Aims
To select a core list of standard outcomes for diabetes to be routinely applied internationally, including patient‐reported outcomes.
Methods
We conducted a structured systematic review of ...outcome measures, focusing on adults with either type 1 or type 2 diabetes. This process was followed by a consensus‐driven modified Delphi panel, including a multidisciplinary group of academics, health professionals and people with diabetes. External feedback to validate the set of outcome measures was sought from people with diabetes and health professionals.
Results
The panel identified an essential set of clinical outcomes related to diabetes control, acute events, chronic complications, health service utilisation, and survival that can be measured using routine administrative data and/or clinical records. Three instruments were recommended for annual measurement of patient‐reported outcome measures: the WHO Well‐Being Index for psychological well‐being; the depression module of the Patient Health Questionnaire for depression; and the Problem Areas in Diabetes scale for diabetes distress. A range of factors related to demographic, diagnostic profile, lifestyle, social support and treatment of diabetes were also identified for case‐mix adjustment.
Conclusions
We recommend the standard set identified in this study for use in routine practice to monitor, benchmark and improve diabetes care. The inclusion of patient‐reported outcomes enables people living with diabetes to report directly on their condition in a structured way.
What's new?
Standardized monitoring of diabetes care can improve quality through routine audit and benchmarking. Inconsistencies between measures adopted in different countries hamper this process and undermine international comparisons.
This study was the first multinational effort to recommend a standard list of outcomes that matter most to people with diabetes, and that can be used in routine clinical practice to monitor, benchmark and improve diabetes care.
The essential outcomes relate to diabetes control, acute events, chronic complications, health service utilisation and survival, measured using routine administrative data and/or clinical records. Three instruments were recommended for annual measurement of patient‐reported outcome measures (PROMs): the WHO Well‐Being Index for psychological well‐being; the depression module of the Patient Health Questionnaire for depression; and the Problem Areas in Diabetes scale for diabetes distress.
Aims
: Adiponectin and leptin are adipocytokines associated with insulin resistance. The objective of this study was to evaluate the performance of the adiponectin-leptin ratio as a measure of ...insulin resistance in comparison with other surrogate measures of insulin resistance based on fasting insulin and glucose levels homeostasis model assessment (HOMA), quantitative insulin sensitivity check index (QUICKI), fasting glucose/insulin ratio and with measures based on fasting insulin and triglyceride levels (McAuley index) in Caucasian patients with Type 2 diabetes (T2D).
Methods
: In 70 patients included in DEMAND (delapril and manidipine for nephroprotection in diabetes) study, fasting samples of plasma insulin and adiponectin were determined by a radioimmunoassay, whereas plasma leptin was determined by an enzyme-linked immunosorbent assay. Insulin resistance estimates were derived by the established equations and compared with the direct measurement of insulin resistance obtained with the euglycemic hyperinsulinemic clamp. Insulin resistance estimates and the clamp derived sensitivity index were compared by correlation analysis.
Results
: The adiponectin-leptin ratio correlated best with the clamp derived sensitivity index (r=0.553,
p
<0.001) compared to other surrogate measures of insulin resistance. In multiple linear regression models including different surrogate measures of insulin resistance as independent predictors of the sensitivity index, the model with the adiponectin-leptin ratio accounted for the highest variability of the sensitivity index (
r
2
=0.336,
p
<0.001).
Conclusions
: The adiponectin-leptin ratio is associated with insulin resistance, measured with the euglycemic hyperinsulinemic clamp, in Caucasians with T2D. The association with clamp derived sensitivity index is even stronger than that of HOMA, QUICKI, fasting glucose/insulin ratio or McAuley index and is independent of body mass index or glycemic control. The adiponectin-leptin ratio promises to become a new laboratory marker of insulin resistance in T2D.
To develop and validate a simplified screening test for undiagnosed Type 2 diabetes mellitus and impaired fasting glucose for the Slovenian population (SloRisk) to be used in the general population.
...Data on 11 391 people were collected from the electronic health records of comprehensive medical examinations in five Slovenian healthcare centres. Fasting plasma glucose as well as information related to the Finnish Diabetes Risk Score questionnaire, FINDRISC, were collected for 2073 people to build predictive models. Bootstrapping-based evaluation was used to estimate the area under the receiver-operating characteristic curve performance metric of two proposed logistic regression models as well as the Finnish Diabetes Risk Score model both at recommended and at alternative cut-off values.
The final model contained five questions for undiagnosed Type 2 diabetes prediction and achieved an area under the receiver-operating characteristic curve of 0.851 (95% CI 0.850-0.853). The impaired fasting glucose prediction model included six questions and achieved an area under the receiver-operating characteristic curve of 0.840 (95% CI 0.839-0.840). There were four questions that were included in both models (age, sex, waist circumference and blood sugar history), with physical activity selected only for undiagnosed Type 2 diabetes and questions on family history and hypertension drug use selected only for the impaired fasting glucose prediction model.
