Abstract:
Objectives: Personalized and evidenced-based nutritional interventions are needed to overcome the burden of type 2 diabetes (T2D) epidemic. The aim of this study was to describe the implementation and impact on glycemic control of an intervention based on Nutritional Care Process Terminology (NCPT) within a T2D comprehensive care program in Mexicans.
Methods: This is a single-arm study of a 2-years follow-up. We evaluated 258 individuals of the CAIPaDi program across six visits. The program seeks to achieve metabolic goals and provide self-efficacy to recently T2D-diagnosed patients. The customized nutritional intervention was implemented for all participants based on an NCPT model. The intervention was implemented by two dietitians, following the NCPT program. Each participant engaged in a 30-minutes session each visit. The main outcome is the achievement of treatment goals defined by the National Committee for Quality Assurance criteria (NCQA).
Results: The program was effective to reduce the prevalence of subjects with poor glycemic control from 85% to 57% (P < .0001) after 2 years. Nutritional diagnoses were grouped into the three main domains, 1) ingestion, 2) clinical, and 3) Behavioral/Environmental. At baseline, the most prevalent diagnostic was behavioral diagnostics (44%), followed by ingestion (39%), and clinical (17%). The majority of individuals with behavioral diagnostics migrated to ingestion, whereas individuals with ingestion diagnoses at baseline migrated to the non-diagnostic at the final visit. At the end of the follow-up, the most frequent diagnostic was ingestion (45%), with 29% of the subjects with good glycemic control, contrasting with 79% of the non-diagnostic individuals (p = .0001). Subjects in the category the non-diagnostic nutritional in one previous visit, were 89% more likely to reach a good glycemic control in the last visit (HR 1.89; 95CI% 1.17–3.05) even after adjusting by confounders: age, sex, body fat, years of onset and HbA1c at baseline.
Conclusions: An intervention based on NCPT can help provide individualized nutritional interventions and prioritize clinical attention to improve the effectiveness of a T2D comprehensive care program.

Abstract:
Introduction: In 2020, several countries established a global emergency state. Lockdowns restricted people’s lifestyles and daily activities to prevent coronavirus spread. These measures hindered diabetes mellitus control and lifestyle changes. This study aims to evaluate if attending a multidisciplinary program before the pandemic helped maintain a good metabolic state, lifestyle modifications, and mental health in patients with diabetes mellitus during the COVID-19 lockdown.
Methods: Patients included in this study attended a multidisciplinary program, with < 5 years of diagnosis of type 2 diabetes, without disabling complications, between 18– 70 years old. The complete lockdown occurred from February 27, 2020, to May 31, 2020. The first patient (non-COVID) to return to the center for face-to-face consultation was in March 2021. Consultations in 2019 were face-to-face and changed to a virtual modality during 2020. We analyzed metabolic, lifestyle, mental health, and diabetes education parameters.
Results: A total of 133 patients with type 2 diabetes mellitus were included with complete information in visits before and during the lockdown. Metabolic parameters and self-care measures (nutrition plan, foot evaluation, and self-glucose monitoring) evaluated on our patients had no change during the lockdown. We found a significant increase in the time patients spent sitting during the day (p< 0.05). Barriers to exercise increased during lockdown, being joint pain (3.8% to 12.0%, p< 0.01) and lack of time to exercise (4.5% to 7.5%, p=0.33) being the most common. There was no significant difference in symptoms of anxiety and depression, quality of life, and empowerment.
Conclusion: A multidisciplinary diabetes mellitus program, including diabetes education for self-care activities, positively impacts patients, maintaining good outcomes despite lockdown difficulties.

