Teleconsultation's prominence during the COVID-19 epidemic boosted accessibility for people with type 2 diabetes mellitus (T2DM). Previous research, however, could not differentiate the effectiveness between synchronous and asynchronous teleconsultation. We investigated the efficacy of simultaneous teleconsultation for T2DM patients. From conception to July 2021, we searched Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library and Cochrane Database of Systematic Reviews, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform databases. All of the research considered were randomized controlled trials of synchronous teleconsultation for persons with T2DM vs standard care. Reviewers collected data separately and used the Cochrane method to assess the risk of bias. Random-effects models were used in meta-analyses. A pooled mean difference was determined for HbA1c (%) and BMI (kg/m2), SBP (mmHg), DBP (mmHg), and LDL-cholesterol (mg/dL). Depression, medication adherence, and quality of life were also evaluated as patient-reported outcomes. A total of 9807 abstracts were identified, with 27 trials included. When compared to the usual care group, synchronous teleconsultation resulted in a larger drop in HbA1c (n=8746, 0.35, 95% Cl: 0.20, 0.49, I2=73%, P<0.001). There were no significant effects on BMI (n = 699, 0.08 kg/m2, 95% CI: -0.54, 0.69), SBP (n = 5512, 1.32 mmHg, 95% CI: 0.09, 2.73), DBP (n = 2898, 0.17 mmHg, 95% CI: -1.18, 1.52) or LDL-cholesterol (n = 5276, 3.21 mg/dL, 95% CI: -1.75, 8.17).The effect of teleconsultation in improving patient-reported outcomes was uncertain. Thus synchronous teleconsultation could be an alternative to usual care.

Teleconsultation's prominence during the COVID-19 epidemic boosted accessibility for people with type 2 diabetes mellitus (T2DM). Previous research, however, could not differentiate the effectiveness between synchronous and asynchronous teleconsultation. We investigated the efficacy of simultaneous teleconsultation for T2DM patients. From conception to July 2021, we searched Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library and Cochrane Database of Systematic Reviews, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform databases. All of the research considered were randomized controlled trials of synchronous teleconsultation for persons with T2DM vs standard care. Reviewers collected data separately and used the Cochrane method to assess the risk of bias. Random-effects models were used in meta-analyses. A pooled mean difference in HbA1c (%) and body mass index (BMI,kg/m2), as well as systolic blood pressure(SBP,mmHg). Random-effects models were used in meta-analyses. A pooled mean difference was determined for HbA1c (%) and BMI (kg/m2), SBP (mmHg), DBP (mmHg), and LDL-cholesterol (mg/dL). Depression, medication adherence, and quality of life were also evaluated as patient-reported outcomes. A total of 9807 abstracts were identified, with 27 trials included. When compared to the usual care group, synchronous teleconsultation resulted in a larger drop in HbA1c (n=8746, 0.35, 95% Cl: 0.20, 0.49, I2=73%, P0.001). There were no significant effects on BMI (n = 699, 0.08 kg/m2, 95% CI: 0.54, 0.69), SBP (n = 5512, 1.32 mmHg, 95% CI: 0.09, 2.73), DBP (n = 2898, 0.17 mmHg, 95% CI: -1.18, 1.52) or LDL-cholesterol (n = 5276, 3.21 mg/dL, 95% CI: 1.75, The effect of teleconsultation in improving patient-reported outcomes was uncertain. Thus synchronous teleconsultation could be an alternative to usual care.

Background: Up to 36% of people with type 2 diabetes experience diabetes distress, the negative emotional experience from the challenges of living with diabetes. Routine assessment using the guideline-recommended Problem Areas in Diabetes (PAID) scale is infrequent. Given that most people with type 2 diabetes receive medical care in general practice, it is important to optimise approaches.
Aim: To design and implement a digital health solution to support general practice to assess and address diabetes distress.
Methods: In the first phase, iterative design thinking was used in three qualitative sessions with nine general practice staff to design a solution to collect the PAID scale. The second phase was a 12-week case study in three general practices to explore implementation barriers and facilitators. Qualitative data were collected from general practice staff and people with type 2 diabetes. Analysis was in NVivo 12 using Framework Analysis, guided by the Theoretical Domains Framework and the Consolidated Framework for Implementation Research.
Results: The developed solution digitally collected and stored the PAID scale with links to resources. Key themes identified in phase one included focusing on language to minimise patients’ negative emotions, flexibility within the solution to fit the environment, and clarity regarding the intention. In phase two, the solution worked technically as designed, with 25 people with type 2 diabetes participating. People with type 2 diabetes found the solution simple to use. Practice nurses sent the PAID scale, with general practitioners (GPs) reviewing responses. Implementation was separate from routine diabetes care, offered to people with an ongoing GP-patient relationship, rather than a recommendation from diabetes guidelines. COVID-19 diverted practice priorities and limited staff engagement.
Conclusions: Completing the PAID scale using the developed digital solution was acceptable to people with type 2 diabetes. The PAID scale, if used, was within an ongoing GP-patient relationship.

