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DIABETES

Telemedicine in Diabetic Retinal Screening: Pre- and Post-COVID-19 Challenges a New Perspective (Baig A, Zafar A)

Telemedicine in ophthalmology has been established for decades and has shown particular success in diabetic retinal screening, as demonstrated by the UK National Diabetic Eye Screening Programme introduced in 2003; however, much of this screening has relied on human graders for triage. The COVID-19 pandemic disproportionately affected patients with chronic conditions such as diabetes and contributed to significant increases in waiting lists, highlighting the need for more efficient approaches. Even before the pandemic, research had demonstrated the potential of artificial intelligence (AI) and deep-learning algorithms to analyse retinal images obtained during diabetic retinopathy screening. This transition from human graders to AI-based image analysis could allow screening of a wider patient population, helping to address backlogs that have worsened since the pandemic. Understanding the role of AI in this context—particularly in terms of patient acceptability, cost-effectiveness, and reliability—is therefore crucial, as it offers promising solutions to streamline and future-proof diabetic retinopathy screening services.

Study Link https://doi.org/10.4103/JME.JME_173_23.

 

As therapeutic options for type 2 diabetes expand, healthcare professionals face increasing complexity in treatment decisions, contributing to therapeutic inertia, defined as the failure to escalate or de-escalate therapy when clinically indicated. Although widely studied in various settings, therapeutic inertia has not been examined specifically among primary care physicians with an interest in diabetes, who are increasingly central to managing complex cases in the community. This retrospective audit in the UK assessed its prevalence and the predictive role of patient-level characteristics in this group of clinicians. Among 240 patients reviewed, therapeutic inertia was observed in 53 cases (22.1%). The full model containing all selected variables was not statistically significant (p = 0.59), and no individual patient-level characteristic was predictive of therapeutic inertia. These findings suggest that therapeutic inertia affects approximately one-fifth of patients managed by primary care physicians with an interest in diabetes, highlighting the need for further research into clinician and system-level factors driving this phenomenon.

Study Link 

https://doi.org/10.1016/j.pcd.2017.09.001.

 

We conducted a randomised controlled trial across 11 primary care practices in the UK to compare a computer-based risk score (Leicester Practice Computer Risk Score, LPCRS) with a patient self-assessment score (Leicester Self-Assessment Score, LSAS) for identifying individuals at risk of type 2 diabetes. A total of 577 patients aged 40–75 years with no current diabetes diagnosis were recruited and followed up. The rate of self-referral for blood tests was significantly higher in the LPCRS group than in the LSAS group (118.98 [95% CI: 102.85–137.64] vs 92.14 [95% CI: 78.25–108.49] per 1000 high-risk patient-years, p = 0.022). However, the combined rate of diagnosis of type 2 diabetes and prediabetes (impaired glucose tolerance or impaired fasting glucose) did not differ significantly between groups (15.12 [95% CI: 9.11–25.08] vs 14.72 [95% CI: 9.59–22.57] per 1000 high-risk patient-years, p = 0.699). Economic analysis indicated that the cost per new case of type 2 diabetes diagnosed was lower for the LPCRS (£168 [95% CrI: 76–364]) than for the LSAS (£352 [95% CrI: 109–1148]). These findings suggest that, compared with a self-assessment tool, the computer-based risk score increases uptake of initial blood testing and offers potential cost-effectiveness advantages in primary care diabetes risk screening.

Study Link

https://doi.org/10.1016/j.diabres.2016.04.054.

 

This qualitative study explored perceptions of clinical inertia—the failure to intensify treatment in patients with suboptimal blood glucose control—among primary healthcare providers in Leicestershire and Northamptonshire, UK. Using purposive sampling based on routine target achievement data, twenty semi-structured interviews were conducted face-to-face or by telephone, and thematic analysis was informed by the constant comparative approach. A key theme that emerged was the attribution and explanation of responsibility for clinical inertia. While participants generally accepted some responsibility, many held inaccurate perceptions of target achievement in their centres and sought to minimize accountability by citing patient-level barriers, such as comorbidities and human fallibility, as well as system-level barriers, particularly time constraints. Addressing clinical inertia was not seen as straightforward, reflecting a complex and cumulative pattern of obstacles. The findings suggest that provider, patient, and system-level barriers should be considered together, and that acknowledging responsibility may serve as a positive motivator for change.

Study Link

https://doi.org/10.1111/dme.12592


Diabetes is a highly prevalent and serious chronic disease, ranked as the fourth leading cause of death in Europe. Despite clear evidence supporting the benefits of tight glycemic control, many people with diabetes fail to achieve target glucose levels. A major contributing factor is clinical inertia, defined as the recognition of suboptimal control but failure to act by primary care professionals. Effective management of type 2 diabetes (T2DM) requires early detection of problems, realistic goal setting, improved patient adherence, comprehensive knowledge of pharmacotherapeutic options, and timely intervention. Overcoming clinical inertia is essential for healthcare professionals to ensure appropriate and prompt intensification of therapy, ultimately improving patient outcomes.

Study Link

https://doi.org/10.1016/j.pcd.2010.07.003