Diabetic Patients In Primary Care Research Articles

What primary care physicians think about insulin initiation in type 2 diabetes: a field-based study.

A significant number of patients with type 2 diabetes mellitus require insulin and little is known about the possible physician-related factors that could cause a delay in the initiation of insulin treatment in patients with type 2 diabetes. This study aimed to evaluate those factors. A total of 87 family physicians working at 36 family health centers in urban Malatya participated in our study on a voluntary basis. A self-administered survey form was structured to gather the views of the primary care physicians. The survey was developed based on a review of the literature. The survey consisted of Likert scale item questions regarding knowledge about the disease of diabetes mellitus and the views of the primary care physicians regarding insulin initiation for type 2 diabetic patients. Almost half of the participants (42.5%, n = 37) felt incompetent in the starting dosage adjustment and 40.2% (n = 35) of the participants felt incompetent in maintaining the appropriate dosage adjustment. In terms of sex, female family physicians were found to be more uncertain about the timing of initiating insulin treatment for diabetic patients. This study shows the necessity of continuous education activities and interventions to promote motivation in family physicians to improve care of diabetic patients in primary care.

Continued smoking abstinence in diabetic patients in primary care: A cluster randomized controlled multicenter study

To assess the effectiveness of an intensive smoking cessation intervention based on the transtheoretical model of change (TTM) in diabetic smokers attending primary care. A cluster randomized controlled clinical trial was designed in which the unit of randomization (intervention vs. usual care) was the primary care team. An intensive, individualized intervention using motivational interview and therapies and medications adapted to the patient's stage of change was delivered. The duration of the study was 1 year. A total of 722 people with diabetes who were smokers (345 in the intervention group and 377 in the control group) completed the study. After 1 year, continued abstinence was recorded in 90 (26.1%) patients in the intervention group and in 67 (17.8%) controls (p=0.007). In patients with smoking abstinence, there was a higher percentage in the precontemplation and contemplation stages at baseline in the intervention group than in controls (21.2% vs. 13.7%, p=0.024). When the precontemplation stage was taken as reference (OR=1.0), preparation/action stage at baseline showed a protective effect, decreasing 3.41 times odds of continuing smoking (OR=0.293 95% CI 0.179-0.479, p<0.001). Contemplation stage at baseline also showed a protective effect, decreasing the odds of continuing smoking (OR=0.518, 95% CI 0.318-0.845, p=0.008). An intensive intervention adapted to the individual stage of change delivered in primary care was feasible and effective, with a smoking cessation rate of 26.1% after 1 year.

Measuring quality of life of old type 2 diabetic patients in primary care in Portugal: a cross-sectional study.

BackgroundWith the increasing prevalence of diabetes in patients aged over 75, the task of ensuring a good quality of life became even greater. This study aimed to evaluate quality of life of the very elderly (≥75 years) type 2 diabetic primary care patient, in an urban family practice setting.MethodsA cross sectional study was conducted. Quality of life (QoL) was assessed with the Portuguese version of EASY-Care. Descriptive and inferential analyses were performed.ResultsEighty three elderly type 2 diabetics were included in the study, with a mean age of 80.9 ± 4.3 years old. Most were women, widowed or married, with low educational levels, living with family members in urban areas and presented medium/low incomes. Participants were diagnosed with diabetes for 11.2 ± 10.1 years. Most of them were treated with oral antidiabetic agents, presented complications of diabetes and had good glycemic control. Despite that, excess weight, uncontrolled blood pressure and poor lipid management were noticed.In general, the participants perceived a positive quality of life. The worst perceived domain was “mental health and well-being”. Within the sociodemographic variables, gender, monthly income, and living arrangements interfered the most with the quality of life domains. Studied clinical variables affected quality of life very modestly.ConclusionsIn an urban primary care setting, when treating very elderly type 2 diabetic patients, and despite good glycemic control, attention should be paid to the QoL of women, the low income diabetics, their living arrangements and thoroughly evaluate the mental health and well-being of these patients.

