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Tag: SAGE Publications UK

  • Diabetes Treatments Less Studied in Black Patients

    Diabetes Treatments Less Studied in Black Patients

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    Newswise — New research analysing the effects of two drugs used to treat type 2 diabetes indicates a consistent lack of cardiovascular and renal benefits in Black populations. Cardiovascular disease is the leading cause of severe illness and death associated with type 2 diabetes. Renal disease is also a common complication of type 2 diabetes.

    The drugs, called sodium-glucose co-transporter 2 inhibitors (SGLT2-Is) and glucogen-like peptide 1 receptor agonists (GLP1-RAs), are some of the newer treatments prescribed to lower blood sugar levels in people with type 2 diabetes.

    The research findings, published in the Journal of the Royal Society of Medicine, show that for White and Asian populations, SGLT2-Is and GLP1-RAs have beneficial effects on blood pressure, weight control and renal function, and significantly reduce the risk of severe heart problems and kidney disease. However, the research shows no evidence of these beneficial effects in Black populations.

    Researchers at the Diabetes Research Centre at the University of Leicester analysed the results of 14 randomised controlled trials of SGLT2-Is and GLP1-RAs reporting cardiovascular and renal outcomes by race, ethnicity and region.

    Lead researcher Professor Samuel Seidu, Professor in Primary Care Diabetes and Cardio-metabolic Medicine at the University of Leicester, said: “Given the well-documented evidence that Black and other ethnic minority populations are more likely to develop type 2 diabetes and at a younger age, the consistent lack of benefits we observed among Black populations is concerning.

    “Minimising racial and ethnic variations in the cardiovascular and renal complications of type 2 diabetes requires targeted improved access to care and treatment for those most at risk.”

    The researchers suggest there are many factors that could have contributed to the lack of evidence of beneficial effects for Black and other non-White populations. Low statistical power due to small sample sizes of these populations may be partly responsible.

    “It is quite clear from the current data that some racial/ethnic groups such as Black populations were underrepresented in all the included trials,” pointed out Professor Seidu.

    Enrolment in the trials ranged from 66.6% to 93.2% for White populations, 1.2% and 21.6% for Asian populations, and 2.4% to 8.3% for Black populations.

    However, the researchers suggest that, given the consistent nature of the significant lack of beneficial effects across the majority of outcomes for Black populations, other factors may also be at play.

    “”Whether the differences are due to issues with under-representation of Black populations and low statistical power, or to racial/ethnic variations in the way the body and these drugs interact with each other needs further investigation,” said Professor Seidu. “It is therefore important that prescribers don’t hasten to deny these newer treatments to Black populations on the back of this research.”

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  • Remote symptom reporting systems for patients may reduce outpatient waiting lists

    Remote symptom reporting systems for patients may reduce outpatient waiting lists

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    Newswise — Digital systems for patients to monitor and report symptoms remotely may offer a solution to reduce outpatient waiting lists, according to a new review published by the Journal of the Royal Society of Medicine.

    The review, led by researchers from the Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research at the University of Birmingham, looked at international examples of the use of electronic patient-reported outcome (ePRO) systems to triage clinical care.

    ePROs allow patients to fill out questionnaires at home or location of their choice, with the results sent back to the clinician in near real-time to use in clinical decision-making. Studies of various groups of patients, including those with epilepsy, sleep apnoea, type 1 diabetes, cancer, rheumatoid arthritis and HIV, were included in the review. In Denmark Ambuflex, a generic ePRO system, has been used in over 40,000 patients across a range of chronic conditions and has led to substantial reductions in outpatient appointments. In epilepsy clinics, the system led to reductions of up to 48% in in-person outpatient appointments.

    Lead author Dr Lee Aiyegbusi, Associate Professor and Deputy Director at CPROR, said: “The use of PROs is well established in research settings to evaluate the effectiveness, cost-effectiveness and tolerability of interventions from a patient perspective. Clinicians are now interested in using patient-level symptom reporting for the clinical management of individual patients in routine practice.”

