Abstract
Background: Type 2 diabetes mellitus (T2DM) is a significant health problem around the world.
Objective: This review aims to define missed opportunities and how they apply to patients with T2DM.
Method: This narrative review describes the natural history of T2DM and also describes where missed opportunities may arise.
Results: Missed opportunities may relate to prevention, early detection, diagnosis, and treatment of diabetes. The cornerstone of T2DM prevention is the control of modifiable risk factors and lifestyle changes to potentially prevent diabetes. Early detection of T2DM is important as it is a chronic condition that can progress rapidly if untreated. Missed opportunities related to the diagnosis of T2DM draw attention to the heterogeneous presentation of diabetes. The condition can be incidentally identified in asymptomatic patients, so all healthcare professionals should be aware of the disease. Furthermore, it is not unexpected that patients with atypical symptoms may have a delay in diagnosis. The treatment-related missed opportunities in T2DM are broad and include self-care, education, remission of T2DM, risk factor management, prevention of complications, medication therapy and compliance, as well as individualized care. Considering patient pathways is a useful approach to evaluate missed opportunities in patient care.
Conclusion: Missed opportunities are a concept that is not often considered in diabetes care, which calls upon reflection of real-world activities and consideration of whether patient outcomes could have been improved with changes in decision-making. Future studies that aim to improve patient care should consider this concept.
[1]
World Health Organization. Available from: https://www.who.int/news-room/facts-in-pictures/detail/diabetes
[2]
Speight J, Holmes-Truscott E, Hendrieckx C, Skovlund S, Cooke D. Assessing the impact of diabetes on quality of life: what have the past 25 years taught us? Diabet Med 2020; 37(3): 483-92.
[http://dx.doi.org/10.1111/dme.14196] [PMID: 31797443]
[http://dx.doi.org/10.1111/dme.14196] [PMID: 31797443]
[3]
Dal Canto E, Ceriello A, Rydén L, et al. Diabetes as a cardiovascular risk factor: An overview of global trends of macro and micro vascular complications. Eur J Prev Cardiol 2019; 26(2_suppl): 25-32.
[http://dx.doi.org/10.1177/2047487319878371] [PMID: 31722562]
[http://dx.doi.org/10.1177/2047487319878371] [PMID: 31722562]
[4]
Bommer C, Heesemann E, Sagalova V, et al. The global economic burden of diabetes in adults aged 20–79 years: A cost-of-illness study. Lancet Diabetes Endocrinol 2017; 5(6): 423-30.
[http://dx.doi.org/10.1016/S2213-8587(17)30097-9] [PMID: 28456416]
[http://dx.doi.org/10.1016/S2213-8587(17)30097-9] [PMID: 28456416]
[5]
Kwok CS, Satchithananda D, Mallen CD. Missed opportunities in coronary artery disease: Reflection on practice to improve patient outcomes. Coron Artery Dis 2022; 33(3): 233-8.
[http://dx.doi.org/10.1097/MCA.0000000000001075] [PMID: 34086614]
[http://dx.doi.org/10.1097/MCA.0000000000001075] [PMID: 34086614]
[6]
Kwok CS, Burke H, McDermott S, et al. Missed opportunities in the diagnosis of heart failure: Evaluation of pathways to determine sources of delay to specialist evaluation. Curr Heart Fail Rep 2022; 19(4): 247-53.
[http://dx.doi.org/10.1007/s11897-022-00551-4] [PMID: 35666345]
[http://dx.doi.org/10.1007/s11897-022-00551-4] [PMID: 35666345]
[7]
Kwok CS, Satchithananda D, Ahmed FZ, et al. A critical evaluation of patient pathways and missed opportunities in treatment of heart failure. J Cardiovasc Dev Dis 2022; 9(12): 455.
[http://dx.doi.org/10.3390/jcdd9120455] [PMID: 36547452]
[http://dx.doi.org/10.3390/jcdd9120455] [PMID: 36547452]
[8]
Scott RA, Langenberg C, Sharp SJ, et al. The link between family history and risk of Type 2 diabetes is not explained by anthropometric, lifestyle or genetic risk factors: The EPIC-InterAct study. Diabetologia 2013; 56(1): 60-9.
[http://dx.doi.org/10.1007/s00125-012-2715-x] [PMID: 23052052]
[http://dx.doi.org/10.1007/s00125-012-2715-x] [PMID: 23052052]
[9]
Goff LM. Ethnicity and Type 2 diabetes in the UK. Diabet Med 2019; 36(8): 927-38.
[http://dx.doi.org/10.1111/dme.13895] [PMID: 30614072]
[http://dx.doi.org/10.1111/dme.13895] [PMID: 30614072]
[10]
Bi Y, Wang T, Xu M, et al. Advanced research on risk factors of Type 2 diabetes. Diabetes Metab Res Rev 2012; 28(s2) (Suppl. 2): 32-9.
