Diabetes In Primary Care Setting Research Articles

Information and Communications Technology-Based Monitoring Service for Tailored Chronic Disease Management in Primary Care: Cost-Effectiveness Analysis Based on ICT-CM Trial Results.

Information and communications technology-based tailored management (TM) intervention is a novel automatic system in which a smartphone app for the management of patients with hypertension and diabetes, the provider web, and Bluetooth devices are linked. However, little evidence exists regarding the cost-effectiveness of the interventions using mobile apps. This study aimed to assess the cost-effectiveness of TM intervention for adult patients with hypertension or diabetes in primary care compared with usual care (UC). Cost-effectiveness analysis using a Markov model was conducted from the Korean health care system perspective. Based on 6-month outcome data from an information and communications technology-based tailored chronic disease management (ICT-CM) trial, effectiveness over a lifetime beyond the trial periods was extrapolated using a cardiovascular disease risk prediction model. Costs were estimated using ICT-CM trial data and national health insurance claims data. Health utility weights were obtained from the Korea National Health and Nutrition Examination Survey. In the base-case analysis, compared with UC, TM was more costly (US $23,157 for TM vs US $22,391 for UC) and more effective (12.006 quality-adjusted life-years [QALYs] for TM vs 11.868 QALYs for UC). The incremental cost-effectiveness ratio was US $5556 per QALY gained. Probabilistic sensitivity analysis showed that the probability of TM being cost-effective compared with UC was approximately 97% at an incremental cost-effectiveness ratio threshold of US $26,515 (KRW 35 million) per QALY gained. Compared with UC, TM intervention is a cost-effective option for patients with hypertension or diabetes in primary care settings. The study results can assist policy makers in making evidence-based decisions when implementing accessible chronic disease management services.

Comparison of machine learning methods for the prediction of type 2 diabetes in primary care setting using EHR data

Diabetes remains a major global public health challenge, thus the need for better methods for managing diabetes. Machine learning could provide reliable solutions to the need for early detection and management of diabetes. This study conducted experiments to compare a number of selected machine learning approaches to determine their suitability for early detection of diabetes in the primary care setting. A retrospective study was conducted using EHR dataset of confirmed cases of diabetes collected during routine care at Nairobi Hospital. Institutional ethical approvals were obtained, and data were retrieved from the database through stratified sampling based on gender. Diagnoses were confirmed using the ICD-10 codes. Records with 5% or so of missing values were excluded from this analysis. Data were processed by correction of errors and replacement of missing values using measures of central tendency. The data were transformed through normalization using the decimal-scaling method. Data analysis was conducted using selected supervised and unsupervised learning algorithms. Model performances were validated using metrics for the evaluation of classification and clustering results, respectively. Random Forest had the highest accuracy (0.95) and error rate (0.05), while Gradient Boosting and Multilayer Perceptron (MLP) with 3 hidden layers obtained accuracy (0.94) and error rate (0.06), respectively. The process of selecting machine learning algorithms needs to explore both supervised and unsupervised learning techniques. In addition, an appropriate architectural design of an MLP could present astounding results for classification tasks in primary care settings.

The feasibility and efficacy of a community-based multifactorial intervention to improve the cardiovascular risk factor control among patients with type 2 diabetes: A 2-year cluster randomized trial.

