| 1. |
- Hellgren, Margareta, 1955, et al.
(författare)
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Haemoglobin A1c as a screening tool for type 2 diabetes and prediabetes in populations of Swedish and Middle-East ancestry
- 2017
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Ingår i: Primary Care Diabetes. - : Elsevier BV. - 1751-9918 .- 1878-0210. ; 60, s. S148-S148
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To explore and compare sensitivity and specificity for HbA1c >= 48 mmol/mol as a predictor for type 2 diabetes mellitus (T2DM) in two populations with different ethnicity and to examine the predictive value of two levels of HbA1c (>= 42 mmol/mol, >= 39 mmol/mol) for prediabetes in these populations. Methods: Four cohorts were examined with an oral glucose tolerance test. (1) The MEDIM Study (n = 1991 individuals of Swedish and Iraqi ancestry); (2) The Skaraborg Project (n=1327 individuals of Swedish ancestry); (3) The 4-D study (n=424 individuals of Swedish, Iraqi and Turkish ancestry); (4) The Flemingsberg study (n = 212 participants of Turkish ancestry). Results: HbA1c >= 48 mmol/mol had a sensitivity for T2DM of 31% and 25% respectively in individuals of Middle-East and Swedish ancestry. The positive and negative predictive value was high in both populations (70.3, 96.4 and 96.2, 97.6 respectively). Using HbA1c >= 42 mmol/mol and >= 39 mmol/mol as a predictor for prediabetes gave a sensitivity of 17% and 36% in individuals of Middle-East and 15% and 34% in individuals of Swedish ancestry. Conclusions: Even if HbA1c >= 48 mmol/mol is a valuable diagnostic tool, it is a blunt and insensitive tool for screening and would exclude most people with T2DM, independent of ancestry and age. HbA1c is an inefficient way to detect individuals with prediabetes. (C) 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
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| 2. |
- Husdal, Rebecka, et al.
(författare)
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Resource allocation and organisational features in Swedish primary diabetes care : Changes from 2006 to 2013
- 2017
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Ingår i: Primary Care Diabetes. - : Elsevier. - 1751-9918 .- 1878-0210. ; 11:1, s. 20-28
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To compare the resource allocation and organisational features in Swedish primary diabetes care for patients with type 2 diabetes mellitus (T2DM) between 2006 and 2013.Methods: Using a repeated cross-sectional study design, questionnaires covering personnel resources and organisational features for patients with T2DM in 2006 and 2013 were sent to all Swedish primary health care centres (PHCCs) during the following year. In total, 684 (74.3%) PHCCs responded in 2006 and 880 (76.4%) in 2013.Results: Compared with 2006, the median list size had decreased in 2013 (p<0.001), whereas the median number of listed patients with T2DM had increased (p<0.001). Time devoted to patients with T2DM and diabetes-specific education levels for registered nurses (RNs) had increased, and more PHCCs had in-house psychologists (all p<0.001). The use of follow-up systems and medical check-ups had increased (all p<0.05). Individual counselling was more often based on patients' needs, while arrangement of group-based education remained low. Patient participation in setting treatment targets mainly remained low.Conclusions: Even though the diabetes-specific educational level among RNs increased, the arrangement of group-based education and patient participation in setting treatment targets remained low. These results are of concern and should be prioritised as key features in the care of patients with T2DM. (C) 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
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| 3. |
- Kalkan, Almina, et al.
(författare)
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Increased healthcare utilization costs following initiation of insulin treatment in type 2 diabetes : A long-term follow-up in clinical practice
- 2017
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Ingår i: Primary Care Diabetes. - : Elsevier. - 1751-9918 .- 1878-0210. ; 11:2, s. 184-192
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To compare long-term changes in healthcare utilization and costs for type 2 diabetes patients before and after insulin initiation, as well as healthcare costs after insulin versus non-insulin anti-diabetic (NIAD) initiation. Methods: Patients newly initiated on insulin (n = 2823) were identified in primary health care records from 84 Swedish primary care centers, between 1999 to 2009. First, healthcare costs per patient were evaluated for primary care, hospitalizations and secondary outpatient care, before and up to seven years after insulin initiation. Second, patients prescribed insulin in second line were matched to patients prescribed NIAD in second line, and the healthcare costs of the matched groups were compared. Results: The total mean annual healthcare cost increased from 1656 per patient 2 years before insulin initiation to 3814 seven years after insulin initiation. The total cumulative mean healthcare cost per patient at year 5 after second-line treatment was 13,823 in the insulin group compared to 9989 in the NIAD group. Conclusions: Initiation of insulin in type 2 diabetes patients was followed by increased healthcare costs. The increases in costs were larger than those seen in a matched patient population initiated on NIAD treatment in second-line. (C) 2016 The Author(s). Published by Elsevier Ltd on behalf of Primary Care Diabetes Europe. This is an open access article under the CC BY-NC-ND license.
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| 4. |
- Sabale, Ugne, et al.
