Journal articles on the topic 'Diabetes eye exams'
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Wilcox, Samuel, Hayrettin Okut, Robert Badgett, Stephanie Hassouneh, and Elizabeth Ablah. "Effectiveness of Flow Sheet Implementation on Diabetes Progression Screening at a Student-Run Free Clinic." Kansas Journal of Medicine 13 (November 24, 2020): 285–89. http://dx.doi.org/10.17161/kjm.vol13.13423.
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Introduction: Diabetes mellitus (DM) disproportionately affects people with low socioeconomic-status (SES). Student-run free clinics (SRFC) aim to care for low SES populations and experience high clinician turnover. Flow sheets have been used to improve care for those with diabetes, yet no research has assessed the use of such a flow sheet in a SRFC. The aim of this project was to determine if use of a flow sheet improved care for people with DM in an SRFC.
Methods: Charts from all patients receiving care for DM at one SRFC in the year before (n=53) and after (n=56) implementation of the flow sheet were reviewed. Pre and post group comparisons and post subgroup comparisons were made for glycosylated-hemoglobin (HgbA1c), microalbumin, and foot and eye exams.
Results: During a one-year period, a larger proportion of patients who received care post flow sheet introduction received at least two HgbA1c tests (53%), a microalbumin test (46%), and a foot-exam (46%) compared to those receiving care before the flow sheet (28%, 2%, and 25%, respectively). There was no difference in proportions of patients undergoing eye exams. In post subgroup analysis, flow sheets were used for 50% of patients, and patients who received care with the flow sheet were more likely to receive at least two HgbA1c tests and a foot exam per year.
Conclusions: Our study suggests that flow sheets can improve the process of care for patients with diabetes in a SRFC. A systematic integration of the flow sheet is being implemented in the SRFC now.
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Comer-HaGans, DeLawnia, Shamly Austin, Zo Ramamonjiarivelo, and Alicia K. Matthews. "Diabetes Standard of Care Among Individuals Who Have Diabetes With and Without Cognitive Limitation Disabilities." Diabetes Educator 46, no. 1 (December 24, 2019): 94–107. http://dx.doi.org/10.1177/0145721719896262.
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Purpose The purpose of this study is to examine diabetes standard of care among individuals who have diabetes with and without cognitive limitation disabilities (CLDs). Individuals with CLDs are more likely to develop diabetes and less likely to participate in diabetes standard of care services compared to those without CLDs. Methods We used pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS). Dependent variables were utilization of dilated eye exams, foot checks, A1C blood tests, and engagement in moderate or vigorous physical exercise 5 times per week. Our independent variable was diabetes with CLDs vs diabetes without CLDs. We controlled for predisposing, enabling, and need factors. Results Findings suggest that individuals with diabetes and CLDs were less likely to engage in moderate or vigorous physical exercise 5 times per week compared to individuals without CLDs. For other diabetes care services, individuals with CLDs are as likely to participate in health services utilization as those without CLDs. Conclusions Our study supports research that indicates individuals with diabetes and CLDs were less likely to participate in physical exercise compared to individuals without CLDs. Conversely, individuals with diabetes and CLDs were just as likely to receive a dilated eye exam, have their feet checked, and have their A1C checked as individuals without CLDs, which is a very encouraging finding.
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Hillenbrand, Molly, and Senu Apewokin. "1166. Evaluating the Impact of the 2016 Candidemia Guidelines on the Incidence of Ocular Complications of Candidemia." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S609. http://dx.doi.org/10.1093/ofid/ofaa439.1352.
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Abstract Background The incidence of Candida bloodstream infections has risen over the last several decades. Complications of candidemia include endogenous fungal endophthalmitis which can result in devastating outcomes including vision loss. In 2015, the IDSA guidelines were updated to recommend echinocandins as initial therapy for candidemia. Given the poor ocular penetration of echinocandins there has been some concern this change may portend an increased incidence of ocular complications in candidemic patients. We sought to examine whether patients who received empiric echinocandin therapy developed higher rates of ophthalmic complications of candidemia. Methods We identified patients in our healthcare system who had blood cultures positive for Candida species and a completed ophthalmology consult between January 1, 2014 and April 30, 2019. Chi-squared analysis was used to compare antifungal prescribing patterns before and after release of the updated IDSA guidelines. We assessed whether the switch to empiric echinocandin therapy as directed by the guidelines was associated with higher rates of abnormal eye exams. Results 47 patients treated before the guideline change were compared to 57 patients treated after the guideline change. There was no significant difference in age, gender, or comorbid diabetes and hypertension between the groups. Before the guideline change, 24/47 (51%) of patients received eye-penetrating antifungals. This decreased to 21/57 after the updated guideline (37%, p=0.21). The percentage of patients with positive eye exams was nearly equal before and after the updated guidelines, 10/47 (21%) before vs 13/57 (22%) after (p=1). After the guideline change, 7/21 (33%) of the patients treated with penetrating antifungals had positive eye exams vs 6/36 (16%) who received echinocandins (p=0.19). Conclusion Echinocandins are known to have poor ocular penetration yet our data demonstrate no change in the incidence of ophthalmic complications of candidemia after the 2016 guideline endorsed echinocandins as empiric therapy. The prevalence of positive eye exams throughout our study period was 22%, suggesting ongoing utility for these exams. Ongoing investigation is necessary to confirm and further study these findings. Disclosures All Authors: No reported disclosures
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Chen, Roxana, Allen Cheadle, Donna Johnson, and Bonnie Duran. "US Trends in Receipt of Appropriate Diabetes Clinical and Self-care From 2001 to 2010 and Racial/Ethnic Disparities in Care." Diabetes Educator 40, no. 6 (August 20, 2014): 756–66. http://dx.doi.org/10.1177/0145721714546721.
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Purpose The purpose of this study was to examine trends in the receipt of 8 recommended diabetes clinical and self-care indicators from 2001 to 2010 and assess racial/ethnic disparities in care. Methods This observational study examined receipt of A1C tests, annual eye and foot exams, flu vaccination, diabetes self-management education (DSME), exercise, self-monitoring of blood glucose (SMBG), and self feet examinations among US adults with diabetes using national survey data from 2001 to 2010. Analyses included estimating proportions for each indicator by year, testing differences in magnitude of change from 2001 to 2010 by race/ethnicity, and regression models to assess changes in care over time and factors associated with care. Results There were significant increases from 2001 to 2010 in A1C tests, annual foot exams, flu shots, DSME, and SMBG but declines in eye and self feet exams. DSME was positively associated with receipt of several care indicators. However, only half of respondents received DSME. White and black non-Hispanics, respectively, experienced improvements in at least 3 indicators. Hispanics experienced a significant increase in exercise but were consistently less likely than whites to receive or engage in most care. Conclusions While improvements in several indicators were observed, patterns varied by race/ethnicity, with Hispanics falling short on most measures. DSME was strongly associated with most care and demonstrates the potential to improve receipt of recommended care by increasing DSME participation. With the Affordable Care Act (ACA), health professionals have a prime opportunity to leverage ACA provisions to increase access to recommended services, including DSME.
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Zhou, Yifan, Xiaowen Li, Qinglei Sun, Jin Wei, Haiyun Liu, Keyan Wang, and Jianfeng Luo. "Adherence to Annual Fundus Exams among Chinese Population with Diagnosed Diabetes." Journal of Clinical Medicine 11, no. 22 (November 21, 2022): 6859. http://dx.doi.org/10.3390/jcm11226859.
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Adherence to annual fundus examinations in the Chinese population with diabetes and its correlates have not been investigated. The present study obtained data for the first nationally representative survey in China, China Health and Retirement Longitudinal Survey (CHARLS), which collected a wide range of data every 2 years, including demographic, socioeconomic, medical and lifestyle-related information. The adherence rates to annual fundus exams across four waves (2011–2018) were assessed. Univariate and multivariable logistic regressions were used to determine factors associated with adherence. The adherence rates to annual fundus examinations of ou study population were 23.6% in 2011, 15.3% in 2013, 17.5% in 2015 and 21.5% in 2018, respectively. Consistent results over four waves showed that non-adherent patients had a relatively lower educational level, insufficient diabetes medication use, fewer non-medication treatments and irregular physical examination compared to those who were adherent to the annual fundus exam (all p values < 0.05). These variables were further identified as factors associated with adherence according to univariate and multivariate logistic regression analyses (all p values < 0.05). The present study provides explicit evidence that the adherence rate to annual fundus examinations among Chinese population with diabetes is worryingly low. Insufficient educational attainment, especially specific diabetes education, has a negative impact on patients’ adherence to clinical guideline for eye health.
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Vaughan, Elizabeth M., Craig A. Johnston, Victor J. Cardenas, Jennette P. Moreno, and John P. Foreyt. "Integrating CHWs as Part of the Team Leading Diabetes Group Visits: A Randomized Controlled Feasibility Study." Diabetes Educator 43, no. 6 (October 19, 2017): 589–99. http://dx.doi.org/10.1177/0145721717737742.
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Purpose The purpose of the study was to evaluate the feasibility of integrating Community Health Workers (CHWs) as part of the team leading diabetes group visits. Methods This was a randomized controlled study that integrated CHWs as part of the team leading diabetes group visits for low-income Hispanic adults (n = 50). Group visits met for 3 hours each month for a 6-month duration. Main measures included baseline and 6-month clinical outcomes (ie, A1C, lipids), concordance with 8 standard of care guidelines (ie, screens for cervical, breast, and colon cancer) from the US Preventive Task Force and American Diabetes Association, and participant acceptability. Results Compared to control participants, the intervention group resulted in significantly better clinical outcomes or guideline concordance for the following areas: target A1C levels, retinal eye exams, diabetes foot exams, mammograms, and urine microalbumin. Significantly more individuals in the control group gained weight, whereas a greater number of participants in the intervention group lost weight. Intervention participants found the group visits highly acceptable. Conclusions Integrating CHWs as part a comprehensive diabetes group visit program is a feasible and effective system-level intervention to improve glycemic control and achieve guideline concordance.
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Gediminas, Raila, Liseckienė Ida, Jarusevičienė Lina, and Leonas Valius. "Guideline Adherence and the Factors Associated with Better Care for Type 2 Diabetes Mellitus Patients in Lithuanian PHC: Diabetes Mellitus Guideline Adherence in Lithuania PHC." Open Medicine Journal 6, no. 1 (August 30, 2019): 50–57. http://dx.doi.org/10.2174/1874220301906010050.