Our study is to investigate the feasibility and effectiveness of multiple cardiovascular factors intervention (MFI) in type 2 diabetes patients in China's primary care setting. We performed a cluster randomized trial to compare the proportion of patients achieved the targets between usual care group (control, 9 sites, n = 868) and MFI group (8 sites, n = 739) among patients with type 2 diabetes in primary care setting. Logistic regression model with random effects was used to estimate the association of the effect of intervention and the proportion achieved the targets. At baseline, the end of 1 year, and 2 years follow-up, the proportion of patients achieved all 3 target goals (HbA1c < 7.0%, blood pressure < 130/80 mm Hg and low-density lipoprotein cholesterol < 2.6 mmol/L) were 5.7%, 5.9%, 5.7% in the control group and 5.9%, 10.6%, 12.3% in the MFI group. After adjusting sex, age, diabetes duration, body mass index, HbA1c, blood pressure, and low-density lipoprotein cholesterol at baseline, there was no difference between the 2 groups (OR (95% CI): 1.27 (0.38-4.27) and 1.86 (0.79-4.38) for the first year and second year, respectively). When stratified by payment method, the patients with medical insurance or public expenses had a higher proportion achieved target goals (6.9% vs 16.4%, OR (95% CI): 2.30 (1.04-5.08)) in the second year. The controlling of cardiovascular risk factor targets remains suboptimal among patients with type 2 diabetes in primary care setting. MFI in type 2 diabetes improved cardiovascular disease risk profile, especially in the patients with medical insurance.

Interprofessional Collaboration and Diabetes Management in Primary Care: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes.

The global spread of diabetes poses serious threats to public health requiring a patient-centered approach based both on interprofessional collaboration (IPC) given by the cooperation of several different health professionals, and patients’ perspective through the assessment of Patient-Reported Outcomes (PROs). The aim of the present study is to evaluate the impact of interprofessional collaboration interventions, for the management of type 2 diabetes in primary care settings, through PROs. A systematic review and meta-analysis was conducted querying the PubMed, Scopus and Embase databases. Out of the 1961 papers initially retrieved, 19 met the inclusion criteria. Interprofessional collaboration is significantly associated with an increase in both patient’s satisfaction (SMD 0.32 95% CI 0.05–0.59) and in the mental well-being component of the HRQoL (SMD 0.18; 95% CI 0.06–0.30), and there was also promising evidence supporting the association between an interprofessional approach and an increase in self-care and in generic and specific quality-of-life. No statistical differences were found, supporting the positive impact on IPC interventions on the physical component of the HRQoL, depression, emotional distress, and self-efficacy. In conclusion, the effect of IPC impacts positively on the few areas assessed by PROMs. Policymakers should promote the widespread adoption of a collaborative approach as well as to endorse an active engagement of patients across the whole process of care.

Association between availability of glucose-lowering drugs in primary health institutions and diabetes patients’ medication adherence: a cross-sectional study in Shandong Province, China

BackgroundPrimary health care system is a critical component of diabetes care and management. This article aimed to analyze the availability of glucose-lowering drugs in primary health institutions (PHIs) in China, and to explore the relationship between availability of glucose-lowering drugs and medication adherence among type 2 diabetes mellitus (T2DM) patients. MethodsThis cross-sectional study conducted in Shandong Province, eastern China (hereafter referred to as Shandong), between August and December 2017. In total, 2 520 community-managed T2DM patients were selected from 68 PHIs in Shandong, including 62 village-level and 6 township-level PHIs. The self-developed questionnaire was used to survey the availability of glucose-lowering drugs in PHIs. Patients’ medication adherence was assessed by four self-reported questions, and was classified as either adherent or non-adherent. Descriptive statistics was used to analyze the availability of glucose-lowering drugs in PHIs and the medication adherence among the T2DM patients. Multilevel logistic regression models were used to explore the relationship between the availability of glucose-lowering drugs in PHIs and patients’ medication adherence. ResultsA total of 1 866 T2DM patients prescribed with at least one glucose-lowering drug were included in analysis. Among them, 58.5% patients followed their antidiabetic treatment well. In village-level PHIs, the patient's adherence rate was lower than in township-level PHIs (55.9% vs. 61.1%, P < 0.05). Among the 68 PHIs, average (2.53±0.97) glucose-lowering products (generic names) were available, which in village-level PHIs were less than in township-level PHIs (2.47 vs. 3.17, P < 0.05). And the number of available glucose-lowering products in PHIs was associated with the adherence of T2DM patients. ConclusionPoor availability of glucose-lowering products was found in PHIs in Shandong. The availability of glucose-lowering products in PHIs was positively associated with patients’ medication adherence, and could be enhanced to improve the control of diabetes in primary care settings.

