| 1. |
- Schnell, Oliver, et al.
(author)
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CVOT Summit Report 2023 : new cardiovascular, kidney, and metabolic outcomes
- 2024
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In: Cardiovascular Diabetology. - 1475-2840. ; 23:1
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Journal article (peer-reviewed)abstract
- The 9th Cardiovascular Outcome Trial (CVOT) Summit: Congress on Cardiovascular, Kidney, and Metabolic Outcomes was held virtually on November 30-December 1, 2023. This reference congress served as a platform for in-depth discussions and exchange on recently completed outcomes trials including dapagliflozin (DAPA-MI), semaglutide (SELECT and STEP-HFpEF) and bempedoic acid (CLEAR Outcomes), and the advances they represent in reducing the risk of major adverse cardiovascular events (MACE), improving metabolic outcomes, and treating obesity-related heart failure with preserved ejection fraction (HFpEF). A broad audience of endocrinologists, diabetologists, cardiologists, nephrologists and primary care physicians participated in online discussions on guideline updates for the management of cardiovascular disease (CVD) in diabetes, heart failure (HF) and chronic kidney disease (CKD); advances in the management of type 1 diabetes (T1D) and its comorbidities; advances in the management of CKD with SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists (nsMRAs); and advances in the treatment of obesity with GLP-1 and dual GIP/GLP-1 receptor agonists. The association of diabetes and obesity with nonalcoholic steatohepatitis (NASH; metabolic dysfunction-associated steatohepatitis, MASH) and cancer and possible treatments for these complications were also explored. It is generally assumed that treatment of chronic diseases is equally effective for all patients. However, as discussed at the Summit, this assumption may not be true. Therefore, it is important to enroll patients from diverse racial and ethnic groups in clinical trials and to analyze patient-reported outcomes to assess treatment efficacy, and to develop innovative approaches to tailor medications to those who benefit most with minimal side effects. Other keys to a successful management of diabetes and comorbidities, including dementia, entail the use of continuous glucose monitoring (CGM) technology and the implementation of appropriate patient-physician communication strategies. The 10th Cardiovascular Outcome Trial Summit will be held virtually on December 5–6, 2024 (http://www.cvot.org).
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| 2. |
- Bendig, Eileen, et al.
(author)
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Internet-Based Interventions in Chronic Somatic Disease
- 2018
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In: Deutsches Ärzteblatt International. - : DEUTSCHER AERZTE-VERLAG GMBH. - 1866-0452. ; 115:38, s. 659-
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Research review (peer-reviewed)abstract
- Background: Clinical guidelines recommend psychosocial care as an integral part of medical treatment, but access is often limited. Technology-based approaches provide an attractive opportunity to optimize health outcomes and quality of life in people with chronic somatic diseases e.g. by means of Internet-and mobile-based interventions (IMIs). The present article provides an overview on the basics of IMIs, applications and their evidence base for people living with chronic somatic diseases. Methods: We conducted a selective literature search in the PubMed and Cochrane databases. Reviews which included randomized controlled trials investigating psychological IMIs were discussed pertaining to their relevance for the population described. Results: IMIs lead to a change in unfavorable behavior connected to chronic somatic diseases. IMIs can foster protective factors like balanced physical activity or risk factors like smoking or alcohol consumption. However, studies reveal small effect sizes of d=0.25 for physical activity and an averaged effect size of d=0.20 for smoking and alcohol consumption. Additionally, IMIs can be used for the (co-) treatment of chronic somatic diseases, for instance to increase disease-specific self-efficacy in patients with diabetes (d=0.23). Studies included in meta-analyses are often highly heterogenous and are investigated in research contexts with limited health care services relevance. Conclusion: IMIs are potentially effective when aiming at lifestyle changes and supporting medical treatment in people with chronic somatic diseases. However, results are still heterogenous and the evidence base is limited regarding specific settings, compounding the discussion of possible ways of implementing IMIs into our health-care systems.
