"It Takes a Village"- A Conversation with the Interprofessional Diabetes Clinic at the ECU Health Family Medicine Center.

Interprofessional collaboration and shared understanding positively impact both patients and providers. Current recommendations from the CDC and experts agree that collaboration between diverse professions is necessary to improve patient outcomes and empower patients to selfmanage their chronic conditions.

The effectiveness of social media-based microlearning in improving knowledge, self-efficacy, and self-care behaviors among adult patients with type 2 diabetes: an educational intervention.

BACKGROUND: The purpose of this study is to investigate the impact of social media-based microlearning (SMBM) on enhancing the knowledge, self-care, and self-efficacy behaviors of patients with type 2 diabetes (T2D) receiving care at a hospital-based diabetes clinic in Zahedan, Iran. METHODS: This intervention study was conducted from September 2021 to the end of 2022, with an intervention group (SMBM) and a control group (conventional-based training) consisting of patients with T2D. A total of 80 eligible patients were selected using a convenience sampling method and randomly assigned to either the intervention group (n = 40) or the control group (n = 40). The knowledge level, self-care, and self-efficacy of the samples were assessed before and two weeks after the educational intervention. Data analysis was conducted using SPSS version 24, and independent and paired T-tests were used for analysis. RESULTS: The results of the study revealed that after the intervention, the levels of knowledge, self-care, and self-efficacy in the intervention group were significantly higher than those in the control group (p-value < 0.001). CONCLUSION: In conclusion, the SMBM appears to be an effective tool for improving self-efficacy, self-care, and knowledge among patients with type 2 diabetes.

Virtual clinic for young people with type 1 diabetes: a randomised wait-list controlled study.

BACKGROUND: The transition from paediatric to adult care for young adults with type 1 diabetes poses unique challenges. Virtual diabetes clinics using smartphone applications offer a promising approach to support self-management and enhance communication with healthcare providers. The primary objective of this study was to evaluate the effects of a virtual diabetes clinic on glycaemic control, treatment satisfaction, and quality of life among young adults diagnosed with type 1. METHODS: 79 participants with type 1 diabetes aged 18-25 years were included in a prospective, single-centre, randomised, wait-list controlled trial. Participants were randomly assigned to either the intervention group or the wait-list control group. The intervention group received instant access to a virtual care platform called Vista Dialog, which facilitated real-time communication between patients and healthcare providers. Glycosylated haemoglobin (HbA1c) levels, time in range (TIR), time below range (TBR), diabetes treatment satisfaction, and quality of life were assessed at baseline and after 6 months. RESULTS: Baseline characteristics were similar between the intervention and control groups, except for education level, where there was a skewed distribution between the groups (the intervention group had a lower education level). At the 6-month follow-up, there were no significant differences in HbA1c levels, TIR, TBR, or diabetes treatment satisfaction between the two groups. However, the intervention group demonstrated a significant decrease in the burden on physical health compared with the control group, indicating an improved quality of life. CONCLUSIONS: The implementation of a virtual diabetes clinic using the Vista Dialog platform did not result in significant improvements in glycaemic control or treatment satisfaction compared with usual care. However, it did show potential benefits in terms of reducing the burden on physical health and improving quality of life in young adults with type 1 diabetes. Further research is needed to explore the long-term effects and optimal use of virtual clinics in diabetes management. TRIAL REGISTRATION: ISRCTN number: 73,435,627 (registration date: 23/10/2019): https://doi.org/10.1186/ISRCTN73435627 . The performance and results of this trial adhere to the guidelines outlined in the CONSORT 2010 (Consolidated Standards of Reporting Trials) recommendations.

Planning and Selection of Facility Layout in Healthcare Services.

Facility layout planning (FLP) is an integral part of the hospital layout design. The purpose of this article is to develop and elaborate a FLP method for a diabetes clinic using a case study approach. In this study, the Systematic Layout Planning (SLP) approach was used to design three alternatives to diabetes clinic design using group decision making. A multi-criterion decision-making (MCDM) approach, fuzzy-Technique for an order of preference by similarity to an ideal solution (fuzzy-TOPSIS) was used to select the best among the alternatives. The method used for the calculation of weight for various selection criteria was modified digital logic (MDL). The study elaborates the method using a diabetes specialty clinic but can be used for solving more complex selection problems as well. The research is the first of its kind to address the problem of FLP in the case of a diabetes clinic. The method can be easily adapted for layout selection in other specialty and multispecialty hospitals.

Diabetes clinic reinvented: will technology change the future of diabetes care?