Collaborative care model for diabetes in primary care settings in Qatar: a qualitative exploration among healthcare professionals and patients who experienced the service

BackgroundDiabetes mellitus is highly prevalent and associated with huge economic burden globally. The conventional care and management of diabetes mellitus is highly fragmented and complex, warranting the need for a comprehensive Collaborative Care Model (CCM). Little is known about the perception of patients with diabetes and their healthcare providers about CCM, its barriers and facilitators. This study aimed to explore the value of CCM in diabetes care at a primary healthcare (PHC) setting from the perspective of patients with diabetes and healthcare professionals (HCPs), in an effort to expand our current knowledge on collaborative care in diabetes at primary care level for the purpose of quality improvement and service expansion.MethodsUsing an exploratory case study approach, semi-structured interviews were conducted among patients and HCPs who encountered CCM in Qatar during 2019 and 2020. The semi-structured interviews were transcribed verbatim and the data were analysed and interpreted using a deductive-inductive thematic analysis approach.ResultsTwelve patients and 12 HCPs at a diabetes clinic participated in one-to-one interviews. The interviews resulted in five different themes: the process and components of collaborative care model (four subthemes), current organizational support and resources (three subthemes), impact of collaborative care model on diabetes outcomes (three subthemes), enablers of collaborative care model (three subthemes), and barriers to collaborative care model (three subthemes). The participants indicated easy access to and communication with competent and pleasant HCPs. The patients appreciated the extra time spent with HCPs, frequent follow-up visits, and health education, which empowered them to self-manage diabetes. HCPs believed that successful CCM provision relied on their interest and commitment to care for patients with diabetes. Generally, participants identified barriers and facilitators that are related to patients, HCPs, and healthcare system.ConclusionsThe providers and users of CCM had an overall positive perception and appreciation of this model in PHC settings. Barriers to CCM such as undesirable attributes of HCPs and patients, unsupportive hospital system, and high workload must be addressed before implementing the model in other PHC settings.

Risk factors for cardiovascular disease in rural South India: cohort study

Background and objectivesCardiovascular diseases (CVD) accounted for one-third of the deaths in India. We conducted a cohort study to estimate the incidence of CVD and the association of established risk...

1265-P: The Paradox of Care Delivery for Type 1 Diabetes in Primary Care Settings: A Call for Interventions to Reduce Health Disparities

Adults and children with type 1 diabetes (T1D) in the U.S. do not meet targets for HbA1c. These deficits are even more pronounced based on race/ethnicity and socioeconomic status (SES). Most studies on T1D health outcomes focus on data from endocrinology clinics, yet, primary care clinics play a central role in the management of patients, especially those affected by health disparities. To better understand barriers for individuals with T1D in primary care settings, survey research was conducted with 110 Primary Care Providers (PCPs) in Florida (n=52) and California (n=58) using publicly available state-wide provider directories. Surveys were completed by PCPs in a range of settings including solo (20%), multi-specialty group (35%), single-specialty group (21%), hospital/hospital-owned systems (12%) and ‘other’ (12%). For pediatric T1D populations, 58% of PCPs reported referring children to endocrinologists for diabetes care and only 45% checked HbA1c for children with T1D during clinic visits. For adult T1D populations, 30% of PCPs referred patients to endocrinologists and 65% checked for HbA1c. Overall, providers expressed a lack of confidence in caring for T1D patients, especially when it came to technologies like CGMs (only 28% said they were “moderately” or “extremely” confident herein) and insulin pumps (only 17% said they were “moderately” or “extremely” confident). The lack of confidence surrounding diabetes-technologies was especially evident for PCPs in practice 1-10 years or 31+ years (p&amp;lt;.05 for CGMs and p&amp;lt;.01 for pumps). Despite the lack of confidence in caring for patients with T1D, 73% of PCPs reported filling an insulin prescription for a T1D patient in the last year. Surveys with PCPs from a range of clinical settings demonstrate gaps in delivering standard of care and concurrently reveal the critical role PCPs play in T1D care. Efforts to improve outcomes in T1D must include targeted interventions in primary care settings. Disclosure A.F. Walker: None. N. Cuttriss: None. M.J. Haller: Advisory Panel; Self; Pancreum, SAB Biotherapeutics. K. Yabut: None. C. Anez-Zabala: None. R. Lal: Consultant; Self; Abbott. E. Sheehan: None. M. Basina: None. K.K. Hood: Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc. Speaker's Bureau; Self; Johnson &amp; Johnson Diabetes Institute. A. Bernier: None. L.G. Baer: None. S.L. Filipp: None. C. Wang: None. M. Town: None. M.J. Gurka: None. D.M. Maahs: Advisory Panel; Self; Novo Nordisk Inc. Consultant; Self; Abbott, Sanofi. Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Evaluation of a Community-Based Diabetes Prevention Program in Thailand: A Cluster Randomized Controlled Trial.

