المؤلفون: Schnell, Oliver, Amann-Zalan, Ildiko, Jelsovsky, Zhihong, Moritz, Annette, Bermejo, Justo, Parkin, Christopher, Schweitzer, Matthias, Polonsky, William, Fisher, Lawrence

المصدر: Diabetes reviews (Alexandria, Va.). 36(7)

مصطلحات موضوعية: Aged, Biomarkers, Blood Glucose, Blood Glucose Self-Monitoring, C-Reactive Protein, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Prospective Studies

الوصف: OBJECTIVE: The effect of therapeutic strategies on cardiovascular (CV) disease can be evaluated by monitoring changes in CV risk biomarkers. This study investigated the effect of a structured self-monitoring of blood glucose (SMBG) protocol and the resulting improvements in glycemic control on changes in high-sensitivity C-reactive protein (hs-CRP) in insulin-naïve patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: The Structured Testing Program (STeP) study was a prospective, cluster-randomized, multicenter trial in which 483 poorly controlled, insulin-naïve patients with type 2 diabetes were randomized to active control (ACG) or structured testing (STG) that included quarterly structured SMBG. Changes in A1C, hs-CRP, and glycemic variability (STG subjects only) were measured at baseline and quarterly. RESULTS: Reductions in geometric mean hs-CRP values were significantly greater in the STG group at months 3 (P = 0.005), 6 (P = 0.0003), and 12 (P = 0.04) than in the ACG group. STG patients at high CV risk (>3 mg/L) showed significantly greater reductions in hs-CRP levels than ACG patients at high CV risk: -3.64 mg/dL (95% CI -4.21 to -3.06) versus -2.18 mg/dL (-2.93 to -1.43), respectively (P = 0.002). There was a strong correlation between reductions in hs-CRP and A1C in both groups: standardized coefficient (β) was 0.25 for the entire cohort (P < 0.0001), 0.31 for STG (P < 0.0001), and 0.16 for ACG (P = 0.02). CONCLUSIONS: Reductions in hs-CRP level are associated with reductions in A1C but not reductions in lipids or glycemic variability. Comprehensive structured SMBG-based interventions that lower A1C may translate into improvements in CV risk, as evidenced by levels of the biomarker hs-CRP.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/6b51h835Test
https://escholarship.org/content/qt6b51h835/qt6b51h835.pdfTest

المؤلفون: Polonsky, William, Fisher, Lawrence

المصدر: Diabetes reviews (Alexandria, Va.). 36(1)

مصطلحات موضوعية: Blood Glucose, Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 2, Humans, Hypoglycemic Agents, Insulin

الوصف: Given the importance of glycemic control in the development of diabetes complications, the plethora of tools now available to monitor the day-to-day trends in glycemia is remarkable. In this regard, self-monitoring of blood glucose (SMBG) has been considered a key component of patient management. Arguably, there remains almost universal agreement that SMBG should be available to all diabetic patients regardless of current treatment strategy. However, recently there have been reports that have challenged the current paradigm that all patients should use SMBG and concluded that SMBG for type 2 diabetic patients not on insulin may not be beneficial on glycemic control and must be weighed against the expense and inconvenience. In the counterpoint narrative following the contribution by Malanda et al., Drs. Polonsky and Fisher provide a compelling argument suggesting that while it is evident that implementing SMBG in unstructured ways without training patients and clinicians is likely to be a waste of resources, there are effective and powerful ways to use structured SMBG in insulin-naïve type 2 diabetic patients. -William T. Cefalu, MD Editor in Chief, Diabetes Care.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/61407387Test
https://escholarship.org/content/qt61407387/qt61407387.pdfTest

المؤلفون: Fisher, Lawrence, Polonsky, WH

الوصول الحر: https://escholarship.org/uc/item/43r5c79vTest

المؤلفون: Liu, Jingwen, Poon, Jiat-Ling, Bispham, Jeoffrey, Perez-Nieves, Magaly, Hughes, Allyson, Chapman, Katherine, Mitchell, Beth, Hood, Korey, Snoek, Frank, Fisher, Lawrence

المساهمون: Medical psychology, APH - Health Behaviors & Chronic Diseases, APH - Mental Health, Amsterdam Reproduction & Development (AR&D)

