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ObjectivesThis study is aimed to develop and validate a prediction model for multi-state transitions across different stages of chronic kidney disease in patients with type 2 diabetes mellitus under primary care.SettingWe retrieved the anonymized electronic health records of a population based retrospective cohort in Hong Kong.ParticipantsA total of 26,197 patients were included in the analysis.Primary and secondary outcome measuresThe new-onset, progression, and regression of chronic kidney disease were defined by the transitions of four stages that were classified by combining glomerular filtration rate and urine albumin-to-creatinine ratio. We applied a multi-scale multi-state Poisson regression model to estimate the rates of the stage transitions by integrating the baseline demographic characteristics, routine laboratory test results and clinical data from electronic health records.ResultsDuring the mean follow-up time of 1.7 years, there were 2,935 patients newly diagnosed with chronic kidney disease, 1,443 progressed to the next stage and 1,971 regressed into an earlier stage. The models achieved the best performance in predicting the new-onset and progression with the predictors of sex, age, body mass index, systolic blood pressure, diastolic blood pressure, serum creatinine, HbA1c, total cholesterol, LDL, HDL, triglycerides and drug prescriptions.ConclusionsThis study demonstrated that individual risks of new-onset and progression of chronic kidney disease can be predicted from the routine physical and laboratory test results. The individualized prediction curves developed from this study could potentially be applied to routine clinical practices, to facilitate clinical decision making, risk communications with patients and early interventions.Article summaryStrengths of this studyEarly predictions for chronic kidney disease progression and timely intervention is critical for clinical management of patients with diabetes.We successfully developed a multi-scale multi-state Poisson regression models that achieved the satisfactory performance in predicting the new-onset and progression of chronic kidney diseases.The model incorporates the predictors of demographic characteristics, routine laboratory test results and clinical data from electronic health records.The individualized prediction curves could potentially be applied to facilitate clinical decision making, risk communications with patients and early interventions of CKD progression.Limitations of this studyThe cohort has a relatively short follow-up period and the retrospective study design might suffer from report bias and selection bias.

BACKGROUND The nonpharmacological approach to diabetic control in patients with diabetes focuses on a healthy diet, physical activity, and self-management. Therefore, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns and include brief advice and counseling services. Within this context, motivational interviewing (MI) has proven to be effective in changing health behaviors for specific cases. However, stronger evidence is needed on the effectiveness of MI in treating chronic pathologies such as diabetes. OBJECTIVE This study will obtain preliminary data on the impact of a nurse-led MI intervention in improving glycemic control, as well as clinical, psychosocial, and self-care outcomes for individuals with type 2 diabetes mellitus when compared with usual care, with the aim of improving diabetic control in patients with diabetes. METHODS An open, two-arm, parallel, randomized controlled, pilot exploratory trial will be performed. Two government outpatient clinics in the New Territories West Cluster in Hong Kong will be involved. In total, 20 to 25 participants will be invited in each arm. Intervention participants will receive face-to-face MI interventions in addition to their usual care from the clinic. Control participants will only receive usual care. Outcomes are assessed at baseline, 6 months, and 12 months. The primary outcome measure is glycated hemoglobin levels. Secondary outcomes include blood pressure, BMI, hip and waist circumference, fasting blood, and psychosocial and self-care measures. RESULTS This study is currently underway with funding support from the Hong Kong College of Family Physician Research Seed Fund 2017. CONCLUSIONS MI skills constitute the main strategies primary care nurses use on their patients. Having economical, simple, effective, and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of MI. It will be performed with strict control over the data collection, ensuring the maintenance of therapeutic integrity. CLINICALTRIAL Centre for Clinical Research and Biostatistics CUHK_CCRB00614; https://tinyurl.com/v9awzk6 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/15709

