Use of clinical targets in diabetes patient education: qualitative analysis of the expectations and impact of a structured self‐management programme in Type 1 diabetes

Snow, Rosamund; Sandall, Jane; Humphrey, Christopher

doi:10.1111/dme.12401

Cited by 11 publications

(19 citation statements)

References 19 publications

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“…It is possible that physicians were more lenient with the younger age group because of their high glycemic values at baseline and the wish to set a realistic target. Indeed, setting unrealistically low glycemic targets has been suggested to be counterproductive for long-term motivation in patients with type 1 diabetes,6 and this is likely to extrapolate to patients with T2DM.…”

Section: Discussionmentioning

confidence: 99%

“…Guidelines pertaining specifically to older patients with diabetes emphasize the influence of age on the appropriacy of treatment regimens and the added importance of recognizing individual patient characteristics in this population 1 5 6. Indeed, elderly patients tend to be more comorbid and have more atherosclerotic vasculature, poorer kidney function, and shorter life expectancy 7.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, patient mental state, functionality, and quality of support systems may dictate the feasibility of meeting such targets in elderly patients, especially where insulin administration is indicated. Therefore, guidelines suggest that individual glycemic targets may be relaxed as age increases (HbA1c 7.5%–8.0%; 58–64 mmol/mol), with prevention of hypoglycemia and quality of life particularly important aspects 5 6. Conversely, younger patients with long life expectancies and lower rate of comorbidities may be assigned a more stringent target (HbA1c 6.0%–6.5%; 42–48 mmol/mol), given the potential protective effect of intensive glycemic control against long-term microvascular complications and cardiovascular events 9 10…”

Section: Introductionmentioning

confidence: 99%

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HbA1c target achievement in the elderly: results of the Titration and Optimization trial for initiation of insulin glargine 100 U/mL in patients with type 2 diabetes poorly controlled on oral antidiabetic drugs

Fritsche

Anderten²,

Pfohl

et al. 2019

BMJ Open Diab Res Care

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ObjectivesTo identify real-world, age-related trends in the use of insulin glargine 100 U/mL (Gla-100) as part of basal-supported oral therapy (BOT).Research design and methodsThe prospective, observational Titration and Optimization registry enrolled patients with poorly controlled type 2 diabetes mellitus initiated on Gla-100 BOT. The primary outcome was the proportion of patients with capillary fasting blood glucose (FBG) ≤110 mg/dL on ≥2 occasions and/or who met their individual HbA1c target within 12 months.Results2462 patients were analyzed (<65 years: n=1122; 65–74 years: n=771; ≥75 years: n=569). Diabetes duration (6.8, 8.9, and 11.2 years, p<0.0001) and proportion of women (40.7%, 47.9%, and 55.7%, p<0.0001) increased with age. Baseline HbA1c was highest in <65-year-olds (8.6% vs 8.4% and 8.5%, p<0.0001). Gla-100 up-titration until 12 months was highest in <65-year-olds (+11.6 U/day), compared with 65–74 (+10.2 U/day) and ≥75 years (+8.8; p<0.0001) but similar by units per kilogram, as was the decrease in FBG (<65: −64.1 mg/dL; 65–74: −56.1 mg/dL; ≥75: −53.4 mg/dL) and HbA1c (<65: −1.47%; 65–74: −1.31%; ≥75: −1.22%, p<0.0001). At 12 months, 65.9% of participants met the primary endpoint, with no significant difference between age groups. The proportion achieving their individual HbA1c target was lower for <65-year-olds (46.0% vs 54.3% and 54.7%; p<0.02). Symptomatic hypoglycemia incidence was more common in the ≥75-year-old group (3.4% vs 1.4% and 1.4%; p=0.0126).ConclusionsBOT with Gla-100 results in similar improvements of glycemic values with low risk of hypoglycemia across age groups. Given the link between HbA1c and long-term cardiovascular risk, ensuring appropriately stringent target-setting, intensification of basal insulin and making sure hypoglycemia is avoided is of paramount importance.Trial registration numberDatabase:https://awbdb.bfarm.de; Identifier: 1641; Date of registration: September 23, 2013

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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HbA1c target achievement in the elderly: results of the Titration and Optimization trial for initiation of insulin glargine 100 U/mL in patients with type 2 diabetes poorly controlled on oral antidiabetic drugs