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Background: Type 2 diabetes mellitus is one of the most common chronic conditions, which requires appropriate management and care at PHC level, which is described in guidelines. However, guideline adherence at the international arena is insufficient and little is known about the reasons for guideline non-adherence. Objective: The aim of the survey was to analyse to what extent the Lithuanian family practitioners adhere to diabetes guidelines in order to compare to international data and to discover the factors associated with better diabetes care. Methods: The present study is a part of EUPRIMECARE Project, which sets out to develop a framework aiming at the analysis of PHC across Europe. The sample strategy was based on an unequal probability sampling design. An audit of 4 public and 6 private PHC medical records of the year 2011 was carried out in Kaunas region, clinical records of 382 diabetes type 2 patients were reviewed. Demography, diseases and diabetes performance indicators data were collected using a uniform template. Binary and multivariable logistic regression analyses were used in the investigation of the factors related to better diabetes guideline adherence. Results: Three guideline adherence levels were identified: high performance (performed in more than 90% cases) - BP measurement and HbA1c exam; good performance (performed in more than 50% cases) - ECG examination and serum creatinine check; insufficient performance (performed in less than 50% of cases) - annual endocrinologist consultation, eye fundus and foot examinations, LDL check and BMI calculation. Insufficient glycaemic control was positive associated with increased endocrinologist consultation and foot exam rates, elevated BP demonstrated the positive effect to creatinine check rate, multimorbidity had positive association to the annual eye, ECG, creatinine check rates; frequent FP attendance showed no positive effect on process indicators. Rural patients have a negative association to foot and ECG exam rates compared to urban patients. In a stepwise logistic regression model, 3 dependent variables had statistically significant impact on overall diabetes care indicator performance: negative - rural location of patients (OR 0.4, 95% CI 0.2-0.8), elevated mean BP (OR 0.6, 95% CI 0.4-0.9); positive - multimorbidity (OR 2.0, 95% CI 1.2-3.4). Conclusion: Guideline adherence for T2DM is not optimal in Lithuanian PHC. The best are BP and HbA1c checks. Suboptimal are BMI and LDL annual checks. The situation with these is almost the same as in other European countries. The better guideline adherence has been observed in urban (foot exam, ECG exam), multimorbidity (eye, ECG, creatinine exams), controlled by means of BP patients (serum creatinine test).
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Armor, Becky L., Mark L. Britton, Vincent C. Dennis, and Nancy A. Letassy. "A Review of Pharmacist Contributions to Diabetes Care in the United States." Journal of Pharmacy Practice 23, no. 3 (May 28, 2009): 250–64. http://dx.doi.org/10.1177/0897190009336668.
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This paper summarizes the outcomes associated with pharmacist involvement in diabetes care in all pharmacy practice settings. Published literature was identified through a search of MEDLINE (1960 to September, week 1, 2008) and International Pharmaceutical Abstracts using the search terms “pharmacist,” “pharmaceutical care,” and “diabetes mellitus.” Only articles reporting clinical or behavior change outcomes were selected for review; papers written outside the United States and citations only in abstract form were not reviewed. The specific data extracted included the following: practice setting, model of care, roles of the pharmacist, study design, number of patients studied, duration of the evaluation, and documented outcomes such as changes in hemoglobin A1c values, adherence to standards of care (lipids, blood pressure, eye exams, foot exams, aspirin use), and changes in quality of life. The greatest improvements in hemoglobin A1c values tend to be observed when pharmacists work in collaborative practice models. Growing evidence demonstrates that pharmacists, working as educators, consultants, or clinicians in partnership with other health care professionals, are able to contribute to improved patient outcomes.
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Comer-HaGans, DeLawnia, Shamly Austin, Zo Ramamonjiarivelo, and Ledric D. Sherman. "Diabetes Self-Management Among Individuals With Diabetes and Physical Disabilities." Science of Diabetes Self-Management and Care 47, no. 4 (August 2021): 264–78. http://dx.doi.org/10.1177/26350106211024136.
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Purpose The purpose of this study was to examine diabetes self-management behavior among individuals who have diabetes living with and without physical limitations. Methods Pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey was used. Dependent variables were utilization of dilated eye exams, foot checks, at least 1 dental checkup annually, treating diabetes with oral medication, treating diabetes with insulin injections, and engagement in moderate or vigorous physical exercise 5 times per week. The independent variable was diabetes with physical limitations compared with diabetes without physical limitations. The study controlled for predisposing, enabling, and need factors. Results Findings indicate that individuals with diabetes and physical limitations were less likely to engage in moderate or vigorous physical exercise 5 times per week, have at least 1 annual dental checkup, and treat their diabetes orally with medication. Conclusions Self-management behavior was poor among individuals with diabetes and physical limitations. Environmental barriers may partially contribute to reasons why individuals with diabetes and physical limitations do not engage in diabetes self-management behaviors that would assist them in mitigating diabetes complications. Other reasons could be the lack of equipment accessibility or adaptability and cultural competence among providers treating/caring for individuals with physical limitations.
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Kiran, T., A. Kopp, R. Moineddin, J. C. Victor, R. J. Campbell, B. R. Shah, and R. H. Glazier. "Unintended consequences of delisting routine eye exams on retinopathy screening for people with diabetes in Ontario, Canada." Canadian Medical Association Journal 185, no. 3 (January 7, 2013): E167—E173. http://dx.doi.org/10.1503/cmaj.120862.
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Lee, Shinduk, Matthew L. Smith, and Marcia G. Ory. "EFFECTS OF COGNITIVE DECLINE ON DIABETES SELF-MANAGEMENT EDUCATION AND CARE." Innovation in Aging 3, Supplement_1 (November 2019): S35—S36. http://dx.doi.org/10.1093/geroni/igz038.139.
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Abstract People with diabetes experience a faster cognitive decline and have a greater risk for future dementia diagnoses. Cognitive impairment can negatively influence diabetes management activities. Diabetes self-management education (DSME) can enhance diabetes control, but limited evidence exists about the differential effects of DSME based on cognitive status. This study examines the moderation effects of cognition on the relationship between participation in DSME and diabetes management among older adults using Georgia 2017 BRFSS data (N=496). Primary outcomes were diabetes self-management (e.g., self-blood glucose monitoring, self-feet check, and physical activity) and clinical care (e.g., seeing a health professional for diabetes and A1C, feet, and eye exams). Multiple logistic regression models examined the effects of DSME and self-reported cognitive decline on diabetes care. Based on the Anderson-and-Newman Framework, all regression models were adjusted for predisposing (age, sex, race, ethnicity, and education), enabling (income, marital status, and health plan), and need (insulin treatment) factors. About 48% of participants participated in a DSME, and about 16% reported experiencing cognitive decline. DSME participation was positively associated with self-blood glucose monitoring (p=0.014), physical activity (p=0.024), seeing a health professional for diabetes (p=0.002), and feet exam (p=0.043), but cognitive decline was not significantly associated with most diabetes care (p>0.05). Further, no significant difference in DSME impact on diabetes care based on reported cognitive decline was observed (p>0.05). Findings suggest that DSME can benefit diabetes care among people with and without cognitive decline. Future research can expand upon impacts of rates and degrees of cognitive decline on program benefits.
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Zhang, Wenlan, Peter Nicholas, Stefanie Gail Schuman, Michael John Allingham, Ambar Faridi, Tushar Suthar, Scott William Cousins, and Sasapin Grace Prakalapakorn. "Screening for Diabetic Retinopathy Using a Portable, Noncontact, Nonmydriatic Handheld Retinal Camera." Journal of Diabetes Science and Technology 11, no. 1 (July 11, 2016): 128–34. http://dx.doi.org/10.1177/1932296816658902.
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Background: Diabetic retinopathy (DR) is a leading cause of low vision and blindness. We evaluated the feasibility of using a handheld, noncontact digital retinal camera, Pictor, to obtain retinal images in dilated and undilated eyes for DR screening. We also evaluated the accuracy of ophthalmologists with different levels of training/experience in grading these images to identify eyes with vision-threatening DR. Methods: A prospective study of diabetic adults scheduled to have dilated eye exams at Duke Eye Center from January to May 2014 was conducted. An imager acquired retinal images pre- and postdilation with Pictor and selected 1 pre- and 1 postdilation image per eye. Five masked ophthalmologists graded images for gradability (based on image focus and centration) and the presence of no, mild, moderate, or severe nonproliferative DR (NPDR) or proliferative DR (PDR). Referable disease was defined as moderate or severe NPDR or PDR on image grading. We evaluated feasibility based on the graders’ evaluation of image gradability. We evaluated accuracy of identifying vision-threatening disease (severe NPDR or PDR documented on dilated clinical examination) based on the graders’ sensitivity and specificity of grading referable disease. Results: Images were gradable in 86-94% of predilation and 94-97% of postdilation photos. Compared to the dilated clinical exam, overall sensitivity for identifying vision-threatening DR was 64-88% and specificity was 71-90%. Conclusions: Pictor can capture retinal images of sufficient quality to screen for DR with and without dilation. Single retinal images obtained using Pictor can identify eyes with vision-threatening DR with high sensitivity and acceptable specificity compared to clinical exam.
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Miller, Stephania T., Jennifer Cunningham-Erves, and Sylvie A. Akohoue. "Diabetes Education, Specialty Care, and Self-Care Advice among Obese African American Women with Type 2 Diabetes." Ethnicity & Disease 26, no. 2 (April 20, 2016): 229. http://dx.doi.org/10.18865/ed.26.2.229.
