Heart failure (HF) has been recognized as a common complication of diabetes, with a prevalence of up to 22% in individuals with diabetes and increasing incidence rates. Data also suggest that HF may ...develop in individuals with diabetes even in the absence of hypertension, coronary heart disease, or valvular heart disease and, as such, represents a major cardiovascular complication in this vulnerable population; HF may also be the first presentation of cardiovascular disease in many individuals with diabetes. Given that during the past decade, the prevalence of diabetes (particularly type 2 diabetes) has risen by 30% globally (with prevalence expected to increase further), the burden of HF on the health care system will continue to rise. The scope of this American Diabetes Association consensus report with designated representation from the American College of Cardiology is to provide clear guidance to practitioners on the best approaches for screening and diagnosing HF in individuals with diabetes or prediabetes, with the goal to ensure access to optimal, evidence-based management for all and to mitigate the risks of serious complications, leveraging prior policy statements by the American College of Cardiology and American Heart Association.
Aims/hypothesis
Youth with type 1 diabetes are at high risk for loss to follow-up during the transition from paediatric to adult diabetes care. Our aim was to assess the effect of a communication ...technology enhanced transition coordinator intervention compared with usual care on clinic attendance among transitioning youth with type 1 diabetes.
Methods
In this open label, pragmatic clinical trial of youth with type 1 diabetes, aged 17–18 years, transitioning from paediatric to adult diabetes care, the intervention group received support from a transition coordinator who used communication technology and the control group received usual care. The primary outcome was the proportion of individuals that did not attend at least one routine clinic visit in adult diabetes care within 1 year after transfer. Secondary outcomes included diabetes-related clinical outcomes and quality of life measures.
Results
There were no baseline differences in age, sex, HbA
1c
and number of follow-up visits, emergency department visits and diabetic ketoacidosis admissions in the 1 year prior to transition between the usual care (
n
= 101) and intervention (
n
= 102) groups. In the year following transfer, 47.1% in the usual care group vs 11.9% in the intervention group did not attend any outpatient diabetes appointments (
p
< 0.01). There were no differences in glycaemic control or diabetic ketoacidosis post transfer.
Conclusions/interpretation
Our intervention was successful in improving clinic attendance among transitioning youth with type 1 diabetes. Importantly, this programme used simple, readily accessible communication technologies, which increases the sustainability and transferability of this strategy.
Trial registration
isrctn.org
ISRCTN13459962
Graphical abstract
We examined the association between hemoglobin A1c (HbA1c) and the development of cardiovascular disease (CVD) in men and women, without diabetes or CVD at baseline.
This retrospective cohort study ...included adults aged 40 to <80 years in Alberta, Canada. Men and women were divided into categories based on a random HbA1c during a 3-year enrollment period. The primary outcome of CVD hospitalization and secondary outcome of combined CVD hospitalization/mortality were examined during a 5-year follow-up period until March 31, 2021. A total of 608 474 individuals (55.2% women) were included. Compared with HbA1c 5.0% to 5.4%, men with HbA1c of 5.5% to 5.9% had an increased risk of CVD hospitalization (adjusted hazard ratio aHR, 1.12 95% CI, 1.07-1.19) whereas women did not (aHR, 1.01 95% CI, 0.95-1.08). Men and women with HbA1c of 6.0% to 6.4% had a 38% and 17% higher risk and men and women with HbA1c ≥6.5% had a 79% and 51% higher risk of CVD hospitalization, respectively. In addition, HbA1c of 6.0% to 6.4% and HbA1c ≥6.5% were associated with a higher risk (14% and 41%, respectively) of CVD hospitalization/death in men, but HbA1c ≥6.5% was associated with a 24% higher risk only among women.
In both men and women, HbA1c ≥6.0% was associated with an increased risk of CVD and mortality outcomes. The association between CVD and HbA1c levels of 5.5% to 5.9%, considered to be in the "normal" range, highlights the importance of optimizing cardiovascular risk profiles at all levels of glycemia, especially in men.
