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1.
Artigo em Inglês | MEDLINE | ID: mdl-34770132

RESUMO

Morbidity and mortality due to noncommunicable diseases (NCDs) are growing exponentially across Tanzania. The limited availability of dedicated services and the disparity between rural and urban areas represent key factors for the increased burden of NCDs in the country. From March 2019, an integrated management system was started in the Iringa District Council. The system implements an integrated management of hypertension and diabetes between the hospital and the peripheral health centers and introduces the use of paper-based treatment cards. The aim of the study was to present the results of the first 6 months' roll-out of the system, which included 542 patients. Data showed that 46.1% of patients returned for the reassessment visit (±1 month), more than 98.4% of patients had blood pressure measured and were checked for complication, more than 88.6% of patients had blood sugar tested during follow-up visit, and blood pressure was at target in 42.8% of patients with hypertension and blood sugar in 37.3% of diabetic patients. Most patients who were lost to follow-up or did not reach the targets were those without medical insurance or living in remote peripheries. Our findings suggest that integrated management systems connecting primary health facilities and referral hospitals may be useful in care and follow-up of patients with hypertension and diabetes.


Assuntos
Diabetes Mellitus , Hipertensão , Doenças não Transmissíveis , Pressão Sanguínea , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/terapia , Tanzânia/epidemiologia
2.
BMC Health Serv Res ; 21(1): 1235, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34781929

RESUMO

BACKGROUND: Although HIV continues to have a high prevalence among adults in sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an urgent need to expand the capacity of healthcare systems in SSA to provide NCD services and scale up existing chronic care management pathways. The aim of this study was to identify key components, outcomes, and best practice in integrated service provision for the prevention, identification and treatment of HIV, hypertension and diabetes. METHODS: An international, multi stakeholder e-Delphi consensus study was conducted over two successive rounds. In Round 1, 24 participants were asked to score 27 statements, under the headings 'Service Provision' and 'Benefits of Integration', by importance. In Round 2, the 16 participants who completed Round 1 were shown the distribution of scores from other participants along with the score that they attributed to an outcome and were asked to reflect on the score they gave, based on the scores of the other participants and then to rescore if they wished to. Nine participants completed Round 2. RESULTS: Based on the Round 1 ranking, 19 of the 27 outcomes met the 70% threshold for consensus. Four additional outcomes suggested by participants in Round 1 were added to Round 2, and upon review by participants, 22 of the 31 outcomes met the consensus threshold. The five items participants scored from 7 to 9 in both rounds as essential for effective integrated healthcare delivery of health services for chronic conditions were improved data collection and surveillance of NCDs among people living with HIV to inform integrated NCD/HIV programme management, strengthened drug procurement systems, availability of equipment and access to relevant blood tests, health education for all chronic conditions, and enhanced continuity of care for patients with multimorbidity. CONCLUSIONS: This study highlights the outcomes which may form key components of future complex interventions to define a model of integrated healthcare delivery for diabetes, hypertension and HIV in sub-Saharan Africa.


Assuntos
Prestação Integrada de Cuidados de Saúde , Diabetes Mellitus , Infecções por HIV , Hipertensão , Adulto , África ao Sul do Saara/epidemiologia , Consenso , Técnica Delfos , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/terapia , Prevalência
3.
J Pak Med Assoc ; 71(11): 2674-2675, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34783760

RESUMO

History taking and clinical interviewing is usually the start of medical contact with patients with chronic diseases like diabetes mellitus in primary care. The current novel corona virus-19 epidemic has limited our ability to conduct in-person consultations with patients as before and most of us limit physical contact to the minimum. This has made the process of history taking either by virtual consultations or physically in our offices but by maintaining appropriate physical distance more important than even before. This review summarizes an easy-to-understand hierarchy of questioning to help us in maximizing the information obtained by history taking. We initiate the clinical interview with a warm welcome and first focus on the primary felt need of the patient. Then we interview the patient about his duration and current control of his diabetes. The second part of the interview focuses on current clinical status including reviewing for complications and co-morbidities. The third part focuses on current ongoing management including life style, diet, glucose lowering and other drugs and the use of complementary and alternative medicines. The fourth part of the interview focuses on emotional status including religious and cultural beliefs about diabetes management and presence of diabetes related distress. Special attention should be paid to the financial status of patients who are paying for their treatment out of pocket. The interview should conclude with summarization of current issues with regards to diabetes management and a therapeutic plan individualized for the patient.


