Evaluation of Pharmacist- or Nurse-driven Long-acting Insulin Titration Protocol in Adult Primary Care Patients with Type 2 Diabetes

INTRODUCTION Studies have supported protocolized insulin titration to optimize insulin therapy. We implemented a long acting insulin titration (LAIT) protocol in a primary care setting to aid patients achieve optimal control of their diabetes. The purpose of the study was to evaluate the performance of the LAIT protocol. METHODS This retrospective analysis included patients ≥18 years with type 2 diabetes (T2D) and a hemoglobin A1c (A1C) \u3e8% who were managed as outpatients at clinics within our health care system. We collected demographic and clinical data before and after a patient’s enrollment in the LAIT protocol. Our primary outcome measure was the change in A1C value between pre-protocol enrollment and post-protocol measurement. RESULTS Nurse care managers managed 180 (87.8%) patients while 25 (12.2%) were managed by pharmacists. Patients enrolled in the LAIT protocol experienced a significant decrease in A1C (from 9.97 ± 1.85% pre-referral to 8.60 ± 1.67% post-referral, p DISCUSSION The LAIT protocol was successful in improving glycemic control among patients with T2D. Future enhancements to the protocol could focus on analyzing referral utilization and patient engagement. CONCLUSION The LAIT protocol allows pharmacists and nurse care managers to make a significant contribution toward achieving glycemic goals in those with uncontrolled diabetes

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified