Primary Care Diabetes最新文献

{"title":"HbA1c and systolic blood pressure variation to predict all-cause mortality in patients with type 2 diabetes mellitus","authors":"Yun-Chi Lee ,&nbsp;Chwen-Tzuei Chang ,&nbsp;Rong-Hsing Chen ,&nbsp;Tzu-Yuan Wang ,&nbsp;Ching-Chu Chen","doi":"10.1016/j.pcd.2024.01.014","DOIUrl":"10.1016/j.pcd.2024.01.014","url":null,"abstract":"<div><h3>Background</h3><p>Glycated hemoglobin A1c (HbA1c) variation or blood pressure (BP) variation was known to be an independent predictor of all-cause mortality in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate the combined effect of HbA1c and systolic blood pressure (SBP) variation on all-cause mortality and if there was a gender difference in patients with T2DM.</p></div><div><h3>Methods</h3><p>Patients with T2DM who had at least three HbA1c, SBP measurements within 12–24 months during 2001–2007 were included. Coefficient of variation (CV) was used to evaluate variation. The 75th percentile of HbA1c-CV and SBP-CV were set as a cutoff to define high and low variation. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazard models.</p></div><div><h3>Results</h3><p>A total of 2744 patients were included, of whom 769 died during the 11.7 observation years. The associated risk of all-cause mortality was 1.22 [1.01- 1.48], P = 0.044, for low HbA1c-CV &amp; high SBP-CV; 1.28 [1.04–1.57], P = 0.020, for high HbA1c-CV &amp; low SBP-CV; and 1.68 [1.31–2.17], P &lt; 0.001, for high HbA1c-CV &amp; high SBP-CV. The associated risk remained unchanged in either males or females older than 50 years old, although there is only numerically higher for high HbA1c-CV &amp; low SBP-CV in females older than 50 years old.</p></div><div><h3>Conclusions</h3><p>Both HbA1c and SBP variation were significant predictors of all-cause mortality in patients with T2DM. The combined effect was higher than either alone and no gender difference in patients older than 50 years old.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 2","pages":"Pages 146-150"},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1751991824000263/pdfft?md5=c9e976695e0b26d6b87e512d07d82aae&pid=1-s2.0-S1751991824000263-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139667886","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":"Diabetes-related complications, glycemic levels, and healthcare utilization outcomes after therapeutic inertia in type 2 diabetes mellitus","authors":"Cassidi C. McDaniel ,&nbsp;Wei-Hsuan Lo-Ciganic ,&nbsp;Chiahung Chou","doi":"10.1016/j.pcd.2023.12.004","DOIUrl":"10.1016/j.pcd.2023.12.004","url":null,"abstract":"<div><h3>Aims</h3><p>To assess diabetes-related complications, glycemic<span> levels, and healthcare utilization 12 months after exposure to therapeutic inertia among patients with type 2 diabetes mellitus (T2D).</span></p></div><div><h3>Methods</h3><p><span><span>This retrospective cohort study analyzed data from the OneFlorida </span>Clinical Research<span><span> Consortium (electronic health records from Florida practices/clinics). The cohort included adult patients (≥18 years old) with T2D who had an HbA1c≥7.0% (53 mmol/mol) recorded from January 1, 2014-September 30, 2019. Therapeutic inertia (exposed vs. not exposed) was evaluated during the six months following HbA1c≥7.0% (53 mmol/mol). The outcomes assessed during the 12-month follow-up period included diabetes-related complications (continuous </span>Diabetes Complications and Severity Index (DCSI)), glycemic levels (continuous follow-up </span></span>HbA1c lab), and healthcare utilization counts. We analyzed data using multivariable regression models, adjusting for covariates.</p></div><div><h3>Results</h3><p>The cohort included 26,881 patients with T2D (58.94% White race, 49.72% female, and mean age of 58.82 (SD=13.09)). After adjusting for covariates, therapeutic inertia exposure was associated with lower DCSI (estimate=−0.14 (SE=0.03), p &lt; 0.001), higher follow-up HbA1c (estimate=0.14 (SE=0.04), p &lt; 0.001), and lower rates of ambulatory visits (rate ratio=0.79, 95% CI=0.75–0.82).</p></div><div><h3>Conclusions</h3><p>Findings communicate the clinical practice implications and public health implications for combating therapeutic inertia in diabetes care.