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| 3. |
- Karyotaki, Eirini, et al.
(author)
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Do guided internet-based interventions result in clinically relevant changes for patients with depression? : An individual participant data meta-analysis
- 2018
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In: Clinical Psychology Review. - : Elsevier. - 0272-7358 .- 1873-7811. ; 63, s. 80-92
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Research review (peer-reviewed)abstract
- Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17-2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07-2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving intemet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.
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| 4. |
- Saleh Stattin, Nuha, 1960-
(author)
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Immigrant Patients with Diabetes: How They Understand, Learn to Manage and Live with Their Diabetes
- 2001
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Doctoral thesis (other academic/artistic)abstract
- This study was initially based on the assumption that difficulties that arise between the Swedish health-care providers and immigrant diabetes patients are due to linguistic and cultural barriers. This assumption weakened as the study developed and began to point to the fact that the patient’s own understanding of his experience of living with and managing his diabetes has a more far-reaching effect than that of the cultural and linguistic differences.The study developed through three sub-studies. During sub-study A I described problems as perceived by immigrant patients and their health-care providers. This was carried out in two phases: first phase by interviewing both patients and health-care providers. In phase two, I arranged a workshop to which patients, interpreters and health-care providers were invited to discuss these problems. The results indicated that even though culture constitutes one problem, it is just one aspect among others to be considered.In sub-study B, the objective was to try to elicit the patients’ own experiences and understanding of their illness. Through semi-structured in-depth interviews, ten patients were interviewed. A model was developed describing patients’ understanding of diabetes.Sub-study C consisted of a follow-up of the learning process where two kinds of interventions were observed. The first was teacher-centred, where the patient was passive. The second was patient-centred where the patient was active, reflective and experimented. During this kind of intervention the role of the health provider entailed supporting and helping the patient. It was after such interventions that behavioural changes occurred and learning took place.Culture and ethnic background is only a part of the patient’s understanding of diabetes. In order for health providers to plan effective interventions leading to changes in patient’s behaviour, they need to understand how patients understand their diabetes and help them in the learning process towards accomplishing the task of managing their diabetes. The model developed could be used as a helpful tool for accessing the patient’s understanding of his experience of his illness and planning more effective interventions.
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| 5. |
- Snoek, Frank J., et al.
(author)
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Roles and competencies of the clinical psychologist in adult diabetes care : A consensus report
- 2024
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In: Diabetic Medicine. - 0742-3071 .- 1464-5491. ; 41:5
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Research review (peer-reviewed)abstract
- Aims: Psychological care is recognised as an integral part of quality diabetes care. We set out to describe the roles and competencies of the clinical psychologist as a member of the multidisciplinary adult diabetes care team, focused on secondary care.Methods: The authors are clinically experienced psychologists involved in adult diabetes care, from Australia, Europe and North America, and active members of the international psychosocial aspects of diabetes study group. Consensus was reached as a group on the roles and competencies of the clinical psychologist working in adult diabetes secondary care, building both on expert opinion and a selective review and discussion of the literature on psychological care in diabetes, clinical guidelines and competency frameworks.Results: The clinical psychologist fulfils multiple roles: (1) as a clinician (psychological assessment and therapy), (2) as advisor to the healthcare team (training, consulting), (3) as a communicator and promotor of person-centred care initiatives and (4) as a researcher. Four competencies that are key to successfully fulfilling the above-mentioned roles in a diabetes setting are as follows: (a) specialised knowledge, (b) teamwork and advice, (c) assessment, (d) psychotherapy (referred to as STAP framework).Conclusions: The roles and competencies of clinical psychologists working in diabetes extend beyond the requirements of most university and post-graduate curricula. There is a need for a comprehensive, accredited specialist post-graduate training for clinical psychologists working in diabetes care, building on the proposed STAP framework. This calls for a collaborative effort involving diabetes organisations, clinical psychology societies and diabetes psychology interest groups.
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