NIHR Evidence: Sharing electronic records with patients led to improved control of type two diabetes

NIHR (2020) |Sharing electronic records with patients led to improved control of type two diabetes| 10.3310/alert_42103

A new review has pooled data from over 20 years’ worth of electronic records, its’ analysis indicates that sharing these records with patients with diabetes could help them control their sugar levels.

The review included trials between 1997 and 2017, with patients included in the study having medical conditions such as cancer, hypertension as well as diabetes.

Across all studies in the review safety outcomes were improved for patients who had access to electronic healthcare records, including medicines safety. Researchers also found that most studies found either a reduction in how often patients accessed healthcare, or no change.

Specifically in the case of studies relating to diabetes, multiple studies reported in similar ways, and these results could be pooled. The analysis found that sharing care records with diabetic patients was effective in reducing blood sugar. This is a major predictor of death in type 2 diabetes. A few studies also indicated a positive effect on anxiety, cardiac symptoms and cholesterol levels in the blood (Source: NIHR).

Related:

he full paper: Neves AL and others. Impact of providing patients access to electronic health records on quality and safety of care: a systematic review and meta-analysisBMJ Quality and Safety. 2020;0:1-14.

An editorial on this paper discusses its implications: Sarkar U and Lyles C. Devil in the details: understanding the effects of providing electronic health record access to patients and familiesBMJ Quality and Safety. 2020. doi: 10.1136/bmjqs-2020-011185.

Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis

Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis | Diabetology & Metabolic Syndrome | Full Text

de Almeida-Pititto, B., et al. Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis. Diabetol Metab Syndr 12, 75 (2020). https://doi.org/10.1186/s13098-020-00586-4

A study has examined the impact of ACEI inhibitors (medications for hypertension as well as heart and kidney problems) in patients with COVID-19. It finds that conditions such as high blood pressure, diabetes and cardiovascular disease are risk factors for both severity and mortality

Abstract

Background

The aim of this study is to evaluate the impact of diabetes, hypertension, cardiovascular disease and the use of angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) with severity (invasive mechanical ventilation or intensive care unit admission or O2 saturation < 90%) and mortality of COVID-19 cases.

Methods

Systematic review of the PubMed, Cochrane Library and SciELO databases was performed to identify relevant articles published from December 2019 to 6th May 2020. Forty articles were included involving 18.012 COVID-19 patients.

Results

The random-effect meta-analysis showed that diabetes mellitus and hypertension were moderately associated respectively with severity and mortality for COVID-19: Diabetes [OR 2.35 95% CI 1.80–3.06 and OR 2.50 95% CI 1.74–3.59] Hypertension: [OR 2.98 95% CI 2.37–3.75 and OR 2.88 (2.22–3.74)]. Cardiovascular disease was strongly associated with both severity and mortality, respectively [OR 4.02 (2.76–5.86) and OR 6.34 (3.71–10.84)]. On the contrary, the use of ACEI/ARB, was not associate with severity of COVID-19.

Conclusion

In conclusion, diabetes, hypertension and especially cardiovascular disease, are important risk factors for severity and mortality in COVID-19 infected people and are targets that must be intensively addressed in the management of this infection.

The full study is available from BMC

Metformin Should Not Be Used to Treat Prediabetes

Davidson, M.B. (2020)| Metformin Should Not Be Used to Treat Prediabetes | Diabetes Care| DOI: 10.2337/dc19-2221

Abstract

Based on the results of the Diabetes Prevention Program Outcomes Study (DPPOS), in which metformin significantly decreased the development of diabetes in individuals with baseline fasting plasma glucose (FPG) concentrations of 110-125 vs. 100-109 mg/dL (6.1-6.9 vs. 5.6-6.0 mmol/L) and A1C levels 6.0-6.4% (42-46 mmol/mol) vs. less than 6.0% and in women with a history of gestational diabetes mellitus, it has been suggested that metformin should be used to treat people with prediabetes. Since the association between prediabetes and cardiovascular disease is due to the associated nonglycemic risk factors in people with prediabetes, not to the slightly increased glycemia, the only reason to treat with metformin is to delay or prevent the development of diabetes. There are three reasons not to do so. First, approximately two-thirds of people with prediabetes do not develop diabetes, even after many years. Second, approximately one-third of people with prediabetes return to normal glucose regulation. Third, people who meet the glycemic criteria for prediabetes are not at risk for the microvascular complications of diabetes and thus metformin treatment will not affect this important outcome. Why put people who are not at risk for the microvascular complications of diabetes on a drug (possibly for the rest of their lives) that has no immediate advantage except to lower subdiabetes glycemia to even lower levels? Rather, individuals at the highest risk for developing diabetes-i.e., those with FPG concentrations of 110-125 mg/dL (6.1-6.9 mmol/L) or A1C levels of 6.0-6.4% (42-46 mmol/mol) or women with a history of gestational diabetes mellitus-should be followed closely and metformin immediately introduced only when they are diagnosed with diabetes.

Rotherham NHS staff can request a copy of this article from the Library