Outpatient Diabetes Research Articles

Pharmacist care for hypertension management among patients with diabetes: a systematic review

Abstract Background Improving blood pressure (BP) control is of major importance among patients with diabetes, due to their high risk of micro- and macrovascular complications. Community-based models of care with the involvement of pharmacists and other nonphysician healthcare providers can help manage hypertension. We aimed to estimate the effectiveness of pharmacist interventions, alone or in collaboration, on BP among outpatients with diabetes and hypertension. Methods We conducted systematic searches of randomized controlled trials assessing the effect of pharmacist interventions on BP among outpatients with hypertension and diabetes compared to usual care. The outcome was the systolic and diastolic BP change or BP control. We performed a meta-analysis with random effects models and results are presented by mean difference along with relative 95% CI.We will perform subgroup analyses for the types and intensity (duration, frequeny) of pharmacist interventions, patients’ characteristics, and healthcare settings. The protocol was registered in PROSPERO (CRD42021279751) and published in an open-access peer-reviewed journal. Results Out of 2048 study records identified by electronic database searching, we included 9 studies, with 5067 participants, published between 2008 and 2022. These studies were conducted mainly in North America (n = 5; other regions: n = 4). The intervention was led by the pharmacist in 78% of the studies and in collaboration with other healthcare providers in 22%. Pharmacist intervention included patient education in 67%, healthcare providers education in 11% of studies and feedback to healthcare providers in 44% of the studies. Systolic and diastolic BP were reduced after pharmacist intervention by -5.6 mmHg (95% CI: -10.6 to -0.6) and -4.1 mmHg (95% CI: -7.1 to -1.2) respectively. Additional analyses will be presented at the congress. Conclusions Pharmacist interventions improve blood pressure control in hypertensive diabetic outpatients. Key messages • Recent hypertension guidelines recommend pharmacist involvement in hypertension care management. • This systematic review provide updated evidence on the effect of pharmacist interventions on hypertension management of patients with diabetes.

Prevalence of Vitamin B12 Deficiency in Patients With Type 2 Diabetes Mellitus on Metformin Therapy: A Cross-Sectional Study.

Background Metformin is frequently prescribed as a first-line oral hypoglycemic drug to treat insulin resistance-causing type 2 diabetesmellitus (T2DM). Long-term metformin use results in vitamin B12 deficiency, which is frequently overlooked and undiagnosed. A severe deficit may cause severe anemiaand gastrointestinal, or neurological issues. Studies are scarce onthis issue in Pakistani patients with T2DM. The current study aimed to estimate the prevalence of metformin-induced vitamin B12 deficiency in T2DM patients and to explore how it relates to metformin dosage or duration of therapy. Methodology A descriptive cross-sectional study was conducted on 260 T2DM patients using metformin therapy for more than a year and attending the outpatient diabetes clinic and the medicine department of Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan, from August 2022 to October 2023. All socio-demographic, clinical, and general characteristics were collected. Blood samples were taken to measure the serum vitamin B12 levels, and based on these levels, deficient and normal group characteristics were compared. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). Results Based on the serum levels of vitamin B12 of the studied T2DM on the metformin regimen, the overall prevalence of vitamin B12 deficiency was found to be 36.54% (95). The B12 deficiency was higher among the age group of 41-50 years (109, 41.9%), female gender (150, 57.7%, p-value=0.0035), urban residents (194, 74.6%), non-smokers (197, 75.8%), and with a history of chronic disease (131, 50.4%). There was a statistically significant difference in vitamin B12 levels based on T2DM duration (p=0.012), with a higher prevalence in patients with a longer diabetes history of more than two years. There was no discernible statistical relationship between patients receiving different dosages of metformin (odds ratio (OR)=0.8627; 95% confidence interval (CI) (0.5195, 1.4326); p-value=0.568), durations of metformin (OR=0.7400; 95% CI (0.442, 1.2325); p-value=0.247), or intake of vitamin B12 (OR=0.8532; 95% CI (0.5073, 1.4351); p-value=0.549). Conclusion The prevalence of vitamin B12 deficiency impacted more than one-third of T2DM patients using metformin (36.54%). The risk of vitamin B12 deficiency may increase in females with higher metformin dosages and longer durations of treatment. Furthermore, a statistically significant correlation exists between vitamin B12 deficiency and the longer duration of T2DM. These findings highlight the relevance of routinely monitoring serum levels of vitamin B12 among those with T2DM, especially when metformin is being given for over a year or at doses greater than 1000 mg per day. These preventive strategies will aid in the early detection of vitamin B12 deficiency, allowing patients to be treated with supplementation before problems such as anemia or neuropathies arise, resulting in improved quality of life and a lower socioeconomic burden.

