Diabetes Care Management Research Articles

Daily Life Management Guidelines for Diabetic Foot Patients

Diabetic foot ulcers are a significant complication of diabetes, often leading to hospitalization and, in severe cases, lower limb amputation, causing substantial medical costs and reduced quality of life. Approximately 15% of diabetic patients develop foot ulcers, with 15% of these cases progressing to amputation, highlighting the critical need for foot care in diabetes management. These ulcers have a high mortality rate and a high likelihood of recurrence, highlighting the need for both blood sugar control and foot care. In South Korea, around 2.9% of diabetic patients over the age of 20 were diagnosed with diabetic foot ulcers in 2011, affecting approximately 100,000 individuals. Globally, about one-third of diabetic patients will experience foot ulcers in their lifetime, with a high recurrence rate. Diabetic foot ulcers are prone to infections, potentially leading to amputation or even death, emphasizing the importance of prevention and proper treatment. Educating patients with diabetic foot ulcer about foot care can significantly enhance their knowledge and performance in caring for their feet, including the use of moisturizers. Providing specific and practical foot care instructions is crucial to improve self-foot care practices and to minimize the risk of complications.

Cost-Effectiveness of Pharmacist Care in Diabetes Management: A Systematic Review.

In recent years, the role of pharmacists has undergone significant transformation to become more patient-centered and involved in managing chronic diseases. Nonetheless, it remains unclear whether pharmacist involvement in diabetes management is cost-effective. This study aimed to systematically review the cost-effectiveness and reporting quality in comprehensive economic evaluations of pharmacist management compared to standard care in diabetes. Eligible studies included cost-effectiveness analyses employing pharmacist professional services as the intervention for diabetes. A literature search was conducted in the bibliographic databases Pubmed, Scopus, China National Knowledge Infrastructure (CNKI), and the International Health Technology Assessment (HTA) database from their inception until July 2023. Two independent reviewers performed title, abstract, full-text screening, and data abstraction and assessed the quality of reporting and methodological approaches using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklists. Twelve studies were identified with an average research quality score of 19.8, including cost-utility (n = 5) and cost-effectiveness (n = 7) analyses, with only four studies rated as high quality. The efficacy data were derived from randomized controlled trials (n = 7), retrospective studies (n = 2), and published literature sources (n = 2). Half of the included studies were conducted in high-income countries, while the other half was in upper-middle and lower-middle-income countries, respectively. Despite significant variations in the cost of pharmacist intervention, consistent findings demonstrate that pharmacist involvement in diabetes management is more cost-effective or even cost-saving than standard care, primarily attributed to better glycemic control, enhanced patient compliance, and reduced risks of medication-related problems. This systematic review substantiates that pharmacist involvement in diabetes management is cost-effective compared with standard care. However, the overall quality of reporting needs to be improved, and high-quality evidence is urgently needed to support healthcare decision-making in pharmacy practice.

Evaluating the effectiveness of community health worker interventions on glycaemic control in type 2 diabetes: a systematic review and meta-analysis