Abstract:
Aims: Assess the effect of a diabetes program on lifestyle, metabolic, and mental health parameters in relatives of patients with T2D, and correlate changes between relatives and patients.
Methods: Relatives were included in a structured program for patients with T2D. They received individualized interventions or were asked to follow lifestyle modifications indicated to their patient with diabetes. Outcomes were change in BMI, fat loss, patients achieving LDL-c and triglycerides goals, exercise, and mental health indicators at three and twelve months. Results: We included 200 relatives. Obesity was present in 42 %, hypertension in 8.5 %, hypercholesterolemia in 29.5 %, and hypertriglyceridemia in 46 % of relatives. Relatives lost − 3.7 kg and − 3.0 kg of body fat at three months and one-year evaluations. At least 60 % achieved normal triglycerides and LDL-c, and 40 % exercised at least 150 min/week. Anxiety symptoms dropped from 37 % to 22 % (p = 0.001), and depressive symptoms from 22 % to 12.9 % (p = 0.01) at three months. Correlations were found between the changes in relatives and patients in weight at three months (r = 0.22, p = 0.001), one year (r = 0.3, p < 0.001), and the number of goals achieved at one year.
Conclusion: Relatives of patients with diabetes attending a multidisciplinary program for T2D benefit in metabolic, lifestyle, and mental health indicators.

Abstract:
Empowerment interventions for chronic diseases are an evolving process. No agreement exists regarding the necessary components and methodologies to be applied. Systematic reviews have assessed the effect of self-management interventions. Improvements in illness beliefs, adherence to drug therapy and glucose monitoring have been reported. In the long term, no major changes have been achieved in weight, physical activity, smoking status, and depression scores. There is a need for additional studies. The CAIPaDi (Centro de Atención Integral del Paciente con Diabetes) program is an intervention designed to provide education and empowerment techniques (using simple low-cost interactive tools) over a short period of time followed by at-distance support using internet or cell phone technology. The target population consists of patients with type 2 diabetes, free of chronic complications who are non-smokers. The intervention is composed of four monthly visits followed by a continuous at-distance support system. At each visit, patients stay for six hours in the center. Information is presented in group sessions. Empowerment techniques are applied during individual exchanges with the team or during facilitated group sessions. In summary, empowerment programs are an unmet need in many healthcare services. This review also discusses relevant studies and patents in the management of type 2 diabetes.

Abstract:
The aim of this study was to know the level of AF in health professionals (HP) by using a pedometer, to maintain an active lifestyle for 12 weeks. For this pilot study we included 26 participants. The number of steps per day was recorded each week and strategies were provided to increase AF. We did a descriptive analysis of steps and body composition.

At the beginning, the average number of steps was 7,430. At 12 weeks it increased to 8,535 (p=0.06). The weight decrased from 61.6 to 61.3 kg in 12 weeks. No significant changes were observed in relation to body mass index, mass body fat and skeletal lean mass. The most common barrier was lack of time and type of work. The PS in this study did not reach with the AF recommendations reported in international guidelines.

Abstract:
Background: Diabetes increases the risk of periodontal disease. Integrating periodontal care with the treatment of type 2 diabetes (T2DM) may facilitate the management of both diseases.

Aim of the study: To evaluate the periodontal status at two years in patients with T2DM and assess glycated hemoglobin (HbA1c) according to the severity and extension of periodontitis.

Methods: This is a descriptive cohort study. Full-mouth periodontal evaluation was performed and blood samples were obtained to analyze HbA1c at baseline, 3, 12 and 24 months. Clinical attachment level, probing depth, bleeding on probing and oral hygiene were measured. We analyzed mean HbA1c according to severity and extension of periodontitis.

Results: We included 160 patients with T2DM. Basal HbA1c was 7.7 ± 2.2%. Periodontal health increased 27.5 % at 24 months. At baseline, moderate and severe periodontitis was present in 29.9% and 13.4% patients, respectively. At two years, 22.5% and 11.8% had moderate and severe periodontitis, respectively.

Bleeding on probing decreased from 15.7% to 6.4% at 24 months. HbA1c was higher in subjects with severe and generalized periodontitis.