Treatment switch from multiple daily insulin injections to sulphonylureas in an African young adult diagnosed with HNF1A MODY: a case report

BackgroundMaturity onset diabetes of the young is one of the commonest causes of monogenic diabetes and can easily be mistaken for type 1 diabetes. A diagnosis of maturity onset diabetes of the young can have direct implications for genetic counseling, family screening, and precision diabetes treatment. However, the cost of genetic testing and identifying individuals to test are the main challenges for diagnosis and management in sub-Saharan Africa. We report the very first documented case of HNF1A maturity onset diabetes of the young in the sub-Saharan African region.Case presentationA 20-year-old female Black African young adult diagnosed with type 1 diabetes aged 14 presented for routine out-patient diabetes consultation. She was on multiple daily insulin injections; total combined dose 0.79 IU/kg/day with an HbA1c of 7.7%. The rest of her laboratory examinations were normal. On extended laboratory analysis, she had good residual insulin secretion with post-meal plasma C-peptide levels at 1150 pmol/L. She tested negative for glutamic acid decarboxylase (GAD65), islet antigen-2 (IA-2), and zinc transporter 8 (ZnT8) islet autoantibodies. Targeted next-generation sequencing (t-NGS) for monogenic diabetes was performed using DNA extracted from a buccal sample. She was diagnosed with HNF1A maturity onset diabetes of the young, with the c.607C > T; p.(Arg203Cys) pathogenic variant, which has never been reported in sub-Saharan Africa. Her clinical practitioners provided genetic and therapeutic counseling. Within 10 months following the diagnosis of maturity onset diabetes of the young, she was successfully switched from multiple daily insulin injections to oral antidiabetic tablets (sulphonylurea) while maintaining stable glycemic control (HBA1c of 7.0%) and reducing hypoglycemia. She expressed a huge relief from the daily finger pricks for blood glucose monitoring.ConclusionThis case reveals that HNF1A maturity onset diabetes of the young (and probably other causes of monogenic diabetes) can present in sub-Saharan Africa. A diagnosis of maturity onset diabetes of the young can have significant life-changing therapeutic implications.

Utilization of Diabetes Self-Management Education and Support Among Medicare Beneficiaries Newly Diagnosed With Diabetes in Arkansas, 12 Months Postdiagnosis (2015-2018).

The purpose of the study was to determine the rate of diabetes self-management education and support (DSMES) utilization among Medicare fee-for-service (FFS) and Medicare Advantage (MA) populations with type 2 diabetes in Arkansas. The Arkansas All-Payer Claims Database was used to identify Medicare FFS and MA beneficiaries diagnosed with type 2 diabetes from 2015 to 2018. Claims from 2013 to 2020 were analyzed to determine newly diagnosed individuals from 2015 to 2018. The criteria included 1 outpatient diabetes claim in the index year and at least 1 inpatient or outpatient claim in the 2 years following the initial claim. A total of 15 648 Medicare FFS individuals and 7520 MA individuals with newly diagnosed type 2 diabetes were identified. The use of DSMES 1 year following the diagnosis dates for both Medicare FFS and MA populations was assessed. Descriptive statistics and multiple logistic regression analyses were conducted to understand the factors associated with DSMES utilization. DSMES utilization consistently remained lower in the MA population compared to Medicare FFS (2.3% vs 4.9%). The adjusted analysis indicated that factors such as older age, living in a rural area, belonging to a racial group other than White, and MA enrollment were associated with a lower likelihood of receiving DSMES. DSMES utilization in Arkansas, where the prevalence of diabetes is higher than the national average, is notably low. There is a need for coordinated efforts at various levels to enhance access to DSMES.

Scoring Health Behaviors of Patients with Type 2 Diabetes.

