scholarly journals Association between weight change and remission of type 2 diabetes: a retrospective cohort study in primary care

2021 ◽  
Vol 38 (5) ◽  
pp. 8
Author(s):  
Hajira Dambha‐Miller ◽  
Hilda Hounkpatin ◽  
Beth Stuart ◽  
Andrew Farmer
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Cohort Study ◽  
Weight Change ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort

scholarly journals Time trends in the incidence of clinically diagnosed type 2 diabetes and pre-diabetes in the UK 2009–2018: a retrospective cohort study

2021 ◽  
Vol 9 (1) ◽  
pp. e001989
Author(s):  
Kingshuk Pal ◽  
Laura Horsfall ◽  
Manuj Sharma ◽  
Irwin Nazareth ◽  
Irene Petersen
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Cohort Study ◽  
Incidence Rate ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Complication Rates ◽  
Clinical Diagnoses ◽  
The Uk

IntroductionTo describe recent trends in the incidence of clinically diagnosed type 2 diabetes and pre-diabetes in people seen in UK general practice.Research design and methodsA retrospective cohort study using IQVIA Medical Research Data looking at people newly diagnosed with type 2 diabetes and pre-diabetes through primary care registers in the UK between 1 January 2009 and 31 December 2018.ResultsA cohort of 426 717 people were clinically diagnosed with type 2 diabetes and 418 656 people met the criteria for a diagnosis of pre-diabetes in that time period. The incidence of clinically diagnosed type 2 diabetes per 1000 person years at risk (PYAR) in men decreased from a peak of 5.06 per 1000 PYAR (95% CI 4.97 to 5.15) in 2013 to 3.56 per 1000 PYAR (95% CI 3.46 to 3.66) by 2018. For women, the incidence of clinically diagnosed type 2 diabetes per 1000 PYAR decreased from 4.45 (95% CI 4.37 to 4.54) in 2013 to 2.85 (2.76 to 2.93) in 2018. The incidence rate of pre-diabetes tripled by the end of the same study period in men and women.ConclusionsBetween 2009 and 2018, the incidence rate of new clinical diagnoses of type 2 diabetes recorded in a UK primary care database decreased by a third from its peak in 2013–2014, while the incidence of pre-diabetes has tripled. The implications of this on timely treatment, complication rates and mortality need further longer term exploration.

scholarly journals Is therapeutic inertia present in hyperglycaemia, hypertension and hypercholesterolaemia management among adults with type 2 diabetes in three health clinics in Malaysia? a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Boon-How Chew ◽  
Husni Hussain ◽  
Ziti Akthar Supian
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Ldl Cholesterol ◽  
Therapeutic Inertia ◽  
Treatment Targets ◽  
Health Clinics

Abstract Background Good-quality evidence has shown that early glycaemic, blood pressure and LDL-cholesterol control in people with type 2 diabetes (T2D) leads to better outcomes. In spite of that, diseases control have been inadequate globally, and therapeutic inertia could be one of the main cause. Evidence on therapeutic inertia has been lacking at primary care setting. This retrospective cohort study aimed to determine the proportions of therapeutic inertia when treatment targets of HbA1c, blood pressure and LDL-cholesterol were not achieved in adults with T2D at three public health clinics in Malaysia. Methods The index prescriptions were those that when the annual blood tests were reviewed. Prescriptions of medication were verified, compared to the preceding prescriptions and classified as 1) no change, 2) stepping up and 3) stepping down. The treatment targets were HbA1c < 7.0% (53 mmol/mol), blood pressure (BP) < 140/90 mmHg and LDL-cholesterol < 2.6 mmol/L. Therapeutic inertia was defined as no change in the medication use in the present of not reaching the treatment targets. Descriptive, univariable, multivariable logistic regression and sensitive analyses were conducted. Results A total of 552 cohorts were available for the assessment of therapeutic inertia (78.9% completion rate). The mean (SD) age and diabetes duration were 60.0 (9.9) years and 5.0 (6.0) years, respectively. High therapeutic inertia were observed in oral anti-diabetic (61–72%), anti-hypertensive (34–65%) and lipid-lowering therapies (56–77%), and lesser in insulin (34–52%). Insulin therapeutic inertia was more likely among those with shorter diabetes duration (adjusted OR 0.9, 95% CI 0.87, 0.98). Those who did not achieve treatment targets were less likely to experience therapeutic inertia: HbA1c ≥ 7.0%: adjusted OR 0.10 (0.04, 0.24); BP ≥ 140/90 mmHg: 0.28 (0.16, 0.50); LDL-cholesterol ≥ 2.6 mmol/L: 0.37 (0.22, 0.64). Conclusions Although therapeutic intensifications were more likely in the presence of non-achieved treatment targets but the proportions of therapeutic inertia were high. Possible causes of therapeutic inertia were less of the physician behaviours but might be more of patient-related non-adherence or non-availability of the oral medications. These observations require urgent identification and rectification to improve disease control, avoiding detrimental health implications and costly consequences. Trial registration Number NCT02730754, April 6, 2016.

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