .074), and 17.9 vs 12.8 (P < .001), respectively. Socioeconomic disadvantage and minority status were linked with nonadherence to the ADA-recommended processes of diabetes care. Adherence to the ADA recommendation was associated with significant reduction in inpatient hospitalization and a trend toward less ED visits. Our findings may apply to the United States and are likely to be different in other parts of the world.

Lifestyle Risk Factors for Type 2 Diabetes Mellitus and National Diabetes Care Systems in European Countries.

Background. Diabetes is increasing by 3.09% per year in males and 1.92% in females. Lifestyle risk factors are related to diabetes. The aim of this work is to highlight within EU-28 countries the distribution percentages of some lifestyle risk factors and some components of diabetes health care. Methods. A literature search was conducted to highlight the presence of diabetes registries, which are fundamental tools for disease surveillance and health planning; the presence of a national diabetes plan (NDP); the care setting; and methods used for reimbursement of drugs, devices, and coverage of any comorbidities associated with diabetes. A multiple correspondence analysis (MCA) was carried out to evaluate the possible associations between the variables considered. Results. The highest percentages of diabetes (>10%) are registered in Bulgaria, Malta, and Hungary. Concerning the prevalence of overweight, no European country shows overall percentages of less than 50%. Regarding obesity, 57% of countries show prevalence rates of 25%. The record for physical inactivity belongs to Malta, with 45% of individuals being inactive. The percentage of physical inactivity for females is higher than for males across Europe. In total, 57% of the countries have an insurance-based health system, while 12 countries have public national health systems. Further, 57% of countries have an NDP, while 42% of the EU countries have established a prevalence register for diabetes. Conclusions. Prevalence rates for type 2 DM in the range of 8–9% are noted in 50% of EU-28 countries. In total, 21 out of EU countries show a high prevalence rate for overweight, while 7% of EU-28 countries have an obesity prevalence rate of 25%. Diabetes treatment is entrusted to general practitioners in most countries. The results of this work highlight the differences between countries, but also between genders.

Impact of Physician-Pharmacist Collaboration on Diabetes Outcomes and Health Care Use.

To evaluate the impact of physician-pharmacist collaboration for disease-state management on diabetes outcomes in primary care by comparing outcomes between physician-managed care and pharmacist collaborative care. A retrospective, observational cohort study was conducted at Ascension Medical Group Via Christi, P.A. from January 1, 2016 to June 30, 2018. Health outcomes were analyzed in 385 patients with diabetes mellitus collaboratively managed by a physician and pharmacist (collaborative care group). Similar patients managed by physician only (usual care group) were matched to the collaborative care group using nearest neighbor matching. The primary outcome compared glycosylated hemoglobin (HbA1c) change between collaborative care and usual care groups at 12 months. The mean change in HbA1c decreased by 1.75% in the collaborative care group and 0.16% in the usual care group (P < .0001). The usual care group had a larger number of patients with HbA1c less than 8% at follow-up (P = .0049). Additional outcomes included decrease in total cholesterol (P = .0023), triglycerides (P = .0016), and an increase in PPSV23 pneumococcal vaccinations (P = .0255) in the collaborative care group. The usual care group had an increase in PCV13 pneumococcal vaccinations (P = .0075). Both emergency department visits (P = .0162) and hospitalizations (P = .0225) decreased significantly in the collaborative care group, estimating total savings of $633,015. The collaboration of pharmacists and physicians in the primary care setting is associated with improved diabetes outcomes and substantially reduces costs related to decreased health care use.

An orthopaedist’s review of diabetic foot wounds and osteomyelitis

As the number of patients with diabetes continues to grow, complications of diabetes have likewise increased. Specifically, diabetic foot ulcers have become a massive burden to both the diabetic patient population and national healthcare systems. Diabetic foot ulcers occur due to nerve damage as a result of extensive hyperglycemia. This nerve damage can allow the progression of ulceration, thus providing a window of opportunity for various pathogens to invade the surrounding tissue. Extensive infection of the ulcer tissue can lead to infection of nearby bone, which may require both surgical and antimicrobial intervention for proper wound healing. The aim of this review was to describe the etiology, pathological progressions, and the advancement of ideologies pertaining to treatment options for diabetic foot ulcers.

