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Rodney A Hayward - One of the best experts on this subject based on the ideXlab platform.

  • effect of patients risks and preferences on health gains with plasma glucose level lowering in type 2 diabetes mellitus
    JAMA Internal Medicine, 2014
    Co-Authors: Sandeep Vijan, Jeremy B Sussman, John S Yudkin, Rodney A Hayward
    Abstract:

    IMPORTANCE Type 2 diabetes mellitus is common, and treatment to correct blood glucose levels is standard. However, treatment burden starts years before treatment benefits accrue. Because guidelines often ignore treatment burden, many patients with diabetes may be Overtreated. OBJECTIVE To examine how treatment burden affects the benefits of intensive vs moderate glycemic control in patients with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS We estimated the effects of hemoglobin A1c (HbA1c) reduction on diabetes outcomes and overall quality-adjusted life years (QALYs) using a Markov simulation model. Model probabilities were based on estimates from randomized trials and observational studies. Simulated patients were based on adult patients with type 2 diabetes drawn from the National Health and Nutrition Examination Study.

Rimke C. Vos - One of the best experts on this subject based on the ideXlab platform.

  • Overtreatment of older patients with type 2 diabetes mellitus in primary care.
    Diabetes obesity & metabolism, 2018
    Co-Authors: Huberta E. Hart, Guy E.h.m. Rutten, Kyra N. Bontje, Rimke C. Vos
    Abstract:

    Given that there are indications of overtreatment in older patients with type 2 diabetes in both the United States and Europe, we assessed the level of personalized diabetes treatment for older patients in primary care, focusing on overtreatment. Based on Dutch guidelines individuals aged ≥70 years were classified into 3 glycated haemoglobin (HbA1c) treatment target groups: 7% (53 mmol/mol), 7.5% (58 mmol/mol) and 8% (64 mmol/mol). In our cohort of 1002 patients (n = 319 aged ≥70 years), the 165 patients with HbA1c targets >7% had more micro- and macrovascular complications, more often used ≥5 medicines and were more often frail compared with those with an HbA1c target ≤7%. Of these 165 patients, 64 (38.8%) were Overtreated; that is, 20% of all people aged ≥70 years. The majority of Overtreated people were frail and used ≥5 medicines. Hypoglycaemia occurred in 20.3% of these patients and almost 30% reported accidents involving falls. Personalized treatment in older people with type 2 diabetes is not common practice. A substantial number of older people are Overtreated, with probable harmful consequences. To prevent overtreatment, definition of lower HbA1c limits might be helpful.

Sandeep Vijan - One of the best experts on this subject based on the ideXlab platform.

  • effect of patients risks and preferences on health gains with plasma glucose level lowering in type 2 diabetes mellitus
    JAMA Internal Medicine, 2014
    Co-Authors: Sandeep Vijan, Jeremy B Sussman, John S Yudkin, Rodney A Hayward
    Abstract:

    IMPORTANCE Type 2 diabetes mellitus is common, and treatment to correct blood glucose levels is standard. However, treatment burden starts years before treatment benefits accrue. Because guidelines often ignore treatment burden, many patients with diabetes may be Overtreated. OBJECTIVE To examine how treatment burden affects the benefits of intensive vs moderate glycemic control in patients with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS We estimated the effects of hemoglobin A1c (HbA1c) reduction on diabetes outcomes and overall quality-adjusted life years (QALYs) using a Markov simulation model. Model probabilities were based on estimates from randomized trials and observational studies. Simulated patients were based on adult patients with type 2 diabetes drawn from the National Health and Nutrition Examination Study.

John Lazarus - One of the best experts on this subject based on the ideXlab platform.

  • Have we Overtreated children with vesicoureteric reflux?
    African Journal of Urology, 2010
    Co-Authors: John Lazarus
    Abstract:

    Urinary tract infections (UTI) are the most common serious bacterial infections in young children. These UTIs have a high association with vesicoureteric reflux (VUR). The pathophysiology of VUR’s renal sequelae, its investigation and management is presently undergoing a reassessment. This review documents these changes focusing on compelling new data. With regard to the need for and benefit of imaging procedures in children with UTIs we present an algorithm for investigation that is tailored to the African context. The value of continuous antibiotic prophylaxis is questioned and the role of injectable ureteric bulking is discussed with reference to the Swedish Reflux Trial.

  • review article have we Overtreated children with vesicoureteric reflux
    2010
    Co-Authors: John Lazarus
    Abstract:

    Urinary tract infections (UTI) are the most common serious bacterial infections in young children. These UTIs have a high association with vesicoureteric reflux (VUR). The pathophysiology of VUR’s renal sequelae, its investigation and management is presently undergoing a reassessment. This review documents these changes focusing on compelling new data. With regard to the need for and benefit of imaging procedures in children with UTIs we present an algorithm for investigation that is tailored to the African context. The value of continuous antibiotic prophylaxis is questioned and the role of injectable ureteric bulking is discussed with reference to the Swedish Reflux Trial.

Dean T Eurich - One of the best experts on this subject based on the ideXlab platform.

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