Search

BackgroundMobile health interventions are widely used for self-management of diabetes, which is one of the most burdensome noncommunicable chronic diseases worldwide. However, little is known about the distribution of characteristics and functions of in-store mobile apps for diabetes. ObjectiveThis study aimed to investigate the distribution of characteristics and functions of the in-store mobile apps for self-management of diabetes in the United States and China using a predefined functional taxonomy, which was developed and published in our previous study. MethodsWe identified apps by searching diabetes in English or Chinese in the Apple iTunes Store and Android Markets (both in the United States and China) and included apps for diabetes self-management. We examined the validity and reliability of the predefined functional taxonomy with 3 dimensions: clinical module, functional module, and potential risk. We then classified all functions in the included apps according to the predefined taxonomy and compared the differences in the features of these apps between the United States and China. ResultsWe included 171 mobile diabetes apps, with 133 from the United States and 38 from China. Apps from both countries faced the challenges of evidence-based information, proper risk assessment, and declaration, especially Chinese apps. More Chinese apps provide app-based communication functions (general communication: Chinese vs US apps, 39%, 15/38 vs 18.0%, 24/133; P=.006 and patient-clinician communication: Chinese vs US apps, 68%, 26/38 vs 6.0%, 8/133; P.99) are neglected by the 2 countries. ConclusionsThe distribution of characteristics and functions of in-store mobile apps for diabetes self-management in the United States was different from China. The design of in-store diabetes apps needs to be monitored closely.

Background Pharmacotherapy is the cornerstone of primary and secondary prevention of atherosclerotic cardiovascular diseases (ASCVD), but the values and preferences of community patients for pharmacotherapy remain unclear. Objective To understand the values and preferences surrounding pharmacotherapy among community patients at risk of or undergoing treatment for ASCVD, which would help clarify the individualized treatment burden and provide patient-centered clinical practice. Methods This study employed a sequential exploratory mixed-methods design. Firstly, we recruited eligible patients in West China Hospital of Sichuan University and Yulin Community Health Service Center in Wuhou District, Chengdu City from November 2021 to January 2022. for a focus group discussion, aiming to collect qualitative insights into their experience, values, and preferences for medication use. The software MAXQDA 2020 was used to support qualitative data analysis, and Colaizzi's seven-step approach was further used to identify themes. After completing the qualitative phase, a questionnaire was designed based on the emergent themes to further quantitatively analyze the values and preferences regarding pharmacotherapy. Results Four themes emerged from the qualitative data, including knowledge and use of medications, barriers of medication use, facilitators of medication use, and need for medical services. A total of 186 valid questionnaires were collected in the quantitative study (response rate of 93.5%). The quantitative data showed a commonality in missed dose and confirmed the existence of social stigma and treatment burden in this group of participants. Although preferences in medication use were highly heterogeneous, participants generally preferred taking fewer medications with less frequency, and were less likely to use injectable medications. Conclusion The study suggests that it may be appropriate to increase the use of compound preparations, and make treatment plans in accordance with patients' daily lives and work to reduce the treatment burden of pharmacotherapy. In addition, we should be active in managing the misconceptions and improper practices in pharmacotherapy in order to improve patients' medication adherence.

BackgroundMobile health apps for diabetes self-management have different functions. However, the efficacy and safety of each function are not well studied, and no classification is available for these functions. ObjectiveThe aims of this study were to (1) develop and validate a taxonomy of apps for diabetes self-management, (2) investigate the glycemic efficacy of mobile app-based interventions among adults with diabetes in a systematic review of randomized controlled trials (RCTs), and (3) explore the contribution of different function to the effectiveness of entire app-based interventions using the taxonomy. MethodsWe developed a 3-axis taxonomy with columns of clinical modules, rows of functional modules and cells of functions with risk assessments. This taxonomy was validated by reviewing and classifying commercially available diabetes apps. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Chinese Biomedical Literature Database, and ClinicalTrials.gov from January 2007 to May 2016. We included RCTs of adult outpatients with diabetes that compared using mobile app-based interventions with usual care alone. The mean differences (MDs) in hemoglobin A1c (HbA1c) concentrations and risk ratios of adverse events were pooled using a random-effects meta-analysis. After taxonomic classification, we performed exploratory subgroup analyses of the presence or absence of each module across the included app-based interventions. ResultsAcross 12 included trials involving 974 participants, using app-based interventions was associated with a clinically significant reduction of HbA1c (MD 0.48%, 95% CI 0.19%-0.78%) without excess adverse events. Larger HbA1c reductions were noted among patients with type 2 diabetes than those with type 1 diabetes (MD 0.67%, 95% CI 0.30%-1.03% vs MD 0.37%, 95% CI –0.12%-0.86%). Having a complication prevention module in app-based interventions was associated with a greater HbA1c reduction (with complication prevention: MD 1.31%, 95% CI 0.66%-1.96% vs without: MD 0.38%, 95% CI 0.09%-0.67%; intersubgroup P=.01), as was having a structured display (with structured display: MD 0.69%, 95% CI 0.32%-1.06% vs without: MD 0.69%, 95% CI –0.18%-0.53%; intersubgroup P=.03). However, having a clinical decision-making function was not associated with a larger HbA1c reduction (with clinical decision making: MD 0.19%, 95% CI –0.24%-0.63% vs without: MD 0.61%, 95% CI 0.27%-0.95%; intersubgroup P=.14). ConclusionsThe use of mobile app-based interventions yields a clinically significant HbA1c reduction among adult outpatients with diabetes, especially among those with type 2 diabetes. Our study suggests that the clinical decision-making function needs further improvement and evaluation before being added to apps.

