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Clinical inertia on insulin treatment intensification in type 2 diabetes mellitus patients of a tertiary public diabetes center with limited pharmacologic armamentarium from an upper-middle income country.

ABSTRACT: Background:Clinical inertia is related to the difficulty of achieving and maintaining optimal glycemic control. It has been extensively studied the delay of the period to insulin introduction in type 2 diabetes mellitus (T2DM) patients. This study aims to evaluate clinical inertia of insulin treatment intensification in a group of T2DM patients followed at a tertiary public Diabetes Center with limited pharmacologic armamentarium (Metformin, Sulphonylurea and Human Insulin). Methods:This is a real life retrospective record based study with T2DM patients. Demographic, clinical and laboratory characteristics were reviewed. Clinical inertia was considered when the patients did not achieve the individualized glycemic goals and there were no changes on insulin daily dose in the period. Results:We studied 323 T2DM patients on insulin therapy (plus Metformin and or Sulphonylurea) for a period of 2 years. The insulin daily dose did not change in the period and the glycated hemoglobin (A1c) ranged from 8.8?+?1.8% to 8.7?±?1.7% (basal vs 1st year; ns) and to 8.5?±?1.8% (basal vs 2nd year; p?=?0.035). The clinical inertia prevalence was 65.8% (basal), 61.9% (after 1 year) and 58.2% (after 2 years; basal vs 1st year vs 2nd year; ns). In a subgroup of 100 patients, we also studied the first 2 years after insulin introduction. The insulin daily dose ranged from 0.22?±?0.12 to 0.32?±?0.24 IU/kg of body weight/day (basal vs 1st year; p?

SUBMITTER: Alvarenga MA

PROVIDER: S-EPMC6206856 | biostudies-other | 2018

REPOSITORIES: biostudies-other

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Clinical inertia on insulin treatment intensification in type 2 diabetes mellitus patients of a tertiary public diabetes center with limited pharmacologic armamentarium from an upper-middle income country.

Alvarenga Marcelo Alves MA Komatsu William Ricardo WR de Sa Joao Roberto JR Chacra Antonio Roberto AR Dib Sergio Atala SA

Diabetology & metabolic syndrome 20181029

<h4>Background</h4>Clinical inertia is related to the difficulty of achieving and maintaining optimal glycemic control. It has been extensively studied the delay of the period to insulin introduction in type 2 diabetes mellitus (T2DM) patients. This study aims to evaluate clinical inertia of insulin treatment intensification in a group of T2DM patients followed at a tertiary public Diabetes Center with limited pharmacologic armamentarium (Metformin, Sulphonylurea and Human Insulin).<h4>Methods</ ...[more]

PMID: 30386438

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Project description:BackgroundClinical inertia can lead to poor glycemic control among type 2 diabetes patients. However, there is paucity of information on clinical inertia in low- and middle-income countries including Malaysia. This study aimed to determine the time to treatment intensification among T2D patients with HbA1c of ≥7% (≥53 mmol/mol) in Malaysian public health clinics. The proportion of patients with treatment intensification and its associated factors were also determined.Material and methodsThis was a five-year retrospective open cohort study using secondary data from the National Diabetes Registry. The study setting was all public health clinics (n = 47) in the state of Negeri Sembilan, Malaysia. Time to treatment intensification was defined as the number of years from the index year until the addition of another oral antidiabetic drug or initiation of insulin. Life table survival analysis based on best-worst case scenarios was used to determine the time to treatment intensification. Discrete-time proportional hazards model was fitted for the factors associated with treatment intensification.ResultsThe mean follow-up duration was 2.6 (SD 1.1) years. Of 7,646 patients, the median time to treatment intensification was 1.29 years (15.5 months), 1.58 years (19.0 months) and 2.32 years (27.8 months) under the best-, average- and worst-case scenarios respectively. The proportion of patients with treatment intensification was 45.4% (95% CI: 44.2-46.5), of which 34.6% occurred only after one year. Younger adults, overweight, obesity, use of antiplatelet medications and poorer HbA1c were positively associated with treatment intensification. Patients treated with more oral antidiabetics were less likely to have treatment intensification.ConclusionClinical inertia is present in the management of T2D patients in Malaysian public health clinics. We recommend further studies in lower- and middle-income countries to explore its causes so that targeted strategies can be developed to address this issue.