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 2","pages":"Pages 188-195"},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139374287","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 polyunsaturated fatty acids and progression among patients with diabetic kidney disease","authors":"Wu Liu ,&nbsp;Shiyi Liu ,&nbsp;Qiuyue Ren ,&nbsp;Ronglu Yang ,&nbsp;Shanshan Su ,&nbsp;Xiaoyu Jiang","doi":"10.1016/j.pcd.2024.01.002","DOIUrl":"10.1016/j.pcd.2024.01.002","url":null,"abstract":"<div><h3>Aims</h3><p>Diabetic kidney disease (DKD) is the major complication of diabetes mellitus (DM) and one of the leading causes of end-stage renal disease. Early detection and treatment are contributing to delay the progression of DKD. Dietary management has potential benefits for DKD, especially the intake of polyunsaturated fatty acids (PUFAs). However, there is a lack of sufficient evidence, so we aimed to explore the association between PUFAs intake and DKD progression.</p></div><div><h3>Methods</h3><p>In the National Heath and Nutrition Examination Survey (NHANES) between 2011–2018, a cross-sectional study was conducted among adults with T2DM. DKD was diagnosed with urine albumin to creatinine ratio (ACR) ≥ 30 mg/g or estimated glomerular filtration rate (eGFR) ＜60 ml/min/1.73 m². Using Survey package of R to arrange the collected PUFAs intake data in order from small to large and divide them into four equal parts, which were expressed as Q1, Q2, Q3 and Q4 respectively. To investigate the association between PUFAs intake and DKD, a weighted univariate logistic regression analysis was performed and the odds ratio (OR) and 95% confidence interval (CI) were calculated for the association with DKD and PUFAs quartiles.</p></div><div><h3>Results</h3><p>The study involved 3287 participants with T2DM, including 2043 non-DKD and 1244 DKD patients. The results showed that the intake of PUFAs was a protective factor for DKD (p = 0.022), and with the increase of the PUFAs, renal function improved in DKD patients, the adjusted mean of eGFR and Scr changing from 57 (41, 86) in Q1 to 71 (55, 101) ml/min in Q4 (<em>p 0.001), 103 (73, 131) in Q1 to 90 (68, 117) in Q4 (p = 0.031), respectively.</em></p></div><div><h3>Conclusion</h3><p>Our study indicated that intake of more PUFAs may contribute to delay DKD progression, while different n-6/n-3 ratios need to be explored to protect the kidney.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 2","pages":"Pages 177-182"},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1751991824000020/pdfft?md5=786b3380bf0cc74f1b53978757f2937f&pid=1-s2.0-S1751991824000020-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139503288","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":"A prospective, multicentre, randomized, open-label comparison of a long-acting basal insulin analog glargine plus glulisine with premixed insulin in insulin naïve patients with Type 2 diabetes – A study from India","authors":"Arun Raghavan,&nbsp;Arun Nanditha,&nbsp;Krishnamoorthy Satheesh,&nbsp;Priscilla Susairaj,&nbsp;Ramachandran Vinitha,&nbsp;Dhruv Rajesh Nair,&nbsp;Chamukuttan Snehalatha,&nbsp;Ambady Ramachandran","doi":"10.1016/j.pcd.2024.01.006","DOIUrl":"10.1016/j.pcd.2024.01.006","url":null,"abstract":"<div><h3>Aims</h3><p>We aimed to compare the effectiveness of Glargine plus Glulisine<span> to premixed insulin analogue, as measured by HbA1c<span> ≤ 7.0% in insulin naive Type 2 Diabetes (T2D) patients with elevated fasting and/or postprandial plasma glucose.</span></span></p></div><div><h3>Methods</h3><p><span>Insulin-naive T2D patients (116 men, 84 women) on ≥ 2 </span>oral hypoglycemic agents<span> with inadequate glycemic control<span> were randomized either to group 1 (insulin Glargine plus Glulisine, n = 101) or group 2 (Premixed Insulin analogue, n = 99).