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The convergence of advances in medical science, human biology, data science and technology has enabled the generation of new insights into the phenotype known as 'diabetes'. Increased knowledge of this condition has emerged from populations around the world, illuminating the differences in how diabetes presents, its variable prevalence and how best practice in treatment varies between populations. In parallel, focus has been placed on the development of tools for the application of precision medicine to numerous conditions. This Consensus Report presents the American Diabetes Association (ADA) Precision Medicine in Diabetes Initiative in partnership with the European Association for the Study of Diabetes (EASD), including its mission, the current state of the field and prospects for the future. Expert opinions are presented on areas of precision diagnostics and precision therapeutics (including prevention and treatment) and key barriers to and opportunities for implementation of precision diabetes medicine, with better care and outcomes around the globe, are highlighted. Cases where precision diagnosis is already feasible and effective (i.e. monogenic forms of diabetes) are presented, while the major hurdles to the global implementation of precision diagnosis of complex forms of diabetes are discussed. The situation is similar for precision therapeutics, in which the appropriate therapy will often change over time owing to the manner in which diabetes evolves within individual patients. This Consensus Report describes a foundation for precision diabetes medicine, while highlighting what remains to be done to realise its potential. This, combined with a subsequent, detailed evidence-based review (due 2022), will provide a roadmap for precision medicine in diabetes that helps improve the quality of life for all those with diabetes. ; This article is freely available via Open Access. Please click on the Publisher URL to access it via the publisher's site. ; Funding for the PMDI is from the American Diabetes Association. In-kind support has been provided by the academic institutions of each Task Force member. The ideas and opinions expressed in this report were derived in part from work undertaken by the coauthors, 1688 Diabetologia (2020) 63:1671–1693 for which they report the following support: WKC (NIH: R01 DK52431, P30 DK26687, U54 TR001873, and U54DK118612); JMN (NIH: R01DK104351, R21 AI142483); ATH (MASTERMIND Consortium sponsored by the Medical Research Council [MRC]: MR-K005707-1; a Wellcome Trust Senior Investigator award to ATH [and S. Ellard, University of Exeter Medical School, Exeter, UK]: WT098395/Z/12/Z; National Institute for Health Research [NIHR] Clinical Research Facility); M-FH (ADA 1-15-ACE-26, NIH 5R01HD94150-02); MIM (Wellcome Trust Senior Investigator and NIHR Senior Investigator: 203141 212259 098381; NIDDK: U01-DK105535); ERP (Wellcome Trust New Investigator award: 102820/Z/13/Z); LP (NIH:R01DK104942, P30 DK02059, U54DK118612); SSR (NIH: DP3 DK111906, R01 DK122586; University of Virginia Strategic Investment Fund SIF88); PWF (European Research Council: CoG2015_681742_NASCENT; Swedish Research Council; Novo Nordisk Foundation; European Diabetes Research Foundation; Swedish Heart Lung Foundation; Innovative Medicines Initiative of the European Union: no. 115317 – DIRECT and no. 115881 – RHAPSODY; no.875534 – SOPHIA). ; published version, accepted version (12 month embargo)

Healthcare commissioners and those making reimbursement decisions require data on the "natural history" of diseases to estimate quantities such as life expectancy and quality of life. However, such data are commonly acquired from unrepresentative sources like trial placebo arms or case series. We used Scottish Diabetes Research Network-National Diabetes Dataset to characterise life expectancy for people with type 2 diabetes mellitus (T2DM).
Data from >99% of people with diabetes in Scotland are available from primary and secondary care (including from clinical investigations) and can be linked to hospital admission and death records for research purposes. As part of an MRC-funded (MR/T017112/1) systematic review and modelling study (PROSPERO registration CRD42020184174) building on work funded by the Chief Scientific Office for Scotland (CSO HIPS_17_26), we used these linked data to define a treatment-eligible population for three drug classes — SGLT-2 inhibitors, GLP-1 agonists, and DPP-4 inhibitors. Fitting a Gompertz model, we estimated life expectancy for this 'treatment-eligible' group.
The treatment-eligible population, compared to the entire Scottish T2DM population, was younger (63.8 (12.1) vs. 66.7 (12.7) year-old), with larger proportions of men (60.6% vs. 56.2%), higher HbA1c levels (67.4 (13.1) vs. 60.2 (15.1) mmol/L), larger proportions prescribed metformin (69.2% vs 55.2%) and higher life expectancy at age 65 (in women 21 vs 19 years and in men 20 vs 18 years).
Using linked data to define and characterise treatment-eligible populations is feasible and may impact decision models. These findings will be useful to those making resourcing decisions and future economic analyses.

Objective: To know the limits and strategies of health professionals in the process of adherence to treatment of people with diabetes. Method: Integrative review with time frame of 10 years. Follow six simple steps for selecting and analyzing the data, we found 388 articles, only 15 met the inclusion criteria. Results: For the limits of health professionals regarding the process of adherence to diabetes revealed three themes: organizational factors, individual factors and occupational factors, the strategies used by them were grouped into individual proposals, inter and customer relations. Conclusion: The professionals seem to understand the magnitude of the elements limiting their practice and engender efforts to overcome it. It was evident the importance of understanding the issues that relate to the accession process and the lack of studies that focus on these aspects in the professional perspective.