BackgroundInterventions with community health workers, trained to provide basic medical education and holistic support, have been used to enhance type 2 diabetes outcomes in various settings. Evidence of their effectiveness is poor because of variations in intervention design and duration. We did a systematic review of randomised trials evaluating the effectiveness of community health worker interventions integrated into conventional care to improve glycaemic control in adults with diabetes. MethodsIn this systematic review and meta-analysis, we included randomised trials of community health worker interventions of at least-12 months’ duration in adults with type 2 diabetes that compared HbA1c levels with usual care. We searched Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL and the Web of Science Core Collection for studies published in English between Jan 1, 2000, and March 1, 2023, for studies containing “community health worker” or “lay health worker”, and “type 2 diabetes”. We extracted both qualitative and quantitative data to assimilate community health worker intervention characteristics. We did a meta-analysis comparing changes in HbA1c levels from baseline between intervention groups and usual care groups. To be included in the meta-analysis, studies had to have HbA1c values at baseline and after 12 months and a patient dropout rate of less than 25% at 12 months follow-up. The main outcome was the mean weighted difference of % change in HbA1c after at least 12 months, assessed using Revman, the inverse variance-weighted average model (IVW). Quality was assessed using the Cochrane Rob2 tool. FindingsSeven of 86 retrieved studies were eligible for inclusion; six studies were conducted in the USA and one study in Indigenous Australia. Participants in all studies were recruited from Latino, African American and Indigenous Australian ethnic minority groups. The meta-analysis of six studies including 1280 participants (mean age 52·6 years [SD 3·68]; 832 [65%] female and 448 [35%] male) showed a significant improvement in HbA1c level at 12 months follow-up, with a mean weighted difference of 0·5% (95% CI 0·31–0·68) in the community health worker intervention group (p<0·0001), that reached the generally accepted minimal clinically important difference (≥0·5%). Outcome heterogeneity was low. InterpretationCommunity health worker interventions showed a significant reduction in HbA1c level adjunct to usual care, but caution must be taken given the point effect estimate is only just the MCID, and the true effect could be smaller. Given the current resource constraints faced by primary care, community health worker interventions could be innovative in informing the primary and secondary management of diabetes care in UK practice. A cost-effectiveness analysis of these interventions is required before implementation in routine diabetes care can be recommended. FundingNone.

A single framework of precision surveillance of diabetes disease prognosis for better care with collaboration

We present a decision support model for patient-centered precision surveillance that assists clinicians and patients for the whole disease prospect to provide a single operational framework of whole type 2 diabetic person care management while introducing experts in the loop modeling that facilitates data collection. Based on real-world data, the scientific computation shall be adopted with experts’ experiences for providing the patient health education and accessing complication risks thereby easily delineating disease pathways. A decision tree technique is used to build a single framework consisting of every possible diabetes complication in the decision process. Coping with the complex medical system for the prevention of diabetes and diabetic complications, a patient-centered framework gives the patient interactive, transparent and useful information for better communication in the decision process that includes experts’ experience as well as the value of the prediction generated from population-based data.

Community Pharmacists' Attitude, Practice and Confidence in Supporting People with Diabetes in Japan and Ireland: A Cross-sectional Survey.

Diabetes is a chronic disease requiring long-term management. Poorly controlled diabetes is associated with reduced quality of life and micro- and macro-vascular complications. Community pharmacists have a role in supporting people with diabetes to better address their condition and reduce their risk of diabetes-related illness. The purpose of this study was to examine and compare the attitudes, practices, and confidence of community pharmacists in Japan and Ireland on the care of people with diabetes. A cross-sectional survey of community pharmacists in Ireland (388 respondents) and Japan (144 respondents) was conducted to assess their attitudes, practices, confidence, and other characteristics linked to diabetes management. A Likert scale was utilized, with a range of strongly agree to strongly disagree. The study reported that Japanese pharmacists have lower levels of practice (p<0.004), confidence, trust by patients, job satisfaction, concern with patients, and knowledge (all p<0.001) regarding diabetes management than Irish pharmacists. Although there was no significant difference in the attitude of pharmacists in both countries, the results show almost similar attitudes toward diabetes management, indicating their willingness to support people with diabetes. These results demonstrated less confidence in diabetes management and less practice of diabetes management care among Japanese pharmacists than Irish pharmacists. The results can be used to identify pharmacist education needs and develop training programs in diabetes management for pharmacists in Japan and Ireland.

Study on the determinants of health professionals’ performance on diabetes management care in China