Background Clinical practice guidelines in primary care are important tools to guide primary care practice, but they are found with relatively low quality and unstandardized reporting on the whole. Objective To develop the reporting guideline for clinical practice guidelines in primary care based on the Reporting Items for practice Guidelines in HealThcare (RIGHT) . Methods According to the reporting methods recommended by EQUATOR Network, an item development group and an expert consensus group were established to develop reporting guideline for clinical practice guidelines in primary care. Content analysis, brainstorming, and topic analysis were used in developing the initial items. The Delphi survey was conducted to determine the final items. Results Thirteen items (five were modified and eight were added) were developed initially, covering five domains: guideline title, health issues, intended setting, recommendations and suggestions for future research. Then the initial item checklist was revised to a final version consisting of 15 items according to the results of two rounds of Delphi survey (with 100% response rates from 22 experts) conducted from December 2 to December 26, 2022. Conclusion This reporting checklist will provide a detailed guide for developers of guidelines in primary care, which will further improve the reporting quality of guidelines in primary care, especially that of those in China.

Background Diabetes is one of the common diseases among inpatients in non-endocrinology department. Patients with diabetes require assistance from endocrinologists in their blood glucose management. Objective To investigate consultation of blood glucose management for inpatients with diabetes in non-endocrinology department and analyze the quality of consultation and the needs of patients. Methods The inpatients with diabetes in non-endocrinology department consulted by the endocrinologists in West China Hospital, Sichuan University from January 1, 2013 to May 23, 2019 were selected and reviewed. The consultation and medical record information was recorded and organized. The recommended medications for the patients were analyzed to determine the potential contraindications according to drug instructions. Results During the study period, we identified 145 428 inpatients with diabetes in non-endocrinology department, 24 499 of them had 31 369 consultations from endocrinologists (0.17 consultations/inpatients), and 20 486 of them had 24 343 consultations for blood glucose management (0.17 consultations/inpatients). The top three departments with the most blood glucose management consultations per patient were neurology (0.30 consultations/inpatients), respiratory medicine (0.25 consultations/inpatients), and cardiology (0.18 consultations/inpatients). There were 18 306 blood glucose management consultations (16 269 inpatients) with complete suggestions, and the most commonly recommended hypoglycemic regimen was the combination of insulin with a meal and basal insulin, accounting for 32.34% (5 921/18 306). Among the all consultations, 1.16% (212/18 306) patients' hypoglycemic regimens had drug contraindications. Conclusion A large number of inpatients with diabetes in non-endocrinology department need specialized blood glucose management. The overall quality of the consultation for blood glucose management is relatively high but far from meeting the management requirements.

The increased clinical demand for glycemic control in hospitalized patients has led to a new transformation of clinical technologies and medical models, which has brought challenges to medical management. We built an active blood glucose intervention operation and management model for inpatients using the Plan-Do-Check-Action (PDCA) cycle: Firstly, we concertized the practical management problems through root cause analysis, namely man - machine - material - method - environment. Then, we used PDCA cycle quality management tools to facilitate the construction of the operation and management models based on the PDCA cycle. We finally formed an efficient multidepartment cooperation mechanism and tiered management system and process for inpatients, and established an information system of glycemic management, quality control system and operational performance guarantee system. By use of the model, the blood glucose management has been successfully promoted with some achievements obtained, and the rate of blood glucose meeting the target level within 72 hours after glycemic management has increased month by month in West China Hospital, Sichuan University. This model developed by our hospital may be used as a reference for other hospitals to conduct glycemic management, and it also has great significance for improving the inpatient blood glucose management.

Diabetes is a disease frequently encountered in hospitals in China. Good glycemic management can improve clinical outcomes and shorten the length of stay of diabetic patients, enhance healthcare efficiency and save medical resources. To provide a reference for clinical glycemic management and associated research, we reviewed relevant literature, then summarized the characteristics and applicable settings of different blood glucose management modes, and detailed the advantages and limitations of three major glycemic management models, including general-specialist consultation, hospital-wide glycemic management program, and smart decision support system for blood glucose management. With the support of information technology, different glycemic management modes will contribute to the continuous improvement of efficiency and quality of hospital care.