[http://dx.doi.org/10.1002/dmrr.2352] [PMID: 23280864]
[http://dx.doi.org/10.1002/dmrr.2352] [PMID: 23280864]
[11]
Fazeli PK, Lee H, Steinhauser ML. Aging is a powerful risk factor for Type 2 diabetes mellitus independent of body mass index. Gerontology 2020; 66(2): 209-10.
[http://dx.doi.org/10.1159/000501745] [PMID: 31505500]
[http://dx.doi.org/10.1159/000501745] [PMID: 31505500]
[12]
Lindström J, Louheranta A, Mannelin M, et al. The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 2003; 26(12): 3230-6.
[http://dx.doi.org/10.2337/diacare.26.12.3230] [PMID: 14633807]
[http://dx.doi.org/10.2337/diacare.26.12.3230] [PMID: 14633807]
[13]
Gong Q, Zhang P, Wang J, et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. Lancet Diabetes Endocrinol 2019; 7(6): 452-61.
[http://dx.doi.org/10.1016/S2213-8587(19)30093-2] [PMID: 31036503]
[http://dx.doi.org/10.1016/S2213-8587(19)30093-2] [PMID: 31036503]
[14]
Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent Type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 2006; 49(2): 289-97.
[http://dx.doi.org/10.1007/s00125-005-0097-z] [PMID: 16391903]
[http://dx.doi.org/10.1007/s00125-005-0097-z] [PMID: 16391903]
[15]
National Health Service England NHS Diabetes Prevention Programme Available from: https://www.england.nhs.uk/diabetes/diabetes-prevention/ (Accessed on: 11 January 2023).
[16]
Newcastle University Press Office. Type 2 diabetes readmission is possible for people with lower BMIs Available from: https://www.ncl.ac.uk/press/articles/latest/2022/04/diabetesremissionforlowbmi/ (Accessed on: 11 January 2023).
[17]
Diabetes UK. Weight loss can put type 2 diabetes into remission for at least two years – the latest findings from DIRECT Available from: https://www.diabetes.org.uk/about_us/news/weight-loss-type-2-diabetes-remission-direct-latest (Accessed on: 11 January 2023).
[18]
Simmons RK, Griffin SJ, Witte DR, Borch-Johnsen K, Lauritzen T, Sandbæk A. Effect of population screening for type 2 diabetes and cardiovascular risk factors on mortality rate and cardiovascular events: A controlled trial among 1,912,392 Danish adults. Diabetologia 2017; 60(11): 2183-91.
[http://dx.doi.org/10.1007/s00125-017-4323-2] [PMID: 28831535]
[http://dx.doi.org/10.1007/s00125-017-4323-2] [PMID: 28831535]
[19]
Waugh NR, Shyangdan D, Taylor-Phillips S, Suri G, Hall B. Screening for Type 2 diabetes: A short report for the National Screening Committee. Health Techol Assess. 2013; p. 17.
[20]
Davidson KW, Barry MJ, Mangione CM, et al. Screening for prediabetes and type 2 diabetes. JAMA 2021; 326(8): 736-43.
[http://dx.doi.org/10.1001/jama.2021.12531] [PMID: 34427594]
[http://dx.doi.org/10.1001/jama.2021.12531] [PMID: 34427594]
[21]
Marshall MC Jr. Diabetes in African Americans. Postgrad Med J 2005; 81(962): 734-40.
[http://dx.doi.org/10.1136/pgmj.2004.028274] [PMID: 16344294]
[http://dx.doi.org/10.1136/pgmj.2004.028274] [PMID: 16344294]
[22]
Narayan KMV, Kanaya AM. Why are South Asians prone to Type 2 diabetes? A hypothesis based on underexplored pathways. Diabetologia 2020; 63(6): 1103-9.
[http://dx.doi.org/10.1007/s00125-020-05132-5] [PMID: 32236731]
[http://dx.doi.org/10.1007/s00125-020-05132-5] [PMID: 32236731]
[23]
National Institute of Diabetes and Digestive and Kidney Diseases Diabetes Risk Test https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2-diabetes/diabetes-risk-test
[24]
Diabetes UK. Type 2 diabetes known your risk.. Available from: https://riskscore.diabetes.org.uk/start
[25]
Kasujja FX, Nuwaha F, Daivadanam M, Kiguli J, Etajak S, Mayega RW. Understanding the diagnostic delays and pathways for diabetes in eastern Uganda: A qualitative study. PLoS One 2021; 16(4): e0250421.