BackgroundAs the direct providers of diabetes management care in primary health care facilities (PHFs) in China, health professionals’ performance on management care of diabetes determines the quality of services and patients’ outcomes. This study aims to analyze the key determinants of health professionals’ performance on diabetes management care in PHFs in China.MethodsWe conducted a cross-sectional study in 72 PHFs in 6 cities that piloted the contracted family doctor service (CFDS). Self-developed questionnaire was used to measure three kinds of factors (capacity, motivation and opportunity) potentially influencing the performance of health professionals. The performance of diabetes management care in the study was measured as whether health professionals delivered 7 service items required by the National Basic Public Health Service Guideline with a total of 7 points and was divided into three grades of good, medium and bad. The questionnaire is self-administered by all the health professionals involved in the study with the number of 434. The Chi-square tests were used to compare differences of performance on diabetes management care among health professionals with different characteristics. The ordinal logistic regression was used to analyze the determinants on the performance of diabetes management care.ResultsHealth professionals who got higher score on diabetes knowledge test had odds of better performance on diabetes management care (OR = 1.529, P < 0.001). health professionals with higher degree of self-reported satisfaction on training (OR = 1.224, P < 0.05) and perception of decreasing workload (OR = 3.336, P < 0.01) had odds of better performance on diabetes management care. While health professionals with negative feeling on information system support had odds of worse performance on diabetes management care (OR = 0.664, P < 0.01).ConclusionsAttention should be paid to the training of health professionals’ knowledge on diabetes management capacity. Furthermore, measures to improve training for health professionals could satisfying their needs for self-growth and improve the motivation of health professionals. The information system supporting management care should be improved continuously to improve the health professionals’ working opportunities and decrease the workload.

Association of body indices and risk of mortality in patients with type 2 diabetes

IntroductionA body shape index (ABSI) is independently associated with mortality in general population, but studies on the predictability of ABSI in the risk of mortality in patients with type 2...

"My Autism is Linked with Everything": at the Crossroads of Autism and Diabetes.

Autistic adults experience stark health disparities and difficulties accessing health care. Their realities of managing complex health conditions are unknown. Our research explored the experience of Autistic adults self-managing diabetes. Interviews with Autistic adults with diabetes and their support people were thematically analysed to identify three key themes. The Autistic experience influenced diabetes self-management, including autism-unique challenges and strengths. Participants prioritised avoiding Autistic burnout over diabetes self-management; mitigating the psychosocial pressures of neurotypical systems took precedence. Health professionals often separated autism and diabetes subsequently overlooking key factors impacting diabetes self-management. To better meet the needs of Autistic adults, diabetes care and health management more broadly should be considered within the context of autism, including supports for self-management during Autistic burnout.

Patient Perspectives on Virtual Care for Diabetes Management in the Era of COVID-19

ObjectiveThe aim of this study was to characterize patient perspectives on the quality of diabetes care at The Ottawa Hospital Endocrinology and Metabolism multidisciplinary clinic delivered virtually during the COVID-19 pandemic. MethodsAn online survey was developed to collect quantitative and qualitative data on patients’ experiences with virtual diabetes clinic visits between March 2020 and April 2021. ResultsA total of 333 patients were included in this study; 45% were female and had a mean age of 60 years. Seventy-nine percent were born in Canada and 87% identified as Caucasian. Thirty-six percent were treated for type 1 diabetes and 62% for type 2 diabetes. Eighty-seven percent of virtual visits occurred by phone, with 12% of these on Zoom. Overall, 83% were “very satisfied” or “satisfied” with their virtual care experience. Most respondents perceived all treatment-related factors to be equally well addressed virtually as in person, except for physical examination. Auxiliary factors like travel, cost, and time spent were rated more favourably with virtual care. Qualitative findings provided further contextualization and identified gaps in virtual care delivery. For future visits, 44% wanted in-person visits only as needed, 36% wanted a hybrid of in-person and virtual appointments, and 11% preferred in-person appointments only. ConclusionsPatients perceive that virtual care provides high-fidelity diabetes management while reducing their pandemic risks as well as minimizing travel and time associated with in-person care. Virtual care is an important medium for diabetes care delivery that should be used according to patient preference and intermixed with in-person appointments.

Knowledge of diabetic foot care management among medical students at Tabuk University, Tabuk, Saudi Arabia

Knowledge of diabetic foot care management among medical students at Tabuk University, Tabuk, Saudi Arabia

1826-PUB: Efficacy of Digital Diabetes Care Program in India—Retrospective Analysis