المصدر: Liu, J, Poon, J-L, Bispham, J, Perez-Nieves, M, Hughes, A, Chapman, K, Mitchell, B, Hood, K, Snoek, F & Fisher, L 2023, ' Development and validation of fear of hypoglycemia screener : results from the T1D exchange registry ', Journal of Patient-Reported Outcomes, vol. 7, no. 1, 43 . https://doi.org/10.1186/s41687-023-00585-9Test
Journal of Patient-Reported Outcomes, 7(1):43. Springer International Publishing AG

مصطلحات موضوعية: Health Information Management, Health Informatics

الوصف: Background Fear of Hypoglycemia (FoH) in people with diabetes has a significant impact on their quality of life, psychological well-being, and self-management of disease. There are a few questionnaires assessing FoH in people living with diabetes, but they are more often used in research than clinical practice. This study aimed to develop and validate a short and actionable FoH screener for adults living with type 1 diabetes (T1D) for use in routine clinical practice. Methods We developed an initial screener based on literature review and, interviews with healthcare providers (HCPs) and people with T1D. We developed a cross-sectional web-based survey, which was then conducted to examine the reliability and validity of the screener. Adults (aged ≥ 18 years) with diagnosis of T1D for ≥ 1 year were recruited from the T1D Exchange Registry (August–September 2020). The validation analyses were conducted using exploratory factor analyses, correlation, and multivariable regression models for predicting cut-off scores for the final screener. Results The final FoH screener comprised nine items assessing two domains, “worry” (6-items) and “avoidance behavior” (three items), in 592 participants. The FoH screener showed good internal consistency (Cronbach’s α = 0.88). The screener also demonstrated high correlations (r = 0.71–0.75) with the Hypoglycemia Fear Survey and moderate correlations with depression, anxiety, and diabetes distress scales (r = 0.44–0.66). Multivariable regression analysis showed that higher FoH screener scores were significantly associated with higher glycated hemoglobin (HbA1c) (b = 0.04) and number of comorbidities (b = 0.03). Conclusions This short FoH screener demonstrated good reliability and validity. Further research is planned to assess clinical usability to identify patients with FoH and assist effective HCP-patient conversations.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::73edcf758bf16df3220d1fd823c3942bTest
https://doi.org/10.1186/s41687-023-00585-9Test

المؤلفون: Fisher, Lawrence, Hessler, Danielle M, Polonsky, William H, Mullan, Joseph

المصدر: Diabetes Care. 35(2)

مصطلحات موضوعية: Public Health, Health Sciences, Diabetes, Nutrition, Clinical Research, Metabolic and endocrine, Aged, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Stress, Psychological, Medical and Health Sciences, Endocrinology & Metabolism, Biomedical and clinical sciences, Health sciences

الوصف: ObjectiveTo identify the pattern of relationships between the 17-item Diabetes Distress Scale (DDS17) and diabetes variables to establish scale cut points for high distress among patients with type 2 diabetes.Research design and methodsRecruited were 506 study 1 and 392 study 2 adults with type 2 diabetes from community medical groups. Multiple regression equations associated the DDS17, a 17-item scale that yields a mean-item score, with HbA(1c), diabetes self-efficacy, diet, and physical activity. Associations also were undertaken for the two-item DDS (DDS2) screener. Analyses included control variables, linear, and quadratic (curvilinear) DDS terms.ResultsSignificant quadratic effects occurred between the DDS17 and each diabetes variable, with increases in distress associated with poorer outcomes: study 1 HbA(1c) (P < 0.02), self-efficacy (P < 0.001), diet (P < 0.001), physical activity (P < 0.04); study 2 HbA(1c) (P < 0.03), self-efficacy (P < 0.004), diet (P < 0.04), physical activity (P = NS). Substantive curvilinear associations with all four variables in both studies began at unexpectedly low levels of DDS17: the slope increased linearly between scores 1 and 2, was more muted between 2 and 3, and reached a maximum between 3 and 4. This suggested three patient subgroups: little or no distress,

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/3wt600rtTest

المؤلفون: Glasgow, Russell E, Dickinson, Perry, Fisher, Lawrence, Christiansen, Steve, Toobert, Deborah J, Bender, Bruce G, Dickinson, L Miriam, Jortberg, Bonnie, Estabrooks, Paul A

المصدر: Implementation Science. 6(1)