Effectiveness and cost‐effectiveness of 3‐monthly versus 6‐monthly monitoring of well‐controlled type 2 diabetes patients: a pragmatic randomised controlled patient‐preference equivalence trial in primary care (EFFIMODI study)

To investigate effectiveness and cost-effectiveness of 6-monthly monitoring compared with 3-monthly monitoring of well-controlled type 2 diabetes patients in primary care. A pragmatic randomised controlled patient-preference equivalence trial was performed. From April 2009 to August 2010, 2215 patients from 233 general practitioners across the Netherlands were included. Patients were eligible if between 40- and 80-years-old, diagnosed with type 2 diabetes for more than a year, treated by their general practitioner, not on insulin treatment and well-controlled during the last year (HbA1c ≤ 58 mmol/mol, systolic blood pressure ≤ 145 mmHg and total cholesterol ≤ 5.2 mmol/l). Patients without a strong preference for their monitoring frequency were randomised to 3-monthly or 6-monthly monitoring. Follow-up was 18 months. The primary outcome is the percentage of patients remaining under: HbA1c ≤ 58 mmol/mol, systolic blood pressure ≤ 145 mmHg and total cholesterol ≤ 5.2 mmol/l. Equivalence was assumed if the two-sided 95% confidence interval (CI) was between -5 and 5%. Cost-effectiveness was determined using a cost-minimisation analysis. In the 3-monthly group 69.5% remained under good cardiometabolic control, versus 69.8% in the 6-monthly group (difference: 0.3%; 95%CI: -6.2-6.7%). All secondary outcomes were equivalent for 3-monthly and 6-monthly monitoring, except the systolic blood pressure target, physical activity and antihypertensive drug use. Six-monthly monitoring was €387 (£333) cheaper per patient compared to 3-monthly monitoring during the study period. Patients with good cardiometabolic control and without preference for their monitoring frequency can visit the primary care physician less often. The cost-savings can be considerable.

Prevalence of complications among Chinese diabetic patients in urban primary care clinics: a cross-sectional study.

BackgroundA territory-wide diabetes management program (Risk Assessment Management Program – RAMP) was recently established, providing comprehensive management for all diabetics, helping to delineate current level of control and complications prevalence among primary care diabetic patients in Hong Kong.MethodThis cross-sectional study captured anonymous clinical data from RAMP patients. Data obtained include sociodemographic details, type of diabetes, illness duration, family history, drug usage, coexisting illnesses, diabetic complications and other clinical parameters.ResultsData from 15,856 type 2 diabetic patients were analyzed. 57.1% were above 60 years old, with mean disease duration of 7.3 years. Hypertension was the commonest coexisting chronic illness (57.6%). 30.2% and 61.8% have their systolic and diastolic pressure controlled to below 130 mmHg and 80 mmHg respectively. Over half (51.5%) had an HbA1c level of less than 7.0%. 88.4% did not achieve target lipid level. 15% were on diet control alone. Only 22.2% were on statins. In patients with microalbuminuria and macroalbuminuria, 40.7% and 54.5% were on angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) respectively. 12.9%, 38.8% and 2.4% had diabetic retinopathy, nephropathy and neuropathy respectively. Overall, 37.9%, 7.3% and 0.4% had single, two and three concurrent microvascular complications respectively.ConclusionThe level of diabetic control is comparable with other developed countries. We demonstrated a high prevalence of microvascular complications among Chinese primary care patients despite achieving adequate HbA1c levels, highlighting the importance of managing all aspects of diabetes including weight, lipid and blood pressure. Efforts to improve holistic management must be tailored according to the needs of our population, with the challenges that the majority have low educational background and in the older age group.

EPA-0023 – Diabetes and major depressive disorder interaction: no effect of baseline diabetic control on six month depression outcomes