Project description:BackgroundThe diagnosis of Type 1 diabetes is commonly missed in most health facilities in Nigeria. Adequate knowledge of childhood diabetes is necessary for the recognition and possible intervention for the control of the disease. However, research to assess knowledge deficiencies and their relationship to attitude is lacking in most developing countries including Nigeria. This study intends to survey the beliefs and perceptions of caregivers of children towards diabetes in childhood. It also aims at determining the caregivers' depth of knowledge of diabetes in children, the relationship between knowledge and practices as well as the association between level of education and gender with practices and knowledge. The study outcome will help in the formulation of policy and education of the communities with regards to the preconceived myths and realities of childhood diabetes.MethodsA descriptive study involving 500 respondents, population groups were selected by multi-staged sampling from different areas in Enugu metropolis, south-East of Nigeria. A validated structured interviewer-administered questionnaire was used. Ethical approval was obtained, and only consenting subjects were interviewed. Data was analyzed with Statistical Package for the Social Sciences (SPSS) version 20.ResultAlmost all the respondents (99.8%) had heard of diabetes in adults. However, a lower proportion of respondents 43.2% knew about diabetes in childhood. Only 24.8% had good knowledge of the different aspects of diabetes. Although females were more knowledgeable about the effects of healthy life style modifications on diabetes, there was no gender predisposition in knowledge about diabetes in childhood. A positive association existed between knowledge and education [p < 0.001] concerning childhood diabetes. Irrespective of this association 82.6% of the respondents with good knowledge of the disease still had a poor attitude towards healthy life style practices.ConclusionThis study has shown that beliefs and perceptions of childhood diabetes among the adult caregivers in Enugu, south - East Nigeria is mostly erroneous and their knowledge deficient. Literacy did not improve both knowledge and attitude to healthy lifestyle practices.

Project description:The Sustainable Development Goals recognize that the availability and quality of improved water sources affect how households use and benefit from these sources. Although unreliability in piped water supplies in low- and middle-income countries (LMICs) has been described, few studies have assessed household coping strategies in response to unreliable water supplies and associated health outcomes. We characterized unreliability in the piped water supply of the town of Borbón, Ecuador over the twelve years following a major upgrade, as well as household coping strategies and associations with diarrhea. We examined trends in primary and secondary drinking water sources, water storage, and water treatment using longitudinal data collected from 2005 to 2012. In 2017, a follow-up survey was administered (N?=?202) and a subset of 84 household water samples were tested for chlorine residual levels and microbial contamination. From 2005 to 2017, access to a household water connection increased from 19.4% to 90.3%. However, reliability decreased over time, as in the latter half of 2009, households had access to piped water 79% of the time, compared to 63% by 2017. Piped water samples were highly contaminated with total coliforms (100% of samples) and Escherichia coli (89% of samples). From 2005 to 2017, households less likely to report drinking water treatment (50.6%-5.0%). And from 2009 to 2017, bottled water was increasingly consumed as the primary drinking water source (18.8%-62.4%). From 2005 to 2012, having a household connection was not statistically significantly associated with diarrhea case status (OR: 0.86 95%CI: 0.53, 1.39). Neither household water treatment nor bottled water consumption were negatively associated with diarrhea. Increased water storage was associated with diarrhea (OR: 1.33 per 10L of water stored, 95%CI: 1.05, 1.69). Household water treatment, and consumption of purchased bottled water, two coping strategies that households may have undertaken in response to an unreliable water supply, were not associated with a reduced likelihood of diarrhea. These data suggest a need to understand how impoverished rural households in LMICs respond to unreliable water supplies, and to develop heath messaging appropriate for this context.

