Primary Care Diabetes最新文献

{"title":"Effect of applying a diabetes risk score on lifestyle counselling and shared decision-making in primary care: A pragmatic cluster randomised trial","authors":"Esther Seidel-Jacobs ,&nbsp;Fiona Kohl ,&nbsp;Joachim Rosenbauer ,&nbsp;Matthias B. Schulze ,&nbsp;Oliver Kuss ,&nbsp;Wolfgang Rathmann","doi":"10.1016/j.pcd.2024.12.009","DOIUrl":"10.1016/j.pcd.2024.12.009","url":null,"abstract":"<div><h3>Aims</h3><div>There is a lack of studies on the impact of diabetes risk scores on diabetes prevention. The aim of this study was to investigate the effect of applying a non-invasive diabetes risk score as component of routine health checks on counselling intensity and shared decision-making (SDM) in primary care.</div></div><div><h3>Methods</h3><div>Cluster randomised trial, in which primary care physicians (n = 30) enrolled participants (n = 315) with statutory health insurance without known diabetes, ≥ 35 years of age with a body mass index (BMI) ≥ 27.0 kg/m². In the intervention group, the German Diabetes Risk Score (GDRS) was applied as add-on to the standard routine health check. Outcomes were length and intensity of the counselling interview and the process of SDM. Analysis was by intention-to-treat using mixed models.</div></div><div><h3>Results</h3><div>In the intervention group, higher odds were found for a more intensive counselling interview regarding physical activity, healthy diet and body weight (e.g., participants` perspective: odds ratios between 1.8 and 2.5) compared to controls. Analysis of total SDM score showed a more participative counselling interview in the intervention than in the control group.</div></div><div><h3>Conclusions</h3><div>GDRS use in routine primary care improves intensity of lifestyle counselling and process of SDM already in people with moderate diabetes risk.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 1","pages":"Pages 86-91"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in type 2 diabetes medication use and guideline adherence in Belgian primary care (2019–2023)","authors":"Willem Raat ,&nbsp;Pavlos Mamouris ,&nbsp;Chantal Mathieu ,&nbsp;Geert Goderis ,&nbsp;Bert Vaes","doi":"10.1016/j.pcd.2024.10.007","DOIUrl":"10.1016/j.pcd.2024.10.007","url":null,"abstract":"<div><h3>Aims</h3><div>To assess the prevalence of atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD) among patients with type 2 diabetes (T2D) in Belgium. To analyze trends in medication use and adherence to guidelines from 2019 to 2023.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional analysis using data from the Intego primary care database, encompassing records from 431 general practitioners. We identified adults with T2D through diagnostic codes and glycated hemoglobin levels and analyzed subgroups with ASCVD, HF, and CKD for trends in medication use, particularly SGLT2 inhibitors (SGLT2-i) and GLP-1 receptor agonists (GLP-1).</div></div><div><h3>Results</h3><div>The T2D population increased from 20,766 in 2019 to 21,764 in 2023. The prevalence of ASCVD, HF, and CKD among T2D patients slightly increased to 27 %, 6.7 %, and 23.7 % by 2023 (from 25.2 %, 4.9 % and 21.5 % respectively). Medication prescription trends showed a tripling of SGLT2-i and GLP-1 prescribing in the study period to 6.2 % and 11.5 % respectively. Despite these increases, only 7.5 % of eligible patients received these medications as of 2023.</div></div><div><h3>Conclusion</h3><div>The study highlights a growing burden of ASCVD, HF, and CKD among T2D patients in Belgium and an increase in the use of guideline-recommended medications. However, there remains a substantial gap in the optimal use of these therapies, indicating a need for improved implementation of clinical guidelines in primary care.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 1","pages":"Pages 29-34"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between periodontal disease and gestational diabetes: Systematic review and meta-analysis","authors":"Juan Manuel García-Martos ,&nbsp;Francisco Javier Valverde-Bolívar ,&nbsp;María Teresa Campillo-López ,&nbsp;Miguel Delgado-Rodríguez","doi":"10.1016/j.pcd.2024.11.003","DOIUrl":"10.1016/j.pcd.2024.11.003","url":null,"abstract":"<div><h3>Aim</h3><div>Periodontal disease (PD) can aggravate insulin resistance during pregnancy and trigger the development of gestational diabetes mellitus (GDM).