Diabetes is a chronic disease that affects nearly 463 million people globally and involves multiple co-morbid conditions that require effective treatment and continuous management. These include lifestyle and behavioral modifications, compliance to diabetes medications and close patient monitoring, all of which can be efficiently conducted via telehealth. Integrating digital technology of telehealth and mobile health into diabetes care may improve diabetes management and increase its efficiency. In this review, we examine recent advances in healthcare technology of diabetes. Moreover, we present an example of a comprehensive virtual diabetes clinic, the "Joslin HOME," as an innovative digital ecosystem for future application in diabetes care. This model utilizes digital health technology and comprises frequent short visits with easy two-way scheduling, focused documentation and simple billing methods. In this new model, a multidisciplinary team is connected with their patients using telehealth and mobile health to overcome the barriers of distance and location. It may possibly extend quality diabetes care to remote, underserved or rural areas.

Predictors of loss to follow up among patients with type 2 diabetes mellitus attending a private not for profit urban diabetes clinic in Uganda - a descriptive retrospective study.

BACKGROUND: Although the prevalence of type 2 diabetes mellitus is increasing in Uganda, data on loss to follow up (LTFU) of patients in care is scanty. We aimed to estimate proportions of patients LTFU and document associated factors among patients attending a private not for profit urban diabetes clinic in Uganda. METHODS: We conducted a descriptive retrospective study between March and May 2017. We reviewed 1818 out-patient medical records of adults diagnosed with type 2 diabetes mellitus registered between July 2003 and September 2016 at St. Francis Hospital - Nsambya Diabetes clinic in Uganda. Data was extracted on: patients' registration dates, demographics, socioeconomic status, smoking, glycaemic control, type of treatment, diabetes mellitus complications and last follow-up clinic visit. LTFU was defined as missing collecting medication for six months or more from the date of last clinic visit, excluding situations of death or referral to another clinic. We used Kaplan-Meier technique to estimate time to defaulting medical care after initial registration, log-rank test to test the significance of observed differences between groups. Cox proportional hazards regression model was used to determine predictors of patients' LTFU rates in hazard ratios (HRs). RESULTS: Between July 2003 and September 2016, one thousand eight hundred eighteen patients with type 2 diabetes mellitus were followed for 4847.1 person-years. Majority of patients were female 1066/1818 (59%) and 1317/1818 (72%) had poor glycaemic control. Over the 13 years, 1690/1818 (93%) patients were LTFU, giving a LTFU rate of 34.9 patients per 100 person-years (95%CI: 33.2-36.6). LTFU was significantly higher among males, younger patients (< 45 years), smokers, patients on dual therapy, lower socioeconomic status, and those with diabetes complications like neuropathy and nephropathy. CONCLUSION: We found high proportions of patients LTFU in this diabetes clinic which warrants intervention studies targeting the identified risk factors and strengthening follow up of patients.

Healthcare delivery for paediatric and adolescent diabetes in low resource settings: Type 1 diabetes clinics in Uganda.

The management of type 1 diabetes (T1DM) includes setting up organised follow-up clinics. A programme for establishing such clinics in Uganda commenced in 2009. The clinics were established along the chronic care model and were integrated into the health structure of other chronic diseases. Web-based electronic medical records were utilised to establish a centralised registry. All children with diabetes below 18 years of age were encouraged to enrol into the programme by attending the nearest established T1DM clinic. At the commencement of the programme, there were 178 patients with T1DM receiving care in various health facilities but without organised follow-up T1DM clinics. These patients were subsequently enrolled into the programme and as of June 30, 2018, the programme had a total of 32 clinics with 1187 children; 3 with neonatal diabetes. Challenges encountered included difficulties in timely diagnosis, failure to provide adequate care in the remote rural areas and failure to achieve pre-defined glycated haemoglobin (HbA1c) goals. Despite these challenges, this observational study demonstrates that healthcare delivery for T1DM organised along the chronic care model and supported by web-based electronic medical records is achievable and provides care that is sustainable. Addressing the encountered challenges should result in improved outcomes for T1DM.

Mobile care teams improve metabolic control for adults with Type II diabetes in the Southern West Bank, Palestine.

AIM: The purpose of this study is to assess the effectiveness of the Diabetes Comprehensive Care Model (DCCM) intervention on diabetes care outcomes. We hypothesized that participants receiving diabetes care from the mobile diabetes clinic (intervention group) would demonstrate significant improvement in glycemic control compared to those receiving treatment as usual (control group). MATERIALS AND METHODS: We conducted a longitudinal, quasi-experimental study in which two similar clinics were identified. From both, we recruited 100 patients diagnosed with Type II diabetes. At baseline, patients were similar in terms of both socio-demographic and diabetes health variables. The team visited patients at the Bethlehem clinic at the beginning and end of the study (control group). Mobile diabetes care teams implemented the DCCM in Hebron four times over one year (treatment group). RESULTS: Most participants were female (63.5%) with average diabetes duration of 7.9 years. Initial HbA1c was 9.49% on average (SD = 1.93) and 9.20% (SD = 1.92) for the control and intervention groups, respectively. Statistically significant change in HbA1c, cholesterol, creatinine and systolic BP were observed in the intervention group (differences in change between recruitment and follow-up). That is, significant improvement over time was observed for the treatment group whereas little or no change was observed for the control group. CONCLUSION: The DCCM-based intervention leads to improved glycemic control parameters indicative of diabetes control. Clinically significant change was observed in treatment group only. Integrative diabetes care appears especially well suited for fragmented healthcare systems with limited resources.

