Type 2 Diabetes Management, Control and Outcomes During the COVID-19 Pandemic in Older US Veterans: an Observational Study.
Type 2 Diabetes Management, Control and Outcomes During the COVID-19 Pandemic in Older US Veterans: an Observational Study.
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2型糖尿病的管理，控制和结果在美国老年退伍军人的大流行期间：一项观察性研究。
DOI：
10.1007/s11606-021-07301-7
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发表时间：
2022-03
影响因子：
5.7
通讯作者：
Hofer TP
中科院分区：
文献类型：
--
作者：
Aubert CE;Henderson JB;Kerr EA;Holleman R;Klamerus ML;Hofer TP
COVID-19大流行需要改变门诊服务模式，包括从面对面就诊转变为虚拟就诊，这可能影响了弱势患者的护理。描述老年2型糖尿病（T2 D）患者的管理、控制和结局的变化，这些变化与从面对面到虚拟访视的转变相关。在年龄≥ 65岁的T2 D退伍军人中，我们评估了2020年3月和2020年4月至11月（大流行期）的访视率（亲自，虚拟），A1 c测量，抗糖尿病去强化/强化，ER访视和住院（低血糖，高血糖，其他原因）以及A1 c水平。我们使用负二项回归来评估随时间的变化（参考：大流行前时期，2018年7月至2020年2月），通过基线Charlson Comorbid指数（CCI; > 2 vs. <= 2）和A1 c水平。在740，602名退伍军人中，（平均年龄74.2 [SD 6.6]岁），有55%（95% CI 52-58%）减少亲自访问，821%（95% CI 793-856%）更多虚拟访问，6%与基线相比，大流行期间A1 c测量值减少14%（95% CI 10-17%），治疗强化增加14%（95% CI 10-17%）。CCI > 2的患者虚拟访视的相对增加比CCI <= 2的患者小14%（95%CI 12-16%）。我们观察到A1 c水平和治疗调整的季节性，但与大流行无关。在大流行开始时有所下降后，其他原因（但不是低血糖和高血糖相关）的急诊就诊和住院人数在2020年6月至11月出现反弹。尽管在大流行期间转向虚拟访问和A1 c测量减少，但我们没有观察到与A1 c水平或短期T2 D相关结果的关联，这为虚拟访问的充分性提供了一些保证。进一步的研究应该评估在不同人群中转向虚拟访问的长期影响，以帮助个性化护理，提高效率，并在减少过度使用的同时保持适当的护理。在线版本包含补充材料，可通过10.1007/s11606-021-07301-7获得。
The COVID-19 pandemic required a change in outpatient care delivery models, including shifting from in-person to virtual visits, which may have impacted care of vulnerable patients. To describe the changes in management, control, and outcomes in older people with type 2 diabetes (T2D) associated with the shift from in-person to virtual visits. In veterans aged ≥ 65 years with T2D, we assessed the rates of visits (in person, virtual), A1c measurements, antidiabetic deintensification/intensification, ER visits and hospitalizations (for hypoglycemia, hyperglycemia, other causes), and A1c level, in March 2020 and April–November 2020 (pandemic period). We used negative binomial regression to assess change over time (reference: pre-pandemic period, July 2018 to February 2020), by baseline Charlson Comorbidity Index (CCI; > 2 vs. <= 2) and A1c level. Among 740,602 veterans (mean age 74.2 [SD 6.6] years), there were 55% (95% CI 52–58%) fewer in-person visits, 821% (95% CI 793–856%) more virtual visits, 6% (95% CI 1–11%) fewer A1c measurements, and 14% (95% CI 10–17%) more treatment intensification during the pandemic, relative to baseline. Patients with CCI > 2 had a 14% (95% CI 12–16%) smaller relative increase in virtual visits than those with CCI <= 2. We observed a seasonality of A1c level and treatment modification, but no association of either with the pandemic. After a decrease at the beginning of the pandemic, there was a rebound in other-cause (but not hypo- and hyperglycemia-related) ER visits and hospitalizations from June to November 2020. Despite a shift to virtual visits and a decrease in A1c measurement during the pandemic, we observed no association with A1c level or short-term T2D-related outcomes, providing some reassurance about the adequacy of virtual visits. Further studies should assess the longer-term effects of shifting to virtual visits in different populations to help individualize care, improve efficiency, and maintain appropriate care while reducing overuse. The online version contains supplementary material available at 10.1007/s11606-021-07301-7.
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影响因子：
2.3
作者：
Irmak, Aylin Y.;Celikkalp, Ulfiye;Ekuklu, Galip
通讯作者：
Ekuklu, Galip
DOI：
10.1016/j.ajem.2020.11.029
发表时间：
2021-04
期刊：
The American journal of emergency medicine
影响因子：
--
作者：
Nourazari S;Davis SR;Granovsky R;Austin R;Straff DJ;Joseph JW;Sanchez LD
通讯作者：
Sanchez LD
影响因子：
33.9
作者：
Moreland, Amanda;Herlihy, Christine;Baldwin, Grant
通讯作者：
Baldwin, Grant
影响因子：
3.5
作者：
Kendzerska T;Zhu DT;Gershon AS;Edwards JD;Peixoto C;Robillard R;Kendall CE
通讯作者：
Kendall CE
DOI：
10.1161/circoutcomes.112.966697
发表时间：
2013-01-01
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Beard AJ;Hofer TP;Downs JR;Lucatorto M;Klamerus ML;Holleman R;Kerr EA;Diabetes Clinical Action Measures Workgroup
通讯作者：
Diabetes Clinical Action Measures Workgroup