الوصف: Abstract Background Much has been written about how the medical home model can enhance patient-centeredness, care continuity, and follow-up, but few comprehensive aids or resources exist to help practices accomplish these aims. The complexity of primary care can overwhelm those concerned with quality improvement. Methods The RE-AIM planning and evaluation model was used to develop a multimedia, multiple-health behavior tool with psychosocial assessment and feedback features to facilitate and guide patient-centered communication, care, and follow-up related to prevention and self-management of the most common adult chronic illnesses seen in primary care. Results The Connection to Health Patient Self-Management System, a web-based patient assessment and support resource, was developed using the RE-AIM factors of reach (e.g., allowing input and output via choice of different modalities), effectiveness (e.g., using evidence-based intervention strategies), adoption (e.g., assistance in integrating the system into practice workflows and permitting customization of the website and feedback materials by practice teams), implementation (e.g., identifying and targeting actionable priority behavioral and psychosocial issues for patients and teams), and maintenance/sustainability (e.g., integration with current National Committee for Quality Assurance recommendations and clinical pathways of care). Connection to Health can work on a variety of input and output platforms, and assesses and provides feedback on multiple health behaviors and multiple chronic conditions frequently managed in adult primary care. As such, it should help to make patient-healthcare team encounters more informed and patient-centered. Formative research with clinicians indicated that the program addressed a number of practical concerns and they appreciated the flexibility and how the Connection to Health program could be customized to their office. Conclusions This primary care practice tool based on an implementation science model has the potential to guide patients to more healthful behaviors and improved self-management of chronic conditions, while fostering effective and efficient communication between patients and their healthcare team. RE-AIM and similar models can help clinicians and media developers create practical products more likely to be widely adopted, feasible in busy medical practices, and able to produce public health impact.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/5zt2k30wTest

المؤلفون: Kalirai,Samaneh, Ivanova,Jasmina I, Perez-Nieves,Magaly, Stephenson,Judith J, Hadjiyianni,Irene, Grabner,Michael, Pollom,Roy Daniel, Geremakis,Caroline, Reed,Beverly L, Fisher,Lawrence

مصطلحات موضوعية: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy

الوصف: Samaneh Kalirai,1 Jasmina I Ivanova,2 Magaly Perez-Nieves,1 Judith J Stephenson,3 Irene Hadjiyianni,1 Michael Grabner,3 Roy Daniel Pollom,1 Caroline Geremakis,3 Beverly L Reed,1 Lawrence Fisher4 1Eli Lilly and Company, Indianapolis, IN, USA; 2Analysis Group Inc., New York, NY, USA; 3HealthCore Inc., Wilmington, DE, USA; 4Department of Family and Community Medicine, UC San Francisco, San Francisco, CA, USACorrespondence: Michael GrabnerHealthCore, Inc., 123 Justison St, Suite 200, Wilmington, DE 19801, USATel +1 302 230-2000Email mgrabner@healthcore.comObjective: A survey of US adults with type 2 diabetes mellitus was conducted to better understand patients’ insulin initiation experiences and treatment persistence behaviors.Research Design and Methods: Participants were recruited from consumer panels and grouped by basal insulin treatment pattern: continuers (no gap of ≥ 7 days within 6 months of initiation); interrupters (gap ≥ 7 days, resumed treatment); discontinuers (stopped for ≥ 7 days, not resumed). A quota of approximately 50 respondents per persistence category was set.Results: A total of 154 respondents (52 continuers, 52 interrupters, 50 discontinuers) completed the survey. Mean age was 51.4 years; 51.9% male. Continuers were more likely to report their views being considered during initiation, and less likely to report a sense of failure. Concerns included insulin dependence (64.3% agree/strongly agree), frequent blood glucose monitoring (55.2%), costs/ability to pay (53.9%), fears of or mistakes during self-injection (52.6%), and weight gain (52.6%). Continuers were motivated by benefits of insulin therapy; experienced or potential side effects were notable factors for interruption/discontinuation. Healthcare provider instruction was indicated as a reason for continuing, stopping, and restarting therapy.Conclusion: Benefits of basal insulin therapy motivated continuers while side effects impacted interruption/discontinuation. Persistence on basal insulin is often influenced by provider actions. ...

