Parole chiave: autocontrollo, prestazione educazione, opinione/attitudini dei medici, aderenza de... more Parole chiave: autocontrollo, prestazione educazione, opinione/attitudini dei medici, aderenza dei pazienti all'autocontrollo Key words: self-monitoring blood glucose, education, opinion/attitude of physicians, patient compliance to self-monitoring blood glucose Il Giornale di AMD, 2011;14:28-34 Riassunto Mentre l'utilità dell'autocontrollo nel paziente con diabete di tipo 1 adulto è indiscussa, il suo utilizzo nel tipo 2 e nel diabete gestazionale è meno supportato dalle evidenze. AMD nell'ambito dell'iniziativa "SUBITO!" ha promosso una survey on-line con l'obiettivo di indagare la variabilità esistente nell'applicazione/ utilizzazione dell'autocontrollo in diverse tipologie di pazienti, evidenziando le differenze nell'organizzazione/legislazione delle diverse regioni o aziende sanitarie, e testare le opinioni/attitudini dei diabetologi sulla formazione dei pazienti. Complessivamente, sono stati compilati 160 questionari da diabe-tolog...
New approaches to cope with clinical and psychosocial aspects of type 2 diabetes (T2DM) are neede... more New approaches to cope with clinical and psychosocial aspects of type 2 diabetes (T2DM) are needed; gender influences the complex interplay between clinical and non-clinical factors. We used data from the BENCH-D study to assess gender-differences in terms of clinical and person-centered measures in T2DM. Clinical quality of care indicators relative to control of HbA1c, lipid profile, blood pressure, and BMI were derived from electronic medical records. Ten self-administered validated questionnaires (SF-12 Health Survey; WHO-5 well-being index; Problem Areas in Diabetes (PAID) 5, Health Care Climate Questionnaire, Patients Assessment of Chronic Illness Care, Diabetes Empowerment Scale, Diabetes Self-care Activities, Global Satisfaction for Diabetes Treatment, Barriers to Taking Medications, Perceived Social Support) were adopted as person-centered outcomes indicators. Overall, 26 diabetes clinics enrolled 2,335 people (men: 59.7%; women: 40.3%). Lower percentages of women reached Hb...
Background: The aim of this multicenter, longitudinal, single-arm, pre-post comparison was to tes... more Background: The aim of this multicenter, longitudinal, single-arm, pre-post comparison was to test a telemedicine system able to promote body weight reduction, nutritional education, and consumption of fresh local produce. Methods: DAI Ò (MeTeDa srl, San Benedetto del Tronto, Italy) is a software for mobile phones to support patients following a specific dietetic program. It facilitates the communication between the patient and dietician via short text messages. Overall, three specialized dieticians enrolled 140 consecutive patients with body mass index (BMI) !25 kg/m 2 who voluntered to follow a specific diet program to be managed with DAI. At baseline and after 20 weeks, data on body weight, waist circumference, BMI, fasting blood glucose, lipid profile, food habits, and physical activity were collected and compared by the Wilcoxon test or the McNemar test. Results: Overall, 115 individuals (82.1%) completed the follow-up. The mean (95% confidence interval) reduction in body weight was À2.5 (À3.2; À1.8) kg, whereas the reduction in waist circumference was À3.7 (À4.6; À2.9) cm, and that in BMI was 1.0 (À0.7; À1.2) kg/m 2. The software was useful as an educational tool: participants achieving the Mediterranean diet targets increased from 14.4% to 69.8% after 20 weeks. On average, each patient recognized and chose fresh local vegetables eight times per week during the follow-up. Participants regularly communicated with dieticians through short text messages. Conclusions: This study allowed the documentation of the efficacy of a new telemedicine system in supporting people who need to lose body weight. The tool was also suitable for a more articulated initiative of ''nutritional education'' aiming to promote the healthy properties of the Mediterranean diet and the consumption of local produce.