[http://dx.doi.org/10.1371/journal.pone.0250421] [PMID: 33882116]
[http://dx.doi.org/10.1371/journal.pone.0250421] [PMID: 33882116]
[26]
Wexler DJ. Initial management of hyperglycemia in adults with Type 2 diabetes mellitus. UpToDate
[27]
Świątoniowska N, Sarzyńska K, Szymańska-Chabowska A, Jankowska-Polańska B. The role of education in Type 2 diabetes treatment. Diabetes Res Clin Pract 2019; 151: 237-46.
[http://dx.doi.org/10.1016/j.diabres.2019.04.004] [PMID: 31063855]
[http://dx.doi.org/10.1016/j.diabres.2019.04.004] [PMID: 31063855]
[28]
Mc Sharry J, Dinneen SF, Humphreys M, et al. Barriers and facilitators to attendance at Type 2 diabetes structured education programmes: A qualitative study of educators and attendees. Diabet Med 2019; 36(1): 70-9.
[http://dx.doi.org/10.1111/dme.13805] [PMID: 30156335]
[http://dx.doi.org/10.1111/dme.13805] [PMID: 30156335]
[29]
Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes 2008; 26(2): 77-82.
[http://dx.doi.org/10.2337/diaclin.26.2.77]
[http://dx.doi.org/10.2337/diaclin.26.2.77]
[30]
Capoccia K, Odegard PS, Letassy N. Medication adherence with diabetes medication: A systematic review of the literature. Diabetes Educ 2016; 42(1): 34-71.
[http://dx.doi.org/10.1177/0145721715619038] [PMID: 26637240]
[http://dx.doi.org/10.1177/0145721715619038] [PMID: 26637240]
[31]
El-Abbassy A. Non-ahderence to lifestyle medication recommendations of diet & exercise amongst diabetic patients. IOSR J Nurs Health Sci 2015; 4: 7-18.
[32]
Mumu SJ, Saleh F, Ara F, Ali L. Non-adherence to lifestyle medication and its determinants among Bangladeshi Type 2 diabetic patients. Int J Epidemiol 2015; 44 (Suppl. 1): i148-9.
[http://dx.doi.org/10.1093/ije/dyv096.177]
[http://dx.doi.org/10.1093/ije/dyv096.177]
[33]
Saleh F, Mumu SJ, Ara F, Hafez MA, Ali L. Non-adherence to self-care practices & medication and health related quality of life among patients with Type 2 diabetes: A cross-sectional study. BMC Public Health 2014; 14(1): 431.
[http://dx.doi.org/10.1186/1471-2458-14-431] [PMID: 24885315]
[http://dx.doi.org/10.1186/1471-2458-14-431] [PMID: 24885315]
[34]
Kwok CS, Muntean EA, Mallen CD. The patient pathway review: A new method of evaluating clinical practices to understand the complexities of real-world care. Crit Pathw Cardiol 2021; 20(4): 213-9.
[http://dx.doi.org/10.1097/HPC.0000000000000267] [PMID: 34494981]
[http://dx.doi.org/10.1097/HPC.0000000000000267] [PMID: 34494981]
[35]
Kwok CS, Waters D, Phan T, Myint PK, Lip GYH. Should audits consider the care pathway model? A new approach to benchmaring real-world activities. Health care 2022; 10(9): 1798.
[http://dx.doi.org/10.3390/healthcare10091798] [PMID: 36141410]
[http://dx.doi.org/10.3390/healthcare10091798] [PMID: 36141410]
[36]
Kwok CS, Muntean EA, Foster W, Mallen CD. Patient pathways in cardiology: Should pharmaceutical and medical device companies care? Crit Pathw Cardiol 2022; 21(1): 57-60.
[http://dx.doi.org/10.1097/HPC.0000000000000278] [PMID: 35050949]
[http://dx.doi.org/10.1097/HPC.0000000000000278] [PMID: 35050949]
[37]
Patil SP. Atypical diabetes and management considerations. Prim Care 2022; 49(2): 225-37.
[http://dx.doi.org/10.1016/j.pop.2021.11.003] [PMID: 35595479]
[http://dx.doi.org/10.1016/j.pop.2021.11.003] [PMID: 35595479]
[38]
Becker MH, Maiman LA. Strategies for enhancing patient compliance. J Community Health 1980; 6(2): 113-35.
[http://dx.doi.org/10.1007/BF01318980] [PMID: 7204635]
[http://dx.doi.org/10.1007/BF01318980] [PMID: 7204635]
[39]
Kwok CS, Waters D, Phan T, Myint PK, Lip GYH. Should audits consider the care pathway model? A new approach to benchmarking real-world activities. Health care 2022; 10(9): 1798.
[http://dx.doi.org/10.3390/healthcare10091798] [PMID: 36141410]
[http://dx.doi.org/10.3390/healthcare10091798] [PMID: 36141410]