Supply chain partnership assessment of a diabetes clinic.

Purpose Diabetes is one of the major healthcare challenges in India. The chronic nature of the disease makes the lifetime cost of the treatment exorbitantly high. The medicine cost contributes a major size of expense in diabetes management. To make healthcare available to poorest of the poor, it is imperative to control the rising cost of diabetes treatment. The earlier research works done in this area focuses more on inventory management techniques to control the cost of healthcare. Less interest is shown in the role of better supply chain partnership (SCP) in reducing the cost of procurement of medicine. The purpose of this paper is to develop and use the SCP assessment framework for a diabetes clinic. The approach is generalized enough to be adopted for other similar organization. Design/methodology/approach This paper adopts self-assessment criteria of the European Foundation for Quality Management (EFQM) business excellence model for analysis of SCP in the supply chain of a private diabetes clinic in Varanasi. The paper uses analytic hierarchy process (AHP) method for calculation of weights of criteria. Findings The EFQM-based framework can be adopted as easy-to-use tool to make an objective assessment of the SCP. The proposed model in the study is a balanced model between enablers and results, which includes multiple assessment dimensions. The supply chain performance score of the diabetes clinic under study was found as the Tool Pusher, which means the effort in direction of SCP is not too good. The organization needs to clearly define the SCP goal and analyze the results to identify the gap areas. Originality/value The study is first of its kind and contributes to the literature by providing non-prescriptive and easy-to-use SCP assessment framework, for chronic disease care. The case study approach provides a procedure for the healthcare organization willing to adopt this approach.

Attending Diabetes Clinics is associated with a lower all-cause mortality. A meta-analysis of observational studies performed in Italy.

OBJECTIVE: The epidemiological explosion of diabetes is a challenge for Health Systems and the identification of the most appropriate models of care are warranted. The inclusion of primary care physicians in the models is unquestioned whereas the role played by secondary and tertiary care (Diabetes Clinic) is often debated. However, studies focusing on hard endpoints and comparing Diabetes Clinic attendance vs. no attendance are scant. RESEARCH DESIGN AND METHODS: A meta-analysis was performed including all observational cohort studies performed in Italy, reporting crude and/or adjusted estimates of all-cause mortality in patients with diabetes attending or not attending Diabetes Clinics. Attendance was defined by prescriptions and reimbursement of specialist visits by the National Health System. RESULTS: Three studies enrolling 191,847 subjects with diabetes were included in the analysis, and about half of them had at least one visit in the Diabetes Clinic per year. During the follow-up, ranging 1-11 years, 9653 subjects died. Mortality was remarkably lower in subjects attending Diabetes Clinic (MH-OR 0.70, 95% CI 0.55-0.88, p = 0.002). Results were confirmed after adjusting for confounders (MH-OR 0.81, 95% CI 0.69-0.95, p = 0.009). CONCLUSIONS: The results of the present study suggest that attending Diabetes Clinics is associated with a lower all-cause mortality. This finding might be instrumental to implement the best models of care for persons with diabetes.

An Internal Audit of Diabetes Care for Type 2 Diabetic Patients in a Public Hospital Diabetes Clinic in Malaysia.

INTRODUCTION: Earlier studies have identified a gap between guidelines and actual clinical diabetes care in Malaysia. OBJECTIVE: We audited the quality of care for patients with type 2 diabetes mellitus (T2DM) attending our diabetes clinic at a public hospital. METHODS: A structured review of the outpatient clinic cards, prescriptions and laboratory results was conducted for patients attending the diabetes clinic at Sibu Hospital in October and November 2014. RESULTS: For the total of 233 patients who were audited, the levels of fasting blood sugar, blood pressure, body mass index and fasting lipid profile were satisfactory at 99.1%, 99.6%, 92.6% and 99.6% respectively. 79.7% of the subjects had had HbA1c performed at least once over the previous six months. Only 25.8% had annual foot screening, while the eye screening rate was 71.2% and the albuminuria screening rate was 93.6%. For outcome measures, the mean (SD) HbA1c level was 9.2% (1.91%), with 13 patients (6.7%) having HbA1c less than 6.5%; 36.4% of participants achieved BP < 130/80 mmHg; and 69.4% had LDL < 2.6 mmol/L. The majority of the patients were overweight or obese (91.4%). CONCLUSIONS: Overall, the performance of diabetic care processes at our hospital was satisfactory, except for foot examination. The glycaemic and weight control among the subjects were suboptimal and warrant an optimised and comprehensive approach on the part of the management.

