Diabetes Services Research Articles

6521 Continuation of Continuous Glucose Monitors in Hospitalized Diabetic Patients Decreased the Incidence of Hypoglycemia

Abstract Disclosure: C.E. DeClue: None. S. Bao: None. Objective: Glycemic control improves patient outcomes in hospitalized patients, and this is generally achieved by monitoring point-of-care (POC) capillary glucose levels. In the outpatient setting, continuous glucose monitoring (CGM) devices have shown improved glycemic control in diabetic patients, but their evidence in hospitalized patients is lacking. Methods: To evaluate CGM accuracy and safety of use in the inpatient setting, 567 consults were analyzed in a single-center inpatient diabetes service between November 2022 and January 2023. Patients were included if managed with multiple daily injections or insulin pump therapy and separated into four groups based on CGM continuation and type of diabetes. POC glucose and incidence of hypoglycemia were recorded over 72 hours from the time of consultation. Results: Forty-six Type-1 (T1DM) and 72 Type-2 (T2DM) diabetic patients were included in this study, with average hemoglobin A1c of 8.6% and 9.0%, respectively. Both diabetic groups showed an average POC glucose that was not statistically different based on CGM continuation (185 mg/dL for T1DM and 187 mg/dL for T2DM continued on CGM versus 183 mg/dL for T1DM and 188 mg/dL for T2DM not using CGM). However, only 2 of the 18 T1DM patients continued on CGM experienced hypoglycemia, whereas 17 of the 28 T1DM patients not using CGM experienced at least 1 hypoglycemic event. Similarly, only 2 of the 20 T2DM patients continued on CGM experienced hypoglycemia, whereas 13 of the 52 patients not using CGM experienced at least 1 hypoglycemic event. Additionally, less glucose variability was observed in both T1DM and T2DM patients continued on CGM (average standard deviation of 64 mg/dL and 55 mg/dL, respectively) compared to those not using CGM (average standard deviation of 84 mg/dL and 62 mg/dL, respectively). Conclusion: CGM has great potential to improve patient care and nursing workload in the hospital, but the safety and accuracy are not yet well-established. In this study, there seemed to be a statistically insignificant trend to less glycemic variability for CGM users despite no glycemic difference on average POC testing. Importantly, significantly fewer hypoglycemic events were observed in patients continued on CGM devices regardless of type of diabetes or baseline glycemic control. This study adds further evidence to the growing body of work supporting improved safety of CGM utilization in hospitalized diabetic patients. Presentation: 6/1/2024

The transition to the adult diabetes service: step-by-step support

The transition of young type 1 diabetic patients from pediatrics to adult diabetes services is a delicate stage, with the risk of a break in the care pathway. These adolescents are apprehensive about leaving the pediatric sector, and often experience the change as an abandonment. It is therefore vital to prepare them and support them during and after the transfer, in order to improve their experience.

Changes in the Epidemiological Landscape of Diabetes in South Korea: Trends in Prevalence, Incidence, and Healthcare Expenditures.

Diabetes is a serious public health concern that significantly contributes to the global burden of disease. In Korea, the prevalence of diabetes is 12.5% among individuals aged 19 and older, and 14.8% among individuals aged 30 and older as of 2022. The total number of people with diabetes among those aged 19 and older is estimated to be 5.4 million. The incidence of diabetes decreased from 8.1 per 1,000 persons in 2006 to 6.3 per 1,000 persons in 2014, before rising again to 7.5 per 1,000 persons in 2019. Meanwhile, the incidence of type 1 diabetes increased significantly, from 1.1 per 100,000 persons in 1995 to 4.8 per 100,000 persons in 2016, with the prevalence reaching 41.0 per 100,000 persons in 2017. Additionally, the prevalence of gestational diabetes saw a substantial rise from 4.1% in 2007 to 22.3% in 2023. These changes have resulted in increases in the total medical costs for diabetes, covering both outpatient and inpatient services. Therefore, effective diabetes prevention strategies are urgently needed.