</span></span></p></div><div><h3>Results</h3><p><span>In the intention to treat analysis<span>, at week 24, percentage of patients with good glycaemic control (HbA1c ≤ 7.0%) was similar between the two groups (16.8% in Group 1 vs. 13.1% in Group 2, χ2 – 0.535, p = 0.47). Significant reductions in fasting and postprandial levels were observed in groups 1 and 2 at both post-baseline time points (Week 12 and 24). In group 1, reduction in HbA1c from baseline to week 12 was 0.6 ± 0.1 and 0.7 ± 0.2 at week 24, p &lt; 0.0001 for all. In group 2, no significant change in HbA1c was observed. In group 1, 83.2% required an additional dose of glulisine and in group 2, 88.9% required an additional dose of premixed insulin. </span></span>Hypoglycemic events were similar in both groups (0.12 events per person-year in group 1 and 0.13 events per person-year in group 2). Weight gain was non-significant in both groups.</p></div><div><h3>Conclusions</h3><p>Glargine plus Glulisine, though in higher dose was effective as premixed insulin in lowering HbA1c. Hypoglycemic events per person-year were similar in both groups.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 2","pages":"Pages 210-217"},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139547902","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":"Effect of exercise training on glycemic control in diabetic peripheral neuropathy: A GRADE assessed systematic review and meta-analysis of randomized-controlled trials","authors":"Farhad Gholami ,&nbsp;Aynollah Naderi ,&nbsp;Asal Saeidpour ,&nbsp;Jean Pascal Lefaucheur","doi":"10.1016/j.pcd.2024.01.008","DOIUrl":"10.1016/j.pcd.2024.01.008","url":null,"abstract":"<div><h3>Aims</h3><p>We conducted a systematic review<span> and meta-analysis to investigate the effect of exercise training on HbA1c<span><span><span>, and on fasting and postprandial plasma glucose concentrations </span>in patients with </span>diabetic peripheral neuropathy (DPN).</span></span></p></div><div><h3>Methods</h3><p>Two independent researchers performed a systematic search in the electronic databases of PubMed, Web of Science and Scopus. Studies investigating the effect of exercise training on patients diagnosed with DPN using a randomized-controlled design were included in the meta-analysis.</p></div><div><h3>Results</h3><p>Of 1254 retrieved studies, 68 studies were identified to undergo full-text review; out of these a total of 13 randomized trials met the inclusion criteria. Eleven studies assessed HbA1c, 8 fasting plasma-glucose concentration, and 3 postprandial plasma-glucose concentration. Overall, exercise training significantly decreased HbA1c [−0.54% (95% CI −0.78 to −0.31%)], fasting plasma glucose [−32.6 mg/dl [−1.8 mmol/L] (–44.2 to –20.9 mg/dl [−2.4 to −1.1 mmol/L])] and postprandial plasma glucose [−67.5 mg/dl [−3.7 mmol/L] (–129.5 to −5.4 mg/dl [−7.1 to −0.3 mmol/L])]. Studies with aerobic training intervention yielded the largest significant mean reduction in HbA1c (−0.75%) and fasting plasma glucose concertation (34.0 mg/dl).</p></div><div><h3>Conclusions</h3><p><span>aerobic training is the most effective modality to reduces HbA1c, fasting and postprandial plasma glucose concentration in patients with DPN. From a metabolic perspective, the magnitude precision range of the reduction in HbA1c is of clinical importance for patients with DPN. This area of research warrants further attention to investigate the impact of various exercise modalities on </span>glycemic control.</p><p>Registration number CRD42023413687</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 2","pages":"Pages 109-118"},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139577204","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":"Primary care diabetes assessment when HbA1c and other measures of glycemia disagree","authors":"Jared G. Friedman ,&nbsp;Eric P. Smith ,&nbsp;Sanjana S. Awasty ,&nbsp;Morgan Behan ,&nbsp;Matthew T. Genco ,&nbsp;Hannah Hempel ,&nbsp;Sabih Jafri ,&nbsp;Roman Jandarov ,&nbsp;Tara Nagaraj ,&nbsp;Robert S. Franco ,&nbsp;Robert M. Cohen","doi":"10.1016/j.pcd.2023.12.005","DOIUrl":"10.1016/j.pcd.2023.12.005","url":null,"abstract":"<div><h3>Aims</h3><p><span>Although diabetes management decisions in primary care are typically based largely on </span>HbA1c<span><span>, mismatches between HbA1c<span> and other measures of glycemia that are increasingly more available present challenges to optimal management. This study aimed to assess a systematic approach to identify the frequency of mismatches of potential </span></span>clinical significance<span> amongst various measures of glycemia in a primary care setting.