Conclusions: The periodontal status in patients with newly diagnosis of T2DM who received a comprehensive diabetes care improved at 3 months. This improvement was maintained at 24 months of follow-up.

Abstract:
Aims: To evaluate the effectiveness of a comprehensive care program to achieve and maintain goals in patients with type 2 diabetes.

Methods: The CAIPaDi program includes 9 interventions delivered in 7 h. It seeks to achieve metabolic goals, identify and resolve barriers that would make implementation difficult, and provide self-efficacy and empowerment to patients by identifying personal profiles to establish individualized strategies. The program consists of a 4 intervention visits (1, 2, 3, and 4 months) and two follow up visits (12 and 24 months). Outcomes are compared between every visit. Main outcome was the attainment of the USA National Committee for Quality Assurance treatment goals.

Results: 1104 patients completed the first 4 visits, 545 the 12 month evaluation, and 218 the 24 month evaluation. After the conclusion of the four monthly sessions, 80.6% had HbA1c <7%, 72.1% had BP <130/80 mmHg and 71.6% had LDL- cholesterol <100 mg/dl. After twelve months, the percentage of goals achieved were 65.9%, 67.7% and 43.3% respectively (p < 0.001). For the 2-year evaluation the percentages were 61.0%, 70.6%, and 40.8% respectively (p < 0.001). All patients had renal, eye, foot and dental evaluations. Empowerment and quality of life showed significant changes; anxiety and depression scores remained low at annual follow-ups.

The CAIPaDI program results in sustained improvement and maintenance of treatment goals.

Abstract:
Context Patients with a body mass index (BMI) ≥35 kg/m2 have lower benefits with intensive treatments and metabolic control goals are more difficult to reach.

Objective: Evaluate the effect of a comprehensive care program in patients with a BMI ≥35 kg/m².

Design:Prospective cohort study.

Setting:Comprehensive Care Center in a National Institute of Health.

Patients:Patients with type 2 diabetes, ≤5 years of diagnosis, without disabling complications, nonsmokers, and a BMI <45 kg/m².

Interventions:Exercise and nutritional interventions are modified for patients with a higher BMI to achieve metabolic control.

Main Outcome Measures: Main outcome is achievement of treatment goals defined as HbA1c <7%, low-density lipoprotein cholesterol (LDL-c) <100 mg/dL, and blood pressure <130/80 mm Hg. Secondary measures were the percentage of patients achieving three metabolic goals.

Results: A total of 587 patients with annual evaluation were included. Mean age was 55.3 ± 9.5 years, 56.6% women, time since diagnosis of 1 year (0 to 5). BMI <35 kg/m2 group included 521 patients and BMI ≥35 kg/m² group included 66 patients. In the BMI ≥35 kg/m² group, we observed a greater decrease in weight and fat mass at 3 months compared with <35 kg/m² group, but the HbA1c, LDL-c, or blood pressure goals were similar at 3 months and 1 year between groups.

Conclusions: Comprehensive interventions are equally effective in patients with recently diagnosed type 2 diabetes with BMI ≥35 kg/m2 compared with patients with a lower BMI.

Abstract:
Introduction: Lifestyle changes in medical nutrition therapy (MNT) are associated to HbA1c decreases ranging from 0.3 to 2%. Evidence shows that people with barriers are less likely to adhere to a long-term nutritional plan. Little information is available on the barriers that prevent the implementation of a healthy nutritional plan, and the strategies used to overcome them.

Objective: To report the longitudinal changes in perceptions of barriers to adherence to a nutritional plan in T2DM.

Methods: A prospective cohort study with intervention. Follow-up was assessed at two years, and all patients received comprehensive care according to the CAIPaDi model. A questionnaire was used to detect the most common barriers to adherence to a nutritional plan at baseline and at 3 months and 1 and 2 years of follow-up. The analysis included data from 320 patients with complete evaluations from baseline to 2 years. Patients with T2DM aged 53.8±9.1 years (55.9% women), BMI 29.2±4.4kg/m2, and time since the diagnosis 1 (0-5) years were included in the study.