Background and Objectives: Millions of people worldwide suffer from diabetes. The ever-increasing number of patients poses a huge challenge to healthcare systems. The purpose of this study was to evaluate the lifestyle and self-monitoring of type 2 diabetes patients using the Healthy Lifestyle and Self-Monitoring Questionnaire. Material and Methods: The analyses conducted were based on data collected using the Polish version of the Healthy Lifestyle and Self-Control Questionnaire among 104 patients diagnosed with type 2 diabetes who were treated at the Diabetes Outpatient Clinic. The in-house study also included an analysis of the relationship between lifestyle habits and disease acceptance and chronic disease functioning. Results: Respondents scored statistically significantly higher for the Healthy Lifestyle and Self-Monitoring Questionnaire than the norms assume, and the largest differences were observed in terms of the healthy dietary choices subscale (t = 8.07; p < 0.05). Only for the subscale of organized exercise were no statistically significant differences found (t = 0.50; p = 0.620). Conclusions: Type 2 diabetes is one of the diseases in which lifestyle not only contributes to its development but is also associated with its course and treatment outcomes. Reinforcing a health-promoting lifestyle is one of the cornerstones of treating patients with type 2 diabetes.

8668 Total And Trunk Body Fat Are Associated With Chronic Kidney Disease Progression In Type 2 Diabetes Patients: A Prospective Study

Abstract Disclosure: T. Zelmanovitz: None. D. Weber: None. C. Pavinatto: None. G. Bello: None. M.R. de Souza: None. R.B. Junior: None. M. Azevedo: None. B.L. Dama: None. S. Silveiro: None. Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease and obesity is considered an independent risk factor for the development and progression of this complication. However, BMI alone, the most commonly used measure to assess adiposity, may not be enough to identification of high risk patients. The ideal markers of adiposity in these patients still need to be better determined. The aim of this study was to evaluate the association between the progression of DKD in type 2 diabetes patients and the following body adiposity markers: BMI, waist circumference (WC) and estimated total and trunk body fat. Research design and methods: In this prospective cohort study, at baseline, type 2 diabetes outpatients were submitted to percentage body fat (PBF) evaluation estimated by bioelectrical impedance (BIA; InBody 230, Biospace, Korea) as well as Dual Energy X-Ray Absorptiometry (DXA; Lunar - iDXA), as a reference standard. Clinical evaluation consisted of glycemic and lipid profile, blood pressure control and the search for diabetic chronic complications. Urinary albumin was measured twice and estimated glomerular filtration rate (eGFR) was estimated by using the CKD-EPI equation. The progression of DKD was defined by the presence of at least one of the following: worsening of albuminuria, a decline of eGFR ≥ 5 ml/min/1.73m2 per year, a decline in eGFR of ≥ 40% from baseline or kidney failure defined by sustained eGFR &amp;lt; 15 ml/min/1.73m2. Results: A total of 201 patients with type 2 diabetes (aged 63 ± 9 years; 42% male), were followed during 6 years. In a multivariate Cox regression analysis, the PBF was associated with progression of DKD (HR=1.04, 95% CI: 1.008 - 1.08; P= 0.015), adjusted for age, gender, using ACE inhibitors or angiotensin receptor blockers, and systolic blood pressure values. In a different model, percentage of trunk fat was also associated with progression of DKD (HR=1.05, 95% CI: 1.02 - 1.09; P= 0.003), adjusted for the same covariates. No association was observed with BMI and WC. Conclusion: In patients with type 2 diabetes, percentage total and trunk body fat, as markers of body adiposity, seem to be associated with progression of DKD. Confirming these findings with further studies, it could provide one more tool in the evaluation and management of a modifiable risk factor of this complication. Presentation: 6/1/2024

Impact of Telemedicine Versus In-Person Pediatric Outpatient Type 1 Diabetes Visits on Immediate Glycemic Control: Retrospective Chart Review.