Assuntos
COVID-19 , Diabetes Mellitus , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Humanos , Anamnese , Atenção Primária à Saúde , SARS-CoV-2
4.
Rev Med Suisse ; 17(757): 1883-1887, 2021 Nov 03.
Artigo em Francês | MEDLINE | ID: mdl-34738763

RESUMO

Improving glycaemia level is helpful to the clinician in diabetes management. Elderly diabetics make up a group that is non-homogeneous and with a very varied health status, whose treatment must be adjusted to take into account comorbidities, degree of frailty and both functional and mental disability, in addition to their life expectancy and personal preferences. Thus, the target of treatment should be defined along three categories of patients: robust, vulnerable and dependent. This article reviews information from the literature high-lighting current recommendations for treatment, the clear inclination towards overtreatment of the elderly diabetic and the resulting noxious effects of occurring hypoglycemia, that are often not recognized by the patient and his doctor.


Assuntos
Diabetes Mellitus , Fragilidade , Hipoglicemia , Idoso , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Idoso Fragilizado , Fragilidade/terapia , Avaliação Geriátrica , Nível de Saúde , Humanos , Hipoglicemia/epidemiologia
5.
J Prim Care Community Health ; 12: 21501327211051930, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34719302

RESUMO

BACKGROUND: COVID-19 pandemic has led to health service modification and temporary disruption of the routine care provided to patients with diabetes mellitus (DM) in primary care. This was done to minimize outpatient visits, permit physical distancing, and ensure patients' and healthcare providers safety. There is no evidence that explored or measured the impact of COVID-19 pandemic on diabetes services and patients' glycemic outcome in Oman. AIM AND OBJECTIVES: To explore the accessibility of DM services in primary care after COVID-19 pandemic announcement, and measure patients' glycemic outcome. METHODS: Before and after, retrospective cohort study using Al-Shifa healthcare database in primary care. One thousand adult patients with diabetes who attended DM clinic before pandemic announcement in 2019 were randomly selected and followed up until end of 2020. Patients aged ≥18 years and had at least 2 visits in 2019 were included. Access to DM services was identified by number of patients received care, frequency of consultations, mode of consultation, and type of intervention given to patients. Patients' glycated hemoglobin (HbA1c), and other glycemic parameters after pandemic announcement in 2020 were determined and compared with the same parameters before pandemic in 2019. Association between patients' HbA1c and mode of consultation was measured using multivariable regression analysis. RESULTS: A total of 937 patients continued to follow and received DM care after pandemic announcement. Median number of consultations was 2 with interquartile range (IQR): 3-2. 57.4% had face-to-face alone, 32.4% had combined face to face and telephone consultation, and 10% had telephone consultation alone. Mean difference in HbA1c (%) before and after pandemic announcement was 0.2 ± 1.4 (95% CI: 0.1 to 0.3), P = .002. With multivariable linear regression, the mean difference in HbA1c was -0.3 (-2.3 to 1.5), P = .734 for telephone consultation alone, -0.5 (-2.4 to 1.4), P = .613 for face-to-face alone, and -0.5 (-2.4 to 1.3), P = .636 for combined consultations, compared to those who did not receive any formal consultation. CONCLUSION: Despite service modification and disruption of comprehensive care in primary care after COVID-19 pandemic announcement, DM services were accessible as majority of patients maintained follow up. There was an overall increase in mean glycated hemoglobin, however, it was a less than 1 unit increase. After adjusting for multivariable, glycated hemoglobin was reduced among those who received consultation including telephone consultation compared to those who did not, however evidence was unconvincing.


Assuntos
COVID-19 , Diabetes Mellitus , Adolescente , Adulto , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Humanos , Omã , Pandemias , Atenção Primária à Saúde , Encaminhamento e Consulta , Estudos Retrospectivos , SARS-CoV-2 , Telefone
6.
Rev Esc Enferm USP ; 55: e20210295, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34825697

RESUMO

OBJECTIVE: To map evidence on the use of digital technologies in the care of people with diabetes during the COVID-19 pandemic. METHOD: This is a scoping review, based on the JBI manual, which included scientific articles and gray literature from nine primary and seven secondary databases. Articles were independently assessed by two reviewers. Rayyan® was used to select the studies. The description of study characterization is presented in a table and tables, ending in a narrative synthesis. RESULTS: A total of 1,964 studies were identified and, after selection, 23 publications remained for analysis. It turned out that telemedicine was used in all studies and remote consultation support technologies included continuous glucose monitoring devices, glucose data analysis software, insulin delivery systems, applications, audio and/or voice communication devices, which facilitated remote diabetes mellitus monitoring and management. CONCLUSION: Telehealth, monitoring technologies, insulin delivery systems and communication devices were tools used to monitor patients with diabetes during the pandemic.