Abstract. The article seeks to cover the the theoretical bases of the development of the multiparty system in the Republic of Uzbekistan, the formation of parties in the world history, their directions, classification, goals and tasks on the basis of the analysis of scientific literature. Furthermore, the types and directions of political parties according to the organizational structure printouts have also been subjects of a comprehensive analysis.

The author explains the connections between diabetes and visual impairment, discusses possible treatments, and describes various devices suitable for visually impaired diabetics.

Background: Diabetes is one of the leading causes of poor health and high care costs in Ukraine. To prevent diabetes complications and alleviate the financial burden of diabetes care on patients, the Ukrainian government reimburses diabetes medication and provides glucose monitoring, but there are significant gaps in the care continuum. We estimate the costs of providing diabetes care and the most cost-effective ways to address these gaps in the Poltava region of Ukraine. Methods: We gathered data on the unit costs of diabetes interventions in Poltava and estimated expenditure on diabetes care. We estimated the optimal combination of facility-based and outreach screening and investigated how additional funding could best be allocated to improve glucose control outcomes. Results: Of the ~ 40,000 adults in diabetes care, only ~ 25% achieved sustained glucose control. Monitoring costs were higher for those who did not: by 10% for patients receiving non-pharmacological treatment, by 61% for insulin patients, and twice as high for patients prescribed oral treatment. Initiatives to improve treatment adherence (e.g. medication copayment schemes, enhanced adherence counseling) would address barriers along the care continuum and we estimate such expenditures may be recouped by reductions in patient monitoring costs. Improvements in case detection are also needed, with only around two-thirds of estimated cases having been diagnosed. Outreach screening campaigns could play a significant role: depending on how well-targeted and scalable such campaigns are, we estimate that 10-46% of all screening could be conducted via outreach, at a cost per positive patient identified of US$7.12-9.63. Conclusions: Investments to improve case detection and treatment adherence are the most efficient interventions for improved diabetes control in Poltava. Quantitative tools provide essential decision support for targeting investment to close the gaps in care.

Abstract. Background: Treatment adherence is associated with a number of personal characteristics (e.g., self-esteem, self-efficacy, locus of control) and illness perceptions. However, there is a lack of studies for Type 2 Diabetes Mellitus (T2DM). Aims: The aim of this study was to compare adherence behavior of British and Greek people with T2DM and examine the association between personal characteristics, illness perceptions, and adherence. Method: This was a cross-cultural, cross-sectional study. Five hundred eighty participants completed questionnaires, 208 males (35.9%) and 372 females (64.1%) with a mean age of 49 years. Regression analyses and t-tests were used. Results: Personal characteristics and illness perceptions predicted adherence and British patients reported better exercise adherence while Greek patients reported better diet and medication adherence; both groups reported suboptimal adherence. Self-efficacy, Health Locus of Control (HLoC), and illness perceptions were the main adherence determinants. Limitations: The use of self-reports and the convenience sampling method are the main limitations of this study. Conclusion: The findings address a significant gap in research and can inform future adherence-enhancing interventions to promote the well-being of people with T2DM.

INTRODUCTION: This study assessed the treatment satisfaction and sense of well-being attained when patients with type 1 diabetes use the FreeStyle Libre flash glucose monitoring system (FSL; Abbott Diabetes Care, Inc., Alameda, CA, USA). METHODS: A 12-week prospective study was conducted from January 2018 to May 2018 at the Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Study participants (aged 14–21 years) were treated for type 1 diabetes with an insulin pump (IP) (n = 10) or multiple dose injections (MDI) (n = 23), and used the conventional finger-pricking method for glucose self-testing. At the baseline visit, FSL sensors were placed on each participant by a trained diabetes educator. At baseline and 12 weeks, a trained interviewer administered the Arabic version of the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the WHO-5 Well-Being Index (WHO-5) (1998 version) questionnaire. RESULTS: As compared with the baseline, positive differences were found after 12 weeks of FSL use for all of the items in the DTSQ (p < 0.001) and the WHO-5 questionnaire (p < 0.001). The overall score for the DTSQ improved from a mean (SD) of 14.4 ± 6.5 at baseline to 32.1 ± 1.8 at 12 weeks. For the WHO-5 questionnaire, the overall well-being percentage score improved from 45.1% at baseline to 93.6% at 12 weeks (p < 0.001). CONCLUSION: Use of the FSL along with IP or MDI led to higher treatment satisfaction and a greater sense of mental well-being compared with the baseline conventional finger-pricking method. FUNDING: No funding or sponsorship was received for this study. The article processing charges were funded by Abbott Diabetes Care.

Acute illness treatment models fail to meet the needs of the chronically ill. Traditional medical education of physicians fails to adequately prepare them to deliver effective care to community-based patients who will never be well. The wants and needs of patients with chronic illness may be dramatically opposed to the wants and needs of the treating physicians. The patients want a competent, sensitive, and caring physician. Medical training programs graduate disease-oriented specialists. These models need to be integrated. This article proposes a more realistic disease model based on a humanistic approach to illness and the education of physicians. This model will allow patients and physicians to be more satisfied with their treatment alternatives and more comfortable with their outcomes—a paradigm for delivering improved health care services for the patients medicine cannot cure.