Leader: Jacopo Lenzi (UNIBO); Other collaborator(s):
Task 1 will start with an analysis of the literature and of the administrative datasets as well as of the relevant clinical registers to select one or more populations targeted by programs of health promotion and/or prevention. The main output of the Task is to build a data platform integrating individual-level databases on healthcare services with supply-side databases on the type of interventions provided by primary care professionals (including incentives for GPs), specialist practitioners and intermediate care structures (home care, community homes, community hospitals, residential care homes). The Task aims at providing a pilot study on how to supplement the databases typically used by policy makers with more specific details on the relevant supply-side aspects affecting the implementation of prevention programmes.
Brief description of the activities and of the intermediate results
November/December 2023: Completion of data-linkage activities to build a retrospective cohort of residents in the LHA of Romagna with an estimated onset of type 2 diabetes in 2015–2017, with follow-up until 2022. Administrative databases include Hospital Discharge Records, Residential Care Discharge Records, Mental Health Information System, Outpatient Pharmaceutical Database, and Vital Registration System. A multistate survival analysis is performed to investigate the risk of major depression and dementia in these patients, including dementia resulting from depression, and their impact on diabetes-related complications and mortality. The findings are submitted to Diabetes Care and Clinical Practice.
January/February 2024: The manuscript, revised based on reviewers’ feedback, is published online. The key findings are presented at the AGE-IT Spoke 10 Workshop, and a short paper is submitted to the AGE-IT General Meeting scheduled for May 2024. A new paper investigating the relationship between the age of onset of type 2 diabetes and dementia is under construction and is expected to be submitted to Diabetes Care in May 2024. This study aims to provide practical insights into the correct target age and timing for cognitive screening in incident cases of diabetes.
March 2024: Launch of a study aimed at assessing the uptake of recommended vaccines in individuals with diabetes. To determine policy and practice implications for promoting compliance with these vaccinations, we will evaluate potential determinants of vaccine uptake, including proximity to “Ambulatori dell’igiene pubblica” and “Case della comunità”, and characteristics of the “Nuclei di cure primarie” of family doctors. We held meetings with colleagues from the Public Health Department of Romagna’s LHA to define the technical aspects required for data extraction.
Main policy, industrial and scientific implications
Our multi-state analysis suggests that patients with depression are more likely to experience diabetes complications than those with diabetes alone. This underscores the need for integrated physical and mental healthcare to foster medication adherence and glucose control, aiming to prevent the impact of depression on self-care and self-efficacy. We also identified depression as a risk factor for dementia, especially two years after diabetes onset, suggesting shared pathophysiological mechanisms that involve both conditionsOur study further emphasizes the impact of depression and dementia on mortality. This reinforces the cruciality of integrating early strategies for optimal diabetes control, reduced diabetes distress, and preserved cognitive function. Collaborative models involving primary and specialist care professionals may enhance the management of these comorbidities through the introduction of early psychosocial screening activities, mental health interventions, and targeted treatments within diabetes care pathways.
The latest ADA “Standards of Care in Diabetes” recommend the screening of all patients with type 2 diabetes for depression and anxiety during the initial visit and at regular annual check-ups. When indicated, the guidelines advise collaborative referrals to behavioral or mental health professionals for comprehensive evaluation and targeted treatment. The ADA proposes a similar approach to assess cognitive performance in individuals aged ≥65 and, in case of altered ability to perform self-care behaviors, suggests involving a laycare professional to serve the capacities of day-to-day monitoring. The guidelines also emphasize the importance of simplifying diabetes treatment plans.
To reduce the share of complications and mortality attributable to post-diabetes depression and dementia, it is imperative to integrate the ADA’s standards of care into clinical practice and promote their adoption across diabetes care pathways.
Brief description of the activities and of the intermediate results
Brief description of the activities and of the intermediate results
Brief description of the activities and of the intermediate results