BackgroundPhysical inactivity is known to be one of the major risk factors for many chronic conditions.AimTo determine Hong Kong Chinese adults’ physical activity (PA) knowledge, its relationship with certain variables including sex, education, age, and its correlation with different types of chronic diseases, such as heart disease, cerebrovascular disease, diabetes mellitus, obesity, and others. The Hong Kong Chinese adults' general attitudes towards PA will also be examined.Design & settingCross-sectional study in one primary care centre.MethodA randomized sample of Chinese adults aged >18 years with anonymous self-administered questionnaires.ResultsThe mean percentage of correct responses for exercise guidelines was 62.3%, 84.5% for traditional PA, and 48.4% for lifestyle PA, respectively. Traditional PA refers to exercises which use large muscle groups. Lifestyle PAs include activities which can be done throughout the day. The total mean percentage of correct responses was 67% (knowledge score 13.4 +/– 3.34). There were no significant differences between PA knowledge and sex, education levels, age groups, and presence of chronic diseases (P>0.05), but the knowledge level for lifestyle PA was less than that of traditional PA (PP>0.05). Two hundred and sixy-six (93.3%) responders reported a willingness to maintain or start exercise.ConclusionThe results suggest a need for more education about the latest PA recommendations, especially lifestyle PA. The weak correlation between PA knowledge and actual behaviour showed that PA knowledge itself might not affect PA behaviour. The enhancement of the general public’s knowledge, motivation, and psychosocial support along with stage-of-change interventions and the provision of counselling skills may result in PA behaviour change, which in turn can lead to the achievement of health benefits.

Background The nonpharmacological approach to diabetic control in patients with diabetes focuses on a healthy diet, physical activity, and self-management. Therefore, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns and include brief advice and counseling services. Within this context, motivational interviewing (MI) has proven to be effective in changing health behaviors for specific cases. However, stronger evidence is needed on the effectiveness of MI in treating chronic pathologies such as diabetes. Objective This study will obtain preliminary data on the impact of a nurse-led MI intervention in improving glycemic control, as well as clinical, psychosocial, and self-care outcomes for individuals with type 2 diabetes mellitus when compared with usual care, with the aim of improving diabetic control in patients with diabetes. Methods An open, two-arm, parallel, randomized controlled, pilot exploratory trial will be performed. Two government outpatient clinics in the New Territories West Cluster in Hong Kong will be involved. In total, 20 to 25 participants will be invited in each arm. Intervention participants will receive face-to-face MI interventions in addition to their usual care from the clinic. Control participants will only receive usual care. Outcomes are assessed at baseline, 6 months, and 12 months. The primary outcome measure is glycated hemoglobin levels. Secondary outcomes include blood pressure, BMI, hip and waist circumference, fasting blood, and psychosocial and self-care measures. Results This study is currently underway with funding support from the Hong Kong College of Family Physician Research Seed Fund 2017. Conclusions MI skills constitute the main strategies primary care nurses use on their patients. Having economical, simple, effective, and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of MI. It will be performed with strict control over the data collection, ensuring the maintenance of therapeutic integrity. Trial Registration Centre for Clinical Research and Biostatistics CUHK_CCRB00614; https://tinyurl.com/v9awzk6 International Registered Report Identifier (IRRID) DERR1-10.2196/15709

In this study we conducted a cross sectional study to comprehensively evaluated the risk factors of chronic kidney disease (CKD) in a large sample of Chinese adults under primary care for type 2 diabetes mellitus (T2DM). We investigated the risk factors associated with the prevalence of CKD in adults with T2DM, who were enrolled in the Risk Factor Assessment and Management Programme for Patients with Diabetes Mellitus (RAMP-DM) of Hong Kong from July 2014 to June 2017. We collected the individual data of 31,574 subjects, with mean age of 63.0 (±10.8) years and mean DM duration of 7.4 (±6.4) years. Of them 9,386 (29.7%) had CKD and 7,452 (23.6%) had micro- or macro-albuminuria. After adjustment for multiple demographic and lifestyle confounders, we identified several modifiable risk factors associated with higher rate of CKD: obesity (OR = 1.54), current smoking (OR = 1.33), higher systolic blood pressure (OR = 1.01), dyslipidemia (OR = 1.32 and 0.61 for triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C)), hyperglycemia (OR = 1.11 for HbA1c), diabetic retinopathy (OR = 1.36 and 2.60 for non-sight and sight threatening retinopathy), and stroke (OR = 1.43). The risk factors of lower dialytic blood pressure and coronary heart disease were identified only in men, whereas peripheral arterial disease only in women. In conclusion, several modifiable and gender specific risk factors were significantly associated with higher prevalence of CKD in Chinese adults with T2DM. The high-risk populations identified in this study shall receive regular screening for renal functions to achieve better patient management in primary care settings.