1. Diabetes distress impacts important outcomes such as glycaemia and self-management strategies.
2. Only using the PAID scale in people with diabetes with an existing GP-patient relationship will overlook people most likely to be experiencing diabetes distress.
3. Practice nurses can facilitate the implementation of the PAID scale in conjunction with a GP to review responses.

Background
Polyfluoroalkyl substances (PFAS) are man-made chemicals used in a wide range of manufactured products, which can accumulate in the environment and in the human body. Everyday products, including shampoo or dental floss, contain PFAS. People can intake them by drinking contaminated well water, or eating fish with high levels of PFAS. Although the mechanism of pathogenesis and homogametic effects in different races are unclear, PFAS exposure has previously been linked to adverse health effects such as metabolic syndrome and dyslipidaemia. The aim of this study was to determine the association of serum PFAS levels with markers of metabolic syndrome and other clinical conditions, using the clinical data of participants from Okinawa Prefecture, Japan.

Method
A cross-sectional study was conducted using blood samples and clinical data collected from outpatients of a clinic in Okinawa, one of the highest PFAS-exposed prefectures in Japan. Linear regression analysis was used to investigate the relationship between serum PFAS levels and body mass index (BMI), as well as other markers of metabolic syndrome, dyslipidaemia, and fatty liver.

Results
Of the 403 participants, the mean age was 53.5 (standard deviation, SD: 15.3), and 220 participants (54.6%) were male. Mean serum levels of Per Fluoro Octanoic Acid (PFOA) and Per Fluoro Octane Sulfonic Acid (PFOS), which are ones of PFAS, were 2.81 ng/mL (SD: 1.93) and 7.58 ng/mL (SD: 5.85), respectively. Higher serum levels of PFAS were not significantly associated with: higher BMI, higher serum levels of triglyceride, alanine transaminase, and low-density lipoprotein cholesterol; lower levels of high-density lipoprotein cholesterol; diabetes or hypertension.

Conclusion
Greater PFAS exposure was not associated with increased prevalence of obesity, metabolic syndrome, dyslipidaemia, diabetes, or hypertension in the Okinawan patient cohort. Further studies with different cohorts will be needed to solidify the PFAS effects on the human body.

1. PFAS exposure has been reported as a risk factor for dyslipidaemia or metabolic syndrome.
2. This study focused on the association between PFAS exposure and metabolic syndrome in Okinawa, one of the highest PFAS-exposed prefectures in Japan.
3. Greater PFAS exposure was not related to increased prevalence of obesity, metabolic syndrome, dyslipidaemia, diabetes, or hypertension.

Background
Self-management is a challenge for many people with type 2 diabetes and interventional approaches have inconsistent outcomes. Diabetes-related distress (DRD), mental and physical health (health-related quality of life), self-efficacy and diabetes knowledge (DQSK) have been found to impact on lifestyle behaviors and outcomes. Therefore, stratification of patients by DQSK profiles may support a population-approach to developing self-management programs. Our study aimed to identify DQSK profiles and to explore the association between DQSK profiles with lifestyle behaviors, hemoglobin A1c (HbA1c) and body mass index (BMI).

Methods
A cross-sectional survey was conducted in 518 participants with type 2 diabetes at the National Healthcare Group Polyclinics (Singapore), and included assessment of DRD (diabetes-distress scale), mental and physical component scores (SF-12), self-efficacy (diabetes empowerment scale), diabetes knowledge (Michigan diabetes knowledge test), diet and physical activity (summary of diabetes self-care scale), medication adherence (medication adherence report scale) and social support (medical outcomes study social support survey). An mixed-model latent profile analysis identified unique profiles on eight DQSK variables, and sociodemographic characteristics, self-care behaviors, HbA1c and BMI were compared across the profiles using multinomial regression analysis.

Results
Four unique DQSK profiles were identified: profile 1 (carefree), profile 2(distressed, diabetes-specific), profile 3 (distressed, global) and profile 4 (activated). Profile 3 was associated with the poorest self-care scores (diet, exercise and medication adherence), metabolic profiles (HbA1c and BMI) and social support scores, while profile 4 was associated with the best self-care behaviors, metabolic profiles and social support scores. Self-care behaviors and metabolic profiles also different in profiles 1 and 2.

Conclusions
Our study identified four novel DQSK profiles which were associated with differential self-care behaviors and metabolic profiles. This suggests that identifying DQSK profiles may help to stratify people with type 2 diabetes by their care needs, supporting the development of more targeted approaches.