The Scale-Up of Diabetes and Hypertension Care (SCUBY) - large-scale evaluation using routine health information systems

Abstract The SCUBY project aims to (1) change the organization of primary health care for diabetes and hypertension in order to (2) improve the outcome of chronic care in three countries (Belgium-Slovenia-Cambodia). These two aims require two types of data, namely data on the organization of care and data on the chronic illness outcomes. It can however be challenging to (1) gather all these data (from various sources) on both the organization and outcomes and (2) create cross-culturally valid datasets. The presentation will present the strategy of SCUBY to gather data and discuss the issues of cross-cultural validity.

Weight stigma and diabetes stigma in U.S. adults with type 2 diabetes: Associations with diabetes self-care behaviors and perceptions of health care

AimsDiabetes stigma and weight stigma have been identified as important but neglected issues that warrant attention among people with type 2 diabetes. This study assessed associations of diabetes stigma and weight stigma with diabetes self-care behaviors and health care in adults with type 2 diabetes. MethodsU.S. adults with type 2 diabetes (N = 1,227) completed self-report questionnaires to assess their experiences of weight stigma, diabetes stigma, diabetes self-management, diabetes-specific distress, healthcare utilization, perceptions of diabetes-specific health care. They also provided sociodemographic information. Linear regressions examined relationships among stigma and diabetes self-care and related health care, controlling for participants’ age, education, income, gender, race/ethnicity, and body mass index. ResultsInternalized weight stigma and diabetes self-stigma were both significantly associated with higher diabetes-specific distress. Adults who expressed self-stigma for their diabetes reported less diabetes self-management and lower self-efficacy, and those who reported being judged about their weight by a doctor exhibited greater diabetes-specific distress. While a history of experienced weight stigma (in general) did not reduce frequency of seeking health care, lower quality interactions with health care professionals were reported by adults who expressed diabetes self-stigma and those who experienced weight stigma from a doctor. ConclusionsSelf-stigma for diabetes and body weight, as well as experiencing judgment about weight from doctors, may have negative implications for diabetes-specific self-care behaviors and perceived quality of health care. Efforts to promote wellbeing in individuals with type 2 diabetes need to consider reducing both diabetes and weight stigma and their potentially harmful consequences.

Smart Healthcare for Diabetes During COVID-19

Diabetic patients are at higher risk from novel coronavirus disease 2019 (COVID-19) that spreads through Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). There are around 20% to 50% of COVID-19 cases who had diabetes across the different regions of the world. This article discusses recommendations and associated risks for diabetic patients to balance glycemic profiles during the COVID-19 outbreak. It also discusses the case study of various countries with impact of COVID-19 for diabetic patients. It presents emerging smart healthcare that can potentially safeguard against COVID-19.

The prevalence and risk factors for systemic hypertension among Sudanese patients with diabetes mellitus: A survey in diabetes healthcare facility

Background and aimsDiabetes and hypertension are common chronic diseases that affect about one fifth of Sudanese adults. The aim of this study was to assess the prevalence of hypertension among Sudanese individuals with diabetes. Materials and methodsThis a survey in diabetes healthcare facility-based study that recruited 266 individuals with diabetes mellitus (DM). Data was collected using a standardized pretested questionnaire, and was analyzed by performing descriptive and inferential statistics through SPSS program. ResultThe study showed that average age of participants was 58.7 (±10.5 SD) years, males were 59% and most of the participants (72.6%) from urban areas. Diabetes for 1–5 years was observed in 10.9% and for more than 11 years in 71.4%. The majority (91.7%) had type 2 diabetes mellitus while only (8.3%) had type 1 diabetes. The prevalence of hypertension was 47.7% among the study group, this was significantly associated with age (p value 0.016), and retinopathy (p value 0.001). Logistic regression analysis showed that age, body mass index (BMI), serum creatinine and retinopathy had statistically significant associations with the presence of hypertension (p values 0.002,0,016, 0.008,0.001) respectively. ConclusionPrevalence of hypertension in Sudanese patients with diabetes presenting to diabetes clinic was 47.7%, and it increased with age and presence of retinopathy. Risk factors of hypertension were age, body mass index (BMI), serum creatinine and retinopathy.