Assuntos
COVID-19 , Diabetes Mellitus , Telemedicina , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Tecnologia Digital , Humanos , Pandemias , SARS-CoV-2
7.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(9): 1670-1676, 2021 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-34814599

RESUMO

Objective: The study investigated and analyzed the health-related quality of life of diabetes patients in Gansu province before and after the healthcare reform and its influencing factors, so as to provide scientific evidence to improve the health-related quality of life of diabetes patients. Methods: The study used data of the fourth and sixth national health service household survey in Gansu province before (2008) and after (2018) medical reform separately, and EQ-5D health utility index was calculated on the basis of Chinese time frade-off values for EuroQol Five-Dimensions Questionnaire Utility Value scoring system. Results: Compared with the period before the healthcare reform, the five dimensions of EQ-5D for residents, aged 15 and above in Gansu, changed significantly after the healthcare reform: action capability improved by 8.08% (27.43% vs. 19.35%), self-care improved by 16.16% (26.55% vs. 10.39%), normal activity improved by 8.97% (28.32% vs. 19.35%), pain/discomfort worsened by 1.38% (38.05% vs. 39.43%), anxiety/depression worsened by 1.83% (16.81% vs. 18.64%), and the EQ-VAS score increased by 3.36 (60.53 vs. 63.89). The health utility index increased by 0.04 (0.83 vs. 0.87). Multivariate regression analysis results showed that the dimension influence factors were not completely consistent, on the whole, the health-related quality of life of diabetes patients with older age, lower education level, no physical exercise and multi chronic diseases was worse (P<0.05), and multiple chronic disease had the most serious effect on the health of patients with diabetes. The health-related quality of life of diabetes patients with the medical insurance in urban area and after the new medical reform was higher (P<0.05). Conclusion: The new healthcare reform has active influence on the health-related quality of life of diabetes patients in Gansu province, health care providers and policy makers should pay attention to the impacts of multi prechronic diseases on the health-related quality of life of diabetes patients and the mental health of patients with diabetes.


Assuntos
Diabetes Mellitus , Qualidade de Vida , Idoso , Diabetes Mellitus/terapia , Reforma dos Serviços de Saúde , Nível de Saúde , Humanos , Medicina Estatal
8.
MMWR Morb Mortal Wkly Rep ; 70(46): 1597-1602, 2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34793416

RESUMO

Diabetes affects approximately one in 10 persons in the United States† and is a risk factor for severe COVID-19 (1), especially when a patient's diabetes is not well managed (2). The extent to which the COVID-19 pandemic has affected diabetes care and management, and whether this varies across age groups, is currently unknown. To evaluate access to and use of health care, as well as experiences, attitudes, and behaviors about COVID-19 prevention and vaccination, a nonprobability, Internet-based survey was administered to 5,261 U.S. adults aged ≥18 years during February-March 2021. Among respondents, 760 (14%) adults who reported having diabetes currently managed with medication were included in the analysis. Younger adults (aged 18-29 years) with diabetes were more likely to report having missed medical care during the past 3 months (87%; 79) than were those aged 30-59 years (63%; 372) or ≥60 years (26%; 309) (p<0.001). Overall, 44% of younger adults reported difficulty accessing diabetes medications. Younger adults with diabetes also reported lower intention to receive COVID-19 vaccination (66%) compared with adults aged ≥60 years§ (85%; p = 0.001). During the COVID-19 pandemic, efforts to enhance access to diabetes care for adults with diabetes and deliver public health messages emphasizing the importance of diabetes management and COVID-19 prevention, including vaccination, are warranted, especially in younger adults.