</span></span></p></div><div><h3>Methods</h3><p><span>Following screening to exclude conditions known to affect HbA1c interpretation, HbA1c, and fructosamine were obtained and repeated after ∼90 days on 53 adults with </span>prediabetes<span> or type 2 diabetes<span>. A subset of 13 participants with repeat labs wore continuous glucose monitoring (CGM) for 10 days.</span></span></p></div><div><h3>Results</h3><p><span>As expected, HbA1c and fructosamine only modestly correlated (initial R</span>² = 0.768/repeat R² = 0.655). The HbA1c/fructosamine mismatch frequency of ± 0.5% (using the following regression HbA1c = 0.015 *fructosamine + 2.994 calculated from the initial sample) was 27.0%. Of the 13 participants with CGM data, HbA1c and CGM-based Glucose Management Indicator correlated at R² = 0.786 with a mismatch frequency of ± 0.5% at 46.2% compared to a HbA1c/fructosamine mismatch frequency of ± 0.5% at 30.8%.</p></div><div><h3>Conclusions</h3><p><span>HbA1c is frequently mismatched with fructosamine and CGM data. As each of the measures has strengths and </span>weaknesses, the utilization of multiple different measures of glycemia may be informative for diabetes assessment in the clinical setting.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 2","pages":"Pages 151-156"},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089787","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":"Type 2 diabetes-related health measures during the initial COVID-19 surge at an academic internal medicine practice","authors":"Lawrence Ma,&nbsp;Joseph Diaz,&nbsp;Jennifer Deconde,&nbsp;Melissa Wong,&nbsp;Bernice Ruo","doi":"10.1016/j.pcd.2024.01.007","DOIUrl":"10.1016/j.pcd.2024.01.007","url":null,"abstract":"<div><p>The COVID-19 pandemic disrupted chronic disease management in the United States and across the world. This study reports minimal effects of the initial COVID-19 surge on body mass index, blood pressure, cholesterol, and blood glucose control in ambulatory general internal medicine patients with Type 2 diabetes at a single academic center.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 2","pages":"Pages 246-247"},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S175199182400007X/pdfft?md5=5e645e09191820e18c0fd99607870fdc&pid=1-s2.0-S175199182400007X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139552339","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":"National treatment guidelines poorly achieved among older subjects with type 2 diabetes – call to action!","authors":"Maika Kummel ,&nbsp;Emma Luther-Tontasse ,&nbsp;Jaana Koskenniemi ,&nbsp;Tero Vahlberg ,&nbsp;Matti Viitanen ,&nbsp;Jouni Johansson ,&nbsp;Päivi Korhonen ,&nbsp;Laura Viikari ,&nbsp;Marika Salminen","doi":"10.1016/j.pcd.2024.01.012","DOIUrl":"10.1016/j.pcd.2024.01.012","url":null,"abstract":"<div><h3>Objective</h3><p>To assess risk factors and factors associated with nonachievement of the treatment target levels among 75-year-old Finns with type 2 diabetes (T2D).</p></div><div><h3>Design</h3><p>Cross-sectional study.</p></div><div><h3>Setting</h3><p>Outpatient<u><u>.</u></u></p></div><div><h3>Subjects</h3><p>Seventy-five-year-old participants of the Turku Senior Health Clinic Study (N = 1296) with T2D (n = 247).</p><p>Main outcome measures:</p><p>Nonachievement of fasting blood glucose (FBG), low-density lipoprotein (LDL-C), and blood pressure (BP) levels set by the national treatment guidelines.</p></div><div><h3>Results</h3><p>Nonachievement rates of FBG, BP and LDL-C were 47%, 85%, and 47%, respectively. Non-usage of T2D medication was negatively (adjusted OR 0.38, 95% CI 0.16–0.88) and central obesity positively (1.88, 1.09–3.24) related to nonachievement of FBG target level; alcohol use was positively (3.71, 1.04–13.16) and decreased self-rated health negatively (0.34, 0.12–0.97) related to the nonachievement of BP target level. Nonachievement of LDL-C target level was positively related to poor financial status (3.50, 1.19–10.28) and non-use of lipid-lowering medication (7.70, 4.07–14.56)<u><u>.