Aim: To explore the trend of burden and care quality of chronic kidney disease due to type 2 diabetes mellitus (CKD‐T2DM) and their cross‐country inequalities from 1990 to 2021. Materials and Methods: Data were from the Global Burden of Disease 2021 study. Disease burden and care quality were quantified using the disability‐adjusted life years rate and the quality‐of‐care index (QCI). Trend analyses of the age‐standardized disability‐adjusted life years rate (ASDR) and age‐standardized QCI from 1990 to 2021 were conducted using the estimated annual percentage change. The associations of disease burden and care quality with the socio‐demographic index (SDI) were explored. Cross‐country inequalities in disease burden and care quality were assessed using the slope index of inequality (SII) and concentration index. Results: From 1990 to 2021, the global ASDR for CKD‐T2DM increased, while the age‐standardized QCI slightly decreased, with an estimated annual percentage change of 0.81 [95% confidence interval (CI): 0.75, 0.87] and −0.08 (95% CI: −0.09, −0.07). The ASDR escalated with increasing SDI, reaching a peak at mid‐level SDI, followed by a decrease. The age‐standardized QCI was higher with increasing SDI. Globally, ASDR concentrated on countries/territories with a lower SDI. The SII of ASDR was −96.64 (95% CI: −136.94, −56.35) in 1990 and −118.15 (95% CI: −166.36, −69.94) in 2021, with a concentration index of −0.1298 (95% CI: −0.1904, −0.0692) in 1990 and −0.1104 (95% CI: −0.1819, −0.0389) in 2021. In 1990 and 2021, countries/territories at higher SDI levels exhibited increased age‐standardized QCI, indicated by an SII of 15.09 (95% CI: 10.74, 19.45) and 15.75 (95% CI: 10.92, 20.59), and a concentration index of 0.0393 (95% CI: 0.0283, 0.0503) and 0.0400 (95% CI: 0.0264, 0.0536). Conclusions: Our study highlights considerable disparities in the burden and care quality of CKD‐T2DM. Regions experiencing an increasing burden and a declining care quality simultaneously underscore the need for further research and tailored health interventions. [ABSTRACT FROM AUTHOR]

A meta-analysis of 25 randomized controlled trials involving 24,595 individuals with heart failure was conducted to examine the effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors. The analysis found that SGLT2 inhibitors reduced hospitalization for heart failure and cardiovascular death in patients with heart failure, regardless of the presence of type 2 diabetes. However, the magnitude of benefit diminished over time. SGLT2 inhibitors also increased the risk of genital infection. The study highlights the importance of considering treatment duration and baseline risk when using SGLT2 inhibitors in patients with heart failure. [Extracted from the article]

Aims: To investigate the sex‐specific associations between predicted skeletal muscle mass index (pSMI) and incident type 2 diabetes in a retrospective longitudinal cohort of Chinese men and women. Materials and Methods: We enrolled Chinese adults without diabetes at baseline from WATCH (West chinA adulT health CoHort), a large health check‐up‐based database. We calculated pSMI to estimate skeletal muscular mass, and measured blood glucose variables and assessed self‐reported history to identify new‐onset diabetes. The nonlinear association between pSMI and incident type 2 diabetes was modelled using the penalized spline method. The piecewise association was estimated using segmented linear splines in weighted Cox proportional hazards regression models. Results: Of 47 885 adults (53.2% women) with a median age of 40 years, 1836 developed type 2 diabetes after a 5‐year median follow‐up. In women, higher pSMI was associated with a lower risk of incident type 2 diabetes (Pnonlinearity = 0.09, hazard ratio [HR] per standard deviation increment in pSMI: 0.79 [95% confidence interval {CI} 0.68, 0.91]). A nonlinear association of pSMI with incident type 2 diabetes was detected in men (Pnonlinearity < 0.001). In men with pSMI lower than 8.1, higher pSMI was associated with a lower risk of incident type 2 diabetes (HR 0.58 [95% CI 0.40, 0.84]), whereas pSMI was not significantly associated with incident diabetes in men with pSMI equal to or greater than 8.1 (HR 1.08 [95% CI 0.93, 1.25]). Conclusions: In females, a larger muscular mass is associated with a lower risk of type 2 diabetes. For males, this association is significant only among those with diminished muscle mass. [ABSTRACT FROM AUTHOR]

