4. Comprehensive Medical Evaluation and Assessment of Comorbidities:<i>Standards of Care in Diabetes—2023</i>

ElSayed, Nuha A.; Aroda, Vanita R.; Bannuru, Raveendhara R.; Brown, F. C.; Bruemmer, Dennis; Collins, Billy; Cusi, Kenneth; Hilliard, Marisa E.; Isaacs, Diana; Johnson, Eric L.; Kahan, Scott; Khunti, Kamlesh; Lyons, Sarah K.; Perry, Mary Lou; Prahalad, Priya; Pratley, Richard E.; Seley, Jane Jeffrie; Stanton, Robert C.; Gabbay, Robert A.

doi:10.2337/dc23-s004

Cited by 92 publications

(140 citation statements)

References 256 publications

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“…We also did not evaluate the advanced hepatic fibrosis or steatosis status. Recently, ADA guideline proposed algorithm using FIB-4 index for risk stratification in individuals with NAFLD or nonalcoholic steatohepatitis [ 48 ]. Further study should confirm the difference in fibrotic burden between MAFLD and its impact on HF outcomes.…”

Section: Discussionmentioning

confidence: 99%

The effect of metabolic dysfunction-associated fatty liver disease and diabetic kidney disease on the risk of hospitalization of heart failure in type 2 diabetes: a retrospective cohort study

Lee

Yoo²,

Kim³

et al. 2023

Diabetol Metab Syndr

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Background Diabetes mellitus is a major risk factor for heart failure. A recent consensus statement recommended annual cardiac biomarker testing (e.g. natriuretic peptide or high-sensitivity cardiac troponin) for all patients with diabetes. We aimed to identify patients at a higher risk of hospitalization for heart failure among patients with type 2 diabetes to prioritize those who would require screening. Methods Overall, 1,189,113 patients who underwent two medical health checkup cycles (2009–2012 and 2011–2014) and had stable diabetic kidney disease (DKD) phenotype in the Korean National Health Insurance Service database were included in this study. After excluding those with concurrent proteinuria (PU) and reduced estimated glomerular filtration rate, three groups (no-DKD, PU+DKD, and PU−DKD) were identified. A fatty liver index of ≥ 60 was defined as metabolic dysfunction–associated fatty liver disease (MAFLD). Patients were followed up until December 2018 or until outcomes developed. The Cox proportional hazard model was used to compare the risk of hospitalization for heart failure across groups. Results During an average of 6.6 years of follow-up, 5781 patients developed hospitalization for heart failure. After adjusting for covariates, the risk of hospitalization for heart failure was highest in the PU+DKD group [HR 3.12, 95% CI (2.75–3.55)], followed by the PU−DKD group [HR 1.85, 95% CI (1.73–1.99)] using the no-DKD group as the reference category. The risk of hospitalization for heart failure was comparable regardless of MAFLD status in patients who already had DKD. However, in the no-DKD group, the risk of hospitalization for heart failure was 1.4 times higher in patients with MAFLD than in those without [HR 1.41, 95% CI (1.31–1.52)]. Conclusions In lines with the international consensus statement, we suggest that annual cardiac biomarker testing should be conducted at least in patients with DKD and/or MAFLD.

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Section: Discussionmentioning

confidence: 99%

The effect of metabolic dysfunction-associated fatty liver disease and diabetic kidney disease on the risk of hospitalization of heart failure in type 2 diabetes: a retrospective cohort study

Lee

Yoo²,

Kim³

et al. 2023

Diabetol Metab Syndr

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“…Second, most guidelines recommend screening at least some patients with T2DM, though EASL guidelines restrict this recommendation to older adults and ADA includes people with pre-diabetes but restricts to those with elevated liver enzymes or steatosis on imaging. [30] The association between T2DM and at-risk NAFLD is well-established. As many as 70% of patients with T2DM have NAFLD and about 20% of individuals with T2DM also have clinically significant liver fibrosis [31,32].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Screening for At-Risk Nonalcoholic Fatty Liver Disease in the Primary Care Setting

Urias

Chen

2023

Semin Liver Dis

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While non-alcoholic fatty liver disease is a leading cause of end-stage liver disease, most patients with non-alcoholic fatty liver disease do not develop cirrhosis and its complications. Therefore, risk stratification using inexpensive, non-invasive screening modalities is critical to avoid overdiagnosis and overtreatment of a large proportion of the population. In this review, we discuss the data supporting screening and current professional society recommendations on this topic. Screening for at-risk non-alcoholic fatty liver disease is recommended in patients with risk factors including diabetes, the metabolic syndrome, hepatic steatosis, and elevated aminotransferases. Screening typically consists of noninvasive testing using serum biomarkers followed by elastography using specialized imaging modalities. This sequential screening approach accurately identifies both high- and low-risk patients and is cost effective when applied to at-risk populations. In conclusion, screening for advanced non-alcoholic fatty liver disease in the primary care setting is a crucial part of identifying high-risk patients who may benefit from aggressive intervention while avoiding overtreatment of patients at low risk of liver-related complications.

