Mingyue Zheng

Aims: To estimate the effectiveness of metformin on glycaemic parameters among participants with incident prediabetes attending Australian general practices.Methods: This retrospective cohort study used electronic health records of regular participants (3+ visits in two consecutive years) attending 383 Australian general practices (MedicineInsight). Participants with ‘incident’ prediabetes (newly recorded diagnosis between 2012 and 2017) and their glycaemic parameters (haemoglobin A1c [HbA1c] or fasting blood glucose [FBG]) at 6‐, 12‐, and 18–24 months post diagnosis (unexposed) or post‐management with metformin (treatment) were identified from the database. We estimated the average treatment effect (ATE) of metformin management on glycaemic parameters using both linear regression and augmented inverse probability weighting.Results: Of the 4770 investigated participants with ‘incident’ prediabetes, 10.2% were managed with metformin. Participants on metformin had higher HbA1c levels at the baseline than those unexposed (mean 45 mmol/mol [6.2%] and 41 mmol/mol [5.9%], respectively), but no differences were observed at 6–12 months (mmol/mol ATE 0.0, 95% CI −0.4; 0.7) or 12–18 months (ATE −0.3, 95% CI −1.2; 0.3). However, participants on metformin had lower mean HbA1c mmol/mol at 18–24 months (ATE −1.1, 95% CI −2.0; 0.1) than those unexposed. Consistent results were observed for FBG (ATE at 6–12 months −0.14 [95% CI −0.25; −0.04], 12–18 months 0.02 [95% CI −0.08; 0.13] and 18–24 months −0.07 [95% CI −0.25; 0.12]).Conclusion: The higher HbA1c and FBG baseline levels among participants with ‘incident’ prediabetes managed with metformin improved after 6–12 months of starting pharmacological management, and the effect persisted for up to 24 months. Management with metformin could prevent further deterioration of glycaemic levels.

Objectives: This study investigated whether the monitoring and control of clinical parameters are better among patients with newly compared with past recorded diabetes diagnosis. Design: Retrospective cohort study. Setting: MedicineInsight, a national general practice database in Australia. Participants: 101 875 ‘regular’ adults aged 18+ years with past recorded (2015–2016) and 9236 with newly recorded (2017) diabetes diagnosis. Main outcome measures: Two different groups of outcomes were assessed in 2018. The first group of outcomes was the proportion of patients with clinical parameters (ie, glycated haemoglobin A1c (HbA1c), blood pressure (BP), total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, estimated glomerular filtration rate and albumin-to-creatinine ratio) monitored at least once in 2018. The second group of outcomes were those related to diabetes control in 2018 (HbA1c ≤7.0%, (BP) ≤140/90 mm Hg, total cholesterol adj ) and adjusted probabilities (%) were obtained based on logistic regression models adjusted for practice variables and patients’ socio-demographic and clinical characteristics. Results: The study included 111 111 patients (51.7% men; mean age 65.3±15.0 years) with recorded diabetes diagnosis (11.0% of all 1 007 714 adults in the database). HbA1c was monitored in 39.2% (95% CI 36.9% to 41.6%) of patients with newly recorded and 45.2% (95% CI 42.6% to 47.8%) with past recorded diabetes (OR _adj 0.78, 95% CI 0.73 to 0.82). HbA1c control was achieved by 78.4% (95% CI 76.7% to 80.0%) and 54.4% (95% CI 53.4% to 55.4%) of monitored patients with newly or past recorded diabetes, respectively (OR _adj 3.11, 95% CI 2.82 to 3.39). Less than 20% of patients with newly or past recorded diabetes had their HbA1c, BP and total cholesterol levels controlled (OR _adj 1.08, 95% CI 0.97 to 1.21). Conclusions: The monitoring of clinical parameters was lower among patients with newly than past recorded diabetes. However, diabetes control was similarly low in both groups, with only one in five monitored patients achieving control of all clinical parameters.