Insights from a Wolfram syndrome cohort: clinical and molecular findings from a specialized diabetes reference center.

Considering the rarity and clinical and molecular diversity of Wolfram syndrome (WS), the objective of this study was to identify patients with a clinical presentation suggestive of WS following up at a single Brazilian diabetes service and analyze their clinical and molecular characteristics. The study included all patients with a clinical presentation of WS following up between 1991 and 2022 with early-onset diabetes mellitus and other WS signs and symptoms. A retrospective analysis was conducted, including patients' age, sex, consanguinity, age at symptom onset, diagnosis of diabetes mellitus, optic atrophy, diabetes insipidus, neurological and psychiatric disorders, hearing loss, urinary disorders, hypogonadism, and WFS1 molecular analysis. Eight patients were identified, all of whom were diagnosed with diabetes mellitus at an average age of 3.7 years. Optic atrophy, diabetes insipidus, and hearing loss were common, while psychiatric and neurological alterations were observed in some cases. Genetic analysis revealed pathogenic variants in homozygosity or compound heterozygosity. The most frequent variant was p. Val412Serfs29, present in five of the seven families. This study represents the second-largest Brazilian sample of WS and is the first cohort from a single center in Southeast Brazil. The patients had an early, severe, and complete clinical presentation. The genetic variants identified were consistent with previous literature descriptions. The variant p. Val412Serfs29 was particularly common in this cohort, highlighting its relevance in the region.

Are Ethiopian health facilities providing diabetes services capable of managing tuberculosis? Policy implications for introducing diabetes and tuberculosis collaborative care

ObjectiveThis study aimed to assess the availability and preparedness of health facilities offering diabetes mellitus (DM) to manage tuberculosis (TB) in Ethiopia.DesignSecondary data analysis of institution-based cross-sectional national survey data.SettingData...

A study of referral patterns and patient characteristics observed in Ireland's first fully functional community hub diabetes service during its inaugural year of operation

A study of referral patterns and patient characteristics observed in Ireland's first fully functional community hub diabetes service during its inaugural year of operation

Outcomes of real-time continuous glucose monitoring in adults with type 1 diabetes - quality improvement in diabetes care in a regional diabetes service in Ireland

Outcomes of real-time continuous glucose monitoring in adults with type 1 diabetes - quality improvement in diabetes care in a regional diabetes service in Ireland

Improving reproducibility and validity in measures of chronic disease incidence using large-scale linked data in Australia.

Objective and ApproachOur study aimed to improve methods for identifying incident chronic kidney disease (CKD), cardiovascular disease (CVD), and diabetes in a young cohort from the Antecedents of Renal Disease in Aboriginal Children (ARDAC) study. We linked 20 state and federal administrative health datasets, including hospital records, Medicare claims, pharmaceutical data, and the National Diabetes Services Scheme (NDSS) data for the first time. This approach facilitated the development of new algorithms for disease detection. Notably, we will make the R code for these algorithms publicly available. ResultsThe analysis, involving 3,758 ARDAC study participants, created clinically robust definitions of CKD, CVD, and diabetes (by subtype) in the Australian linked data context; and revealed that all other data sources inaccurately estimated the incidence of diabetes compared to the NDSS data. ConclusionsThis key finding illustrates the discrepancy in diabetes incidence estimates and highlights the value of integrating multiple data sources for the investigation of chronic disease. ImplicationsHundreds of published studies use data linkage to investigate CVD, CKD, and diabetes in the Australian context. Our novel robust case definitions, and the identified poor estimation of diabetes incidence among young people, underscores the need to critically evaluate linked data sources used to inform health policy and research. By sharing the developed R code, we support ongoing efforts to improve transparency and replicability in health research. Our study refines chronic disease definition methods and contributes to more effective public health strategies, with particular focus on improving outcomes for Indigenous communities.

A qualitative study to understand the barriers and enablers of access to diabetic screening services in Nigeria.