Objectives: Lifestyle interventions have been shown to effectively reduce the incidence of diabetes, but evidence from middle-income countries is scarce. We evaluated the effectiveness of a lifestyle program to prevent diabetes in primary-care settings in Thailand. Methods: A matched-pair cluster randomized controlled trial was conducted in 68 primary care units in 8 provinces. The primary care units were randomly assigned to intervention or control arms. Individuals aged 30 to 65 years with impaired oral glucose tolerance were recruited and followed up for 2 years. The intervention included periodic group-based activities on healthy lifestyle behaviors; the control group received a one-time education program. The primary outcome was the incidence rate of type 2 diabetes at 24 months after the intervention. Results: A total of 1903 individuals participated (873 in the control group and 1030 in the intervention group). At baseline, participants’ characteristics did not differ between groups. After 24 months, the incidence rates (per 100 person-year) of diabetes was 12.1% (95% CI 10.7% to 13.8%) in the intervention group, and 16.6% (95% CI 14.6 to 18.8%) in the control group (P < .001). Overall, the adjusted hazard ratio for diabetes incidence was 0.72 (95% CI 0.60 to 0.86). A mean body weight reduction of 1.5 kg was observed in the intervention group, whereas, an increase of 0.4 kg was observed in the control group (P < .001). Conclusion: A community-based lifestyle modification through participatory group activities can prevent or delay the incidence of diabetes among Thai populations with impaired glucose tolerance.

Characteristics of Syrian and Lebanese Diabetes and Hypertension Patients in Lebanon

Background:Given the protracted nature of the crisis in Syria, the large caseload of Syrian refugee patients with non-communicable diseases, and the high costs of providing non-communicable disease care, implications for Lebanon’s health system are vast.Objective:To provide a profile of the health status of diabetes and hypertension patients enrolled in a longitudinal cohort study in Lebanon.Methods:A longitudinal cohort study was implemented from January 2015 through August 2016 to evaluate the effectiveness of treatment guidelines and an mHealth application on the quality of care and health outcomes for patients in primary health care facilities in Lebanon offering low-cost services serving both Syrian refugees and Lebanese host communities. This paper presents baseline characteristics of enrolled patients, providing an overall health status profile.Results:Among participants, 11.5% of patients with hypertension and 9.7% of patients with diabetes were previously undiagnosed. Quality of care, measured as the proportion of patients with biometrics reported and whose condition is controlled, is less than ideal and varied by geographic location. Controlled blood pressure measurements were observed in 64.2% of patients with hypertension; HbA1C values indicated diabetes control in 43.5% of the patients.Conclusion:Differences in diagnostic history and disease control between Syrian and Lebanese patients and across geographic regions were observed, which could be applied to inform strategies aimed at improving diagnosis and quality of care for hypertension and diabetes in primary care settings in Lebanon.