Aims. To investigate the epidemiology of diabetes diagnosis and screening in Australian general practice. Methods. Cross-sectional study using electronic health records of 1,522,622 patients aged 18+ years attending 544 Australian general practices (MedicineInsight database). The prevalence of diagnosed diabetes and diabetes screening was explored using all recorded diagnoses, laboratory results, and prescriptions between 2016 and 2018. Their relationship with patient sociodemographic and clinical characteristics was also investigated. Results. Overall, 7.5 (95 CI 7.3, 7.8) of adults had diabetes diagnosis, 0.7 (95 CI 0.6, 0.7) prediabetes, and 0.3 (95 CI 0.3, 0.3) unrecorded diabetes/prediabetes (elevated glucose levels without a recorded diagnosis). Patients with unrecorded diabetes/prediabetes had clinical characteristics similar to those with recorded diabetes, except for a lower prevalence of overweight/obesity (55.5 and 69.9, respectively). Dyslipidaemia was 1.8 times higher (36.2 vs. 19.7), and hypertension was 15 more likely (38.6 vs. 33.8) among patients with prediabetes than with diabetes. Diabetes screening (last three years) among people at high risk of diabetes was 55.2 (95 CI 52.7, 57.7), with lower rates among young or elderly males. Conclusions. Unrecorded diabetes/prediabetes is infrequent in Australian general practice, but prediabetes diagnosis was also lower than expected. Diabetes screening among high-risk individuals can be improved, especially in men, to enhance earlier diabetes diagnosis and management.

Introduction Studies suggest that continuous glucose monitors (CGMs) play an important role in the management of diabetes. Although general acceptance has been reported by patients with type 2 diabetes towards the use of CGMs, potential barriers exist like pain due to sensor insertion, accidental removal of the device or adhesive strip, impacts of daily activities, skin reactions to sensor adhesive, etc. This systematic review of qualitative studies aims to explore the perspectives, experiences and narratives of patients and caregivers about CGM use, and its barriers and facilitators. Methods and analysis This review will include qualitative studies and cross-sectional and longitudinal cohort studies using open-ended questions, published in English by 30 October 2021. The following electronic databases will be searched: Cochrane Library, PubMed, EMBASE, CINAHL, PsycINFO and Scopus. A search of grey literature will be conducted via an online search of Google Scholar, WorldCat, ClinicalTrials.gov and OpenGrey A combined search strategy using medical subject headings (MeSH), controlled vocabulary and ‘free-text’ terms will be appropriately revised to suit each database. Primary outcomes will include patient and caregiver perspectives on diabetes management regarding glucose control; living with CGM (quality of life, experience of wearing a CGM); psychological aspects (anxiety, depression, emotional burden); barriers (technical issues, financial issues) to use of CGM and thoughts (interpretation, understanding) on the CGM report. A qualitative meta-synthesis will be conducted employing a systematic literature search of existing literature, quality assessment using study-specific tools and an aggregative thematic synthesis by a multidisciplinary team. Ethics and dissemination Ethical approval is not required since this is a systematic review. The results will help improve clinical implementation of CGMs on part of both patients and caregivers. PROSPERO registration number CRD42020152211.

Objective. Panax ginseng and Atractylodes macrocephala Koidz. (AMK) are widely used in treating various diseases; however, research is insufficient on measuring the relationship that exists by combining this drug pair using the copula function. Methods. In this study, 279 traditional Chinese medicine prescriptions containing the Panax ginseng and AMK drug pair were extracted from the prescription database for three types of screened indications, namely, diabetes mellitus, diarrhea, and insomnia. Following the principle of dose conversion, each dynasty unit was uniformly converted into a modern unit. Then, the kernel density distribution of Panax ginseng and AMK was fitted with their empirical distribution functions. Finally, the optimal copula function was selected from the copula function family as a t-copula function. Results. The empirical distribution and probability density functions of Panax ginseng and AMK were obtained. From the results, their Kendall rank correlation coefficients with indications of diabetes mellitus, insomnia, and diarrhea were 0.8689, 0.7858, and 0.7403, whereas their Spearman rank correlation coefficients were 0.9563, 0.9276, and 0.8958. Results also indicated that the use of the t-copula function can better reflect the correlation between Panax ginseng and AMK doses. Conclusion. From the three indications, the dose between Panax ginseng and AMK was positively correlated. This study, therefore, confirms the medicinal principle of Chinese medicine combining from the perspective of mathematical statistics. Results from this study are practical to evaluate the correlation between the drug pair doses, Panax ginseng and AMK, using the copula function model, which provides a new model for the scientific explanation of compatibility for Chinese medicines. This study also provides a methodological basis for more drug measurement studies and clinical medications.