1. People with type 2 diabetes have differing psychological, health-related quality of life, self-efficacy and knowledge profiles
2. These unique profiles are associated with lifestyle behaviours, glycaemic levels and body mass index
3. Identifying these profiles may support population stratification and development of more targeted interventions

Background: COVID-19 pandemic has severely affected health services for non-communicable diseases (NCDs); especially those vulnerable and requiring regular or long-term care. This study aims to gain insights into the effect of the COVID-19 pandemic lockdown on the accessibility of health services and health care of diabetic patients in primary health care.
Methods: A cross-sectional study was conducted in a rural area on 400 diabetic participants. A pre-tested semi-structured multidimensional questionnaire in the Arabic language was utilized in the study. It consists of four parts; the first for the Sociodemographic data, the second for status of the clinical diabetic investigations during the lockdown, the third was for the medication adherence and the fourth entailed questions pertaining to barriers for primary health care visit.
Results: About half of the participants suffered from difficulty in healthcare service accessibility. The most significant predictors were older age, female gender, lower education level, internet use, low and middle socioeconomic standard, and depending on private healthcare facilities. Costly services followed by limited work hours, fear of infection, difficulty using internet were the main challenges they face during their doctor visit. The more difficult the accessibility, the lower the adherence to medication. Telemedicine was the adopted alternative during the pandemic.
Conclusion: Medical health services in primary health care were extremely affected during the pandemic and consequently medication adherence. Telemedicine was used as a coping strategy to overcome limited accessibility to DM-related healthcare services during the COVID-19 lockdown

1-Medical health services in primary health care were extremely affected during the pandemic and consequently medication adherence.
2-Telemedicine can be used as a coping strategy to overcome limited accessibility to DM-related healthcare services during the COVID-19 lockdown

Aim: There have been significant advances in knowledge, technology, and drug treatments for type 2 diabetes over the last two decades. However, the benefits for patients, society and the economy are yet to be fully realised, through improved diabetes management and patient outcomes. The aim was to test whether a specialist-led model of care integrated in general practice led to spillover benefits in all patients with type 2 diabetes in the general practices.

Content: Seventy-two general practice sites (clusters), including 22,706 active patients with type 2 diabetes received the Diabetes Alliance intervention, forming a non-randomised stepped wedge trial. The intervention included case conferencing, delivered directly to <5% of the active patients (n=1,072), as well as practice-level feedback, and clinician education and training. Data were extracted from the MedicineInsight electronic database. Linear and logistic mixed models were used to test for difference in clinical outcomes before and after Diabetes Alliance.

The odds of patients receiving screening tests at or above the recommended intervals for managing type 2 diabetes was significantly higher for all recommended tests after the Diabetes Alliance intervention. Small but significant clinical improvements were also observed for mean reductions in weight, blood pressure, HbA1c, total cholesterol, and triglycerides after the intervention.

Goals: Diabetes Alliance enhances General Practitioner capability in managing type 2 diabetes and that treatment benefit extends to the whole general practice population with type 2 diabetes, not just the small cohort who are seen during specialist-led case conferencing. Integrated care partnerships are one pathway of translating evidence into clinical practice and improving the quality of diabetes care at scale. The goal of Diabetes Alliance is now to scale up across a geographic area roughly the size of England, and then across other areas of Australia.

1. A partnership between tertiary diabetes specialists and general practitioners is effective for improving diabetes care delivery and patient outcomes at scale. 2. Three strategic activities used to enhance patient care include: (i) face-to-face specialist-led case conferencing, delivered in the general practice setting with the patient and their usual care providers, (ii) practice-level feedback reports to monitor and assess diabetes care using practice-level clinical and process metrics, and (iii) masterclass education and training for health professionals working in diabetes. 3. Diabetes Alliance is a real-world model of care designed for scalability to addresses the “prevention paradox”, where a large number of individuals with less risk creates more cases in absolute terms than the small number of individuals with higher risk.

Background: General Practitioner (GP) Primary Care Networks (PCN) in Singapore are networks of GPs with nurse counselling and health screening support. Three organisational types exist: single-handed clinics, regional health systems-led clinics, and corporate medical group practices. One of the PCNs’ roles is to provide care for patients living with chronic diseases. The PCNs comprise about 600 clinics and 100,000 patients with type 2 diabetes.

Aim: To address the information gap on PCN´s performance by conducting a structured evaluation using the Chronic Care Model (CCM), an evidence-based approach to designing chronic care delivery.

Hypothesis: There are differences in CCM elements across PCN types.

Methodology: A convenience sample of patients with diabetes was recruited from clinic waiting rooms and GP lists. The Patient Assessment of Chronic Illness Care (PACIC) questionnaire, which was specifically developed for appraising CCM components, was administered. The mean and standard deviation of each subscale and an overall score were calculated. Linear regression was used with the overall score as the outcome in both unadjusted and adjusted models.