</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was carried out. Two researchers carried out a literature search using internet databases. Studies that met the inclusion criteria were selected. OR was used as the measure of association. The fixed effects model was applied, and due to the presence of heterogeneity, the DerSimonian and Laird random effects model was applied. The level of significance was p &lt; 0.05. The presence of biases was assessed using the Egger test and the funnel plot.</div></div><div><h3>Results</h3><div>Of the 176 articles found, 11 were included. 2032 pregnant women were analyzed, of which 572 developed GDM. It was found that PD was a risk factor for developing GDM when all studies were assessed (OR=1.83 95 % CI 1.25–2.69, p &lt; 0.0017) and when analyzing only those that included an adjusted OR (OR= 1.83 95 % CI 1.31–2.56, p &lt; 0.004).</div></div><div><h3>Conclusions</h3><div>PD poses a high risk of suffering from GDM. The development of oral health programs in women who wish to conceive is essential to improve metabolic control and reduce obstetric and perinatal complications.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 1","pages":"Pages 1-6"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between insurance status and prevalence of diabetic retinopathy in patients with diabetes in the United States from 2011 to 2020","authors":"Jordan Khorsandi ,&nbsp;Daniel Kraversky ,&nbsp;Jack Martinyan ,&nbsp;Prashant Parekh ,&nbsp;Grettel Castro ,&nbsp;Noël Barengo","doi":"10.1016/j.pcd.2024.12.007","DOIUrl":"10.1016/j.pcd.2024.12.007","url":null,"abstract":"<div><h3>Aim</h3><div>To determine whether an association exists between health insurance and diabetic retinopathy (DR) prevalence in adults with diabetes.</div></div><div><h3>Methods</h3><div>An analytical cross-sectional study was conducted utilizing the National Health and Nutrition Examination Survey database. 4530 Patients aged ≥ 18 with diabetes from 2011 to 2020 with various insurance types (no insurance, private, Medicare, Medicaid, or other) were evaluated for prevalence of DR, including covariates. Unadjusted and adjusted logistic regression analysis were conducted to calculate odds ratios (OR) and 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>There was no significant association between insurance status and DR prevalence when adjusting for confounders. OR for DR in patients without insurance, Medicare, Medicaid, or other insurance compared to those with private insurance were 1.13 (95 % CI 0.74–1.71), 0.78 (95 % CI 0.54–1.13), 1.20 (95 % CI 0.80–1.81), and 0.81 (95 % CI 0.47–1.37) respectively. However, factors like age ≥ 65 and use of diabetes medication were associated with reduced DR prevalence.</div></div><div><h3>Conclusion</h3><div>Although insurance status alone does not have an association with the prevalence of DR, this study highlights several confounding variables that potentially influence previously reported associations between insurance status and DR.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 1","pages":"Pages 46-52"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board and Aims & Scopes","authors":"","doi":"10.1016/S1751-9918(25)00013-0","DOIUrl":"10.1016/S1751-9918(25)00013-0","url":null,"abstract":"","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 1","pages":"Pages ii-iii"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143344395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of healthcare utilization in diabetes patients according to foot risk level","authors":"Cristina Blaya Fernández ,&nbsp;Alba Gracia-Sánchez ,&nbsp;Sara Zúnica-García ,&nbsp;Esther Chicharro-Luna","doi":"10.1016/j.pcd.2024.12.005","DOIUrl":"10.1016/j.pcd.2024.12.005","url":null,"abstract":"<div><h3>Aims</h3><div>To quantify healthcare service utilization over the past two years according to the foot risk level in patients with type 2 diabetes (T2DM).</div></div><div><h3>Methodology</h3><div>A descriptive observational study was conducted in a Primary Care Nursing consultation, evaluating patients with T2DM through examination and collection of sociodemographic and clinical data.</div></div><div><h3>Results</h3><div>A total of 153 patients were included. The prevalence of underdiagnosis was 71.2 % for neuropathy and 59.5 % for peripheral arterial disease. Patients with a high foot risk level had more consultations in PC Nursing for foot-related issues (2022 y 2023; p=&lt;0.001). The number of hospitalization days in 2022 was also higher in patients with a high foot risk. Patients with diagnosed neuropathy consistently utilized healthcare services more frequently than those with undiagnosed or no neuropathy across most categories.