News in brief: Life expectancy tables for people with T1D; Avoid stigmatising language in medical records; Routine BMD assessment advised for young people with diabetes

Wednesday, 28 Jul 2021

Table maps life expectancy in type 1 diabetes patients

A type 1 diabetes life expectancy table has been developed to help endocrinologists better communicate morbidity and mortality risks with patients.

The table stratifies life expectancy by sex, age, BMI, smoking status, eGFR and HbA1c.

Australian researchers said life expectancy tables were already available for people with T2D and they co-developed the T1D table via a simulation model, incorporating data from the Swedish National Diabetes register.

For each of the table’s 1024 cells, a synthetic cohort of 1000 individuals was created, with other risk factors assigned values representative of the real-world population, University of Melbourne Centre for Health Policy Senior Research Fellow, Dr An Tran-Duy and his team wrote in Diabetologia.

The table shows “substantial variation in life expectancy across individuals with different modifiable risk factors” and “allows for rapid communications in an easily understood format between healthcare professionals, health economists, researchers, policy makers and patients”, they said.

Physicians urged to avoid stigmatising language in medical records

When writing in a patient’s medical record, physicians should be conscious of the use of language that reinforces negative and stigmatising attitudes toward patients that may influence the decisions of other clinicians subsequently caring for that patient, according to the authors of a US study.

An analysis of 600 medical records written by 138 physicians at a major hospital identified five types of negative and judgmental language used to describe patient encounters that encompassed racial and class stereotyping, personal disapproval of their actions, questioning a patient’s credibility and portraying them as a difficult or non-compliant. The stigmatising attitudes found in medical notes also included the use of authoritative and paternalistic language by physicians in which they recorded themselves as ‘instructing’ patients, according to researchers from Johns Hopkins University.

In their article, published in JAMA Network Open, they offered six examples of how physicians could use positive and collaborative language in medical records including compliments, approval of positive behaviours and noting of humanising personal details, in addition to acknowledgement of the physician’s own negative attitude and explaining non-adherence in a non-judgmental way.

“Just as we have developed a greater understanding about microaggressions and micro-inequities, this study’s findings suggest that we must raise consciousness about how we write and read medical records,” they said.

“Language has a powerful role in influencing subsequent clinician attitudes and behaviour. Attention to this language could have a large influence on the promotion of respect and reduction of disparities for disadvantaged groups.”

Routine BMD assessment call for young people with T1D

Bone mineral density (BMD) should be routinely assessed in type 1 diabetic youth, according to Australian paediatric registrars and endocrinologists.

A review of 2617 case and 3851 controls (mean age: 12.6 ± 2.3 years) showed type 1 diabetic youth typically had lower total body, lumbar spine, femur, tibia, radius, phalanx and calcaneum BMD than non-diabetic patients, paediatric registrar, Phoebe Loxton and her team wrote in Diabetes Care.

Total body BMD was associated with older age, but not with longer diabetes duration or HbA1c, they found.

BMD was assessed using DXA, peripheral quantitative computed tomography and/or quantitative ultrasound.

“There is substantial evidence that adults with type 1 diabetes have reduced BMD, however, findings in youth are inconsistent,” the authors said.

This study adds evidence that “bone development is abnormal in youth with type 1 diabetes”.

“Routine assessment of BMD should be considered in all youth with type 1 diabetes,” they concluded.

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