This study proposes two simplified models based on FINDRISC questions for screening of undiagnosed Type 2 diabetes and impaired fasting glucose in the Slovenian population. A significant improvement in performance was achieved compared with the original FINDRISC questionnaire. Both models include waist circumference instead of BMI.
AIMSAdiponectin and leptin are adipocytokines associated with insulin resistance. The objective of this study was to evaluate the performance of the adiponectin-leptin ratio as a measure of insulin ...resistance in comparison with other surrogate measures of insulin resistance based on fasting insulin and glucose levels homeostasis model assessment (HOMA), quantitative insulin sensitivity check index (QUICKI), fasting glucose/insulin ratio and with measures based on fasting insulin and triglyceride levels (McAuley index) in Caucasian patients with Type 2 diabetes (T2D). METHODSIn 70 patients included in DEMAND (delapril and manidipine for nephroprotection in diabetes) study, fasting samples of plasma insulin and adiponectin were determined by a radioimmunoassay, whereas plasma leptin was determined by an enzyme-linked immunosorbent assay. Insulin resistance estimates were derived by the established equations and compared with the direct measurement of insulin resistance obtained with the euglycemic hyperinsulinemic clamp. Insulin resistance estimates and the clamp derived sensitivity index were compared by correlation analysis. RESULTSThe adiponectin-leptin ratio correlated best with the clamp derived sensitivity index (r=0.553, p<0.001) compared to other surrogate measures of insulin resistance. In multiple linear regression models including different surrogate measures of insulin resistance as independent predictors of the sensitivity index, the model with the adiponectin-leptin ratio accounted for the highest variability of the sensitivity index (r2=0.336, p<0.001). CONCLUSIONSThe adiponectin-leptin ratio is associated with insulin resistance, measured with the euglycemic hyperinsulinemic clamp, in Caucasians with T2D. The association with clamp derived sensitivity index is even stronger than that of HOMA, QUICKI, fasting glucose/insulin ratio or McAuley index and is independent of body mass index or glycemic control. The adiponectin-leptin ratio promises to become a new laboratory marker of insulin resistance in T2D.
Neurological conditions are the leading cause of death and disability combined. This public health crisis has become a global priority with the introduction of WHO's Intersectoral Global Action Plan ...on Epilepsy and Other Neurological Disorders 2022–2031 (IGAP). 18 months after this plan was adopted, global neurology stakeholders, including representatives of the OneNeurology Partnership (a consortium uniting global neurology organisations), take stock and advocate for urgent acceleration of IGAP implementation. Drawing on lessons from relevant global health contexts, this Health Policy identifies two priority IGAP targets to expedite national delivery of the entire 10-year plan: namely, to update national policies and plans, and to create awareness campaigns and advocacy programmes for neurological conditions and brain health. To ensure rapid attainment of the identified priority targets, six strategic drivers are proposed: universal community awareness, integrated neurology approaches, intersectoral governance, regionally coordinated IGAP domestication, lived experience-informed policy making, and neurological mainstreaming (advocating to embed brain health into broader policy agendas). Contextualised with globally emerging IGAP-directed efforts and key considerations for intersectoral policy design, this novel framework provides actionable recommendations for policy makers and IGAP implementation partners. Timely, synergistic pursuit of the six drivers might aid WHO member states in cultivating public awareness and policy structures required for successful intersectoral roll-out of IGAP by 2031, paving the way towards brain health for all.
Decreased renal functional reserve might precede incipient diabetic nephropathy in patients with Type 1 diabetes. The aim of this study was to assess the relationship between renal functional reserve ...and easily assessable estimates of systemic endothelial dysfunction in normoalbuminuric patients with Type 1 diabetes and diabetic retinopathy.
Renal functional reserve was calculated as the relative change in glomerular filtration rate after protein ingestion. Glomerular filtration rate was measured using pharmacokinetic compartmental analysis of single-shot plasma sinistrin clearance. We measured the activity of von Willebrand factor and concentrations of C-reactive protein and apolipoprotein B, as easily assessable estimates of systemic endothelial dysfunction.
Twenty-two patients were studied. Renal functional reserve was inversely associated with activity of von Willebrand factor (R=-0.431, p=0.045) and, in a multivariate model, with concentration of C-reactive protein (R=0.652, p=0.031).
Renal functional reserve is inversely associated with concentration of C-reactive protein in normoalbuminuric patients with Type 1 diabetes and diabetic retinopathy. This finding provides evidence that decreased renal functional reserve might reflect endothelial dysfunction. We speculate that decreased renal functional reserve might possibly show as an early marker of diabetic nephropathy.
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