    The review provides evidence to support the implementation of ePRO systems for outpatient care, including significant reductions in outpatient appointments without compromising patient outcomes or satisfaction with care.

    Dr Aiyegbusi said: “ePROs for outpatient care could facilitate the tailoring of care to patient needs. Stable patients can be monitored remotely using ePROs, thereby avoiding unnecessary check-ups in outpatient clinics and associated costs, such as travel and time off work, without lowering the quality of treatment. This efficient use of scarce healthcare resources could free up outpatient clinics for patients with high symptom burden or concerning symptoms, so they can be seen more quickly.”

    The authors say it is important to acknowledge that a proportion of patients, especially the elderly, may prefer face-to-face or telephone outpatient consultations regardless of their health status and may be concerned about or averse to the use of ePROs as a triaging tool.

    They also say the findings demonstrate why it is crucial that the use of ePROs for outpatient care is carefully considered, planned and implemented to ensure that people from underserved populations are not further disadvantaged.

    They concluded: “The use of ePROs in outpatient care could potentially allow a more responsive healthcare system, reduce demand for clinic appointments, reduce time to care with associated improved outcomes, and enhance cost-effectiveness of healthcare delivery – all of which are beneficial to patients, their families and society.”

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  • Self-driven healthcare can improve health outcomes and reduce costs

    Self-driven healthcare can improve health outcomes and reduce costs

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    Newswise — A vision for building sustainable, self-driven healthcare spanning primary care, secondary care and the wider health and social care system has been set out by medical innovators writing in the Journal of the Royal Society of Medicine.

    Self-driven healthcare (SDH) is an umbrella term introduced by Innovate UK, the UK’s national innovation agency, to conceptualise aspects of healthcare delivery that can support people in becoming more engaged in managing their own health and wellbeing, rather than being passive receivers of healthcare.

    In their paper, the authors, from Imperial College London and Innovate UK, describe an SDH ecosystem that supports individuals to take more ownership of their health and wellbeing and in recording their own data (e.g. weight, blood pressure) using a phone app, tablet, computer or Bluetooth device. This self-generated data would then be uploaded onto a secure online SDH portal which holds all their health records, including those generated in the wider healthcare system.

    Lead author Dr Austen El-Osta, Director of the Self-Care Academic Research Unit (SCARU) at Imperial College London, said: “Individuals would also enter other data such as what medication they had taken that day, the food they had eaten or the exercise they had done. They may even have a range of other devices that automatically record and upload useful information, such as environmental data about local air quality that day.”

    A personalised dashboard would automatically present the user with their ‘digital twin’ and the portal may also be enabled to routinely offered insights and actionable advice, including microlearning and behaviour change interventions and a holistic picture of the person’s overall health and wellbeing status.

    Dr El-Osta said: “The vision for SDH is that these personal healthcare management systems are integrated with the wider healthcare system, including the NHS.” He added: “SDH would support better online interaction with healthcare professionals and improve the exchange of information, including shareable personal healthcare records and self-generated data.”

    Dr El-Osta and his co-authors believe that by building a personal healthcare infrastructure capability that connects people to the wider healthcare system, SDH also has the potential to integrate a wider range of activities, such as AI-guided clinical coaching, preventative medicine and home clinical trials.

    When applied at scale, SDH ecosystems could, say the authors, help governments and health organisations, including the NHS, to achieve their ambition of improving health outcomes while controlling costs and addressing priority areas such as equality, diversity and inclusion, levelling up and net-zero.

    The authors caution that the SDH approach must create better access to all sections of the community rather than just wealthier and more technically literate individuals. It is also crucial, they say, that the SDH movement does not exacerbate inequalities due to the digital divide.

    Dr Chris Rowe, Medical Technology Innovation Lead at Innovate UK said: “How SDH is adopted in the future is very important, especially when it is applied to help enhance the consumer health system by trying to link it effectively with state-funded NHS health and social care systems. It will be important to determine if these online environments will be provided by expanding the NHS App, for example, or by commercial companies.”

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