Assuntos
COVID-19/epidemiologia , Diabetes Mellitus/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
9.
Int J Med Inform ; 156: 104598, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34624662

RESUMO

BACKGROUND AND OBJECTIVE: Diabetes and hypertension are two prevalent and related chronic conditions. To inform the design and development of mobile health applications (mHealth apps) for people living with multiple chronic conditions, this paper examines features mentioned in developers' descriptions and user reviews of mHealth apps, along with users' attitudes toward associated features. MATERIALS AND METHODS: Eleven top apps for diabetes and hypertension were identified from Google Play as of January 2020. Based on a stratified sampling strategy, 1,100 user reviews were selected to form the final dataset. Developers' descriptions were also collected for analysis. Using the grounded theory approach, we developed a feature-oriented coding scheme, which was used to identify three levels of features mentioned in app descriptions and user reviews: feature group (the highest level), feature type (the second level), and individual feature (the lowest level). Users' attitudes toward app features mentioned in user reviews were also analyzed. RESULTS: Most top-rated apps for diabetes and hypertension under study were multifeatured, incorporating self-management, information sharing, and decision support features. At the feature-group level, most informative user reviews commented on features related to self-management, followed by decision support and information sharing. The four most frequently mentioned feature types were data entry, data export/import, data visualization, and assessment. Users expressed overwhelming positive attitudes toward app features across all feature categories. Based on users' assessments of existing features and requests for additional features, design implications for app development are provided. CONCLUSIONS: Despite the diversity of app features provided by mHealth apps and users' primarily positive attitudes toward existing app features, more comprehensive and personalized features are expected by app users to satisfy their health needs. Beyond identifying app features in user reviews, future research may seek more in-depth feedback from real-life patients for app development and design using methods like interviews and focus groups, to further enhance the overall quality of relevant mHealth apps to better support users.


Assuntos
Diabetes Mellitus , Hipertensão , Aplicativos Móveis , Telemedicina , Diabetes Mellitus/terapia , Humanos , Hipertensão/terapia
10.
Harefuah ; 160(10): 693-697, 2021 10.
Artigo em Hebraico | MEDLINE | ID: mdl-34689441

RESUMO

INTRODUCTION: The prevalence of diabetes increases with age. Diabetes is a risk factor for many complications such as cardiovascular disease, kidney failure, stroke, neuropathy, and retinopathy. Data from recent years indicate that it is also a risk factor for cognitive impairment, dementia, functional disability and frailty. Diabetes is a disease that requires complex self-care capabilities; the individuals with diabetes are required to take medications on time, examine their feet, exercise, maintain a balance diet, preform daily glucose monitoring, cope with hypoglycemia and understand how differing life situations may effect glucose levels. All of these require intact cognitive and functional abilities. Thus, treatment plans should take into consideration the person's cognitive/functional state. Indeed, in the last several years many professional organizations such as the American Diabetes Association, the International Diabetes Federation, and the American Endocrinology Society have published guidelines for treating older people with diabetes. The Israeli National Diabetes Council, headed by Prof. Itamar Raz, in collaboration with other physician unions and other national councils, have recently authorized the Israeli guidelines for treating older people with diabetes. The Israeli guidelines include categorization of older adults with diabetes in relation to their functional status in order to reach determined treatment targets. According to the Israeli guidelines and in accordance with international guidelines, the treatment targets of the elderly person with diabetes should not be determined by the chronological age of the individuals but rather by their risk for functional deterioration. Older people with diabetes are categorized into three groups according to their risk for functional deterioration. Each category has unique glucose, blood pressure and lipid targets. The guidelines offer valid and reliable tools that, in addition to personal acquaintance with the patient, can help determine the level of risk of functional decline.


Assuntos
Diabetes Mellitus , Envelhecimento Saudável , Hipoglicemia , Idoso , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Humanos , Estados Unidos
11.
Rev Bras Enferm ; 75(1): e20201257, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34614076

RESUMO

OBJECTIVE: To analyze the self-care activities of elderly people with diabetes mellitus and its correlation with the nurse-patient interpersonal relationship. METHODS: Cross-sectional quantitative study, with 144 elderly people followed up in Family Health Units, with data collected by the Diabetes Self-Care Activities Questionnaire and Interpersonal Relationship Questionnaire in Nursing Care, being analyzed by descriptive and inferential statistics. RESULTS: There was a greater accomplishment of the activities Take insulin injections as recommended (6.74), Take diabetes medications as recommended (6.55) and Take the indicated number of diabetes pills (6.52). The interpersonal relationship showed moderate effectiveness (80.6%). The correlation between self-care with diabetes and interpersonal relationships showed a positive and significant value in the dimension Specific feeding. CONCLUSION: The effectiveness of the interpersonal relationship in nursing care resulted in greater compliance with activities related to specific food.