Nigeria in working to redefine its health care system's approach to diabetic retinopathy (DR) screening services needs to reduce obstacles and highlight the enablers to services provision. Due to the increased prevalence of diabetes, this has become increasingly necessary. A qualitative study examining the perceptions, practices, and experiences of Nigerian DR healthcare practitioners (HCPs) in relation to the facilitators and barriers of access to DR screening services. Mode of participant recruitment was on-line through e-mails by using snowballing method. In-depth interviews were used to acquire information from 6 DR HCPs (all ophthalmologists) at three eye centers in the three geo-political areas of Nigeria and at international center for eye health (ICEH) in London via on-line Microsoft teams. Thematic analysis was used for data analysis and all the steps applied to the data analysis process. Non-systematic screening, poverty, poor transport systems, insecurity, and poor motivation are key barriers to DR screening access in Nigeria while enablers include government participation through subsidized costs and remuneration of workers. Screening in communities, and using low-cost techniques are key to enable access. Other enablers include collaboration and integration between endocrinology and ocular units in terms of referrals, information sharing, use of intermediary carers, technology, man-power and health resource provision including low- cost services. A dearth of personnel, screening technologies, and resources, have an impact on the effectiveness of the DR screening services in Nigeria as well as social and individual factors, such as the cost of the services and national insecurity.

A roadmap for integrating mental health and diabetes services

A roadmap for integrating mental health and diabetes services

Barriers and system improvements for physical activity promotion after gestational diabetes: A qualitative exploration of the views of healthcare professionals.

Physical activity is an important behaviour for managing the ten times increased risk of type 2 diabetes after gestational diabetes. Previous studies exploring physical activity promotion in healthcare focus on general practitioners but have not explored the gestational diabetes pathway. Therefore, this paper explores the barriers to and suggestions for, activity promotion along the gestational diabetes healthcare pathway. The paper was written in accordance with the Standards for Reporting Qualitative Research. Patient and Public Involvement with women who had lived experiences of gestational diabetes informed purposeful sampling by identifying which healthcare professional roles should be targeted in participant recruitment. Participants were recruited through word-of-mouth, that is, email and connections with local healthcare service leads. Twelve participants took part in semi-structured one-to-one interviews, analysed using reflexive thematic analysis. Participants included a Public Health Midwife (n = 1), Diabetes Midwifes (n = 3), Diabetes Dietitian (n = 1), Diabetes Consultants (n = 2), Diabetes Specialist Nurse (n = 1), general practitioners (n = 2), Practice nurse (n = 1) and a Dietitian from the UK National Diabetes Prevention Program (n = 1). Six themes were generated: 'management of gestational diabetes takes precedent', 'poor continuity of care', 'lack of capacity to promote PA', 'beliefs about the acceptability of PA promotion', 'resources to support conversations about PA' and 'adapting healthcare services for women post-gestational diabetes'. During pregnancy messaging around physical activity is consistent, yet this is specific for managing gestational diabetes and is not followed through postnatally. Improvements in continuity of care are necessary, in addition to ensuring the availability and links with wider exercise and activity schemes.

Trends in rates of hospitalisation for infection in people with diabetes and the general population.

To describe the trends of hospitalisation for infections in people with diabetes and in the general population. People with diabetes were identified from the Australian National Diabetes Services Scheme linked to hospitalisation datasets from 2010/11 to 2018/19. Data on hospitalisations in the general population were obtained from the Australian Institute of Health and Welfare. Joinpoint regression software was used to calculate the annual percentage change (APC) of rates. The rate of hospitalisation for total infections increased with an APC of 2.6% (95% CI: 1.5, 3.7) among people with type 1 diabetes, 3.6% (2.6, 4.6) among people with type 2 diabetes, and 2.5% (1.3, 3.9) in the general population. Increasing rates were observed for sepsis, influenza, kidney infections, osteomyelitis, cellulitis, and foot infections in all groups. The rate of hospitalisation for urinary tract infection declined among people with type 2 diabetes though it was stable in other groups. The rate of hospitalisation for respiratory tract infections was stable among people with type 1 diabetes but increased in other groups. The rate of hospitalisation for gastrointestinal infection was stable in all cohorts. Hospitalisation rates for infection have increased more rapidly over time in people with diabetes than in the general population.