Quality of Life and Treatment Satisfaction in Patients with Type 1DIABETES: A Comparison Between Continuous Subcutaneous Insulininjection and Multiple Daily Injections
Background: New approaches to cope with clinical and psychosocial aspects of type 2 diabetes (T2D... more Background: New approaches to cope with clinical and psychosocial aspects of type 2 diabetes (T2DM) are needed; gender influences the complex interplay between clinical and non-clinical factors. We used data from the BENCH-D study to assess gender-differences in terms of clinical and person-centered measures in T2DM. Methods: Clinical quality of care indicators relative to control of HbA1c, lipid profile, blood pressure, and BMI were derived from electronic medical records. Ten self-administered validated questionnaires (SF-12 Health Survey; WHO-5 well-being index; Problem Areas in Diabetes (PAID) 5, Health Care Climate Questionnaire, Patients Assessment of Chronic Illness Care, Diabetes Empowerment Scale, Diabetes Self-care Activities, Global Satisfaction for Diabetes Treatment, Barriers to Taking Medications, Perceived Social Support) were adopted as person-centered outcomes indicators. Results: Overall, 26 diabetes clinics enrolled 2,335 people (men: 59.7%; women: 40.3%). Lower percentages of women reached HbA1c levels < =7.0% (23.2% vs. 27.8%; p = 0.03), LDL-cholesterol < 100 mg/dl (48.3 vs. 57.8%; p = 0.0005), and BMI <27 Kg/m2 (27.2 vs. 31.6%; p = 0.04) than men. Women had statistically significant poorer scores for physical functioning, psychological well-being, self-care activities dedicated to physical activities, empowerment, diabetes-related distress, satisfaction with treatment, barriers to medication taking, satisfaction with access to chronic care and healthcare communication, and perceived social support than men; 24.8% of women and 8.8% of men had WHO-5 < =28 (likely depression) (p < 0.0001); 67.7% of women and 55.1% of men had PAID-5 > 40 (high levels of diabetes-related distress) (p < 0.0001). At multivariate analysis, factors associated with an increased likelihood of having elevated HbA1c levels (≥8.0%) were different in men and women, e.g. having PAID-5 levels >40 was associated with a higher likelihood of HbA1c ≥8.0% in women (OR = 1.15; 95%CI 1.05-1.25) but not in men (OR = 1.00; 95%CI 0.93-1.08). Conclusions: In T2DM, women show poorer clinical and person-centered outcomes indicators than men. Diabetesrelated distress plays a role as a correlate of metabolic control in women but not in men. The study provides new information about the interplay between clinical and person-centered indicators in men and women which may guide further improvements in diabetes education and support programs.
Parole chiave: autocontrollo, prestazione educazione, opinione/attitudini dei medici, aderenza de... more Parole chiave: autocontrollo, prestazione educazione, opinione/attitudini dei medici, aderenza dei pazienti all'autocontrollo Key words: self-monitoring blood glucose, education, opinion/attitude of physicians, patient compliance to self-monitoring blood glucose Il Giornale di AMD, 2011;14:28-34 Riassunto Mentre l'utilità dell'autocontrollo nel paziente con diabete di tipo 1 adulto è indiscussa, il suo utilizzo nel tipo 2 e nel diabete gestazionale è meno supportato dalle evidenze. AMD nell'ambito dell'iniziativa "SUBITO!" ha promosso una survey on-line con l'obiettivo di indagare la variabilità esistente nell'applicazione/ utilizzazione dell'autocontrollo in diverse tipologie di pazienti, evidenziando le differenze nell'organizzazione/legislazione delle diverse regioni o aziende sanitarie, e testare le opinioni/attitudini dei diabetologi sulla formazione dei pazienti. Complessivamente, sono stati compilati 160 questionari da diabe-tolog...
New approaches to cope with clinical and psychosocial aspects of type 2 diabetes (T2DM) are neede... more New approaches to cope with clinical and psychosocial aspects of type 2 diabetes (T2DM) are needed; gender influences the complex interplay between clinical and non-clinical factors. We used data from the BENCH-D study to assess gender-differences in terms of clinical and person-centered measures in T2DM. Clinical quality of care indicators relative to control of HbA1c, lipid profile, blood pressure, and BMI were derived from electronic medical records. Ten self-administered validated questionnaires (SF-12 Health Survey; WHO-5 well-being index; Problem Areas in Diabetes (PAID) 5, Health Care Climate Questionnaire, Patients Assessment of Chronic Illness Care, Diabetes Empowerment Scale, Diabetes Self-care Activities, Global Satisfaction for Diabetes Treatment, Barriers to Taking Medications, Perceived Social Support) were adopted as person-centered outcomes indicators. Overall, 26 diabetes clinics enrolled 2,335 people (men: 59.7%; women: 40.3%). Lower percentages of women reached Hb...