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<p><strong>Objective</strong>: Healthy People 2020 (HP2020) includes benchmarks for diabetes management. The objective of our study was to describe diabetes management among African American women, a patient group that carries a disproportionate diabetes burden.</p><p><strong>Design:</strong> Cross-sectional survey study.</p><p><strong>Participants:</strong> African American women with type 2 diabetes enrolled in dietary and weight management interventions.</p><p><strong>Main Outcome Measures:</strong> Self-report assessments of diabetes education, specialty care, self-care behaviors and advice. Associations between diabetes self-care behaviors and diabetes advice using Chi-square tests.</p><p><strong>Results:</strong> Among 96 participants (age = 53 ± 9.4; BMI = 37.9 ± 7.3 kg/m2), reported diabetes education and foot exams were lower than HP2020 benchmarks, 48.9% vs 62.5% and 35.1% vs 74.8%, respectively and higher for dilated eye exams (70.1% vs 58.7%). The most frequently reported dietary advice was to increase fruit/ vegetable intake (58%) and approximately 50% reported physical activity advice. Receiving no exercise advice was associated with greater odds of little or no physical activity (OR = 3.38) and planned exercises (OR = 2.65).</p><p><strong>Conclusion:</strong> Receipt of diabetes education and some specialty care were below national benchmarks while health care provider advice influenced patient self-care behaviors. Increasing diabetes education and specialty care should be included within existing efforts to address the excess diabetes burden experienced by African American women. Longitudinal studies exploring the relationship between health care provider advice and self-care behaviors are needed. <em>Ethn Dis.</em> 2016;26(2):229-234; doi:10.18865/ed.26.2.229</p>
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Lundeen, Elizabeth A., John Wittenborn, Stephen R. Benoit, and Jinan Saaddine. "Disparities in Receipt of Eye Exams Among Medicare Part B Fee-for-Service Beneficiaries with Diabetes — United States, 2017." MMWR. Morbidity and Mortality Weekly Report 68, no. 45 (November 15, 2019): 1020–23. http://dx.doi.org/10.15585/mmwr.mm6845a3.
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Winters, David, Robin Casten, Barry Rovner, Ann Murchison, Benjamin E. Leiby, Julia A. Haller, Lisa Hark, David M. Weiss, and Laura T. Pizzi. "Cost-Effectiveness of Behavior Activation Versus Supportive Therapy on Adherence to Eye Exams in Older African Americans With Diabetes." American Journal of Medical Quality 32, no. 6 (November 24, 2016): 661–67. http://dx.doi.org/10.1177/1062860616680290.
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Although the importance of ophthalmologic screening in diabetic patients is widely recognized by clinicians, the cost-effectiveness of strategies aimed at improving eye care utilization in this population is not well established. A cost-effectiveness analysis was performed comparing behavior activation (BA) to supportive therapy (ST) in activating patients to receive a dilated fundus exam (DFE) and promoting healthy management of diabetes. Two hundred six subjects were randomized to receive either BA or ST between 2009 and 2013. Cost-effectiveness was calculated as incremental cost-effectiveness ratio (ICER) of BA versus ST. Total costs for BA and ST per participant were $259.02 and $216.12, respectively. At the 6-month follow-up, 87.91% of BA subjects received a DFE compared to 34.48% of ST subjects. The ICER for BA versus ST was $80.29/percent increase in DFE rate. In terms of improving DFE rates, BA was found to be more cost-effective than ST.
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Cuadros, Jorge, and George Bresnick. "Can Commercially Available Handheld Retinal Cameras Effectively Screen Diabetic Retinopathy?" Journal of Diabetes Science and Technology 11, no. 1 (December 18, 2016): 135–37. http://dx.doi.org/10.1177/1932296816682033.
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Organizations that care for people with diabetes have increasingly adopted telemedicine-based diabetic retinopathy screening (TMDRS) as a way to increase adherence to recommended retinal exams. Recently, handheld retinal cameras have emerged as a low-cost, lightweight alternative to traditional bulky tabletop retinal cameras. Few published clinical trials have been performed on handheld retinal cameras. Peer-reviewed articles about commercially available handheld retinal cameras have concluded that they are a usable alternative for TMDRS, however, the clinical results presented in these articles do not meet criteria published by the United Kingdom Diabetic Eye Screening Programme and the American Academy of Ophthalmology. The future will likely remedy the shortcomings of currently available handheld retinal cameras, and will create more opportunities for preventing diabetic blindness.
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Schaneman, Justin, Amy Kagey, Stephen Soltesz, and Julie Stone. "The Role of Comprehensive Eye Exams in the Early Detection of Diabetes and Other Chronic Diseases in an Employed Population." Population Health Management 13, no. 4 (August 2010): 195–99. http://dx.doi.org/10.1089/pop.2009.0050.
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Quast, Troy, and Karoline Mortensen. "Diabetes Care Provided to Children Displaced by Hurricane Katrina." Disaster Medicine and Public Health Preparedness 9, no. 5 (August 17, 2015): 480–83. http://dx.doi.org/10.1017/dmp.2015.98.
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AbstractObjectiveAlthough previous studies have examined the impact of Hurricane Katrina on adults with diabetes, less is known about the effects on children with diabetes and on those displaced by the storm. We analyzed individual-level enrollment and utilization data of children with diabetes who were displaced from Louisiana and were enrolled in the Texas Medicaid Hurricane Katrina emergency waiver (TexKat).MethodsWe compared the utilization and outcomes of children displaced from Louisiana with those of children who lived in areas less affected by Hurricane Katrina. Data from both before and after the storm were used to calculate difference-in-difference estimates of the effects of displacement on the children. We analyzed 4 diabetes management procedures (glycated hemoglobin [HbA1C] tests, eye exams, microalbumin tests, and thyroid tests) and a complication from poor diabetes management (diabetic ketoacidosis).ResultsChildren enrolled in the waiver generally did not experience a decrease in care relative to the control group while the waiver program was in effect. After the waiver ended, however, we observed a drop in care and an increase in complications relative to the control group.ConclusionsAlthough the waiver appeared to have been largely successful immediately following Katrina, future waivers may be improved by ensuring that enrollees continue to receive care after the waivers expire. (Disaster Med Public Health Preparedness. 2015;9:480–483)
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Corrao, Giovanni, Federico Rea, Mirko Di Martino, Adele Lallo, Marina Davoli, Rossana DlE PlALMA, Laura Belotti, et al. "Effectiveness of adherence to recommended clinical examinations of diabetic patients in preventing diabetes-related hospitalizations." International Journal for Quality in Health Care 31, no. 6 (July 1, 2019): 464–72. http://dx.doi.org/10.1093/intqhc/mzy186.
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Abstract Objective To validate a set of indicators for quality of diabetes care through their relationship with measurable clinical outcomes. Design A retrospective cohort study was carried out from 2010 to 2015. Setting Population-based study. Data were retrieved from healthcare utilization databases of three Italian regions (Lombardy, Emilia Romagna and Lazio) on the whole covering 20 million citizens. Participants The 77 285 individuals who were newly taken in care for diabetes during 2010 entered into the cohort. Interventions Exposure to selected clinical recommendations (i.e. periodic controls for glycated hemoglobin, lipid profile, urine albumin excretion, serum creatinine and dilated eye exams) was recorded. Main outcomes measures A composite outcome was employed taking into account hospitalizations for brief-term diabetes complications, uncontrolled diabetes, long-term vascular outcomes and no traumatic lower limb amputation. A multivariable proportional hazards model was fitted to estimate hazard ratio, and 95% confidence intervals (CI), for the exposure-outcome association. Results Among the newly taken in care patients with diabetes, those who adhered to almost none (0 or 1), just some (2 or 3) or almost all (4 or 5) recommendations during the first year after diagnosis were 44%, 36% and 20%, respectively. Compared patients who adhered to almost none recommendation, significant risk reductions of 16% (95% CI, 6–24%) and 20% (7–28%) were observed for those who adhered to just some and almost all recommendations, respectively. Conclusions Tight control of patients with diabetes through regular clinical examinations must to be considered the cornerstone of national guidance, national audits and quality improvement incentives schemes.
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Tariq, Hassan, Muhammad Rashid, Asfa Javed, Eeman Zafar, Saud S. Alotaibi, and Muhammad Yousuf Irfan Zia. "Performance Analysis of Deep-Neural-Network-Based Automatic Diagnosis of Diabetic Retinopathy." Sensors 22, no. 1 (December 29, 2021): 205. http://dx.doi.org/10.3390/s22010205.
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Diabetic retinopathy (DR) is a human eye disease that affects people who are suffering from diabetes. It causes damage to their eyes, including vision loss. It is treatable; however, it takes a long time to diagnose and may require many eye exams. Early detection of DR may prevent or delay the vision loss. Therefore, a robust, automatic and computer-based diagnosis of DR is essential. Currently, deep neural networks are being utilized in numerous medical areas to diagnose various diseases. Consequently, deep transfer learning is utilized in this article. We employ five convolutional-neural-network-based designs (AlexNet, GoogleNet, Inception V4, Inception ResNet V2 and ResNeXt-50). A collection of DR pictures is created. Subsequently, the created collections are labeled with an appropriate treatment approach. This automates the diagnosis and assists patients through subsequent therapies. Furthermore, in order to identify the severity of DR retina pictures, we use our own dataset to train deep convolutional neural networks (CNNs). Experimental results reveal that the pre-trained model Se-ResNeXt-50 obtains the best classification accuracy of 97.53% for our dataset out of all pre-trained models. Moreover, we perform five different experiments on each CNN architecture. As a result, a minimum accuracy of 84.01% is achieved for a five-degree classification.
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Zhu, X., Y. Xu, X. Xu, J. Zhu, X. He, L. Lu, and H. Zou. "Psychometric assessment and application of the Chinese version of the Compliance with Annual Diabetic Eye Exams Survey in people with diabetic retinopathy." Diabetic Medicine 37, no. 1 (August 18, 2019): 84–94. http://dx.doi.org/10.1111/dme.14092.
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Alemayehu, Henok Biruk, Melkamu Temeselew Tegegn, and Mikias Mered Tilahun. "Prevalence and associated factors of visual impairment among adult diabetic patients visiting Adare General Hospital, Hawassa, South Ethiopia, 2022." PLOS ONE 17, no. 10 (October 13, 2022): e0276194. http://dx.doi.org/10.1371/journal.pone.0276194.
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Background The increased prevalence of visual impairment among diabetic patients has become a major public health problem. However, there was limited information on the extent of visual impairment among diabetic patients in our country, and there was no study in the study area. Providing updated data regarding this area is critical for the prevention of visual impairment among diabetic patients. Purpose The study aimed to assess the prevalence and associated factors of visual impairment among adult diabetic patients visiting Adare General Hospital, Hawassa, South Ethiopia, 2022. Methods A hospital-based cross-sectional study was conducted on adult diabetic patients from May 30 to July 15, 2022, at Adare General Hospital, Hawassa, South Ethiopia. A systematic random sampling method was used to select 398 study participants. Data was collected through a face-to-face interview, a medical chart review, and an ocular examination. A binary logistic regression was performed to identify potential risk factors for visual impairment and their strength of association was expressed using an adjusted odds ratio with a 95% confidence interval. Variables with a P-value of < 0.05 were considered statistically significant. Result In this study, a total of 391 participants were involved, with a response rate of 98.2%. The prevalence of visual impairment was 28.6% (95% CI: 24.6–33.0). Age ≥ 60 years (AOR = 4.03, 95% CI: 1.72, 10.71), poor physical exercise (AOR = 3.26, 95% CI: 1.62, 6.53), poor glycemic control (AOR = 4.34, 95% CI: 2.26, 8.34), history of eye examination (AOR = 2.94, 95% CI: 1.50, 5.76), duration of diabetes ≥ 9 years (AOR = 4.78, 95% CI: 2.11, 10.83) and diabetic peripheral neuropathy (AOR = 3.01, 95% CI: 1.21, 7.50) were positively associated with visual impairment. Conclusion The study found a high prevalence of visual impairment among adult diabetic patients. Older age, longer duration of diabetes, poor physical exercise, poor glycemic control, history of eye examination, and diabetic peripheral neuropathy were significantly associated with visual impairment. Thus, regular physical activity, good control of glucose levels, and regular eye exams were recommended for all diabetic patients.