Background: Lack of knowledge in self-management and limited access to specialized healthcare services leads to uncontrolled diabetes. Continuous digital care delivered through a mobile healthcare app aid in metabolic control. Aims: To analyze the efficacy of BeatO’s digital diabetes care management program among people with diabetes Methods: A retrospective analysis of 721 participants enrolled in BeatO’s mobile app-based diabetes care program for 3 months, the period of enrollment was between 28th February to 31st August 2022. Participants received remote access to health professionals for diabetes education, nutritional guidance and doctor consultation through the BeatO app. Throughout the care program, they were connected with a dedicated health coach. The medication prescribed by the doctor was delivered to the participant’s home. Regular blood glucose monitoring was done using BeatO’s smartphone-connected glucometer that works in accordance with the BeatO app. The parameters like FBG, PPBG, HbA1c, lipid profile and weight was recorded at baseline and after 3 months. Results: Of the 721 participants, 96.5 % had Type 2 diabetes. The mean age of the participants was 47.5 years, and the majority (80.8%) were males. T2DM was present in 696, T1DM (11), LADA (9), Prediabetes (3) and GDM (2). Out of these, 704 participants completed the program. A significant improvement in blood glucose control was observed, as reflected by a mean decrease in FBG by 38 mg/dL (p &amp;lt;0.0001), PPBG by 37 mg/dL (p &amp;lt;0.0001) and HbA1c reduced by 2.16% (p &amp;lt; 0.0001) at the end of 3 months. There was a significant weight loss of about 1.8 kg (p = 0.01) and a reduction in total cholesterol by 15 mg/dl through this remote personalized care. Conclusions: BeatO's digital diabetes care management program among people with diabetes showed good efficacy in terms of glycemic control and weight loss. Hence, the implementation of digital technology in diabetes care can help in increasing access and awareness of diabetes care and achieving glycemic targets. Disclosure N.Agrawal: Advisory Panel; Biocon, Eris Lifesciences Ltd., Lupin Pharmaceuticals, Inc., Sanofi, USV Private Limited, Other Relationship; BeatO, Health Arx Technologies Pvt LTD. A.Panjabi: Advisory Panel; Torrent Pharmaceuticals Ltd, USV Private Limited, Consultant; BeatO, Health Arx Technologies. P.K.Dixit: Advisory Panel; USV Private Limited, Intas Pharmaceuticals Ltd., Consultant; Beato, Health Arx Technologies. B.D: Consultant; BEAT-O, HEALTH ARX TECHNOLOGIES.

562-P: Improved Glycemic and Cardiometabolic Parameters in Type 2 Diabetes Using AI-Enabled Digital Precision Care with Remote Monitoring

In India, the average HbA1c in adults with type 2 diabetes is 8.9 ± 2.1% with associated increase in prevalence at 74.2 million is a major challenge in health care sector. Barriers includes insufficient knowledge on self management, medication adherence, emotional disturbances, nutrition and activity guidance and personalized care approach. Studies have suggested remote monitoring using technology, bridges the gap between the patient and health care professionals, at their home and at a lower cost. Use of technology for remote monitoring and personalized guidance in real world settings was evaluated using Credo Health precision care programme. Method: The cohort consists of 72 type 2 diabetes members who enrolled for the diabetes management programme for 3 months at Credo Health. Informed consent was sought from the all the individuals and statistics was applied using GraphPad Prism V-5.0. Results: Significant improvement was achieved at the end of 90 days in mean Glycosylated A1c (Figure 1) (8.7 ± 2.2; 7.2 ± 1.1, p: &amp;lt;0.0001), FPG (172.3 ±73.1; 128.5 ± 37.9, p: &amp;lt;0.001), PPPG (231.8 ± 95.8; 153.8 ± 41.1, p: &amp;lt;0.001), SBP (128.7 ± 18.3; 119.9 ± 11.8, p: &amp;lt;0.001), Serum TGL (206.4 ± 99.9; 161.0 ± 67.27, p: &amp;lt;0.05). Conclusion: Remote monitoring and personalized precision diabetes care management improved glycaemic and cardiometabolic outcomes in 3 months. Disclosure M.Kn: None. B.B: None. A.Khadar: None. D.Mohan: None. M.Mani: None. A.R.Pillai: None. C.S: None. R.Channabasavaiah: None.

