Evidence-based Diabetes Care Research Articles

Enhancing Diabetes Management Education in Community Health Centers: Empowering Patients and Improving Health Outcomes

Background: Diabetes poses significant public health challenges globally, with South Africa experiencing high prevalence rates, particularly in underserved regions. The lack of tailored diabetes management programs in community health centers (CHCs) exacerbates poor health outcomes and increases healthcare costs. Methods and Materials: This project aimed to enhance diabetes management education at Pholela Community Health Centre in Durban, South Africa, through comprehensive educational interventions and healthcare provider training. Culturally sensitive educational materials were developed and delivered in multiple languages, targeting patient self-management and healthcare provider competence. Results : The intervention led to a 20% increase in the proportion of diabetic patients achieving target HbA1c levels within one year. Healthcare providers showed improved proficiency in delivering culturally sensitive, evidence-based diabetes care. Patient education workshops and peer support groups significantly improved patient knowledge and self-management practices. Conclusion: The project successfully addressed critical gaps in diabetes education and care at Pholela CHC, resulting in improved patient outcomes and enhanced healthcare practices. Continued community engagement and resource allocation are essential for sustaining these improvements and reducing the disease burden in underserved populations.

The Impact of New and Renewed Restrictive State Abortion Laws on Pregnancy-Capable People with Diabetes.

When the Supreme Court handed down its decision in Dobbs v Jackson Women's Health Organization in June 2022, the constitutional right to abortion was no longer protected by Roe v Wade. Fifteen states now have total or near-total bans on abortion care or no clinics providing abortion services. We review how these restrictions affect the medical care of people with pregestational diabetes. Of the ten states with the highest percent of adult women living with diabetes, eight currently have complete or 6-week abortion bans. People with diabetes are at high risk of diabetes-related pregnancy complications and pregnancy-related diabetes complications and are disproportionately burdened by abortion bans. Abortion is an essential part of comprehensive, evidence-based diabetes care, yet no medical society has published guidelines on pregestational diabetes that explicitly discuss the importance and role of safe abortion care. Medical societies enacting standards for diabetes care and clinicians providing diabetes care must advocate for access to abortion to reduce pregnancy-related morbidity and mortality for pregnant people with diabetes.

Uptake and effectiveness of online diabetes continuing education: The perspectives of Thai general practitioner trainees

BackgroundDespite continuing medical education (CME) programmes on evidence-based diabetes care, evidence-based best practice and actual GP practice remain scant. Online CME offers numerous benefits to general practitioners (GPs), particularly during the coronavirus disease 2019 (COVID-19) pandemic. In Thailand, CME is a voluntary process and is yet to be established as a mandatory requirement. This study examined GP uptake of online diabetes CME and the changes in GPs’ attitudes to and knowledge of Type 2 diabetes management. MethodsA cross-sectional study and a before-and-after study were employed with 279 GP trainees who voluntarily undertook a newly-developed online diabetes programme. A follow-up survey was conducted six months after the GP trainees completed their training. ResultsOne hundred and twelve out of 279 GP trainees (40.1%) participated in the study, of whom 37 (13.3%) enrolled in the online diabetes programme, and 20 (7.2%) completed the programme. Before enrolling in the programme, the participants' mean diabetes knowledge score was 61.5%. The participants’ confidence in effective insulin treatment increased significantly after the programme (95% Confidence interval [CI], −0.51-0.00; P = 0.05), but their knowledge scores before and after the programme were not statistically different (95% CI, −3.93-0.59; P = 0.14). ConclusionUptake of the online diabetes CME was poor, although appropriate recruitment strategies were employed, and the online educational option was attractive and accessible during the COVID-19 pandemic. This study emphasises the gap between evidence-based practice and actual GP practice and the need for mandatory CME.

Social determinants of vulnerabilities in type 2 diabetes: a call to action.

Type 2 diabetes (T2D) is a chronic disease which leads to high morbidity, mortality and healthcare costs. Although relevant gains have been made towards evidence-based diabetes care, patients with T2D still experience diabetes complications and excess mortality risk, owing to multiple contributors, including non-clinical factors. The aim of this paper is to provide an overview of the main social determinants of vulnerabilities, which are known to have a relevant impact on T2D outcomes. As chronic diseases are under the influence of social inequalities, medicine and sociology are intertwined in the attempt to understand, explain and address them. There is robust evidence about a clear relationship between social determinants of health (SDOH), such as socio-economic status (occupation, education, income), and the likelihood of developing T2D and its complications. Furthermore, the uncontrolled widespread of T2D in urban areas, mainly among suburban communities, suggests that cities might act as amplifiers of SDOH, enhancing inequalities in health care and, therefore, life expectancy. In light of the strong association between socio-cultural aspects and T2D outcomes, a global action is needed to raise awareness about disparities in diabetes prevention and treatment to reduce the burden of the disease.