Prior studies have demonstrated an inter-relationship between the diagnosis of diabetes, obesity and depression. Our prior studies have shown that the diagnosis of diabetes or baseline body mass index (BMI) did not impact six month depression remission rates. Our hypothesis was that level of control of diabetes (hemoglobulin A1c < 8.0%) in depressed diabetic patients would have no effect on depression remission rates six months after diagnosis. This study was retrospective analysis of 451 diabetic primary care patients diagnosed with Major Depressive Disorder or Dysthymia with a PHQ-9 score of 10 or greater. ▪ Outcome variable was clinical remission (PHQ-9 < 5) at six months. ▪ Logistic regression modeling included the demographic variables of age, gender, marital status, the clinical variables of BMI, baseline PHQ-9 score, hemoglobin A1c level (at date of diagnosis of depression) and clinical diagnosis (recurrent or first episode of depression, or dysthymia). 78.5% (354) of depressed diabetics were in good control of diabetes (hemoglobin A1c< 8%) at enrollment. Obesity (BMI≥ 30) at baseline was not different between the controlled and uncontrolled diabetic patients at baseline (approximately 70%), p=0.36. Figure 1 Odds ratio for clinical remission (PHQ-9<5) at six months in diabetic primary care patients, by variable (N=451). Controlling for age, gender, marital status, race, clinical diagnosis and clinical site. ▪ Baseline control of diabetes was not an independent predictor for depression outcome at six months. This data suggests that poor diabetic control was not associated worsening clinical outcomes in depression management.

Web-based self-management with and without coaching for type 2 diabetes patients in primary care: design of a randomized controlled trial.

BackgroundSelf-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs have the potential of supporting type 2 diabetes patients with managing their diabetes and reducing the workload for the care provider, where the addition of online coaching could improve patient motivation and reduce program attrition. This study aims to test the hypothesis that a web-based self-management program with coaching will prove more effective on improving patient self-management behavior and clinical outcome measures than a web-based self-management program without coaching.MethodsThe effects of a web-based self-management program with and without coaching will be tested with a nested randomized controlled trial within a healthcare group in the Netherlands. In one year 220 type 2 diabetes patients will be randomized into an intervention group (n = 110) or a control group (n = 110). The control group will receive only the online self-management program. The intervention group will receive the online self-management program and additional online coaching. Participants will be followed for one year, with follow-up measurements at 6 and 12 months.DiscussionThe intervention being tested is set to support type 2 diabetes patients with their diabetes self-management and is expected to have beneficial effects on self-care activities, well being and clinical outcomes. When proven effective this self-management support program could be offered to other health care groups and their type 2 diabetes patients in the Netherlands.Trial registrationNederlands Trial Register NTR4064

Development and validation of the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ) for primary care patients with type 2 diabetes.

ObjectivesTo develop and evaluate the psychometric properties of a Chinese questionnaire which assesses the barriers and enablers to commencing insulin in primary care patients with poorly controlled Type 2 diabetes.Research Design and MethodQuestionnaire items were identified using literature review. Content validation was performed and items were further refined using an expert panel. Following translation, back translation and cognitive debriefing, the translated Chinese questionnaire was piloted on target patients. Exploratory factor analysis and item-scale correlations were performed to test the construct validity of the subscales and items. Internal reliability was tested by Cronbach’s alpha.ResultsTwenty-seven identified items underwent content validation, translation and cognitive debriefing. The translated questionnaire was piloted on 303 insulin naïve (never taken insulin) Type 2 diabetes patients recruited from 10 government-funded primary care clinics across Hong Kong. Sufficient variability in the dataset for factor analysis was confirmed by Bartlett’s Test of Sphericity (P<0.001). Using exploratory factor analysis with varimax rotation, 10 factors were generated onto which 26 items loaded with loading scores > 0.4 and Eigenvalues >1. Total variance for the 10 factors was 66.22%. Kaiser-Meyer-Olkin measure was 0.725. Cronbach’s alpha coefficients for the first four factors were ≥0.6 identifying four sub-scales to which 13 items correlated. Remaining sub-scales and items with poor internal reliability were deleted. The final 13-item instrument had a four scale structure addressing: ‘Self-image and stigmatization’; ‘Factors promoting self-efficacy; ‘Fear of pain or needles’; and ‘Time and family support’.ConclusionThe Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ) appears to be a reliable and valid measure for assessing barriers to starting insulin. This short instrument is easy to administer and may be used by healthcare providers and researchers as an assessment tool for Chinese diabetic primary care patients, including the elderly, who are unwilling to start insulin.

