Automatic identification of type 2 diabetes, hypertension, ischaemic heart disease, heart failure and their levels of severity from Italian General Practitioners' electronic medical records: a validation study Validation of the IMS CORE Diabetes Model. Systemic Cytokines in Type 2 Diabetes Mellitus and Chronic Periodontitis. Development and Validation of a Computer Application to Aid the Physician's Decision-Making Process at the Start of and during Treatment with Insulin in Type 2 Diabetes: A Randomized and Controlled Trial The effectiveness of yoga to prevent diabetes mellitus type 2
Objectives The Italian project MATRICE aim ed to assess how well cases of type 2 diabetes ( T2DM ) , hypertension , ischaemic heart disease ( IHD ) and heart failure ( HF ) and their levels of severity can be automatically extracted from the Health Search /CSD Longitudinal Patient Data base ( HSD ) . From the medical records of the general practitioners ( GP ) who volunteered to participate , cases were extracted by algorithms based on diagnosis codes , keywords , drug prescriptions and results of diagnostic tests . A r and om sample of identified cases was vali date d by interviewing their GPs . Setting HSD is a data base of primary care medical records . A panel of 12 GPs participated in this validation study . Participants 300 patients were sample d for each disease , except for HF , where 243 patients were assessed . Outcome measures The positive predictive value ( PPV ) was assessed for the presence/absence of each condition against the GP 's response to the question naire , and Cohen 's κ was calculated for agreement on the severity level . Results The PPV was 100 % ( 99 % to 100 % ) for T2DM and hypertension , 98 % ( 96 % to 100 % ) for IHD and 55 % ( 49 % to 61 % ) for HF . Cohen 's kappa for agreement on the severity level was 0.70 for T2DM and 0.69 for hypertension and IHD . Conclusions This study shows that individuals with T2DM , hypertension or IHD can be validly identified in HSD by automated identification algorithms . Automatic queries for levels of severity of the same diseases compare well with the corresponding clinical definitions , but some misclassification occurs . For HF , further research is needed to refine the current algorithm BACKGROUND The IMS CORE Diabetes Model ( CDM ) is a widely published and vali date d simulation model applied in both type 1 diabetes mellitus ( T1DM ) and type 2 diabetes mellitus ( T2DM ) analyses . Validation to external studies is an important part of demonstrating model credibility . OBJECTIVE Because the CDM is widely used to estimate long-term clinical outcomes in diabetes patients , the objective of this analysis was to vali date the CDM to contemporary outcomes studies , including those with long-term follow-up periods . METHODS A total of 112 validation simulations were performed , stratified by study follow-up duration . For long-term results ( ≥15-year follow-up ) , simulation cohorts representing baseline Diabetes Control and Complications Trial ( DCCT ) and United Kingdom Prospect i ve Diabetes Study ( UKPDS ) cohorts were generated and intensive and conventional treatment arms were defined in the CDM . Predicted versus observed macrovascular and microvascular complications and all-cause mortality were assessed using the coefficient of determination ( R(2 ) ) goodness-of-fit measure . RESULTS Across all validation studies , the CDM simulations produced an R(2 ) statistic of 0.90 . For validation studies with a follow-up duration of less than 15 years , R(2 ) values of 0.90 and 0.88 were achieved for T1DM and T2DM respectively . In T1DM , validating against 30-year outcomes data ( DCCT ) result ed in an R(2 ) of 0.72 . In T2DM , validating against 20-year outcomes data ( UKPDS ) result ed in an R(2 ) of 0.92 . CONCLUSIONS This analysis supports the CDM as a credible tool for predicting the absolute number of clinical events in DCCT- and UKPDS-like population s. With increasing incidence of diabetes worldwide , the CDM is particularly important for health care decision makers , for whom the robust evaluation of health care policies is essential BACKGROUND Cytokine dysregulation plays an important role in Type 2 Diabetes Mellitus ( T2DM ) and Chronic Periodontitis ( CP ) with a commonality in pathogenic mechanisms . CP is considered the sixth complication of diabetes and may have an increased influence on systemic levels of cytokines in individuals with T2DM . OBJECTIVE This study investigated two pro- , and two presumed anti-inflammatory cytokines and their ratios in the serum of healthy individuals , in chronic periodontitis with and without T2DM with , and without CP and in CP alone aim ed at evaluating the systemic inflammatory burden of a local oral infection . METHODS Eighty participants were divided equally into four groups as healthy volunteers ( H ) and patients having T2DM with , and without CP ( T2DM+CP , and T2DM ) and only CP ( CP ) . Serum sample s were collected to measure glycated hemoglobin ( HbA1c ) , R and om Blood Sugar ( RBS ) and