Short-term impact of co-payment level increase on the use of medication and patient-reported outcomes in Finnish patients with type 2 diabetes

A new reimbursement scheme for non-insulin medications used for treatment of hyperglycemia in type 2 diabetes (T2D) was implemented in Finland on January 1, 2017. The aim of the study was to evaluate the impact of this co-payment increase (i.e. + 35 percentage points) on patient-reported satisfaction for diabetes care, diabetes medication use, and financial difficulties. Baseline data were collected in 114 pharmacies, where patients with T2D were asked to fill in a questionnaire in November 2016. Follow-ups were conducted at 6 and 12 months. In total, 955 participants with T2D attended the baseline examination. During the follow-up, satisfaction with diabetes care decreased significantly (p < 0.001). Use of insulin increased (OR 1.16, 95 % CI 1.06–1.27) whereas use of metformin and DPP-4 inhibitors decreased (metformin: OR 0.80, 95 % CI 0.70‒0.90; DPP-4 inhibitors: OR 0.82, 95 % CI 0.73‒0.93). Financial difficulties with the purchase of diabetes medications were reported more often both at 6 (OR 2.44, 95 % CI 1.96–3.03) and at 12 months (OR 2.70, 95 % CI 2.18–3.35) than at baseline. These negative short-term effects require future studies. If persistent, the long-term effects of lower treatment satisfaction and increased financial difficulties may imply impaired metabolic control and increased diabetes complication risk and health care costs. Patient perspective should be taken into account in future policy making.

Strukturierte Diabetesschulung

AbstractSuccessful diabetes treatment requires a high degree of therapy-related competence and everyday coping from the patients. The necessary knowledge and skills are developed in diabetes education programs together with the diabetes health care team. This article presents history, structural components and methodological-didactic aspects, gives an up-to-date overview of existing programs in Germany and an outlook on future diabetes education in view of technological progress.

Does Collective Always Mean Cohesive? Collective Institutional Entrepreneurship and Radical Flanks

Despite an expanding literature on collective institutional entrepreneurship, we know little about the mechanics and internal dynamics between different and potentially divergent entrepreneurial paths, the responses from actors outside the collective, and the effects that divergent entrepreneurial paths have on the outcome of the institutional change project. In this paper, we set out to explore how diverse paths in collective institutional entrepreneurship can contribute to institutional change. Informed by literature on collective institutional entrepreneurship and radical flank effects and relying on qualitative processual data on a collective attempt to change the standards in Type-1 diabetes healthcare, we show how multiple and diverse entrepreneurial paths interweave in the pursuit of a common institutional change project. We contribute to literature on collective institutional entrepreneurship by detailing the mechanisms that yield synergetic and dynamic relationships between entrepreneurial actors (creating urgency, creating the network and creating the cohesion) and by detailing how different types of institutional work undertaken by the different groups contribute to institutional change over time. We also contribute to literature on radical flank effects by demonstrating how emotional cohesion functions as a social glue that connects discrepant entrepreneurial paths in a common institutional change project.