Barriers to Technology Adoption by Patients and Providers in Diabetes and Hypertension Care Management

Remote monitoring has been demonstrated to be an effective tool for decreasing costs and improving outcomes, however, both patients and providers have shown a reluctance to embrace technology. This survey-based, cross-sectional designed study assessed the barriers faced by patients and providers in the District of Columbia for technology adoption in remote monitoring. The patients had a diagnosis of either diabetes, hypertension, or both conditions, and utilized the technology of a home blood glucose monitor, continuous glucose monitor or ambulatory blood pressure monitor. The surveyed providers included staff engaged in chronic disease management of patients with diabetes and hypertension. An adapted version of the Barriers to Health Promoting Activities for Disabled Persons Scale (BHADP)was administered to study participants and statistically analyzed. Data analysis compared and contrasted demographics and survey responses and revealed that there is a discordance in the ways that patients perceive the barriers to technology as compared to the ways that providers perceive them. Data analysis also revealed significant system barriers that limited providers use of remote monitoring technologies. A model is proposed that identifies inputs and barriers experienced by the patient in their journey to initiate or continue a technology (adapted from Moore et al.’s 2021 Conceptual Model).

Advancements in diabetes Care in Poland

Background: The aging population and increasing prevalence of diabetes are placing significant strain on healthcare systems globally, including in Poland. In recent years, notable progress has been made in establishing patient care systems and improving access to treatment, with significant changes in the reimbursement of innovative therapies. However, as the impact of diabetes on the healthcare system continues to grow and advancements are introduced in patient care, there is a pressing need, to continually search for the most optimal solutions to further enhance diabetes care. Objectives: This paper summarize developments of diabetes care in Poland with a special focus on reimbursement of novel therapies introduced in recent 5 years. Methods: We conducted a review of published sources and publications on the management of diabetes care in Poland. This included an analysis of the latest advancements in coordinated care, the collaborative efforts between general practice physicians and specialists, as well as changes in reimbursement policies and other notable progressions in patient-centric care. Furthermore, we analyzed published reports from the National Fund and assessed reimbursement expenditures. Conclusion: The landscape of diabetes treatment in Poland has undergone significant changes in recent years driven by advancements in pharmacological therapies, technological innovations, and healthcare policies. While challenges remain, these changes offer opportunities for further progress in diabetes care in Poland. Continuous efforts to improve patient centered care along with embracing emerging technologies, will contribute to more effective diabetes management and improved quality of life for individuals with diabetes in the country.

Feasibility and Preliminary Behavioral and Clinical Efficacy of a Diabetes Education Chatbot Pilot Among Adults With Type 2 Diabetes.

Diabetes self-management education and support (DSMES) improves diabetes outcomes yet remains consistently underutilized. Chatbot technology offers the potential to increase access to and engagement in DSMES. Evidence supporting the case for chatbot uptake and efficacy in people with diabetes (PWD) is needed. A diabetes education and support chatbot was deployed in a regional health care system. Adults with type 2 diabetes with an A1C of 8.0% to 8.9% and/or having recently completed a 12-week diabetes care management program were enrolled in a pilot program. Weekly chats included three elements: knowledge assessment, limited self-reporting of blood glucose data and medication taking behaviors, and education content (short videos and printable materials). A clinician facing dashboard identified need for escalation via flags based on participant responses. Data were collected to assess satisfaction, engagement, and preliminary glycemic outcomes. Over 16 months, 150 PWD (majority above 50 years of age, female, and African American) were enrolled. The unenrollment rate was 5%. Most escalation flags (N = 128) were for hypoglycemia (41%), hyperglycemia (32%), and medication issues (11%). Overall satisfaction was high for chat content, length, and frequency, and 87% reported increased self-care confidence. Enrollees completing more than one chat had a mean drop in A1C of -1.04%, whereas those completing one chat or less had a mean increase in A1C of +0.09% (P = .008). This diabetes education chatbot pilot demonstrated PWD acceptability, satisfaction, and engagement plus preliminary evidence of self-care confidence and A1C improvement. Further efforts are needed to validate these promising early findings.