</u></u></p></div><div><h3>Conclusions</h3><p>Nonachievement rates of the national treatment goals were high among older T2D patients, and nonachievement was related to use of medication, obesity, alcohol use, poor health, and poor financial status. We emphasize the importance of customized target setting by risk factor levels and active treatment.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 2","pages":"Pages 126-131"},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139718208","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":"Therapeutic inertia in treatment of older adults with type II diabetes at high risk for hypoglycemia","authors":"Brittany Ricci ,&nbsp;Jane Lee ,&nbsp;Minjia Xie ,&nbsp;Alexander Turchin","doi":"10.1016/j.pcd.2024.01.015","DOIUrl":"10.1016/j.pcd.2024.01.015","url":null,"abstract":"<div><p>Patients 80 years or older with HbA1c<span> &lt;7.0% (53 mmol/mol) treated with multiple daily insulin injections had low rates of rapid-acting insulin deprescription and initiation of diabetes medications with lower risk of hypoglycemia. Further investigation is needed to elucidate factors contributing to potentially inappropriately aggressive treatment of these patients.</span></p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 2","pages":"Pages 238-240"},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699181","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":"Deintensification of potentially inappropriate medications amongst older frail people with type 2 diabetes: Protocol for a cluster randomised controlled trial (D-MED study)","authors":"Lauren O’Mahoney ,&nbsp;Patrick Highton ,&nbsp;Ruksar Abdala ,&nbsp;Helen Dallosso ,&nbsp;Clare L. Gillies ,&nbsp;Seema Ragha ,&nbsp;Fiona Munday ,&nbsp;John Robinson ,&nbsp;Andrew Marshall ,&nbsp;James P. Sheppard ,&nbsp;Kamlesh Khunti ,&nbsp;Samuel Seidu","doi":"10.1016/j.pcd.2023.12.001","DOIUrl":"10.1016/j.pcd.2023.12.001","url":null,"abstract":"<div><h3>Aims</h3><p>Amongst elderly people with type 2 diabetes (T2D) over prescribing can result in emergency ambulance call-outs, falls and fractures and increased mortality, particularly in frail patients. Current clinical guidelines, however, remain focused on medication intensification rather than deintensification where appropriate. This study aims to evaluate the effectiveness of an electronic decision-support system and training for the deintensification of potentially inappropriate medications amongst older frail people with T2D, when compared to ‘usual’ care at 12-months.</p></div><div><h3>Methods</h3><p>This study is an open-label, multi-site, two-armed pragmatic cluster-randomised trial. GP practices randomised to the ‘enhanced care’ group have an electronic decision support system installed and receive training on the tool and de-intensification of diabetes medications. The system flags eligible patients for possible deintensification of diabetes medications, linking the health care professional to a clinical algorithm. The primary outcome will be the number of patients at 12-months who have had potentially inappropriate diabetes medications de-intensified.</p></div><div><h3>Results</h3><p>Study recruitment commenced in June 2022. Data collection commenced in January 2023. Baseline data have been extracted from 40 practices (3145 patients).</p></div><div><h3>Conclusions</h3><p>Digital technology, involving computer decision systems, may have the potential to reduce inappropriate medications and aid the process of de-intensification.</p></div><div><h3>Trial registration</h3><p>International Standard Randomised Controlled Trial Number: ISRCTN53221378. Available at: https://www.isrctn.com/ISRCTN53221378.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 2","pages":"Pages 132-137"},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S175199182300219X/pdfft?md5=71a40ec3385d427682f1b862a1512b30&pid=1-s2.0-S175199182300219X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139463813","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}