Predictors of hypoglycaemia in insulin-treated type 2 diabetes patients in primary care: A retrospective database analysis

AimsTo investigate the frequency and predictors (diabetes care and treatment, comorbidity) of documented hypoglycaemia in primary care patients with insulin-treated type 2 diabetes. MethodsData from 32,545 patients (mean age: 70 (SD 11) years, 50.3% males) from 1072 practices were retrospectively analyzed (Disease Analyzer database Germany: 09/2011–08/2012). Logistic regression (≥1 documented hypoglyemia) was used to adjust for confounders (age, sex, practice characteristics, diabetes treatment regimen). ResultsThe prevalence of patients (12 months) with at least one reported hypoglycaemia was 2.2% (95% CI: 2.0–2.4%). The adjusted odds of having hypoglycemia were increased for renal failure (OR; 95% CI: 1.26; 1.16–1.37), autonomic neuropathy (1.34; 1.20–1.49), and adrenocortical insufficiency (3.08; 1.35–7.05). Patients with mental disorders including dementia (1.49; 1.31–1.69), depression (1.24; 1.13–1.35), anxiety (1.18; 1.01–1.37), and affective disorders (1.80; 1.36–2.38) also showed an increased odds of having hypoglycemia. Location of the practice in an urban area was associated with a lower odds ratio (0.74; 0.68–0.80). ConclusionsBoth individual patient characteristics (e.g. comorbidity) and regional factors (practice location) have a substantial impact on hypoglycaemia in primary care patients with insulin therapy.

PDB85 - Diabetic Patients in Primary Care: Self-Perception and Satisfaction. Comparative Study Spain Versus Europe

EUprimecare is an European Union project aimed at analyzing the costs and quality of the different models of primary care (PC) in Europe. The aim of this study is to analyze the management of diabetic patients in PC services in Spain compared to other European countries, the satisfaction of these patients with PC services and their self-perceived health status. We conducted a population survey by telephone among PC users in each of the consortium countries (Germany, Spain, Estonia, Finland, Hungary, Italy and Lithuania). The questionnaire included information on sociodemographic characteristics, health status, satisfaction, utilization of PC services, and frequency of some interventions carried out by PC professionals. The survey was conducted to 431-432 PC users in each country (Ntotal = 3020). The percentage of diabetic patients in Spain was 6.7% (N = 29), lower than the overall average (9.1%). Eighty three percent of patients living in Spain were diagnosed by their PC physicians compared with 73% of the European average. Eighty six percent of patients in Spain said that they were being treated for diabetes (EU average = 84%) and in 88% of these cases the treatment was prescribed by their PC doctor (EU average = 70%). Only 6.9% of patients said their health was poor or very poor, the lowest proportion of all countries assessed. The overall satisfaction with PC services among diabetic patients was 4.10 points on a scale of 1 to 5. Satisfaction in Spain was below the global average for all the items measured. Diabetic patients in Spain are more frequently controlled by PC professionals than in other European countries. These patients have a better self-perceived health status and the results of this study suggest a lower level of dissatisfaction with the services provided by PC.

Clinical inertia in the treatment of hyperglycemia in type 2 diabetes patients in primary care

Objective:To assess clinical inertia, defined as failure to intensify antidiabetic treatment of patients who have not achieved the HbA1c therapeutic goal (≤7%).Research design and methods:Multicenter cross-sectional study. Clinical inertia was assessed in a random sample of type 2 diabetes mellitus (T2DM) patients seen in primary care centers.Results:A total of 2783 patients (51.3% males; mean age: 68 [±11.5] years; diabetes duration: 7.1 [±5.6] years; mean HbA1c: 6.8 [±1.5]) were analyzed. Of those, 997 (35.8%) had HbA1c >7%. Treatment was intensified in 66.8% and consisted of: dose increase (40.5%); addition of oral antidiabetic (45.8%); or insulin treatment initiation (3.7%). Mean HbA1c values in patients for whom treatment was intensified vs. non-intensified were 8.4% (±1.2) vs. 8.2% (±1.2), p < 0.05. Clinical inertia was detected in 33.2% of patients and diminished along with treatment complexity: lifestyle changes only (38.8%), oral monotherapy (40.3%), combined oral antidiabetics (34.5%), insulin monotherapy (26.1%) and combination of insulin and oral antidiabetics (21.4%). Clinical inertia decreased as HbA1c increased: 37.3% for HbA1c values ranging between 7.1%–8%; 29.4% for the 8.1%–9% HbA1c range and 27.1% for HbA1c ≥9%. Multivariate analysis confirmed that diabetes duration, step of treatment and HbA1c were related to inertia. For each unit of HbA1c increase clinical inertia decreased 47% (OR: 0.53).Limitations:The retrospective design of the study precluded an accurate investigation about reasons for lack of intensification that could actually be justified by some patient conditions, especially patients’ lack of adherence.Conclusions:Clinical inertia affected one third of T2DM patients with poor glycemic control and was greater in patients treated with only lifestyle changes or oral monotherapy. Treatment changes were performed when mean HbA1c values were 1.4 points above therapeutic goals.