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Smith-Ray, Renae, Tanya Singh, Evie Makris, Jaime Horan, and Michael Taitel. "Impact of a Pharmacist-Led Diabetes Management Intervention to Improve Health Equity." Innovation in Aging 5, Supplement_1 (December 1, 2021): 236–37. http://dx.doi.org/10.1093/geroni/igab046.913.
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Abstract The COVID-19 pandemic and Black Lives Matter movement brought increased recognition to the need for health equity. Diabetes, the 7th leading cause of death, is one of many conditions where health inequities are evident. A higher percentage of Black (11.7%) and Hispanic (12.5%) U.S. adults are diagnosed with diabetes compared to non-Hispanic Whites (7.5%). To address this health inequity, a nationwide pharmacy chain implemented telephonic ‘Advanced Care’ (AC) outreach for patients with diabetes. During the AC call, pharmacists used motivational interviewing techniques to counsel patients on the importance of closing gaps in care and reducing barriers to medication adherence. Gaps included timely A1C testing, exams (eye, foot, kidney), immunizations (influenza, pneumonia, Hepatitis B), and recommendation of additional therapies for patients with multiple chronic conditions (ACE/ARB, statins). Medication fill gaps were compared between the Intervention period (8/1/20-1/31/-21) and a pre-intervention period (2/1/20-7/31/20). The AC pilot occurred in 8 Chicago Walgreens locations that primarily serve Black and Hispanic patients. Eight control stores were matched on census block-level household income and race/ethnicity, patient volume, and insurance mix. A pre/post-test vs. control difference-in-difference (DID) analysis was conducted to compare on-time refill rates. Of the 1,009 older patients (age≥50) called, 59.9% were reached. The DID analysis showed that patients in pilot stores had improved pre-post on-time refill rates compared to controls (p<0.0001). Diabetes self-management is key to reducing diabetes-related complications. Early findings from this pilot demonstrate that the Walgreens AC intervention improves medication adherence - an important step toward improving health equity.
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Croisant, Sharon, Krista Bohn, John Prochaska, Hanaa Sallam, Hani Serag, and Randall Urban. "198 A Team-based Approach to an Integrated Model of Diabetes Care." Journal of Clinical and Translational Science 6, s1 (April 2022): 28–29. http://dx.doi.org/10.1017/cts.2022.100.
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OBJECTIVES/GOALS: Diabetes is related to risk for heart disease, stroke, high blood pressure, and COVID-19. It is exacerbated by built/social environment issues, e.g., food insecurity, access to healthy foods and health care, and other poverty-related factors. Our goal is to assess the efficacy of an integrated care model for patients with poorly controlled diabetes. METHODS/STUDY POPULATION: We utilize an integrated, team-based approach to diabetes treatment. In a traditional care model, too little focus is on social determinants and their impacts on health and well-being. Our project involves enrollment of patients with diabetes in an intervention whereby their medical care is integrated with intensive diabetes education and provision of social and other health services, including diet and nutrition, exercise, provision of foods and nutritional supplements, and other support services as needed to achieve optimal health and to reduce morbidity and unnecessary hospitalization and emergency room visits. Subjects are underserved patients treated through our non-profit community clinic partners. We track metrics including individual outcomes, organizational outcomes, and collective impact. RESULTS/ANTICIPATED RESULTS: We anticipate that patients enrolled in this study will demonstrate significant improvements in diabetes control and management. Clinical improvements will include better glycemic control, improved hypertension and dyslipidemia management, reduced complications, and increased preventive measures including foot, eye and oral health exams and monitoring of microalbuminuria. Overall, we anticipate decreased frequency of hospitalizations and readmissions as well as decreased frequency of emergency care visits for treatment of diabetes-related issues. We expect patients to experience enhanced self-efficacy, increased physical activity, and improved quality of life. Their outcomes will be compared to controls receiving the standard medical regimen, matched on age, race, gender, and time of onset. DISCUSSION/SIGNIFICANCE: These activities will improve understanding of factors influencing diabetes outcomes at individual and upstream levels. It will inform food distribution and models of care for improved patient outcomes, including social determinants of health and will establish new protocols for community-based provision of health care to our most vulnerable.
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Woznick, Walter K., Ashley Engel, and Diana Maas. "A Rare Case of Metastatic Transformation to Pituitary Carcinoma." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A565—A566. http://dx.doi.org/10.1210/jendso/bvab048.1153.
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Abstract Background: Pituitary carcinomas are rare and comprise less than 0.5% of pituitary tumors and frequently arise from previously resected and/or radiated infiltrating adenomas.1 Radiation therapy is used to prevent regrowth but does not have significant data supporting improved prognosis.2 True pituitary carcinomas requires the presence of craniospinal and/or systemic metastases. Here, we present a case of benign pituitary adenoma that had progressed to a metastatic tumor and responded to radiation therapy. Clinical Case: Our patient was first diagnosed in 1982 with a pituitary mass after undergoing an MRI due to right eye blindness. He ultimately had a transcranial resection of the tumor and post-operative external radiation to residual tumor. Final pathology was consistent with a nonsecretory tumor. Additionally, he was diagnosed with panhypopituitarism and he was treated accordingly. Due to barriers of patient adherence, only one post-operative MRI was obtained, and he was lost to endocrine follow up. In 2007, he was again referred to endocrinology for new vision loss in the left eye. An MRI revealed a 3.0 x 3.8 x 4.4 cm tumor that compressed the optic chiasm. Additionally, multiple lesions were seen within the dural and leptomeningeal extra-axial areas including the largest left frontal lesion of 2.4 cm and a 1.7 cm lesion posterior to the cord within the foramen magnum. The patient underwent endonasal transsphenoidal resection of the sellar mass and biopsy of the frontal lesion in October 2007. Pathology showed pituitary adenocarcinoma in both the sellar and frontal lesions and immunoperoxidase staining was negative for all hormones. He completed salvage radiation to the sellar and craniospinal lesions in December 2007. MRI scans completed 7 months later showed stable residual pituitary and metastatic lesions. The patient received 6-month MRI screening exams for the first 2 years and then annually thereafter, as well as PET scanning, without significant progression or new metastatic lesions. Conclusion: We present a case of benign pituitary adenoma which transformed following resection to a malignant tumor with metastatic lesions in the brain and spinal cord that was treated with radiation with relative success. Despite the often-aggressive nature of these metastatic tumors, the patient has experienced a successful treatment course with minimal side effects and without progression 13 years after initial treatment of the metastatic pituitary carcinoma.
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Silver, M., R. Kaushal, and L. M. Kern. "State Funding for Health Information Technology and Selected Ambulatory Healthcare Quality Measures." Applied Clinical Informatics 05, no. 02 (2014): 594–602. http://dx.doi.org/10.4338/aci-2013-12-ra-0108.
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SummaryBackground: Previous studies on the effects of health information technology (health IT) on ambulatory quality have had mixed results. New York State has invested heavily in health IT throughout the State, creating a unique opportunity to assess effects on health care quality across multiple communities.Objective: To determine any association between primary care providers’ receipt of funding from New York State’s Healthcare Efficiency and Affordability Law for New Yorkers Program (HEAL NY) and ambulatory quality of careMethods: A statewide, longitudinal cohort study of primary care physicians in New York State was conducted. Data regarding which primary care physicians received funding through the HEAL NY program (Phase 5 or Phase 10) in 2008 or 2009 were obtained from the New York State Department of Health. Health care quality in 2010 was measured using claims data that had been aggregated across 7 commercial health plans across the state. Physicians were divided into 2 groups, based on receipt of HEAL funding (yes/no). Any association was measured between study group and each of 7 quality measures, all of which appear in the Stage 1 federal Meaningful Use program. Negative binomial regression was used, adjusting for provider gender and specialty.Results: The study included 3,988 primary care providers, of whom 863 (22%) had received HEAL NY funding. The HEAL-funded physicians provided higher quality of care on 5 of the 7 measures: breast cancer screening, eye exams in patients with diabetes, nephropathy screening in patients with diabetes, influenza vaccination and pneumococcal vaccination (p<0.0001 for all adjusted comparisons). The HEAL-funded group provided higher quality of care by an absolute 2 to 6 percentage points per measure for those 5 measures.Conclusion: Primary care physicians who received state funding for health IT provided higher quality of care than those who did not receive such funding.Citation: Kern LM, Silver M, Kaushal R; with the HITEC Investigators. State funding for health information technology and selected ambulatory healthcare quality measures. Appl Clin Inf 2014; 5: 594–602 http://dx.doi.org/10.4338/ACI-2013-12-RA-0108
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Cuadros, Jorge, and George Bresnick. "EyePACS: An Adaptable Telemedicine System for Diabetic Retinopathy Screening." Journal of Diabetes Science and Technology 3, no. 3 (May 2009): 509–16. http://dx.doi.org/10.1177/193229680900300315.
