Screening for type 2 diabetes after a diagnosis of gestational diabetes by ethnicity: A retrospective cohort study

Aims: To estimate rates and identify determinants of post-partum glucose screening attendance in women with a history of gestational diabetes mellitus (GDM). Methods: Retrospective cohort study using the Clinical Practice Research Datalink linked to Hospital Episode Statistics, to identify women diagnosed with GDM between 01/01/2000 and 05/11/2018. Age adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression models. Results: In 10,868 women with GDM, with an average follow-up of 5.38 years (95% CI 5.31,5.45), there was an average of 3.79 (95% CI 3.70,3.89) screening episodes per individual, with a mean time to first screening test of 1.22 (95% CI 1.18, 1.25) years. South Asian women had a significantly greater likelihood of being screened compared to White women within the first 5 years post-partum, aOR: 1.89 95% CI (1.20,2.98). A low proportion of women received at least one test per year of follow-up (23.87%). Older age at GDM diagnosis, polycystic ovary syndrome, prescribed medication for GDM, and living in England, were all associated with a greater likelihood of being screened. Conclusion: While the majority of women with previous GDM receive at least one glucose screening test within the first 5 years post-partum, fewer than a quarter of them receive on average one test per year of follow-up. Developing strategies to motivate more women to attend screening in primary care is essential

Adapted cardiac rehabilitation for people with sub-acute, mild-to-moderate stroke: a mixed methods feasibility study

Objective: To determine the recruitment strategy, acceptability, adherence, outcome measures, and adverse events for a definitive study that will explore adapted cardiac rehabilitation (CR) for people post-stroke with mild-to-moderate severity stroke in the sub-acute stage of recovery. Design: Mixed methods feasibility study. Setting: Acute hospital setting, neurology outpatients and community hospitals. Participants: 32 participants with stroke (mean age: 64.4 years) of median National Institutes of Health Stroke Scale (NIHSS) score 2 (range: 0 to 6) within six months of stroke. Intervention: All participants attended six weeks, adapted CR within one to six months after a stroke. A combined class with people post cardiac event. Main outcome measures: Incremental shuttle walk test (ISWT), blood pressure, heart rate, weight, body mass index, quality of life, fatigue, anxiety and depression, tone, falls, stroke attitude and knowledge, physical activity (accelerometry) and functional ability. Qualitative: Interviews with participants, non-participants and people post-cardiac event. Focus groups with Stroke and CR teams. Results: 32 participants were recruited. The programme was acceptable to people with mild stroke (NIHSS 2. Clinical Trial Registration Number: ISRCTN14861846

Factors associated with therapeutic inertia in individuals with type 2 diabetes mellitus started on basal insulin

Aim: In this study we aim to identify the factors associated with treatment inertia in patients with type 2 diabetes mellitus (T2DM) who have been recently started on basal insulin (BI). Methods: Using UK CPRD GOLD, we identified adults with T2DM with suboptimal glycaemia (HbA1c within 12 months of BI ≥ 7% (≥53 mmol/mol)). We used multivariable Cox regression model to describe the association between patient characteristics and the time to treatment intensification. Results: A total of 12,556 patients were analysed. Compared to individuals aged < 65 years, those aged ≥ 65 years had lower risk of treatment intensification (HR: 0.69; 95% CI: 0.64–0.73). Other factors included being female (0.93, 0.89–0.99), longer T2DM duration (0.99, 0.98–0.99), living in the most deprived areas (0.90, 0.83–0.98), being a current smoker (0.91, 0.84–0.98), having one (0.91, 0.85–0.97) or more than one comorbidity (0.88, 0.82–0.94), and patients who were on metformin (0.71, 0.63–0.80), or 2nd generation sulphonylureas (0.85; 0.79–0.92) or DPP4 inhibitors (0.87, 0.82–0.93) compared to those who were not. Conclusion: Therapeutic inertia still remains a major barrier, with multiple factors associated with delay in intensification. Interventions to overcome therapeutic inertia need to be implemented at both patient and health care professional level

COVID-19 vaccine uptake and hesitancy opinions from frontline health care and social care workers: Survey data from 37 countries

Background and aimsVaccine hesitancy is an ongoing major challenge. We aimed to assess the uptake and hesitancy of the COVID-19 vaccination.MethodsA short online survey was posted between April 12 to July 31, 2021 targeted at health and social care workers (HCWs) across the globe.Results275 from 37 countries responded. Most were hospital or primary care physicians or nurses, 59% women, aged 18–60 years, and 21% had chronic conditions with most prevalent being diabetes, hypertension, and asthma. We found that most HCWs (93%) had taken or willing to receive the COVID-19 vaccine. While 7% were vaccine hesitant (mainly women aged 30–39 years), respondents main concerns was the safety or potential side effects. Vaccine willing respondents raised concerns of unequal access to the COVID-19 vaccination in some countries, and highlighted that the only solution to overcoming COVID-19 infections was the vaccine booster doses given annually and free mass vaccination.ConclusionsThis study found that the majority of the frontline HCWs are willing to receive the COVID-19 vaccine. Further promotion of the COVID-19 vaccine would reassure and persuade HCWs to become vaccinated.</div