Glycemic outcomes and patient satisfaction and self-management improves in transition from standard to virtual multidisciplinary care.

AIMS: With advances in cloud-based technologies, there has been a rise in remote T1D care. We hypothesized that transitioning T1DM care to a virtual, multidisciplinary clinic could improve measures beyond HbA1c. METHODS: To assess the impact of transitioning from standard to virtual T1DM care, we evaluated glycemic measures and patient reported outcomes. RESULTS: Sixty-one adults with T1DM were included, with mean age 40.2 ± 13.5 years and diabetes duration 16.9 ± 9.0 years. Most patients were treated with insulin pumps and CGM. The number of annual diabetes care encounters rose from 2.1 ± 4.2 to 12.8 ± 5.5. Baseline HbA1c was 7.9 ± 1.6 %(63 ± 16.9 mmol/mol), declining to 7.3 ± 1.1 %(56 ± 8.5 mmol/mol) and 7.1 ± 1.0 %(54 ± 7.7 mmol/mol) at 6 and 12 months respectively (p < 0.001 for both). In parallel, TIR improved from 63.1 ± 19.3 % to 69.2 ± 13.8 % (p < 0.001) and 67.5 ± 19.4 % (p = 0.03) at 6 and 12 months respectively, while TBR declined. Scores from validated diabetes treatment and self-management questionnaires rose significantly and these rises were associated with a reduction in HbA1c, the latter score was also associated with increased TIR. There was a trend toward a correlation between encounter frequency and improvement in HbA1c and TIR. CONCLUSIONS: Transitioning from standard to virtual, coordinated, multidisciplinary T1DM care is associated with increased visit frequency, improving glycemic control, treatment satisfaction and self-care behaviors.

Subcutaneous Semaglutide Use for Weight Management: Practice and Attitudes of Physicians in Israel.

BACKGROUND: In 2019, 1 mg subcutaneous semaglutide was registered for the treatment of diabetes in Israel. Recognition of its effect on weight has led to its use as a treatment for obesity. OBJECTIVES: To explore physicians' pre-therapy considerations, therapy practices, and attitudes regarding subcutaneous semaglutide for weight loss. METHODS: A 22-item questionnaire was disseminated to physicians who prescribed semaglutide 1-mg for weight loss using an authorized off-label path. RESULTS: In total, 127 physicians completed the questionnaire. As for pretreatment requirements, in the absence of diabetes, 30% requested a minimal body mass index of 30 kg/m2. Additional requirements were documented lifestyle-change effort (67%) and prior weight loss medication use (13%). Half of the physicians regarded calorie restriction, and 23% considered physical activity as necessary for weight loss while on therapy. As for dose, most physicians (78%) started with a 0.25-mg weekly injection, 57% doubled the dose monthly, and all others recommended doubling when side effects subsided. Regarding weight loss goal, 43% of the physicians set a personal goal with each patient while 26% limited the goal to 10% of initial weight. Fewer than 50% of physicians discussed treatment duration with their patients, and 52% of patients discontinued therapy in the first 3 months. The main reasons for discontinuation were price, lack of effect, and fear of long-term side effects. CONCLUSIONS: The diverse approaches regarding off-label use of semaglutide for weight reduction highlight the necessity to guide physicians and standardize treatment regimen.

Attitudes and perceived knowledge of health professionals on the food labelling reform in Israel.

OBJECTIVES: To assess the attitudes and perceived knowledge of health professionals regarding the food product judgemental-labelling reform that began in January 2020 in Israel. DESIGN: Cross-sectional survey. SETTINGS: An online survey among health professionals working in the Israeli health system. PARTICIPANTS: 456 participants (118 physicians, 207 nurses, 131 nutritionists). RESULTS: Most respondents (89·9 %) were women, 36 % had over 20 years of professional experience. All nutritionists, 96·6 % of physicians and 94·7 % of nurses reported hearing about the reform, and most (88·9 % of nurses, 76·3 % of physicians and 75·6 % of nutritionists) claimed supporting the reform to a great or very great extent. Most respondents believe they should discuss issues related to healthy eating with their patients (91·8 % of nurses, 94·9 % of physicians and all nutritionists), but only about half (47·5 % of physicians and 57·0 % of nurses) reported that they have sufficient knowledge in this field, particularly about food labelling. Almost two-thirds of nutritionists (60·3 %) reported instructing patients to change their food intake according to labelling v. 40·1 % and 34·7 % of nurses and physicians, respectively. Only some respondents felt that they could influence their patients' nutrition habits. Most participants believe that additional regulatory measures should also be used to promote healthy nutrition. CONCLUSIONS: There is a gap between the desire of physicians and nurses to provide nutritional guidance to the public and their actual knowledge about the labels' meaning as well as their competencies in providing nutrition counselling. When formulating a reform, policymakers should provide clear guidelines about the expectations of implementing it in therapeutic practice.

Determinants of COVID-19 vaccine acceptance among adults with diabetes and in the general population in Israel: A cross-sectional study.

AIMS: To explore and compare key determinants of COVID-19 vaccine acceptance and willingness to get vaccinated among people with diabetes and the general population. METHODS: A cross-sectional survey study of 807 Israeli adults with and without diabetes was conducted prior to the first vaccination campaign in Israel in December 2020. Data was analyzed by population group and gender. A multinomial logistic regression determined the association between acceptance factors and willingness to get vaccinated. RESULTS: Diabetes patients had more anxiety about COVID-19, higher levels of confidence in vaccine safety, and greater willingness to get vaccinated than the general population. In both groups, women reported higher levels of anxiety toward COVID-19 but lower levels of confidence in vaccine safety and less willingness to get vaccinated than men. Vaccine safety had the largest contribution to diabetes patients' willingness to get vaccinated. For participants without diabetes, the perception that more than 50% of Israelis would get vaccinated had the largest contribution. Participants in both groups who had vaccinated against seasonal influenza were more likely to get vaccinated against COVID-19. CONCLUSION: Policies aimed at improving vaccine acceptance should target vulnerable populations, particularly female diabetes patients, whose concerns must be addressed to increase their vaccination rates.

Ethnic Disparities in Physical Activity among Adolescents in Israel.

Objectives: In this study, we examined physical activity (PA) levels among Jewish and Arab adolescents in Israel, as well as factors associated with PA. We used a socio-ecological framework to understand differences in levels of PA across ethnic groups and the factors associated with these differences. Methods: We used data based on the Israeli population as reported in the 2014-15 Health Behavior of School-Aged Children standardized survey, which studied 16,145 Israeli adolescents. Levels of PA, as well as parent, sibling, and peer engagement in PA, in-school PA breaks, and liking PA were measured across ethnic groups and sex. Results: Jewish adolescents reported higher levels of PA. Girls were significantly less physically active than boys in both ethnicities. In addition, we found that family, peer, and school related factors were positively associated with levels of PA. Conclusions: Our findings show a disparity in PA levels by ethnicity among Israel adolescents, which can lead to health disparities. We propose targeted interventions involving the factors affecting PA to reduce health disparities.