Multidisciplinary collaborative care in the management of patients with uncontrolled diabetes: A systematic review and meta-analysis

Siaw, Melanie Yee Lee; Lee, Joyce Yu‐Chia

doi:10.1111/ijcp.13288

Cited by 42 publications

(53 citation statements)

References 45 publications

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“…The lower FT 3 , even within a normal reference range, was the factor most related to reduced eGFR compared with all other thyroid hormones. Multidisciplinary collaborative care, including nephrologists, endocrinologists, or internal medicine specialists, is needed and appears to positively impact the clinical, humanistic, and economic outcomes of patients with diabetes [51,52].…”

Section: Resultsmentioning

confidence: 99%

Thyroid Parameters and Kidney Disorder in Type 2 Diabetes: Results from the METAL Study

Chen

Zhang

Wang

et al. 2020

Journal of Diabetes Research

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Objective. Diabetic kidney disease is one of the most common microvascular complications of diabetes mellitus. We aimed to analyze the association of thyroid parameters with kidney disorders, especially in euthyroid participants. Methods. The data were obtained from a cross-sectional study, the METAL study. Thyroid parameters, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), triiodothyronine (T3), thyroxin (T4), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb), of 4136 participants with type 2 diabetes were measured. Two structure parameters of thyroid homeostasis, including the sum activity of step-up deiodinases (SPINA-GD) and thyroid secretory capacity (SPINA-GT), and two pituitary thyrotropic function indices, including Jostel’s TSH index (TSHI) and the thyrotroph thyroid hormone resistance index (TTSI), were also calculated. Kidney disorders were described according to the presence of reduced estimated glomerular filtration rate (eGFR) and/or higher urinary albumin to creatinine ratio (UACR). Results. The prevalence of kidney disorders increased with decreasing FT3 or T3 and increasing FT4 or T4 quartile levels (all P<0.05). After full adjustment, linear regression showed that UACR levels were negatively associated with FT3 and T3 (P<0.001). In addition, eGFR was positively associated with FT3 and T3 and was negatively associated with TSH and FT4 levels and TgAb positivity (all P<0.05). By using binary logistic regression, higher TSH and FT4 and lower FT3 and T3 were associated with kidney disorders (all P<0.05). Similar results were seen in sensitivity analyses, which were performed in 3035 euthyroid diabetic participants; however, TSH was no longer related to them. The area under the receiver operating characteristic curve (AUROC) of lower FT3 for existing kidney disorder was greater than that for any other thyroid hormones (all P<0.001). The cutoff value of FT3 for reduced eGFR was 4.39 pmol/L. Regarding thyroid homeostasis parameters, SPINA-GD was negatively associated with three statuses of kidney disorders, and TSHI and TTSI were positively associated with reduced eGFR (all P<0.05). Conclusions. Among patients with type 2 diabetes, elevated TSH and FT4 (or T4), lower FT3 (or T3), TgAb positivity, lower SPINA-GD, and higher TSHI and TTSI were associated with kidney disorders. The lower FT3, even within the normal range (<4.38 pmol/L), may be the factor most related to reduced eGFR compared with other thyroid hormones in diabetic patients.

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Section: Resultsmentioning

confidence: 99%

Thyroid Parameters and Kidney Disorder in Type 2 Diabetes: Results from the METAL Study

Chen

Zhang

Wang

et al. 2020

Journal of Diabetes Research

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“…This is something to be strived for as evidence from Bangladesh suggests that a lack of empathy and reassurance from participants’ physicians were barriers to effective diabetes management [ 29 ]. Training multidisciplinary care teams, including nurses, dieticians, pharmacists, and social workers in counselling and motivational interviews could be useful to enhance self-management skills and adherence to medications in patient with diabetes [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Exploring perceptions, attitudes and beliefs of Thai patients with type 2 diabetes mellitus as they relate to medication adherence at an out-patient primary care clinic in Chiang Mai, Thailand

et al. 2020

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Background: Within the sphere of diabetes self-management, much emphasis has been placed on medication adherence. There has been a shift in thinking about medication adherence, moving from "compliance" and historically paternalistic models of care, to seeking better ways of characterizing dynamic and complex relationships that determine medication adherence and diabetes control. This study sought to understand the relationship between patient's attitudes and medication adherence for oral anti-diabetics in Thailand. Methods: In-depth interviews of patients with type 2 diabetes mellitus, taking oral anti-diabetic drugs, at the outpatient clinic run by the Department of Family Medicine, Chiang Mai University between May and December 2016. Thematic analysis followed the WHO framework for medication adherence in chronic disease to explore patient's attitudes and their influence on medication compliance. Results: Of 24 patients, 9 were men. The mean age was 62 years (SD 8.9 years). 67% had high compliance. Four themes were identified as important factors related to medication adherence: attitudes toward disease, attitudes toward treatment, attitudes toward family support and attitudes toward health care team. Specifically, symptoms at diagnosis, understanding and acceptance in taking medication, the presence of family support and the perception of concern by the doctor relate to improved medication compliance. Conclusions: Medication adherence in Thai patients with diabetes requires support from both the health care providers and the family. The patient's perception of the doctor's concern creates greater patient trust in the health care team. This trust, along with family support, helps deepen patients' understanding of the disease, accept the chronic nature of their disease, and engenders a positive attitude towards taking medication that can improve medication adherence.

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“…14,15 Patients frequently report improved satisfaction and outcomes with the integrated approach, siting the benefit of direct communication with group formation of treatment decisions at a single point in time. [16][17][18] This integrated practice model produces sharing of knowledge and clinical expertise between the different subspecialties, creates a support staff familiar with all aspects of care, and reduces time and financial burden on the patients.…”

Section: Current Models Of Multidisciplinary Carementioning

confidence: 99%

How We Established a Multidisciplinary Program for Vascular Anomalies

Borst

Swerdlin

Phillips

et al. 2020

Preprint

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The care of patients with vascular anomalies is quickly becoming a complex field requiring high quality, coordinated multidisciplinary care. In this article, we review the history of multidisciplinary care in this field, discuss the benefits of this model of care, and outline some of the essential components and structure of a successful vascular anomalies team. We provide an overview of two example programs and a roadmap for other centers to develop their own multidisciplinary vascular anomalies teams.

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Multidisciplinary collaborative care in the management of patients with uncontrolled diabetes: A systematic review and meta-analysis

Cited by 42 publications

References 45 publications

Thyroid Parameters and Kidney Disorder in Type 2 Diabetes: Results from the METAL Study

Thyroid Parameters and Kidney Disorder in Type 2 Diabetes: Results from the METAL Study

Exploring perceptions, attitudes and beliefs of Thai patients with type 2 diabetes mellitus as they relate to medication adherence at an out-patient primary care clinic in Chiang Mai, Thailand

How We Established a Multidisciplinary Program for Vascular Anomalies

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