Intensification of insulin therapy for type 2 diabetic patients in primary care: basal-bolus regimen versus premix insulin analogs: when and for whom?

In April 2012, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a joint position statement regarding treatment of hyperglycemia in type 2 diabetes, “Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach” (1). As most diabetic patients (>366 million worldwide) (2) are treated by their primary family physician and not by an endocrinologist or diabetologist, the guidelines were intended to help physicians choose the best treatment for their patients. Some of the advantages of this position statement, over previous guidelines (3–8), are as follows: emphasizing the importance of individualization of treatment, widening treatment options, and stating the pros and cons of the different treatment option. However, as the statement was written by a group of world-known diabetologists, without the input of nurses, dietitians, family physicians, or the patients themselves, questions have been raised as to how “patient-centered” it actually is and how useful and relevant it is to the primary care setting. Choosing the best insulin regimen for initiation and intensification of insulin therapy in type 2 diabetic patients is still debatable both in the specialist clinic and in the primary care setting. The intention of this article is to review the data available and offer reasonable guidance regarding the selection of the preferred insulin regimen for initiation and intensification of insulin treatment, especially in a primary care setting. The ADA/EASD statement includes recommendations for the initiation and titration of insulin therapy (1). The recommendations point out three important aspects that need to be addressed when choosing or adjusting insulin regimens: the number of injections needed and the complexity and the flexibility of the regimens. The insulin regimens under consideration include basal insulin, premixed, basal insulin with one premeal short-acting insulin injection (referred to as basal plus regimen), and …

The contextual influence of coal abandoned mine lands in communities and type 2 diabetes in Pennsylvania

Coal abandoned mine lands (AMLs), persistent and prevalent across Pennsylvania, offer an instructive evaluation of potential contextual influences of chronic environmental contamination (CEC) on individual health. We evaluated associations between the burden of AMLs, represented by 10 contextual metrics at the community level, and individual-level type 2 diabetes using hemoglobin A1c (HbA1c) as a biomarker. Cross-sectional and longitudinal multilevel analyses were conducted with over 28,000 diabetic primary care patients of the Geisinger Clinic. Adjusted models revealed five AML burden measures were associated (p<0.05), and three additional were borderline associated (0.05≤p≤0.10), with higher and/or change in HbA1c levels. This study provides key empirical evidence of adverse impacts of CEC in communities on an important chronic disease, illustrating the contextual effects of living in long-term degraded landscapes and communities.

Changes in time to insulin initiation in type 2 diabetes patients: A retrospective database analysis in Germany and UK (2005–2010)

AimsTo study whether the time to insulin therapy in type 2 diabetic patients in primary care in Germany and UK has increased (2005–2010). MethodsLongitudinal data from general practices in Germany and UK (Disease Analyser) from 1995 to 2010 were analyzed. Patients who started their insulin treatment from 2005 to 2010 were analyzed regarding the time from the first diabetes diagnosis in the practices (index date) and the first insulin prescription, including 6368 patients (age: 68 (SD: 12) years) in Germany and 1998 patients (age: 64 (12) yrs) in UK. ResultsMedian (interquartile range) time to insulin therapy in the practices increased from 943 (214–1994) days in 2005 to 1549 (957–2533) days in 2010 (p<0.001). In UK, time to onset of insulin treatment increased from 1700 (649–2521) days in 2005 to 2061 (1309–2686) days in 2010 (p<0.001). The last HbA1c values before insulin initiation were high and slightly increased during the study period (Germany: 2005: 8.2%, 2010: 8.4%; UK: 2005: 9.5%, 2010: 9.8%; both p<0.001). ConclusionsThis real world data shows that the time to insulin therapy has increased in type 2 diabetes patients from 2005 to 2010 (Germany, UK). The average HbA1c values before insulin therapy also slightly increased during this period.