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“…4 In order to prevent or delay complications and optimize patients' quality of life, the intervention involves offering healthcare, such as providing education on problem-solving skills for all aspects of diabetes, exercise or medication adjustment, and so on. 5 There are two types of teleconsultation: (1) asynchronous teleconsultation, which involves monitoring and delivering feedback exclusively via short message service text messaging, email, internet/web-based platforms, home gateway, server, or post; and (2) synchronous teleconsultation, which involves real-time video interactions between physician(s) and patient(s) (via videoconferencing equipment of videophone, television, digital camera, webcam, and so on) and 2 BMJ Open Diab Res Care 2023;11:e003180. doi:10.1136/bmjdrc-2022-003180…”

Section: Introductionmentioning

confidence: 99%

“…Teleconsultation is a two-way conversation between caregivers and one or more patients using a variety of communication and information technologies (automated messaging system, email, internet, phone, or other devices without actual face-to-face interaction) 4. In order to prevent or delay complications and optimize patients’ quality of life, the intervention involves offering healthcare, such as providing education on problem-solving skills for all aspects of diabetes, exercise or medication adjustment, and so on 5. There are two types of teleconsultation: (1) asynchronous teleconsultation, which involves monitoring and delivering feedback exclusively via short message service text messaging, email, internet/web-based platforms, home gateway, server, or post; and (2) synchronous teleconsultation, which involves real-time video interactions between physician(s) and patient(s) (via videoconferencing equipment of videophone, television, digital camera, webcam, and so on) and real-time audio interactions (synchronous telephone coaching and counseling that link a number of patients and healthcare professionals at once) 6 7…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of synchronous teleconsultation for patients with type 2 diabetes mellitus: a systematic review and meta-analysis

Zhang

Xie

et al. 2023

BMJ Open Diab Res Care

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The popularity of teleconsultation during the COVID-19 pandemic enabled increased accessibility for individuals with type 2 diabetes mellitus (T2DM). However, previous studies did not distinguish between synchronous and asynchronous teleconsultation. We evaluated the effectiveness of synchronous teleconsultation for patients with T2DM. We searched Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library and Cochrane Database of Systematic Reviews,ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform databases from inception to July 2021. All included studies were randomized controlled trials of synchronous teleconsultation for adults with T2DM compared with usual care. Reviewers independently extracted data and used the Cochrane tool to evaluate risk of bias. Meta-analyses were conducted using random-effects models. A pooled mean difference for both HbA1c (%) and body mass index (BMI) (kg/m2), systolic blood pressure (SBP) (mm Hg), diastolic blood pressure (DBP) (mm Hg), and low density lipoprotein cholesterol (LDL-cholesterol) (mg/dL) were calculated. Patient-reported outcomes, such as depression, medication adherence, and quality of life, were also assessed. A total of 9807 abstracts were identified and 27 trials were included. Synchronous teleconsultation significantly resulted in greater decrease in HbA1c compared with usual care group (n=8746, 0.35, 95% CI 0.20 to 0.49, I2=73%, p<0.001). No significant effects on BMI (n=699, 0.08 kg/m2, 95% CI −0.54 to 0.69), SBP (n=5512, 1.32 mm Hg, 95% CI -0.09 to 2.73), DBP (n=2898, 0.17 mm Hg, 95% CI −1.18 to 1.52), or LDL-cholesterol (n=5276, 3.21 mg/dL, 95% CI −1.75 to 8.17) were found. The effect of teleconsultation in improving patient-reported outcomes was uncertain. Thus, synchronous teleconsultation could be an alternative to usual care. Systematic review registration is PROSPERO CRD42021267019.

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4. Comprehensive Medical Evaluation and Assessment of Comorbidities:Standards of Care in Diabetes—2023

Cited by 92 publications

References 256 publications

The effect of metabolic dysfunction-associated fatty liver disease and diabetic kidney disease on the risk of hospitalization of heart failure in type 2 diabetes: a retrospective cohort study

The effect of metabolic dysfunction-associated fatty liver disease and diabetic kidney disease on the risk of hospitalization of heart failure in type 2 diabetes: a retrospective cohort study

Screening for At-Risk Nonalcoholic Fatty Liver Disease in the Primary Care Setting

Effectiveness of synchronous teleconsultation for patients with type 2 diabetes mellitus: a systematic review and meta-analysis

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