وصف الملف: text/html

العلاقة: https://www.dovepress.com/basal-insulin-initiation-and-maintenance-in-adults-with-type-2-diabete-peer-reviewed-fulltext-article-DMSOTest

الإتاحة: https://doi.org/10.2147/DMSO.S237948Test
https://www.dovepress.com/basal-insulin-initiation-and-maintenance-in-adults-with-type-2-diabete-peer-reviewed-fulltext-article-DMSOTest

المؤلفون: Kalirai, Samaneh, Ivanova, Jasmina I, Perez-Nieves, Magaly, Stephenson, Judith J, Hadjiyianni, Irene, Grabner, Michael, Pollom, Roy Daniel, Geremakis, Caroline, Reed, Beverly L, Fisher, Lawrence

المصدر: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy ; volume Volume 13, page 1023-1033 ; ISSN 1178-7007

الإتاحة: https://doi.org/10.2147/dmso.s237948Test
https://www.dovepress.com/getfile.php?fileID=57226Test

المؤلفون: Polonsky, William, Fisher, Lawrence, Schikman, Charles, Hinnen, Deborah, Parkin, Christopher, Jelsovsky, Zhihong, Amstutz, Linda, Schweitzer, Matthias, Wagner, Robin

المصدر: BMC Family Practice. 11(1)

الوصف: Abstract Background The value and utility of self-monitoring of blood glucose (SMBG) in non-insulin treated T2DM has yet to be clearly determined. Findings from studies in this population have been inconsistent, due mainly to design differences and limitations, including the prescribed frequency and timing of SMBG, role of the patient and physician in responding to SMBG results, inclusion criteria that may contribute to untoward floor effects, subject compliance, and cross-arm contamination. We have designed an SMBG intervention study that attempts to address these issues. Methods/design The Structured Testing Program (STeP) study is a 12-month, cluster-randomised, multi-centre clinical trial to evaluate whether poorly controlled (HbA1c ≥ 7.5%), non-insulin treated T2DM patients will benefit from a comprehensive, integrated physician/patient intervention using structured SMBG in US primary care practices. Thirty-four practices will be recruited and randomly assigned to an active control group (ACG) that receives enhanced usual care or to an enhanced usual care group plus structured SMBG (STG). A total of 504 patients will be enrolled; eligible patients at each site will be randomly selected using a defined protocol. Anticipated attrition of 20% will yield a sample size of at least 204 per arm, which will provide a 90% power to detect a difference of at least 0.5% in change from baseline in HbA1c values, assuming a common standard deviation of 1.5%. Differences in timing and degree of treatment intensification, cost effectiveness, and changes in patient self-management behaviours, mood, and quality of life (QOL) over time will also be assessed. Analysis of change in HbA1c and other dependent variables over time will be performed using both intent-to-treat and per protocol analyses. Trial results will be available in 2010. Discussion The intervention and trial design builds upon previous research by emphasizing appropriate and collaborative use of SMBG by both patients and physicians. Utilization of per protocol and intent-to-treat analyses facilitates a comprehensive assessment of the intervention. Use of practice site cluster-randomisation reduces the potential for intervention contamination, and inclusion criteria (HbA1c ≥ 7.5%) reduces the possibility of floor effects. Inclusion of multiple dependent variables allows us to assess the broader impact of the intervention, including changes in patient and physician attitudes and behaviours. Trial Registration Current Controlled Trials NCT00674986.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0z0823stTest

المؤلفون: Fisher, Lawrence, Glasgow, Russell E, Strycker, Lisa A

المصدر: Diabetes Care. 33(5)

مصطلحات موضوعية: Health Sciences, Depression, Prevention, Diabetes, Mental Health, Nutrition, Behavioral and Social Science, Metabolic and endocrine, Affective Symptoms, Aged, Depressive Disorder, Major, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Health Status, Humans, Hyperglycemia, Male, Middle Aged, Predictive Value of Tests, Regression Analysis, Self Care, Surveys and Questionnaires, Medical and Health Sciences, Endocrinology & Metabolism, Biomedical and clinical sciences, Health sciences

الوصف: ObjectiveTo clarify previous findings that diabetes distress is related to glycemic control and self-management whereas measures of depression are not, using both binary and continuous measures of depression.Research design and methodsFour hundred and sixty-three type 2 patients completed measures of diabetes distress (Diabetes Distress Scale [DDS]) and clinical depression (Patient Health Questionnaire 8 [PHQ8]). PHQ8 was employed as either a binary (>or=10) or continuous variable. Dependent variables were A1C, diet, physical activity (PA), and medication adherence (MA).ResultsThe inclusion of a binary or continuous PHQ8 score yielded no differences in any equation. DDS was significantly associated with A1C and PA, whereas PHQ8 was not; both DDS and PHQ8 were significantly and independently associated with diet and MA.ConclusionsThe lack of association between depression and glycemic control is not due to the use of a binary measure of depression. Findings further clarify the significant association between distress and A1C.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0kp0z5tkTest