Project description:BackgroundMobile technology to promote exercise is effective; however, most evidence is from studies of younger groups in high-income countries. Investigating if short message service (SMS) texting can affect exercise participation in older adults from an upper-middle-income country is important considering the proliferation of mobile phones in developing regions and the increased interest of older adults in using mobile phones.ObjectiveThe main objective was to examine the short- and long-term effects of SMS text messaging on exercise frequency in older adults. Secondary objectives were to investigate how SMS text messages impact study participants' exercise frequency and the effects of the intervention on secondary outcomes.MethodsThe Malaysian Physical Activity for Health Study (myPAtHS) was a 24-week, 2-arm, parallel randomized controlled trial conducted in urban Malaysia. Participants were recruited via health talks in resident associations and religious facilities. Older Malaysians (aged 55-70 years) who used mobile phones and did not exercise regularly were eligible to participate in the study. Participants randomly allocated to the SMS texting arm received an exercise booklet and 5 weekly SMS text messages over 12 weeks. The content of the SMS text messages was derived from effective behavior change techniques. The non-SMS texting arm participants received only the exercise booklet. Home visits were conducted to collect outcome data: (1) exercise frequency at 12 and 24 weeks, (2) secondary outcome data (exercise self-efficacy, physical activity-related energy expenditure, sitting time, body mass index, grip and leg strength) at baseline and at 12 and 24 weeks. Intention-to-treat procedures were applied for data analysis. Semistructured interviews focusing primarily on the SMS text messages and their impact on exercise frequency were conducted at weeks 12 and 24.ResultsIn total, 43 participants were randomized into the SMS texting arm (n=22) and the non-SMS texting arm (n=21). Study-unrelated injuries forced 4 participants to discontinue after a few weeks (they were not included in any analyses). Overall retention was 86% (37/43). After 12 weeks, SMS texting arm participants exercised significantly more than non-SMS texting arm participants (mean difference 1.21 times, bias-corrected and accelerated bootstrap [BCa] 95% CI 0.18-2.24). Interview analysis revealed that the SMS text messages positively influenced SMS texting arm participants who experienced exercise barriers. They described the SMS text messages as being encouraging, a push, and a reminder. After 24 weeks, there was no significant difference between the research arms (mean difference 0.74, BCa 95% CI -0.30 to 1.76). There were no significant effects for secondary outcomes.ConclusionsThis study provides evidence that SMS text messaging is effective in promoting exercise in older adults from an upper-middle-income country. Although the effects were not maintained when SMS text messaging ceased, the results are promising and warrant more research on behavioral mobile health interventions in other regions.Trial registrationClinicaltrials.gov NCT02123342; http://clinicaltrials.gov/ct2/show/NCT02123342 (Archived by WebCite at http://www.webcitation.org/6eGSsu2EI).

Project description:BackgroundWhile efforts have been made to validate intrinsic capacity (IC) as a multidimensional indicator of healthy aging in high-income countries, we still need evidence from lower-income countries. We examined associations of IC with wide ranges of activities of daily living in a nationally representative sample of Brazilians aged≥50 years.MethodsThis cross-sectional analysis included 7175 participants from the Brazilian Longitudinal Study of Aging. IC domains (cognitive, psychological, sensory, locomotor, and vitality) were determined using self-reported and physical performance measures. IC was operationalized through factorial analysis. We investigated associations of IC and its domains with functional ability in basic, instrumental, and advanced activities of daily living (ADL, IADL, and AADL) using logistic regressions adjusted for sociodemographic, clinical, and modifiable risk factors.FindingsThe IC bi-factorial model revealed satisfactory goodness-of-fit. Preserved ability in ADL and IADL, respectively, ranged from 69% and 29% to 89% and 74% across IC quartiles. In adjusted analyses, every standard deviation increment in IC composite score was associated with almost twice the odds of preserved ADL (OR=1·72; 95%CI=1·54-1·93), preserved IADL (OR=1·95; 95%CI=1·77-2·16), and high performance in AADL (OR=1·79; 95%CI=1·59-2·00). Similar results were reported using the IC domains as predictors. Although age, race/ethnicity, and education did not modify associations of IC with functional ability, we found sex differences with stronger relationships of IC with preserved ADL or IADL in females.InterpretationOur results support IC validity and reliability to measure healthy aging in diverse socioeconomic and cultural settings. Incorporating IC in routine practices can promote holistic and person-centered care approaches in aging societies.FundingThe Brazilian Ministry of Health and Ministry of Science, Technology, Innovation, and Communication.

Dataset Information

Clinical inertia on insulin treatment intensification in type 2 diabetes mellitus patients of a tertiary public diabetes center with limited pharmacologic armamentarium from an upper-middle income country.

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Clinical inertia on insulin treatment intensification in type 2 diabetes mellitus patients of a tertiary public diabetes center with limited pharmacologic armamentarium from an upper-middle income country.

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