Children and adolescents with type 1 diabetes require frequent outpatient evaluation to assess glucose trends, modify insulin doses, and screen for comorbidities. Continuous glucose monitoring (CGM) provides a detailed glycemic control assessment. Telemedicine has been increasingly used since the COVID-19 pandemic. To investigate CGM profile parameter improvement immediately following pediatric outpatient diabetes visits and determine if visit modality impacted these metrics, completion of screening laboratory tests, or diabetic emergency occurrence. A dual-center retrospective review of medical records assessed the CGM metrics time in range and glucose management indicator for pediatric outpatient diabetes visits during 2021. Baseline values were compared with those at 2 and 4 weeks post visit. Rates of completion of screening laboratory tests and diabetic emergencies following visits were determined. A total of 269 outpatient visits (41.2% telemedicine) were included. Mean time in range increased by 1.63% and 1.35% at 2 and 4 weeks post visit (P=.003 and .01, respectively). Mean glucose management indicator decreased by 0.07% and 0.06% at 2 and 4 weeks post visit (P=.003 and .02, respectively). These improvements in time in range and glucose management indicator were seen across both telemedicine visits and in-person visits without a significant difference. However, patients seen in person were 2.69 times more likely to complete screening laboratory tests (P=.03). Diabetic emergencies occurred too infrequently to analyze. Our findings demonstrate an immediate improvement in CGM metrics following outpatient visits, regardless of modality. While statistically significant, the magnitude of these changes was small; hence, multiple visits over time would be required to achieve clinically relevant improvement. However, completion of screening laboratory tests was found to be more likely after visits occurring in person. Therefore, we suggest a hybrid approach that allows patient convenience with telemedicine but also incorporates periodic in-person assessment.

Accuracy and reliability of the Ipswich touch test in identifying loss of protective sensation among diabetic patients

ObjectiveTo evaluate the accuracy of the Ipswich touch test compared to the 10-g monofilament test for identifying of loss of protective sensation in Thai patients with diabetes mellitus. MethodsA cross-sectional observational study was conducted on Thai patients with diabetes mellitus who attended routine annual foot check-ups in an outpatient diabetes clinic. The loss of protective sensation was assessed by the Ipswich touch test and compared with the Semmes-Weinstein 10-g monofilament test. Sensitivity, specificity, predictive values and likelihood ratios were calculated to measure the accuracy of the Ipswich touch test against 10-g monofilament as a reference standard. The interrater reliability of the Ipswich touch test was assessed by two raters. ResultsIn a study of 283 diabetic patients, 10-g monofilament detected a 25 % prevalence of loss protective sensation. The Ipswich touch test demonstrated a good diagnostic accuracy, with a sensitivity of 70.8 %, specificity of 98.6 %, and an area under the curve of 0.85 when compared to 10-g monofilament. Positive and negative predictive values were 94.4 % and 90.8 % respectively. The positive likelihood ratio was 49.82, and the negative likelihood ratio was 0.30. Interrater reliability, assessed with two raters in a subset of 93 participants, yielded a kappa of 0.88, indicating almost perfect agreement. ConclusionsThe Ipswich Touch Test demonstrated good accuracy and interrater reliability compared to the standard 10-g monofilament, thus establishing its effectiveness as a valuable diagnostic tool for identifying loss of protective sensation among diabetic patients. However, its relatively low sensitivity suggests it should be used with caution as a screening tool.

Ten years trajectories of estimated glomerular filtration rate (eGFR) in a multiethnic cohort of people with type 1 diabetes and preserved renal function

ObjectivesWe aim to evaluate estimated glomerular filtration rate (eGFR) patterns of progression in a multiethnic cohort of people with type I diabetes mellitus and with baseline eGFR ≥45 mL/min/1.73 m2.DesignObservational...

Frailty Detection in Older Adults with Diabetes: A Scoping Review of Assessment Tools and Their Link to Key Clinical Outcomes.

Objectives: With the increasing prevalence of diabetes and frailty among older adults, there is an urgent need for precision medicine that incorporates comprehensive geriatric assessments, including frailty detection. This scoping review aims to map and synthesize the available evidence on validated tools for detecting pre-frailty and frailty in community-dwelling elderly individuals with diabetes and outpatient diabetes patients. Specifically, it addresses: (1) What validated tools are available for detecting pre-frailty and frailty in this population? (2) How are these tools associated with outcomes such as glycemic control, hypoglycemia, and metabolic phenotypes? (3) What gaps exist in the literature regarding these tools? Methods: The review followed PRISMA-ScR guidelines, conducting a systematic search across PubMed, Cochrane Library, and Web of Science. The inclusion criteria focused on studies involving individuals aged 70 years and older with diabetes, emphasizing tools with predictive capacity for disability and mortality. Results: Eight instruments met the inclusion criteria, including the Frailty Index, Physical Frailty Phenotype, and Clinical Frailty Scale. These tools varied in domains such as physical, psychological, and social aspects of frailty and their association with glycemic control, hypoglycemia, and metabolic phenotypes. The review identified significant gaps in predicting diabetes-related complications and their clinical application. Conclusions: Routine management of older adults with diabetes should incorporate frailty detection, as it is crucial for their overall health. Although widely used, the reviewed tools require refinement to address the unique characteristics of this population. Developing tailored instruments will enhance precision medicine, leading to more effective, individualized interventions for elderly individuals with diabetes.