490 Patients’ and Pharmacists’ Experiences of a Community Pharmacy-Based Diabetes Care Plan

Abstract Introduction The traditional view of healthcare professionals as the main decision-makers has changed, recognising the importance of people managing their own conditions (1). An evidence-informed Community Pharmacy-Based Diabetes Care Plan (2) provided person-centred care for adults living with type 2 diabetes in Lagos, Nigeria. Due to the Covid-19 pandemic, community pharmacists (n =20) had monthly remote consultations with patients (n =89) over six months, supporting patients in setting and reviewing their own goals. Aim Part of a larger evaluation, this paper aims to describe patients’ and pharmacists’ experiences, acceptability and contextual barriers and facilitators to the care plan. Methods An invitation for all participants to participate in study interviews during months 4-6 of the care plan was sent via the pharmacists. The researcher contacted participants that sent their consent or consent to contact form in remotely. Semi-structured telephone interviews were conducted with consent. Participants’ reasons for enrolling, participation experiences, barriers and facilitators were explored. Interviews were conducted in English, audio-recorded and transcribed verbatim. Transcripts were thematically analysed, aided by NVivo12. At study completion, all patients were provided with a post-study questionnaire (PSQ). Results Seventy patients completed the PSQ. Of these, 88% were satisfied with the service on a 10-point satisfaction scale (1= very dissatisfied and 10= very satisfied). All respondents stated that the care plan helped them manage their conditions better. Based on their experience with the care plan, all respondents indicated they were likely or much more likely to recommend the care plan to friends and family if they need similar care. Interviews lasting 14-42 minutes were conducted with 10 pharmacists and 15 patients. Seven themes emerged from the data: reasons for agreeing to participate; perception of pharmacy (premises and profession); remote consultations - a new way of working; service delivery and care coordination; acceptability of the care plan; types of goals, goal attainment and patients’ satisfaction; and facilitators, barriers, and recommendations to the care plan. The care plan was perceived as valuable, and it improved patients’ confidence regarding diabetes management. Key benefits of the care plan were patients’ empowerment, including better self-care and addition to therapeutics. Monthly online (majority) meetings between the pharmacists and patients maintained patients’ engagement with the care plan and allowed improvements in goal achievements and better follow-up across the pharmacies. The remote consultations were perceived as innovative and useful, though a few patients were seen face to face in particular circumstances. Identified barriers included time and technology. Patients were satisfied and passionate about the new service, and pharmacists were excited about the opportunities to provide person-centred care in their pharmacies. Conclusion This study is the first mixed-methods evaluation of a person-centred goal-setting intervention for people living with diabetes in Lagos, Nigeria. It showed that the care plan was acceptable and useful to patients and pharmacists. It supports the importance of personalised care in diabetes management. A key limitation was selection bias-only those who expressed interest were interviewed. No follow-up on non-participants was done because the research team had no access to patients’ contact details.

Diabetes care among individuals with and without schizophrenia in three Canadian provinces: A retrospective cohort study

ObjectiveDiabetes is present in approximately 10% of people living with schizophrenia and substantially contributes to early mortality, but some aspects of diabetes care among those with schizophrenia have been inadequately investigated to date. We assessed diabetes care and comorbidity management among people with and without schizophrenia. MethodsWe conducted a cohort study with data obtained from primary care electronic medical records stored in the Diabetes Action Canada (DAC) National Repository from Alberta, Ontario, and Quebec, Canada. The population studied included patients with diabetes, with and without schizophrenia, who had at least 3 primary care visits in a 2 year period between July 2017 and June 2019. Outcomes included glycemia; diabetes complication screening and monitoring; antihyperglycemic and cardioprotective medication prescription; health service use. ResultsWe identified 69,512 patients with diabetes; 911 (1.3%) of whom also had schizophrenia. Prevalence of high HbA1C (>8.5%) (9083/68601; 13.2% vs. 137/911; 15.0%) and high blood pressure (>130/80 mmHg) (4248/68601; 6.2% vs. 73/911; 8.0%) was similar between the two groups. Half (50.0%) of patients with schizophrenia (n = 455) had 11 or more primary care visits in the past year, compared with 27.8% of people without schizophrenia. (p < 0.0001). Patients with schizophrenia had lower odds of ever having blood pressure recorded (OR = 0.81, 95% CI 0.71–0.94) and fewer of those with chronic kidney disease (CKD) were prescribed renin-angiotensin aldosterone system inhibitors, compared to patients without schizophrenia (10.3% vs 15.8%, p = 0.0005). ConclusionsPatients with diabetes and schizophrenia achieved similar blood glucose and blood pressure levels to those without schizophrenia, and had more primary care visits. However, they had fewer blood pressure readings and lower prescription of recommended medications among those who also had CKD. These results are both encouraging and represent opportunities for improvement in care.