(författare)
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Weight change patterns and healthcare costs in patients with newly-diagnosed type-2 diabetes in Sweden
- 2017
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Ingår i: Primary Care Diabetes. - : Elsevier BV. - 1751-9918 .- 1878-0210. ; 11:3, s. 217-225
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To describe weight-change pathways in patients with type 2 diabetes (T2D) and associated healthcare costs using repeated BMI measurements and healthcare utilization data.Methods: Patients with newly-diagnosed T2D with body mass index (BMI, kg/m(2)) at diagnosis and subsequent measures at year 1-3 were identified. Based on three-year BMI change, patients were assigned to one of 27 BMI change pathways defined by annual BMI change: BMI NE arrow (>= 1 BMI unit increase), BMI -> (<1 BMI unit change), and BMI SE arrow (>= 1 BMI unit decrease). Mean annual and three-year cumulative healthcare costs were estimated for each pathway by combining Swedish unit costs with resource use from primary care and national patient registers.Results: Cohort consisted of 15,819 patients; 44% women, mean age of 61 years, HbA1c of 6.7% (50 mmol/mol), BMI of 30.6 kg/m(2). Most common BMI pathways (mean costs): BMI ->->-> ((sic)5,311), BMI SE arrow ->->((sic)5,461), and BMI ->->SE arrow((sic)6,281). General trends: BMI)->->-> linked to lowest, BMI NE arrow ->NE arrow linked to highest costs.Conclusion: In patients with newly -diagnosed T2D, weight stability was the most common BMI change pattern over 3 years and associated with lowest healthcare costs. Relationship between weight change and healthcare costs appears complex warranting further investigation.
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| 5. |
- Staff, Angelica, et al.
(författare)
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Patients requests and needs for culturally and individually adapted supportive care in type 2 diabetes patients A comparative study between Nordic and non-Nordic patients in a social economical vulnerable area of Linkoping, Sweden
- 2017
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Ingår i: Primary Care Diabetes. - : ELSEVIER SCI LTD. - 1751-9918 .- 1878-0210. ; 11:6, s. 522-528
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Tidskriftsartikel (refereegranskat)abstract
- Aims: This study sought to determine and compare the metabolic control of type 2 diabetes mellitus (T2DM) in non-Nordic immigrants and native Nordics. The aim was also to describe and compare the request of supportive care between these two groups. Methods: One hundred and eighty-four patients (n = 184) coming to a routine check-up in a primary healthcare setting (PHC), were consecutively enrolled to the study during a period of one year. Data on therapeutic interventions, clinical measurements, healthcare consumption, and adherence to standard diabetes healthcare program were extracted from the patients medical record. Structured interviews on supportive care were conducted by diabetes trained nurses. If needed, a qualified interpreter was used. Comparisons were made between Nordic patients (n =151) and non-Nordic patients (n = 33). Results: Among T2DM patients in a setting of PHC, there was a difference in meeting the metabolic target HbA1c, between native Nordics and non-Nordic immigrants. There was also a difference in request on supportive care. The non-Nordic group significantly requested more and different supportive care. They also attended the standard diabetes program to a lesser degree. Conclusions: Culturally/individually adapted prevention is not only medically warranted but also requested by the patients themselves. (C) 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
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| 6. |
- Aghili, Rokhsareh, et al.
(författare)
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The challenge of living with diabetes in women and younger adults : A structural equation model
- 2017
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Ingår i: Primary Care Diabetes. - : Elsevier BV. - 1751-9918. ; 11:5, s. 467-473
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Tidskriftsartikel (refereegranskat)abstract
- Background: Attitudes toward diabetes care are different between genders and age-groups. Furthermore, diabetes related challenges may cause psychosocial problems. Therefore, we were to compare the psychosocial status and glycemic control in women and men with type 2 diabetes (T2D) in different age-groups. Methods: 441 adults with T2D were recruited. Demographic, self-care behavior, resources and affective variables as well as the health related quality of life (HRQoL) were measured. The median age of 55 was used as the cut-off for the age comparison. Structured equation modeling (SEM) investigated the relationship between age, gender, psychosocial factors and glycemic control. Results: Finally, 203 women and 177 men completed the study (86.1%). There was no significant difference in mean duration of T2D, or glycemic control between genders or age-groups. Women, especially those below the median age of 55, had significantly higher level of diabetes-related distress (2.16. ±. 0.94 vs. 1.92. ±. 0.81), depression (9.67. ±. 5.37 vs. 7.54. ±. 5.06), and anxiety (19.81. ±. 12.04 vs. 12.81. ±. 9.04, P. <. 0.05 for all comparisons), while people above the age of 55 reported better self-management and patient-physician relationship. HRQoL was lower in women compared to men (0.77. ±. 0.23 vs. 0.81. ±. 0.18, P = 0.02). The final SEM suggested that the effect (standardized β coefficient) of gender and age on affective variables was 0.25 and -0.19 (P. <. 0.05), respectively, though psychosocial factors did not directly influence HbA1c. Conclusions: This study shows that psychosocial factors are associated with age and gender in patients with T2D; with younger women demonstrating higher level of depressive symptoms, anxiety, and diabetes-related distress independent of status of glycemic control.
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| 7. |
- Claesson, Rickard, et al.