Results: At baseline, 78.4% of patients reported any barrier that limited adherence to a nutritional plan. The most common were "Lack of information on an adequate diet" (24.7%), "I eat away from home most of the time" (19.7%), and "Denial or refusal to make changes in my diet" (14.4%). After a structured nutritional intervention including strategies to eliminate each barrier, a 37% reduction (p<0.001) was seen in barriers at 2 years of follow-up. Patients with persistent barriers at two years had a greater proportion of HbA1c values >7% (24.7%) and triglyceride levels >150mg/dL (27.5%) out of the control range as compared to those with no barriers (11.6% and 14.4% respectively, p<0.05).

Conclusions: Identification of barriers to adherence to a nutritional plan may allow healthcare professionals design interventions with the specific behavioral components needed to overcome such barrier, thus improving adherence to the nutritional plan with the resultant long-term changes

Abstract:
Objective: To determine the prevalence of diabetic retinopathy (DR) and diabetic macular oedema (DME) and their associated risk factors in patients recently diagnosed with type 2 diabetes.

Methods and analysis: We carried out a cross-sectional study from April 2014 to August 2017. We included patients aged ≥18 years. Diabetes was defined as fasting plasma glucose of >7.8 mmol/L or 2-hour postload plasma glucose of >11.1 mmol/L. Non-mydriatic fundus examination with a digital-fundus camera was performed. Three images centred in the macula, optic disc and temporal to the macula were obtained and graded according to the Scottish Scale Classification of Diabetic Retinopathy.

Results: 1232 patients (mean age 51.5 years) with a diabetes duration of 0-5 years were examined. Age-adjusted and sex-adjusted prevalence of DR and DME was 17.4% (95% CI 15.3% to 19.6%) and 6.6% (95% CI 5.4% to 8.2%), respectively. DR was associated with diabetes duration (OR per year=1.20, p<0.001), haemoglobin A1c (HbA1c) from 7.0 to 8.9 (OR=2.19, p<0.001), HbA1c≥9 (OR=2.98, p<0.001) and systolic blood pressure (SBP) (OR=1.16 per 5 mm Hg, p<0.001). DME was associated with diabetes duration (OR per year=1.26, p<0.01), HbA1c from 7.0 to 8.9 (OR=2.26, p<0.05), HbA1c≥9 (OR=2.38, p<0.01), SBP (OR per mm Hg=1.15, p<0.001) and albuminuria (OR=2.45, p<0.01).

Conclusion: Our study contributes to the evidence of progressive increase in DR and DME risk in early stages of diabetes, supporting the urgent need for early screening.

Abstract:
The Integral Diabetes Monitoring System (SMID) is a technological tool linked to a database, including 291 indicators for a comprehensive care center and 142 indicators for individual praxis with a comprehensive approach. It is available in an open electronic portal where the user record in realtime data generated. It includes metabolic (glycemic targets and hypoglycemia), psychosocial outcomes (mental health, distress, and depression), barriers for adherence, foot care, and chronic and acute complications. Patients can obtain education, advice, and feedback,

If metabolic control goals are not achieved and there are no changes in the treatment, the system issues an alert to motivate change or treatment adjustment and educational material is offered. In subsequent evaluations, graphs can be displayed showing evolution in the parameters.

Abstract:
Aims: To evaluate the use of the electronic integral monitoring system (SMID) to identify factors associated to glycemic control and its impact in the quality of care in patients with type 2 diabetes (T2D).

Methods: T2D patients registered in SMID were analyzed. Biochemical, clinical and lifestyle variables were recorded. Factors associated to HbA1c ≤7% were explored. Quality of care of the clinic was measured according to the National Committee for Quality Assurance Criteria (NCQA) that requires a score of 75 to achieve a good quality of care.