Diabetes‐related distress in people with type 2 diabetes: experience from a community diabetes clinic

AbstractBackground: Diabetes distress is the term used to describe the diabetes‐specific emotional distress resulting from the challenges of managing this demanding chronic condition.Aims: This study aimed to determine the prevalence of diabetes distress and its subtypes in adults with type 2 diabetes who attended our community‐based clinics and to investigate the relationship between diabetes distress scores and demographic factors and diabetes variables (HbA1c and treatment regimen).Methods: Patients were referred to our specialist diabetes team by primary care teams. Clinical details, including current treatment regimen and recent HbA1c result, were recorded. Patients then completed the Diabetes Distress Scale (DDS) 17 questionnaire. Data from all 82 patients who attended our clinic from May 2022 to November 2022 were analysed.Results: A high level of diabetes distress (mean score of ≥3) was found in 17 patients (20.7%), and a moderate level of diabetes distress was found in 22 patients (26.8%). Patients with an HbA1c of >90mmol/mol had significantly higher mean regimen‐related distress than those with an HbA1c of <60mmol/mol (2.58±1.18 vs 1.86±0.8, respectively; p=0.03). In addition, patients with higher HbA1c had higher diabetes‐related emotional distress than those with lower HbA1c. However, this result did not demonstrate statistical significance. Conversely, patients with optimal HbA1c levels had significantly lower mean interpersonal distress scores than the rest of the cohort (1.13±0.99 vs 1.80±0.99, respectively; p=0.01).Conclusions: Diabetes distress is common among patients attending community‐based diabetes services. Further research is needed to determine the most effective strategies for reducing diabetes distress and improving clinical outcomes.

Impact of the use of a smartphone‐based blood glucose management system within a maternal diabetes service

AbstractBackground: The incidence of gestational diabetes mellitus is increasing, placing more demand on pregnancy diabetes services.Aims: This study aimed to explore the impact of implementing GDm‐Health, a remote blood glucose monitoring application (app), on a tertiary pregnancy diabetes service.Methods: This retrospective cohort study was conducted as part of a quality improvement project. We assessed the frequency of interactions between patients and health care professionals, the type of interactions (face‐to‐face [f2f] or non‐f2f [via text or phone call]), effect on time to treatment initiation and women's satisfaction with the app. We compared two cohorts: cohort 1, women diagnosed in September 2019 (n=52) prior to app introduction, and cohort 2, women diagnosed in September 2020 (n=54) after app introduction. Data were collected from the electronic notes, and app satisfaction was assessed using a questionnaire.Results: Median interactions for each woman from diagnosis to delivery increased from 5 (interquartile range [IQR], 3–6) in cohort 1 to 7 (IQR, 5–10) in cohort 2 (p<0.001). In cohort 2, 88.4% of interactions were non‐f2f compared to 13.7% in cohort 1. There was no change in the time to treatment initiation (19 days [cohort 1] vs 20 days [cohort 2]; p=0.59). Women using the app were satisfied with their care.Conclusions: After GDm‐Health was introduced, women had more interactions with the diabetes team; however, most were non‐f2f interactions via telephone. The app has helped health care professionals streamline the service, particularly in terms of the allocation of clinic space and appointments, and has been well received by patients.

Impact of type 2 diabetes and its duration on incidence rates of dementia death and medication prescription in the Australian population during 2003–2016