</div></div><div><h3>Conclusion</h3><div>Patients with a high foot risk level consume more healthcare resources. Early detection and management of diabetic foot is crucial to avoid underdiagnosis, optimize resource use, and prevent serious complications.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 1","pages":"Pages 53-60"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and factors associated with new depressive episodes in adults with newly treated type 2 diabetes: A cohort study","authors":"Jessica Kuntz,&nbsp;Candace Necyk,&nbsp;Scot H. Simpson","doi":"10.1016/j.pcd.2024.12.001","DOIUrl":"10.1016/j.pcd.2024.12.001","url":null,"abstract":"<div><h3>Aims</h3><div>Several methods are available to help identify people with depression; however, there is little guidance on when to start screening. This study estimated the incidence of new depressive episodes and identified factors associated with onset in adults with newly treated type 2 diabetes.</div></div><div><h3>Methods</h3><div>Administrative health data from Alberta, Canada was used to identify people starting metformin between April 2011 and March 2015. People with a history of depression before metformin initiation were excluded. Person-time analysis was used to calculate the incidence rate of new depressive episodes over the next 3 years, stratified by sex, age, and year. Multivariable logistic regression was used to identify factors independently associated with a new depressive episode.</div></div><div><h3>Results</h3><div>42,694 adults initiated metformin; mean age 56 years, 38 % female. A new depressive episode occurred in 2752 (6 %) individuals, mean time to onset was 1.4 years and overall incidence rate was 22.3/1000 person-years. Factors associated with a new depressive episode were female sex, younger age, previous mental health conditions, frequent healthcare utilization, and multiple comorbid conditions.</div></div><div><h3>Conclusions</h3><div>Screening for depression should begin within 1–2 years of metformin initiation and focus on females, those &lt; 55 years old, those with a history of mental health conditions, and those with multiple comorbid conditions.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 1","pages":"Pages 21-28"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycemic and weight control in people with type 2 diabetes: A real-world observational study in primary care","authors":"D Orozco-Beltran ,&nbsp;M Mata-Cases ,&nbsp;S Artola-Menéndez ,&nbsp;F Álvarez-Guisasola ,&nbsp;AM Cebrián-Cuenca ,&nbsp;A Pérez ,&nbsp;DIAMOND2 Study Coordinating Group. On behalf of the study investigators","doi":"10.1016/j.pcd.2024.12.002","DOIUrl":"10.1016/j.pcd.2024.12.002","url":null,"abstract":"<div><h3>Aims</h3><div>To analyze glycemic and bodyweight control in people with type 2 diabetes mellitus (T2DM), and prescribing patterns in primary care.</div></div><div><h3>Methods</h3><div>We reviewed the electronic medical records of 5009 randomly selected T2DM patients, from 70 health centers in Spain. We analyzed results by age group and presence/absence of obesity. All data were collected in 2022.</div></div><div><h3>Results</h3><div>Regarding treatment, 13.2 % of the sample were on lifestyle therapy only, 76.5 % received metformin, 37.6 % SGLT2 inhibitors, 32.2 % DPP-4 inhibitors, 12.2 % GLP-1 agonists, 18.9 % insulin, 6.5 % sulfonylureas, and 1.3 % glitazones. Glycated Hemoglobin (HbA1c) was below 7 % in 57.7 % of patients, and 62.3 % met their individualized HbA1c targets. Overall, 42 % of the population was obese (45.6 % of women vs 39.1 % of men; p = 0.001). Obesity rates decreased with age in both sexes. We found no association between obesity and poor glycemic control (HbA1c&lt;7 %) (43,5 % vs 41,4 %; p = 0,17).</div></div><div><h3>Conclusions</h3><div>In 2022, over 60 % of people with T2DM treated by family doctors in Spain met their individualized glycemic control targets, but only one in three had good glycemic control without obesity. The use of drugs with cardiorenal benefits (particularly SGLT2 inhibitors) is higher than previous published data in our setting.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 1","pages":"Pages 7-14"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic myonecrosis: A rare complication of long-standing diabetes mellitus","authors":"Rosamaria Dias ,&nbsp;Ovie Enaohwo ,&nbsp;Richard Felli ,&nbsp;Aman Garg ,&nbsp;Meet Shah ,&nbsp;Kathleen Beebe","doi":"10.1016/j.pcd.2024.11.001","DOIUrl":"10.1016/j.pcd.