Results: 511 patients were included. Prescription of basal insulin, SGLT-2 inhibitors and barriers to follow nutritional plan were associated with decreased probability of having adequate glycemic control. Patients in the maintenance stage of motivation had higher probability of having HbA1c ≤7%. According to NCQA evaluation 60 points were achieved. Glucose goals were not met; 35.9% had HbA1c ≥9% and 17% HbA1c <7%. While foot evaluation, smoking approach, blood pressure and lipids goals were accomplished; eye and renal evaluations were borderline.

Conclusion: Glycemic control in patients with long standing T2D and multiple comorbidities is challenging, which directly impacts in the quality of care. Professionals should focus in reinforcing non-pharmacological interventions to optimize glycemic targets.

Abstract:
Introduction: In a comprehensive approach, patients with diabetes who have evidence of microvascular damage should be considered to have abnormalities in various systems. This can modulate the expected response to the prescription of physical activity and exercise.

Objectives: to evaluate the changes in autonomic nervous response in patients with T2DM and elevated albumin/creatinine ratio (ACR) after an individualized exercise program.

Methods: We analyzed data from patients with T2DM attending a comprehensive care program. We divide them in 2 groups (ACR <30 mg/g and ACR ≥30 mg/g); and compared metabolic, exercise and autonomic function parameters heart rate recovery (HRR) in the 6 minutes walking test (6MWT) and sudomotor function after 3 months with an exercise program.

Results: We included 988 patients, age 52±9.8 years, 53% women, median time of diabetes diagnosis 1 (0-5) years; 17.1% patients had ACR ≥30 mg/g. Although the parameters improvement compared with baseline, at 3 months there were significant differences in the group with ACR≥30 mg/g compared with normal renal function in A1c (6.3±0.8% vs 6.7±1%, p <0.001), systolic blood pressure (116.5 ±11 mmHg vs 118 ±13 mmHg, p<0.03), HRR at minute 1 (14 (9-20) min vs 17 (7-18) , p< 0.01), HRR at minute 2 (21 (15-27) vs 19 (12-26), p=0.007) and the risk of autonomic cardiac neuropathy (33% (25-40) vs 30% (23-38), p=0.01).

Conclusion: Patients with elevated urine albumin/creatinine ratio had a less HRR than patients with normal urine albumin creatinine ratio. It is important to consider kidney and autonomic function before exercise prescription in patients with T2DM.

Abstract:
Objective: To evaluate misconceptions about diabetes in people who attend the first visit at the CAIPaDi program, as well as its association with metabolic and psychological variables at short and long term.

Methods and Analysis: The frequency of misconceptions in diabetes was determined through a true/false survey. We compared sociodemographic, metabolic and psychological variables between people with and without misconceptions at baseline, at 3 months and 1 year after a multidisciplinary educational program. Results: 902 participants answered the survey, with an age of 50 ±10 years old, 54.3% were women, with 1 (0-5) years living with type 2 diabetes. At baseline, 53% of the participants had at least 1 misconception, being more frequent in women (p=0.045) and in population with lower educational level (p<0.001). The most common were "emotional stress and fright cause diabetes" (34.4%), "in the control of my diabetes only matters glucose management" (15.2%) and "women with diabetes should not get pregnant" (11.8%). At basal, patients with misconceptions had higher HbA1c (9.0 ± 2.6 vs 8.4 ± 2.4, p <0.001), lower quality of life (DQOL 95.2 ± 26.2 vs 90.2 ± 23.6, p = 0.03), more problematic areas in diabetes (41.2 [21.2-58.4] vs 35 [17.5-52.6], p = 0.01), more depression (42.6% vs 32.9%, p = 0.003) and anxiety (58.6% vs 40.6%, p = 0.001) compared to patients without misconceptions. With the exception of HbA1c (6.6 ± 1 vs 6.4 ± 0.8, p = 0.025 at 1 year), no differences were observed in the annual visits.