AimsTo quantify rates of dementia treatment and death among Australians with type 2 diabetes relative to those without diabetes using linked national registries of Australia. MethodsThe study included 891,418 people with type 2 diabetes registered on the National Diabetes Services Scheme and a randomly sampled, population-based comparison group (n = 1,131,369). Outcomes included dementia death (all-cause dementia, Alzheimer’s disease (AD) or vascular dementia), and first prescription of cholinesterase inhibitors or memantine. ResultsExcess dementia risk was observed in the diabetes group for the composite outcome of all-cause dementia death or dementia medication prescription but varied with age at diabetes diagnosis and its duration. At age 70, the rate of dementia death/medication prescription was ∼1.3 (95% CI 1.2, 1.3) and 1.1 (95% CI 1.1, 1.2) times higher in people with ten and five years of diabetes duration, respectively. Individual outcomes showed that diabetes was associated with a higher incidence of vascular dementia death, whereas an increased risk of AD death was only observed beyond ∼10 years of diabetes duration. Further, the incidence of dementia medication prescription was lower among people with diabetes. ConclusionsA higher incidence of AD death in the setting of 10+ years of diabetes duration coupled with a lower incidence of AD treatment suggests an under-recognition of this dementia phenotype among people with type 2 diabetes.

Trends in diabetic ketoacidosis in Victoria, Australia 2002–2016

BackgroundInternational longitudinal studies have indicated an increasing incidence of diabetic ketoacidosis (DKA). We aim to examine the incident trends, demographic differences, length of stay and mortality for DKA in adults with type 1 diabetes (T1D) and type 2 diabetes (T2D) in Victoria, Australia from 2002 to 2016.MethodsAge and sex adjusted incident trends, length of stay and mortality for DKA was retrospectively obtained using the Victorian Admitted Episode Dataset between 2002 and 2016. Data for adults with T1D and T2D was obtained from the National Diabetes Services Scheme (NDSS). Joinpoint regression analysis was used to identify changes in linear trends that were described as average annual percentage change (AAPC).ResultsThere were 23,628 DKA presentations in Victoria between 2002 and 2016. For T1D there was an increase in DKA presentations (AAPC + 6.8%) from 2003 to 2016 and for T2D there was a decline from 2003 to 2011 (APC − 3.5%), increase from 2011 to 2014 (APC + 38.5%), and a decrease from 2014 to 2016 (APC − 20.9%). Length of stay was longer for people with T2D than T1D (P < 0.001) and the mortality rate was 0.51% for the study period.ConclusionsDKA rates increased for T2D from 2011 to 2014 which correlates with the introduction of sodium glucose-linked transport protein 2 inhibitors. However, the aetiology for the observed increase in T1D from 2002 to 2016 remains unknown.

Transition between paediatric and adult diabetes healthcare services: An online global survey of healthcare professionals’ experiences and perceptions

IntroductionYouth with diabetes should transition from paediatric to adult diabetes services in a deliberate, organized and cooperative way. We sought to identify healthcare professionals’ (HCPs) experiences and perceptions around transition readiness planning, policies and procedures, and the actual transfer to adult services. MethodsData were collected via an online global survey (seven language options), broadly advertised by the International Society for Pediatric and Adolescent Diabetes (ISPAD), European Association for the Study of Diabetes (EASD), team members and partners, via newsletters, websites, e-mails and social media. ResultsRespondents (n = 372) were mainly physicians (74.5 %), practicing in government funded (59.4 %), paediatric (54.0 %), metropolitan settings (85.8 %) in Europe (44.9 %); 37.1 % in low and middle-income countries (LMICs). Few centers used a transition readiness checklist (32.8 %), provided written transition information (29.6 %), or had a dedicated staff member (23.7 %). Similarly, few involved a psychologist (25.8 %), had combined (35.2 %) or transition/young person-only clinics (34.9 %), or a structured transition education program (22.6 %); 49.8 % advised youth to use technology to assist the transfer.Most (91.9 %) respondents reported barriers in offering a good transition experience. Proportionally, more respondents from LMICs prioritised more funding (p = 0.01), a structured protocol (p < 0.001) and education (p < 0.001). ConclusionHCPs’ experiences and perceptions related to transition vary widely. There is a pressing need for an international consensus transition guideline.

Excess Risk of Injury in Individuals With Type 1 or Type 2 Diabetes Compared With the General Population.