Type 1 diabetes management: Room for improvement.

Optimal diabetes care and risk factor management are important to delay micro- and macrovascular complications in individuals with type 1 diabetes (T1D). Ongoing improvement of management strategies requires the evaluation of target achievement and identification of risk factors in individuals who do (or do not) achieve these targets. Cross-sectional data were collected from adults with T1D visiting six diabetes centers in the Netherlands in 2018. Targets were defined as glycated hemoglobin (HbA1c) <53 mmol/mol, low-density lipoprotein-cholesterol (LDL-c) <2.6 mmoL/L (no cardiovascular disease [CVD] present) or <1.8 mmoL/L (CVD present), or blood pressure (BP) <140/90 mm Hg. Target achievement was compared for individuals with and without CVD. Data from 1737 individuals were included. Mean HbA1c was 63 mmol/mol (7.9%), LDL-c was 2.67 mmoL/L, and BP 131/76 mm Hg. In individuals with CVD, 24%, 33%, and 46% achieved HbA1c, LDL-c, and BP targets respectively. In individuals without CVD these percentages were 29%, 54%, and 77%, respectively. Individuals with CVD did not have any significant risk factors for HbA1c, LDL-c, and BP target achievement. In comparison, individuals without CVD were more likely to achieve glycemic targets if they were men and insulin pump users. Smoking, microvascular complications, and the prescription of lipid-lowering and antihypertensive medication were negatively associated with glycemic target achievement. No characteristics were associated with LDL-c target achievement. Microvascular complications and antihypertensive medication prescription were negatively associated with BP target attainment. Opportunities for improvement of diabetes management exist for the achievement of glycemic, lipid, and BP targets but may differ between individuals with and without CVD.

‘Not just a diabetic’: Exploring the service needs of young people with diabetes

BackgroundDiabetes is a complex chronic health condition that can have a significant impact on physical health and psychological wellbeing. Diabetes management can be particularly difficult for young people (YP) with a diagnosis, and complications arising from poor diabetes self-care can be personally and economically costly. There are ongoing local and national priorities to improve diabetes care management (NHS England, 2016/2017) and streamline resources. A service evaluation was commissioned to understand YP’s experiences of living with diabetes.MethodsA qualitative approach was used to elicit YP’s (16–25) experiences of living with diabetes. Eight YP were interviewed using a semi-structured format.ResultsFive themes were identified from the data: 1) Experience of diagnosis, 2) Day-to-day management, 3) Self-identity, 4) Interactions with staff and 5) Peer support.ConclusionsOverall, the findings of this evaluation indicated that YP found navigating and balancing the demands of diabetes and engagement in typical developmental activities a challenging process. These were sometimes at odds with the priorities of healthcare professionals (HCPs), and lead to differences in the perception of optimal diabetes management. This in turn often had a major impact on engagement and diabetes self-care. The evaluation identified that there is an important role for a psychology service to support the psychological wellbeing of YP with diabetes and to create a shared understanding between YP and HCPs to help increase engagement, collaboration and self-management.

Effectiveness of RADAR: An Innovative Model to Organize Diabetes Care in First Nations Communities.

Challenges exist for the management of diabetes care in First Nations populations. RADAR (Reorganizing the Approach to Diabetes through the Application of Registries) is a culturally appropriate, innovative care model that incorporates a disease registry and electronic health record for local care provision with remote coordination, tailored for First Nations people. This study assessed the effectiveness of RADAR on patient outcomes and diabetes care organization in participating communities in Alberta, Canada. It revealed significant improvements in outcomes after 2 years, with 91% of patients achieving a primary combined end point of a 10% improvement in or persistence at target for A1C, systolic blood pressure, and/or LDL cholesterol. Qualitative assessment showed that diabetes care organization also improved. These multimethod findings support tailored diabetes care practices in First Nations populations.