Conclusion: We found a high prevalence of people with misconceptions in diabetes. This group had worst glycaemic control, higher scores in PAID questionnaire, lower quality of life and more depression and anxiety symptoms. Participants with misconceptions had lower educational level. An educative program an educational assistance program can minimize differences by eradicating misconceptions.

Abstract:
Objective: To evaluate misconceptions about diabetes in people who attend the first visit at the CAIPaDi program, as well as its association with metabolic and psychological variables at short and long term.

Methods and Analysis: The frequency of misconceptions in diabetes was determined through a true/false survey. We compared sociodemographic, metabolic and psychological variables between people with and without misconceptions at baseline, at 3 months and 1 year after a multidisciplinary educational program. Results: 902 participants answered the survey, with an age of 50 ±10 years old, 54.3% were women, with 1 (0-5) years living with type 2 diabetes. At baseline, 53% of the participants had at least 1 misconception, being more frequent in women (p=0.045) and in population with lower educational level (p<0.001). The most common were "emotional stress and fright cause diabetes" (34.4%), "in the control of my diabetes only matters glucose management" (15.2%) and "women with diabetes should not get pregnant" (11.8%). At basal, patients with misconceptions had higher HbA1c (9.0 ± 2.6 vs 8.4 ± 2.4, p <0.001), lower quality of life (DQOL 95.2 ± 26.2 vs 90.2 ± 23.6, p = 0.03), more problematic areas in diabetes (41.2 [21.2-58.4] vs 35 [17.5-52.6], p = 0.01), more depression (42.6% vs 32.9%, p = 0.003) and anxiety (58.6% vs 40.6%, p = 0.001) compared to patients without misconceptions. With the exception of HbA1c (6.6 ± 1 vs 6.4 ± 0.8, p = 0.025 at 1 year), no differences were observed in the annual visits.

Conclusion: We found a high prevalence of people with misconceptions in diabetes. This group had worst glycaemic control, higher scores in PAID questionnaire, lower quality of life and more depression and anxiety symptoms. Participants with misconceptions had lower educational level. An educative program an educational assistance program can minimize differences by eradicating misconceptions.

Abstract:
Comprehensive care refers to addressing all aspects of the patient’s life that can determine outcomes in the care of a disease. In all chronic diseases, comprehensive care is recommended as the standard approach to achieve excellent quality care. In this way, the main objective is to direct all patient-centered attention. For this, the systematization of medical aspects, mental health, education and lifestyle changes is required, taking as a central point the patient’s resource (medical, cognitive, social and economic). In this document, we address the comprehensive management in type 2 diabetes and propose the aspects that seek to contribute to the achievement of control goals and improvement in the quality of care.

Abstract:
Introduction: Lipid control is essential in type 2 diabetes mellitus (T2DM). The aim of this study is to investigate factors associated with lipid therapy adherence and achievement of goals in real-life setting among patients with recently diagnosed T2DM.

Research design and methods: This is a longitudinal analysis in a center of comprehensive care for patients with diabetes. We include patients with T2DM, <5 years of diagnosis, without disabling complications (eg, amputation, myocardial infarct, stroke, proliferative retinopathy, glomerular filtration rate <60 mL/min/m2) and completed 2-year follow-up. The comprehensive diabetes care model includes 9 interventions in 4 initial visits and annual evaluations. Endocrinologists follow the clinic's guideline and adapt therapy to reach risk-based treatment goal. The main outcome measures were the proportion of patients meeting low-density lipoprotein cholesterol (c-LDL) (<100 mg/dL) and triglycerides (<150 mg/dL) and proportion of patients taking statin, fibrate or combination at baseline, 3 months and annual evaluations.