Exploring heterogeneities of cardiovascular efficacy and effectiveness of SGLT2 inhibitors in patients with type 2 diabetes: an umbrella review of evidence from randomized clinical trials versus real-world observational studies.

We aimed to explore possible contributors to discrepancies between randomized controlled trials (RCTs) and real-world observational studies (OS) in cardiovascular benefits of sodium-glucose cotransporter 2 (SGLT2) inhibitors in type 2 diabetes (T2D) patients. Wesearched PubMed and EMBASE to identify meta-analyses of RCTs and OS oncardiovascular effects of SGLT2 inhibitors in T2D patients. Cardiovascular outcomes included major adverse cardiovascular events (MACE), myocardial infarction (MI), stroke, cardiovascular mortality (CVM), all-cause mortality (ACM), hospitalization for heart failure(HHF), andatrial fibrillation (AF). We examined the summary relative risk (RR) and 95% confidence interval (CI) for each endpoint from meta-analyses of RCTs. We identified and included 15 eligible meta-analyses, 13 for RCTs and 2 for OS, with moderatelystrong evidence. The results revealed a significant discrepancy between RCTs and OS for MI (RR, 95% CI 1.05, 0.82-1.38; I = 91.5% versus odds ratio (OR), 95% CI 0.77, 0.73-0.81; I = 15.0%), stroke (RR, 95% CI 0.99, 0.76-1.29; I = 93.4%versus OR, 95% CI 0.75, 0.72-0.78; I = 23.0%), and AF (RR, 95% CI 0.72, 0.62-0.85; I = 0.0% versus OR, 95% CI 0.92,0.83-1.02; I = 0.0%). OS presented significant benefits of SGLT2 inhibitors both on primary and secondary preventions of MACE, MI, stroke, ACM, CVM, and HHF; RCTs did not. Given the spectrum of T2D patient characteristics and the strength of overall evidence, our review underscored the importance of constant integration of all available information and critical interpretation of all inconsistencies to optimize evidence-based diabetes care.

Establishing and evaluating physician-pharmacist collaborative clinics to manage patients with type 2 diabetes in primary hospitals in Hunan province: study protocol of a multi-site randomized controlled trial in the era of COVID-19 pandemic

BackgroundThe COVID-19 pandemic has exerted an unprecedented and universal impact on global health system, resulting in noticeable challenges in traditional chronic disease care, of which diabetes was reported to be most influenced by the reduction in healthcare resources in the pandemic. China has the world’s largest diabetes population, and current diabetes management in China is unsatisfactory, particularly in rural areas. Studies in developed countries have demonstrated that physician-pharmacist collaborative clinics are efficient and cost-effective for diabetes management, but little is known if this mode could be adapted in primary hospitals in China. The aim of this proposed study is to develop and evaluate physician-pharmacist collaborative clinics to manage type 2 diabetes mellitus (T2DM) in primary hospitals in Hunan province.MethodsA multi-site randomized controlled trial will be conducted to evaluate the effectiveness and cost-effectiveness of the physician-pharmacist collaborative clinics compared with usual care for Chinese patients with T2DM. Six primary hospitals will participate in the study, which will recruit 600 eligible patients. Patients in the intervention group will receive services from both physicians and pharmacists in the collaborative clinics, while the control group will receive usual care from physicians. Patients will be followed up at the 3rd, 6th, 9th and 12th month. Comparison between the two groups will be conducted by assessing the clinical parameters, process indicators and costs on diabetes. A satisfaction survey will also be carried out at the end of the study.DiscussionIf effective, the physician-pharmacist collaborative clinics can be adapted and used in primary hospitals of China to improve glycemic control, enhance medication adherence, decrease incidence of complications and reduce patients’ dependence on physicians. Findings from the present study are meaningful for developing evidence-based diabetes care policy in rural China, especially in the COVID-19 pandemic era.Trial registrationChinese Clinical Trial Registry, ChiCTR2000031839, Registered 12 April 2020.