Assuntos
Diabetes Mellitus , Autocuidado , Idoso , Estudos Transversais , Diabetes Mellitus/terapia , Humanos
12.
J Formos Med Assoc ; 120(11): 2016-2022, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34636727

RESUMO

BACKGROUND: Management of comorbidities of people living with HIV (PLHIV) involves different care models, including providing diabetes care and HIV care by the same infectious diseases physician (IDP) ("consolidated care") or providing diabetes care by the physicians other than IDP ("shared care"). The impact of diabetes care model on PLHIV with diabetes mellitus (DM) has not been well-evaluated. METHODS: A nationwide cross-sectional sample in the Taiwan National Health Insurance Research Database was used to compare the performance rates of seven guideline-recommended tests provided by the different subspecialists. RESULTS: Of 523 PLHIV with DM, there were 54.88% (n = 287) in the consolidated care group and 45.12% (n = 236) in the shared care group. More patients in the consolidated care group received the tests of lipid profile (92.33% vs. 79.24%), creatinine (Cr) (93.73% vs. 78.39%), and alanine transaminase (ALT) (91.99% vs. 75.42%), but fewer received urine protein test (35.54% vs. 51.69%) and fundoscopic examination (8.01% vs. 33.90%). The two groups did not differ in the performance rates of serum fasting glucose and HbA1c. After controlling for demographic factors and diabetic severity, the consolidated group was less likely to miss the serum tests of lipid profile (odds ratio [OR]: 0.30), Cr (OR: 0.19), and ALT (OR: 0.23), but more often missed urine protein test (OR: 1.56) and fundoscopic examination (OR: 4.97). CONCLUSION: These findings suggest the need to focus on different process indicators of diabetes cares in different care models to enhance the diabetes care for PLHIV.


Assuntos
Diabetes Mellitus , Infecções por HIV , Médicos , Comorbidade , Estudos Transversais , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Humanos
13.
BMC Health Serv Res ; 21(1): 1039, 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34598702

RESUMO

BACKGROUND: This report describes how we refined a protocol for a pragmatic comparative effectiveness study of two models of an evidence-based diabetes shared medical appointment intervention and used the PRECIS-2 rating system to evaluate these adaptations. METHODS: We report primary data collected between June and August 2019, and protocol refinements completed between 2018 and 2020. Twenty-two members of the study team collaborated in protocol refinement and completed the PRECIS-2 ratings of study pragmatism. We discuss study design refinements made to achieve the desired level of pragmatism vs. experimental control for each of the nine PRECIS-2 dimensions. Study team members received training on PRECIS-2 scoring and were asked to rate the study protocol on the nine PRECIS-2 dimensions. Ratings were compared using descriptive statistics. RESULTS: In general, the PRECIS-2 ratings revealed high levels of pragmatism, but somewhat less pragmatic ratings on the categories of Delivery and Organization (costs and resources). This variation was purposeful, and we provide the rationale for and steps taken to obtain the targeted level of pragmatism on each PRECIS-2 dimension, as well as detail design changes made to a) make the design more pragmatic and b) address COVID-19 issues. There was general agreement among team members and across different types of stakeholders on PRECIS-2 ratings. CONCLUSIONS: We discuss lessons learned from use of PRECIS-2 and experiences in refining the study to be maximally pragmatic on some dimensions and less so on other dimensions. This paper expands on prior research by describing actions to achieve higher levels of pragmatism and revise our protocol fit to the changed context. We make recommendations for future use of PRECIS-2 to help address changing context and other strategies for the planning of and transparent reporting on pragmatic research and comparative effectiveness research. TRIAL REGISTRATION: Clinicaltrials.gov Registration ID: NCT03590041 .