IntroductionPhysical inactivity is a costly and leading health risk factor. Engaging in moderate or more intense regular physical activity reduces premature mortality at the population level. Walking ...is a viable option for achieving the recommended level of physical activity. Yet, the sedentary lifestyle is trending. Determinants of physical activity may be personal, social or environmental. Health promotion endeavours aiming to enhance population-level physical activity are reported in the literature. However, a full range of factors influencing the development and implementation of sustainable indoor walking programmes is unclear. The current review protocol is aimed at describing a process of realist synthesis to uncover contexts, mechanisms and outcomes of indoor walking intervention programmes, which might reveal facilitators, constraints and barriers of planning, implementing and participating in indoor walking initiatives open for the members of the general public.Methods and analysisWe will employ a realist synthesis to determine successes or failures in certain circumstances for specific stakeholders, which will aid in developing a sustainable mall walking health promotion and community engagement programme. Qualitative, quantitative and mixed-method articles and reports will be screened for intervention theories and models in order to identify elements of programmes that may be linked to the success or failure of the interventions. Data related to the context, mechanism and outcome of the interventions will be collected, analysed and synthesised iteratively until a theoretical understanding develops, which might explain the intricacies of the success and failure of identified indoor walking programmes. The review process will be conducted and evaluated by using the recommended tools.Ethics and disseminationEthical approval, such as Conjoint Health Research Ethics Board, was not required for this study because no direct interaction with patients will occur for data collection and analysis. We will disseminate directly to the scholarly community through publication and presentation and may post on social media or websites.PROSPERO registration numberCRD42020150415.
ObjectivesThe overall goal of this study is to identify priorities for cardiovascular (CV) health research that are important to patients and clinician-researchers. We brought together a group of CV ...patients and clinician-researchers new to patient-oriented research (POR), to build a multidisciplinary POR team and form an advisory committee for the Libin Cardiovascular Institute of Alberta.DesignThis qualitative POR used a participatory health research paradigm to work with participants in eliciting their priorities. Therefore, participants were involved in priority setting, and analysis of findings. Participants also developed a plan for continued engagement to support POR in CV health research.SettingLibin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Canada.ParticipantsA total of 23 participants, including patients and family caregivers (n=12) and clinician-researchers (n=11).ResultsParticipants identified barriers and facilitators to POR in CV health (lack of awareness of POR and poor understanding on the role of patients) and 10 research priorities for improving CV health. The CV health research priorities include: (1) CV disease prediction and prevention, (2) access to CV care, (3) communication with providers, (4) use of eHealth technology, (5) patient experiences in healthcare, (6) patient engagement, (7) transitions and continuity of CV care, (8) integrated CV care, (9) development of structures for patient-to-patient support and (10) research on rare heart diseases.ConclusionsIn this study, research priorities were identified by patients and clinician-researchers working together to improve CV health. Future research programme and projects will be developed to address these priorities. A key output of this study is the creation of the patient advisory council that will provide support and will work with clinician-researchers to improve CV health.
Background and Aims
When youth with diabetes transition from pediatric to adult diabetes care, they are at high risk for loss to follow up and worsening glucose control. We aimed to gain insight on ...how to improve the transition of youth with type 1 diabetes from pediatric to adult diabetes care from the patients' and parents' perspective.
Methods
We conducted focus groups in youth with type 1 diabetes in transition from pediatric to adult diabetes care and their parents, in Calgary, Alberta, between June and August 2014. Eligibility criteria included: (a) type 1 diabetes; (b) aged 15 to 25 years; (c) have or had received care at the pediatric hospital; and, (d) either pre or post‐transfer; or, (e) parents of recently transferred youth. Purposive sampling was used, and the theoretical framework used was the Integrated Behaviour Model. Participants were asked about positive, negative, or challenging experiences related to diabetes and transition, solutions to challenges, and tools and strategies to improve and better support transition. Thematic analysis was conducted after focus groups were recorded and transcribed.
Results
Three focus groups were conducted: pre‐transfer youth with diabetes (4 females and 3 males; median age 17.5 years, IQR 1.3 years); post‐transfer young adults with diabetes (2 females and 2 males; median age 23.5 years, IQR 1.2 years); and parents of recently transferred young adults with diabetes (n = 3). Main themes were: (a) communication technology; (b) the need for more transition and diabetes education and preparation during transition; and, (c) the importance and need for social and peer support.