Clinical characteristics and health care received among patients with type 2 diabetes attending secondary and tertiary healthcare facilities in Mwanza Region, Tanzania: a cross-sectional study

BackgroundTanzania is among the sub-Saharan African countries facing a tremendous increase in the burden of type 2 diabetes mellitus. In order to provide diabetes health care services, the government has established diabetes care clinics in secondary and tertiary healthcare facilities. However, previous studies have demonstrated a disparity in availability of supplies and equipment for provision of diabetes health care services at these healthcare facilities. This study aims to assess the clinical characteristics and health care received among patients with type 2 diabetes attending secondary and tertiary healthcare facilities in Mwanza Region, Tanzania.MethodsA cross-sectional study was conducted in Mwanza Region from June to September, 2018.Three hundred and thirty patients were selected by systematic random sampling from three healthcare facilities. A structured questionnaire was utilized to collect information on patient characteristics, health care received and patient perception of care. Patient blood pressure, blood glucose, weight and height were measured during the study. Percentages, chi-square tests and multivariable analysis were conducted to obtain the proportions, make comparisons and determining the correlates of tertiary-level healthcare facility.ResultsApproximately half of respondents (54.5%) were from secondary healthcare facilities. The prevalence of hypertension (63.3%), hyperglycemia (95.8%) and obesity (93.3%) were high. The prevalence of hyperglycemia was slightly higher at secondary-level healthcare facility (p = 0.005). The proportion of respondents recently diagnosed with diabetes (≤ 10 years) was significantly higher at tertiary-level healthcare facility (p = 0.000). The prevalence of diabetes related complications was higher at tertiary-level healthcare facility (80.7% versus 53.3%, p = 0.000). Assessments of body weight, blood pressure, blood glucose, feet and eye examination were conducted on a monthly basis at all facilities. None of the respondents had undergone lipid profile testing. All of the respondents (100%) received care from a nurse during diabetes clinic visits and half of the respondents (49.7%) also received care from a clinician. Relatively young patients, married and recently diagnosed patients were more likely to attend clinic at tertiary facilities. Tertiary-level healthcare facilities were more likely to have patients with complications and to have a dietitian available at the clinic.

“I Had Nobody to Represent Me”: How Perceptions of Diabetes Health-Care Providers’ Age, Gender and Ethnicity Impact Shared Decision-Making in Adults With Type 1 and Type 2 Diabetes

ObjectivesOur aim in this study was to investigate how patients’ perceptions of their diabetes health-care providers’ (HCP) age, gender and ethnicity impact shared decision-making using the Theory of Planned Behaviour. MethodsAdult participants receiving diabetes care at community sites, primary care or specialty clinics participated in semistructured, one-on-one interviews conducted from November 2018 to January 2019. Responses were transcribed and qualitatively analyzed for emergent themes using statistical software (NVivo version 9). ResultsWe conducted 28 interviews with participants 34 to 81 years of age. The following themes were identified: 1) participants’ gestalt of their diabetes HCP was strongly gender dependent 2) there was a hidden preference for Caucasian HCPs, 3) age evoked a less defensive response with regard to shared decision-making and 4) degree of trust in self and in their diabetes HCP directed participants’ readiness to be part of the shared decision-making. ConclusionsParticipants’ narrative experiences strongly suggest that they view their diabetes HCPs through a gendered and racialized lens.

2234-PUB: The Impact of a Community Paramedicine Program on Diabetes Outcomes and Health Care Utilization

Background: As of 2017, South Carolina ranked 5th highest in the U.S. for percentage of adults with diabetes, which has negative health and cost implications. The innovative community paramedicine program (CPP) aims to improve management of patients with chronic diseases and high utilization of the Emergency Department (ED), by providing in-home disease management, education, and care/community resource connection by paramedics. The impact of CPs has not been extensively studied in diabetes. Objective: To assess impact of CPP participation on health outcomes and healthcare utilization for patients with diabetes. Methods: Retrospective analysis of CPP participants diagnosed pre-enrollment with diabetes. Demographics and variables reported as percentages, and differences between A1c values pre/post CPP tested using Student’s t-test. Healthcare cost and utilization data was extracted from EMR using SAP BusinessObjects and analyzed with Qlik. Results: From 2015-2019, 64 people with diabetes enrolled. Participants were primarily insured by Medicare (48.4%) and/or Medicaid (35.9%) or uninsured (32.8%). Comparing pre and post-enrollment average values, participants in CPP for &amp;gt;180 days (d) demonstrated a clinically significant improvement in A1c, although this did not reach statistical significance (181-270d: 10.04+/-1.33 to 8.51+/-1.35, p=0.159; 271-365d: 10.83+/-2.95 to 7.65+/-2.39,p=0.098; 365+d: 9.31+/-2.58 to 7.76 +/-1.45, p=0.23). Participants also showed increased rates of screening for microvascular complications. To date, the utilization analysis for the 52 CPP graduates who participated &amp;gt;14d suggests decrease in average cost of care and ED visits per person comparing 6 months prior and up to 6 months post CPP enrollment ($16,514 vs. $4,717; 2.77 vs. 0.73 ED visits). Conclusions: The CPP demonstrated improvement in disease control and reduced costs/ED visits for patients with diabetes. This is a promising care delivery innovation that merits further research. Disclosure M. Eicken: None. D. Lee: None. J.A. Ewing: None. J.N. Butler: None. M.E. Lutz: None. J.Z. Snow: None. C. Hipp: None. D.T. Thomas: None. C.P. Head: None. R.S. Hudson-Dobbs: None. V.E. Green: None. S.L. Weber: None.