Aims: To assess the time‐dependent risk of fracture in adults with type 2 diabetes receiving anti‐diabetic drugs. Materials and Methods: We searched MEDLINE, EMBASE, and Cochrane Library up to 18 November 2021, for randomized controlled trials (RCTs) and propensity‐score‐matched non‐randomized studies (NRSs) comparing all anti‐diabetic drugs with standard treatment or with each other on fracture in adults with type 2 diabetes. The study performed a one‐stage network meta‐analysis using discrete‐time hazard regression with reconstructed individual time‐to‐event data. Results: This network meta‐analysis involved seven RCTs (65,051 adults with type 2 diabetes) with a median follow‐up of 36 months and three propensity‐score‐based NRSs (17,954 participants) with a median follow‐up of 27.3 months. Among anti‐diabetic drugs, thiazolidinediones increased the overall hazard of fracture by 42% (95% credible interval [CrI], 3%–97%) and almost tripled the risk after 4 years (hazard ratio [HR], 2.74; 95% CrI, 1.53–4.80). Credible subgroup analysis suggested that thiazolidinediones increased the hazard of fracture only in females (HR, 2.19; 95% CrI, 1.26–3.74) but not among males (HR, 0.81; 95% CrI, 0.45–1.40). Moderate certainty evidence established that thiazolidinediones increase 92 fractures in five years per 1000 female patients. We did not find the risk of fractures with other anti‐diabetic drugs including metformin, sulfonylureas, sodium‐glucose cotransporter‐2 (SGLT2) inhibitors, and dipeptidyl peptidase‐4 (DPP‐4) inhibitors. Conclusions: Long‐term use of thiazolidinediones elevates the risk of fracture among females with type 2 diabetes. There is no evidence eliciting fracture risk associated with other anti‐diabetic drugs. [ABSTRACT FROM AUTHOR]

Background Clinical observation suggests the atheroprotective effect of chloroquine and its derivatives, while its mechanism remains unclear. This study aimed to observe the protective effect of chloroquine against atherosclerosis and explore the underlying mechanism. Methods Ataxia telangiectasia mutated (ATM) wild-type or haploinsufficient apolipoprotein-E-knockout (ATM+/+ ApoE−/− or ATM+/− ApoE−/−) mice were treated with different dosages of chloroquine. Anti-CD25 antibody was used to deplete natural Tregs in ATM+/+ ApoE−/− mice. The atherosclerotic burden in different groups of mice was comprehensively evaluated by H&E staining and Masson staining. The effect of chloroquine on the regulatory T cells (Tregs) was assessed in vivo and in vitro by flow cytometry and immunohistochemical staining. The expression of related proteins was detected by real-time polymerase chain reaction and western blotting. Results In ATM+/+ ApoE−/− mice, chloroquine alleviated atherosclerotic lesions, stabilized the plaque, and increased Treg counts in the atherosclerotic lesions and spleens. However, in ATM haploinsufficient mice (ATM+/− ApoE−/−), chloroquine no longer prevented atherosclerosis or impacted Treg counts. Abolishing Treg cells using an anti-CD25 antibody in vivo abrogated the atheroprotective effect of chloroquine. In vitro, chloroquine promoted the differentiation of Tregs from naïve T cells, which was accompanied by enhanced ATM/AMP-activated protein kinase (AMPK) activity and reduced downstream mammalian target of rapamycin (mTOR) activity. Discussion These findings suggest that chloroquine ameliorates atherosclerosis and stabilizes plaque by modulating Tregs differentiation through the regulation of the ATM/AMPK/mTOR pathway. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (KOA) is the most common degenerative joint disease in China, causing a huge economic burden on patients, families, and society. Standardized KOA rehabilitation treatment is an important means to prevent and treat the disease and promote the development of high‐quality medical services. This guideline is updated on the basis of the 2016 and 2019 editions. Methods: Clinical questions regarding rehabilitation assessment and treatment were selected through clinical questions screening and deconstruction, and multiple rounds of Delphi questionnaire consultation. The International Classification of Functioning, Disability and Health (ICF) was used as the theoretical framework, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to grade the quality of evidence and recommendations. Results: The reporting of this guideline followed the standard of Reporting Items for Practice Guidelines in Healthcare (RIGHT). Taking into account patients' preferences and values and the needs of Chinese clinical practice, a total of 11 clinical questions and 28 recommendations were established. The clinical questions were grouped into two categories: KOA assessment (body function, body structure, activity and participation, quality of life, and environmental factors and clinical outcomes assessment, resulting in 9 recommendations) and KOA treatment (health education, therapeutic exercise, therapeutic modalities, occupational therapy, assistive devices, and regenerative rehabilitation approaches, resulting in 19 recommendations). Conclusion: This is the first evidence‐based guideline for KOA rehabilitation in China utilizing the ICF framework. This guideline provides key guidance for developing systematic, standardized, and precise rehabilitation protocols for KOA across various healthcare settings. [ABSTRACT FROM AUTHOR]