Aims To explore the current status of Chinese nurses’ willingness to work during the COVID‐19 pandemic and the factors that influence them. Background The demand for frontline nurses continues to grow during the COVID‐19 pandemic, but their willingness varies significantly. Therefore, it is crucial to explore nurses’ willingness to report for frontline work. Methods A cross‐sectional study of 1,310 nurses from six tertiary hospitals, was conducted. The participants completed self‐administered online questionnaires. Results A total of 90.5% of nurses reported that they would like to voluntarily participate in frontline work. Those with previous training, higher self‐efficacy scores, and lower perceived risk and self‐worth scores were more likely to participate in frontline work, while nurses, who had 11–15 years of work experience and were worried about their family and the lack of family support, were less likely to be involved in frontline work. Conclusion This study found that the vast majority of nurses were willing to participate in frontline work and affirmed the positive effects of previous infection prevention training, self‐efficacy, and self‐worth. Implications for Nursing Management This research emphasises the necessity of infection prevention training and provides evidence for further emergency workforce deployment and incentives.

Background This study aimed to analyse which influencing factors may be more effective to achieve diabetes management targets in the community by the adaptive-lasso logistic regression model. Methods A cross-sectional study (N=1,127) was adopted to establish the adaptive-lasso logistic regression model of influencing factors for community management based on multi-stage cluster sampling data among patients with diabetes in China. Patient’s fasting blood glucose level, blood pressure, and triglycerides was collected. Results Overall, 90.6% of included people had a fasting glucose level higher than 6.1mol/L, and 9.4% of them were below 6.1mol/L. By cross-validation, after folding eight times, the variables involved in the adaptive lasso-logistic regression model include age, education level, main source of income, marital status, average monthly income, free medical service, basic medical insurance for residents, hospital history, number of follow-up evaluations by family doctor team, voluntary participation in community blood glucose measurement. The Akaike Information Criterion and Bayesian Information Criterion of adaptive lasso-logistic regression model were 1980 and 2021, which were lower than the full-variable logistic model (2041, 2245) and the ridge logistic model (2043, 2348). The adaptive-lasso logistic regression model was better than the other two models regarding time cost.Conclusions The adaptive-lasso logistic regression model can analyse the influencing factors of community management in patients with diabetes. Community intervention and intensive management measures can significantly improve the blood glucose status of patients with diabetes.

Objective This study aimed to investigate the inhibitory effect of berberine hydrochloride (BH) on Candida albicans (C.albicans) ATCC10231 biofilm formation. Results This paper found a positive correlation between the concentration of BH and its inhibitory effect on the cellular activity of early biofilms because we found that 128 and 32 μg/mL BH significantly inhibited biofilm formation (P < 0.05). BH significantly inhibited the cellular activity in early biofilms, destroyed the microscopic morphology of C.albicans and reduced the thickness of the biofilm. Both 128 and 32 μg/mL concentration solutions of BH significantly inhibited biofilm formation (P < 0.05). We found that the inhibitory effect of BH solution was positively correlated with its concentration and 128 μg/mL BH was better than 4 μg/mL fluconazole. Additionally, the results of RT-PCR indicated that 128 and 32 μg/mL BH inhibited the expression of EFG1, HWP1, ECE1, and ALS1 (P < 0.05). Conclusion The efficacy of BH in inhibiting the formation of C.albicans biofilm by killing the cells in the biofilm and destroying its structure; and the mechanism may be to down-regulate the expression of EFG1, HWP1, ECE1, and ALS1 in hyphae formation, thereby, retarding the morphological transformation of C. albicans.