Efficiency of the Outpatient Diabetes Care System in Czechia: A Geodemographic Perspective

Efficiency of the Outpatient Diabetes Care System in Czechia: A Geodemographic Perspective

Population-level trends in self-reported healthcare utilization among older adults in Mexico with and without cognitive impairment

BackgroundOlder adults with cognitive impairment exhibit different patterns of healthcare utilization compared to their cognitively healthy counterparts. Despite extensive research in high-income countries, similar studies in low- and middle-income countries are lacking. This study aims to investigate the population-level patterns in healthcare utilization among older adults with and without cognitive impairment in Mexico.MethodsData came from five waves (2001–2018) of the Mexican Health and Aging Study. We used self-reported measures for one or more over-night hospital stays, doctor visits, visits to homeopathic doctors, and dental visits in the past year; seeing a pharmacist in the past year; and being screened for cholesterol, diabetes, and hypertension in the past two years. Cognitive impairment was defined using a modified version of the Cross Cultural Cognitive Examination that assessed verbal memory, visuospatial and visual scanning. Total sample included 5,673 participants with cognitive impairment and 34,497 without cognitive impairment interviewed between 2001 and 2018. Generalized Estimating Equation models that adjusted for time-varying demographic and health characteristics and included an interaction term between time and cognitive status were used.ResultsFor all participants, the risk for one or more overnight hospital stays, doctor visits, and dental visits in the past year, and being screened for diabetes, hypertension, and high cholesterol increased from 2001 to 2012 and leveled off or decreased in 2015 and 2018. Conversely, seeing a homeopathic doctor decreased. Cognitive impairment was associated with higher risk of hospitalization (RR = 1.13, 1.03–1.23) but lower risk of outpatient services (RR = 0.95, 0.93–0.97), cholesterol screening (RR = 0.93, 0.91–0.96), and diabetes screening (RR = 0.95, 0.92–0.97).No significant difference was observed in the use of pharmacists, homeopathic doctors, or folk healers based on cognitive status. Interaction effects indicated participants with cognitive impairment had lower risk for dental visits and hypertension screening but that these trajectories differed over time compared to participants without cognitive impairment.ConclusionsWe identified distinct population-level trends in self-reported healthcare utilization and differences according to cognitive status, particularly for elective and screening services. These findings highlight the necessity for policy interventions to ensure older adults with cognitive impairment have their healthcare needs met.

Mortality patterns in Dutch diabetes outpatients.

Diabetes mellitus is a major cause of death. Outpatients with diabetes have more complications than patients in general practice; mortality patterns have only been studied in the total diabetes population. This study aims to assess mortality, causes, and predictors in outpatients with diabetes. A cohort study, included people with diabetes mellitus from the nationwide Dutch Paediatric and Adult Registry of Diabetes (DPARD) visiting diabetes outpatient clinics in 2016-2020. DPARD data were linked to Statistics Netherlands (CBS), comprising data on mortality, ethnicity and education. All-cause and cardiovascular mortality rates were estimated using Cox proportional hazard regression. During a median follow-up of 3.1 years among 12 992 people with diabetes, mortality rates per 10 000 person-years were 67.7 in adult type 1 diabetes and 324.2 in type 2 diabetes. The major cause of non-cardiovascular death was malignancy. During the pandemic years of influenza (2018) and COVID (2020), mortality rates peaked. Age, smoking and an estimated glomerular filtration rate of <60 ml/min were associated with all-cause mortality. In type 2 diabetes, additional factors were male sex, body mass index <20 kg/m2, diabetes duration <1 year and hypertension. Mortality among Dutch outpatients with diabetes is high. Smoking and renal failure were associated with mortality in both types. Further focus on early detection and treatment of mortality-associated factors may improve clinical outcomes.