Assuntos
COVID-19 , Diabetes Mellitus , Agendamento de Consultas , Pesquisa Comparativa da Efetividade , Diabetes Mellitus/terapia , Humanos , SARS-CoV-2
15.
BMJ Open ; 11(10): e047979, 2021 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-34645657

RESUMO

INTRODUCTION: HIV programmes in sub-Saharan Africa are well funded but programmes for diabetes and hypertension are weak with only a small proportion of patients in regular care. Healthcare provision is organised from stand-alone clinics. In this cluster randomised trial, we are evaluating a concept of integrated care for people with HIV infection, diabetes or hypertension from a single point of care. METHODS AND ANALYSIS: 32 primary care health facilities in Dar es Salaam and Kampala regions were randomised to either integrated or standard vertical care. In the integrated care arm, services are organised from a single clinic where patients with either HIV infection, diabetes or hypertension are managed by the same clinical and counselling teams. They use the same pharmacy and laboratory and have the same style of patient records. Standard care involves separate pathways, that is, separate clinics, waiting and counselling areas, a separate pharmacy and separate medical records. The trial has two primary endpoints: retention in care of people with hypertension or diabetes and plasma viral load suppression. Recruitment is expected to take 6 months and follow-up is for 12 months. With 100 participants enrolled in each facility with diabetes or hypertension, the trial will provide 90% power to detect an absolute difference in retention of 15% between the study arms (at the 5% two-sided significance level). If 100 participants with HIV infection are also enrolled in each facility, we will have 90% power to show non-inferiority in virological suppression to a delta=10% margin (ie, that the upper limit of the one-sided 95% CI of the difference between the two arms will not exceed 10%). To allow for lost to follow-up, the trial will enrol over 220 persons per facility. This is the only trial of its kind evaluating the concept of a single integrated clinic for chronic conditions in Africa. ETHICS AND DISSEMINATION: The protocol has been approved by ethics committee of The AIDS Support Organisation, National Institute of Medical Research and the Liverpool School of Tropical Medicine. Dissemination of findings will be done through journal publications and meetings involving study participants, healthcare providers and other stakeholders. TRIAL REGISTRATION NUMBER: ISRCTN43896688.


Assuntos
Diabetes Mellitus , Infecções por HIV , Hipertensão , Instituições de Assistência Ambulatorial , Diabetes Mellitus/terapia , Infecções por HIV/terapia , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Tanzânia , Uganda/epidemiologia
16.
Public Health ; 199: 110-117, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34626911

RESUMO

OBJECTIVES: The management of non-communicable chronic diseases such as diabetes mellitus is often poor in humanitarian crisis settings. Poor disease management can have serious long-term consequences. This review sought to identify studies that explored the effectiveness of interventions and the determinants that may improve the management of diabetes in the humanitarian context. STUDY DESIGN: A systematic review was conducted of all types of studies that implemented diabetes programmes in humanitarian settings. METHODS: MEDLINE, Embase, CINAHL and Web of Science were searched for relevant articles using multiple search terms for relevant studies published in English between 2000 and June 2020. Quality assessments using valid tools, were conducted. A narrative synthesis of the findings was then performed. RESULTS: The search yielded 550 citations. After de-duplicating and screening, 19 studies were eligible for inclusion. Most studies were conducted in the Middle East (74%), Asia (16%) and Africa (10%). The interventions reported to improved diabetes care included the mHealth tool, intensive lifestyle intervention, task-shifting, psychosocial support, distribution of glucometers and comprehensive care. Insufficient drug supply, out-of-pocket cost, the complexity of insulin therapy and low adherence to guidelines were identified as barriers. CONCLUSION: There is a paucity of evidence on optimal diabetes care in acute crisis and natural disaster settings. The review was constrained by the low quality of the studies included. Nevertheless, it is likely that mHealth can be feasibly utilised, as educational SMS messages are cost-effective and electronic medical records can enhance disease monitoring. In addition, a multidisciplinary approach to care improves glycaemic control and is desirable due to the multifaceted nature of the disease and management required. Several key barriers have been identified that need to be tackled. Overall, the evidence base for diabetes care in humanitarian settings remains sparse, and further research is needed.