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Background: Annual retinal screening of patients with diabetes is the standard clinical practice to prevent visual impairment and blindness from diabetic retinopathy. Telemedicine-based diabetic retinopathy screening (DRS) in primary care settings can effectively detect sight-threatening retinopathy and significantly increase compliance with annual retinal exams. EyePACS is a license-free Web-based DRS system designed to simplify the process of image capture, transmission, and review. The system provides a flexible platform for collaboration among clinicians about diabetic retinopathy. Methods: Primary clinic personnel (i.e., nursing, technical, or administrative staff) are trained and certified by the EyePACS program to acquire retinal images from standard digital retinal cameras. Relevant clinical data and eight high-resolution images per patient (two external and six retinal images) are encrypted and transmitted to a secure Internet server, using a standard computer and Web browser. Images are then interpreted by certified EyePACS reviewers or local eye care providers who are certified through the EyePACS Retinopathy Grading System. Reports indicating retinopathy level and referral recommendations are transmitted back to primary care providers through the EyePACS Web site or through interfaces between EyePACS and Health Level 7-compliant electronic medical records or chronic disease registries. Results: The pilot phase of the EyePACS DRS program in California (2005–2006) recorded 3562 encounters. Since 2006, EyePACS has been expanded to over 120 primary care sites throughout California and elsewhere recording over 34,000 DRSs. The overall rate of referral is 8.21% for sight-threatening retinopathy and 7.83% for other conditions (e.g., cataract and glaucoma). Conclusion: The use of license-free Web-based software, standard interfaces, and flexible protocols has allowed primary care providers to adopt retinopathy screening with minimal effort and resources.
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Cooper, Blake. "Ten Key Elements of a Diabetes-Related Eye Examination." ADA Clinical Compendia 2022, no. 3 (2022): 4–7. http://dx.doi.org/10.2337/db20223-4.
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Diabetes-related eye examinations focus on detecting the impact of diabetes on ocular health, including diabetes-related retinal disease (DRD), diabetes-related macular edema (DME), glaucoma, and cataracts. Screening and early treatment can often halt or reverse the level of DRD and protect eyesight. This chapter reviews the 10 key elements of a diabetes-related eye exam: history, visual acuity, intraocular pressure, pupils, extraocular motility, visual field, external examination, slit-lamp examination, dilated funduscopic examination, and diagnostic testing. By its conclusion, readers should understand the basics of a diabetes-related eye exam and how to prepare people for their visits to an eye care professional (ECP).
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Martinez-Hollingsworth, Adrienne, Theodore Friedman, and Mohsen Bazargan. "Connecting Patient and Provider Burnout to Eye Exam Frequency among Latinx Older Adults with Diabetes Mellitus." Innovation in Aging 5, Supplement_1 (December 1, 2021): 625. http://dx.doi.org/10.1093/geroni/igab046.2383.
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Abstract Among Latinx older adults, our current understanding of barriers to eye exam often fails to consider the impact of patient and provider burnout which can decrease treatment adherence and recommendation receptivity in this group. The purpose of this study was to examine correlates of eye exam frequency among Latinx older adults in South Los Angeles and explore associations reflecting patient and/or provider burnout. Data analysis was informed by the Secret Self-Management Loop and the Burnout Dyad conceptual models. This secondary analysis used data collected from a convenience sample of non-institutionalized Latinx adults 55+ in South LA (n=165) and used multinomial regression analysis. Outcome variable is recency of eye exam, independent variables are self-reported health, including diabetes mellitus diagnosis, and either patient or provider burnout (that are functions of grouped demographic or quality of care variables). Variables associated with Provider Burnout, appear to represent a larger influence on eye examination frequency then variables associated with Patient Burnout, with the most influential factor being provider recommendation. A surprising finding was the number of participants who had never received this recommendation from a provider (21%). One-third (32%) of participants with diabetes mellitus had not had an eye examination within 12 months and almost one-fifth (13%) of participants with diabetes who had received this recommendation had not received the exam. Further exploration is needed to support a better understanding of how both patient and provider burnout impacts adherence to eye examination and other preventive care recommendations for diabetes mellitus among Latinx older adults.
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Mendez, Isabel, Elizabeth A. Lundeen, Magon Saunders, Alexis Williams, Jinan Saaddine, and Ann Albright. "Diabetes Self-Management Education and Association With Diabetes Self-Care and Clinical Preventive Care Practices." Science of Diabetes Self-Management and Care 48, no. 1 (January 13, 2022): 23–34. http://dx.doi.org/10.1177/26350106211065378.
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Purpose: The purpose of the study is to assess self-reported receipt of diabetes education among people with diabetes and its association with following recommended self-care and clinical preventive care practices. Methods: We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System for 61 424 adults (≥18 years) with self-reported diabetes in 43 states and Washington, DC. Diabetes education was defined as ever taking a diabetes self-management class. The association of diabetes education with self-care practices (daily glucose testing, daily foot checks, smoking abstention, and engaging in leisure-time physical activity) and clinical practices (pneumococcal vaccination, biannual A1C test, and an annual dilated eye exam, influenza vaccination, health care visit for diabetes, and foot exam by a medical professional) was assessed. Multivariable logistic regression with predicted margins was used to predict the probability of following these practices, by diabetes education, controlling for sociodemographic factors. Results: Of adults with diabetes, only half reported receiving diabetes education. Results indicate that receipt of diabetes education is associated with following self-care and clinical preventive care practices. Those who did receive diabetes education had a higher predicted probability for following all 4 self-care practices (smoking abstention, daily glucose testing, daily foot check, and engaging in leisure-time physical activity) and all 6 clinical practices (pneumonia vaccination, biannual A1C test, and an annual eye exam, flu vaccination, health care visit, and medical foot exam). Conclusions: The prevalence of adults with diabetes receiving diabetes education remains low. Increasing receipt of diabetes education may improve diabetes-related preventive care.
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Pescosolido, Nicola, and Giuseppe Buomprisco. "Psychophysical Exams as Early Indicators of Diabetic Retinopathy." European Endocrinology 10, no. 1 (2010): 61. http://dx.doi.org/10.17925/ee.2014.10.01.61.
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Retinopathy is a serious and common complication of diabetes that represents the leading cause of blindness, among people of working age, in developed countries. It is estimated that the number of people with diabetic retinopathy (DR) will increase from 126.6 million in 2011 to 191 million by 2030. The visual function that seems to be affected first in the course of DR is probably the contrast sensitivity; in addition, being mainly a macular function, the perception of colour is also compromised. Moreover, the duration of the disease, the levels of glycated haemoglobin (HbA1c) and the presence of cystoid macular oedema are strongly associated with the impairment of fixation stability in patients with diabetes with clinically significant macular oedema, suggesting the possible diagnostic role of microperimetry. The test of contrast sensitivity and the microperimetry and the chromatic sensitivity tests have proved to be useful, safe, reproducible and inexpensive tools to diagnose the disease early.
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Houri, Muhammad. "ODP506 Posterior Staphyloma misdiagnosed as unilateral Grave's ophthalmopathy." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A777. http://dx.doi.org/10.1210/jendso/bvac150.1606.
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Abstract 21 year old female presented to our clinic for management of "grave's disease" She was given diagnosis of Graves’ disease three years before presentation to our institution She was treated with PTU for 2-3 months then it was stopped On physical exam On physical exam she has a small diffused goiter Left eye was prominent without chemosis or lid lag Right eye was normal Decreased vision in the left eye, counting fingers only Thyroid function was normal Thyroid receptor antibody was negative Because of decline of vision and unilateral protrusion of Left eye she was referred to ophthalmology for further evaluation. MRI of the Orbits was ordered MRI revealed findings consistent with Staphyloma Staphyloma is a chronic eye condition which results from poor vision if left untreated and causes increase in AP diameter of eye which results in protrusion of eye which might be confused with grave's ophthalmopathy This diagnosis should be considered when patients present with unilateral ophthalmopathy, especially if there is significant decline in vision in the effected eye. Since she presented late in adulthood there is no treatment to improve her vision at this point From the thyroid standpoint she had negative thyroid antibodies and normal thyroid function Ultrasound of thyroid showed thyroid to be diffusely enlarged with homogenous texture Complete eye exam by ophthalmology is indicated in evaluation of ophthalmopathy especially in case of red flags like decreased vison or unilateral presentation With unilateral Ophthalmopathy MRI of the orbits should be part of the workup to exclude other etiologies such as retro-orbital tumors which may be confused with grave's ophthalmopathy. As evident in this case MRI revealed different diagnosis. Presentation: No date and time listed
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Liu, Selina L., Lewis W. Mahon, Neil S. Klar, David C. Schulz, John R. Gonder, Irene M. Hramiak, and Jeffrey L. Mahon. "A randomised trial of non-mydriatic ultra-wide field retinal imaging versus usual care to screen for diabetic eye disease: rationale and protocol for the Clearsight trial." BMJ Open 7, no. 8 (August 2017): e015382. http://dx.doi.org/10.1136/bmjopen-2016-015382.
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IntroductionSuboptimal screening for diabetic eye disease is a major cause of preventable vision loss. Screening barriers include mydriasis and the extra time patients need to attend dedicated eye screening appointments. In the Clearsight trial, we are testing whether screening by non-mydriatic ultra-wide field (NM UWF) imaging on the day patients attend their diabetes outpatient clinic visit improves detection of clinically important eye disease compared with usual screening.Methods and analysisPatients with diabetes due for a screening eye exam by the 2013 Canadian Diabetes Association (CDA) practice guidelines are being randomised to on-site screening by NM UWF imaging on the day of their clinic visit or to usual screening where, per CDA guidelines, they are encouraged to arrange an exam by an optometrist. The primary outcome is actionable eye disease (AED) based on a need for referral to ophthalmology and/or increased ocular surveillance. The primary analysis will use an intention-to-screen approach that compares the proportions of detected AED between on-site and usual screening groups under a superiority hypothesis in favour of on-site screening. With 740 randomised participants, the study will have 80% power to detect ≥5% absolute increase in the AED rate among on-site screening versus usual screening participants. This difference translates into a number-needed-to-screen by on-site screening of 20 to detect 1 additional person with AED.Ethics and disseminationThe protocol was approved by the institutional review board of Western University. The findings of the trial will be disseminated directly to participants and through peer-reviewed publications and conference presentations.Trial registration numberClinicalTrials.GovNCT02579837(registered 16 October 2015).Protocol issue date18 November 2015.
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Mosley-Johnson, Elise, Rebekah J. Walker, Sneha Nagavally, Laura Hawks, Sanjay Bhandari, Hannah Trasser, Jennifer A. Campbell, and Leonard E. Egede. "Relationship between food insecurity and housing instability on quality of care and quality of life in adults with diabetes." PLOS ONE 17, no. 12 (December 6, 2022): e0278650. http://dx.doi.org/10.1371/journal.pone.0278650.