The frequency of cachexia and its associated factors in elderly diabetic patients with chronic diseases: A study using the diagnostic criteria of the Asian Working Group for Cachexia

To evaluate the frequency of cachexia and its associated factors using the Asian Working Group for Cachexia (AWGC) criteria in elderly patients with diabetes and chronic diseases. The subjects were diabetic outpatients of ≥65 years of age who were managed at Ise Red Cross Hospital. Patients with chronic disease (chronic heart failure, cancer, or chronic renal failure). Cachexia was evaluated based on the AWGC criteria and was defined as a body mass index (BMI) <21 kg/m2 and one or more of the following: anorexia, elevated C-reactive protein, and decreased grip strength. A logistic regression analysis was used to identify cachexia-related factors, with cachexia as the dependent variable, and various variables (basic attributes, blood glucose-related parameters, diabetic complications, comorbidities, and treatment) as explanatory variables. Two hundred forty-two patients (male, n=164; female, n=78) were included in the study. Forty patients (16.5%) had cachexia. A logistic analysis revealed that age (odds ratio (OR), 1.16; P<0.001), type 1 diabetes (OR, 15.25; P=0.002), diabetic retinopathy (OR, 5.72; P=0.001), and physical frailty (OR, 7.06; P<0.001) were associated with cachexia. Elderly diabetics with chronic diseases were more likely to have cachexia. According to the AWGC criteria, the frequency of cachexia was 16.5% in elderly patients with diabetes and chronic diseases. Additionally, type 1 diabetes, diabetic retinopathy, age, and physical frailty were identified as factors associated with cachexia. In elderly diabetes patients with chronic diseases, it is therefore important to raise awareness regarding cachexia when these related factors are diagnosed.

Stenopool: A Comprehensive Platform for Consolidating Diabetes Device Data.

The growing adoption of diabetes devices has highlighted the need for integrated platforms to consolidate data from various vendors and device types, enhancing the patient experience and treatment. This shift could pave the way for a transition from conventional outpatient diabetes clinics to advanced home monitoring and virtual care methods. Overall, we wished to empower individuals with diabetes and healthcare providers to interpret and utilize information from diabetes devices more effectively. Stenopool integrates most diabetes devices for glucose monitoring and insulin administration in our clinic. The platform was initially developed with inspiration from open-source software, and the current version is a unique digital platform for managing and analyzing diabetes device data. The development process, outcomes, and status are described. Since November 2021, Stenopool has been used in our outpatient clinic to integrate over 30 different diabetes devices from around 7000 individuals. Data are primarily uploaded via wired connections, but also using semi-automated and automated cloud-to-cloud data transfers. The platform offers a streamlined workflow for healthcare providers and displays data from various glucose meter, insulin pump, and continuous glucose monitor (CGM) vendors on a single screen in a manner that healthcare providers can modify. A data warehouse with data from Stenopool and electronical health records is nearing completion, preparing the development of tools for population health management, quality assessment, and risk stratification of patients. Using Stenopool, we aimed to enhance diabetes device data management, facilitate the future for virtual patient care pathways, and improve outcomes. This article outlines the platform's development process and challenges.

Receipt of Diabetes Specialty Care and Management Services by Older Adults With Diabetes in the U.S., 2015-2019: An Analysis of Medicare Fee-for-Service Claims.

We characterized the receipt of diabetes specialty care and management services among older adults with diabetes. Using a 20% random sample of fee-for-service Medicare beneficiaries aged ≥65 years, we analyzed cohorts of type 1 diabetes (T1D) or type 2 diabetes (T2D) with history of severe hypoglycemia (HoH), and all other T2D annually from 2015 to 2019. Outcomes were receipt of office-based endocrinology care, diabetes education, outpatient diabetes health services, excluding those provided in primary care, and any of the aforementioned services. In the T1D cohort, receipt of endocrinology care and any service increased from 25.9% and 29.2% in 2015 to 32.7% and 37.4% in 2019, respectively. In the T2D with HoH cohort, receipt of endocrinology care and any service was 13.9% and 16.4% in 2015, with minimal increases. Age, race/ethnicity, residential setting, and income were associated with receiving care. These findings suggest that many older adults may not receive specialty diabetes care and underscore health disparities.