To estimate the relative risk (RR) and excess hospitalization rate for injury in individuals with diabetes compared with the general population. Data were obtained from the Australian National Diabetes Services Scheme, hospitalization data sets, the Australian Pharmaceutical Benefits Scheme, the National Death Index, and the census spanning from 2011 to 2017. Hospitalizations for injury were coded as head and neck, lower-extremity, upper-extremity, or abdominal and thoracic injury; burns; or other injury. Poisson regression was used to estimate the age- and sex-adjusted RR of hospitalization for injury. The total number of hospitalizations for any injury was 117,705 in people with diabetes and 3,463,173 in the general population. Compared with that in the general population, an elevated adjusted risk of admission was observed for any injury (RR 1.22; 95% CI 1.21, 1.22), head and neck (1.28; 1.26, 1.30), lower extremity (1.24; 1.23, 1.26), abdominal and thoracic (1.29; 1.27, 1.30), upper extremity (1.03; 1.02, 1.05), burns (1.52; 1.44, 1.61), and other injury (1.37; 1.33, 1.40). The adjusted RR of any injury was 1.62 (1.58, 1.66) in individuals with type 1 diabetes, 1.65 (1.63, 1.66) in those with type 2 diabetes who were taking insulin, and 1.07 (1.06, 1.08) in individuals with type 2 diabetes not using insulin. Falls were the primary cause of injury in individuals with diabetes. Individuals with diabetes, especially those using insulin, had a higher risk of hospitalization for injury compared with the general population.

1957-LB: Transition between Pediatric and Adult Diabetes Services—The Experiences and Perceptions of Health Care Professionals Worldwide

1957-LB: Transition between Pediatric and Adult Diabetes Services—The Experiences and Perceptions of Health Care Professionals Worldwide

Proactive review for people with diabetes in hospital: a cluster randomised feasibility trial with process evaluation, protocol V3.1

BackgroundDiabetes inpatient specialist services vary across the country, with limited evidence to guide service delivery. Currently, referrals to diabetes inpatient specialists are usually ‘reactive’ after diabetes-related events have taken place, which are associated with an increased risk of morbidity/mortality and increased length of hospital stay. We propose that a proactive diabetes review model of care, delivered by diabetes inpatient specialist nurses, may contribute to the prevention of such diabetes-related events and result in a reduction in the risk of harm.MethodWe will conduct a cluster randomised feasibility study with process evaluation. The proactive diabetes review model (PDRM) is a complex intervention that focuses on the prevention of potentially modifiable diabetes-related harms. All eligible patients will receive a comprehensive, structured diabetes review that aims to identify and prevent potentially modifiable diabetes-related harms through utilising a standardised review structure. Reviews are undertaken by a diabetes inpatient specialist nurse within one working day of admission. This differs from usual care where patients are often only seen after diabetes-related harms have taken place. The trial duration will be approximately 32 weeks, with intervention delivery throughout. There will be an initial 8-week run-in phase, followed by a 24-week data collection phase. Eight wards will be equally randomised to either PDRM or usual care. Adult patients with a known diagnosis of diabetes admitted to an included ward will be eligible. Data collection will be limited to that typically collected as part of usual care. Data collected will include descriptive data at both the ward and patient level and glucose measures, such as frequency and results of capillary glucose testing, ketonaemia and hypoglycaemic events. The analysis aims to determine the fidelity and acceptability of the intervention and the feasibility of a future definitive trial. Whilst this study is primarily about trial feasibility, the findings of the process evaluation may lead to changes to both trial processes and modifications to the intervention. A qualitative process evaluation will be conducted in parallel to the trial. A minimum of 22 patients, nurses, doctors, and managers will be recruited with methods including direct non-participant observation and semi-structured interviews. The feasibility of a future definitive trial will be assessed by evaluating recruitment and randomisation processes, staffing resources and quality of available data.DiscussionThe aim of this cluster randomised feasibility trial with a process evaluation is to explore the feasibility of a definitive trial and identify appropriate outcome measures. If a trial is feasible and the effectiveness of PDRM can be evaluated, this could inform the future development of inpatient diabetes services nationally.Trial registrationUK Clinical Research Network, 51,167. ISRCTN, ISRCTN70402110. Registered on 21 February 2022.