Results: We included 288 consecutive patients (54±9 years, 53.8% women), time since T2DM diagnosis 1 (0-5) year. Baseline, 10.8% patients were receiving statin therapy (46.5% moderate-intensity therapy and 4.6% high-intensity therapy), 8.3% fibrates and 4.2% combined treatment. The proportion of patients with combined treatment increased to 41.6% at 3 months, decreased to 20.8% at 1 year and increased to 38.9% at 2 years of evaluation. Patients receiving treatment met LDL and triglycerides goals at 3 months (17% vs 59.7%, relative ratio (RR)=0.89, 95% CI 0.71 to 1.12), at 1 year (17% vs 26.7%, RR=0.62, 95% CI 0.41 to 0.95) and at 2 years (17% vs 29.9%, RR=0.63, 95% CI 0.43 to 0.93). Main reasons for medication suspension: patient considered treatment was not important (37.5%) and other physician suspended treatment (31.3%).

Conclusion: 88.2% of patients with T2DM required lipid-lowering drugs. Education for patients and physicians is critical to achieve and maintain diabetes goals.

Abstract:
Introduction: To assess the cost-effectiveness of a multidisciplinary and comprehensive innovative diabetes care program (CAIPaDi) versus usual treatment in public health institutions.

Research design and methods Using a cost-effectiveness analysis, we compared the CAIPaDi program versus usual treatment given in Mexican public health institutions. The analysis was based on the IQVIA Core Diabetes Model, a validated simulation model used to estimate long-term clinical outcomes. Data were prospectively obtained from the CAIPaDi program and from public databases and published papers. Health outcomes were expressed in terms of life-years gained and quality-adjusted life years (QALYs). Health and economic outcomes were estimated from a public perspective and discounted at 5% per year over a 20-year horizon. Costs are reported in US dollars (US$) of 2019. A probabilistic sensitivity analysis was performed using life-years gained and QALYs.

Results The CAIPaDi costs on average US$559 (95% CI: −$879 to −$239) less than the usual treatment (95% CI: −$879 to −$239) and produced a difference in mean life-years gained (0.48, 95% CI: 0.45 to 0.52) and mean QALYs (1.43, 95% CI: 1.40 to 1.46). The cost-effectiveness ratio resulted in a saving per life-year gained of −US$1155 (95% CI: −$1962 to −$460). Mean differences in QALYs resulted in a saving per QALY of −US$735 (95% CI: −$1193 to −$305). Probabilistic sensitivity analysis proved the results are robust on both life-years gained and QALYs.

Conclusions CAIPaDi has a better cost-effectiveness ratio than the usual therapy in Mexican public health institutions.

Abstract:
Objective: To investigate whether a peer-support (PS) program at-distance (PSAD) helps maintain metabolic and mental health in patients with a recent diagnosis of type 2 diabetes (T2DM) after a multidisciplinary intervention.

Methods: Patients were randomized in PSAD and PS face-to-face groups (PSFF). Leaders were selected if they accomplished the eligibility criteria such as metabolic control and mental health department approval.

Results: We included 133 patients divided into three groups, at-distance (n=62), face-to-face (n=59), and leaders (n=12). Patients in the PSFF had higher odds of reaching glycemic targets at three months than PSAD (OR 2.52 95%CI 1.18-5.38, p=0.01) and improved scores in Diabetes Quality of Life Measure (DQoL) and empowerment.

Conclusion: PS increases long-term empowerment and decreases problem areas in T2DM, which increases the likelihood of achieving HbA1c target goals, LDL-C control, and promotes weight loss.

Abstract:
Background and aims: Type 2 diabetes mellitus is one of the major public health concerns. The current lifestyle and advances in technology resulted in the development of a virtual mode of professional healthcare, which is an effective alternative method of management of patients. This study aimed to assess the feasibility of implementation of a virtual comprehensive care programme during the COVID-19 pandemic, patients’ acceptance and the changes in self-care behaviours, metabolic parameters and emotional factors.