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Diabetes mellitus is a rapidly growing health illness worldwide and its incidence is expected to continue rising. Various complications have been cited including retinopathy, nephropathy, peripheral artery disease and ulceration among others. However, rarer complications such as diabetic myonecrosis are limited in literature. This case report demonstrates the presentation of this complication to allow for earlier detection and treatment by providers.</div></div><div><h3>Case report</h3><div>This case highlights a 49-year-old man with an extensive past medical history inclusive of diabetes mellitus type 2, who presented with acute onset left thigh pain and swelling. On presentation, the patient has an HbA1c of 8 % and hyperpigmented spots were noted bilaterally on the lower extremities. Initial management was centered around infectious etiologies and management which failed to improve his symptoms. Further work-up included a negative lower extremity duplex ultrasound and a CT scan showing a hypodense lesion in the left lower extremity. Following unsuccessful drainage of the lesion to assess for a possible abscess, MRI of the lower extremities showed bilateral myositis and myonecrosis centered in the left vastus medialis.</div></div><div><h3>Conclusion</h3><div>This case report highlights a rare complication of diabetes mellitus known as diabetic myonecrosis (DMN). The gold-standard diagnostic tool is a muscle biopsy, however, sensitive imaging like MRI and clinical context are sufficient for a diagnosis. Supportive care centered around pain management remains the standard of care. While this remains as a diagnosis of exclusion, early identification may decrease the number of unnecessary treatments and should remain as a differential in patients with this presentation.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 1","pages":"Pages 82-85"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing the uptake of culturally tailored diabetes self-management education and support programmes among ethnic minority patients with type 2 diabetes: A systematic review","authors":"Sariata Abu ,&nbsp;Sofia Llahana","doi":"10.1016/j.pcd.2025.01.010","DOIUrl":"10.1016/j.pcd.2025.01.010","url":null,"abstract":"<div><h3>Purpose</h3><div>This systematic review aimed to evaluate the factors influencing the uptake of culturally-tailored Diabetes Self-Management Education and Support (DSMES) programmes among ethnic minority patients diagnosed with type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>A systematic review, following PRISMA guidelines, was conducted, including quantitative research studies published in peer-reviewed journals from January 2013 to January 2023. Studies were extracted via the following databases, AMED, MEDLINE, CINAHL, EMBASE, EMCARE, PSYCHINFO, Ovid Nursing, and grey literature. Studies were selected based on eligibility criteria including the evaluation of DSMES programmes tailored for ethnic minorities and involving adult participants with T2DM. The factors affecting the uptake of these programs were mapped against the three categories of the Andersen's Behavioural Model of Health Services Use: predisposing, enabling, and need factors. The quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) checklist, and a narrative synthesis was conducted to analyse the findings.</div></div><div><h3>Results</h3><div>Nine studies met the inclusion criteria, demonstrating that culturally-tailored DSMES programmes significantly improve uptake among ethnic minorities. Key factors influencing participation included demographic characteristics, diabetes knowledge, emotional support, and cultural beliefs. Barriers such as language proficiency, cost, and diabetes fatalism were identified, while enablers included the use of local champions and culturally specific strategies.</div></div><div><h3>Conclusions</h3><div>This systematic review highlights the effectiveness of culturally-tailored DSMES programmes in improving health outcomes among ethnic minority groups. It suggests that more research is needed to explore these barriers and develop strategies to enhance the uptake of DSMES programmes among underserved populations.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 2","pages":"Pages 103-110"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}