Adapting the Comprehensive Unit Safety Program (CUSP) implementation strategy to increase delivery of evidence-based cardiovascular risk factor care in community mental health organizations: protocol for a pilot study

BackgroundPeople with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder experience excess mortality driven in large part by high rates of poorly controlled and under-treated cardiovascular risk factors. In the USA, integrated “behavioral health home” models in which specialty mental health organizations coordinate and manage physical health care for people with SMI are designed to improve guideline-concordant cardiovascular care for this group. Such models have been shown to improve cardiovascular care for clients with SMI in randomized clinical trials, but real-world implementation has fallen short. Key implementation barriers include lack of alignment of specialty mental health program culture and physical health care coordination and management for clients with SMI and lack of structured protocols for conducting effective physical health care coordination and management in the specialty mental health program context. This protocol describes a pilot study of an implementation intervention designed to overcome these barriers.MethodsThis pilot study uses a single-group, pre/post-study design to examine the effects of an adapted Comprehensive Unit Safety Program (CUSP) implementation strategy designed to support behavioral health home programs in conducting effective cardiovascular care coordination and management for clients with SMI. The CUSP strategy, which was originally designed to improve inpatient safety, includes provider training, expert facilitation, and implementation of a five-step quality improvement process. We will examine the acceptability, appropriateness, and feasibility of the implementation strategy and how this strategy influences mental health organization culture; specialty mental health providers’ self-efficacy to conduct evidence-based cardiovascular care coordination and management; and receipt of guideline-concordant care for hypertension, dyslipidemia, and diabetes mellitus among people with SMI.DiscussionWhile we apply CUSP to the implementation of evidence-based hypertension, dyslipidemia, and diabetes care, this implementation strategy could be used in the future to support the delivery of other types of evidence-based care, such as smoking cessation treatment, in behavioral health home programs. CUSP is designed to be fully integrated into organizations, sustained indefinitely, and used to continually improve evidence-based practice delivery.Trial registrationClinicalTrials.gov, NCT04696653. Registered on January 6, 2021

Uptake and Effectiveness of Online Diabetes Continuing Education: The Perspectives of Thai General Practitioner Trainees

Background: Despite continuing medical education (CME) programmes about evidence-based diabetes care, there remains a paucity of evidence-based best practice and actual GP practice. Online CME offers numerous benefits to general practitioners (GPs), particularly during the coronavirus disease 2019 (COVID-19) pandemic. In Thailand, CME is a voluntary process and yet to be established as mandatory. This study aimed to examine GP uptake on the online diabetes CME and its effectiveness on changes in the GPs’ attitudes and knowledge about Type 2 diabetes management.Methods: A cross-sectional study and a before-and-after study were employed with 279 GP trainees who voluntarily undertook the newly developed diabetes programme online. A follow-up survey was conducted 6 months after the GP trainees completed their training.Results: One hundred and twelve out of 279 GP trainees (40.1%) participated, of whom 37 (13.3%) enrolled in the online diabetes programme, and 20 (7.2%) completed the programme. The participants’ mean diabetes knowledge score before enrolling the programme was 61.5%. The participants’ confidence in effective insulin treatment increased significantly after the programme (95% Confident interval [CI], -0.51-0.00; P=0.05) but their knowledge scores before and after the programme were not statistically different (95% CI, -3.93-0.59; P=0.14).Conclusion: There was poor uptake for an online diabetes CME, even though effective recruitment strategies were employed, and while the online educational option is attractive and accessible during the COVID-19 pandemic. This present study emphasises not only the gap between evidence-based practice and actual GP practice but also a need for mandatory CME.Funding Information: This study was financially supported by the Faculty of Medicine, Khon Kaen University (Grant no. IN62338).Declaration of Interests: No potential conflict of interest relevant to this article was reported.Ethics Approval Statement: The study was approved by the Khon Kaen University Human Research Ethics Committee: Project number HE621379.

Evidence-based early stage type 2 diabetes follow-up in Belgian primary care practices: Impact of multi-professional teams and care protocols

AimThe aim of this research is to explore the current early-stage diabetes mellitus type 2 care in Belgian general practices. This, to find out if the care is provided according to the proposed evidence-based national diabetes care guideline. Additionally, this research aims to detect which person and practice characteristics can be associated with a more evidence-based care provision. MethodsPeople were included in the study if they were recently diagnosed with type 2 diabetes by the participating practice. Practice and person characteristics, and clinical parameter monitoring and lifestyle monitoring data were collected by using a questionnaire and a topic list. ResultsA total of 27 general practices participated and a total of 249 people were included through their patient records. People monitored in a practice according to a self-developed protocol were 5.5 times more likely to have a better clinical parameter follow-up. Larger practices (>2000 patients), follow-up by general practitioners and practice nurses together and according to self-developed protocols were associated with a significantly better lifestyle follow-up. ConclusionPractices providing multidisciplinary diabetes care, in collaboration with practice nurses, and with diabetes care based on self-developed protocols achieved a more comprehensive follow-up.