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Objective Examine the relationship between food and housing insecurities, quality of care and quality of life in adults with diabetes using a nationally representative data source. Methods Data from 39,604 adults with diabetes who indicated if they experienced food and/or housing insecurity in the Behavioral Risk Factor Surveillance System (2014, 2015, 2017) was analyzed. Outcomes included quality of care (HbA1c test, eye exam, diabetes education, foot check) and quality of life (general health status, poor physical and mental health days, poor overall health days). Logistic models were run for each quality of care measure and linear models were run for each quality of life measure adjusting for socio-demographics, insurance status, and comorbidity count. Results 35.6% of adults with diabetes reported housing insecurity, 31.8% reported food insecurity, and 23.4% reported both. After adjustment, food and housing insecurity was significantly associated with lower odds of having an eye exam (housing:0.73, 95%CI:0.63,0.85; food:0.78, 95%CI:0.67,0.92; both:0.69, 95%CI:0.59,0.82), worse general health status (housing:-0.06 95%CI:-0.11,-0.01; food:-0.16, 95%CI:-0.21,-0.10; both:-0.14, 95%CI:-0.20,-0.09), and an increased number of poor mental health days (housing:1.73, 95%CI:0.83,2.63; food:2.08, 95%CI:1.16,3.00; both:1.97, 95%CI:1.05,2.90). Food insecurity was also associated with lower odds of receiving diabetes education (0.86, 95%CI:0.74,0.99) and an increased number of poor physical health days (0.95, 95%CI:0.14,1.76). Conclusion Changes to our healthcare delivery system are critical to improving standards of care and quality of life in all populations and may require a shift towards consideration of overlapping social risk factors rather than the siloed approach currently used.
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An, Jaejin, Craig Cheetham, Fang Niu, Yamina Rajput, and Adam Turpcu. "Dilated Eye Exam Compliance for Persons With Diabetes Mellitus in a Managed Care Setting." Journal of Patient-Centered Research and Reviews 2, no. 2 (April 30, 2015): 105. http://dx.doi.org/10.17294/2330-0698.1115.
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Tran, Phoebe, Lam Tran, and Liem Tran. "Nonadherence in diabetes care among US adults with diabetes by stroke status." PLOS ONE 16, no. 12 (December 22, 2021): e0260778. http://dx.doi.org/10.1371/journal.pone.0260778.
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Objective Effects of stroke (i.e., memory loss, paralysis) may make effective diabetes care difficult which can in turn contribute to additional diabetes related complications and hospitalization. However, little is known about US post-stroke diabetes care levels. This study sought to examine diabetes care levels among US adults with diabetes by stroke status. Methods Using 2015–2018 Behavioral Risk Factor Surveillance System surveys, the prevalence of nonadherence with the American Diabetes Association’s diabetes care measures (<1 eye exam annually, <1 foot exam annually, <1 blood glucose check daily, <2 A1C tests annually, no receipt of annual flu vaccination) was ascertained in people with diabetes by stroke status. A separate logistic regression model was run for each diabetes care measure to determine if nonadherence patterns differed by stroke status after adjustment for stroke and diabetes associated factors. Results Our study included 72,630 individuals, with 9.8% having had a stroke. Nonadherence levels varied for each diabetes care measure ranging from 20.4–42.2% for stroke survivors and 22.8–44.0% for those who had never had stroke. By stroke status, nonadherence with diabetes management measures was comparable except for stroke survivors having both a lower prevalence (30.2% versus 40.1%) and odds of nonadherence (OR: 0.73, 95% CI: 0.65, 0.82) with daily blood glucose check than those who had never had stroke. Conclusion While nonadherence with diabetes management does not vary by stroke status, considerable nonadherence still exists among stroke survivors with diabetes. Additional interventions to improve diabetes care may help to reduce risk of further diabetes complications in this population.
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Ibrahim, Amira, and Victoria Loseva. "Abducens Nerve Palsy as the First Manifestation of Type Two Diabetes Mellitus." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A362—A363. http://dx.doi.org/10.1210/jendso/bvab048.738.
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Abstract Introduction: Diabetes mellitus has varied presentations at different times from onset. One of the uncommon presentations is cranial nerve palsy secondary to microvascular ischemia. Approximately 20% of isolated abducens nerve palsies are secondary to vascular microangiopathy. Clinical Case: A 53-year-old female with no significant past medical history presented to the emergency department with concerns of double vision. The patient first noticed her symptoms five days prior to presentation. The patient endorsed blurry vision and stated that she has double vision in certain gazes that resolves with shutting either eye. Furthermore, she has also developed headaches during that period, described as a pressure-like sensation in her forehead and behind her eyes. She otherwise denied any tearing, redness, or pain. On review of systems, she denied numbness, tingling, changes in hearing, changes in speech, or extremity weakness. Due to the persistence of symptoms the patient presented to the emergency department. On exam, the patient’s vitals were normal. Pupils were equal and briskly reactive to light with no relative afferent pupillary defect. External examination was unremarkable without scalp tenderness, proptosis, or ptosis. Color vision was intact. Ocular motility testing revealed limited abduction of the left eye causing double vision on lateral gaze. Confrontation visual fields were full in each eye. Bilateral lower extremity exam revealed decreased sensation in the sole of the foot. The rest of the physical exam was unremarkable. Laboratory work revealed blood glucose level of 305 mg/dl (Reference range 70–99 mg/dl). HBA1C was 12.3% (Reference range 3.8–5.6%). CT head and CTA of the neck was performed and were unremarkable. Given the normal imaging and findings on examinations, her ocular motor findings were attributed to diabetes mellitus. The patient was started on insulin, aspirin, and received diabetic education for lifestyle modification, and was scheduled for outpatient follow up. The patient’s acute isolated left sixth cranial nerve palsy was most likely owing to microvascular ischemia from previously undiagnosed diabetes mellitus. A study of 59 patients with an isolated sixth cranial nerve palsy showed a 6-fold increase in the odds of having diabetes compared with controls.(1) Conclusion: Given the infrequent presentation of Diabetes with Abducens nerve palsy, diagnosis is usually delayed with the expense of ordering costly investigations that put a financial and psychological burden on patients. Thus, we urge clinicians’ awareness when encountering cases of isolated cranial nerve palsies. References: 1) Sanders SK, Kawasaki A, Purvin VA. Long-term prognosis in patients with vasculopathic sixth nerve palsy. Am J Ophthalmol. 2002;134(1):81–84.
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Schreiberová, Zuzana, Oldřich Chrapek, and Juraj Šimičák. "Ocular Complications of Diabetes Mellitus in Pregnancy – Case Report." Czech and Slovak Ophthalmology 76, no. 4 (November 1, 2020): 166–70. http://dx.doi.org/10.31348/2020/26.
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Pregnancy is associated with increased risk of progression of diabetic retinopathy (DR), the greatest risk of worsening occurs during the second trimester of pregnancy and persists as long as one year after the childbirth. The risk factors include duration of the diabetes, insufficient metabolic control, severity of DR at the time of conception and presence of coexisting vascular disease, such as arterial hypertension, and pregnancy itself. The recommendations for retinopathy screening in pregnancy vary significantly. A dilated fundus exam should be done in the beginning of pregnancy, the next follow-up throughout pregnancy depends on the severity of ocular findings. The cooperation of multi-disciplinary team consisting of ophthalmologist, obstetrition and endocrinologist is essential to provide the best health care. The authors present a case report of a pregnant woman with type 1 diabetes mellitus (DM), who had a progression of DR and diabetic macular edema (DME) in both eyes during pregnancy. She has had DM for 24 years and has been treated with insulin. The patient was examined at the 23rd week of the second pregnancy (first pregnancy was terminated because of missed miscarriage). The diagnosis of advanced proliferative DR and advanced DME in both eyes was made so we performed panretinal laser photocoagulation of the retina of both eyes. Despite that the ocular findings got worse and we found vitreous haemorrhage in the left eye. We performed pars plana vitrectomy (PPV) of the left eye at the 28th week of pregnancy, nevertheless the DME got worse in both eyes, so we recommended to terminate the pregnancy at the 31st week because of the risk of loss of vision. The visual acuity of the left eye improved, but suddenly there was vitreous haemorrhage in the right eye after the delivery. We indicated PPV of the right eye, the outcome of the surgery was satisfying. We still take care about this patient.
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Yusuf, Ahmed Mohamud, Rebecca Claire Lusobya, John Mukisa, Charles Batte, Damalie Nakanjako, and Otiti Juliet-Sengeri. "Validity of smartphone-based retinal photography (PEEK-retina) compared to the standard ophthalmic fundus camera in diagnosing diabetic retinopathy in Uganda: A cross-sectional study." PLOS ONE 17, no. 9 (September 6, 2022): e0273633. http://dx.doi.org/10.1371/journal.pone.0273633.
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Introduction Diabetic retinopathy (DR) is one of the major complications of diabetes mellitus and is a significant cause of blindness worldwide. In Uganda, the prevalence of diabetes is approximately 2.7% of the urban population and 1% in rural areas. Many diabetics cannot access an eye exam due to the lack of less costly and user-friendly equipment that primary eye workers can use. Smartphone-based fundus photography allows for a cheap and mobile fundus examination. The study aimed to determine the sensitivity and specificity of the Portable Eye Examination Kit (PEEK) retina compared to a standard ophthalmic fundus camera (Zeiss Visucam 200) for the diagnosis of DR. Methods From January-March 2020, 286 people with diabetes (type 1 & 2) patients were seen at Kiruddu National referral hospital diabetes clinic. All participants had funduscopy with PEEK retina and the standard ophthalmic fundus camera following ophthalmic examination and pupillary dilation. The PEEK retina’s sensitivity, specificity and reliability were determined using an ophthalmic fundus camera as the gold standard. Results The participants’ mean age was 51 with a standard deviation of ±11years, 213 (74.5%) were females, and the majority (93.4%) had Type 2 diabetes. The overall Sensitivity of PEEK retina for DR was 84% (95% CI 70.9–83.5), while the specificity was 79.9% (95% CI 76–83.5) with a positive predictive value (PPV) of 30.9% (95% CI 23.2–39.4) and a negative predictive value (NPV) of 97.9% (95% CI 95.9–99.1). Conclusions PEEK retina has high sensitivity and specificity, making it suitable for screening and diagnostic purposes. Therefore, we recommend the integration of the PEEK retina in the screening and diagnosis of DR in resource-limited settings.
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Adil, Munazir, Samreen Siddiqui, Swati Waghdhare, Amit Bhargava, and Sujeet Jha. "Awareness of retinal screening in patients with Type 2 diabetes mellitus: Are we meeting standards of care?" Asian Journal of Medical Sciences 8, no. 6 (November 1, 2017): 9–12. http://dx.doi.org/10.3126/ajms.v8i6.18058.