Adherence to clinical guidelines for monitoring diabetes in primary care settings

Objective Adherence to clinical guidelines is key to improving diabetes care. Contemporary knowledge of guideline adherence is lacking. This study sought to produce a national snapshot of primary care physicians’ (PCPs) adherence to the American Diabetes Association guidelines for monitoring diabetes and determine whether continuity of care promotes adherence. Methods Using the 2013 National Ambulatory Medical Care Survey, we examined adherence to ordering hemoglobin A1c (HbA1c) and lipid profile tests as recommended by the American Diabetes Association for monitoring diabetes in 2379 primary care visits of patient with diabetes. Results In the preceding 12 months, less than 60.0% of the patients were given a test recommended for monitoring diabetes (58.0% for HbA1c and 57.0% for lipid profile). Continuity of care with PCPs increased the odds of adhering to diabetes monitoring guidelines by 36.0% for the HbA1c test (P=0.06) and by 76.0% for the lipid profile test (P=0.0006). Conclusion A substantial gap exists in achieving optimal monitoring for diabetes in primary care settings in the United States. While PCPs are ideally positioned to ensure that guidelines are closely followed, we found that even in primary care settings, patient-provider continuity of care was associated with guideline adherence. Significance statement Adherence to clinical guidelines is an integral part of the World Health Organization’s Global Action Plan to reduce the impact of diabetes. In this study, we used the 2013 National Ambulatory Care Survey to assess US physicians’ adherence to the American Diabetes Association’s guidelines for monitoring diabetes. We found a substantial gap between what was done in primary care settings and what is recommended for optimal diabetes management. Our findings support the positive effect of continuity of care on improving diabetes quality of care.

Provider Perspectives on Quality Payment Programs Targeting Diabetes in Primary Care Settings.

Public and private insurers increasingly use quality payment programs as a tool to improve quality of care in primary care settings. However, little is known about primary care providers' perspectives on whether and how quality payment programs improve diabetes quality of care. In this qualitative study, the authors conducted semi-structured interviews and focus groups with 23 providers from March to June 2015. Transcripts were analyzed to identify key themes using the immersion-crystallization method. Almost all of the providers believed that insurers play a meaningful role in improving quality of care for diabetes patients. Most thought that insurers' efforts are more effective when channeled through providers and delivery systems rather than directed at patients. Providers generally believed that quality payment programs have had a positive impact on quality of diabetes care, although provider views were not evidence based. Providers in practices in which quality payment programs were believed to have had a positive impact stated that the programs provided financial incentives and resources for improved population health management systems and additional staff. Conversely, most providers did not believe that quality payment programs have had any impact via direct financial incentives to individual physicians. A few providers were skeptical about the impact of quality payment programs and noted negative consequences that they had observed. Providers recommended strategies to improve quality payment programs (eg, refine quality measures, provide regular feedback on quality and costs) and additional strategies that insurers could consider to address provider- and patient-level barriers to high-quality diabetes care.

Derivation and external validation of risk algorithms for cerebrovascular (re)hospitalisation in patients with type 2 diabetes: Two cohorts study

AimsCerebrovascular disease is one of more typical reasons for hospitalisation and re-hospitalisation in people with type 2 diabetes. We aimed to derive and externally validate two risk prediction algorithms for cerebrovascular hospitalisation and re-hospitalisation. MethodsTwo independent cohorts were used to derive and externally validate the two risk scores. The development cohort comprises 4704 patients with type 2 diabetes registered in 18 general practices across Cambridgeshire. The validation cohort includes 1121 type 2 patients from a post-trial cohort data. Outcomes were cerebrovascular hospitalisation within two years and cerebrovascular re-hospitalisation within ninety days of the previous cerebrovascular hospitalisation. Logistic regression was applied to derive the two risk scores for cerebrovascular hospitalisation and re-hospitalisation from development cohort, which were externally validated in the validation cohort. ResultsThe incidence of cerebrovascular hospitalisation and re-hospitalisation was 3.76% and 1.46% in the development cohort, and 4.99% and 1.87% in the external validation cohort. Age, gender, body mass index, blood pressures, and lipid profiles were included in the final model. Model discrimination was similar in both cohorts, with all C-statistics > 0.70, and very good calibration of observed and predicted individual risks. ConclusionTwo new risk scores that quantify individual risks of cerebrovascular hospitalisation and re-hospitalisation have been well derived and externally validated. Both scores are on the basis of a few of clinical measurements that are commonly available for patients with type 2 diabetes in primary care settings and could work as tools to identify individuals at high risk of cerebrovascular hospitalisation and re-hospitalisation.

