Socio-economic status and HbA1c in type 2 diabetes: A systematic review and meta-analysis

Up until now, differences in HbA1c levels by socio-economic status (SES) have been identified, but not yet quantified in people with type 2 diabetes. The aim of this study was therefore to assess the difference in HbA1c levels between people with type 2 diabetes of different SES in a systematic review and meta-analysis. A systematic literature search was conducted in MEDLINE, Embase, Ebsco, and the Cochrane Library until January 14, 2018. Included studies described adults with type 2 diabetes in whom the association between SES and HbA1c levels was studied. Studies were rated for methodological quality and data were synthesized quantitatively (meta-analysis) and qualitatively (levels of evidence), stratified for type of SES variable, i.e., education, income, deprivation, and employment. Fifty-one studies were included: 15 high, 27 moderate, and 9 of low methodological quality. Strong evidence was provided that people of low SES have higher HbA1c levels than people of high SES, for deprivation, education, and employment status. The pooled mean difference in HbA1c levels between people of low and high SES was 0.26% (95% CI, 0.09-0.43) or 3.12 mmol/mol (95% CI, 1.21-5.04) for education and 0.20% (95% CI, −0.05 to 0.46) or 2.36 mmol/mol (95%CI, −0.61 to 5.33) for income. In conclusion, our systematic review and meta-analysis showed that there was an inverse association between SES and HbA1c levels in people with type 2 diabetes. Future research should focus on finding SES-sensitive strategies to reduce HbA1c levels in people with type 2 diabetes

Effectiveness of a PLISSIT model intervention in patients with type 2 diabetes mellitus in primary care: design of a cluster-randomised controlled trial

Sexual dysfunction is prevalent in patients with type 2 diabetes mellitus, but remains one of the most frequently neglected complications in diabetes care. Both patients and care providers appear to have difficulty with discussing sexual problems in diabetes care. A sexual counselling model for care providers, such as the PLISSIT model, might be a useful tool to improve the discussion of sexual issues in patients with type 2 diabetes mellitus. PLISSIT stands for Permission, Limited Information, Specific Suggestions, and Intensive Therapy. Even though the use of the PLISSIT model has often been recommended in diabetes care, no evidence with regards to its effectiveness in patients with type 2 diabetes mellitus exists. This study describes the design of a cluster-randomised controlled trial evaluating the effectiveness of a PLISSIT-model intervention in men and women with type 2 diabetes mellitus in primary care. Patients with type 2 diabetes mellitus, aged 40-75 years, who indicate to be dissatisfied about their sexual functioning and that they would like to talk about their sexual problem(s) with their general practitioner are recruited. All participants receive an information leaflet from the practice nurse. In the intervention group, each participant will also receive sexual counselling based on the PLISSIT model from their general practitioner. In the control group, usual care will be provided to those participants requesting an appointment with their general practitioner when the information leaflet was not deemed sufficient. Primary outcomes include sexual functioning, satisfaction about sexual function, and quality of life. Secondary outcomes are depressive symptoms, sexual distress, emotional well-being, and treatment satisfaction. Outcomes will be measured by means of self-report questionnaires at baseline, and after 3 and 12 months post-baseline. Treatment satisfaction will be assessed in telephone interviews. This paper describes the design of a cluster-randomised controlled trial that will investigate the effectiveness of a PLISSIT-model intervention in patients with type 2 diabetes mellitus in primary care. Our study will add important and currently missing insight into the effectiveness of PLISSIT on important patient-reported outcomes of men and women with type 2 diabetes mellitus. Dutch Trial Registry NTR480

Screening for sexual dissatisfaction among people with type 2 diabetes in primary care

Aims The identification and discussion of sexual care needs in people with type 2 diabetes mellitus (T2DM) in primary care is currently insufficient. The objective of this study was to determine the prevalence of sexual dissatisfaction, sexual problems and need for help by using a screening instrument among people with T2DM in primary care. Methods Data were collected in 45 general practices in the Netherlands from January 2015 to February 2016. The Brief Sexual Symptom Checklist (BSSC) was used to screen among 40–75 year old men and women. Results In total, 786 people with T2DM (66.5% men) were screened. The prevalence of sexual dissatisfaction was 36.6%, significantly higher among men than among women (41.1% vs. 27.8%). Sexually dissatisfied men most often reported erectile dysfunction (71.6%); for sexually dissatisfied women, low sexual desire (52.8%) and lubrication problems (45.8%) were most common. More than half of all dissatisfied people had a need for care (61.8%), significantly more men than women (66.8% vs. 47.2%). Conclusions One third of people with T2DM is sexually dissatisfied and more than half of these people report a need for help. The BSSC could be used a tool to proactively identify sexually dissatisfied people in primary care