Comparative Study of Compliance Between Hospital and Primary Care Diabetic Patients

Modern day chronic diseases such as diabetes are related with the lifestyle, especially unhealthy diet and physical inactivity. This study aims to determine the level of compliance of diabetic patients with their doctors' advice about diet and physical activity, comparing ambulatory patients with those who were recently hospitalized. We developed a combined database of the two studies. Both studies were cross-sectional studies using systematic random sampling comprising patients of T2DM, and including the following variables: health facility used by the patient; age; gender; marital status; education; whether the patient received health education in the past; patient's weight and height and presence of other diseases; family history of diabetes; current smoking; dietary habits; and exercise. We used the SPSS data reduction method factor analysis to summarize the data on these two dimensions (diet and exercise) into a single summary variable each. The total number of diabetic patients included in this study was 442. Prevalence of smoking was 7.2% (6.3% among PHC patients and 9.4% among hospital patients; p=0.16). A little more than one third of the PHC patients and nearly three fourth of hospital patients had hypertension, coronary artery disease (CAD) or both (p<0.001). Similarly, a significantly greater proportion of the hospital patients had a family history of diabetes (p<0.001). Obesity was significantly higher among the PHC patients (p=0.011). The prevalence of unhealthy diet was significantly higher among hospital patients (p<0.001). Percentage of patients having unhealthy diet was significantly higher in among hospital patients in both sexes (p < 0.05), and in the 40-59 age-group; having secondary and higher level education, the prevalence of unhealthy diet was several times higher among hospital patients (p < 0.001); same was true among married patients, where the percentage of unhealthy diet was almost twice among hospital patients (p < 0.001). Finally, the prevalence of unhealthy diet was significantly higher among non-obese hospital patients than the non-obese PHC patients (p = 0.001). The prevalence of physical inactivity among male hospital patients was significantly higher than the male PHC patients (p=0.028). In the age 60 years and above, physical inactivity was significantly higher among hospital patients (p < 0.001). Similarly, among patients having less than secondary school education, physical inactivity was significantly higher among hospital patients (p = 0.002). Prevalence of unhealthy diet is significantly higher among hospital patients. We conclude that health care providers in Saudi Arabia should put greater emphasis on health education about diet and exercise. with T2DM.

Type II diabetes patients in primary care: profiles of healthcare utilization obtained from observational data

BackgroundThe high burden of diabetes for healthcare costs and their impact on quality of life and management of the disease have triggered the design and introduction of disease management programmes (DMPs) in many countries. The extent to which diabetes patients vary with regard to their healthcare utilisation and costs is largely unknown and could impact on the design of DMPs. The objectives of this study are to develop profiles based on both the diabetes-related healthcare utilisation and total healthcare utilisation in primary care, to investigate which patient and disease characteristics determine ‘membership’ of each profile, and to investigate the association between these profiles.MethodsData were used from electronic medical records of 6721 known type II diabetes patients listed in 48 Dutch general practices. Latent Class Analyses were conducted to identify profiles of healthcare and regression analyses were used to analyse the characteristics of the profiles.ResultsFor both diabetes-related healthcare utilisation and total healthcare utilisation three profiles could be distinguished: for the diabetes-related healthcare utilisation these were characterised as ‘high utilisation and frequent home visits’ (n=393), ‘low utilisation, GP only’ (n=3231) and ‘high utilisation, GP and nurse’ (n=3097). Profiles differed with respect to the patients’ age and type of medication; the oldest patients using insulin were dominant in the ‘high utilisation, GP and nurse’ profile. High total healthcare utilisation was not associated with high diabetes-related healthcare utilisation.ConclusionsHealthcare utilisation of diabetes patients is heterogeneous. This challenges the development of distinguishable DMPs.