Association of dietary total antioxidant capacity with general and abdominal obesity in type 2 diabetes mellitus patients.

The dual existence of Type 2 Diabetes Mellitus (T2DM) and obesity within a single individual may describe a combined adverse health effects, including impaired quality of life and increased risk for cardiovascular diseases (CVDs). Oxidative stress is a contributing factor to the pathogenesis of obesity. Meanwhile, dietary antioxidants may improve the antioxidant defense system and thereby decrease oxidative injury. Dietary total antioxidant capacity (TAC) is usually used to investigate the potential health effects of dietary antioxidant intake on several oxidative stress induced chronic diseases. This study aimed to examine the association of dietary TAC with obesity-related features in T2DM patients. The present study included 254 type 2 diabetes outpatients with a mean (SD) age of 54.52 (7.21) years and mean (SD) diabetes duration of 8.2 (6.4) years. Data on dietary intake was assessed using a validated food frequency questionnaire. Dietary TAC was estimated by ferric reducing antioxidant potential (FRAP) method. Anthropometric, clinical and lifestyle characteristics were all collected. In linear regression analyses, dietary antioxidant capacity was inversely associated with body mass index (β = -0,231; 95% CI, -0,419 to -0,042), waist circumference (β = -0,427; 95% CI, -0,849 to -0,006) and fat mass percentage (β = -0,328; 95% CI, -0,545 to -0,112) independently of the assessed confounding variables. Interestingly, dietary TAC showed positive and significant associations with vitamin A, vitamin C, β-carotene, magnesium, folic acid and iron intakes, after adjusting for age and daily energy intake. Higher intake of dietary TAC was in association with lower indices of general and central obesity in T2DM patients. Therefore, dietary recommendations for counteracting obesity in patients with T2DM should take into account a high dietary TAC.

Assessing the feasibility and acceptability of a diabetes-specific nurse-led multicomponent smoking cessation intervention in diabetes education: study protocol for an open-label pragmatic randomised controlled trial

IntroductionSmoking cessation is an essential, but often overlooked aspect of diabetes management. Despite the need for tailored smoking cessation support for individuals with diabetes, evidence of effective interventions for this...

Dietary compliance and its determinants among type 2 diabetes patients in Tamale Metropolis, Ghana

BackgroundThe prevalence of type 2 diabetes is currently high and still rising, predominantly in developing countries including Ghana. Type 2 diabetes patients’ adherence to recommended diet is shown to improve their health outcomes. This study investigated dietary compliance and its determinants among type 2 diabetes patients in Tamale Metropolis, Ghana.MethodsThis study employed analytical cross-sectional study design and involved 343 participants selected through systematic random sampling from the outpatient diabetes clinics of Tamale Teaching Hospital, Tamale West Hospital and Tamale Central Hospital. A semi-structured questionnaire was used to document participants’ socio-demographic, lifestyle and clinical characteristics. The modified Morisky dietary adherence scale was used to assess dietary compliance. Bivariate and multivariate analyses were performed to determine the predictors of dietary compliance.ResultsThe mean age of participants was 56.4 ± 15.7 years. More than half of the participants (62.4%) were females. The participants had a higher compliance status (70.6%). The study also revealed that, as a patient’s age increases, compliance decreases [Adjusted odd ratio (AOR): 0.96, 95%, Confidence interval (CI) 0.94–0.99, P = 0.002]. Regarding educational status, patients who completed JHS/Middle School [AOR: 2.458, 95% CI 1.019–5.928, P = 0.045] and SHS/Vocational School [AOR: 2.73, 95% CI 1.08–6.91, P = 0.035] were more likely to comply with dietary recommendations compared to those with no formal education.ConclusionThe rate of dietary compliance was high among the study participants. Age and educational status of participants significantly influenced their dietary compliance, suggesting that these factors should be taken into account when developing strategies to enhance dietary adherence.

1107-P: Reporting on the Full Clinical Implementation of the Digital Danish National PROMS Tool—Optimising Routine Diabetes Outpatient Care and Connecting Each Person with Diabetes Directly with the National IT-Infrastructure

1107-P: Reporting on the Full Clinical Implementation of the Digital Danish National PROMS Tool—Optimising Routine Diabetes Outpatient Care and Connecting Each Person with Diabetes Directly with the National IT-Infrastructure