Conclusion
This study describes specific areas that may improve diabetes transfer and transition from pediatric to adult diabetes care. This information can help inform clinical care delivery for transition and the development of programs, strategies, and interventions to improve transition care.
Abstract Type 1 diabetes is an autoimmune condition that results from the destruction of the insulin-producing beta cells of the pancreas. The excess morbidity and mortality resulting from its ...complications, coupled with its increasing incidence, emphasize the importance of better understanding the causes of this condition. Over the past several decades, a substantive amount of work has been done and, although many advances have occurred in identifying disease-susceptibility genes, there has been a lag in understanding the environmental triggers. Several putative environmental risk factors have been proposed, including infections, dietary factors, air pollution, vaccines, location of residence, family environment and stress. However, most of these factors have been inconclusive, thus supporting the need for further study into the causes of type 1 diabetes.
National guidelines recommend that all adults over the age of 40 years undergo screening for diabetes at least once every 3-years. We examined the adherence to these guidelines among males and ...females after accounting for age, urban/rural residence, and material deprivation. We also examined the incidence of prediabetes and diabetes in adherent and non-adherent individuals.
Our study is based on a retrospective population-level inception cohort of adults aged 40–79 years without pre-existing diabetes or cardiovascular disease on April 1, 2013. Adherence during a 3-year screening period (2013–2016) and prediabetes and diabetes during a 4-year follow-up period were examined. Multivariate logistic regression was used to examine the adjusted association between sex and adherence.
Among 1,380,697 individuals (49·2% male, 50·8% female) adherence rates were 69·9% in males and 79·8% in females. Sex-differences in adherence were largest in younger individuals (58·0% and 72·6% and in males and females aged 40–44 years, respectively) and consistent across rural/urban residence and material deprivation. Females were more adherent (adjusted odds ratio 1·92; 95% confidence interval 1·89 to 1·95) than males. Prediabetes and diabetes rates among individuals who adhered to screening guidelines were 15·7% and 2·6% among males and 13·4% and 1·5% among females. During the follow-up period, an additional 3·2% and 1·9% of adherent males and females had diabetes. Incidence rates of prediabetes and diabetes during the follow-up period among individuals who did not adhere to screening guidelines were 8·8% and 2·1% among males and 7·3% and 1·3% among females.
Adherence to diabetes screening guidelines is sub-optimal, especially among young males. Despite lower rates of adherence to screening, males have higher rates of prediabetes and diabetes compared to females. There is a need for education campaigns to improve diabetes screening rates in young adults, especially males.
This study was funded by the Canadian Institutes of Health Research Sex and Gender Science Chair (Recipient: Kaul).
ObjectiveThe objective of our study was to explore the perspectives of patients and general practitioners (GPs) regarding interventions to increase initiation of cholesterol lowering medication (or ...statins), including a proposed laboratory-based facilitated relay intervention.DesignQualitative descriptive study using interviews and focus groups for data collection, and thematic analysis for data analysis.SettingPrimary care providers and patients in Calgary, Alberta, Canada.Participants17 GPs with primarily community-based, non-academic practices with at least 1 year of practice experience participated in semistructured interviews. 14 patients at high risk of cardiovascular disease participated in focus groups.Main outcome measuresExploration of strategies that might be used to enhance the prescription of, and adherence to statin therapy for patients with statin-indicated conditions.ResultsGPs proposed a variety of interventions to improve statin prescription, including electronic record audit solutions, GP directed education, and patient-oriented campaigns. Patients expressed that they may benefit from being provided access to their laboratory test results, as well as targeted education. Both parties provided positive feedback on the proposed laboratory-based facilitated relay intervention, while pointing out areas for improvement. Notably, GPs were concerned that the patient-directed component of the intervention might jeopardise therapeutic relationships, and patients were concerned about accidental disclosure of personal health information. Important considerations for the design of facilitated relay messaging should include brevity, simplicity and the provision of contact information for inquiries.ConclusionsGPs and patients described several suggestions for increasing statin initiation and welcomed the proposal of a laboratory-based facilitated relay strategy. These findings support further testing of this intervention which may enhance GPs’ ability to successfully engage patients in cardiovascular risk reduction through statin therapy.
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