Methods: The programme employed in this study included nine health interventions in 1 day. Due to the COVID-19 pandemic, the mode of interventions, including questionnaires, patient evaluations and a satisfaction survey, was modified to the virtual form in 2020. This study assessed the changes in self-care behaviours, metabolic parameters and emotional factors and compared the data pertaining to patients who received virtual healthcare in 2020 with those who received face-to-face modality of medical care in 2019.

Results: During June to November 2020, 130 patients received healthcare by means of the virtual modality. The change in modality of healthcare was feasible and 75% of the patients displayed good acceptance of the same. The evaluation of self-care behaviours included self-monitoring blood glucose (SMBG) levels, foot care and regular exercise. The duration of exercise decreased from 120 to 0 min/week (p < 0.001). However, there was no change in metabolic parameters. Regarding the mental health parameters, we observed an increase in the proportion of patients with anxiety (21.5% versus 11.1%), depressive symptoms (10.8% versus 4.3%), diabetes distress (18.5% versus 11.1%) and prescription of psychotropic drugs (32.8% versus 18.2%) (p < 0.05) in virtual versus face-to-face, respectively.

Conclusion: The virtual comprehensive care programme for the management of patients with diabetes is a feasible approach that allows healthcare professionals to provide an adequate care during the COVID-19 pandemic.

Abstract:
Purpose: First-degree family members of patients with type 2 diabetes have a higher risk of developing diabetes. Attendance in a diabetes prevention program is essential to implement prevention strategies. However, many relatives drop out. Identifying the causes behind the program abandonment is necessary to improve attendance adherence.

Methods: We reviewed six different databases for causes of treatment abandonment in prevention programs for type 2 diabetes published between 1980 and 2020. Eleven articles met inclusion criteria and varied in sample size, ethnicity, gender, age of the participating patients, and length of follow-up. Causes of abandonment were categorized into social, biological, lifestyle, and emotional. Results: Sample sizes of the selected studies ranged from 143 to 128,520 subjects. The main barriers were age, economic difficulties, ignorance about risk factors, family history of diabetes, living in public housing, marital status, comorbidities, and low consumption of fruits and vegetables. Physicians' attitudes toward prediabetes screening were also a barrier.

Conclusion: People at risk of developing diabetes face multiple barriers to preventing the development of this disease. During the research, the variety of reasons causing dropouts in prevention programs was great and diverse.

Abstract:
The COVID-19 pandemic had a significant impact on people with chronic degenerative diseases. Diabetes has been identified as an important comorbidity for the rapid progression to the severe form of the disease. In addition to the main pulmonary manifestations, damage and some potential sequelae have been described in various systems, so it is crucial to also direct attention to rehabilitation and data collection on the evolution of patients with diabetes affected by COVID-19. Education and training play a key role in alerting patients with diabetes to its implications and possible consequences.

Abstract:
Purpose: To describe the metabolic status and clinical characteristics associated with NPPD in patients with less than five years of T2D diagnosis and explore the role of age in the presentation of psychiatric comorbidities.

Patients and Methods: This was a cross-sectional study of subjects who attended a comprehensive care program. Patients were assessed using the Mini-International Neuropsychiatric Interview, and clinical and metabolic characteristics were registered. Multivariate logistic regression analyses were conducted to identify risk and protective factors for psychiatric disorders. We performed an analysis to further explore age’s influence on our results.

Results: We included 1953 patients, and 40.1% had any psychiatric disorder. Younger age, female sex, and personal psychiatric history were associated with NPPD. The use of insulin was reported as a protective factor for eating disorders. Body mass index was associated with any psychiatric disorders and eating disorders. The analysis of age reported that patients younger than 45 years had the worst metabolic parameters and increased odds for NPPD, while patients older than 65 years had the best metabolic measures and decreased odds for psychiatric comorbidity.

Conclusion: NPPD were frequent comorbidities in our sample; younger age, female sex, and personal psychiatric history were the most important factors associated with psychiatric comorbidities. Younger subjects experience a higher risk for psychiatric disorders and worst metabolic control.