Identification, prevalence, and treatment of painful diabetic neuropathy in patients from a rural area in South Carolina.

Diabetic peripheral neuropathy (DPN) represents significant burdens to many patients and the public health-care system. Patients with diabetes in rural areas have higher risk of developing complications and having less access to proper treatment. We studied a rural population of patients with diabetes who attended a pharmacist-led free clinic for a diabetic education program. Our objectives were to 1) determine the prevalence of DPN and painful diabetic neuropathy (p-DN) in patients with type 2 diabetes; 2) assess the proportion of patients with DPN and p-DN left undocumented upon physician referral to a pharmacist-led free clinic; and 3) determine the appropriateness of pain medication regimen. We performed a retrospective analysis of clinical records of patients from the Presbyterian College School of Pharmacy (PCSP) Wellness Center located in Clinton, SC. Diagnoses of DPN and/or p-DN were obtained from referral notes in the clinical records and compared with results from foot examinations performed in the free clinic and clinical features. Medication regimens were also obtained and compared using American Academy of Neurology (AAN) treatment guidelines. Within our study population (n=111), the prevalence of DPN was 62.2% (national average of 28%-45%) and that of p-DN was 23.4% (national average of 11%-24%). In p-DN patients (n=26), 53.8% (n=14) had a documented diagnosis of p-DN by the referring physician, and 46.2% (n=12) were identified by the pharmacists. A total of 95% (19 of 20) of the patients treated for p-DN received adequate pharmacological agents, though suboptimal as per clinical guidelines. More than 50% of the patients used subtherapeutic doses of their medications. Gabapentin was the most frequently used medication in our population (65.4%). Patients in rural South Carolina had a higher prevalence of DPN and p-DN with >60% undocumented cases of p-DN. More than 95% of treated patients did not receive optimum therapy according to AAN guidelines.

Partial lipodystrophy of the limbs in a diabetes clinic setting.

OBJECTIVE: Partial lipodystrophy of the limbs (PLL) is a newly described form of lipodystrophy that is characterized by symmetrical distal lipoatrophy of the limbs and insulin resistant diabetes. RESEARCH DESIGN AND METHODS: In this study, we prospectively screened our patients with type 2 diabetes for the presence of PLL phenotype. Metabolic parameters of PLL patients were compared to those with type 2 diabetes who applied to our diabetes clinic during the same period of time. RESULTS: Between Sep 2013 and Mar 2015, 2020 patients with type 2 diabetes were evaluated for the presence of PLL. PLL was confirmed in 16 patients. The prevalence of PLL was calculated as 0.79% in our diabetes clinic. The most common phenotypic presentations were loss of subcutaneous fat in the forearms, calves and thighs, and loss of fat in forearms and calves. Patients with PLL had poor metabolic control and marked insulin resistance compared to subjects with type 2 diabetes. Diabetes had been diagnosed at a younger age in patients with PLL. Patients with PLL also had more atherogenic lipid profiles. CONCLUSIONS: Our data suggests that PLL is a relatively common form of lipodystrophy in diabetes clinics, which is associated with poor metabolic control and marked insulin resistance. The recognition of PLL in patients with type 2 diabetes can help better clinical management by alerting the physician to these associated co-morbidities.

Tuberculosis infection control measures in diabetes clinics in China: a rapid assessment of 10 hospitals.

OBJECTIVE: To assess tuberculosis infection control measures in diabetes mellitus (DM) clinics in China. METHOD: An evaluation questionnaire was developed based on the measures outlined in the WHO policy on TB infection control in healthcare facilities and congregate settings. Ten selected hospitals were assessed between September 2014 and February 2015. RESULTS: All hospitals had an infection control committee, an action plan and training, but there was no focus on activities to prevent airborne transmission of infection, especially from tuberculosis. All DM clinics had natural or artificial ventilation, but at the time of the evaluation half had all windows closed. While all the hospitals provided surgical masks for hospital staff, none had N95-specific respiratory masks and only three provided masks for patients with a cough. There were no policies on identifying DM patients with TB symptoms, minimising the time spent by these patients in the clinics or developing health educational material on diabetes and tuberculosis. CONCLUSION: Infection control measures to prevent airborne transmission in DM clinics are inadequate. More work is needed to better understand and determine the risk of TB infection in DM clinics and to improve their TB infection control practices.