Commentary: Glucose Self-monitoring in Non-Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings: A Randomized Trial

Commentary: Glucose Self-monitoring in Non-Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings: A Randomized Trial

Pregnancy in Diabetes: challenges and opportunities for improving pregnancy outcomes.

Our aim was to review the data from the National Pregnancy in Diabetes (NPID) audit, and to identify the challenges and opportunities for improving pregnancy outcomes in women with diabetes. We reviewed three years of NPID data and relevant diabetes and obstetric literature, and found that there has been little change in pregnancy preparation or outcomes over the past 3years, with substantial clinic-to clinic variations in care. Women with Type 2 diabetes remain less likely to take 5mg preconception folic acid (22.8% vs. 41.8%; P<0.05), and more likely to take potentially harmful medications (statin and/or ACE inhibitor 13.0% vs. 1.8%; P<0.05) than women with Type 1 diabetes. However, women with Type 1 diabetes are less likely to achieve the recommended glucose control target of HbA1c <48mmol/mol (6.5%) (14.9% vs. 38.1%; P<0.05). The following opportunities for improvement were identified. First, the need to integrate reproductive health into the diabetes care plans of all women with diabetes aged 15-50years. Second, to develop more innovative approaches to improve uptake of pre-pregnancy care in women with Type 2 diabetes in primary care settings. Third, to integrate insulin pump, continuous glucose monitoring and automated insulin delivery technologies into the pre-pregnancy and antenatal care of women withType 1 diabetes. Fourth, to improve postnatal care with personalized approaches targeting women with previous pregnancy loss, congenital anomaly and perinatal mortality. A nationwide commitment to delivering integrated reproductive and diabetes healthcare interventions is needed to improve the health outcomes of women with diabetes.

Factors affecting risk of anxiety and depression among diabetic and hypertensive patients who refer to family health centers

This cross-sectional study was carried out to investigate the factors which influence risk of anxiety and depression among diabetic and hypertensive patients who refer to family health centers. The Hospital Anxiety and Depression Scale (HADS) was applied for assessment of emotional status of the patients and the Hypertension Compliance Assessment Scale (HCAS) was applied for assessment of adherence to anti-hypertensive therapy. Of a total of 380 patients, 170 had hypertension (HT), 83 had type 2 diabetes mellitus (T2DM), and 127 had both HT and T2DM. According to HADS, 18.7% of the patients had risk of anxiety, 24.7% had risk of depression, and 12.6% had both risk of anxiety and depression. Mean HAD-Anxiety (HADS-A) score and HADS-Depression (HADS-D) score were significantly lower in the patients who had an adequate compliance to medication therapy (5.1 ± 4.1 and 3.8 ± 3.4, respectively) compared to the patients who had a low compliance to therapy (7.6 ± 4.3 and 5.8 ± 4.0, respectively) according to the Hypertension Compliance Assessment Scale (χ 2 = 15.26, p < 0.01 and χ 2 = 13.80, p < 0.01). Mean HADS-D score was found significantly lower among the diabetic patients with good glycemic control (3.7 ± 2.9) compared to the patients with poor glycemic control (4.5 ± 3.7) (χ 2 = 25.00, p < 0.05). Anxiety and depression are among the most frequent disorders as hypertension and diabetes in primary care setting. We revealed that risk of anxiety and/or depression was greater among hypertensive and diabetic patients, consistently with the previous studies. Our study also revealed that this condition negatively affected treatment compliance in hypertensive patients and glycemic control in diabetic patients.