The Relationships Among the Organizational Factors of a Tertiary Healthcare Center for Type 2 Diabetic Patients in Palestine.

Diabetes prevalence at Palestine was 10%, with a rising fund crisis, and diabetes healthcare problems. There was a limited research concerning diabetes healthcare dimensions including organizational factors and their predictors. This study described patient characteristics and organizational factors, and assessed relationships among organizational factors of type 2 diabetes health care in Palestine. This study is a retrospective cross sectional study, recruited by convenience sampling method in 330 participants from a type 2 diabetes patients list. It was carried out at Ramallah, Palestine. The Statistical Package for Social Sciences (SPSS v 19) was used to analyze data on patient characteristics and organizational factors collected from personal interview and medical records review. The results showed that 51.2% were males, and 88.5% had additional chronic diseases. Preventive healthcare and patient-healthcare professionals' relationship were the most prominent organizational factors in statistically significant relationships among organizational factors. This study reflected the need for reviewing prescription mode, and educational programs that emphasize the diabetes self-care management and the health care providers' role that would be of great benefit in health outcomes further.

Association and Familial Coaggregation of Type 1 Diabetes and Eating Disorders: A Register-Based Cohort Study in Denmark and Sweden.

OBJECTIVETo ascertain the association and coaggregation of eating disorders and childhood-onset type 1 diabetes in families.RESEARCH DESIGN AND METHODSUsing population samples from national registers in Sweden (n = 2,517,277) and Demark (n = 1,825,920), we investigated the within-individual association between type 1 diabetes and eating disorders and their familial coaggregation among full siblings, half siblings, full cousins, and half cousins. On the basis of clinical diagnoses, we classified eating disorders into any eating disorder (AED), anorexia nervosa (AN) and atypical AN, and other eating disorder (OED). Associations were determined with hazard ratios (HRs) with 95% CIs from Cox regressions.RESULTSSwedish and Danish individuals with a type 1 diabetes diagnosis had a greater risk of receiving an eating disorder diagnosis (HR [95% CI] Sweden: AED 2.02 [1.80–2.27], AN 1.63 [1.36–1.96], OED 2.34 [2.07–2.63]; Denmark: AED 2.19 [1.84–2.61], AN 1.78 [1.36–2.33], OED 2.65 [2.20–3.21]). We also meta-analyzed the results: AED 2.07 (1.88–2.28), AN 1.68 (1.44–1.95), OED 2.44 (2.17–2.72). There was an increased risk of receiving an eating disorder diagnosis in full siblings in the Swedish cohort (AED 1.25 [1.07–1.46], AN 1.28 [1.04–1.57], OED 1.28 [1.07–1.52]); these results were nonsignificant in the Danish cohort.CONCLUSIONSPatients with type 1 diabetes are at a higher risk of subsequent eating disorders; however, there is conflicting support for the relationship between having a sibling with type 1 diabetes and an eating disorder diagnosis. Diabetes health care teams should be vigilant about disordered eating behaviors in children and adolescents with type 1 diabetes.

