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First Nations women in Australia diagnosed with type 2 diabetes, co-designed and attended a programmed shared medical appointment that included continuous glucose monitors and culturally responsive food appreciation activities over 8 weekly sessions to improve glycaemic control. The project was a single site, longitudinal change from baseline, mixed methods, feasibility study using HbA1c as the primary outcome measure. Secondary outcome measures included, weight, metabolic health-related blood panels, CGM, Blood Glucose Levels (BGL) time-in-range percentage, Patient Activation Measure (PAM) and Problem Areas In Diabetes (PAID) tools and client satisfaction survey and semi focussed interviews. Forty participants commenced and twenty-five participants completed the program (62,5%). Of the completing participants the mean HbA1c had an absolute reduction of 0.7 percentage points ( from baseline to program completion, = .013). Eighteen (75%) reduced HbA1c and maintained some reduction for 12 months. Seven (28%) achieved remission, HbA1c <6.4% (46 mmol/l) maintained for 12 months. There were statistically significant improvements in weight, systolic blood pressure, liver enzymes, BGL time-in-range, PAM and PAID scores. It is feasible to use programmed shared medical appointments incorporating CGM aiming to improve glycaemic control and other metabolic measures of health among First Nations women in Australia. The project was registered with the Australian and New Zealand Clinical Trial Registry ACTRN12622000650796. https://www.anzctr.org.au/ACTRN12622000650796.aspx.
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http://dx.doi.org/10.1177/15598276241312084 | DOI Listing |
Managing diabetes in older adults requires balancing long-term glycaemic control with the prevention of hypoglycaemia, to which this population is particularly vulnerable owing to frailty, multimorbidity and cognitive decline. Guidelines recommend individualized glucose targets for older adults, particularly those with multimorbidity or increased hypoglycaemia risk. For individuals with frailty or cognitive impairment, relaxed HbA1c targets are often appropriate to reduce the risk of adverse events.
View Article and Find Full Text PDFACS Sens
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Department of Electrical and Computer Engineering, Inha University, Incheon 22212, Republic of Korea.
Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia with multiple clinical manifestations and complications, such as cardiovascular disease, kidney dysfunction, retinal impairment, and peripheral neuropathy. Continuous and minimally invasive glucose monitoring is essential for effective DM management. Microneedles (MNs)-based sensing platforms offer a promising solution; however, conventional polymeric MNs suffer from limited electrochemical sensitivity due to their insufficient electroactive surface area and inefficient loading of catalytic and enzymatic components.
View Article and Find Full Text PDFJ Am Geriatr Soc
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AdventHealth Translational Research Institute, Orlando, Florida, USA.
J Comp Eff Res
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British Heart Foundation, University of Glasgow, Glasgow, UK.
The first paper of this two-part series critically examined the role of composite endpoints in health technology assessments (HTAs) and outlined strategies for determining whether to employ the composite estimate of treatment effect or disaggregate into the component endpoints of the composite and apply separate treatment effects within a modeling framework. In this second paper, we expand the discussion beyond a pivotal trial and consider the way in which additional evidence from the same indication for different drugs in the same class, or the same drug for different indications, could be employed within HTAs. We offer a continuation of the case study of dapagliflozin for the treatment of heart failure with preserved or mildly reduced ejection fraction, where the evidence base was expanded to consider empagliflozin for the same indication, as well as both dapagliflozin and empagliflozin for heart failure with reduced ejection fraction.
View Article and Find Full Text PDFJ Eval Clin Pract
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Health Technology Assessment Unit, Acute and Hospital-Based Care Portfolio, Ontario Health, Toronto, Ontario, Canada.
Rationale: Systematic reviews are essential for evidence-based healthcare decision-making. While it is relatively straightforward to quantitatively assess random errors in systematic reviews, as these are typically reported in primary studies, the assessment of biases often remains narrative. Primary studies seldom provide quantitative estimates of biases and their uncertainties, resulting in systematic reviews rarely including such measurements.
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