Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations

Orozco‐Beltrán, Domingo; Pan, Changyu; Svendsen, Anne Louise; Færch, Louise; Caputo, Salvatore

doi:10.1111/ijcp.12776

Cited by 5 publications

(3 citation statements)

References 32 publications

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“…52 Indeed, in a recent study of greater than 17,000 subjects, no difference in glycemic control after insulin initiation was seen between primary versus specialist care. 53 However, the management of patients with diabetes and concomitant mental health conditions in primary care is fragmented, when diabetes is managed by the primary care doctor and mental health interventions are delivered by behavioral health providers (BHPs) outside the primary care office. 54,55 Historically, communication between physicians and behavioral health providers about shared patients has been infrequent and often non-existent, 56 thus facilitating the provision of health care in ''silos.''…”

Section: Introduction Disparitiesmentioning

confidence: 99%

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Anxiety and diabetes: Innovative approaches to management in primary care

Bickett

Tapp

2016

Exp Biol Med (Maywood)

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Type 2 diabetes mellitus is a chief concern for patients, healthcare providers, and health care systems in America, and around the globe. Individuals with type 2 diabetes mellitus exhibit clinical and subclinical symptoms of anxiety more frequently than people without diabetes. Anxiety is traditionally associated with poor metabolic outcomes and increased medical complications among those with type 2 diabetes mellitus. Collaborative care models have been utilized in the multidisciplinary treatment of mental health problems and chronic disease, and have demonstrated success in managing the pathology of depression which often accompanies diabetes. However, no specific treatment model has been published that links the treatment of anxiety to the treatment of type 2 diabetes mellitus. Given the success of collaborative care models in treating depression associated with diabetes, and anxiety unrelated to chronic disease, it is possible that the collaborative care treatment of primary care patients who suffer from both anxiety and diabetes could be met with the same success. The key issue is determining how to implement and sustain these models in practice. This review summarizes the proposed link between anxiety and diabetes, and offers an innovative and evidence-based collaborative care model for anxiety and diabetes in primary care.

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Section: Introduction Disparitiesmentioning

confidence: 99%

“…52 Indeed, in a recent study of greater than 17,000 subjects, no difference in glycemic control after insulin initiation was seen between primary versus specialist care. 53…”

Section: Introductionmentioning

confidence: 99%

Anxiety and diabetes: Innovative approaches to management in primary care

Bickett

Tapp

2016

Exp Biol Med (Maywood)

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“…15 In comparison, patients in our study had a higher average HbA1c level (9.6%) than Kim et al's study (9.2%), 14 a shorter diabetes duration (6.4 years) compared to previous studies ranging from 8.9 to 11.7 years. 14,[16][17][18][19] This might be due to a low proportion of early diabetes diagnoses since only 36.5% of Chinese diabetes patients were aware of their diagnosis, 1 contributing to severe hyperglycemia with a shorter duration of diagnosed T2DM. Chinese guidelines recommend initiating BI when HbA1c ≥7% after three months of OAD treatment.…”

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confidence: 99%

Where to Initiate Basal Insulin Therapy: Inpatient or Outpatient Department? Real-World Observation in China

Chen¹,

Zhang²,

Zhao³

et al. 2022

DMSO

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Background: This study aims to compare the effectiveness of initiating insulin therapy in inpatient and outpatient settings during a 6-month follow-up period among patients with type 2 diabetes mellitus (T2DM) in real-world settings. Materials and Methods:The study was based on the ORBIT study, a real-world observational study which recruited patients with inadequate glycemic control by oral antidiabetic drugs (OAD) and initiated basal insulin (BI). We compare difference in initiation and evolution of insulin therapy and glycemic control after six months were compared between patients initiating basal insulin in the inpatient department (inpatient initiators) and those starting in outpatient (outpatient initiators) among participants without rehospitalization during the six months follow-up. Results: Among all 18,995 participants in the ORBIT study, 56.0% were inpatient initiators and 44.0% outpatient. We conducted in-depth analysis among 14,860 patients without rehospitalization, 8129 inpatient initiators and 6731 outpatient initiators. (1) Inpatient initiators had lower insulin therapy persistence during six months (64.2%) than outpatient ones (78.6%) (p<0.001), which was mainly explained by more therapy switches from basal-bolus regimen to other therapies among inpatient initiators (50.1%) than that among outpatient initiators (37.5%) (p<0.001). (2) Inpatient initiation had a higher proportion of people achieving glucose targets (HbA1c <7%) than outpatient initiation. However, the benefit of inpatient initiation versus outpatient initiation was mainly observed among patients persisting with the initial insulin therapies (46.3% vs 39.5% p<0.001), rather than those nonpersistent (37.3% vs 36.2%, p=0.723). (3) Among patients with HbA1c <9%, taking only one OAD and without complications at baseline, inpatient insulin initiation did not show a higher proportion of people achieving glucose target than outpatient initiation (adjusted odds ratio=0.96, 95% CI: 0.76-1.21). Conclusion:For patients with HbA1c ≥9%, who were taking more than one OAD and had complications at baseline, initiating insulin treatment during hospitalization has a higher proportion of people achieving glucose target than that in the outpatient department, but the premise is that the initial therapy is acceptable and can be maintained after discharge. Patient-centered approach with co-agreed decision-making to select a suitable insulin regimen should be strengthened.

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