Background: The aim of this multicenter, longitudinal, single-arm, pre-post comparison was to tes... more Background: The aim of this multicenter, longitudinal, single-arm, pre-post comparison was to test a telemedicine system able to promote body weight reduction, nutritional education, and consumption of fresh local produce. Methods: DAI Ò (MeTeDa srl, San Benedetto del Tronto, Italy) is a software for mobile phones to support patients following a specific dietetic program. It facilitates the communication between the patient and dietician via short text messages. Overall, three specialized dieticians enrolled 140 consecutive patients with body mass index (BMI) !25 kg/m 2 who voluntered to follow a specific diet program to be managed with DAI. At baseline and after 20 weeks, data on body weight, waist circumference, BMI, fasting blood glucose, lipid profile, food habits, and physical activity were collected and compared by the Wilcoxon test or the McNemar test. Results: Overall, 115 individuals (82.1%) completed the follow-up. The mean (95% confidence interval) reduction in body weight was À2.5 (À3.2; À1.8) kg, whereas the reduction in waist circumference was À3.7 (À4.6; À2.9) cm, and that in BMI was 1.0 (À0.7; À1.2) kg/m 2. The software was useful as an educational tool: participants achieving the Mediterranean diet targets increased from 14.4% to 69.8% after 20 weeks. On average, each patient recognized and chose fresh local vegetables eight times per week during the follow-up. Participants regularly communicated with dieticians through short text messages. Conclusions: This study allowed the documentation of the efficacy of a new telemedicine system in supporting people who need to lose body weight. The tool was also suitable for a more articulated initiative of ''nutritional education'' aiming to promote the healthy properties of the Mediterranean diet and the consumption of local produce.
Quality of Life and Treatment Satisfaction in Patients with Type 1DIABETES: A Comparison Between Continuous Subcutaneous Insulininjection and Multiple Daily Injections
Background: New approaches to cope with clinical and psychosocial aspects of type 2 diabetes (T2D... more Background: New approaches to cope with clinical and psychosocial aspects of type 2 diabetes (T2DM) are needed; gender influences the complex interplay between clinical and non-clinical factors. We used data from the BENCH-D study to assess gender-differences in terms of clinical and person-centered measures in T2DM. Methods: Clinical quality of care indicators relative to control of HbA1c, lipid profile, blood pressure, and BMI were derived from electronic medical records. Ten self-administered validated questionnaires (SF-12 Health Survey; WHO-5 well-being index; Problem Areas in Diabetes (PAID) 5, Health Care Climate Questionnaire, Patients Assessment of Chronic Illness Care, Diabetes Empowerment Scale, Diabetes Self-care Activities, Global Satisfaction for Diabetes Treatment, Barriers to Taking Medications, Perceived Social Support) were adopted as person-centered outcomes indicators. Results: Overall, 26 diabetes clinics enrolled 2,335 people (men: 59.7%; women: 40.3%). Lower percentages of women reached HbA1c levels < =7.0% (23.2% vs. 27.8%; p = 0.03), LDL-cholesterol < 100 mg/dl (48.3 vs. 57.8%; p = 0.0005), and BMI <27 Kg/m2 (27.2 vs. 31.6%; p = 0.04) than men. Women had statistically significant poorer scores for physical functioning, psychological well-being, self-care activities dedicated to physical activities, empowerment, diabetes-related distress, satisfaction with treatment, barriers to medication taking, satisfaction with access to chronic care and healthcare communication, and perceived social support than men; 24.8% of women and 8.8% of men had WHO-5 < =28 (likely depression) (p < 0.0001); 67.7% of women and 55.1% of men had PAID-5 > 40 (high levels of diabetes-related distress) (p < 0.0001). At multivariate analysis, factors associated with an increased likelihood of having elevated HbA1c levels (≥8.0%) were different in men and women, e.g. having PAID-5 levels >40 was associated with a higher likelihood of HbA1c ≥8.0% in women (OR = 1.15; 95%CI 1.05-1.25) but not in men (OR = 1.00; 95%CI 0.93-1.08). Conclusions: In T2DM, women show poorer clinical and person-centered outcomes indicators than men. Diabetesrelated distress plays a role as a correlate of metabolic control in women but not in men. The study provides new information about the interplay between clinical and person-centered indicators in men and women which may guide further improvements in diabetes education and support programs.
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Papers by Paolo Foglini