Fritsche

Anderten²,

Pfohl

et al. 2019

BMJ Open Diab Res Care

View full text Add to dashboard Cite

show abstract

“…It is increasingly recognized that the language used in diabetes care may not always be helpful for people with diabetes [29]. For example, defining glucose targets and levels as 'good' or 'bad' may convey a sense of failure, leading to reduced engagement in self-management, and may drive fear of complications [30]. Equipping health professionals with strategies to communicate the diagnosis and interact with people early after diagnosis in a way that is more reflective of peoples' experiences may therefore improve their perception of diabetes and their engagement with the diabetes team.…”

Section: Discussionmentioning

confidence: 99%

Learning about Type 1 diabetes and learning to live with it when diagnosed in adulthood: two distinct but inter‐related psychological processes of adaptation A qualitative longitudinal study

et al. 2018

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Aim To explore the experiences of adults with newly diagnosed Type 1 diabetes in order to understand the adaptive processes that occur in the early phase of the condition.Methods We conducted longitudinal semi-structured interviews with 30 adults newly diagnosed with Type 1 diabetes (age range 20-67 years; 16 men; median diabetes duration 23.5 months), recruited from hospitals in Denmark and the UK. The data were analysed using a narrative approach.Results The narratives could be grouped into three thematic areas: the diagnosis; learning about diabetes; and learning to live with diabetes. Diabetes was characterized as a major disruptor to the established and future life plans of participants, causing significant emotional distress. The narratives showed how early experiences triggered the development of ongoing psychological problems (fear of complications or hypoglycaemia) and diabetes distress, and that navigating different social scenarios (relationships and employment) could be challenging, leading to suboptimal selfmanagement behaviours. The narratives also showed that health professionals often did not attend effectively to participants' emotional needs after diagnosis, and that the language used frequently triggered negative feelings, such as fear or a sense of failure.Conclusions Many of the common psychosocial problems associated with Type 1 diabetes seem to gestate in the early phase of life with the condition. There appear to be opportunities to enhance the support provided in this phase to minimize these problems.

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“… 24 Diabetes education handbooks as well as structured diabetes education programs in adults has improved glycemic control as shown in the Dose Adjustments for Normal Eating (DAFNE) trial and post-DAFNE follow-up of patients. 25 – 27 This study also standardized T1DM education for all patients and families. The ADA has guidelines and a recognition program for diabetes education based on the National Standards of Diabetes Self-Management Education and Support (NDSMES).…”

Section: Discussionmentioning

confidence: 99%

Pediatric Type 1 Diabetes: Reducing Admission Rates for Diabetes Ketoacidosis

Ilkowitz

Choi

Rinke

et al. 2016

Quality Management in Health Care

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Background:Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions.Methods:A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families. A before-after study was conducted comparing performance outcomes in years 2007-2010 (preintervention) to 2012-2014 (postintervention) using administrative data and Wilcoxon rank sum and Fischer exact tests.Results:DKA admissions decreased by 44% postintervention (16.7 vs 9.3 per 100 followed patient-years; P = .006), unique patient 30-day readmissions decreased from 20% to 5% postintervention (P = .001), and median LOS significantly decreased postintervention (P < .0001). Although not an original goal of the study, median hemoglobin A1C of a subset of the population transitioned from sliding scale decreased, 10.3% to 8.9% (P < .02).Conclusions:When clinical and widespread program interventions were used, significant reductions in DKA hospitalizations, 30-day readmissions, and LOS occurred for pediatric T1DM. Continuous performance improvement efforts are needed for improving DKA outcomes.

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Use of clinical targets in diabetes patient education: qualitative analysis of the expectations and impact of a structured self‐management programme in Type 1 diabetes

Cited by 11 publications

References 19 publications

HbA1c target achievement in the elderly: results of the Titration and Optimization trial for initiation of insulin glargine 100 U/mL in patients with type 2 diabetes poorly controlled on oral antidiabetic drugs

HbA1c target achievement in the elderly: results of the Titration and Optimization trial for initiation of insulin glargine 100 U/mL in patients with type 2 diabetes poorly controlled on oral antidiabetic drugs

Learning about Type 1 diabetes and learning to live with it when diagnosed in adulthood: two distinct but inter‐related psychological processes of adaptation A qualitative longitudinal study

Pediatric Type 1 Diabetes: Reducing Admission Rates for Diabetes Ketoacidosis

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