The chlamydia care cascade of young people attending Australian general practices; a descriptive study to assess gaps in care.

BACKGROUND: Most chlamydia infections in Australia are diagnosed in general practice. The care cascade concept (testing, treatment and re-testing) can be utilised to explore the management of chlamydia infections. We explored the chlamydia care cascade among young people attending general practices in Australia. METHODS: We analysed de-identified electronic medical record data for 16-29-year-old individuals attending 70 Australian general practices between January 2018 and December 2020. Five outcomes: (1) chlamydia testing, (2) positivity, (3) treatment, (4) re-testing and (5) re-infection were summarised as annual counts and proportions per calendar year. Logistic regression was used to investigate the association of age, gender and clinic location with each outcome. RESULTS: During the study period, a total of 220909 clinical episodes involving 137358 16-29-year-olds were recorded. Of these episodes, 10.45% (n =23077, 95% CI 8.73-12.46) involved a chlamydia test. Of 1632 chlamydia cases, 88.79% (n =1449, 95% CI 86.37-90.82) had appropriate antibiotics recorded as defined in Australian sexually transmitted infection management guidelines. Of 183 chlamydia cases that did not have appropriate antibiotics recorded, 46.45% (n =85) had re-attended the clinic within 90days of diagnosis. Among 1068 chlamydia cases that had appropriate antibiotic recorded in 2018 and 2019, 22.57% (n =241, 95% CI 20.15-25.18) were re-tested within 6weeks to 4months of their diagnosis. One-third of episodes of chlamydia cases that did not have a re-test recorded (n =281) had re-attended the clinics within 4months of diagnosis. CONCLUSION: Our study provides insight into chlamydia management by analysing general practice medical records, indicating substantial gaps in testing and re-testing for 16-29-year-olds. These data can also be used to explore the impact of future interventions to optimise chlamydia management.

Impact of insulin initiation on glycaemic variability and glucose profiles in a primary healthcare Type 2 diabetes cohort: analysis of continuous glucose monitoring data from the INITIATION study.

AIM: To use continuous glucose monitoring to examine the effects of insulin initiation with glargine, with or without glulisine, on glycaemic variability and glycaemia in a cohort of people with Type 2 diabetes receiving maximum oral hypoglycaemic agents in primary healthcare. METHODS: We conducted a post hoc analysis of continuous glucose monitoring data from 89 participants at baseline and at 24 weeks after insulin commencement. Indicators of glycaemic variability (standard deviation, J-index and mean amplitude of glycaemic excursion) and glycaemia (HbA1c , mean glucose, area under the glucose-time curve) were assessed. Multi-level regression analysis was used to identify the predictors of change. RESULTS: Complete glycaemic variability data were available for 78 participants. Of these participants, 41% were women, their mean (sd) age was 59.2 (10.4) years, the median (interquartile range) diabetes duration was 10.4 (6.5, 13.3) years and the median (interquartile range) baseline HbA1c was 82.5 (71.6, 96.7) mmol/mol [9.7 (8.7, 11.0)%]. At baseline, BMI correlated negatively with standard deviation (r = -0.30) and mean amplitude of glycaemic excursion (r = -0.26), but not with J-index; HbA1c correlated with J-index (r = 0.61) but not with mean amplitude of glycaemic excursion and standard deviation. After insulin initiation the mean (sd) glucose level decreased [from 12.0 (3.0) to 8.5 (1.6) mmol/l; P < 0.001], as did the median (interquartile range) J-index [from 66.9 (47.7, 95.1) to 36.9 (27.6, 49.8) mmol/l; P < 0.001]. Baseline HbA1c correlated with a greater J-index reduction (r = -0.45; P < 0.001). The mean amplitude of glycaemic excursion and standard deviation values were unchanged. The baseline temporal profile, showing elevated postprandial morning glucose levels, was unchanged after insulin initiation, despite an overall reduction in glycaemia. CONCLUSION: Insulin initiation reduced hyperglycaemia but did not alter glycaemic variability in adults with Type 2 diabetes receiving maximum oral hypoglycaemic agents. The most significant postprandial excursions were seen in the morning, which identifies prebreakfast as the most effective target for short-acting insulin therapy.

Fertility outcomes in women with hypopituitarism.

BACKGROUND: Women with hypopituitarism are known to have a poor outcome once pregnancy has been achieved by ovulation induction. There are no data, however, recording the efficacy of ovulation induction and pregnancy rates in this group of subfertile women. METHODS: The outcome of fertility treatments in all 19 women with hypopituitarism attending the fertility clinics of University College London Hospitals over the past 20 years was audited. RESULTS: Ovulation was achieved in almost all women (95%) but occurred in only 60% of treatment cycles. Pregnancy was achieved in 47% of women or 11% of cycles resulting in a live birth rate of 6.7% per cycle. Seven of the 18 pregnancies (39%) miscarried. Only 42% of women treated achieved a live birth. CONCLUSION: Ovulation induction in women with hypopituitarism yields relatively low pregnancy rates in comparison to other causes of anovulation and a high miscarriage rate. Pituitary hormone deficiency beyond gonadotrophins has a major adverse effect on achieving pregnancy.