SUN-636 Gaps in Quality of Delivery of Post-Partum Care in Preconception Counselling for Pregnant Women with Pre-Existing Diabetes at a Large Academic Tertiary Centre

BACKGROUND: Women with pre-existing diabetes are at increased risk of serious adverse pregnancy outcomes compared with the general maternity population including congenital anomaly, stillbirth and neonatal death. The 2018 Diabetes Canada Clinical Practice Guidelines (DC CPG) on Diabetes in Pregnancy recommend that women with pre-existing diabetes are provided with postpartum and preconception counseling by their diabetes healthcare team, as this is associated with improved maternal and fetal outcomes. OBJECTIVE: To evaluate the quality of physican counselling of post-partum management and pre conception advice for women with pre-existing diabetes who receive their intrapartum care at Mount Sinai Hospital Diabetes in Pregnancy Clinic in Toronto Ontario. METHODS: Eligible patients were pregnant women with pre-existing Type 1 and Type 2 diabetes who were followed in pregnancy until their 6 weeks postpartum clinic visit. Consecutive baseline chart review of patients between June 2018 - June 2019 was performed to audit documentation of physician counselling of DC CPG recommendations at the 6 week post-partum visit. Key components of the recommendations included: 1) targeting an HbA1c of <7% pre-pregnancy, 2) folic acid supplementation and neural tube defect prevention, 3) weight management and optimization of BMI, 4) contraceptive measures and family planning, 5) information regarding outcomes and risks for mother and baby 6) yearly retinal exam. RESULTS: Results of our chart review found that 42% (n=50) of women with pre-existing diabetes who received their intrapartum care at our clinic returned for their 6 week postpartum visit between June 2018-June 2019. Audit of the 6 week post-partum clinic note found that less than 20% of women had physician documentation of counselling on two or more key components of the DC CPG recommendations (1-6).CONCLUSION: There is a large gap in women attending postpartum appointments and there are significant gaps in physician documentation of counselling among women with pre-existing diabetes. Further analysis will be conducted in order to determine if there is a patient knowledge gap regarding counselling recommendations and a quality improvement project will be undertaken to close this gap.

Counting the cost of preventable diabetes-related lower limb amputations at a single district hospital in KwaZulu-Natal: what does this mean, what can be done?

Background: Healthcare policy decisions are driven by many factors, including cost, hence the need to show costs of diabetes mellitus-related lower limb amputations (DMLLA) to inform amendments to health care. Substantial decreases in amputation rates are associated with specialised podiatry foot clinics and ongoing foot education, as per national guidelines on the multidisciplinary team approach (MDTA) to diabetes health care. There are only two podiatry posts in KwaZulu-Natal (KZN) state health department (DoH).Objectives: Aims were to draft the medical costs for 660 DMLLA at Greys Hospital for the period 2013–2017; to extrapolate costs on annual DMLLA in KZN; to outline socio-economic costs for future investigation; to present evidence that podiatry in the MDTA can decrease numbers of DMLLA.Methods: A retrospective review on clinical data captured in real time and maintained by the Pietermaritzburg Metropolitan Trauma Service (PMTS) and Surgical Service (PMSS) was performed. Costs were analysed on data for 660 patients’ DMLLA at Greys Hospital between 2013 and 2017, and psychological and socio-economic costs via literature review.Results: Medical care at Greys Hospital for 660 DMLLA in the five years cost in excess of ZAR 213 million. Extrapolated to the 1 231 diabetic amputations (2014) equals an annual cost to KZN DoH in excess of ZAR 398 million. Personal, family loss and socio-economic costs are estimated in excess of ZAR five million per amputee, resulting in further cost of ZAR 6.155 billion per annum to KZN. Extrapolation across 11 provinces signifies a national cost of at least ZAR 68 billion.Conclusions: We present a gauge of the cost of DMLLA to KZN and national health. Substantial possible socio-economic losses compound these. The role of podiatrists within MDTA teams has an evidence base to prevent DMLLA.