Self-monitoring of blood glucose did not improve HbA1c or QoL at 1 year in non-insulin-treated type 2 diabetes.

Source Citation Young LA, Buse JB, Weaver MA, et al; Monitor Trial Group. Glucose self-monitoring in non-insulin-treated patients with type 2 diabetes in primary care settings: a randomized trial. ...

Glucose Self-monitoring in Non–Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings

The value of self-monitoring of blood glucose (SMBG) levels in patients with non-insulin-treated type 2 diabetes has been debated. To compare 3 approaches of SMBG for effects on hemoglobin A1c levels and health-related quality of life (HRQOL) among people with non-insulin-treated type 2 diabetes in primary care practice. The Monitor Trial study was a pragmatic, open-label randomized trial conducted in 15 primary care practices in central North Carolina. Participants were randomized between January 2014 and July 2015. Eligible patients with type 2 non-insulin-treated diabetes were: older than 30 years, established with a primary care physician at a participating practice, had glycemic control (hemoglobin A1c) levels higher than 6.5% but lower than 9.5% within the 6 months preceding screening, as obtained from the electronic medical record, and willing to comply with the results of random assignment into a study group. Of the 1032 assessed for eligibility, 450 were randomized. No SMBG, once-daily SMBG, and once-daily SMBG with enhanced patient feedback including automatic tailored messages delivered via the meter. Coprimary outcomes included hemoglobin A1c levels and HRQOL at 52 weeks. A total of 450 patients were randomized and 418 (92.9%) completed the final visit. There were no significant differences in hemoglobin A1c levels across all 3 groups (P = .74; estimated adjusted mean hemoglobin A1c difference, SMBG with messaging vs no SMBG, -0.09%; 95% CI, -0.31% to 0.14%; SMBG vs no SMBG, -0.05%; 95% CI, -0.27% to 0.17%). There were also no significant differences found in HRQOL. There were no notable differences in key adverse events including hypoglycemia frequency, health care utilization, or insulin initiation. In patients with non-insulin-treated type 2 diabetes, we observed no clinically or statistically significant differences at 1 year in glycemic control or HRQOL between patients who performed SMBG compared with those who did not perform SMBG. The addition of this type of tailored feedback provided through messaging via a meter did not provide any advantage in glycemic control. clinicaltrials.gov Identifier: NCT02033499.

Glucose self-monitoring in non-insulin-treated patients with type 2 diabetes in primary care settings: A randomized trial

Glucose self-monitoring in non-insulin-treated patients with type 2 diabetes in primary care settings: A randomized trial

The adoption of the Reference Framework for diabetes care among primary care physicians in primary care settings: A cross-sectional study.

The prevalence of diabetes mellitus has been increasing both globally and locally. Primary care physicians (PCPs) are in a privileged position to provide first contact and continuing care for diabetic patients. A territory-wide Reference Framework for Diabetes Care for Adults has been released by the Hong Kong Primary Care Office in 2010, with the aim to further enhance evidence-based and high quality care for diabetes in the primary care setting through wide adoption of the Reference Framework.A valid questionnaire survey was conducted among PCPs to evaluate the levels of, and the factors associated with, their adoption of the Reference Framework.A total of 414 completed surveys were received with the response rate of 13.0%. The average adoption score was 3.29 (SD 0.51) out of 4. Approximately 70% of PCPs highly adopted the Reference Framework in their routine practice. Binary logistic regression analysis showed that the PCPs perceptions on the inclusion of sufficient local information (adjusted odds ratio [aOR] = 4.748, 95%CI 1.597–14.115, P = 0.005) and reduction of professional autonomy of PCPs (aOR = 1.859, 95%CI 1.013–3.411, P = 0.045) were more likely to influence their adoption level of the Reference Framework for diabetes care in daily practices.The overall level of guideline adoption was found to be relatively high among PCPs for adult diabetes in primary care settings. The adoption barriers identified in this study should be addressed in the continuous updating of the Reference Framework. Strategies need to be considered to enhance the guideline adoption and implementation capacity.