Assuntos
Diabetes Mellitus , Socorro em Desastres , Ásia , Países em Desenvolvimento , Diabetes Mellitus/terapia , Humanos , Renda
17.
Lancet Diabetes Endocrinol ; 9(11): 786-798, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34619105

RESUMO

Up to 50% of the people who have died from COVID-19 had metabolic and vascular disorders. Notably, there are many direct links between COVID-19 and the metabolic and endocrine systems. Thus, not only are patients with metabolic dysfunction (eg, obesity, hypertension, non-alcoholic fatty liver disease, and diabetes) at an increased risk of developing severe COVID-19 but also infection with SARS-CoV-2 might lead to new-onset diabetes or aggravation of pre-existing metabolic disorders. In this Review, we provide an update on the mechanisms of how metabolic and endocrine disorders might predispose patients to develop severe COVID-19. Additionally, we update the practical recommendations and management of patients with COVID-19 and post-pandemic. Furthermore, we summarise new treatment options for patients with both COVID-19 and diabetes, and highlight current challenges in clinical management.


Assuntos
COVID-19/epidemiologia , COVID-19/metabolismo , Gerenciamento Clínico , Doenças Metabólicas/epidemiologia , Doenças Metabólicas/metabolismo , Enzima de Conversão de Angiotensina 2/metabolismo , COVID-19/terapia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/metabolismo , Diabetes Mellitus/terapia , Humanos , Hipertensão/epidemiologia , Hipertensão/metabolismo , Hipertensão/terapia , Doenças Metabólicas/terapia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/terapia , Obesidade/epidemiologia , Obesidade/metabolismo , Obesidade/terapia
18.
Afr J Prim Health Care Fam Med ; 13(1): e1-e10, 2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34636606

RESUMO

BACKGROUND: Patient-centred care (PCC) is one of the pillars of Malawi's quality of care policy initiatives. The role of PCC in facilitating quality service delivery is well documented, and its importance may heighten in chronic disease management. Yet, PCC conceptualisation is known to be context specific. AIM: The study aimed to understand the conceptualisation of PCC amongst patients, healthcare providers (HCP) and policy makers in Diabetes Mellitus (DM) management. SETTING: This study was conducted in DM clinics in Southern Malawi. METHODS: Our qualitative exploratory research study design used in-depth and focus group interviews. We interviewed patients with DM, HCPs and policy makers. The study used framework analysis guided by Mead and Bower's work. RESULTS: Patient-centred care conceptualisations from groups of participants showed convergence. However, they differed in emphasis in some elements. The prominent themes emerging from the participants' conceptualisation of PCC included the following: meeting individual needs, goals and expectations, accessing medication, supporting relationship building, patient involvement, information sharing, holistic care, timeliness and being realistic. CONCLUSION: Patient-centred care conceptualisation in Malawi goes beyond the patient-HCP relational framework to include the technical aspects of care. Contrary to the global view, accessing medication and timeliness are major elements in PCC conceptualisation in Malawi. Whilst PCC conceptualisation is contextual, meeting expectations and needs of patients is fundamental.


Assuntos
Diabetes Mellitus , Logradouros Públicos , Formação de Conceito , Diabetes Mellitus/terapia , Humanos , Malaui , Assistência Centrada no Paciente
19.
Harefuah ; 160(10): 634-637, 2021 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-34689431

RESUMO

INTRODUCTION: Diabetes has become the largest epidemic of the 21st century, with nearly 500 million people diagnosed with diabetes and similar numbers of people with pre-diabetes. Diabetes remains the leading cause of blindness, end-stage renal disease, amputations and heart failure. In Israel approximately 10% of the population above the age of 20 has diabetes. In the last 20 years the prevention and treatment of diabetes have vastly improved and mortality has decreased. Nonetheless, microvascular and macrovascular complications remain a burden of a large proportion of the patients with diabetes.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Falência Renal Crônica , Amputação , Cegueira , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Humanos , Israel/epidemiologia
20.
Zhonghua Nei Ke Za Zhi ; 60(11): 954-959, 2021 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-34689515

RESUMO

Elderly diabetic patients in China accounts for one fourth of the total number of elderly diabetic patients in the world, ranking the first worldwide. In 2021, National Center of Gerontology, Chinese Society of Geriatrics and Diabetes Professional Committee of Chinese Aging Well Association issued China's first guideline on elderly diabetic patients--Guideline for the management of diabetes mellitus in the elderly in China (2021 edition). The present article interprets parts of the important recommendations of the guideline, aiming to facilitate its implementation in clinical practice effectively and improve the clinical prognosis of elderly diabetic patients in our country.


Assuntos
Diabetes Mellitus , Idoso , China , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Humanos , Prognóstico
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