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Background: Since diabetic retinopathy is a silent, but progressive complication of diabetes, and comprises 4.8% of the global causes of blindness, it is imperative that it is detected early and treated in a timely fashion.Awareness about retinopathy amongst patients with diabetes is an important aspect in the management of diabetes.Aims and Objective: To understand the level of awareness of retinal screening in North Indian patients with diabetes mellitus (DM), attending a tertiary care hospital.Materials and Methods: This was an observational, cross-sectional questionnaire based study, conducted over a 6 month period at a tertiary care hospital in North India. Patients above the age of 18, having an underlying diagnosis of type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM), were included in the study. The Unpaired or independent student t-test were used for the comparison of the mean value of two groups, and the Chi-square test for the comparison of categorical variables. The p-value was taken as significant when less than 0.05 (p<0.05). A Confidence interval of 95% was used.Results: The mean age of the study subjects was 53.78±11.24 years, with a mean age of diagnosis of 46.50±10.7 years, and a mean duration of having diabetes of 7.4±7.61 years. Glycemic control was sub-optimal, with the mean HbA1c of the cohort at 9.55%. Of 100 responders, 33% reported being unaware of the ocular complications of diabetes. Only 48% stated that their healthcare provider had advised them that they need a routine yearly dilated eye exam. Despite 62% of the cohort reporting decreased visual acquity, 52% did not have an eye exam in the preceding year.Conclusion: The majority of our patients remains unaware of the complications of their diabetes, and hence may not be engaged in its management. More longitudinal studies are needed to understand what factors are affecting health literacy in the population. Better sustainable and patient-centric education models need to be developed, that will serve to increase health literacy, and improve patient care.Asian Journal of Medical Sciences Vol.8(6) 2017 9-12
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Malerbi, Fernando Korn, Nilson Hideo Matsudo, Adriano Biondi Monteiro Carneiro, and Claudio Luiz Lottenberg. "Retinal diseases in a reference center from a Western Amazon capital city." Einstein (São Paulo) 13, no. 4 (December 2015): 530–34. http://dx.doi.org/10.1590/s1679-45082015ao3538.
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ABSTRACT Objective To describe retinal diseases found in patients who were waiting for treatment at a tertiary care hospital in Rio Branco, Acre, Brazil. Methods Patients underwent slit lamp biomicroscopy, dilated fundus exam and ocular ultrasound. Patients were classified according to phakic status and retinal disease of the most severely affected eye. Results A total of 138 patients were examined. The mean age was 51.3 years. Diabetes was present in 35.3% and hypertension in 45.4% of these patients. Cataract was found in 23.2% of patients, in at least one eye. Retinal examination was possible in 129 patients. The main retinal diseases identified were rhegmatogenous retinal detachment (n=23; 17.8%) and diabetic retinopathy (n=32; 24.8%). Out of 40 patients evaluated due to diabetes, 13 (32.5%) had absent or mild forms of diabetic retinopathy and did not need further treatment, only observation. Conclusion Diabetic retinopathy was the main retinal disease in this population. It is an avoidable cause of blindness and can be remotely evaluated, in its initial stages, by telemedicine strategies. In remote Brazilian areas, telemedicine may be an important tool for retinal diseases diagnosis and follow-up.
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Bazargan, Mohsen, Tavonia Ekwegh, Sharon Cobb, Edward Adinkrah, and Shervin Assari. "Eye Examination Recency among African American Older Adults with Chronic Medical Conditions." Healthcare 8, no. 2 (April 12, 2020): 94. http://dx.doi.org/10.3390/healthcare8020094.
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Background: Pervasive racial and economic inequalities have a disproportionate impact on health care utilization among African Americans. One area where we see such disparities is in the recency of eye examinations among the economically disadvantaged. However, our current understanding of the barriers and facilitators of eye examinations in underserved African-American older adults is limited. Aims: Building on Andersen’s model of health service use and using an exploratory approach; we tested various demographic, social, and health factors that were associated with eye examination among underserved middle-aged and older adults in South Los Angeles. We examined predisposing characteristics, enabling factors, and need-for-care characteristics. Methods: With a cross-sectional design, we conducted this survey on a convenience sample of (n = 740) non-institutionalized African-American older adults who were 55+ years old and residing in South Los Angeles, CA, USA. Data were collected on demographic factors, continuity of care, access to care, self-rated health, chronic medical conditions, and depressive symptoms. The outcome was recency of eye examination. Multivariate regression was used for data analysis. Results: 59% of the participants had received at least one eye examination during the last 12 months. A total of 17% had an eye examination within the last two years. Notably, 26% of diabetic participants did not have an eye examination within the last two years. One out of four participants indicated that, within the last two years, no provider ever recommended that they receive an eye examination. Age, education, continuity of medical care, accessibility of medical care, satisfaction with medical care, providers’ recommendation for eye examination, self-rated health, and a diagnosis of hypertension and diabetes mellitus were predictors of eye examination recency. Overall, our analysis indicates that these enabling factors accounted for most of the variance in the recency of eye examinations. Conclusion: A large proportion of underserved African-American middle-aged and older adults in South Los Angeles do not comply with the recommended annual eye examination. This is, in part, because about one-third of them have not received an eye exam recommendation from their health care providers. However, a wide range of factors such as age, education, continuity of care, satisfaction with access, self-rated health, and a diagnosis of hypertension and diabetes mellitus, also influence whether or not African-American middle-aged and older adults receive an eye examination. Programs should address a wide range of multi-level factors to tackle this health inequality.
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Sinn, Dong Hyun, Danbee Kang, Soo Jin Cho, Seung Woon Paik, Eliseo Guallar, Juhee Cho, and Geum-Youn Gwak. "Lean non-alcoholic fatty liver disease and development of diabetes: a cohort study." European Journal of Endocrinology 181, no. 2 (August 2019): 185–92. http://dx.doi.org/10.1530/eje-19-0143.
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Objective Non-alcoholic fatty liver disease (NAFLD), a condition associated with multiple metabolic abnormalities, is frequently observed in normal weight individuals (lean NAFLD). The metabolic consequences of lean NAFLD, however, are not well characterized. Thus, this study aimed to evaluate the risk of incident diabetes in lean NAFLD. Methods This is a cohort study of 51,463 adults without diabetes, history of liver disease or cancer at baseline who participated in a regular health screening exam. Fatty liver was diagnosed by ultrasonography. The study outcome was the development of diabetes during follow-up. Results During 236,446.6 person-years of follow-up (median follow-up of 4.0 years), 5370 participants developed diabetes. In fully adjusted models, the hazard ratios (HRs) for incident diabetes comparing lean participants with NAFLD, overweight/obese participants without NAFLD and overweight/obese participants with NAFLD to lean participants without NAFLD, were 1.18 (95% CI: 1.03–1.35), 1.06 (0.98–1.14) and 1.45 (1.34–1.57), respectively. The fully adjusted HR for incident diabetes for lean NAFLD participants with low NAFLD fibrosis score (NFS) (<−1.455) and with intermediate-to-high NFS (≥−1.455) compared to lean participants without NAFLD were 1.32 (1.14–1.53) and 2.73 (2.10–3.55), respectively. Conclusions In this large cohort study, the presence and severity of NAFLD in normal weight adults was associated with an increased incidence of diabetes independently of established risk factors. Indeed, isolated lean NAFLD was a stronger risk factor for incident diabetes than the presence of overweight/obesity without NAFLD. Subjects with lean NAFLD require careful monitoring for the development of metabolic abnormalities.
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Petek, Davorina, and Mitja Mlakar. "Quality of care for patients with diabetes mellitus type 2 in ‘model practices’ in Slovenia – first results." Slovenian Journal of Public Health 55, no. 3 (September 1, 2016): 179–84. http://dx.doi.org/10.1515/sjph-2016-0023.
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Abstract Background A new organisation at the primary level, called model practices, introduces a 0.5 full-time equivalent nurse practitioner as a regular member of the team. Nurse practitioners are in charge of registers of chronic patients, and implement an active approach into medical care. Selected quality indicators define the quality of management. The majority of studies confirm the effectiveness of the extended team in the quality of care, which is similar or improved when compared to care performed by the physician alone. The aim of the study is to compare the quality of management of patients with diabetes mellitus type 2 before and after the introduction of model practices. Methods A cohort retrospective study was based on medical records from three practices. Process quality indicators, such as regularity of HbA1c measurement, blood pressure measurement, foot exam, referral to eye exam, performance of yearly laboratory tests and HbA1c level before and after the introduction of model practices were compared. Results The final sample consisted of 132 patients, whose diabetes care was exclusively performed at the primary care level. The process of care has significantly improved after the delivery of model practices. The most outstanding is the increase of foot exam and HbA1c testing. We could not prove better glycaemic control (p>0.1). Nevertheless, the proposed benchmark for the suggested quality process and outcome indicators were mostly exceeded in this cohort. Conclusion The introduction of a nurse into the team improves the process quality of care. Benchmarks for quality indicators are obtainable. Better outcomes of care need further confirmation.
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Damasceno, Sarah dos Santos, Ana Carolina Esteves Tozzi, Ana Júlia Ferreira Fernandes, Bruna Diuly Santos Costa, Gabriela de Oliveira Carvalho, Isabela Pilan Mendonça, Isadora Porto De Aquino, João Victor Mansour Resende, Lorena Rodrigues Ruas, and Reynaldo Afonso Esteves. "Colecistectomia Videolaparoscópica: abordagem técnica, indicações para o tratamento de Colecistite calculosa e prováveis complicações / Videolaparoscopic cholecystectomy: technical approach, indications for the treatment of calculosa Cholecystitis and possible complications." Brazilian Journal of Development 8, no. 7 (July 20, 2022): 52464–83. http://dx.doi.org/10.34117/bjdv8n7-252.