Practice nurses need better diabetes education to meet service and individual needs

Anne Phillips, from the iDEAL advisory group, highlights the need for constant evidence-based educational opportunities to be available and accessible, via a variety of means, to ensure practice nurses can keep up to date and deliver evidence-based diabetes care

1290-P: Achieving and Sustaining Inpatient Glycemic Goals by Employing Targeted Strategies that Include Daily Surveillance and Real-Time Communication

Background: Approximately 30% of inpatient admissions require glycemic management at our 680 bed academic hospital. The Inpatient Diabetes (DM) Program created internal glycemic goals, employed targeted strategies to meet and sustain these goals, and began participation in a national database for comparative benchmarking. Purpose: The purpose of the Inpatient Diabetes Program is to lead evidence-based diabetes care to achieve glycemic outcomes for hospitalized patients. Method: The DM Program uses targeted strategies to meet glycemic outcomes, including daily surveillance, real-time communication with providers, maximization of the Electronic Health Record (EHR), provision of varied educational formats, and empowerment of front line staff in decision making. Daily real-time communication occurs with the prescribing provider (e.g., resident/advanced practice provider and the attending provider regarding recurrent hypoglycemia and persistent hyperglycemia. Follow-up surveillance is completed to evaluate if there was a treatment change. Maximization of the EHR has facilitated standardization of care with the creation of order sets, reports and real-time surveillance. Staff education is provided using various platforms including focused courses, a DM share-point site, videos, and a DM newsletter. Results/Outcomes: The rate of hyperglycemia (BG >180 mg/dL) has decreased in the previous 3 years from 25% to 20% for point of care glucose values, without an increase in hypoglycemia. The hypoglycemia rate has consistently remained at 2% with a severe hypoglycemia rate of 0.1%. Day weighted mean BGs in both critical care and non-critical care meet the national benchmark targets. Implications for Practice: Using targeted interventions that are “active” strategies like frequent surveillance and real-time communication helps achieve inpatient glucose goals. Disclosure E.L. Thompson: None. B. Everhart: None.

Engagement of primary care practice in Australia: learnings from a diabetes care project.

Effective community-based chronic disease management requires general practice engagement and ongoing improvement in care models. This article outlines a case study on contributing factors to insufficient participant recruitment through general practice for an evidence-based diabetes care pilot project. Key stakeholder semi-structured interviews and focus groups were undertaken at cessation of the pilot project. Participants (15 GPs, five practice nurses, eight diabetes educators) were healthcare providers engaged in patient recruitment. Through descriptive analysis, common themes were identified. Four major themes were identified: (1) low perceived need for intervention; (2) communication of intervention problematic; (3) translation of research into practice not occurring; and (4) the service providing the intervention was not widely viewed as a partner in chronic disease care. Engaging GPs in new initiatives is challenging, and measures facilitating uptake of new innovations are required. Any new intervention needs to: be developed with GPs to meet their needs; have considerable lead-in time to develop rapport with GPs and raise awareness; and ideally, have dedicated support staff within practices to reduce the demand on already-overburdened practice staff. Feasible and effective mechanisms need to be developed to facilitate uptake of new innovations in the general practice setting.

Consensus Validation of Simpler™: A Tool to Improve Pharmacist Delivery of Quality, Evidence-Based Diabetes Care.