also Tumor Necrosis Factor (TNF)-α , Interleukin (IL)-4 , -6 - 10 were assessed using commercially available ELISA kits . RESULTS The cytokines were detected in all groups . Significant differences were observed between groups for all the clinical , biochemical parameters and cytokines . Cytokine levels and the ratios showed significant correlations . The ratios of the cytokines differed significantly amongst groups , were highest in T2DM+CP . CONCLUSION In this study , the cytokine ratios provided a qualitative profile along with the absolute levels in T2DM with periodontitis , indicative of an intensified systemic inflammatory state Background : Achieving optimum blood glucose control in patients with type 2 diabetes mellitus ( T2DM ) is difficult . Some primary care physicians ( PCPs ) delay the start of insulin use because of the uncertainty in intensifying insulin therapy . The objective was to develop and vali date a computer application ( CA ) that helps PCPs to make decisions about insulin therapy in order to achieve a significant improvement in glycated hemoglobin ( HbA1c ) . Methods : This was a cluster-r and omized clinical trial . Fourteen primary care centers ( PCCs ) in Madrid with 66 PCPs and 697 T2DM patients on insulin therapy were r and omly divided into two groups of seven PCCs each . In the intervention group , seven PCCs included 39 PCPs and 365 T2DM patients on insulin therapy . These PCPs were free to use the CA . A further seven PCCs were assigned to the control group with 27 PCPs and 332 T2DM patients on insulin therapy . The control group did not use the CA . The duration of the trial was 18 months to vali date the CA . The outcome was a change in HbA1c from baseline . Results : In the intervention group , the final HbA1c was 7.19 % ( st and ard deviation [ SD ] ± 0.93 ) , with a difference from the start of −0.69 % ( p = .001 ) . In the control group , it was 7.71 % ( SD ± 1.37 ) , with a difference from the start of −0.09 % ( p not significant ) . Conclusions : This CA helps to improve HbA1c figures of T2DM patients with insulin when it is used by PCPs to make decisions when starting , continuing , or changing insulin and its dosage Background : Type 2 diabetes mellitus ( T2DM ) is becoming a leading problem worldwide . Emerging reports reveal alarming evidence of increasing prevalence of T2DM that has reached p and emic levels . Despite the significant incidence , there are limited reliable data re sources and comprehensive systematic review and meta- analysis on the effects of yoga on people who are a prediabetic or high risk for developing T2DM . Objective : The objective of this protocol is to conduct a full-scale systematic review and meta-analyses on the effects of yoga on people who are prediabetes or high risk of developing T2DM . Methods : The articles enrolled in the study will be retrieved from the online data bases between 2002 and the date the search es are executed . The search es will be repeated just before the final analyses and further relevant studies for inclusion . We will conduct a bibliographic search in data bases : Medline / PubMed , Scopus , Cochrane Library , EBSCO , and IndMED using keywords including prediabetes state , high risk for diabetes , metabolic syndrome , and yoga . A defined search strategy will be implemented along with selection criteria to obtain full-text articles of relevant studies . This study protocol was prepared according to the Preferred Reporting Items for Systematic Review s and Meta- Analysis for Protocol s 2015 guidelines . There will be no language restrictions . Ethics and dissemination : The proposed study will be based on published studies and publicly available anonymized data without directly involving human participants and therefore requires neither formal human ethical review nor approval by a human research ethics committee . We published an outline of the protocol in the International Prospect i ve Register of Systematic Review s ( PROSPERO ) in 2018 . We plan to disseminate the findings of this systematic review and meta- analysis through publication in a peer- review ed journal and presentation at relevant conference proceedings . In addition , we believe the results of the systematic review will have implication s for policy and practice . We will prepare policymaker summary using a vali date d format , disseminate through social media and email discussion groups . Review registration number : PROSPERO registration number CRD
The proposed EHR-based approach will quantify the T2DM severity for primary care performance management and inform the methodology for measuring severity of other primary care-managed chronic conditions .
INTRODUCTION The increasing prevalence of type 2 diabetes mellitus ( T2DM ) presents a significant burden on affected individuals and healthcare systems internationally .
There is , however , no agreed vali date d measure to infer diabetes severity from electronic health records ( EHRs ) .
We aim to quantify T2DM severity and vali date it using clinical adverse outcomes .