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A litíase biliar consiste na presença de cálculos dentro da vesícula biliar ou nos ductos biliares intra ou extra-hepáticos, sendo que a substância mais comumente responsável pela formação dos cálculos é o colesterol presente na bile. Em virtude da variedade etiológica da colecistite calculosa, a epidemiologia é bastante variada, e a incidência depende de diversos fatores, sendo considerado indivíduos de risco para a formação de cálculos pessoas com idade maior que 40 anos, do sexo feminino, etnia americana, que passaram por uma perda brusca de peso e portadores de distúrbios hemolíticos crônicos, diabetes e/ou obesidade. Além disso, a depender da etiologia da colelitíase, a patogênese, as manifestações clínicas e o prognóstico são diferentes. No que tange ao diagnóstico, esse é, frequentemente, realizado de maneira acidental quando se realiza exames a fim de avaliar outras comorbidades. Todavia, ele pode ser confirmado através do exame físico, associado a parâmetros laboratoriais de inflamação e testes imagiológicos de ultrassom, tomografia computadorizada ou ressonância magnética sugestivos. O manejo terapêutico precoce é imprescindível, a fim de evitar possíveis complicações para o paciente. Sabe-se que a colecistectomia laparoscópica consiste no método padrão-ouro para o tratamento da colecistite aguda por colelitíase, devido a sua baixa invasividade, segurança e recuperação pós operatória mais rápida. Todavia, apesar dos benefícios, é de extrema relevância uma investigação pré operatória adequada, a fim de evitar possíveis complicações.
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Képénékian, Lori, Thomas Mognetti, Jean-Christophe Lifante, Anne-Laure Giraudet, Claire Houzard, Stéphane Pinson, Françoise Borson-Chazot, and Patrick Combemale. "Interest of systematic screening of pheochromocytoma in patients with neurofibromatosis type 1." European Journal of Endocrinology 175, no. 4 (October 2016): 335–44. http://dx.doi.org/10.1530/eje-16-0233.
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Objective Pheochromocytoma (PHEO) may occur in 0.1–5.7% of patients presenting with a neurofibromatosis type 1 (NF1). Current recommendations are to explore only symptomatic patients. The objective of the study is to evaluate the prevalence and the interest of a systematic PHEO screening in this population. Design A prospective study in a French tertiary center including consecutive NF1 patients older than 18 years. Methods A systematic screening combining abdominal imaging and urinary fractionated metanephrines was proposed. In case of positivity of one or both exams, 123I-metaiodobenzylguanidine scintigraphy or [18F]-fluoro-dihydroxyphenylalanine PET imaging was performed. The diagnosis of secreting PHEO was retained in case of elevated urinary metanephrines associated with positive scintigraphy and non-secreting PHEO when urinary metanephrines were normal with a positive scintigraphy. Results Between January 2014 and August 2015, 234 patients were included and 156 patients (66.7%) completed both exams. In these 156 patients, 12 PHEOs were diagnosed, representing a prevalence of 7.7%. Of these, six PHEOs were secreting, with only two symptomatic patients. The tumor size of these PHEOs were bigger than that of non-secreting PHEO (25.2 ± 6.6 vs 14 ± 6.9 mm, P = 0.0165). One lesion was bilateral. Mean metanephrine and normetanephrine levels were 3.2 ± 2.6N and 2.8 ± 1N respectively. Three patients underwent surgery. The six patients with non-secreting PHEO were asymptomatic. One of them had bilateral lesion and one underwent surgery. Conclusions PHEO in NF1, whether or not secreting, are mostly asymptomatic. The current strategy to explore only symptomatic patients leads to an underestimation of prevalence with the risks inherent to the existence of an unrecognized PHEO.
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Ibrahim, Amira, and Victoria Loseva. "A Case of Thyroid Eye Disease Revealed During Secondary Adrenal Insufficiency." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A910. http://dx.doi.org/10.1210/jendso/bvab048.1858.
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Abstract Introduction: Thyroid eye disease (TED) or Graves’ orbitopathy (GO) is an autoimmune disease of the retro-orbital tissues. GO is mostly associated with hyperthyroidism in 90% of patients; however, it may coexist with hypothyroid conditions in 5% of cases. Clinical Case: A 56-year-old male with a past medical history of autoimmune diseases including hypothyroidism and Ulcerative Colitis on chronic steroid therapy presented to the emergency department with nausea, fatigue, weight loss, and muscle weakness. The patient stated that his glucocorticoids were abruptly discontinued a month prior to his current presentation. On examination, vitals were stable. The patient was somnolent with a depressed mood. He had bilateral periorbital edema and bilateral eyeball protrusion, left more pronounced than right. Extraocular muscle movement revealed a delay in the lateral movement of the left eye causing double vision on exam. He had no starring look or lid lag. The thyroid gland was normal in size and contour. Initial Laboratories revealed a white blood cell count of 6.7 K/mcL (4-10 K/mcL) with 18% eosinophil count (0-5%). Cortisol at 8 AM was 2.9 mcg/dL (4.3 -22.4 mcg/dl). The patient was managed for secondary adrenal insufficiency and restarted immediately on Prednisone. A review of a recent CT scan of the head revealed bilateral proptosis with no signs of compressing lesions. Further thyroid studies revealed TSH of 2.9 mcIU/mL (0.3-3.7 mcIU/mL), free T4 of 0.8 ng/dL (0.75-2.0 ng/dL), free T3 of 1.6 ng/dL (2.4-4.2 ng/dL), TPO antibodies <0.3 IU/mL (0.0-9.0 IU/mL) and TSH receptor antibodies 0.90 IU/L (reference range <1.75 IU/L). The patient was then diagnosed with Hypothyroid Grave’s ophthalmopathy with negative antibodies given the evidence of proptosis on CT and exam revealing extraocular muscle movement restriction causing diplopia. The patient had a unique presentation of TED with hypothyroidism and asymmetric ophthalmic signs that were only manifested after the patient discontinued the prednisone and therefore unmasking the underlying disorder. Fortunately, in June of 2020, the US Food and Drug Administration (FDA) approved Teprotumumab (an insulin-like growth factor 1 [IGF-1] receptor inhibitor) for the treatment of Graves’ orbitopathy based on the findings from two 24-week trials comparing teprotumumab with placebo in 171 patients with active, moderate-to-severe orbitopathy. (1) Our patient was started on Levothyroxine along with Prednisone and referred for ophthalmology evaluation for possible qualification for Teprotumumab treatment. Conclusion: Clinician awareness of the unusual presentations of TED would allow for early recognition and prevention of progression, especially with the recently approved treatment modality. References: (1) Teprotumumab for Thyroid-Associated Ophthalmopathy. Smith TJ Et al. N Engl J Med. 2017;376(18):1748.
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Guo, Fangjian, Yu-Li Lin, Mukaila Raji, Bruce Leonard, Lin-Na Chou, and Yong-Fang Kuo. "Processes and outcomes of diabetes mellitus care by different types of team primary care models." PLOS ONE 15, no. 11 (November 5, 2020): e0241516. http://dx.doi.org/10.1371/journal.pone.0241516.
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Background Team care improves processes and outcomes of care, especially for patients with complex medical conditions that require coordination of care. This study aimed to compare the processes and outcomes of care provided to older patients with diabetes by primary care teams comprised of only primary care physicians (PCPs) versus team care that included nurse practitioners (NPs) or physician assistants (PAs). Methods We studied 3,524 primary care practices identified via social network analysis and 306,741 patients ≥66 years old diagnosed with diabetes in or before 2015 in Medicare data. Guideline-recommended diabetes care included eye examination, hemoglobin A1c test, and nephropathy monitoring. High-risk medications were based on recommendations from the American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Preventable hospitalizations were defined as hospitalizations for a potentially preventable condition. Results Compared with patients in the PCP only teams, patients in the team care practices with NPs or PAs received more guideline-recommended diabetes care (annual eye exam: adjusted odds ratio (aOR): 1.04 (95% CI: 1.00–1.08), 1.08 (95% CI: 1.03–1.13), and 1.10 (95% CI: 1.05–1.15), and HbA1C test: aOR: 1.11 (95% CI: 1.04–1.18), 1.11 (95% CI: 1.02–1.20), and 1.15 (95% CI: 1.06–1.25) for PCP/NP, PCP/NP/PA, and PCP/PA teams). Patients in the PCP/NP and the PCP/PA teams had a slightly higher likelihood of being prescribed high-risk medications (aOR: 1.03 (95% CI: 1.00–1.07), and 1.06 (95% CI: 1.02–1.11), respectively). The likelihood of preventable hospitalizations was similar among patients cared for by various types of practices. Conclusion The team care practices with NPs or PAs were associated with better adherence to clinical practice guideline recommendations for diabetes compared to PCP only practices. Both practices had similar outcomes. Further efforts are needed to explore new and cost-effective team-based care delivery models that improve process, outcomes, and continuity of care, as well as patient care experiences.
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Moran, Katherine, Rosanne Burson, John Critchett, and Phillip Olla. "Exploring the Cost and Clinical Outcomes of Integrating the Registered Nurse–Certified Diabetes Educator Into the Patient-Centered Medical Home." Diabetes Educator 37, no. 6 (November 2011): 780–93. http://dx.doi.org/10.1177/0145721711423979.
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Purpose The purpose of this study was to implement and evaluate a care delivery model integrating the registered nurse–certified diabetes educator into the patient-centered medical home to assist in achieving positive clinical and cost outcomes in diabetes care. Methods A 1-group pretest-posttest research design was used. Patients were recruited from 2 patient-centered medical home designated/nominated primary care offices. Inclusion criteria were as follows: diagnosis of type 1 or type 2 diabetes, aged 18 to 80 years, A1C ≥ 8%, English speaking, and no diabetes education within 6 months. There were 34 participants (men, n = 22; women, n = 12) with a mean age of 53.24. The intervention incorporated an assessment, 4 patient-centered monthly group sessions, and 4 individual follow-up sessions. Study measures included program surveys, participation and satisfaction rates, Healthcare Effectiveness Data and Information Set attainment rates, and the following physiologic measures obtained from the medical record: A1C, fasting blood glucose, LDL, urine microalbumin, blood pressure, retinal eye exam, and body mass index. Cost-effectiveness measures included program costs, performance incentives, revenue, provider time saved, and patient health care utilization. Results Paired-samples t tests identified significant improvements in A1C, fasting blood glucose, and LDL. Patients and providers were highly satisfied with the program. Cost-benefit analysis revealed a net pretax program benefit. Conclusions Results of the study indicated that integrating the registered nurse–certified diabetes educator in the patient-centered medical home improves clinical outcomes and is cost-effective. Diabetes education and support are integral components of diabetes management.
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SCHEUFELE, ELISABETH, BEDDA L. ROSARIO, FREDERICK J. ROBERTS, AMOL B. RAJMANE, JUDY GEORGE, HENRY J. FELDMAN, and KYU B. RHEE. "1557-P: Eye Exam Rates for Patients with T2DM from a Large Population with Employer-Sponsored Insurance." Diabetes 69, Supplement 1 (June 2020): 1557—P. http://dx.doi.org/10.2337/db20-1557-p.
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