Results: 343 patients completed the PACIC (197 from single-handed clinics, 97 from regional health system-led clinics, and 49 from group practices). There was no difference in overall scores between the PCN types. The Delivery System Design subscale attained the highest scores (mean 3.81, SD 0.76), followed by Patient Activation (mean 3.44, SD 1.04), Problem Solving/Contextual (mean 3.36, SD 0.93), Goal Setting/Tailoring (mean 3.10, SD 0.83) and Follow-up/coordination (mean 2.71, SD 0.90). Younger patients and spending longer time with the GPs were associated with higher PACIC scores.

Conclusions: There are differences in CCM elements amongst the PCNs in Singapore, as perceived by patients with diabetes, but not between PCN types. With the sampling method being a limitation, future work can focus on systematic sampling and using qualitative research to explain the findings.

1. To evaluate the care delivery by the GP Primary Care Networks in Singapore using the Chronic Care Model, as perceived by patients with type 2 diabetes. 2. To compare the dfference in care if any, between the Primary Care Networks types.

More than 5 % of the Swedish population suffers from diabetes type 2 (DM2) and are treated at primary health care centres. Swedish national guidelines recommend HbA1c target below 52 mmol/mol for most patients and below 70 mmol/mol for older or frailer people. In 2016 only 45 % of DM2 patients met these target values at Vibblaby Husläkarmottagning healthcare centre (Vibblaby HLM) compared to 52 % in Sweden nationally.

To improve the care of DM2 patients a one-stop shop for yearly DM2 check-ups was implemented in 2016 and 2017. The goal was to increase the percentage of patients with HbA1c below 52 mmol/mol to at least national level.

Patients were booked in the morning and instructed to visit the clinic on an empty stomach. Point of care testing was used to check HbA1c, glucose, creatinine, lipid levels and albumin/creatinine ratio. Patients then met a diabetes nurse, who measured blood pressure, checked for diabetic foot problems, and gave dietary advice. Then patients met with their general practitioner, who summarised the examination results, set individual HbA1c and LDL-cholesterol targets and adjusted the medical treatment. Patients who did not meet target values were booked to the diabetes nurse for a follow-up within 3 months.

Between 2016 and 2021 the percentage of DM2 patients at Vibblaby HLM that had an HbA1c below 52 mmol/mol increased from 45 to 60 % and the percentage of DM2 patients with an HbA1c above 70 mmol/mol decreased with from 16 to 7 %. Furthermore, the percentage of DM2 patients with LDL-cholesterol values below 2.5 mmol/L increased from 51 to 70 % during the same period.

Implementing a one-stop shop with point of care testing for yearly check-ups of DM2 has greatly helped us improve patient outcomes to above Swedish national level as this in-practice presentation will demonstrate.

1. see how a one-stop show for yearly diabetes typ 2 check-ups can improve patient outcome,
2. appreciate the practical benefits of a one-stop shop for yearly diabetes typ 2 check-ups and
3. understand how point of care testing can facilitate the implementation of a one-stop shop.

Introduction
Many people living with type 2 diabetes (T2D) do not achieve optimal diabetes management goals. This discrepancy has led to the need to identify innovative and effective self-management support for patients with T2D presenting to general practice (GP) where the majority of T2D diagnosis and management occurs. The aim of this study was to understand the complexity of self-management goal setting in patients with T2DM presenting to GP by evaluating current goal-setting practices.
Methods
Using a previously validated diabetes goal-setting evaluation tool (GET-D), quality of goal setting was assessed among T2D patients presenting to selected mainstream and Aboriginal GP services in a regional Australian setting. Data on goals and action plans over two time points during an 18-month period was extracted from patient records for analysis. Changes in goal attainment scale (GAS) over time was prospectively assessed in a sub-set of the sample by the treating general practitioners.
Results
Of the 218 patient records examined during the preliminary analysis, on average six other comorbid chronic conditions were reported per patient. Most patients had complex care plans with evidence-based goals routinely documented (mean number of goals=11), however, appropriate application of these goals to ensure patient-centredness was not always evident in management plans (mean GET-D score=13; 26 points possible). The change in GAS score ranged from 0 to 54, with a mean of 37 (SD=14; a score of 50 indicating the goal was achieved as expected).
Conclusion
The documentation of individual patient attributes and abilities into evidence-based goals and action plans is not routine in general practice. Complex templates used for GP management plans, time constrains, and limited practitioner skills are likely barriers encountered in this process. Simple, user-friendly, less time intensive resources could provide both the patients and the clinicians with effective, person-centred, diabetes self-management support.

1. Understand the complexity of self-management goal setting in general practice
2. Issues around application of goals to ensure patient-centredness
3. Why using complex templates may not work in busy general practice settings