(författare)
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HbA1c as a predictor of diabetes after gestational diabetes mellitus
- 2017
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Ingår i: Primary Care Diabetes. - : Elsevier BV. - 1751-9918. ; 11:1, s. 46-51
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Tidskriftsartikel (refereegranskat)abstract
- Aim We wanted to investigate third-trimester HbA1c as a predictor of diabetes after gestational diabetes mellitus (GDM). Methods Women with GDM were followed up prospectively for five years from pregnancy to detect the development of diabetes. The ability of HbA1c to predict diabetes was evaluated with receiver-operating characteristic (ROC) curves and logistic regression analysis. Results By five years, 73 of 196 women had been diagnosed with diabetes. An optimal cut-off point for HbA1c of 36 mmol/mol (5.4%) could predict diabetes with 45% sensitivity and 92% specificity. For HbA1c ≥39 mmol/mol (≥5.7%), sensitivity, specificity, and positive predictive value were 30%, 97%, and 91%, respectively. In logistic regression analysis, adjusting for the diagnostic glucose concentration during pregnancy, HbA1c levels in the upper quartile (≥36 mmol/mol) were associated with a 5.5-fold increased risk of diabetes. Conclusion Third-trimester HbA1c levels in the pre-diabetes range revealed women with post-partum diabetes with high specificity and high positive predictive value. HbA1c testing could be used as a strategy to select high-risk women for lifestyle interventions aimed at prevention of diabetes starting during pregnancy. The results should encourage further validation in other populations using new diagnostic criteria for GDM.
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| 8. |
- Martin-Merino, E., et al.
(författare)
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Risk factors for diabetic macular oedema in type 2 diabetes: A case-control study in a United Kingdom primary care setting
- 2017
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Ingår i: Prim Care Diabetes. - : Elsevier BV. - 1751-9918. ; 11:3, s. 288-296
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To identify risk factors associated with the development of DMO among patients diagnosed with type 2 diabetes managed in a primary care setting in the UK. Methods: A case-control study nested in a cohort of incident Type 2 diabetes identified in The Health Improvement Network database from 2000-2007. Cases were people with DMO (N=211) and controls were a DMO-free sample (N=2194). No age restrictions were applied. Adjusted odds ratios and 95%CIs were estimated (OR; 95%CI). Results: DMO increased with high alcohol use (2.88; 1.49-5.55), cataracts (4.10; 2.73-6.15), HbA1c >= 7% (1.58; 1.08-2.32), systolic blood pressure >= 160 mm Hg (2.03; 1.17-3.53), total cholesterol >= 5 mmo/L (1.66; 1.15-2.39), LDL >= 3 mmol/L (1.73; 1.14-2.61), and microalbuminuria (1.78; 1.16-2.73). Diuretic drugs were associated with a reduced risk of DMO (0.68; 0.47-0.99), as did smoking (0.47; 0.28-0.77), overweight (0.53; 0.30-0.96) or obesity (0.52; 0.30-0.91) at diabetes diagnosis, and high triglyceride levels (0.51; 0.35-0.74). Patients treated with anti-diabetic drugs showed higher risk of DMO than non-treated patients, particularly those with sulphonylureas (3.40; 2.42-4.78), insulin (3.21; 1.92-5.36) or glitazones (1.88; 1.17-3.04). Conclusion: In patients with type 2 diabetes managed in primary care, multiple factors associated with DMO were identified, such as cataracts, microalbuminuria and high levels of HbA1c, systolic BP, total cholesterol, and LDL. Diuretic drugs were associated with a reduced risk of DMO. Treated diabetes, particularly with sulphonylureas, insulin or glitazones showed highest risk of DMO. The inverse association between smoking, obesity, and triglycerides and DMO deserves further research. (C) 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
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| 9. |
- Trivedi, H., et al.
(författare)
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Self-knowledge of HbA1c in people with Type 2 Diabetes Mellitus and its association with glycaemic control
- 2017
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Ingår i: Primary Care Diabetes. - : Elsevier BV. - 1751-9918. ; 11:5, s. 414-420
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to evaluate the prevalence of accurate self-knowledge of a patient's own HbA1c level (HbA1c(SK)), as a component of structural education (University Hospital's of Leicester (UHL), 2013) and its association with glycaemic control. Methods: Data from the GUIDANCE study, a cross-sectional study involving 7597 participants from eight European countries was used. HbA1c(SK) was evaluated and compared with laboratory measured HbA1c levels (HbA1c(LAB)), which represented the measure of glycaemic control. Accuracy of the self-reported HbA1c was evaluated by using agreement statistical methods. Results: The prevalence of HbA1csK was 49.4%. Within this group, 78.3% of the participants had accurately reported HbA1c(SK). There was good level of agreement between HbA1c(SK) and HbA1c(LAB) (intra-class correlation statistic =0.84, p <0.0001). Participants with accurately reported HbA1c(SK) were found to have a statistically significantly lower HbA1c(LAB) compared to participants with inaccurately reported HbA1c(SK) (7.0% versus 7.3%, p <0.001). Conclusion: Nearly half of the patients had self-knowledge of their own HbA1c level. Moreover, the participants with accurately reported HbA1c(SK) were found to have associated better glycaemic control. (C) 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
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