Riddle, M. C., Bakris, G., Blonde, L., Boulton, A. J., D’Alessio, D., DiMeglio, L. A., … & Wylie-Rosett, J. (2021). A Lesson From 2020: Public Health Matters for Both COVID-19 and Diabetes.
Commentary published in the journal Diabetes Care underlines the lessons from 2020 and how control of COVID-19 is an urgent concern for people with diabetes. We need to learn more about how to improve outcomes for people with hyperglycemia at diagnosis of COVID-19, even when there is no prior history of diabetes.
Does control of hyperglycemia make a difference?
Which forms of drug therapy are most helpful and which might worsen outcomes?
However, conventional diagnosis and therapy are no longer enough. Both COVID-19 and diabetes are public health crises that require evidence-based approaches, including a focus on the social determinants of health to reduce morbidity and mortality. We need objective information about how to do this. This should include sound epidemiologic studies, preventive programs, screening, regulatory curtailment of risk-enhancing practices, and social and economic support of all disadvantaged and vulnerable populations. The title calls for submissions from all involved directly or indirectly in the care and treatment of patietns with diabetes. Diabetes Care‘s remit is to report the science to support clinical care, guidelines , and public policy, so please send us your best work. Public health also matters
The Library & Knowledge Service is here to support NHS staff in Rotherham we can help you if you wish to write for publication, if you are developing your service or you are updating guidelines or service specifications. Whatever your information needs we will help you find the evidence you need.
Rooney MR, Rawlings AM, Pankow JS, et al. | 2021| Risk of Progression to Diabetes Among Older Adults With Prediabetes. JAMA Intern Med. doi:10.1001/jamainternmed.2020.8774
This study explores the question: What is the risk of progression to diabetes among older adults with prediabetes (based on glycated hemoglobin level of 5.7 per cent-6.4 per cent, fasting glucose levels of 100-125 mg/dL, either, or both) in a community-based population?
It sought to compare the prevalence of prediabetes—based on glycated hemoglobin (HbA1c) levels, fasting glucose (FG) levels, either, or both—and examine progression from normoglycemia to prediabetes or diabetes and progression from prediabetes to diabetes in a community-based cohort of older adults from the Atherosclerosis Risk in Communities (ARIC) Study.
The cohort study followed more than 3 000 adults the prevalence of prediabetes (mean [SD] age, 75.6 [5.2] years) was high and differed substantially depending on the definition used, with estimates ranging from 29 per cent for glycated hemoglobin levels of 5.7 per cent to 6.4 per cent to 73 per cent for either glycated hemoglobin levels of 5.7 per cent to 6.4 per cent or fasting glucose levels of 100 to 125 mg/dL. During the 6 years of follow-up, death or regression to normoglycemia from prediabetes was more frequent than progression to diabetes.
They find that prediabetes may not be a robust diagnostic entity in older age. As although prediabetes was common, during the 6.5-year follow-up period, fewer than 12 per cent of older adults progressed from prediabetes to diabetes, regardless of the definition of prediabetes. In addition, a substantial proportion of individuals with prediabetes at baseline regressed to normoglycemia at the follow-up visit (1 among those with fasting glucose levels of 100-125 mg/dL). Indeed, in older adults with prediabetes, regression to normoglycemia or death was more common than progression to diabetes during the study period.
Carlton, J. et al| 2021|The suitability of patient-reported outcome measures used to assess the impact of hypoglycaemia on quality of life in people with diabetes: a systematic review using COSMIN methods |Diabetologica |
The authors of this systematic review intend to identify the suitability of patient-reported outcome measures (PROMs) used to assess the impact of hypoglycaemia on quality of life (QoL) in patients with diabetes and examine their quality and psychometric properties.
The reviewers highlight the need to follow contemporary guidance to develop new instruments that can assess the impact of hypoglycaemia on QoL.
It is generally accepted that hypoglycaemia can negatively impact the quality of life (QoL) of people living with diabetes. However, the suitability of patient-reported outcome measures (PROMs) used to assess this impact is unclear. The aim of this systematic review was to identify PROMs used to assess the impact of hypoglycaemia on QoL and examine their quality and psychometric properties.
Systematic searches (MEDLINE, EMBASE, PsycINFO, CINAHL and The Cochrane Library databases) were undertaken to identify published articles reporting on the development or validation of hypoglycaemia-specific PROMs used to assess the impact of hypoglycaemia on QoL (or domains of QoL) in adults with diabetes. A protocol was developed and registered with PROSPERO (registration no. CRD42019125153). Studies were assessed for inclusion at title/abstract stage by one reviewer. Full-text articles were scrutinised where considered relevant or potentially relevant or where doubt existed. Twenty per cent of articles were assessed by a second reviewer. PROMS were evaluated, according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines, and data were extracted independently by two reviewers against COSMIN criteria. Assessment of each PROM’s content validity included reviewer ratings (N = 16) of relevance, comprehensiveness and comprehensibility: by researchers (n = 6); clinicians (n = 6); and adults with diabetes (n = 4).
Of the 214 PROMs used to assess the impact of hypoglycaemia on QoL (or domains of QoL), seven hypoglycaemia-specific PROMS were identified and subjected to full evaluation: the Fear of Hypoglycemia 15-item scale; the Hypoglycemia Fear Survey; the Hypoglycemia Fear Survey version II; the Hypoglycemia Fear Survey-II short-form; the Hypoglycemic Attitudes and Behavior Scale; the Hypoglycemic Confidence Scale; and the QoLHYPO questionnaire. Content validity was rated as ‘inconsistent’, with most as ‘(very) low’ quality, while structural validity was deemed ‘unsatisfactory’. Other measurement properties (e.g. reliability) varied, and evidence gaps were apparent across all PROMs. None of the identified studies addressed cross-cultural validity or measurement error. Criterion validity and responsiveness were not assessed due to the lack of a ‘gold standard’ measure of the impact of hypoglycaemia on QoL against which to compare the PROMS.
None of the hypoglycaemia-specific PROMs identified had sufficient evidence to demonstrate satisfactory validity, reliability and responsiveness. All were limited in terms of content and structural validity, which restricts their utility for assessing the impact of hypoglycaemia on QoL in the clinic or research setting. Further research is needed to address the content validity of existing PROMs, or the development of new PROM(s), for the purpose of assessing the impact of hypoglycaemia on QoL.