Studies on a structured method used by pharmacists to provide comprehensive, evidence-based diabetes care are lacking. The aim of this study was to prioritise, rank and construct validate indicators categorised as seven treatment factors utilised in the management of type 2 diabetes namely: Cholesterol, blood pressure and glycaemia control; medication and lifestyle management; cardiovascular risk management and patient education using the Delphi process. A Delphi questionnaire consisted of 29 Part 1 and nine Part 2 indicators which were incorporated into a tool called Simpler™. The indicators were mainly sourced from American, Australian and Malaysian diabetes management guidelines. Diabetes experts were asked to rank indicators in the order of importance in Part 1. In Part 2, indicators had to be chosen for inclusion into Simpler™ using a fivepoint Likert scale. The consensus level was pre-set at 60%. A three round Delphi process was used to validate all 38 indicators by 12 experts from Australia and Malaysia: five pharmacists, four doctors, two endocrinologists and a diabetes nurse. Consensus was reached for 93.1% (27/29) of the Part 1 indicators and all nine Part 2 indicators (100%). Five out of nine indicators in Part 2 questionnaire obtained consensus disagreement for inclusion into the Simpler ™ tool. The Simpler™ tool is the first structured diabetes multifactorial tool to address all seven evidence-based factors. The tool was refined and validated by multi-disciplinary health professionals from Australia and Malaysia. Pharmacists can use the Simpler™ tool to facilitate evidence-based comprehensive individualised care among type 2 diabetes patients.

The Champlain Hospital Pathways Project: Improving Insulin Ordering and Hypoglycemia Management

Background: Diabetes is a common comorbidity affecting hospitalized patients. Evidence-based diabetes care in hospitals is associated with improved outcomes and is reflected in best practice guidelines. Despite this, institutions struggle with glycemic management.

Evidence-Based Diabetes Care in Indonesia—Knowledge Translation and the Transfer of Best Practice

Indonesia is continuously among the top ten countries worldwide in the number of people living with diabetes. Evidence-based practice (EBP) has the potential to improve the effectiveness and efficiency of diabetes care. However, the strategy to efficiently translate the best evidence into practice isof particular concern in developing countries. The overall aim of this thesis is to explore the status of knowledge translation on diabetes care in Indonesia. To answer that, we conducted various assessment on each of the stages on the knowledge translation process. Initially we conducted a survey to assess the degree of awareness, agreement, adoption and adherence of general practitioners (GPs) in Indonesia to type 2 diabetes mellitus guidelines, and their association with characteristics of the responders. The survey found that high awareness of the Indonesian type 2 diabetes guideline does not necessary lead to adoption or adherence to recommendations important for outcomes and quality of care. However, the awareness-to-adherence model helps in identifying barriers for the use of guidelines. We then evaluated the quality of an Indonesian type 2 diabetes guideline (Perkeni’s guideline 2011) adapted from four international guidelines. We found that the process underlying the Indonesian type 2 diabetes guideline development is curtailed due to being under-resourced and the use of the cited suboptimal source guidelines might risk the validity of the recommendations it contains. Implementation of evidence-based practice principles such as those proposed by ADAPTE collaboration should be adhered to when guideline are derived from other guidelines to be used in other than its original context or circumstances. We also conducted an evaluation of the quality of reporting of the risk of bias of the Indonesian medical research. As we found only a small proportion of Indonesian studies which have high quality reporting or methods, we recommend to endorse and follow international reporting guidelines to improve the quality of future studies. In the end we learned that although EBP is a concept which originated from developed countries, its implementation in developing countries like Indonesia is highly relevant. The development of the knowledge and skills on EBP in Indonesia is progressing as there are efforts in integrating evidence-based practice in the medical curriculum along with continuing professional development activities. However, to achieve health benefits, the evidence must be moved into action. This thesis helps identified some gaps in the knowledge creation and application especially on diabetes care. The gaps on the knowledge creation include limited number and low quality of evidence on diabetes care, very little production of systematic reviews on the problems related to diabetes care which are relevant to Indonesian situation and low rigor of development as well as low applicability of the existing diabetes guidelines. The remaining gaps should be assessed thoroughly using rigorous methods which involve relevant stakeholders. The effort should be followed by the continuous action cycle of the knowledge translation process. Promoting the knowledge translation process should be done simultaneously with the evidence-based practice capacity building to achieve improvement in health care in a developing country like Indonesia.

Methods.

Methods.

Dyslipidemia.

Dyslipidemia.

Worldwide pharmacy revolution: Advocating for pharmacy at home and abroad

Worldwide pharmacy revolution: Advocating for pharmacy at home and abroad

Adherence to diabetes care

Adherence to diabetes care

Optimal diabetes care--can we afford it?: Evidence-based diabetes care could be highly cost effective

Management of diabetes is expensive and set to get costlier. Managing the condition and it's devastating complications imposing a huge societal and economic toll on healthcare systems worldwide. While many interventions to reduce complications are available, a number of interventions do not have a strong basis in evidence, and lack cost effectiveness. In a time of economic austerity, and unprecedented pressure to reduce costs of health care in the UK, are there ways improving care, without driving up cost?