Évaluation de la prise en charge des diabétiques par le médecin généraliste dans la province de Khouribga (Maroc)

Diabetes is a disease of concern due to its increasing frequency and high cost of care. This cross-sectional study evaluated the types of care provided to diabetes patients in primary care for management of the condition. Between December 2010 and March 2011, 54 general practitioners (CPs) in health centres in Khouribga province were asked to complete a pretested questionnaire on their care of diabetes patients. For type 2 diabetes, 46% of the CPs would prescribe diet and lifestyle treatment alone. The practice setting influenced how treatment was managed for typel diabetes patients: 88.5% of rural doctors prescribed premixed insulin versus 58.3% of urban GPs (P = 0.02). Insulin analogues were prescribed by 20.8% of urban GPs as against 3.8% of rural GPs (P = 0.09). There are several shortcomings in the quality of care for diabetes patients. Training GPs could be a solution, especially with the lack of specialists in our country.

Self monitoring of blood glucose level among diabetic patients in Muscat, Oman: A pilot study

Introduction: Monitoring of blood glucose (BG) is an important aspect of the diagnosis and management of diabetes. Self monitoring of blood glucose (SMBG) of patients at home can provide patients and physicians with valuable information in the management of diabetes mellitus. Objective: The aim of this pilot study was to assess the awareness, attitude and practice of SMBG among primary care diabetic patients in Muscat region. Materials and Methods: The study was conducted in two phases. In the first phase 140 patients attending diabetes clinics at various health centers in Muscat region were interviewed to identify patients who practice SMBG. In the second phase a closed ended questionnaire containing 10 questions related to demographic characteristics and attitude was self administered to 50 patients recruited from the first phase to generate the data. Results: It was found that only one third of the patients use glucometer to monitor their BG at home. However, majority of the patients were aware of the significance and importance of glucose home monitoring and thus recommended the practice of SMBG to other diabetic patients. Participants acknowledged the role of pharmacist in educating and training the patient about the proper use of glucometers. Patients were convinced with the device performance and pricking finger was not a deterrent, but at the same time the frequency of BG monitoring was poor among the participants. Conclusion: Overall the participants had a positive attitude towards SMBG but there is a room for the improvement among the participants who showed poor frequency of BG monitoring. There is a need to aware and educate the Omani diabetic patients about the importance of SMBG to achieve the desired therapeutic goals.

Sex Disparities in Diabetes Process of Care Measures and Self-Care in High-Risk Patients

Patients with chronic diabetic complications experience high morbidity and mortality. Sex disparities in modifiable factors such as processes of care or self-care activities have not been explored in detail, particularly in these high-risk patients. Sex differences in processes of care and self-care activities were assessed in a cross-sectional analysis of the Pathways Study, an observational cohort of primary care diabetic patients from a managed care organization (N = 4,839). Compared to men, women had decreased odds of dyslipidemia screening (adjusted odds ratio (AOR) 0.73, 95% CI 0.62–0.85), reaching low-density lipoprotein goal (AOR 0.70, 95% CI 0.58–0.86), and statin use (AOR 0.69, 95% CI 0.58–0.81); women had 19% greater odds of reaching hemoglobin A1c <7% (95% CI 1.02–1.41). There were no sex differences in hemoglobin A1c testing, microalbuminuria screening, or angiotensin-converting enzyme inhibitor use. Women were less likely to report regular exercise but had better adherence to healthy diet, glucose monitoring, and self-foot examination compared to men. Patterns of sex differences were consistent in subjects with diabetic complications. Significant sex disparities exist in diabetes process of care measures and self-care, even amongst patients known to have chronic diabetic complications.

Introducing a telemonitoring platform for diabetic patients in primary care: Will it increase the socio-digital divide?

AimsThis study investigates whether diabetes patients visiting a primary care setting are interested in using a telemonitoring platform and if so, whether characteristics of interested users could be distinguished. MethodsThree questionnaires were administered by 92 diabetes persons recruited between May and September 2011. Descriptive statistics and logistic regression analysis were performed. Special attention was drawn to include patients with low educational levels. ResultsPatients with middle or high educational levels show quite some interest in the use of a telemonitoring platform, especially for the transmission of glycaemic data or for asking questions. Patients with low educational levels only show a minor interest in using such a platform. ConclusionsIt is possibly worthwhile to implement a telemonitoring platform in a primary care setting; however this study did not show immediate profit for implementation in a CHC that organises diabetes clinics on regular basis. In primary care settings where it will be implemented, even if there is a social–digital divide today, the use of a telemonitoring platform could possibly reduce inequity in health care as time could become available for those most in need for face-to-face contact with their physician.